1. Introduction
   1. Harm related to the use of alcohol and other drugs is a major cause of preventable disease, illness and death, and imposes a considerable socio-economic burden on the Australian community. The term ‘alcohol and other drugs (AOD)’ encompasses ‘psychoactive substances which when consumed or administered can alter consciousness, mood or cognitive processes’.[1] Drugs in this context is a term used in reference to prescribed medications, medications used for non-prescribed purposes, and illegal substances.
   2. The House of Representatives Standing Committee on Health, Aged Care and Sport (the Committee) commenced an inquiry into the health impacts of AOD in Australia in August 2024—a moment in which the National Drug Strategy 2017-2026 was entering the final stage of its term, and with the National Alcohol Strategy 2019-2028 also in its final operational years. As such, the inquiry represented an opportunity to reflect on these strategies, with a view to ensuring that the subsequent iteration of each document is informed by a comprehensive understanding of the AOD sector and its short and long-term needs.
   3. While the current National Drug Strategy has generally been viewed in positive terms, it is clear from the evidence presented during the inquiry that there are opportunities to revise and enhance Australia’s response to AOD. Multiple AOD sector bodies expressed the view that the re-establishment of a national governing body—to oversee the implementation of the National Drug Strategy, to coordinate federal and state and territory-level AOD strategies, and to facilitate cross-sector collaboration—must be central to these efforts.[2]
   4. Equally, it is clear that the present funding allocation across the three pillars of the National Drug Strategy—demand reduction, supply reduction and harm reduction—has been strongly weighted towards law enforcement efforts aimed at reducing supply. AOD sector representatives repeatedly raised concerns relating to the present funding imbalance, insisting that more needs to be done to refocus Australia’s policy toward a health-led response to AOD harm.[3]
   5. These issues have also been flagged as part of the recent inquiry into challenges and opportunities for law enforcement in addressing Australia’s illicit drug problem, undertaken by the Parliamentary Joint Committee on Law Enforcement.[4] Tabled in May 2024, the inquiry report included recommendations for the establishment of a national governing body, and an evaluation of the National Drug Strategy, including in respect to the resourcing of the three pillars.
   6. The Committee was grateful to receive written evidence and hear from witnesses about a range of issues pertaining to current AOD service delivery, the need for developing AOD responses tailored to different communities, and the urgent challenge of raising the capacity of the AOD workforce. The Committee was also encouraged to learn about the research undertaken in the field of AOD, the value of AOD-related data, and opportunities for developing better data collections and using new technologies to create more effective health messaging.
   7. There are multiple elements of the inquiry terms of reference that the Committee was unable to fully explore. The impact of the COVID-19 pandemic on AOD-related conditions, or the implications that zero-alcohol beverages may have for consumption, are just some of the emerging topics in this domain that would merit close analysis in future.
   8. Equally, it was not possible to convene hearings with all sectors that provided written submissions in support of the inquiry, such as those representing the alcoholic beverage industry or medical cannabis producers. The Committee deemed it appropriate to prioritise wherever possible hearings with individuals with living and lived experience of AOD-related harm.

About the inquiry

1.9On 22 August 2024, the Committee adopted an inquiry into the health impacts of AOD in Australia, which had been referred by the Minister for Health and Aged Care, the Hon Mark Butler MP.

1.10The inquiry undertook a health-focused review of alcohol and other drugs policy, treatment services, community programs, and workforce to determine whether current settings support the prevention, reduction and recovery of AOD-related harms on individuals, families and communities.

1.11In recognising that substance use is a complex problem that cuts across health, social and economic areas, the Committee also sought to examine opportunities for closer collaboration between sectors in tackling AOD use, as well as international responses in this domain that can provide valuable lessons.

Conduct of the inquiry

1.12On 26 August 2024, the Committee formally announced the inquiry and issued a call for submissions. The Committee also wrote to and invited submissions from a range of individuals and organisations with an interest in AOD issues, including federal and state government departments and agencies, not-for-profit and charity organisations working in the AOD sector, industry groups and peak bodies, think tanks, academics, health practitioners, medical research organisations, and pharmaceutical companies.

1.13The Committee received 204 submissions in support of this inquiry. The full list of submissions is at Appendix A.

1.14The inquiry received 9 additional documents, including answers to questions taken on notice at public hearings. The full list of additional documents presented to the inquiry is in Appendix B.

1.15The Committee held seven days of public hearings:

• 28 October 2024—Melbourne, VIC
• 29 October 2024—Melbourne, VIC
• 30 October 2024—Brisbane, QLD
• 7 November 2024—Canberra, ACT
• 21 November 2024—Canberra, ACT
• 28 November 2024—Canberra, ACT
• 7 February 2025—Canberra, ACT
  16. The list of witnesses who attended these public hearings is available at Appendix C. Transcripts of all public hearings are available on the Committee website.
  17. The Committee was keen to hear from witnesses and communities impacted by AOD-related harms across the nation. In the initial phase of the inquiry, the Committee travelled to Melbourne and Brisbane where it had the opportunity to hear from a series of witnesses and undertake site visits.
  18. On 28 October 2024, the Committee undertook a site visit to two locations in St Kilda, Victoria: The Salvation Army’s Access Health, a specialised Comprehensive Primary Health Care Service that supports the health and other needs of people who use drugs; and Windana’s residential detox program for people aged 18 and over.
  19. On 30 October 2024, the Committee visited the Alcohol and Drug Assessment Unit at Princess Alexandra Hospital and heard from its Director, Dr Paul Clark, its staff, and unit patients about some of the unique challenges associated with addressing AOD harm in a hospital setting.

Timeframe

1.20The Committee appreciates the time taken by the witnesses in providing information in these submissions, hearings, and site visits, which constitute a wealth of high-quality evidence addressing the terms of reference.

1.21Noting the breadth of the terms of reference, it was not possible to produce a final report addressing all the aspects of the inquiry prior to the expected dissolution of the House of Representatives for the 2025 Federal Election. In acknowledgment of the significance of this issue for the Australian community, the Committee has produced the issues paper to provide an overview of the evidence and to inform work underway by the Government to update the National Drugs Strategy.

1.22The Committee urges its successor in the 48th Parliament to re-adopt the terms of reference for this inquiry, and to give this important topic the consideration it deserves, including gathering further evidence if required to produce the final report.

Acknowledgements

1.23The Committee would like to thank individuals and organisations who provided written submissions and gave evidence at public hearings. The fact the Committee received over 200 submissions from a wide range of stakeholders, including government agencies, peak bodies, researchers and clinicians, and harm reduction services among others, speaks to the level of interest in, and urgency of, addressing AOD-related harms.

1.24Over the course of the inquiry, multiple witnesses shared their experience of AOD use or supporting someone with substance use problems. The Committee was impressed by the courage and strength these witnesses demonstrated, and their commitment to use personal experience to help others in tackling the impact of AOD-related harm. Individuals with living and lived experience, along with their families and friends, present an invaluable source of knowledge, and the Committee was grateful to draw on their insight in preparing this paper.

Issues paper structure

1.25This paper comprises six chapters. Chapter 2 provides an overview of the health impacts of alcohol and other drugs in Australia, drawing on data from the Department of Health and Aged Care, the Australian Institute of Health and Welfare, and the work of Australia’s leading research centres. It outlines the levels of AOD use in Australia and examines some emerging trends.

1.26Chapter 3 focuses on Australia’s AOD policy and the sector’s funding landscape. The National Drug Strategy and the suite of sub-strategies and frameworks that sit under it are examined, along with state and territory policies. The chapter further discusses Australia’s shift towards a health-led AOD policy response, as well as AOD research and data collections that inform the evidence base.

1.27Chapter 4 examines current AOD service provision and the level of demand for services. It focuses on AOD priority populations, as they are identified under the National Drug Strategy, and the type of services that are required to address some of the unique needs of these populations.[5] The chapter also examines challenges in building the capacity of the AOD workforce.

1.28Chapter 5 outlines the role of AOD prevention and harm reduction services. The issue of stigma, which presents a major barrier in accessing AOD support, is examined, along with the debates surrounding the question of decriminalisation of personal drug use. In addition to discussion of current harm reduction programs and their effectiveness, the chapter also focuses on the levels of current alcohol use in Australia and strategies to mitigate the effects of alcohol-related harm.

1.29Chapter 6 identifies a range of topics that were not able to be covered in this paper, but that the Committee believes are nonetheless deserving of attention. In addition to examining international experience in the field of AOD, the question of risky AOD use within certain professions, AOD impact on priority populations, the relationship between AOD and domestic and family violence, and the relationship between our physical environment and substance use are some of the areas that merit further examination. These are matters which could form the basis for a renewed inquiry in the next Parliament.

Footnotes

[1]The Royal Australian and New Zealand College of Psychiatrists, Submission 19, p. 3.

[2]See Chapter 3.

[3]See Chapter 3.

[4]Parliamentary Joint Committee on Law Enforcement (May 2024), Australia’s illicit drug problem: Challenges and opportunities for law enforcement.

[5]The National Drug Strategy 2017-2026 identifies the following cohorts as priority populations: Aboriginal and Torres Strait Islander people; people with mental health conditions; young people; older people; people in contact with the criminal justice system; culturally and linguistically diverse populations; people identifying as lesbian, gay, bisexual, transgender, and intersex.