Chapter 3

Australia's drug strategies

3.1        Australia's drug strategies have been coordinated through the National Drug Strategy (NDS) since 1985. Recently, the National Ice Taskforce (NIT), the government's response to the NIT's final report and the National Ice Action Strategy (NIAS) have articulated a focus on crystal methamphetamine. This focus has in turn informed the future direction of the NDS, and in particular the current NDS for    2017–2026.

3.2        This chapter considers the NDS, in conjunction with a brief discussion of the NIT's final report and the government's subsequent response to it. The chapter will then examine the NIAS and progress of its implementation since the NIAS was agreed by the Council of Australian Governments (COAG).

National Drug Strategy

3.3        The NDS has been operating since 1985[1] as a co-operative strategy between the federal, state and territory governments and non-government organisations. In recognition of the important relationship between law enforcement and healthcare providers, the NDS aims to:

...contribute to ensuring safe, healthy and resilient Australian communities through minimising alcohol, tobacco and other drug-related health, social and economic harms among individuals, families and communities.[2]

3.4        The current iteration of the NDS is the first to have a ten year term, whereas previous strategies covered a period of five years.

3.5        The NDS is built upon a 'three pillars' approach. The three pillars of the NDS—demand reduction, supply reduction and harm reduction—are described in the following paragraphs.

Demand reduction

3.6        The demand reduction measures are to:

Supply reduction

3.7        The supply reduction (law enforcement approach) measures aim to:

Harm reduction

3.8        The harm reduction measures seek to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs.

National Drug Strategy 2017–2026

3.9        The NDS for 2017–2026 was endorsed by the newly formed Ministerial Drug and Alcohol Forum (MDAF) (see paragraphs 3.40 to 3.43) on 29 May 2017[3] and released on 19 July 2017.

3.10      The current iteration of the NDS is the first to have a ten year lifespan.[4] It promotes continued co-operation between law enforcement and health services, and prioritises:

3.11      The NDS 2017–2026 prioritises populations at higher risk of developing AOD issues, many of which align with the target populations of the NIAS. These include Aboriginal and Torres Strait Islander people; people with co-morbid mental health conditions; young people; older people; people in contact with the criminal justice system; culturally and linguistically diverse populations; and people that identify as gay, lesbian, bisexual, transgender or intersex.[12]

3.12      A number of sub-strategies exist under the NDS. These sub-strategies inform and provide further direction and context on specific AOD issues.[13]  These             sub-strategies include:

3.13      The most recent NDS includes a description of the reformed governance structure of the strategy (a description of the governance structure is at paragraphs 3.40 to 3.46) and the monitoring and progress reporting.

Monitoring and progress reporting

3.14      The NDS 2017–2026 outlines the reporting of NDS activities. Annual progress reports will be released by the MDAF which will provide information on:

3.15      The National Drug Strategy Committee (NDSC) will provide a more detailed progress report to the MDAF, which will subsequently be submitted to COAG every three years. These detailed reports will be released in conjunction with the release of findings from the National Drug Strategy Household Survey (household survey) and will be evaluated against key measures of success. These detailed progress reports will be released in 2018, 2021, 2024 and in 2027.[16]

3.16      Finally, the NDSC will also conduct a mid-point review of the NDS in    2021-2022 to determine new priorities, and identify emerging issues and challenges.[17]

Measures of success

3.17      The three-year detailed progress reports of the NDS will include new measures of success that illustrate its progress. The five headline indicators are:

3.18      In addition to the detailed benchmarks listed above, annual progress reports will include supplementary indicators to monitor the implementation, progress and emerging AOD issues. These indicators include:

3.19      The committee's view in relation to measuring success, in the context of law enforcement strategies, is discussed in chapter 5.

3.20      Further details relating to the NDS will be discussed in the second report which align with the NDS's demand reduction and harm reduction pillars.

The National Ice Taskforce's final report and the government response

3.21      On 8 April 2015, the Abbott government announced the creation of the NIT. It was established to provide advice to government on the impacts of crystal methamphetamine use in the Australian community and assist with the development of the NIAS.[22]

3.22      Three experts were appointed to the taskforce:

3.23      The NIT was overseen by the Minister for Justice, the Hon. Michael Keenan MP and then Minister for Rural Health, Senator the Hon. Fiona Nash.[24]

3.24      The final report of the NIT was delivered to Prime Minister Malcolm Turnbull on 9 October 2015 and released publicly on 6 December 2015.[25]

3.25      The NIT made 38 recommendations under five priority areas:

3.26      In December 2015, the government released a two page response to the NIT's report. The government's response announced a package addressing the five priority areas detailed in the NIT's report. A significant part of the package was the announcement of an additional $285.2 million to fund programs that would 'reduce the demand for ice and the harm it is causing through the delivery of locally-based and targeted solutions'.[27] A further $13 million was also included for the introduction of new Medicare Benefits Schedule items for Addiction Medicine Specialists.[28] In total, $298.2 million was allocated over four years from 1 July 2016.[29]

3.27      The government response also included:

3.28      After the release of the NIT's final report and the government's response, the Minister for Justice discussed the measures focused on supply reduction. The minister stated that the NIT's report highlighted the need to 'improve on intelligence collection and to also go after the money'; he reiterated that the government has achieved this aim by placing ACIC intelligence officers abroad and through a new national unexplained wealth regime.[31]

3.29      The minister's comments also emphasised the need to focus on reducing demand for crystal methamphetamine:

Law enforcement are doing a magnificent job, but it’s very clear that whilst we’re doing everything we can on the supply side—and with seizures up, we’ve had seizures of over $1 billion of this insidious drug. But it is very clear from the Taskforce report that we need to do more on the demand side. So whilst we’re tackling supply, if demand still exists at such a record rate, it’s going to be impossible for law enforcement to retain control of supply. And, of course, the best thing that we can do to help our law enforcement agencies is to stop people from using this drug in the first place.[32]

3.30      The then Minister for Rural Health announced that any current contracts with AOD treatment services would be extended to mid-2017 while the sector transitions to the new PHN-led model. In addition, the minister highlighted that the government would give specific attention to Indigenous treatment services and that PHNs would work closely with the Aboriginal community‑controlled health organisations.[33] The minister stated that the government was supportive of all 38 of the NIT's recommendations and would incorporate these into the government's response, and an agreed response between the Commonwealth and the state and territory governments.[34]

3.31      Upon the release of the NIT's report, Mr Lay asserted that law enforcement will play a very important role in drug policy because of illegal importations, profits and the international responses required to address the illicit drug trade. He highlighted, however, that '[p]olice cannot, will not and will never arrest their way out of this problem. It is far more difficult than that'.[35] He expressed his delight that the government's response to the NIT's report initiates a 'real shift' to support families, facilitate targeted prevention, help users and develop research.[36]

3.32      Associate Professor McCarthy supported the recommendations and the government's response because:

...the impact we expect to see is a very broad impact on all drug use and particularly alcohol which is a great scourge as well and causes a lot of presentations to emergency departments and dysfunction and adverse consequences in the community. We expect to see that when we see a crystal methamphetamine intoxicated person, that there will be much more accessible intervention available, and hopefully at an earlier phase of their use... we anticipate the measures taken as a whole will really support the work of emergency departments, general practitioners, all parts of the health sector, in being able to identify and intervene earlier.[37]

3.33      Associate Professor McCarthy also highlighted the importance of research to assist the AOD sector with an understanding of what works, what is the most effective action and whether it is of value.[38]

3.34      Dr Nadine Ezard, from Saint Vincent's Hospital added that:

...the idea that we will have a treatment sector that can detect early, respond early and then refer into treatment rather than just having some specialised treatment centres scattered around the country, means that we can build a comprehensive response for early intervention and treatment.[39]

3.35      At the time of NIT's release, the Minister for Rural Health wrote that focus on the supply side of the crystal methamphetamine problem would continue, however '[n]ow it is time to focus on reducing demand' as doing so will 'help cripple the ice dealer's model by reducing demand for their despicable product'. Further:

If we can reduce the market by helping the biggest clients give up their habit, demand will drop. If we can educate our children not to ever try ice, there will be less young people coming into the ice market to replace those exiting it.

Credible studies suggest improved aftercare -- ongoing counselling and meetings for recovering addicts who have completed rehabilitation programmes -- could be an important key to keeping those users off the drug and out of the drug market.

Of course, different treatment is appropriate for different people and different levels of addiction, which is why we're having the local Primary Health Networks decide which method of treatment is best for their area -- enlisting local knowledge instead of Canberra ivory-tower policy.[40]

The National Ice Action Strategy

3.36      Following the release of the NIT and the government's response, the government published the NIAS. This strategy was agreed by the COAG on 11 December 2015. The NIAS includes a package encompassing five areas, allocating $298.2 million in new funding over four years from 1 July 2016. The five targeted areas of the package are:

3.37      The NIAS identifies its main priority as supporting those families and communities directly impacted by the harms caused by crystal methamphetamine use. To achieve this goal, it states that the solution to Australia's crystal methamphetamine problem is reducing the demand for the drug, by targeting 'prevention efforts towards high-risk populations, increase investment in treatment with improvements in how treatment programmes are delivered'.[42] Law enforcement remains a critical element of the strategy, by stopping the supply of crystal methamphetamine through activities focused on 'increasing the use of intelligence and international cooperation, as well as directly targeting organised crime groups and criminal networks'.[43]

3.38      Finally, the NIAS highlights the importance of improving the collection of data and evidence to inform policy responses, as well as requiring regular reporting to ensure Commonwealth, state and territory governments track the impact of their efforts.[44]

3.39      A principal feature of the NIAS is the allocation of $241.5 million to PHNs to commission AOD treatment services.[45] In February 2016, the Department of Health (DoH) announced that there would be a phased implementation to prepare PHNs for this additional responsibility. These AOD services will complement the PHNs' role in the coordination of Commonwealth funded mental health programs at a local level, as well as build linkages with primary care.[46] The DoH has developed an AOD treatment program to assist PHNs with the commissioning process and share evidence on best practice drug and alcohol treatment services.[47]

Ministerial Drug and Alcohol Forum

3.40      Another key feature of the NIAS is the establishment of the MDAF. The MDAF brings together ministers from the health and justice portfolios across jurisdictions to coordinate alcohol and drug policies, and law enforcement strategies. Its deliberations and recommendations will be reported to COAG. Initially, the MDAF will 'oversee the development, implementation and monitoring of Australia's national drug policy framework', including the NIAS and the NDS.[48] 

3.41      The DoH informed the committee that the MDAF is co-chaired by the Commonwealth Ministers for Health and Justice. According to the DoH, the establishment of the MDAF is a consolidation of the governance and ministerial arrangements around drugs and alcohol; governance had previously been separately reported through health ministers and justice ministers.[49] The NIAS establishes a requirement for departments to provide progress reports on the implementation of the strategy to COAG. COAG will then determine whether these progress reports are made public.[50]

3.42      According to the Attorney-General's Department (AGD), the COAG Health Council, the COAG Law, Crime and Community Safety Council, and the MDAF all report to COAG on the NIAS. This approach was implemented because:

Not every issue is relevant for all of us around the table in health and justice, so hence the three streams—so you have the whole health stream going up from officials up to ministers, you have the law and justice stream going from officials up to ministers, you have the combined one in the centre for the key issues where it is important for health and justice issues to be considered and then that all reports up to COAG first ministers. So, as I say, in summary, you have all of the great on-the-ground operational cooperation—we have heard from our colleagues; it is at an all-time high in terms of Commonwealth, state and territory cooperation—and then you have this governance structure that is bringing it up through officials into the political level.[51]

3.43      The MDAF has met twice since its establishment, on 16 December 2016 and 29 May 2017. The communiques from these two meetings reference discussions on a range of matters relating to the NIAS across the health and law enforcement sectors. A key consideration of the MDAF was the NDS 2016–2025 which was endorsed by the forum at its second meeting.[52] Other key developments included:

The National Drugs Strategy Committee

3.44      In addition to the MDAF, there is the NDSC, which reports to the MDAF. The committee is co-chaired by the Commonwealth DoH and the AGD. The NDSC was referred the work of the former Intergovernmental Committee on Drugs, which was abolished by the Law, Crime and Community Safety Council in October 2016.[54]

3.45      The NDSC consists of senior officials from across the health, justice and law enforcement portfolios from each jurisdiction. These officials will consider alcohol and other drug policies.[55]

Working groups

3.46      An initiative detailed in the NDS 2017–2026 is the NDSC's authority to establish time limited and expert working groups. These working groups will undertake work on particular projects and issues, and provide ongoing policy advice on AOD issues. The membership of these groups will be inclusive of members from the non-government, research, treatment, intelligence and public health sectors.[56]  

Initial response to the National Ice Taskforce's report and the National Ice Action Strategy

3.47      Overall, the public's initial response to the NIT and the NIAS was positive. In general, commentators were supportive of the shift in both focus and funding from a supply reduction approach to treatment services. However, some commentators were concerned that the NIAS did not provide an adequate balance between reducing demand and harm minimisation. Others felt that the harm minimisation approaches advocated by the NIAS will not be sufficient.

Renewed harm minimisation focus

3.48      The Public Health Association of Australia (PHAA) commented that by 'funding treatment as a main focus of the government's response to the issue of ice there is a much greater likelihood of a reduction in harm associated with the use of this drug'[57] and that:

For too long Australia has paid lip-service to harm reduction while focussing most of the funding and effort on just the supply reduction aspect. This announcement marks the first steps in a sensible return to re-align funding, focus and efforts into moving away from a largely prohibitionist approach to the much more effective approach of harm minimisation.[58]

3.49      Mental Health Australia (MHA) welcomed the NIT's report and highlighted the links between methamphetamine use and mental illness. MHA argued that the NIT report ensures 'closer integration between the mental health system and the alcohol and drug treatment systems...[to ensure] a service that is built around the needs of individuals who require support'.[59] 

3.50      Professor Margaret Hamilton from the University of Melbourne and Professor Adrian Dunlop from the University of Newcastle wrote that the NIT's report provided 'an opportunity for action':[60]

However, many key issues raised in the report still require adequately resourced strategies; this applies especially to specific plans for Indigenous communities. Mixed funding by the federal and state governments makes it challenging to achieve the necessary coherence of response. The Primary Health Networks will need to rapidly develop the capacity to engage with GPs, and specialist drug and alcohol services if they are to play a key role.[61]

3.51      Broadly, commentators were supportive of the NIT and the NIAS because they mark a transition from the previous policy focus on law enforcement initiatives to a response focused on health initiatives.

Primary Health Networks and service delivery

3.52      The PHAA also supported the use of the PHNs to allocate funds for treatment services because the PHNs 'have the ability to ensure that the funding is directed appropriately, to deal with overlap of other drug dependency and to see comorbidities are dealt with in the most effective manner'.[62]

3.53      The Australasian Therapeutic Communities Association (ATCA) was less supportive of the announcement that the PHNs would be used to distribute funds to AOD services. ACTA described the PHNs as 'incredibly patchy' and:

Many are still in a changeover state from Medicare locals and not properly developed...How are those resources going to flow through the PHNs when many would not even have relationships with the community organisations that are doing alcohol and other drug work?[63]

3.54      Professor Rebecca McKetin, in the Drug and Alcohol Review, wrote that although there was a warm reception to the NIT's report, many from the health sector 'were bewildered by the lack of detail or strategy accompanying the response'. Further, the announcement that the new funding would be distributed via the PHNs was a cause of angst amongst those in the sector.[64] Professor McKetin cautioned against the use of the PHNs, noting:

This is an entirely new and uncharted funding model for the AOD sector in Australia, and a surprising shift given that the core business of the PHNs is to increase the efficiency and effectiveness of primary care medical services provided to patients...they have no significant prior experience providing treatment services for AODs.[65]

3.55      Professor McKetin explained that the government's announcement was unclear about the 'nature and scope of services' because allocation of funding would be based on the local needs of each PHNs, and that:

Although this new model of funding has the potential to provide a more integrated service platform at a local level, a significant risk lies in what PHNs may not know about existing AOD treatment infrastructure, including their knowledge about best practice in the field, evidence-based treatment and the gaps in knowledge in encouraging better management of patients with substance use problems in both primary care and specialist AOD services. It may also leave existing service providers out-of-the-loop and result in sub-optimal assessment and commissioning of specialised AOD patient care.[66]

3.56      Professor McKetin also advised that it was unknown whether funding will be available to existing specialist non-government AOD treatment services. Additionally, the breakdown of the amount of funding announced ($241.5 million) across the 31 PHNs over four years equates to under $2 million per PHN, per year.[67] Professor McKetin was concerned that:

It is easy to imagine the Ice Taskforce funding being absorbed in a homogenous model of service provision, catering to the base common denominator across competing health priorities, leaving limited scope for funding or providing specialist non-Government AOD services for either methamphetamine use or for other drug use.[68]

3.57      However, Professor McKetin also remarked that the announcement 'provides the opportunity to develop new and more flexible models of treatment and service provisions' that will 'foster a multidisciplinary approach to help address associated physical, mental and social comorbidities'.[69] For patients, it will also provide a broader range of services that are better integrated, and provide continuum of care. Finally, she said the new funding model would provide individual PHNs the ability to 'commission local services that are most effective and appropriate given the local context'.[70]

3.58      In May 2016, Dr Alex Wodak and Mr Matthew Frei wrote in the Medical Journal of Australia that the illicit drug market in Australia is continuing to grow, despite measures being taken by governments to address the issue. They argued that this situation highlights the disproportionate allocation of funding to law enforcement measures: approximately two-thirds of drug-related spending is directed to law enforcement, with only nine per cent on prevention, 21 per cent on treatment and two per cent on harm minimisation. Despite this reliance on law enforcement strategies, the authors pointed out that Australia's illicit drug market continues to expand and:

Not only are illicit drugs easy to obtain but prices have fallen and many newly identified psychoactive drugs have appeared, often more dangerous than older drugs. Over recent decades, drug-related deaths, disease, crime, corruption and violence appear to have increased.[71]

3.59      Dr Wodak's and Mr Frei's article discussed key recommendations made by the NIT, and was generally supportive of its focus on treatment and funding through the PHNs. However, the authors expressed concerns that these strategies exist within a drug treatment system that is an 'inflexible, poor quality system with limited capacity'.[72] Further, they argued that it is unclear whether the distribution of funds through PHNs 'will be distributed effectively given the fragmented nature of the Australian drug treatment systems'.[73] The authors also questioned the NIT's emphasis on education, arguing the government and community have unrealistic expectations of drug education's ability to reduce demand; generally the gains from educations campaigns are modest or temporary. The authors stated that '[d]rug education must be credible for the target audience, which is hard to achieve in an environment of drug prohibition'.[74]  Finally, the authors expressed their support for supervised consumption facilities in areas of high drug consumption to provide information to users about harm reduction and treatment.[75]

Balance between demand reduction and harm reduction

3.60      A more critical response to the National Ice Action Plan[76] (NIAP) was expressed by Mr Bill O'Loughlin, former Chair of Harm Reduction Victoria. In an opinion piece, Mr O'Loughlin argued that the NIAP returned Australia to 'an old and failed drug response' that:

...exclusively focuses on strategies for preventing people from beginning to use ice and getting users to stop by providing increased and easier access to treatment. It is the old mantra: 'Don’t take drugs and, if you do, then stop'.[77]

3.61      He wrote that the three pillars of Australia's NDS were ignored, despite being essential and effective components to Australia's drug policy. Mr O'Loughlin argued that the NIAP not only ignores harm reduction but that harm reduction was not a feature in the NIT's community consultations.[78] Additionally, Mr O'Loughlin felt that the NIT's report:

...reframes and reinterprets harm reduction by focusing on the harms created by ice and uses this as evidence for the need for treatment services. This is a serious and dangerous reinterpretation of government policy, and of what is accepted by specialists in the field.[79]

3.62      Furthermore, Mr O'Loughlin opined that the report does not address the fact that young people do not communicate with older people or professionals about their drug use, and only seek support when they are in trouble. In some circumstances, young people will be 'quietly and furtively using ice and the report does not give attention to ways to reach them effectively'.[80] His article drew attention to models that already exist which encourage conversations between peers who have experience with crystal methamphetamine use that 'creates a unique space in which people can talk about their drug use and allows for a conversation that encourages safety and wellbeing'.[81]

Committee view

3.63      Two months after the committee first initiated its inquiry into crystal methamphetamine in the 44th Parliament, the Commonwealth government announced the commencement of the NIT. The committee's inquiry was conducted in parallel with the NIT's inquiry, and for this reason much of the evidence and issues discussed in the NIT's final report correlate with the evidence received by the committee. The committee's re-initiated inquiry provided an opportunity to consider the NIT's report, as well as the government's response to it through its action plan outlined in the NIAS.

3.64      As noted earlier, the NIT and the NIAS appear to mark a substantial shift in how Australia responds to illicit drugs and the treatment of people with substance abuse issues. The committee is fully supportive of the 38 recommendations in the NIT's final report and the NIAS. The committee commends the government's substantial investment of $298.2 million for AOD treatment, the shift in emphasis to demand reduction strategies and the strengthening of collaboration between jurisdictions.

3.65      Bringing together health and law enforcement ministers and agencies, through the MDAF, the NDSC and formalised in the NDS 2017–2026, is an important and vital step in the development of a coherent response to the harms of crystal methamphetamine use. If crystal methamphetamine use is to be successfully addressed, health and law enforcement agencies must work in collaboration on AOD matters. The changes to the governance structure brought about by the establishment of the MDAF and NDSC reinforce the key message that demand for crystal methamphetamine and the harm it causes are primarily a health issue. While law enforcement agencies play a key role in targeting the manufacture, importation and distribution of illicit drugs, the committee shares the view that this is not an issue we can arrest our way out of.

3.66      The committee supports the announcement in the NDS 2017–2026 that the MDAF will make its annual progress reports publicly available. However, it is not clear whether the more detailed, three-year progress reports and the mid-point review of the NDS will also be made publicly available. The committee supports the public release of these reports and the mid-term review, and considers this important so that the efficacy of the NDS, and its sub-strategies, such as the NIAS, can be fully assessed.

3.67      In this report, the committee has assessed a number strategies found in the NIAS, and for this reason, considers it important to ensure the actions in the NIAS are properly reported on. For this reason, the committee proposes that the progress reports include the following items:

3.68      The committee believes that the information outlined above must be considered in conjunction with data on the price, purity, availability and seizures of crystal methamphetamine. In this regard, the committee acknowledges the important work of the ACIC and the information presented in its annual Illicit Drug Data Reports. These reports are a valuable source of law enforcement data; however, as the ACIC itself noted, law enforcement data should be read in conjunction with findings from other sources such as DUMA and academic research.[82]

3.69      The committee notes New Zealand's reporting mechanisms on its cross‑agency plan of action to tackle the harms caused by methamphetamine and commends this approach to the MDAF. From 2010 to 2015, the New Zealand Department of the Prime Minister and Cabinet has reported annually on indicators and progress of its Tackling methamphetamine: an Action Plan. The New Zealand reporting arrangements could inform the MDAF and its planned future reporting.[83]

Recommendation 1

3.70      The committee recommends that all progress reports and the mid-point review provided to the Ministerial Drug and Alcohol Forum and Council of Australian Governments on the implementation of the National Drug Strategy 2017–2026 and its sub-strategy, the National Ice Action Strategy (NIAS), are made publicly available, and include but are not limited to:

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