The Australian Greens oppose the measures contained in the Social Services Legislation Amendment (Drug Testing Trial) Bill 2019 (the Bill).
This Bill will establish a two year drug testing trial at three trial sites being Logan in Queensland; Canterbury-Bankstown in New South Wales; and Mandurah in Western Australia.
The trial will involve drug testing 5,000 Newstart Allowance and Youth Allowance recipients. Participants who test positive to one of the testable drugs will be subject to income management for a minimum of two years. Participants who test positive will also undergo further random drug tests, the first of which will occur within 25 working days. If a participant tests positive to a drug test more than once in a 24 month period, they will be referred to a Services Australia contracted medical professional for assessment.
This Bill does nothing to address drug and alcohol abuse as the serious and complex health issue that it is.
The Australian Greens reject the committee view in the majority report that the proposed trial will allow the Government to assess the extent to which drug testing assists people on income support payments to overcome substance abuse issues and find employment.
The Australian Greens note that this is the third legislation inquiry into the drug testing of income support recipients.
In those inquiries health and addiction experts overwhelmingly expressed their strong opposition to the approach. These experts have again expressed their strong opposition.
Royal Australian and New Zealand College of Psychiatrists noted the lack of evidence for the trial:
The RANZCP considers that the proposed drug testing program lacks an evidential basis. Firstly, there is no conclusive evidence that mandatory drug testing of welfare recipients delivers any benefits such as deterring recipients from drug use, increasing levels of employment or reducing welfare spending… Secondly, the notion that illicit drug use is higher amongst the unemployed population and that this results in lowered employment capacities is unfounded.
Royal Australasian College of Physicians said the trial fails to see addiction as a health issue:
This proposed drug testing trial fails to recognise the nature of drug addiction; which is a health issue with complex biological, psychological and social underpinnings. Drug addiction is a chronic relapsing and remitting disorder characterised by drug seeking, use that is compulsive, loss or impairment of control over use and which persists despite harmful consequences.
Network of Alcohol and Other Drugs Agencies noted the trial will increase stigma and pressure on services:
NADA is concerned that the likely outcome of this proposal will be to place further demand on an already stretched specialist service system and further delegitimise and stigmatise people who use drugs and potentially, people receiving income support. NADA also notes that the Bill works in direct contradiction to the National Drug Strategy 2017–2026 which states that as part of good practice in reducing demand for illicit drugs, strategies should seek to reduce the stigma of drug use to increase access to appropriate support services.
A range of medical experts noted in their submissions that they do not support the drug testing trial, including St Vincent’s Health Australia, the Royal Australasian College of Physicians, the Royal Australian and New Zealand College of Psychiatrists.
In addition to our dissenting reports from previous inquiries, we outline further concerns below.
No consultation with community
The Greens are deeply concerned by the fact there has been no consultation with communities across the three trial sites prior to introducing the Bill.
At the hearing, the Department of Social Services provided evidence that stakeholder engagement was undertaken after the introduction of the original Bill. Without undertaking proper consultation on the contents of the Bill, the Government has no way of knowing whether the community is supportive of the trial.
Departmental officials said:
We did not undertake any consultation prior to the government's announcement.
Representatives from the proposed trial sites of Mandurah and Logan reiterated that the Government has not undertaken consultation with communities.
The City of Mandurah noted in its submission:
The Council was unaware that Mandurah was going to be a trial site until the announcement was made by the Minister for Social Services.
Mr Rhys Williams, Mayor, City of Mandurah, said at the hearing:
There has been no consultation with the local government, and that's disappointing because, again, we've got a better idea of what's happening on the ground than the data that is being used to determine this as an appropriate trial location will tell you.
Logan Together also noted the absence of consultation with the Logan community in its submission:
We note the complete absence of engagement and co-design processes with the Logan community and professionals in the sector in the development of the proposed service model. It is hard to see how the proposed intervention and planned new investments could effectively integrate with the existing service system or be positively received by the local community until an engagement and co-design process occurs.
Queensland Council of Social Service (QCOSS) explained that the absence of consultation could mean the proposed trial harms programs and policies already taking place on the ground, such as the place based approaches occurring in Logan.
Mr Mark Henley, Chief Executive Officer, QCOSS, said at the hearing:
There is openly broad support for opposing this bill, and my understanding is that they also provided written submissions the previous time. I think there's a high level of frustration that this runs the risk of harming the great work that they have been doing to date, which has been going on for at least three years, around a place based approach about working with the strengths of what exists in that community. They are seriously concerned that the good work that's been done to date will be derailed.
If the Government had bothered to ask, they would have found communities like Mandurah and Logan are not supportive of the trial. These communities have very different ideas about how drug and alcohol abuse should be addressed and recognise that top down approaches don’t work.
Stigma from testing and income management
Under the 2019 Bill, trial participants who test positive to an initial drug test will be subject to income management for a period of 24 months, managed through the Basics Card.
The Committee heard evidence from several submitters about their concerns with enforcing income management on people who may have substance abuse issues.
The Royal Australasian College of Physicians (RACP) noted in its submission:
Income management does not address the root causes of addiction, and the nature of the disease means that people will often find ways of bypassing the constraints. We know that people with addictions are unable to modify their behaviour, even if they know there are going to be negative consequences, and that includes being placed on income management for a positive test.
We are concerned that imposing income management on a vulnerable group struggling with substance dependency and co-morbid mental health problems, who very often have little or no support themselves, without good social or community supports being put into place, may cause increased levels of anxiety and push vulnerable people over the edge.
The issue of stigma around drug and alcohol abuse was also highlighted in the inquiry.
Clinical Associate Professor Adrian Reynolds, Royal Australasian College of Physicians, said at the hearing:
You've heard the estimates of up to 500,000 people each year. In that 500,000 is a hidden group of people who, we might say, are in need of and could benefit from treatment but do not demand treatment; they do not put their hands up. In part, that is because treatment is not accessible or affordable and because there is a significant degree of stigma still associated with substance-use disorder.
The stigma experienced by people with substance abuse issues will be further compounded through this trial by subjecting participants to compulsory income management.
Dr Shalini Arunogiri, Chair, Faculty of Addiction Psychiatry Committee, Royal Australian and New Zealand College of Psychiatrists, explained the additional stigma participants will experience due to compulsory income management:
It's not just the stigma of having to go in and have a supervised urine test or hair test, for instance; it's also the stigma of carrying a card…
We know that, even aside from having income management as part of that process, people who have substance-use disorders already have a significant burden of stigma in relation to that use disorder—external stigma, but also internalised stigma. That can be related to shame and guilt issues, and that can actually impact significantly on the individual accessing treatment, engaging in treatment and being able to form trust with the people around them and with their therapists too…
If we add to this, on top of that, an additional burden of stigma in relation to income condition management then this is really something that will affect many different parts of that individual's life. I understand that the BasicsCard is something the person will have to carry with them but also will negotiate a whole range of different arrangements in their lives in relation to this.
It is clear that subjecting people who return a positive drug test to income management will add to the stigma they may already experience due to their potential substance abuse issues.
The Bill also provides that the Secretary may, by legislative instrument, determine someone stays on income management for a period of longer than 24 months. The Australian Greens hold serious concerns about the broad discretionary power of the Secretary and how it will be implemented.
Technicalities of drug testing
As part of the trial, participants will be required to provide a sample of saliva, urine or hair for drug testing. A number of submitters noted the issues with different drug testing techniques, including reliability issues and the risk of false positives.
The Ted Noffs Foundation noted that drug tests won’t pick up on the difference between recreational and problematic drug use:
Crucially, a hair, urine or saliva test would not clearly indicate the frequency of cannabis use. It would simply reveal the presence of cannabis in that individual’s system. This fails to distinguish between recreational and problematic use of drugs. There has been little forthcoming from the government about the potential issues this would raise. It calls into question whether the extra costs of testing and targeting people who might use drugs recreationally and without issue, have been factored into the proposed trial.
RACP explained in its submission there are risks that people could switch to drugs that aren’t detected by the tests:
There is a real concern that people could shift their choice of drug to one that isn't being tested for, which in some cases might be more dangerous, for example synthetic cannabis or synthetic opioids such as Fentanyl. Another significant risk is that individuals suffering from substance use disorder may divert their drug use toward prescription drugs which may or may not have been prescribed to them directly…
Representatives from the Workplace Drug Testing Association also provided evidence at the hearing on the technicalities of drug testing.
Mr Darron Brien, Chairman, Workplace Drug Testing Association, said that while there are Australian standards for accreditation to undertake drug testing, there is no governing body to enforce these standards:
Australian standards themselves talk to independent accreditation. To fully comply with a standard, you have to have that independent accreditation. Unfortunately, it's then up to the providers themselves to ensure that they have that accreditation. We don't have any governing body looking after the industry that would be similar to the licensing, for example, for building contractors that ensures all of their members are appropriately accredited.
The committee also heard evidence about the issues with hair testing techniques, including that there is no Australian standard for hair testing.
Mr Darron Brien, Chairman, Workplace Drug Testing Association said:
There is no Australian standard. Accordingly, there are no accepted cut-off levels—in other words, levels at which you might deem a sample to be positive or negative. So you're in a very grey area there.
Hair testing does have a very long detection time frame. It can be up to about three months. It tends to be a very good tool if you're wanting to get a picture of a person's drug-taking behaviour over a long period. In something where you're looking for behaviour change within a 25- or 28-day period, it's not really an effective tool to do so.
The Australian Greens hold serious concerns about the different drug testing techniques the Government is proposing to use in this trial, especially hair testing, and the issues around the enforcement of Australian standards for drug testing.
The Australian Greens reject the committee view that the Department of Social Services and Department of Human Services are undertaking 'all necessary consultation' regarding drug testing processes.
Treatment services
An overwhelming number of experts from the health and addiction sectors spoke about the problems with treatment services for people with substance abuse issues. While the government has announced a $10 million treatment fund will be included as part of the drug testing trial, this will not be sufficient to meet unmet demand.
The latest research from Professor Alison Ritter, lead of the Drug Policy Modelling Program at the Social Policy Research Centre, found there is significant unmet demand for drug and alcohol treatment in Australia. There are between 411,740 people and 755,557 people who need drug and alcohol treatment in Australia. This means treatment services are only meeting between 26.8% and 56.4% of demand in Australia.
There are also significant waiting times involved in accessing treatment for substance abuse issues.
The Ted Noffs Foundation noted in its submission:
Current waiting lists for public treatment facilities can be up to six months long. Placing recipients onto these lists will only add to the burden on the sector. Rather than facilitate access, as the Minister claims, this trial will further complicate pathways to treatment.
Mr Mark Ferry, Chief Operating Officer, Ted Noffs Foundation, elaborated further at the hearing:
We have two rehabs for 13- to 18-year-olds, one here in Canberra and one in Sydney, with a total of 26 beds. We're full, and we have a waiting list of people wanting to get in. So the misnomer of, 'Oh, the treatment will be available,' or 'There's $10 million,' is a bit of a furphy, because there's already a massive queue of people seeking treatment.
Clinical Associate Professor Adrian Reynolds, RACP, said at the hearing:
In my home town in Tasmania, treatment services are simply non-existent and are so in many areas of our state. We know there are many areas of Australia where access to services is not feasible. Of course, like other states, we have a six-to-12-week waiting list.
RACP also noted the trial does not address the service gap or workforce issues:
We do not believe the $10 million Treatment Fund announced by the Government is an adequate measure to address these issues in the trial sites as it is a one-off funding commitment which does not provide sustained funding and will therefore have workforce implications in the longer term. Staff of those services ask whether there is an expectation from Government that those testing positive in the trial will be given priority and in effect jump the queue.
Several witnesses provided evidence at the hearing that a significant financial investment is required to meet the current service gap.
Dr David Martyn Lloyd-Jones, Visiting Medical Officer, St Vincent’s Hospital, said at the hearing:
Ten million dollars will not instantly produce a skilled workforce, so one has to ask again: who will provide this treatment? If the government is serious about assisting Australians with substance use disorders, it should invest heavily in the AOD treatment sector to allow people with substance use disorders to access high-quality and effective evidence based treatment. Recent estimates, as you have heard earlier today, suggest that an investment of $1.2 billion in the AOD sector is required to enable all those in need to access such treatment.
It is clear the $10 million treatment fund will not address the significant unmet demand for treatment services and long waiting lists experienced by people currently trying to get help.
No support for addressing the underlying causes of addiction
The committee heard evidence about the underlying causes of addiction that need to be addressed as part of overcoming substance abuse issues.
Dr kylie valentine, Deputy Director, Social Policy Research Centre, University of New South Wales, noted the shortfalls in other services needed to help address addiction:
When you're talking about people with complex support needs and vulnerabilities, waiting lists for treatment services are one part of the picture. We know that there are extreme shortfalls in other services that are really necessary to support vulnerable people into work: in specialist homelessness services, in counselling, in domestic and family violence, in mental health and in other health services. So waiting lists for treatment services are important, but not the only kinds of shortfalls here.
Ms Jill Rundle, Chief Executive Officer, Western Australian Network of Alcohol and Other Drug Agencies, also noted the underlying issues that need to be addressed:
People in need of treatment present with a range of complex issues—lack of community connection, mental health issues, including anxiety and depression, past experiences of trauma and abuse, homelessness and poverty et cetera. There is no point in addressing any of these issues in isolation.
Despite this gap in service provision, the Department of Social Services said money from the treatment fund will not be used to address the underlying causes of addiction.
When asked whether the treatment fund could be used by individuals in the trial sites for housing, homelessness or mental health services, a spokesperson from the Department of Social Services said:
The $6 million is not for those services, but that doesn't mean that they wouldn't be able to access those services.
The fact that the treatment fund cannot be used to address the underlying causes of addiction highlights how the trail fails to see alcohol and drug dependence as a complex health issue.
Lack of transparency around costs
The Australian Greens have strong concerns about the lack of transparency around the costs of the trial. To date, no information has been published on the cost of the trial apart from the $10 million allocated to the treatment fund.
Queensland Council of Social Service and Queensland Network of Alcohol and Other Drug Agencies noted in their submission:
Testing each of the 5,000 participants has been estimated to cost between $500-$900 per test; a total cost of $2.5 million at the most conservative end. This is around $16,500 per person if 150 were clinically indicated for treatment, costing more than the annual Newstart allowance for a single person with a dependent child.
At the hearing, a spokesperson from the Department of Human Services said that custom rooms have already been built in Centrelink offices for people to undergo drug testing:
Then they would be taken to the appropriate area in the Services Australia office to undertake a saliva test. Their privacy will be maintained. We have built these rooms particularly to support the privacy of people undertaking these tests.
The Australian Greens have serious concerns that money has already been spent preparing Centrelink offices for participants to undergo drug testing when the legislation has not passed Parliament.
It is expected that the cost of the trial would be significant once the costs of drug testing, income management, evaluation and treatment services are combined.
The Government’s lack of transparency in disclosing the costs of the trial is very concerning.
Recommendation
The Australian Greens recommend that the Bill not be passed.