Victoria’s Drug Strategy – The Devil is in the details
Victoria’s Minister for Health, the Honourable Mary Woolridge , today released Victoria’s plan to reduce the alcohol and drug toll. This document guides Victoria’s strategic approach to alcohol and other drugs for the next four years.
For any that are not already aware, the Victorian Alcohol and other Drugs sector has been subject to significant scrutiny and planning for major reforms in recent times. It was therefore with baited breath (and no small amount of anxiety) that many with a stake in ensuring that we have a robust and responsive sector, have awaited the launch of the strategy. I must admit that so far I have only managed to scan the document and will need to spend more time examining the details (because we all know that’s where the devils reside) however, I thought I would share some of my first impressions.
The Good News – Naloxone and Injecting Equipment
Perhaps one of the most exciting shifts (for me anyway) is the announcement that the Victorian Government will assess and implement initiatives that will make naloxone more widely available. Currently in Victoria, Naloxone is predominately used by emergency service first responders (eg. paramedics) and Accident and Emergency facilities in hospitals. Naloxone is not currently widely available to members of the public who may witness an opiate overdose (e.g. family members, peers etc.) The Victorian Government’s signal that they are prepared to look at evidence from other jurisdictions (the trial currently under way in the Australian Capital Territory and intitiatives in the U.K. were both cited as examples) and the positive tone contained within the document towards implementation of projects that make Naloxone more widely available marks a significant leap forward, and has the potential to save many lives each year.
Also very welcome, was the Government’s announcement that they will support a number of actions that will improve access to sterile injecting equipment and harm reduction information by:
- increasing access to services after hours and in growth corridors
- supporting and enhancing harm reduction services through diversifying the availability of equipment to adapt to changing patterns of use of illegal drugs and diverted pharmaceutical drugs
- using needle and syringe programs to connect clients with primary health providers including GPs delivering alcohol and drug treatment (pharmacotherapy)
- improving community understanding of the importance of access to needle and syringe programs and pharmacotherapy
Despite this great news I do have to admit to some very real concerns about some of the content of this new strategy document. First of all let’s look at the title of the document, “Reducing the alcohol and drug toll”. There is a reason that we use the term “alcohol and other drugs’ in the Victorian Service sector; It recognises that alcohol is a drug too. While this might appear on the surface to be a minor gripe, this differentiation of alcohol from other drugs only helps to sustain the hierarchy of stigma regarding different substances that occurs within our communities. This then is problematic in a document that asserts that combating stigma is an important part of the Victorian Alcohol and other Drugs Strategy.
This brings me to my second concern. The 14th point in this 15 point plan for the future is titled, “Promoting successful recovery and reducing stigma in the community”. I didn’t realise that the two actions were conjoined. In fact linking the two concepts promotion of recovery and reduction of stigma at a strategic level may well contribute to the stigma that people who use drugs, but who are not in recovery, might experience.
I made the point in “The bad, the sad and the redeemed” an article on the Injecting Advice website in 2011, that how the media interprets stories of drug use can be highly problematic. These story archetypes are not exclusively the domain of journalism however, they are also the templates that we often apply in everyday situations to synthesise and simplify what are often complex tales. Recovery stories are often presented as tales of redemption.
“This story archetype follows the pattern of I once was lost, but now I’m found. It is a tale of struggles and deprivation that ultimately end in the individuals redemption through some form of recovery. Stories of hope are important to people seeking to change their drug using behaviour, but they can also contribute to the sense of otherness that people who have not entered recovery are subjected to. Not everybody who uses drugs wants, or needs recovery. If the only socially acceptable way for me to disclose my drug use is to state that I am in, or seeking recovery, where does that leave the millions of people who use drugs that are not?
In short these types of stories can reinforce the concepts of moral behaviour that have been shaped by history rather than evidence and contribute to the stigma that non recovering drug users experience.”
Excerpt from The bad, the sad and the redeemed
For people seeking recovery hope is important, but by linking the promotion of recovery with the reduction in stigma we may well be reinforcing the idea that some drug users are more deserving of our compassion, empathy and respect than others.
Perhaps the most anxiety provoking information communicated in this document however is in relation to the Government’s vision for alcohol and other drugs treatment services. The document asserts that as a component of the reformation of the alcohol and other drugs treatment sector the following action will be undertaken:
“…trial flexible, results-based funding to encourage and support innovative local approaches to achieving better outcomes for groups facing particular difficulties.”
While I have no problem with improving the outcomes for people, results based funding can, and has been an unmitigated disaster in jurisdictions outside Australia (e.g. the U.K), resulting in success being measured not by how many people are accessing treatment, but instead by how many people are not engaged with treatment services. So what is success according to the government? Well according to the government’s own stated measures of progress, success will be measured, by amongst other things:
“the number of drinkers and drug users who seek to reduce or stop their use and recover successfully from misuse.”
By potentially attaching funding to this type of measure, the government will essentially be dis-incentivising work undertaken with more complex clients who by the very dint of their complexity, are often also the most vulnerable.
The Devil is in the details
A stated at the start of this article, at this point I have only had a small amount of time to examine the document that will essentially underpin some of the most significant changes to the Victorian alcohol and other drugs sector and alcohol and other drugs policy seen since the Turning the Tide Strategy in the late 1990’s. While I welcome some of the improvements to drug services that will enhance access to much needed services, I do maintain some very real concerns as well. These areas of concern will require further scrutiny, for as we now the devil resides in the details.
I invite you to have a look at the document and see what you think.