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

Some Reservations…

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.

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Comments
8 Responses to “Victoria’s Drug Strategy – The Devil is in the details”
  1. Web Servant says:

    Hey Stonetree, I am a bit confused about your concerns about the notion of “Promoting Successful Recovery and Reducing Stigma in the Community”.

    You question that there is any link between the two objectives and to make the link would be dangerous.

    But then go on to argue that indeed there is a link between the two to suggest that promoting recovery actaully promotes stigma.

    Are you saying that it is impossible to promote recovery and reduce stigma at the same time? That they are incompatible – it is either one or the other so one must yield to the other?

    In each of the five actions that the governement describes both objectives seem to be intertwinned. Are you suggesting they are doomed to failure because they are attempting to acheive incompatible aims?

    Is that what you are saying or am I misunderstanding you?

    • stonetreeaus says:

      Thank you for your comments Web Servant

      You have covered a little bit of ground here, with a number of questions so I have elected to breakdown your comments and respond to them piecemeal

      You wrote:

      “I am a bit confused about your concerns about the notion of “Promoting Successful Recovery and Reducing Stigma in the Community”.
      You question that there is any link between the two objectives and to make the link would be dangerous.”

      My response

      It would indeed be dangerous to link promotion of successful recovery with reducing stigma in the community to the exclusion of drug users who are not in recovery or do not aspire to it. Stigma is not something that is exclusively experienced by people in, or seeking recovery, but something that impacts upon all people who use drugs. By connecting the two goals under one umbrella, my concern is that the stigmatisation of a significant number of people who use drugs will continue to go largely unaddressed. I am sure you would agree that this would be a bad thing.

      You wrote:

      “But then go on to argue that indeed there is a link between the two to suggest that promoting recovery actaully promotes stigma.

      Are you saying that it is impossible to promote recovery and reduce stigma at the same time? That they are incompatible – it is either one or the other so one must yield to the other?”

      My response

      Recovery applies to only a narrow spectrum of the drug experience and not all people will want or seek recovery. My concern is that if recovery stories become the dominant discourse or narrative for understanding drug use and dependency then this will result in stigma being addressed for people who conform to the expected norms of someone ‘in recovery’. The other result however is most likely to be an increased level of stigmatisation of people who fall outside of the norms (which I would suggest are the vast majority of people who use drugs).

      In very simple terms people who are viewed as being in recovery will be seen as ‘good’ while people who drugs who are not ‘in recovery’ will be viewed as ‘bad’ by society. I am not against recovery as such, but I think it has a narrow application and when we are talking about stigma we need a response that meets everybody’s needs.

      You wrote:

      “Are you suggesting they are doomed to failure because they are attempting to acheive incompatible aims?”

      My Response

      Quite frankly I think you are being a little silly here. At no point have I suggested that the strategy is doomed to failure.

      It is an old trick to use hyperbole, or to inflate a position in order to win an argument or to sway opinion. While it may persuade some people that I hold extreme views, it is as misleading as it is unhelpful.

      I have in fact identified 5 areas covered by the strategy including the potential introduction of more widely available naloxone, the expansion of the capacity of needle syringe programs, the use of language in the document and it’s importance, the trialling of new results based funding models in addition to the strategy’s linking of the concepts of recovery and stigma. In each instance I have offered an opinion as to each area’s potential merits (or not) with a rationale.

      At no point have I stated that the strategy is doomed to failure. I have however been very clear that the strategy bears further scrutiny as ‘the devil will be in the details.
      I understand that you may not agree with my opinions or the rationale that I have provided to support them. It is after all only my opinion, however it is a series of opinions that I have expressed supported by a summation of my reasoning. I find it interesting that in you opposition expressed chiefly by the tone of your response and the use of leading questions designed to inflate my position (e.g.” Are you suggesting they are doomed to failure because they are attempting to acheive incompatible aims?”) that you have neither tacitly stated your own position, nor provided any reasoned argument for holding this position.

      It is also somewhat telling that although the article in question covers five specific points that are mentioned in the strategy that you have focussed solely on one point to the exclusion of the others which may well be very important. This suggests to me that the chief concern here is ideological rather than pragmatic. If this is the case then there is no need to respond further as I find ideological arguments a waste of time as it is rare that either side of an ideological debate is prepared to concede a point and this results in unconstructive dialogue. I would invite you however to provide a reasoned argument demonstrating how the promotion of successful recovery does reduce stigma (especially if it can be applied in such a way that does not come at the expense of people who do not participate in recovery). I would also welcome your views on the other four points covered in the article as I believe that they are just as important as the sole point you have chosen to focus upon.

      Regards

      Stonetree

      • Web Servant says:

        Hey Stonetree,

        After our tangle off line and some soul searching – I agree the tone of my reply to your post was not exactly inviting a constructive debate.

        Firstly it is good news about the Naloxone trial and I can’t for the life of me see why it wasn’t rolled out decades ago. The other harm reduction measures announced are welcome – which kind of takes the wind of of the sails of those who insisted that the governments objectives of promoting recovery from addiction and making access easier for people wishing to do so was a indication that a whole sale roll back of harm reduction services and approaches was imminent.

        As for results-based funding, that is a whole can of worms that could go off the rails so easily. One could make a potent recovery oriented critique of the whole idea as evidenced by the way it has been hijacked in the UK but that would be better discussed on another post.

        Back to my reply, I was annoyed that the first government in Australia that had explicitly included tackling stigma in its strategy was not congratulated for it but taken to task because it was linked to the notion of recovery in a way which you find problematic. When I mentioned failure I was referring to 14th point in this 15 point plan, “Promoting successful recovery and reducing stigma in the community” – not the whole strategy.

        I still think it is possible to do both.

        On re reading your argument, I kind of get where you are coming from but first I feel it is worth clarifying our positions on the issue of promoting recovery and reducing stigma as it is an important issue and the links between the two are indeed complex.

        I was certainly not suggesting that people in or seeking recovery are the only drug users who experience stigma – but they certainly do experience stigma and discrimination in ways that can make the process much harder.

        The term drug user is incredibly broad and ill-defined and includes the vast bulk of the population if we include alcohol and so on, so let’s assume we are talking about illicit drugs.

        Stigma when it comes to illicit drug use is too an extremely broad topic and so It is probably worth identify stigma of what?

        There are many kinds of stigma when it comes to drug use and it is worth breaking them down as it may be that harm reduction and recovery are targeting different stigmas but I suggest there is a great deal of over lap and opportunities for synergies.

        Below is a list of relevant stigmas from off the top of my head in a vague order of harm reduction to recovery.

        1. The stigma of violating social norms
        2. The stigma of intoxication
        3. The stigma of illicit drug use
        4. The stigma of injecting drug use
        5. The stigma of experimental drug use
        6. The stigma of recreational drug use
        7. The stigma of instrumental drug use
        8. The stigma of dependent drug use
        9. The stigma of irresponsible or reckless drug use
        10. The stigma of destructive and damaging use
        11. The stigma of self-harm
        12. The stigma of crime associated with drug use
        13. The stigma of incarceration
        14. The stigma of involvement with child protection
        15. The stigma of involvement with child protection
        16. The stigma of losing custody of and access to children
        17. The stigma of living with a blood borne infection
        18. The stigma of overdose (especially for family and friends)
        19. The stigma of addiction
        20. The stigma of help seeking
        21. The stigma of being an ex-user
        22. The stigma of seeking recovery
        23. The stigma of being in recovery
        24. The stigma of being in 12-step recovery

        I suggest harm reduction is focused on drug use and associated harms and so would emphasis addressing stigma from the top of the list down. Recovery is focused on addiction and associated damage and probably starts at the end of the list and works back.

        What do you see as the differing approaches of both harm reduction and recovery to each of these stigmas and whether in the process of tackling one kind of stigma you are unintentionally or unavoidably provoking stigma elsewhere?

        I am genuinely offering an olive branch here – the opportunity of harm reduction and recovery to work together against the stiff winds of zero-tolerance that will blown down from Canberra should not be given up because of relatively minor differences of emphasis in addressing the health and welfare needs of people affected by drug use whether or not they want or need recovery.

      • stonetreeaus says:

        Thanks for your response Web Servant.

        I don’t know how to be any clearer about my reservations, other than to repeat myself so here it goes.

        Recovery applies to only a narrow spectrum of the drug experience and not all people will want or seek recovery. My concern is that if recovery stories become the dominant discourse or narrative for understanding drug use and dependency then this will result in stigma being addressed for people who conform to the expected norms of someone ‘in recovery’. The other result however is most likely to be an increased level of stigmatisation of people who fall outside of the norms (which I would suggest are the vast majority of people who use drugs).

        In very simple terms people who are viewed as being in recovery will be seen as ‘good’ while people who drugs who are not ‘in recovery’ will be viewed as ‘bad’ by society. I am not against recovery as such, but I think it has a narrow application and when we are talking about stigma we need a response that meets everybody’s needs.

        Regards

        Stonetree

  2. Greg Kasarik says:

    Perhaps unsurprisingly, we are once again blessed with a document that gives no recognition to the valid use of mind altering substances for religious and spiritual purposes.

    I have been lobbying the government on this issue for two years now and Mary Woolridge is certainly aware of its importance, but they still insist on pretending that people such as I simply do not exist.

    The reality is that drug law and drug policy is heavily bound up in politics and “druggies” are easy political targets. Nothing will really change until those in authority stop telling lies and start to actually engage with the science and the complex realities of drug use.

    Agree 100% on your comments regarding alcohol. It is a far more dangerous compound than most of those used by those that the politicians despise.

    • stonetreeaus says:

      Interestingly enough in some instances Greg some drugs are not prohibitred in the use of religous ceremonies. I of course refer to the use of alcohol in the form of red wine often utilised in communion services by many Christian denominations. I am not a person who has spent much time contemplating spirituality full stop, so must confess that I do not hold much in the way of either knowledge or opinion in regard to this matter, however I do agree that discussions about the use of substances within our society is heavily politicised. I recently heard a leading AOD academic speak to the fact that the AOD policy building process is neither scientific or rational.

      Regards

      Stonetree

  3. Jane says:

    Hey Matt,
    the devil is most certainly in the details with this one.
    Kinda disappointing that nowhere thru the document does the word Naloxone appear without the word wait not far away. Really sad that Victoria feels the need to have to wait for trials to be evaluated when we all know how long those sorts of things take. It also refers to the trial in the ACT when in fact it is not a trial. I read this as a big handbrake and i see it almost as a step backwards. Naloxone is being given to users in W.A, S.A and there is also a program running out of Kirkton Rd in Sydney but i have heard anecdotal reports that they are having trouble recruiting participants? I hafta wonder if that’s anything to do with the fact that it’s not a “peer” project? In Victoria we have a well established peer driven overdose education program that would be well placed to take on a Naloxone distribution program yet we have to wait? How many more lives will be lost while we wait? Imagine if just one child died as a result of no access to a life saving epi pen? Imagine the outrage if Victorians had to wait while trials of epi pens were evaluated before parents could relax knowing that in the event of an emergency they could administer something so simple that would save a life? Somehow i don’t think “waiting for trial results” would be an acceptable answer.

    as far as your second concern goes, i too have the same reservations as you
    ” 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.”

    and that’s all i’m going to say on the matter because i typed out a rather long rant in response to your post but my tech savvy skills caused me to lose all the text when i tried to log in. Don’t ask me how or why cos i don’t know but overall it was probably a good thing because as i said it was a rather long rant and the much shortened/edited version you see above is definitely less scandalous LOL

    cheers, keep up the great work. i love your posts!
    Jane

    • stonetreeaus says:

      Cheers Jane,

      Your support is very much appreciated (as are your occasionbal rants 🙂 ) I would agree that peer involvement in Nalxone distribution is critical. This is a model that has been used quite successfully in many places across the world, including in partsd of the U.S. and the UK.

      Regards

      Stonetree

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