Welcome to Social Research & Evaluation News and Events
Here I will, from time-to-time, provide information on current initiatives in which the consultancy is involved, and issues of particular interest that I (David McDonald, the consultancy’s Director) believe the on-line community will find of interest.
For summaries and comments on newly-published research findings, and other research activities of particular relevance to alcohol, tobacco and other drug (ATOD) and allied workers, please visit ATODA’s monthly Research eBulletin (a resource that I author). ATODA is the Alcohol Tobacco and Other Drug Association ACT. The ATODA Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.
I have ceased making additions to this blog since the resources are now available, in a fuller form, in ATODA’s monthly Research eBulletin.
|I have ceased making additions to this blog since the resources are now available, in a fuller form, in ATODA’s monthly Research eBulletin.|
|Mar.16||Do moderate drinkers have reduced mortality risk?
Australian and international researchers have now published a thorough refutation of the much-repeated claim that moderate drinking is healthier than abstaining.Abstract: Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and allcause mortality, with reduced risk for low-volume drinkers. However, low-volume drinkers may appear healthy only because the “abstainers” with whom they are compared are biased toward ill health. The purpose of this study was to determine whether misclassifying former and occasional drinkers as abstainers and other potentially confounding study characteristics underlie observed positive health outcomes for lowvolume drinkers in prospective studies of all-cause mortality. A systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded. Without adjustment, meta-analysis of all 87 included studies replicated the classic J-shaped curve, with low-volume drinkers (1.3-24.9 g ethanol per day) having reduced mortality risk (RR = 0.86, 95% CI [0.83, 0.90]). Occasional drinkers (<1.3 g per day) had similar mortality risk (RR = 0.84, 95% CI [0.79, 0.89]), and former drinkers had elevated risk (RR = 1.22, 95% CI [1.14, 1.31]). After adjustment for abstainer biases and quality-related study characteristics, no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]). Analyses of higher-quality bias-free studies also failed to find reduced mortality risk for low-volume alcohol drinkers. Risk estimates for occasional drinkers were similar to those for low- and medium-volume drinkers. Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.Source: Stockwell, TR, Zhao, J, Panwar, S, Roemer, A, Naimi, TS & Chikritzhs, TN 2016, ‘Do “moderate” drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality’, Journal of Studies on Alcohol and Drugs, vol. 77, no. 2.
|09.Sep.15||External evaluation of the capacity building activities of the Australian state and territory alcohol and other drug sector peak bodies
Over recent years I have been conducting an external evaluation of the capacity building activities of the Australian state and territory alcohol and other drug sector peak bodies. The evaluation report was released today.
The evaluation has identified a wide range of activities, undertaken by the AOD peaks, aiming to build the capacity of AOD services and the broader AOD sector to anticipate and respond appropriately to the AOD needs of the Australian community. An analysis of the empirical data elicited through the evaluation, and the program theory underpinning the peaks’ capacity building work, leads to the conclusion that the capacity building work has produced, and is continuing to produce, a more effective, efficient and sustainable AOD sector, producing sound outcomes for AOD clients.
The Australian Government is commended for its commitment to the continued development of the non-government alcohol and other drugs sector through supporting capacity building initiatives such as those delivered by the Australian state and territory AOD peak bodies.
The peaks will use the key findings and recommendations from the report to support their ongoing role in supporting AOD services deliver quality and evidence-based programs in Australian communities.
The report and media release may be downloaded from here.
|31.Aug.15||An Australian first: Overdose antidote saves Canberrans’ lives
I had the privilege of being a member of the team that evaluated Australia’s first take-home naloxone program.
ATODA wrote: The Australian Capital Territory’s trailblazing opioid overdose management program, which makes take-home naloxone available to potential opioid overdose victims, has been overwhelmingly endorsed by an independent evaluation report.
The report, released by ACT Health Minister Simon Corbell on International Overdose Awareness Day, Monday 31 August, shows that take-home naloxone saves lives. Naloxone is a Schedule 4 medicine that reverses the effect of heroin and other opioid drug overdoses.
The first of its kind in Australia, the ACT program has been operating since 2011. It involves comprehensive opioid overdose management training and the prescription and supply of naloxone to eligible participants who are not health professionals.
The evaluation report makes a number of significant findings, including that program-distributed naloxone not only gives participants the ability to save lives, but to take control in overdose situations.
The report found there were 57 overdose reversals using program-issued naloxone during the evaluation period, and recommends an expansion of take-home naloxone programs.
For further information on the Implementing Expanded Naloxone Availability in the ACT (I-ENAACT) project, please visit here.
The evaluation report:
|25.Jul.15||Release of consumer participation report
Last year I worked with the Australia National Council on Drugs (ANCD) on a project that aimed to increase the focus on consumer participation in drug treatment agencies.
Unfortunately, the release of the report was caught up in the Abbott government’s disbandment of ANCD earlier this year.
The good news is that the report is now in the public domain, at the website of ATODA, the Alcohol Tobacco and Other Drug Association ACT. To download a copy, please click here. The direct link to the publication is here.
I extend my thanks to the expert participants on ANCD’s Consumer Participation Roundtable, and hope that this document will contribute to policy work that aims to increase the amount and impacts of consumer participation in drug treatment services in Australia and abroad.
|24.Jul15||Announcement of the May 2016 Anual Conference of the International Society for the Study of Drug Policy, Sydney
Yes, the Society’s 10th annual conference will be held in Sydney next year, 16-18 May 2016, great news! The venue will be Q Station, North Head Scenic Drive, Manly NSW.
Details are available online.
The call for abstracts will open on 2 November this year.
There will also be satellite conferences held in Auckland and Canberra.
I am a member of the conference Organising Committee and the Scientific Committee, so am happy to respond to any questions about this event.
Put it in your diary now!
|03.Apr.15||Parliamentary inquiries into therapeutic cannabis
Therapeutic cannabis, aka medicinal cannabis and medical marijuana, has been a major focus of my work over the last fortnight.
In September last year I assisted the Public Health Association of Australia (PHAA) to develop its Position Statement on Medicinal Cannabis in Australia.
Subsequently, PHAA provided submissions to a standing committee of the Legislative Assembly for the ACT that is inquiring into the exposure draft of a bill to legalise therapeutic cannabis in the ACT, and to a Senate standing committee inquiring into a bill to establish a national Regulator of Medicinal Cannabis.
As a result of those submissions, PHAA was invited to give oral evidence to both committees. On Monday 30 March the CEO of PHAA, Michael Moore, and I, provided evidence to the Senate Standing Committee on Legal and Constitutional Affairs.
On the following day, Tuesday 31 March, Michael and I provided evidence to the Standing Committee on Health, Ageing, Community and Social Services in relation to its Inquiry into the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 Exposure Draft and related discussion paper.
This is a fascinating aspect of drug policy in Australia. The public at large is demanding legal access to therapeutic cannabis. Leading medical profession organisations like the AMA are opposed to it, although many GPs and medical specialists support their patients using therapeutic cannabis.
It does seem to be a topic on which the regulators and legislators are out of step with public opinion. It will be interesting to see what happens with these two bills. Let us hope that common sense, the scientific evidence and the lived experiences of people for whom therapeutic cannbis has been (in some case literally) a life-saver, takes prominence over the drug war warriers and the hyper-conservative elements of the medical profession.
|10-12.Nov.14||APSAD annual conference poster prize
At this week’s annual conference of the Australasian Professional Society on Alcohol and other Drugs (APSAD) I had a poster, co-authored with Amanda Bode and the members of the national AOD NGO Peaks Capacity Building Network, titled Capacity building in the alcohol and other drug sector: what, how and outcomes. It was awarded the prize of runner-up for the best Senior Researcher’s Poster!
Here is the abstract:
|15.Oct.14||The USA seems to have taken another step towards a modern drug policy
On 9 October, in New York, William R. Brownfield, Assistant Secretary, Bureau of International Narcotics and Law Enforcement Affairs, made a public statement setting out the US Government’s approach to global drug policy.
It appears to be a worthwhile step towards a more rational approach, and stepping away from trying to force other nations to follow its own largely failed policies of the past.
Ambassador Brownfield said, in part:
The full statement is online here.
|01.Oct.14||Launch of ACT drug diversion program evaluation
Today the ACT Attorney-General, Simon Corbell MLA, launched the report of the evaluation of the ACT’s drug diversion program: Hughes, C, Shanahan, M, Ritter, A, McDonald, D & Gray-Weale, F 2013, Evaluation of the Australian Capital Territory drug diversion programs, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, The University of New South Wales, Sydney. It is available online here. The Minister’s media release is here.
The evaluation is described at the Drug Policy Modelling Program site (edited) as follows:
Traditional means of evaluation have focused on programs themselves, rather than how programs intersect, and factors outside individual programs that positively or negatively affect program inputs, outputs and outcomes. To overcome this deficit a systems approach was adopted to examine drug diversion in the ACT. This project has generated a thorough understanding of what is going on, to whom, at what costs, and the barriers to and enablers of effective system provision.
|01.Oct.14||New journal article on naloxone in the ACT published
Members of the team that has developed and are evaluating the Australian Capital Territory’s and Australia’s first program of peer-led opioid overdose management incorporating naloxone have had a paper published today on the processes underlying this initiative: Lenton, S, Dietze, P, Olsen, A, Wiggins, N, McDonald, D & Fowlie, C 2014, ‘Working together: expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond’, Drug and Alcohol Review, online ahead of print.
The abstract reads:
|24.Sep.14||‘What’s the drug driving problem represented to be?’
Today the Alcohol Tobacco and Other Drug Association ACT (ATODA) conducted its very successful 7th Annual ACT Alcohol Tobacco and Other Drug Sector Conference. It was held at the National Portrait Gallery in Canberra.
The theme of the conference was What is the drug policy ‘problem’?. It dealt with four topics in which policy and legislation seems to be out of step with what the public is actually doing. The topics were e-cigarettes, drug driving, new psychoactive substances and medicinal cannabis.
Carol Bacchi’s ‘What’s the problem represented to be?’ framework for policy analysis guided the discussion.
I presented a paper titled ‘What’s the drug driving problem represented to be?’. In it I critiqued
A copy of my presentation is here.
|23.Sep.14||Medicinal cannabis in the ACT: supply options
Today the Alcohol Tobacco and Other Drug Association ACT (ATODA) conducted a Public Forum, held at the Legislative Assembly for the ACT, on the topic of Better understanding evidence-based medicinal cannabis options for the ACT. The presenters were Emeritus Professor Lawrence Mather from the University of Sydney, Dr Alex Wodak from the Australian Drug Law Reform Foundation, and myself. At the end of the three presentations, a panel of speakers responded to questions raised by the audience. The panellists were the three speakers, Mr Shane Rattenbury MLA, Dr Chris Bourke MLA and Mr Michael Moore.
The title of my presentation was ‘Medicinal cannabis in the ACT: supply options’. I canvassed the opportunities for and impediments to introducing a compassionate medicinal cannabis regime in the ACT in a way that reflects the strengths of some well-regulated approaches, such as that of the Netherlands Office for Medicinal Cannabis, and avoids the mistakes made in a number of the medicinal cannabis programs in the USA, where the medicinal and recreational markets for the drug are not adequately differentiated. I emphasised that there are a number of things that the ACT (and other Australian governments) can do relatively easily to introduce compassionate medicinal cannabis regimes, and drew attention to some of the more difficult aspects particularly working up the full supply chain for legal medicinal cannabis.
A copy of my presentation is here.
|22.Jul.14||AIDS 2014 Melbourne Declaration: Nobody Left Behind
We express our shared and profound concern at the continued enforcement of discriminatory, stigmatizing, criminalizing and harmful laws which lead to policies and practices that increase vulnerability to HIV. These laws, policies, and practices incite extreme violence towards marginalized populations, reinforce stigma and undermine HIV programmes, and as such are significant steps backward for social justice, equality, human rights and access to health care for both people living with HIV and those people most at risk of acquiring the virus.
In over 80 countries, there are unacceptable laws that criminalize people on the basis of sexual orientation. All people, including lesbian, gay, bisexual, transgender and intersex people are entitled to the same rights as everyone else. All people are born free and equal and are equal members of the human family.
Please support our call for change and sign up now! The petition is here.
|29.May14||Increasing focus on tobacco harm reduction and e-cigarettes
For many years I have advocated that tobacco policies include serious attention to the potential of tobacco harm reduction initiatives including shifting people from smoking tobacco to being able to use nicotine in safer ways, reflecting the fact that people smoke for the nicotine but die from the tars etc. in the smoke.
The contemporary explosion of use of nicotine-containing e-cigarettes across the world has brought this to a head. Today a group of leading health scientists have written to the head of WHO urging that forthcoming negotiations on global tobacco control policy avoid making what they believe could be the huge mistake of restricting access to e-cigarettes.
Their main points are:
Details are online here.
|18.Mar.14||Debunking myths informs opioid overdose prevention
The current issue of the journal Drug and Alcohol Review (vol. 33, no. 2, pp. 109-14) has a valuable editorial by Professor Shane Darke from the (Australian) National Drug and Alcohol Research Centre with the title ‘Opioid overdose and the power of old myths: what we thought we knew, what we do know and why it matters’.
Darke identifies four powerful myths about who is dying and how they are dying:
The research evidence that debunks each of these myths is presented.
The author emphasises that opioid overdose is not an unpredictable, random event. Rather, it is concentrated in ‘older, very experienced polydrug users who die from multiple drug toxicity’.
These deaths can be prevented through enrolling many more long-term opioid users in treatment, better overdose response including the provision of naloxone, focussing on the high-risk period when tolerance is reduced (immediately after detoxification and the first weeks after release from prison), and educating users about the risks of polydrug use—especially combining alcohol and/or benzodiazepines with opioids.
Darke concludes: ‘Drug use patterns, however, are never static and the opioids are no exception. New trends in the demography of opioid use are emerging, most prominently the use of pharmaceutical opioids such as oxycodone, which will require new interventions. At least we now know these events are not random. The fact that we can now identify who is likely to overdose and why substantially increases our chances of successful intervention to reduce the considerable harm attributable to overdose. In terms of overdose, the past few decades of research have been crucial’.
|28.Feb.14||The closure of ADCA
At the end of February ADCA closed its doors. After decades of fine service to the Australian community generally, and to the alcohol, tobacco and other drug sector specifically, its services have ceased.
The Commonwealth Government defunded the organisation without warning, and without providing any credible explanation for its actions.
Perhaps the greatest impact is the loss of the National Drug Sector Information Service (NDSIS). I was the Chair of its National Advisory Committee since the Committee’s inception in 2004. The NDSIS was the world’s largest specialist AOD library and information service, and was the cornerstone of workforce development initiatives for the Australian AOD sector. It was the key source, for thousands of AOD workers (including policy advisers and researchers), about the evidence base that underpins their work.
Soon responsibility for managing ADCA (now an unfunded and unstaffed organisation) will be returned from the Administrator to the Board.
The sad irony is that, some time in the future, the services previously provided by ADCA will be rebuilt, probably at great cost.
|01.Dec.13||Save ADCA, Petition by Friends of ADCA
Last week, without any warning, the Commonwealth Government announced that it would no longer fund ADCA, the Alcohol and other Drugs Council of Australia. ADCA is a national not-for-profit organisation that has represented people and organisations working to support Australians impacted by alcohol and drug use for nearly 50 years.
It’s hard to find a family in Australia that does not have at least one member with a significant alcohol and drug problem. This decision sends a message about the lack of support for people who work closely with those affected by alcohol and other drug use.
Over almost 50 years ADCA has built up knowledge and resources that front line alcohol and drug workers rely on. By defunding ADCA all of this will be lost and the sector will lose its national coordination and representation.
One of Australia’s leading drug and alcohol experts Dr Alex Wodak said: “Governments can close organisations like ADCA in minutes. But it takes many years and much more money to recreate what has been lost.”
Please sign the petition to urge the government to reconsider its decision.
|25-27.Nov.13||Participation in the Australasian Professional Society on Alcohol and other Drugs Annual Conference, Brisbane
At this year’s APSAD conference I was the first author (with Amanda Bode & Carrie Fowlie) of a poster Evaluation of a pilot project to implement eASSIST across the ACT ATOD sector.
I also participated in a Symposium Expanding the availability of naloxone in Australia: reviewing the first year. Co-presenters were Anna Olsen, Paul Dessauer, Paul Dietze, Simon Lenton, Ingrid van Beek and Nicole Wiggins.
|8-11.Sep.13||First Global Conference on Research Integration and Implementation
This conference was conducted at The Australian National University, led by the person who is developing the new discipline of Research Integration and Implementation (I2S), my colleague Professor Gabriele Bammer. Much information about the conference is available here, including well over 200 fantastic digital posters many of which deal with inter-disciplinarity, mult-disciplinarity and trans-disciplinarity.
Colleagues and I have a poster there titled ‘Dialogue methods for synthesising disciplinary and stakeholder knowledge’, poster number 555.
Various presentations and other material from the conference have been posted at the website.
At the conference Professor Bammer’s new book Disciplining interdisciplinarity: Integration and Implementation Sciences for researching complex real-world problems, published by ANU E Press, was launched.
This is a very important initiative for people who feel that, to get substantial advances in dealing with complex social problems, we need to move out of disciplinary silos and work in a much more multi-disciplinary and trans-disciplinary manner. In this context, the trans-discipline of evaluation has an important role to play.
|06.May.13||New book Drug use in Australian society
This month Oxford University Press in Melbourne published the new text book Drug Use in Australian Society. It is described as follows:
[The book] provides students with the relevant concepts, theories and practices required to understand alcohol and other drug use in a local context. Part One introduces the history of drug use in Australian society, outlines theoretical perspectives and explores public policy responses to drug use. Part Two focus on drug policy in action by exploring responses to prevention, treatment, legal issues, regulation and policing. Drug Use in Australian Society offers students a framework for thinking about drug issues and policy that will inform their future practice.I wrote one of its chapters, titled ‘Laws and regulations’ (pp. 226-250). It deals with the following topics:
For more information on this text book please go to the publisher’s website.
|03.Apr.13||Seminar on policy evaluation
Today I presented an invited seminar at the Centre for Aboriginal Economic Policy Research at The Australian National University. Its title was ‘Assessing the quality of proposed Indigenous economic and social policies: a checklist methodology for evaluation’.
The presentation was well received, and a lively discussion session canvassed some of the challenges of evaluating government policies using an ex-ante policy evaluation strategy.
A podcast of the seminar is online.
|30.Jan.13||Strong public support for banning the sale of tobacco
In a Research Letter recently published in the leading journal Tobacco Control, researchers from the Centre for Behavioural Research in Cancer at the Cancer Council Victoria report on a Victorian survey of public opinion on banning tobacco sales. In their 2010 survey they found that 71% of Victorian adults and 58% of smokers responded that, ‘…at some time in the future, the sale of cigarettes from retail outlets should be made illegal. Overall, 53% of adults and 42% of smokers believed a ban should occur within the next 10 years, while a quarter of adults and 38% of smokers stated that cigarette sales should never be banned.’
Prohibiting the sale of tobacco products to the whole population, or to people born in the year 2000 or subsequently, is increasingly being discussed in tobacco control circles and more broadly. At the same time we are seeing moves in Australia to reduce the impact of prohibition with respect to some of the currently-illegal drugs, especially cannabis, and some overseas jurisdictions are legalising this drug. With a solid majority of the Australian community—smokers and non-smokers alike—stating that they support tobacco prohibition, this option warrants serious consideration by policy-makers. The challenge would be to design a prohibition regime that achieves sound public health outcomes while avoiding the many damaging consequences of the current cannabis prohibition model.
Reference: Haye, L, Wakefield, MA & Scollo, MM 2013, ‘Public opinion about ending the sale of tobacco in Australia’, Tobacco Control, online ahead of print.
|11.Jan.13|| Vale Carol Weiss
Carol Weiss died on 8 January.
Carol was one of the heroes in both the evaluation and public policy disciplines and professions.
Her seminal 1979 article on research utilisation ‘The many meanings of research utilization’, Public Administration Review, vol. 39, no. 5, pp. 426-31 is still cited in all serious discussions on that topic.
And her 1998 book Evaluation: methods for studying programs and policies, 2nd edn, Prentice Hall, Upper Saddle River, N.J. remains one of the best of its genre.
A brief obituary was published in the NY Times on 10 January, fuller ones will follow.
Vale Carol Weiss, mentor to so many of us in the evaluation and public policy professions and disciplines.
|Dec.12||Initiating the evaluation of the AOD peak bodies’ roles in building sector capacity
I have been contracted by the Australian state and territory AOD peak organisations to undertake a two-year evaluation of their roles and activities in building capacity in the NGO AOD sector.
This is an important initiative of the Peaks’ Capacity Building Network, and I look forward to working with its Evaluation Reference Group in finalising and implementing the evaluation plan.
|30.Oct.12|| Presentation in Darwin at the Policy Forum and Launch of AADANT
Today I had the pleasure of presenting an invited address to a Policy Forum convened in Darwin, NT, as part of the Launch of the Association of Alcohol and Other Drug Agencies NT (AADANT – pronounced to rhyme with ‘ardent’!).
The title of my presentation was Approaches and Principles for Alcohol and Other Drugs.
It was a most enjoyable occasion, made particularly so as now a peak body for the Alcohol, Tobacco and Other Drug Sector is operating in all eight of Australia’s states and territories.
|27.Sep.12|| Bridging the Research/Policy Divide in Asia course concludes
Today sees the end of the 2012 Bridging the Research/Policy Divide in Asia course that Professor Gabriele Bammer, Dr Mohomed Patel, Professor Romeo Gundran and I, with the support of other colleagues at the ANU, conducted. The course is supported by AusAID under its Australian Leadership Awards (ALA) program.
As with the 2009 and 2010 courses, it was an intensive six-week program. We had seven outstanding senior scientists participating as ALA Fellows; they came from Cambodia, China, Indonesia, Philippines and Thailand.
|14.Sep.12||Global State of Harm Reduction 2012
Today Harm Reduction International released its report The global state of harm reduction 2012: towards an integrated response, available online here. It is described as follows:
In 2008 Harm Reduction International released the Global State of Harm Reduction, a report that mapped responses to drug-related HIV and hepatitis C epidemics around the world for the first time. The report has since been published every two years.The Global State of Harm Reduction 2012 presents the major developments in harm reduction policy adoption and programme implementation that have occurred since 2010, enabling some assessment of global progress. It also explores several key issues for developing an integrated harm reduction response, such as building effective harm reduction services for women who inject drugs, access to harm reduction services by young people, drug use among men who have sex with men, global progress toward drug decriminalisation and sustainability of services in challenging environments.
This report, and other global state of harm reduction resources, are designed to provide reference tools for a wide range of audiences, such as international donor organisations, multilateral and bilateral agencies, civil society and non-governmental organisations, including organisations of people who use drugs, as well as researchers and the media.
|09.Sep.12||Illicit drugs: Plan A is not working. Where is Plan B?
Today Australia21 released the report on its second Roundtable on illicit drugs: Alternatives to prohibition: illicit drugs, how we can stop killing and criminalising young Australians, report of the second Australia21 Roundtable on Illicit Drugs held at the University of Melbourne on 6 July 2012. I was one of the report’s authors, along with Bob Douglas and Alex Wodak.
The report responds to the widespread acknowledgement that our current ways of dealing with illicit drugs (largely through criminal justice system measures, with far too little resources going to prevention, treatment and harm reduction) are failing to achieve their stated goals, and have diverse unintended but predictable adverse consequences. Given these facts, Australia21 is calling for an evidence-informed, multi-sectoral discussing in Australia of alternatives to prohibition. A national summit on illicit drug policy and a Productivity Commission inquiry have been suggested.
The report may be found at Australia21’s website.
|15.Aug.12||ACT prison NSP to go ahead
Today Ms Katy Gallagher MLA, ACT Chief Minister and Minister for Health, announced that the government will implement its policy to have an NSP at Canberra’s prison, the Alexander Maconochie Centre. The model will be a one-for-one syringe exchange that will occur at the prison health centre, commencing in 2013.
The public health community across Australia and internationally has applauded the ACT Government for this initiative as it reflects a substantial body of international evidence as to the effectiveness of such initiatives in reducing the transmission of blood-borne vital diseases, and reducing the risk of prison officers receiving needle-stick injuries.
Sadly, the prison officers’ union, the CPSU, continues to oppose the initiative.
Details are in The Strategic Framework for the Management of Blood Borne Viruses in the Alexander Maconochie Centre 2012-2014, draft 15 August 2012, online here.
|26.Jul.12||Key UN bodies endorse prison NSPs and other evidence-informed strategies to protect prisoner health
To quote a media release:
The 15 interventions are: (1) Information, education and communication, (2) HIV testing and counselling, (3) Treatment, care and support, (4) Prevention, diagnosis and treatment of tuberculosis, (5) Prevention of mother-to-child transmission of HIV, (6) Condom programmes, (7) Prevention and treatment of sexually transmitted infections, (8) Prevention of sexual violence, (9) Drug dependence treatment, (10) Needle and syringe programmes, (11) Vaccination, diagnosis and treatment of viral hepatitis, (12) Post-exposure prophylaxis, (13) Prevention of transmission through medical or dental services, (14) Prevention of transmission through tattooing, piercing and other forms of skin penetration. and (15) Protecting staff from occupational hazards.
|22.Jun.12||Ms Annie Madden inducted into the National Drug & Alcohol Honour Roll
The great news was announced tonight that Ms Annie Madden has been inducted into the National Drug & Alcohol Honour Roll. Annie is the long-serving Executive Officer of AIVL, the Australian Injecting & Illicit Drug Users League, the national peak body for the drug users’ movement.
This is a well-earned award, as Annie has made an outstanding contribution both to national and international drug policy, and to having the views, experiences and insights of drug users taken into account in the development, implementation and evaluation of drug programs.
A personal honour for Annie, and further acknowledgement of the important role that consumers play in Australia’s National Drug Strategy.
|30.May.12||Paper presented to the International Society for the Study of Drug Policy (ISSDP)
The ISSDP’s sixth annual conference was held at the end of May at Canterbury, UK, in a delightful setting in the grounds of the Canterbury Cathedral.
As always, there was a good range of excellent papers, and stimulating conversation about moves towards more rational, evidence-informed drug policy globally.
I presented a paper titled Assessing the Influence on Drug Policy of a Program of Drug Policy Research: the Australian Drug Policy Modelling Program (DPMP), 2006-2011. A copy is here.
|03.Apr.12||Launch of Australia21 report on reforming drug policy and law
Towards the end of 2011 I was invited by the Canberra-based independent think-tank, Australia21, to prepare a background paper for its high-level Roundtable, held at the University of Sydney on 30 January this year, which had the title ‘What are the likely costs and benefits of a change in Australia’s current policy on illicit drugs?’.
Subsequently, Australia21’s Director (Professor Bob Douglas) and I, with the support of Roundtable participants, prepared a report based on the Roundtable deliberations. Its title is ‘The prohibition of illicit drugs is killing and criminalising our children and we are all letting it happen: report of a high level Australia21 Roundtable’.
Both of these reports are available online at Australia21’s website.
The launch of the report at Parliament House, Canberra, on 3 April led to a huge amount of media coverage. Most of the media coverage supported Australia21’s call for a more evidence-informed, rational discussion in this nation about how we can make drug policy, drug law, and the implementation of drug policy and law, better ‘fit for purpose’, and at the same time reduce the many unintended, but predictable, adverse consequences of current approaches.
Australia21 is currently raising funds to engage in other activities that will keep the discussion going, engaging opinion leaders across the nation.
|24.Nov.11||David McDonald and Maggie Brady appointed Life Members of the Alcohol and other Drugs Council of Australia (ADCA)
Today, at ADCA’s AGM, my friend and colleague Dr Maggie Brady, and I, were appointed Life Members of ADCA.
|30.Aug.11||‘Union stymies jail needle bid’
A report in today’s Canberra Times newspaper with this heading indicates that the ACT Government is unlikely to proceed with the needle syringe exchange program at Canberra’s prison, despite the compelling public health arguments supporting this preventive intervention.
Ms Gallagher held a lengthy meeting yesterday with delegates from the prison guards’ union, the Community and Public Sector Union yesterday.
The union delegates left Ms Gallagher in no doubt their members would block the proposal at every step – even if the Government made a needle-and-syringe program a legal requirement.
Afterwards Ms Gallagher, who supports a program on public health grounds, said she now believed nothing would change the guards’ opposition to the plan.
”I’m not going to just steamroll something through because I have a public health opinion if I can’t actually operationalise it in a jail, and if the opposition within that jail is of such a strength that it would have a detrimental effect on staff and prisoners,” the Chief Minister said.
”I think it’s getting increasingly hard to find that middle ground … I think it creates some real difficulties. I’m not prepared to shut the door on it at this stage but I think the road’s a bit harder.”
|28.July.11||A needle syringe program in Canberra’s prison?
Since 2005 I have been involved in various ways in policy work relating to the provision of sterile injecting equipment in prisons (NSPs: needle and syringe programs). This has included preparing policy papers for Canberra-based agencies that have been advocating for this public health intervention in Canberra’s prison, the Alexander Maconochie Centre.
In response to recent reviews of the prison, including the Burnet Centre report discussed in an earlier entry in this blog, today the ACT Chief Minister and Minister for Health, Katy Gallagher MLA, released what is known as the “Moore Report”. The authors, Michael Moore and Melanie Walker from the Public Health Association of Australia, were commissioned to advise the ACT Government on the most suitable model or models for implementing a program of providing sterile injecting equipment in the prison.
Their report Balancing access and safety: meeting the challenge of blood-borne viruses in prison is available online.
It is a well drafted report, reflecting the scientific literature on the topic, consultations conducted with key stakeholders in the ACT, information gleaned through visiting overseas prisons that have NSPs, and the application of the public health “settings” approach.
The ACT Government has commenced a consultation period on the report which closes on 8 September 2011. This is an important public health initiative in which the ACT Government is leading the way. It is hoped that, if the Government decides to proceed to implement one or a blend of the models identified in a consultancy report, it will also commission an independent, external evaluation of the intervention, as this will be the first of its kind in Australia.
|24.Jun.11||David McDonald inducted into the National Drug & Alcohol Honour Roll
Today I had the honour of being inducted into the National Drug & Alcohol Honour Roll. This is a joint initiative of four of Australia’s leading organisations working in the drug & alcohol field, namely the Alcohol and Other Drug Council of Australia, the Ted Noffs Foundation, the Australian Drug Foundation and the Australian National Council on Drugs.
As explained at the Awards website:
I also congratulate Professor Robyn Richmond who was also inducted onto the Honour Roll, Judge Roger Dive who was awarded the Prime Minister’s Award for Excellence, and the other 2011 National Drug & Alcohol Award recipients.
|May.11||Participation in the Annual Conference of the International Society for the Study of Drug Policy
This year’s Conference, the Society’s fifth, was held in Utrecht, The Netherlands. It was another fine meeting, well organised by the Society’s managers with excellent support provided by staff of the Trimbos Institute.
I presented paper with the (somewhat clumsy!) title ‘Developing and trialling a checklist of criteria for assessing the excellence of drug strategy documentation through assessing the respective qualities of the new (2010/2011) national drug strategies of the USA, the United Kingdom and Australia’. A copy is here. Any feedback on its contents will be most welcome.
|07.Apr.11||Report on the evaluation of drug policies & services at the AMC released
Today the ACT Government released the independent evaluation of drug policies and services at Canberra’s prison, the Alexander Maconochie Centre (AMC). The authors are Dr Mark Stoové and Ms Amy Kirwan from the Burnet Institute, Melbourne.
Some time ago I contributed to designing the evaluation, so was naturally very interested to see how it would be implemented, and the outcomes.
It is comprehensive, and of high quality. It applied a mixed-methods research approach, with success. It documents the high proportions of prisoners who are users of illegal drugs, are current smokers and who were heavy drinkers prior to imprisonment. 29% reported injecting illegal drugs while at the AMC and 24% reported that the last time they had injected was in prison.
The evaluators…’identified multiple areas where policy was being implemented ineffectively or not at all. In particular, key principles like integration, collaboration, throughcare, case management, tailored interventions, equity and equivalence are not being implemented into drug-related services and practice at the AMC. Earlier sections of this report included numerous examples of how these principles have been inadequately realised in service provision’ (pp. 164-5) and provided many practical suggestions on how to improve the situation.
They expressed support for an NSP at the prison, though drew attention to the opposition to the proposal held by many (though not all) prison staff. In response to the findings and recommendations of both the Burnet and Hamburger reviews regarding the need for an NSP in the prison, the ACT Government has appointed Michael Moore, the CEO of the Public Health Association of Australia, to investigate ‘…potential [prison NSP] models, how they work within the prison setting, barriers to implementation and how to overcome them’.
The Burnet evaluation provides an excellent basis for improving drug policies and services at the AMC, producing better outcomes for the prisoners, staff and the broader community.
|05.Apr.11||Qualified support released for trialling an NSP in Canberra’s prison
Today the ACT Government released the consultancy report prepared by Mr Keith Hamburger AM & colleagues, a forensic review of Canberra’s prison: Knowledge Consulting 2011, Independent review of operations at the Alexander Maconochie Centre, ACT Corrective Services.
The report discusses the problem of blood-borne virus transmission in prisons, including the Alexander Maconochie Centre (AMC). It acknowledges that prison NSPs are effective ways of reducing the incidence of such transmission, thus improving the health of detainees. It also acknowledges that there have been no attacks on prison staff, using syringes, anywhere in the world where prison NSPs are operating.
The report does not proceed to recommend the development of an NSP trial for the AMC at present, instead concluding as follows:
Although the wording could have been better expressed, the sentiment here is sound: the ACT Government should initiate a careful examination of the range of available intervention approaches (many different prison NSP models have been documented and evaluated), and engage with all the stakeholders to decide on a model that would be viable in the AMC.
Although Mr Hamburger and his colleagues have not directly advocated for the establishment of a mutually-respectful process of dialogue between the parties around what would be needed to make a trial feasible, this is the take-home message from their report.
It is time for the ACT Government to take the initiative on the NSP trial, using the Hamburger report as the springboard for action.
|11.Mar.11||Release of Australia’s National Drug Strategy 2010-2015
Australia’s new National Drug Strategy (NDS), the sixth since the initiative began in 1985, was released today. It is available online.
The new Strategy has a number of strengths, particularly:
There are a number of missed opportunities, including the following:
Overall, my assessment is that this phase of the NDS, if implemented as per the document released today, will be an improvement on the previous one. Those responsible for developing it are to be commended for their achievements.
|Feb.11||‘Imprisonment and crime: can both be reduced?’
In June last year I made a blog entry here under the title ‘How to have less crime and less punishment’. This is the theme of this month’s issue of the journal Criminology & Public Policy. There you will find the key research essay, summarising current knowledge on the topic: Durlauf, SN & Nagin, DS 2011, ‘Imprisonment and crime: can both be reduced?’, Criminology & Public Policy, vol. 10, no. 1, pp. 13-54.
The article’s summary is as follows:
The authors, and other contributors to this issue of the journal, go on to discuss how Western nations can reduce crime and imprisonment simultaneously, a highly desirable outcome.
It is pleasing to see that one of the parties contesting the forthcoming NSW State election has, as part of its platform, reducing prison populations. Perhaps they, and other political parties, should also look closely at the other side of the coin: reducing crime at the same time.
|Jan.11||New article published on governments’ spending on drugs
This month I have had a paper published about priorities in governments’ spending on alcohol, tobacco and other drugs:
McDonald, D 2011, ‘Australian governments’ spending on preventing and responding to drug abuse should target the main sources of drug-related harm and the most cost-effective interventions’, Drug Alcohol Rev, vol. 30, no. 1, pp. 96-100.
A notable feature of Australian drug policy is the limited public and professional attention given to the financial costs of drug abuse and to the levels and patterns of government expenditures incurred in preventing and responding to this. Since 1991, Collins and Lapsley have published scholarly reports documenting the social costs of drug abuse in Australia and their reports also contain estimates of governments’ drug budgets: revenue and expenditures. They show that, in 2004–2005, Australian governments expended at least $5288 million on drug abuse, with 50% of the expenditure directed to preventing and dealing with alcohol-related problems, 45% to illicit drugs and just 5% to tobacco. Some 60% of the expenditure was directed at drug crime and 37% at health interventions. This pattern of resource allocation does not adequately reflect an evidence-informed policy orientation in that it largely fails to focus on the drug types that are the sources of the most harm (tobacco and alcohol rather than illicit drugs), and the sectors for which we have the strongest evidence of the cost-effectiveness of the available interventions (treatment and harm reduction rather than legislation and law enforcement).The 2010–2014 phase of Australia’s National Drug Strategy should include incremental changes to the resource allocation mix, and not simply maintain the historical resource allocation formulae.
|03.Dec.10||‘Dangerous Consumptions’ conference presentation
I presented an invited keynote address to the 8th Dangerous Consumptions conference which was held at The Australian National University on 2-3 December. My topic was ‘Roadside drug testing in Australia: why have we adopted, with such alacrity, this flawed policy?’. The abstract reads as follows:Each of Australia’s states and territories now has legislation empowering police to implement roadside drug testing. This initiative commenced in the State of Victoria in 2004, with a recent Victoria Police media release stating that ‘Victoria Police was the first jurisdiction to introduce random drug testing for motorise (sic) and is recognised as a world leader in this technology’. The initiative is implemented in all of Australia’s states and the Northern Territory, and is expected to commence in the ACT in the near future. I argue, however, that this policy is flawed. Its goals are unclear and the underlying logic model connecting the inputs, activities, outputs and outcomes does not stand up to scrutiny. A policy analysis based on the research evidence leads to the conclusion that roadside drug testing, as implemented in Australia, is not justified. Why, then, has this policy been adopted, across the nation, with such alacrity? Social science theory about how innovations get on the policy agenda and become converted into policy and practice helps answer this question, as does our understanding of the challenges, in public policy terms, involved in applying cost-effectiveness thinking in the context of drug harm reduction.My PowerPoint presentation is here.
|Nov-Dec.10||APSAD 2010 Annual Conference
The 2010 annual conference of the Australasian Professional Society on Alcohol and other Drugs (APSAD) was held in Canberra on 28 November to 1 December. I had the privilege of being the Conference Convenor.
The Conference was a great success, with over 550 registrants. Also participating were 14 students, 16 volunteers and 21 exhibitor representatives. Participants came from all of Australia’s states and territories, plus Finland, Japan, New Zealand, Singapore, Switzerland, UK and USA.
As conference convenor, I was brilliantly supported by the Scientific Program Committee, the national and local Organising Committees and by volunteers from Canberra-based ATOD agencies, both government and non-government. The staff of WALDRONSMITH Management, APSAD’s conference management company, did a superb job.
APSAD’s next annual conference will be held in Hobart in November 2010, see 2010 APSAD Annual Conference.
|21.Aug.10||ACT alcohol & other drugs sector Service Users’ Satisfaction Survey 2009
In November 2009 a Service Users’ Satisfaction Survey (or client satisfaction survey) was conducted in the ACT’s alcohol and other drug services. I designed the survey, analysed the data and prepared a report on the findings. The report is available here. It incorporates the validated eight item CSQ-8, i.e. the Client Satisfaction Survey (R).
The report’s executive summary concludes:
The 2009 ACT Alcohol & Other Drug Services Service User Satisfaction Survey has provided valuable information demonstrating the high overall level of service user satisfaction at the sector wide level, with significant variations on an agency-by-agency basis. The service user and agency variables that are associated with level of satisfaction have also been made explicit. This information provides opportunities for the participating agencies to review their strengths and build upon them, and to explore opportunities for service quality enhancement in areas where client satisfaction levels are relatively low.
The managers of the ACT’s alcohol and other drug services have resolved to conduct the survey again, 12 to 18 months after the first was conducted, to help assess changes in service user (client) satisfaction.
A copy of the final report of the project is here.
|18.Jul.10||‘How to have less crime and less punishment”
For me, the most important and interesting thing happening in contemporary criminological and criminal justice thinking, something of great relevance to the alcohol & other drug field, is scholarship and field trials of ‘coerced abstinence’. It is based on learning theory, and is summarised in terms of the strategy for reducing criminal recividism through having punishment for an offence that is swift, certain but not severe. Applying these principles is producing some remarkable positive outcomes, including assisting people with deeply entrenched illicit drug use and criminal behaviour to turn their lives around.To date, writing about the theory and practice in this area has been dispersed throughout the literature. Recently, however, it has been further developed, and consolidated, in a highly readable new book by Mark Kleiman: When brute force fails: how to have less crime and less punishment, published in 2009 by the Princeton University Press. The publisher’s blurb reads:Since the crime explosion of the 1960s, the prison population in the United States has multiplied fivefold, to one prisoner for every hundred adults–a rate unprecedented in American history and unmatched anywhere in the world. Even as the prisoner head count continues to rise, crime has stopped falling, and poor people and minorities still bear the brunt of both crime and punishment. When Brute Force Fails explains how we got into the current trap and how we can get out of it: to cut both crime and the prison population in half within a decade.
Mark Kleiman demonstrates that simply locking up more people for lengthier terms is no longer a workable crime-control strategy. But, says Kleiman, there has been a revolution–largely unnoticed by the press–in controlling crime by means other than brute-force incarceration: substituting swiftness and certainty of punishment for randomized severity, concentrating enforcement resources rather than dispersing them, communicating specific threats of punishment to specific offenders, and enforcing probation and parole conditions to make community corrections a genuine alternative to incarceration. As Kleiman shows, “zero tolerance” is nonsense: there are always more offenses than there is punishment capacity. But, it is possible–and essential–to create focused zero tolerance, by clearly specifying the rules and then delivering the promised sanctions every time the rules are broken.
Brute-force crime control has been a costly mistake, both socially and financially. Now that we know how to do better, it would be immoral not to put that knowledge to work.
The chapter ‘Drug policy for crime control’ is especially pertinent to readers of this blog.
|24.Jun.10||Third Annual ACT Alcohol, Tobacco and Other Drug Sector conference
One of the key events on Canberra’s Drug Action Week calendar was the Third Annual ACT Alcohol, Tobacco and Other Drug Sector conference, held on 24 June at the National Library of Australia. It is an activity of the ACT Alcohol, Tobacco and Other Drug Sector Project. I gave a keynote address on the topic ‘Thinking about burdens and harms’, introducing some key concepts underlying the Conference theme of ‘All Things Being Equal: Exploring the Burden of Harm’.
My PowerPoint presentation is here.
|May.10||‘A new dawn for drug policy in the USA’
This was the headline of an editorial in The Lancet on 28 May. It went on to say:
A key element of the new strategy, of great relevance to Australia and the recipients of US development assistance, is that the US policy now aims to both reduce drug use and its consequences. Although the US authorities still object to the term ‘harm reduction’, they have fully embraced the harm reduction concept, acknowledging its strong evidence base.
|Mar.10||Fourth Annual Conference of the International Society for the Study of Drug Policy
In March I participated in the Fourth Annual Conference of the International Society for the Study of Drug Policy which was held at the RAND Corporation, Santa Monica, California, USA. It was an outstanding conference, well organised and with many fine presentations and discussions.
I gave a presentation which drew together two areas of research & scholarship in which I am interested: (1) theories of how policy is made and (2) evaluating large, complex social interventions such as Australia’s National Drug Strategy. The paper was jointly authored by the 2009 NDS evaluation team:
This paper is concerned with applying theories of the policy process to evaluating national drug strategies. It explores the utility of theories, frameworks and models of policy processes for understanding the nature of the evaluation/policy nexus, and for maximising the likelihood that drug strategy evaluations will actually contribute to the development of sound social policy on drugs. It addresses scholars’ assertion that ‘There is nothing as practical as a good theory’. We argue that people evaluating policies and their implementation—especially large, complex social interventions such as national drug strategies—will benefit from applying a policy lens to their work. Doing so can provide an entry point to the evaluation, help set boundaries, and contribute to evaluation design.
We evaluated the 2004-2009 phase of Australia’s National Drug Strategy, and use that evaluation to explore policy theory as an aid to understanding drug policy processes. The policy theories that are available include the systems model, the stages heuristic, the rational/comprehensive model, the bounded rationality model, institutional rational choice frameworks, the incrementalism model, the punctuated equilibrium theory, the multiple streams model and the advocacy coalitions model. Each contributes to understanding Australia’s National Drug Strategy and has potential for contributing to its evaluation.
We conclude that policy theory provides, to evaluators of national drug strategies, insights into the policies that they are evaluating that would otherwise remain hidden. Furthermore, it potentially contributes to focusing the evaluation, interpreting the findings and enhancing evaluation utilisation.
Citation: McDonald, D, Cleary, G, Miller, M-E, Lai, SH-C, Siggins, I & Bush, R 2010, ‘Using theories of policy processes in evaluating national drug strategies: the case of the 2009 evaluation of Australia’s National Drug Strategy’, paper presented to Fourth Annual Conference of the International Society for the Study of Drug Policy, Santa Monica, California, USA, 15-16 March, online here.
|06.Feb.10||Further evidence supporting prison needle syringe programs
The two main arguments proffered in support of prison NSPs (needle syringe programs) are that (1) such programs have been demonstrated to reduce the incidence of blood-borne virus transmission – especially hepatitis C and HIV/AIDS – among people who inject illegal drugs and (2) that prison inmates are entitled to health care services (including health promotion services) at least as good as those provided to the community at large.New research has quantified the incidence of transmission of hepatitis C among inmates who inject drugs in NSW prisons. It has shown that the incidence is 34 per 100 person years, that is, one-third of injecting prisoner who enter prison free of hepatitis C become infected, in prison, within a year:Abstract. To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over; reported IDU; had been continuously imprisoned; had a documented negative HCV antibody test result in prison in the last 12 months; provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood sample was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.6-55.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly methamphetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required.
The authors argue for a trial, in an Australian prison, of the provision of sterile injecting equipment to inmates as a strategy for reducing the transmission of blood-borne viral disease, owing to the failure of existing interventions to achieve this important public health goal.
Dolan, K, Teutsch, S, Scheuer, N, Levy, M, Rawlinson, W, Kaldor, J, Lloyd, A & Haber, P 2010, ‘Incidence and risk for acute hepatitis C infection during imprisonment in Australia’, European Journal of Epidemiology, published online 19 January 2010.
|11.Dec.09||Inaugural ACT AOD Sector Awards
Today the first Annual ACT Alcohol & other Drug Sector (AOD) Awards were presented at the Legislative Assembly for the ACT by Ms Mary Porter AM, MLA.
The Inaugural Award for Excellence in Alcohol and other Drug Work was presented to Ms Clare Purcell from ACT Health’s Alcohol and Drug Program.
The Inaugural Lifetime Achievement Award was presented to Ms Dawn Bainbridge from the Alcohol and Drug Foundation of the ACT.
The Inaugural Outstanding Contributions Award was presented to me, David McDonald. The citation reads, in part:
This award recognises the contributions of an individual who has worked to prevent or reduce the psychological, physical, social and/or economic harms caused by alcohol and other drugs in the ACT. The individual need not have worked in direct service delivery or specifically in the AOD sector, but will have over a considerable period of time worked to improve the health and well-being of people affected alcohol and other drug issues.
|07.Dec.09||Publication of the report of the evaluation of Australia’s National Drug Strategy 2004-2009
Over the last couple of years a team of which I was a member, led by Dr Mel Miller of Siggins Miller Consultants, has been monitoring and evaluating the 2004-2009 phase of Australia’s National Drug Strategy. This project has been conducted under contract to the Australian Government Department of Health and Ageing.The final evaluation report was considered by the Ministerial Council on Drug Strategy in May this year and was published, online, last week. There it is described in the following terms: ‘This report evaluates the National Drug Strategy (NDS) as a policy framework, the outcomes of programs under the NDS, and the roles and workings of the advisory structures that inform development and implementation of the NDS. It also monitors performance of the NDS during the period 2006-2009’. The report has three components: Volume 1: findings and recommendations; Volume 2: case studies, literature reviews, and headline indicators; and Appendices.Concurrently with releasing the evaluation report, the managers of the National Drug Strategy have released a consultation paper for the next phase of the NDS which apparently will cover the six-year period 2010 to 2015. They state:
Australia’s National Drug Strategy 2004–2009 is in its final year of implementation. The Strategy has been evaluated by independent experts under the auspices of the Ministerial Council on Drug Strategy (MCDS).
The evaluation found that the Strategy and its three pillars of supply, demand and harm reduction are fundamentally sound and have been vital to the success of the Strategy in reducing the prevalence of, and harms from, drug use in Australia over a long period.
Nonetheless, significant harms from drug use continue to occur inAustralia and new trends are emerging. This Consultation Paper aims to identify emerging issues and seek input from expert stakeholders and the broader community on directions for the next phase of the Strategy 2010–2015.
The Paper has been prepared on behalf of the MCDS by the Intergovernmental Committee on Drugs National Drug Strategy Development Working Group. The MCDS invites feedback on the paper…
The MCDS will consider your feedback in response to this paper in developing a draft of the National Drug Strategy 2010-2015, which will be released for further consultation in the first half of 2010.
This approach to evaluation of the NDS, and widespread consultation as inputs to developing the next phase, has characterised the NDS’ development since it commenced in 1985.
|30.Nov.09||Launches of our new book: Research Integration Using Dialogue Methods
The new book Research Integration Using Dialogue Methods that I have co-authored with Professor Gabriele Bammer and Peter Deane (see 5 Sep 2009, below) was launched this month. The first launch occurred on 20 November at the Institute of Geography, University of Berne, Switzerland, where Gabriele gave a keynote address at the ‘Integration in Inter- and Transdisciplinary Research’ conference. The launch was conducted by Julie Thompson Klein, Professor of Humanities in the Interdisciplinary Studies Program at the College of Lifelong Learning, Wayne State University, Detroit USA.
The second launch was held on 26 November at the Co-op Bookshop at The Australian National University. It was conducted by Professor Ted Lefroy, Director of the Centre for Environment at the University of Tasmania, and a member of the Board of Land & Water Australia. Dr Michael Robinson, CEO of Land & Water Australia, chaired the launch.
The book is published by ANU E Press, and is available as a free download in pdf, html and mobile device formats. It can be read on the screen or downloaded as a whole, or in chapters. Printed copies can also be ordered from the publisher.
|02.Nov.09||APSAD conference presentation on the unintended consequences of drug policy
Today I gave a presentation to the APSAD National Conference which was held in Darwin, NT. The title was ‘Understanding the adverse unintended consequences of policies and interventions addressing drug availability and drug use’. Here is the abstract:Background
Despite some fine achievements in developing and implementing policies addressing psychoactive substances, too many interventions have produced unintended adverse consequences. Furthermore, too many of these were predictable. Two taxonomies of adverse unintended consequences in this field have recently been published, one by a senior United Nations official (Costa) and another by a leading international academic (Reuter). I suggest that this type of taxonomy can be useful in substance abuse policy analysis and in designing evaluations of drug policy and interventions.The study
The two taxonomies have been developed deductively. I will report on the findings of a study which assessed them using published case material: a grounded, inductive approach to taxonomy development. This will help clarify their validity and utility in substance abuse policy development, implementation and evaluation.
Citation: McDonald, D 2009, ‘Understanding the adverse unintended consequences of policies and interventions addressing drug availability and drug use’, Drug and Alcohol Review, vol. 28, no. Supp. 1, p. A43.
|05.Sep.09||Publication of a new book: Research Integration Using Dialogue Methods
Gabriele Bammer, Peter Deane and I have prepared this book. It was published online today by ANU E Press, and is available as a free download in both pdf or html forms. The book can be read on the screen or downloaded as a whole, or in chapters. Printed copies can also be ordered from the publisher.Book description:Research on real-world problems—like restoration of wetlands, the needs of the elderly, effective disaster response and the future of the airline industry—requires expert knowledge from a range of disciplines, as well as from stakeholders affected by the problem and those in a position to do something about it. This book charts new territory in taking a systematic approach to research integration using dialogue methods to bring together multiple perspectives. It links specific dialogue methods to particular research integration tasks.
Fourteen dialogue methods for research integration are classified into two groups:
1. Dialogue methods for understanding a problem broadly: integrating judgements
2. Dialogue methods for understanding particular aspects of a problem: integrating visions, world views, interests and values.
The methods are illustrated by case studies from four research areas: the environment, public health, security and technological innovation.
Recommended citation: McDonald, D, Bammer, G & Deane, P 2009, Research integration using dialogue methods, ANU E Press, Canberra.
|03.Sep.09||Conference paper presented: ‘Applying theories of policy processes to evaluation: the example of evaluating Australia’s National Drug Strategy’
Today, on behalf of the team that conducted the 2009 evaluation of Australia’s National Drug Strategy, I presented a paper at the Australasian Evaluation Society International Conference which was held in Canberra:
McDonald, D, Cleary, G, Miller, M-E, Lai, SH-C, Siggins, I & Bush, R 2009, ‘Applying theories of policy processes to evaluation: the example of evaluating Australia’s National Drug Strategy’.Abstract
This paper explores the utility of theories, frameworks and models of policy processes for understanding the nature of the evaluation/policy nexus, and for maximising the likelihood that evaluation processes and products will actually contribute to the development of sound social policy. We argue that people evaluating policies and their implementation—especially large, complex social interventions—will benefit from applying a policy lens to their work. Doing so can provide an entry point to the evaluation, help set boundaries, and contribute to evaluation design.
The policy theories that are available include the systems model, the stages heuristic, the rational/comprehensive model, the bounded rationality model, institutional rational choice frameworks, the incrementalism model, the multiple streams model and the advocacy coalitions model. Each can contribute to understanding Australia’s National Drug Strategy and potentially contribute to its evaluation.
We conclude that policy theory provides to evaluators insights into the policies that they are evaluating that would otherwise remain hidden. Furthermore, it potentially contributes to focusing the evaluation, interpreting the findings and enhancing evaluation utilisation.The paper is available online .
|20.Aug.09||Further evidence for the effectiveness of heroin maintenance for opioid dependent people who fail to respond to standard treatment
Carefully controlled trials in a number of European countries have demonstrated that opioid-dependent people who fail to benefit from methadone maintenance treatment do well when maintained on injectable diacetylmorphine (pharmaceutical-grade heroin). This finding has now been confirmed in the North American Opiate Medication Initiative (NAOMI) trial conducted in Canada by a group of Canadian and US researchers. The participants were people who engaged in long-term, treatment-refractory opioid use and had previously relapsed from methadone maintenance treatment. They were randomly assigned to receive oral methadone or injectable opioids, with most of the latter group receiving diacetylmorphine but a small number receiving hydromorphone. The provision of the injectable opioids was implemented on a double-blind basis, i.e., neither the participants nor the staff knew whether diacetylmorphine or hydromorphone was being as dispensed to them. The primary outcomes, assessed at 12 months, were retention in treatment or drug-free status and a reduction in illicit drug use or other illegal activity.The results were clear. The retention rate in treatment in the diacetylmorphine group was 88% compared with 54% in the oral methadone group. The reduction in rates of illicit drug use or other illegal activity was 67% in the diacetylmorphine group and 48% in the methadone group. The most common serious adverse events among those who received diacetylmorphine injections were overdoses (in 10 participants) and seizures (in 6). Since the diacetylmorphine and hydromorphone were self-administered at the treatment service, these adverse events were dealt with promptly and all participants recovered satisfactorily.Interestingly, the participants who received injectable opioids were not able to differentiate between diacetylmorphine and hydromorphone. (One implication of this is that further research is required to determine if maintenance on injectable hydromorphone produces outcomes as positive as those from maintenance on diacetylmorphine, among opioid dependent people who have not benefited from standard therapies.)
The researchers concluded that ‘Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available’.
Oviedo-Joekes, E, Brissette, S, Marsh, DC, Lauzon, P, Guh, D, Anis, A & Schechter, MT 2009, ‘Diacetylmorphine versus methadone for the treatment of opioid addiction’, New England Journal of Medicine, vol. 361, no. 8, pp. 777-86.
|Jun.09||Can the secondary exchange of sterile injecting equipment provide an opportunity for health promotion?
Secondary exchange of needles and syringes ‘refers to the giving or receiving of new sterile needles and syringes to/from another individual that were originally obtained from formal or “safe” sources. It can include trading, purchasing or selling of needles and syringes for money, drugs or other commodities or services; or it can simply involve the giving or receiving outright of needles and syringes’. Researchers from the National Centre for HIV Social Research, University of NSW, studied the extent, patterns and contexts of secondary exchange in south east Sydney, and examined whether secondary exchange is independently associated with blood borne viruses risk practices.
They found that secondary exchange ‘is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons’. They conclude that secondary exchange ‘is a practice that could be exploited to expand the reach of current needle distribution programs’ to reach people who inject illicit drugs who do not use formal distribution services.
Bryant, J & Hopwood, M 2008, ‘Secondary exchange of sterile injecting equipment in a high distribution environment: a mixed method analysis in south east Sydney, Australia’, International Journal of Drug Policy, vol. 20, no. 4, pp. 324-28.
|May.2009||Canberra’s syringe vending machines trial evaluation published
Some time ago I completed the evaluation of the trial of syringe vending machines in Canberra. A paper on the topic has now been published: McDonald, D 2009, ‘The evaluation of a trial of syringe vending machines in Canberra, Australia’, Int J Drug Policy, vol. 20, no. 4, pp. 336-9.Abstract:
BACKGROUND: Syringe vending machines (SVMs) have been trialled in Canberra, Australian Capital Territory, Australia, as an intervention aiming to increase the availability of sterile injecting equipment for use by IDUs. This study evaluated the 12-month trial.
METHODS: A utilisation-focused evaluation model, with both formative and summative components, was employed. Four SVMs were installed, each dispensing packs containing four 1mL syringes and associated injecting paraphernalia. The trial participants were the clients of the SVMs and other key informants. The core measurements used were the number of syringes dispensed in Canberra by SVMs and other outlets, SVM clients’ demographics and experiences of and attitudes towards SVMs, perceived impacts of SVMs on needle sharing, unsafe disposal of used syringes in the vicinity of SVMs, and community and stakeholder attitudes.
RESULTS: The trial was implemented successfully, with no adverse consequences identified. The SVMs appear to be serving both the usual clients of the other outlets for sterile injecting equipment (community pharmacies and the Needle Syringe Program outlets) and others who are reluctant to use such outlets or find them inconvenient. The out-of-business-hours provision of syringes through the SVMs was particularly welcomed by both SVM clients and other stakeholders. The continuing operation of the initial four SVMs is widely supported, and additional machines are requested by clients and others.
CONCLUSIONS: Owing to the success of the trial in terms of feasibility and outcomes for both IDUs and for the broader community, it is desirable that providing sterile injecting equipment through SVMs continues and be expanded as an integral component of harm reduction strategies.
|Feb.2009|| Drug driving article published
The issue of drug driving (so-called ‘random drug testing’ of drivers) continues to be of interest, with various Police Services expanding their endeavours in this area. As I have argued previously in this news blog, it appears that the intervention has been implemented without a sound evidence base as to its likely impacts on road safety. Furthermore, there is no sign of any evaluation of its impacts on road safety in Australia.This month has seen the publication of an article I wrote – an opinion piece or commentary: McDonald, D 2009, ‘The policy context of roadside drug testing’, Journal of the Australasian College of Road Safety, vol. 20, no. 1, pp. 37-43.Abstract
Roadside testing of oral fluids for a suite of illegal drugs has been taking place in Victoria since late 2004, is now operating in some form in all of Australia’s States and the Northern Territory. I suggest that the current roadside drug testing regimes have been introduced with insufficient rigour in the underlying policy analysis. The authorities state that it is a road safety initiative and not about punishing drivers for using illegal drugs, but this assertion can be challenged. The research evidence linking particular levels of drugs in the body and driving impairment is limited, no convincing evidence exists demonstrating that roadside drug testing improves traffic safety at the population level, the initiative fails to target some of the drugs the use of which has been demonstrated to be a traffic safety risk, the opportunity costs seem to have been ignored, and it may well fail the human rights test of proportionality.
The Journal issue is available online at http://www.acrs.org.au/journals/.
|24.Nov.08||Conference presentations on roadside drug testing and Australia’s National Drug Strategy
At the National Conference of the Australian Professional Society on Alcohol and other Drugs in Sydney I made two presentations. The first was a poster, co-authored with Dr Sally Hsueh-Chih Lai, titled Evaluating the 2004-2009 phase of Australia’s National Drug Strategy. A copy is here.
The second was a conference paper with the title Roadside drug testing: an example of a flawed policy analysis?. A copy of the Powerpoint presentation is here.
My theme was that roadside drug testing (also – incorrectly – called random drug testing) as implemented in most of Australia’s states and territories is based on a flawed policy analysis:
|07.Nov.08||Prevention is finally on the agenda!
In October the National Preventative Health Taskforce, which was appointed by the Commonwealth Government, released its first three discussion papers. The first, Australia: the healthiest country by 2020, deals with preventive health generally plus obesity, tobacco and alcohol. It was accompanied by three technical reports, separately covering obesity, alcohol (Preventing alcohol-related harm in Australia: a window of opportunity) and tobacco (Tobacco control in Australia: making smoking history).These reports highlight our failure to come to term with prevention, and to implement what we already know works.The discussion paper and technical reports are online at http://www.preventativehealth.org.au/ .
|22.Sep.08||Does tobacco health promotion increase social inequalities?
A long-standing criticism of health promotion as it is usually implemented is that it maintains and, indeed, increases health inequalities. This is because its benefits are more likely to be attained by people in higher socio-economic classes as they have the resources to engage in health-promoting activities. Pleasingly, a new study has demonstrated that population-level tobacco control interventions do not adversely impact on social inequalities in smoking. Specifically:
|25.Jun.08||Alcohol Policy in the ACT
Today I gave a presentation on the topic ‘Alcohol Policy in the ACT’ (ACT = Australian Capital Territory) at the First Annual ACT Alcohol & Other Drug Sector Conference which was conducted as part of Drug Action Week by the ACT Alcohol & Other Drug Sector Project, of which I am a team members. It was held at the National Library of Australia, and featured prominent national authorities and Canberra-based experts discussing various aspects of alcohol policy and interventions.
The Conference was very well-attended – a full house – and was judged by both organisers and participants to be a great success.
I noted the history of alcohol policy in Canberra, commencing with the period of prohibition, through to the present situation where the relatively free availability of alcohol, and the adverse consequences flowing from it, have led the ACT Government to undertake a review of the Liquor Act. (I have contributed to that Review.)
My presentation to the Conference is available online.
|06.Jun.08||Roadside Drug Testing in the ACT: a public forum
Today I participated in a Public Forum at the University of Canberra on the topic of drugs and driving or drug driving. Its focus was RDT: roadside drug testing or random drug testing. It was organised by the ACT Department of Territory and Municipal Services (TAMS) and hosted by the Head of Pharmacy at the University of Canberra, Professor Gabrielle Cooper. In its promotion of the event, TAMS described the Forum as follows.
The Forum will provide an opportunity for the public to hear from experts on the impact of drugs on driving, learn about random roadside drug testing practice in other parts of Australia, and gain insight into current research into drug driving.
The Forum will include presentations and general discussion by a panel comprising University of Canberra researchers, a NSW Police forensic pharmacologist, a member of the Victorian Police Traffic Drug and Alcohol Unit, the ACT Human Rights Commissioner, ACT Government Analytical Laboratory and a health-focussed social researcher.
I was the health-focussed social researcher referred to. My presentation was titled ‘The Policy Context of Drug Driving Countermeasures’ and sought to assess the degree to which the policy analysis underlying the proposed introduction of roadside drug testing in Canberra (and elsewhere) is based on a sound policy analysis, including the research evidence base and a program logic analysis. I conclude that it is not. My PowerPoint presentation is available here.
|May.08||Uncertainty and risk in the alcohol and other drugs sector
The alcohol and other drugs sector is full of uncertainty: we have gaps in knowledge about the extent of drug use and harms, and what to do about them. We don’t know what is the right balance between prevention, treatment and law enforcement or between demand reduction, supply reduction and harm reduction. We are uncertain about matching client to treatment, and about the impacts of social marketing.
In the past, the main approach to uncertainty has been to attempt the impossible, namely to eliminate it. However, new ways of thinking about and addressing uncertainty and risk are being developed. An important new book edited by Australian National university scholars with whom I am associated through our work on Research Integration describes and discusses these: Bammer, G & Smithson, M (eds) 2008, Uncertainty and risk: multidisciplinary perspectives, Earthscan, London. A strength of the book is how it considers the issues from diverse disciplinary and practice stances, including from the alcohol and other drugs sector in a chapter by Drug policy Modelling Program Director Associate Professor Alison Ritter intriguingly titled ‘Heroin : injected with uncertainty’. Details are available from the publisher’s web site.
|Apr.08||The effectiveness of peer education among people who inject illegal drugs
Australian readers might be be aware of the national hand-washing education campaign being conducted under the auspices of AIVL (the Australian Injecting & Illicit Drug Users League) using (among other things) ultra-violet light to demonstrate the extent and nature of contamination of the hands and injecting environments of people who inject illegal drugs. A USA study has investigated the effectiveness of this approach to peer education among people with hepatitis C, in a randomised controlled trial. They found that ‘Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months…and 6 months…a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending…Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy’. This provides further evidence of the effectiveness of peer education among people who use the currently-illegal drugs.
|Aug.08||Are needlestick injuries an important OH&S issue for the staff of correctional services?
With the imminent opening of the Alexander Maconochie Centre, Canberra’s new prison, it is timely that Australian researchers have published an assessment of the extent of needlestick injuries among correctional officers.
The study was conducted in two Australian states in 2006 using a self report questionnaire. Two-thirds of the 246 prison officers who completed the survey reported that they had found needles and syringes in their prison workplaces and 10% of them (7% of the total sample) had experienced at least one needlestick injury during their prison officer career. Most of these injuries occurred during searches.
Fortunately, serological testing for blood-borne viral infections following injury was common, but less than half the injured officers accessed support services.
The authors point out that ‘There have been no published reports of prison officers acquiring [blood-borne viral infections] via accidental needlestick injuries’ (p. 165) and that ‘A pragmatic, inexpensive intervention for reducing the risk of needlestick injuries is the introduction of needle and syringe programs (NSP) in prisons. Prisons in at least six countries, including Spain, Switzerland and Germany, offer sterile equipment to drug injecting inmates. Needles and syringes held by the inmate must be stored in a rigid container in a designated area of the inmate’s cell, reducing the risk that an officer may receive a needlestick injury’ (p. 167).
They concluded that ‘Needlestick injuries appear to be a relatively rare occurrence, but may be further reduced by improving search techniques and equipment and regulating needles and syringes in prisons’.
Larney, S & Dolan, K 2008, ‘An exploratory study of needlestick injuries among Australian prison officers’, Int J Prison Health, vol. 4, no. 3, pp. 164-8.
|14.Mar.08||How Fear and Stigma Inhibit Good Health Policy
Today I was the guest speaker at a packed Public Forum held at the Legislative Assembly for the Australian Capital Territory on the topic ‘How Fear and Stigma Inhibit Good Health Policy’. It was organised by the Community Coalition on Corrections and hosted by Mr Simon Corbell MLA, ACT Attorney-General.
This is the first of a series of Public Forums organised to discuss issues concerning the Alexander Maconochie Centre, Canberra’s new prison that will open later in the year. As requested, my focus was on how stigma and discrimination are linked to the spread of blood-borne viral diseases,especially hepatitis C, hepatitis B and HIV/AIDS, particularly within prisons.
My PowerPoint slides and the audio of the presentation are here.
|19.Feb.08||A February 2008 updated and expanded edition of the research paper The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, that I prepared for ACT Health’s Alcohol and Drug Policy Unit, is now online. It includes a new summary of trends, as well as additional indicators of harm.|
|09.Feb.08||Withdrawing from nicotine and other drugs, and the cannabis withdrawal syndrome
Clinicians have accepted for some years that a cannabis withdrawal syndrome exists, though the authorities who determine the disease taxonomies (such as the DSM and ICD systems) have been slower to acknowledge its reality. Researchers from the Johns Hopkins University School of Medicine in the USA have conducted a small study comparing the nature of withdrawal from cannabis and nicotine, both separately and concurrently, among heavy users of both drugs.They concluded that ‘Overall withdrawal severity associated with cannabis alone and tobacco alone was of a similar magnitude. Withdrawal during simultaneous cessation of both substances was more severe than for each substance alone, but these differences were of short duration and substantial individual differences were noted’ (p. 48).Also noteworthy is their reminder of how little we know about withdrawing from more than one drug at a time: ‘Interestingly, we could not locate another prospective study comparing withdrawal severity during cessation from one versus more than one drug simultaneously’ (p. 53).
Vandrey, RG, Budney, AJ, Hughes, JR & Liguori, A 2008, ‘A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances’, Drug and Alcohol Dependence, vol. 92, no. 1-3, pp. 48-54.
|02.Feb.08||Illicit drug policy: scoping the interventions and taxonomies
For some years I have been involved with the Australian national Drug Policy Modelling Project (DPMP). The Director of the DPMP, Assoc. Professor Alison Ritter and I have recently published an article in which we review the many taxonomies of (national) drug policies, and explore how the diverse interventions dealing with drug issues map to the taxonomies.Ritter, A & McDonald, D 2008, ‘Illicit drug policy: scoping the interventions and taxonomies’, Drugs: education, prevention and policy, vol. 5, no. 1, pp. 15-35.Illicit drug policy interventions cover treatment, law enforcement, prevention and harm reduction. This paper provides a comprehensive list across these sectors, of known drug policy interventions. One hundred and eight interventions were identified. With such a long and undifferentiated list of drug policy interventions, the ways in which these interventions are then coded and classified is also addressed. Ten different classification schemes are reviewed including summary information on the original sources and backgrounds to the schemes. The authors rated each of the policy interventions against the schemes. Those which proved useful in summarising illicit drug policy interventions included the four pillars approach, the UNODC classification, the demand, supply and harm reduction paradigm, the public health model and the policy instruments model. The list of 108 policy interventions will be of use to policy makers, researchers and practitioners in appreciating the array of drug policy options, and could be used in reviews of policy or practice. The classification schemes reveal the different ways in which drug policy interventions can be clustered and described to different audiences.
|07.Jan.08||How effective is drug treatment?
Controversy still exists about the effectiveness of standard treatments of opioid (including heroin) dependence. These important Australia treatment outcomes findings have just been published demonstrating the high levels of successful treatment outcomes seen in Australia: Teesson, M, Mills, K, Ross, J, Darke, S, Williamson, A & Havard, A 2008, ‘The impact of treatment on 3 years’ outcome for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)’, Addiction, vol. 103, no. 1, pp. 80-8.Aim: To examine the impact of treatment for heroin dependence on drug use, injection-related risk-taking, health problems, criminality and general physical and mental health over 3 years among heroin-dependent Australians.
Design: Longitudinal prospective cohort study.
Participants: A total of 615 heroin users enrolled in the Australian Treatment Outcome Study; 94.5% of the sample completed at least one follow-up interview over 36-month follow-up.
Findings: The proportion who reported using heroin in the preceding month continued to decrease significantly from baseline to 24-month follow-up (99% versus 35%), with this rate remaining stable to 36-month follow-up. The reduction in heroin use was accompanied by reductions in other drug use. There were also substantial reductions in risk-taking, crime, injection-related health problems and improvements in general physical and mental health. Positive outcomes were associated with more time in maintenance therapies and residential rehabilitation and fewer treatment episodes. Time spent in detoxification was not associated with positive outcomes. Major depression was also associated consistently with poorer outcome.
Conclusions: At 3 years, there were impressive reductions in drug use, criminality, psychopathology and injection-related health problems following treatment exposure.
|07.Nov.07||Is childhood socio-economic status associated with adult alcohol use?
An important policy issue in this era of increasing acknowledgement of the social determinants of problematic drug use is the link between childhood socio-economic status and patterns of alcohol use in later life. A systematic review of evidence on this link was recently conducted by British researchers. A core finding is that we do not have sufficient quality data upon which to draw definitive, or even strongly indicative, findings:’Nineteen relevant articles were identified…There was little consistent evidence to support an association between lower childhood SES and later (mis)use of alcohol….We found little robust evidence to support the assumption that childhood disadvantage is associated with later alcohol use/abuse. Given the importance of this issue in terms of policy, the lack of evidence is surprising and emphasizes the need for further research in order to inform future policies and public health messages.’Wiles, NJ, Lingford-Hughes, A, Daniel, J, Hickman, M, Farrell, M, Macleod, J, Haynes, JC, Skapinakis, P, Araya, R & Lewis, G 2007, ‘Socio-economic status in childhood and later alcohol use: a systematic review’, Addiction, vol. 102, no. 10, pp. 1546-63.
|15.Oct.07||Tobacco harm reduction: isn’t it time we got serious about this?
An irony of Australia’s National Drug Strategy, since its inception, has been the embracing of harm reduction with regard to alcohol and the illegal drugs, but not with regard to the greatest killer of all, tobacco. This was the subject of an editorial in a recent issue of the International Journal of Drug Policy. The editorialists canvassed the issues, discussed what they see as the public health profession’s denial of the positive roles of tobacco harm reduction, and concluded:‘We can reduce tobacco related death and disease far more rapidly than we can reasonably expect to reduce nicotine use by focusing on the fact that people smoke for the nicotine but die from the smoke. Applying harm reduction principles to public health policies on tobacco/nicotine is more than simply a rational and humane policy. It is more than a pragmatic response to a market that is, anyway, already in the process of undergoing significant changes. It has the potential to lead to one of the greatest public health breakthroughs in human history by fundamentally changing the forecast of a billion cigarette-caused deaths this century’ (p. 74).Source: Sweanor, D, Alcabes, P & Drucker, E 2007, ‘Tobacco harm reduction: how rational public policy could transform a pandemic’, International Journal of Drug Policy, vol. 18, no. 2, pp. 70-4.
|07.Aug.07||Evaluation of the National Drug Strategy: the process
I am a member of a team of researchers undertaking the evaluation of Australia’s National Drug Strategy (NDS). The evaluation has been commissioned by the Commonwealth Department of Health and Ageing with the endorsement of the Ministerial Council on Drug Strategy.
On 7 August Dr Sally Lai and i, on behalf of the evaluation team, gave a presentation to the Australasian Evaluation Society International Conference, describing and discussing the processes involved. The central challenges are defining the evaluand (the scope of the National Drug Strategy and developing an evaluation strategy that deals explicitly with the NDS as a complex intervention. Our paper is available online: McDonald, D, Lai, SH-C, Miller, M-E, Hall, W, Cleary, G, Bush, R, Fowler, G, O’Connor, P, Sumner-Armstrong, C, Siggins, I, Bolton, M, Siggins, E & Price, K 2007, ‘Evaluating major national strategies in human services: challenges and possibilities – the case of Australia’s National Drug Strategy 2004-2009’, paper presented to Australasian Evaluation Society International Conference 2007, Melbourne 5-7 August 2007 .
|Aug.07||Cannabis in Papua New Guinea
Some years ago I undertook a Rapid Situation Assessment of drugs, drug use, drug abuse and responses to these in PNG. This review paper is an off-shoot of that study. Although the issue of the journal is dated 2004, it was only published this year.McDonald, D 2004, ‘Cannabis in Papua New Guinea’, Pacific Health Dialog, vol. 11, no. 1, pp. 96-101.This review covers published information on psychoactive drugs, particularly cannabis, in Papua New Guinea. Legal drugs are mentioned to place the illegal drugs into a broader public health context. Although a number of psychoactive drugs were used traditionally (and are used now), cannabis is the only illicit drug for which prevalence of use is currently not negligible. Very little epidemiology research on cannabis use and its individual and public health sequelae has been conducted, although a fuller criminology literature on the topic exists. The published cannabis use prevalence studies are limited in scope, and the most-cited one is of questionable accuracy. The complex interactions between the health of individuals and their social environments are highlighted by the destructive impacts that cannabis cultivation, trafficking and use are having in contemporary PNG.
|26.Dec.06||Does alcohol consumption confer health benefits?
Whether or not consuming alcohol in small quantities has a protective effect for coronary heart disease, and perhaps other health conditions, has long been of interest to epidemiologists and clinicians, with most studies supporting a protective effect for coronary heart disease. This has been confirmed in a new meta-analysis published this month. The study also concludes that ‘Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women’: Di Castelnuovo, A, Costanzo, S, Bagnardi, V, Donati, MB, Iacoviello, L & de Gaetano, G 2006, ‘Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies’, Archives of Internal Medicine, vol. 166, no. 22, pp. 2437-45, here. This review has already had an impact with clinicians.In contrast, however, is the study published in April 2006 which presents reasonably convincing evidence that many of the studies that show the protective effects of alcohol consumption suffer from a systematic bias in the way they classify drinkers and abstainers: Fillmore, KM, Kerr, WC, Stockwell, T, Chikritzhs, T & Bostrom, A 2006, ‘Moderate alcohol use and reduced mortality risk: systematic error in prospective studies, Addiction Research and Theory, vol. 14, no. 2, pp. 101-32, here.It will be interesting to see how this body of evidence evolves.
|16.Nov.06||I presented a paper Drugs, money and government: estimating ACT Government expenditures on preventing and responding to drug abuse at the ACT Biennial Public Health Forum 2006. The presentation was also based on the published paper listed below at 22.Mar.06.|
|07.Nov.06||I presented a paper ‘Estimating ACT Government expenditure on preventing and responding to drug abuse at the APSAD National Conference: Drugs: Meeting New Challenges, in Cairns, Qld. The presentation was based on the published paper listed below at 22.Mar.06.|
|21.Sep.06||Canberra NGOs’ roles in addressing alcohol and other drugs in correctional settings
The NGOs working in the substance abuse and related fields in Canberra are concerned that the programs covering this area to be introduced to Canberra’s new prison, the Alexander Maconochie Centre (currently under construction), are being developed without their involvement.Accordingly, through Directions ACT, they commissioned me to prepare a background paper to assist them in scoping and focusing on the issues, and to prepare for consultations with the ACT Government and ACT Corrective Services.The report is available online.
|05.Sep.06||I presented a paper at the International Evaluation Conference in Darwin, NT, on the topic Linking policy analysis and program evaluation: the Canberra syringe vending machines trial. It is available online.|
|14.Aug.06||Launch of Drug Policy Modelling Program Stage 2: Seminar ‘Strategic approaches to illicit drug policy: Findings from the first stage of the Drug Policy Modelling Program’
This was an important occasion for illicit drugs policy both nationally and globally. Members of the Drug Policy Modelling Program (DPMP) research team, Program Reference Group members and Technical Advisors, along with a large crowd of other AOD people, participated in the Launch at the University of NSW, Sydney. It was chaired by Professor Margaret Hamilton who established the program – she now describes herself as the Ambassador for the DPMP.I gave a presentation on a DPMP study that I conducted with Assoc Prof Alison Ritter, the DPMP Director, titled ‘Scoping drug policy interventions and taxonomies’, based on DPMP Monograph no. 2: Drug policy interventions: a comprehensive list and a review of classification schemes.Mr Andrew Brookes, Executive Officer of the Colonial Foundation Trust, who are funding the DPMP, formally launched Stage 2. Professor Hamilton and Associate Professor Ritter expressed the research team’s thanks to Colonial Foundation Trust for its generosity and congratulated it on its far-sightedness in supporting what we believe will further develop into a body of research that will make an important contribution to improving illicit drug policy and policy responses.
|Jul.06||Syringe Vending Machine Trial: preliminary findings
The third progress report on Canberra’s trial of syringe vending machines, along with the preliminary findings of the 12 month trial, have now been publicly released.Overall, the trial has gone well. Here are some highlights:
* The mean monthly number of Fitpacks sold in the first five months was 736 and in the following six months 1,082
* The syringe vending machines’ sales composed approximately 8.5% of all syringes sold or otherwise distributed over the 11 months through the various types of Canberra outlets
* Some 575 kg of waste has been placed in the sharps disposal bins adjacent to the machines over the trial period to date
* The trial commenced and has operated over its first 11 months with virtually no adverse comments from members of the public or from opinion leaders. The syringe vending machines seem to have been accepted by the Canberra community as a normal part of the ACT’s community health services.The report is available online.
|Jun.06||Innovative drug policies in the Scottish criminal justice system
While in Scotland this month I was able to make some observations about the criminal justice system’s responses to drugs. The Scots are innovative in this area, and are commended for their down-to-earth, realistic harm reduction approaches.Apparently many Scottish police agencies, and at least one prison, offer sterile injecting equipment to detainees upon release from custody, acknowledging that some of them will inject illegal drugs soon after release, and that the risks in doing so will be reduced if they have sterile equipment. A description of the Lothian and Borders Police activities in this area is online. This is a press release that begins: ‘Lothian and Borders Police are piloting a needle exchange scheme for prisoners in a bid to reduce health risks to police staff and reduce harm to drug users’.The Scottish Prison Service is investigating policy options for improved services for its drug-using prisoners, and is substantially increasing the treatment and rehabilitation services for them.
Congratulations are due to the Scottish police and corrections agencies for developing and implementing realistic, evidence-based policies on drugs.
|02.May.06||Profiling the alcohol and other drug workforce
With excellent co-operation from the Australian Capital Territory alcohol and other drugs agencies, I conducted an online survey of the ACT AOD workforce. The report of the study, ‘A profile of the Australian Capital Territory Alcohol and Other Drug Workforce, April 2006’, is online. All 12 ACT agencies participated; the estimated response rate was 66%, a high enough figure to obtain valid results.
|11.Apr.06||Peer education resources and presentation
The Melbourne-based Alcohol and Drug Foundation, through its Centre for Youth Drug Studies, has this year focussed on peer education as an intervention concerning both licit and illicit drugs. It has produced an excellent set of resource materials on the topic; these are available online. I provided a guest editorial ‘Peer education: “popular but not proven?”’ for their publication DrugInfo: Newsletter of the Australian Drug Foundation’s Prevention Clearinghouse, vol. 4, no. 3, available online at the same site.On 11 April they ran a one-day DrugInfo Seminar: ‘Peer Education as a Drug Prevention Strategy: What Works?.’ I made an presentation with the title ‘Evaluating peer education: whose values and which “gold standard”?’ and a summary of this, along with the other presentations, is also available online.In 2005 I was commissioned to prepare a literature review on school-based peer education: Alcohol and other drug peer education in schools: A review for the ACT Alcohol, Tobacco and Other Drug Strategy Evaluation Group. It is available online.
|Apr.06||The extent and nature of drug use in the Australian Capital Territory
So far this year I have completed two consultancies for ACT Health in this area. The first was a report titled Sources of Published Data on Alcohol, Tobacco and Other Drugs in the Australian Capital Territory, 2nd edition, which was followed-up by The Extent and Nature of Alcohol, Tobacco and Other Drug Use, and Related Harms, in the Australian Capital Territory. These papers were produced as support for the policy activity of the ACT Alcohol, Tobacco and Other Drugs Strategy Implementation and Evaluation Group. Copies are available from the author.
|22.Mar.06||How much do governments spend on drug abuse?
A particularly interesting consultancy assignment addressing this question was also completed this month for ACT Health. Its report, Australian Capital Territory Government Expenditure on Preventing and Responding to Drug Abuse, 2004-05, reveals that the Government spent at least AU$85 million that year in this area, which is some 3.2% of the total ACT Government budget for the year.Approximately 77% of this went was expended on the criminal justice system with most of the balance being hospital expenditures on drug abuse and the costs of operating the government and non-government AOD agencies. The largest single expenditure area was ACT Policing, composing some 48% of the total.The paper is available online.
An important study has recently been published on the impacts of alcohol advertising on consumption by young people. Its significance is that it is the first longitudinal study on the topic and provides powerful evidence of the relationship between alcohol advertising and drinking. It parallels the evidence for the relationship between tobacco advertising and smoking among youth.The study is Snyder, LB, Milici, FF, Slater, M, Sun, H & Strizhakova, Y 2006, ‘Effects of alcohol advertising exposure on drinking among youth’, Archives of Pediatrics and Adolescent Medicine, vol. 160, no. 1, pp. 18-24.The authors state: ‘The results of the present large-scale national longitudinal study provide evidence that the amount of advertising expenditures in 15- to 26-year-olds’ media environment and the amount of advertising recalled related to greater youth drinking’ (p. 22).
|02.Dec.05||Australian Parliamentary Group for Drug Law Reform National Meeting presentation
Today I participated in a National Meeting of the Australian Parliamentary Group for Drug Law Reform, held at Parliament House, Canberra. The National Convenor of the Parliamentary Group, Hon. Duncan Kerr SC, MP, chaired the meeting. The presenters were
# Rev Harry Herbert: ‘Medically Supervised Injecting Centre’
# Hon Dr Mal Washer MP: ‘Zero tolerance: a practitioner’s point of view’
# Dr Andrew Byrne
# David McDonald: ‘At the frontier of drug harm reduction: prisoners’ rights to health & safety’In my presentation I discussed the rights of prisoners to health and safety, emphasising how the United Nations General Assembly’s 1990 resolution on the Basic Principles for the Treatment of Prisoners and the Australian Corrective Services Ministers’ Conference’s 2004 Standard Guidelines for Corrections in Australia both state that prison inmates are entitled to a quality of health care – preventive and curative – of a standard at least as high as that found in the community.I indicated that all Australian corrective services are in breach of this principle in failing to provide an evidence-based preventive health service, namely needle syringe exchange programs (prison NSPs), in their institutions.
My PowerPoint presentation is online, as is my background paper The proposed needle syringe program at the Alexander Maconochie Centre, Canberra’s new prison; an information paper on the evidence underlying the proposal .
|30.Nov.05||Publication of drug policy research reports
I have been working for some years as a member of a multi-disciplinary, multi-centre research collaboration called the Drug Policy Modelling Project. It is based at Turning Point Alcohol & Drug Centre in Melbourne where the Project is headed by Dr Alison Ritter.With colleagues Dr Gabriele Bammer and Ms Gabrielle Breen, I investigated aspects of illicit drugs policy. The results of the study may be downloaded, in summary form, from the link mentioned above – see Bulletin no. 3, Drug policy – mapping structures and enhancing processes.With Dr Alison Ritter I also investigated the diverse taxonomies of drug policy responses; see Bulletin No. 5: Drug policy response schema.
Full reports on the study have been published and are available online. They include two that I have co-authored: Ritter, A & McDonald, D 2005, Drug policy interventions: a comprehensive list and a review of classification schemes, Drug Policy Modelling Project Monograph Series no. 2, and McDonald, D, Bammer, G & Breen, G 2005, Australian illicit drugs policy: mapping structures and processes, Drug Policy Modelling Project Monograph Series no. 4.
|23.Nov.05||Completion of a project for Land & Water Australia
This week we concluded a consultancy undertaken for the Social and Institutional Research Program of Land & Water Australia. Dr Gabriele Bammer of the National Centre for Epidemiology and Population Health at The Australian National University and I have been working with LWA staff and consultants to establish a Social and Institutional Advisory Function. Its purpose is to assist LWA people to gain access to sources of expertise on the social and institutional aspects of their work, and to incorporate it with the biophysical science inputs to natural resource management.
|15.Nov.05||Prison NSP proposed for Canberra
The Australian Capital Territory Minister for Health, Simon Corbell MLA, has announced that he will be proposing to his Cabinet colleagues that the new Canberra prison have a needle syringe program (NSP) as part of its comprehensive health plan.
|14.Nov.05||Prison needle syringe program proposal
Today a Public Forum was held in Canberra addressing the difficult topic of providing sterile injecting equipment to prisoners, i.e. operating a prison needle syringe program (NSP) (or needle exchange program NEP) in prisons. The impetus for this Forum was the impending decisions on the health services to be provided in the new Canberra prison, the Alexander Maconochie Centre, which is expected to open some time next year.The Forum was an initiative of Nicole Wiggins, the Manager of CAHMA, the Canberra Alliance for Harm Minimisation and Advocacy. It was hosted by Dr Deb Foskey, MLA.As one would expect, there was some difference of opinion on the desirability and feasibility of having a NSP in our new prison, with people from the public health community unanimously in support of it and those from the corrections area holding serious reservations.
As is commonplace in debates on illicit drugs, those advocating for the NSP in the prison presented the results of many high quality evaluation studies showing that these interventions are highly effective, without adverse unintended consequences. On the other hand, the conservative elements opposing the prison NSP proposal presented no research evidence at all supporting their position, simply stating that they are ‘not convinced’ by the evidence.
This is a classic case study of the challenges that we face in public health in converting scientific evidence into policy and practice.
I have an annotated bibliography of the key documents on this topic, many of which are available on-line. Please contact me if you would like a copy.
The most up-to-date and comprehensive source at present is Lines, R, Jürgens, R, Betteridge, G, Stöver, H, Laticevschi, D & Nelles, J 2004, Prison needle exchange: lessons from a comprehensive review of international evidence and experience, Canadian HIV/AIDS Legal Network, Montréal, Québec.
Also see their article in the excellent new International Journal of Prisoner Health: Lines, R, Jürgens, R, Betteridge, G & Stöver, H 2005, ‘Taking action to reduce injecting drug-related harms in prisons: the evidence of effectiveness of prison needle exchange in six countries’, International Journal of Prisoner Health, vol. 1, no. 1, pp. 49-64. This article is currently available online in full text, without charge, here. You need to register to get it.
|7-9.Nov.05||Australian Professional Society on Alcohol and Drugs (APSAD) Conference
Over the period 7-9 November I participated in the annual national conference of the Australian Professional Society on Alcohol and Drugs (APSAD) held in Melbourne.This conference is said to be the worlds largest annual conference in the alcohol, tobacco and other drugs field after that of the American Association for the Treatment of Opioid Dependence (AATOD), and certainly the most diverse.I gave two oral presentations and one poster presentation. The abstracts follow.
School-based peer drug education: a policy analysis
The evaluation of the AIVL National Hepatitis C Education Program (poster)
Please contact me if you would like more information on any of these presentations.
|2005||Project reports that I completed earlier in 2005 include:|