News & Events

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.

MEDIA RELEASE
An independent report produced by David McDonald of Social Research and Evaluation has evaluated the capacity building work undertaken by the Australian state and territory alcohol and other drugs (AOD) peak bodies.

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.

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:
Anna Olsen, David McDonald, Simon Lenton & Paul Dietze 2015, Independent evaluation of the ‘Implementing Expanded Naloxone Availability in the ACT (I-ENAACT)’ Program, 2011-2014; final report, Centre for Research Excellence into Injecting Drug Use (CREIDU), Melbourne, online.

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.

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!

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.

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:
Issues: Widespread agreement exists in the alcohol and other drugs (AOD) sector about the importance of capacity building (CB), but it is an elusive concept. CB is probably best thought of as a strategy rather than as an activity or an outcome. The national AOD Peaks Capacity Building Network (PCBN) is exploring the nature of CB in our field, making explicit what it looks like and the kinds of outcomes it produces.
Approach: The PCBN has developed a working definition of CB, clarified the key components of a national AOD CB strategy, gathered data on CB activities and has initiated an evaluation of the strategy.
Key Findings: The PCBN has adopted as its definition of CB “A strategy that improves the ability of AOD workers, services and/or the broader AOD system to achieve better AOD health and social outcomes”. The sub-strategies identified are building sustainable link-ages and strategic partnerships, assisting AOD services to undertake service improvement, identifying and facilitating training opportunities, and developing and promoting information and resources.
Implications for Practice or Policy: This initiative is producing new information that informs policy-making on the targeting of scarce CB resources, and improves the delivery of CB activities.
Implications for Translational Research: Translational research has now entered the era known asT3 research with its emphasis upon translation to practice within a systems context, rather than simply translation from academe to the clinic. We argue that this should be the key focus of contemporary CB work: using research-based knowledge to strengthen people, groups, organisations and systems in the AOD field.
Conclusion: The PCBN is demonstrating what CB looks like in our sector and how, when implemented well, it contributes to valued system, organisational and service user outcomes.

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:
In my statement, I laid out what we call our four pillars as to how we believe the international community should proceed on drug policy. First, the – respect the integrity of the existing UN Drug Control Conventions. Second, accept flexible interpretation of those conventions. The first of them was drafted and enacted in 1961. Things have changed since 1961. We must have enough flexibility to allow us to incorporate those changes into our policies. Third, to tolerate different national drug policies, to accept the fact that some countries will have very strict drug approaches; other countries will legalize entire categories of drugs. All these countries must work together in the international community. We must have some tolerance for those differing policies. And our fourth pillar is agreement and consensus that whatever our approach and policy may be on legalization, decriminalization, de-penalization, we all agree to combat and resist the criminal organizations – not those who buy, consume, but those who market and traffic the product for economic gain. Respect the conventions; flexible interpretation; tolerance for national polices; criminal organizations – that is our mantra. [unquote]

The full statement is online here.

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:
Diversion has become one of the most utilised policy interventions in Australian government responses to drug users. The irony is that many key questions about optimal system design remain unknown: What ought ‘best practice’ diversion involve? And how can Governments improve the operation and outcomes of diversion programs?

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.

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:
Issue: Since the mid 1990s there have been calls to make naloxone, a prescription–only medicine in many countries, available to heroin and other opioid users, their peers and family members to prevent overdose deaths.
Context: In Australia there were calls for a trial of peer naloxone in 2000, yet at the end of that year, heroin availability and harm rapidly declined and a trial did not proceed. In other countries, a number of peer naloxone programs have been successfully implemented. Although a controlled trial had not been conducted, evidence of program implementation demonstrated that trained injecting drug using peers, and others, could successfully administer naloxone to reverse heroin overdose, with few, if any, adverse effects.
Approach: In 2009 Australian drug researchers advocated the broader availability of naloxone for peer administration in cases of opioid overdose. Industrious local advocacy and program development work by a number of stakeholders, notably by the Canberra Alliance for Harm Minimisation and Advocacy (CAHMA), a drug user organisation, contributed to the rollout of Australia’s first prescription naloxone program in the Australian Capital Territory (ACT). Over the subsequent 18mths prescription naloxone programs were commenced in four other Australian states.
Implications: The development of Australia’s first take-home naloxone program in the ACT has been an ‘ice-breaker’ for development of other Australian programs. Issues to be addressed to facilitate future scale-up of naloxone programs concern: scheduling and cost; legal protections for lay administration; prescribing as a barrier to scale-up; intranasal administration; worker administration; and collaboration between key stakeholders.

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

• • The representation of drug driving as a road safety initiative compared with one focusing on prosecuting drug users for driving
  • The assumptions underpinning roadside drug testing in the ACT and other Australian jurisdictions
  • How this representation of the drug driving problem has come about
  • What is left unproblematic in this representation of the drug driving problem
  • In what ways can the problem be thought about differently
  • The effects of the produced by this representation of the problem, and
  • How this representation of the problem could be questioned, disrupted and/or replaced.

A copy of my presentation is here.

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.

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.

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:

1. Tobacco harm reduction is part of the solution, not part of the problem.
2. Tobacco harm reduction policies should be evidence-based and proportionate to risk, and give due weight to the significant reductions in risk that are achieved when a smoker switches to a low risk nicotine product.
3. On a precautionary basis, regulators should avoid support for measures that could have the perverse effect of prolonging cigarette consumption.
4. Targets and indicators for reduction of tobacco consumption should be aligned with the ultimate goal of reducing disease and premature death, not nicotine use per se, and therefore focus primarily on reducing smoking.
5. Tobacco harm reduction is strongly consistent with good public health policy and practice and it would be unethical and harmful to inhibit the option to switch to tobacco harm reduction products.
6. It is counter-productive to ban the advertising of e-cigarettes and other low risk alternative to smoking.
7. It is inappropriate to apply legislation designed to protect bystanders or workers from tobacco smoke to vapour products.
8. The tax regime for nicotine products should reflect risk and be organised to create incentives for users to switch from smoking to low risk harm reduction products.
9. WHO and national governments should take a dispassionate view of scientific arguments, and not accept or promote flawed media or activist misinterpretations of data.
10. WHO and parties to the FCTC need credible objective scientific and policy assessments with an international perspective.

Details are online here.

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:
Myth 1. It is the young, inexperienced user who overdoses
Myth 2. It is variation in the purity of illicit opioids that is the major cause of overdose
Myth 3. It is the opioid that is crucial in overdose, not other drugs
Myth 4. Impurities in illicit opioids are the major cause of overdose.

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’.

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.

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.

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.

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.

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:

• Introduction
• What do we mean when we say that drugs are ‘legal’ and ‘licit’ or ‘illegal’ and ‘illicit’?
• Why do we have laws that criminalise the use of some psychoactive substances but not others?
• How do governments control drugs?
• Implementing drug laws
• Understanding statistics on drug law enforcement
• Criminal penalties and behaviour change: the importance of drug law enforcement
• The drug law reform movement
• Alternatives to total prohibition
• Policy processes in developing and reviewing drug laws
• Current issues that could be informed by further research.

For more information on this text book please go to the publisher’s website.

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.

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.

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.

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.

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.

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.

Information about the course is available here, and information about the Fellows and their work in bridging the research/policy divide is here.

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.

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.

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.

To quote a media release:
26 July 2012 – On the margins of the Washington XIX International AIDS Conference, [the United Nations Office on Drugs and Crime (UNODC)]…launched a joint policy brief entitled “HIV prevention, treatment and care in prisons and other closed settings: a comprehensive package of interventions” . The brief by UNODC, the International Labour Organization and the United Nations Development Programme proposes a comprehensive package of 15 interventions to address HIV in prisons settings.

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.

Online here .

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.

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.

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.

Today, at ADCA’s AGM, my friend and colleague Dr Maggie Brady, and I, were appointed Life Members of ADCA.
This is a great honour, for which I am very grateful.

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.
The report reads, in part, as follows:
quote
Chief Minister Katy Gallagher has acknowledged her plan to introduce a needle-and-syringe program at the Alexander Maconochie Centre may never see the light of day.

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.”
unquote.

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.

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:
‘A National Honour Roll for individuals who have made a significant contribution, over a considerable time period, to the Drug and Alcohol field has been established by the four collaborating organisations responsible for the National Drug and Alcohol Awards.
‘The goal of the Honour Roll is to acknowledge and publicly recognise the exceptional work which is done by some people who have worked tirelessly over a number of years in this sector.
‘…The judging criteria for nominations will be restricted to those who have made an outstanding contribution to addressing drug and alcohol issues over a substantial period of time.
‘Nominations may be made for people who have or are currently working directly in the drug and alcohol field, or in the many related fields.
‘It is expected that the number of inductees into the Drug and Alcohol Honour Roll will be limited to ensure it only truly acknowledges those that have made a sustained and significant contribution.
‘The judging panel for the Honour Roll will consist of members from each of the collaborating organisations.’

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.

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.

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.

The Burnet Report is online: External component of the evaluation of drug policies and services and their subsequent effects on prisoners and staff within the Alexander Maconochie Centre.

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.

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:
quote from pp. 165-6
– On health grounds introduction of a needle and syringe exchange program is an effective way to curtail harm resulting from transfer of blood-borne virus transmission
– In practice it is very unlikely officers at AMC will support such a program at present
– Introduction of a needle exchange program may be possible in future, but is unlikely to succeed at present given staff views.
Finding: 1
That given:
– The strongly divergent views of key stakeholders on the issue of a needle exchange program for the AMC;
– The strongly held views by ACT Corrective Services staff in opposition to such a program; and
– The highly complex nature of AMC operations;
it would be ill advised to proceed to reach a policy decision to implement a needle exchange program at the AMC without:
– A thorough examination of the various implementation methods for such a program to arrive at a viable best practice model that suits the AMC‟s particular circumstances; and
– Achieving support for the implementation method from all key stakeholders who will have responsibility for implementation and for any duty of care outcomes for both staff and detainees.
unquote

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.

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:

• Maintaining the harm minimisation approach that has characterised the NDS since its inception. The idea is to attain a balanced approach between drug demand reduction, supply reduction and harm reduction, referred to as the ‘Three pillars’ approach.
• Adopting the recommendations of the evaluation of the previous phase of the NDS (I was a member of the evaluation team) to establish a structure and process to develop and operate a National Drug Research & Data Strategy. (I hope the people responsible will not start from scratch, but will build on the proposals for this presented to the IGCD in 2000, in a 107 page report, by the then National Drug Research Strategy Committee.)
• Establishing a working group to develop a National Workforce Development Strategy for the ATOD field, a long-overdue initiative.
• Modifying the governance arrangements to have new standing committees advising the IGCD on alcohol, tobacco, illicit drugs and pharmaceutical drug misuse.
• Establishing a working group to develop a new ATOD strategy covering Aboriginal & TSI people.
• Returning to the approach taken in an earlier phase of the NDS of establishing a set of performance indicators, though those selected are a poor choice. The recommendations of the NDS evaluation in this regards have apparently been overlooked or rejected.

There are a number of missed opportunities, including the following:

• A formal, ongoing input to the operations of the NDS by the national peak NGO body for the sector, the Alcohol & Other Drugs Council of Australia (ADCA).
• Taking seriously the imbalance in resource allocation between the demand, supply and harm reduction components of the NDS, and between prevention, treatment and law enforcement.
• Once again prevention is, as the NDS evaluation report stated, ‘missing in action’. There are a number of preventive interventions mentioned in the Strategy, which is good, but we are still avoiding the need to document a national prevention agenda within the NDS.
• Enhance accountability within the NDS by documenting a process that will result in specification of who is responsible for implementing which parts of the Strategy, using what resources, on what timetables, with what intended outcomes and using what monitoring & evaluation approaches.

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.

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:
This study argues that it is a realistic possibility that crime, prison costs, and imprisonment numbers can be reduced simultaneously if policy makers shift from a primary reliance on severity-based policies, mandating lengthy prison terms, to a more effective use of police to make the risks of crime clearer and the consequences of criminal activity faster and more certain. We make the following basic claims:
1. The marginal deterrent effect of increasing already lengthy prison sentences is modest at best.
2. Increasing the visibility of the police by hiring more officers or allocating existing officers in ways that heighten the perceived risk of apprehension seems to have substantial marginal deterrent effects.
3. The experience of imprisonment seems to be criminogenic.

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.

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.

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.

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.

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.

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.

This was the headline of an editorial in The Lancet on 28 May. It went on to say:
’40 years ago, the then US President Richard Nixon launched his “war on drugs”, declaring drug misuse “public enemy number one”. This approach criminalised the production, distribution, and consumption of illegal drugs. On May 11, US President Barack Obama took a decisive shift away from this policy with the release of his 5-year National Drug Control Strategy, which takes a more balanced approach to the problem and emphasises prevention and treatment, as well as law enforcement. This widely anticipated move, called for by the public health community, should be applauded.

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.

See USA 2010 National Drug Control Strategy.

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:
Abstract

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.

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.

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.
David McDonald is a social scientist who has worked tirelessly to improve the health and wellbeing of people affected by alcohol and other drug issues. He has particularly achieved this by contributing to the evidence base upon which ACT public policy is formed; and by supporting the ACT alcohol and other drug sector to engage with the evidence base…
Through his various roles, David has had a significant impact on the sector, with the ACT sector particularly benefiting from his work.
For example his work on the extent and nature of drug use and harms in the ACT; profiling the workforce; conducting evaluations; monthly reviews of the evidence to support workers to bridge the gap between evidence, policy and service delivery; and active participation in over six ACT groups and committees concurrently.
David is dedicated to ensuring that the sector’s public health initiatives and policy are carefully designed, rigorously implemented, and appropriately evaluated. For example, he has contributed to high level endeavours such as the National Drug Strategy and the ACT Alcohol, Tobacco and Other Drug Strategy.
David is a well-respected, valued member of the ACT and national sectors; and he has demonstrated his commitment to reducing the harm caused by alcohol and other drugs over many decades. David’s colleagues therefore wanted acknowledge his achievements by awarding him the inaugural Outstanding Contributions Award.

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.

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.

Results
The study has clarified the validity of the two overlapping taxonomies. It has shown their strengths and weaknesses as tools for contributing to substance abuse policy development, implementation and evaluation.

Implications
Policy analysis guidelines direct analysts to consider both the predictable and unpredictable unintended adverse consequences of competing policy options. This study builds on Costa’s and Reuter’s suggestions for ways of thinking about the unintended consequences of drug policy. It does so by providing new insights for drug policy analysts and evaluators, enabling them to address, in a more systematic and explicit manner, the adverse unintended consequences of drug policies.

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.

Recommended citation: McDonald, D, Bammer, G & Deane, P 2009, Research integration using dialogue methods, ANU E Press, Canberra.

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.

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.

The Journal issue is available online at http://www.acrs.org.au/journals/.

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:

• Unclear goal specification: roadside drug testing purports to have as its aim improving road safety, i.e. reducing crash incidence & severity.
• A program logic analysis suggests that we are unlikely to attain this goal from this intervention.
• The research evidence also suggests that we are unlikely to attain this goal from this intervention.
• We have no evidence of careful consideration of the opportunity costs or the relative cost-effectiveness of other interventions aiming to improve road safety.
• The human rights considerations appear to have been ignored.

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:
‘No strong evidence of differential effects was found for smoking restrictions in workplaces and public places, although those in higher occupational groups may be more likely to change their attitudes or behaviour. Smoking restrictions in schools may be more effective in girls. Restrictions on sales to minors may be more effective in girls and younger children. Increasing the price of tobacco products may be more effective in reducing smoking among lower-income adults and those in manual occupations, although there was also some evidence to suggest that adults with higher levels of education may be more price-sensitive. Young people aged under 25 are also affected by price increases, with some evidence that boys and non-white young people may be more sensitive to price.’
Thomas, S, Fayter, D, Misso, K, Ogilvie, D, Petticrew, M, Sowden, A, Whitehead, M & Worthy, G 2008, ‘Population tobacco control interventions and their effects on social inequalities in smoking: systematic review’, Tobacco Control, vol. 17, no. 4, pp. 230-7.

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.

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.

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.

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.
Latka, MH, Hagan, H, Kapadia, F, Golub, ET, Bonner, S, Campbell, JV, Coady, MH, Garfein, RS, Pu, M, Thomas, DL, Thiel, TK & Strathdee, SA 2008, ‘A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C’, American Journal of Public Health, vol. 98, no. 5, pp. 853-61.

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.

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.

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.

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 .

Congratulations are due to the Scottish police and corrections agencies for developing and implementing realistic, evidence-based policies on drugs.

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 .

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.

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.

School-based peer drug education: a policy analysis
Peer education in schools, addressing alcohol, tobacco and other drugs, is being expanded nationally as an initiative of the Australian Government Department of Education, Science and Training. A policy analysis in this area was undertaken for Australian Capital Territory Government agencies. It concluded that the current widespread enthusiasm for school-based peer drug education does not adequately reflect the limited evidence base for its effectiveness. The implications of this conclusion for policy activity in the health and education sectors are discussed as an illustration of the sometimes problematic nature of the evidence-policy-practice nexus in the drugs field.

The evaluation of the AIVL National Hepatitis C Education Program (poster)
AIVL (the Australian Injecting and Illicit Drug Users League) is the national peak organisation representing the Australian State and Territory-based drug user organisations and addresses issues of national significance for people who use illicit drugs. For some years it has been funded by the Australian Government to develop and implement a National Hepatitis C Education Program for people who use illicit drugs. This is a multi-faceted intervention, employing diverse messages and communication channels aimed at specific categories of people who use illicit drugs. I will describe the strategy used to evaluate the 2003-2005 phase of the Program, drawing particular attention to the utilisation of a program logic approach. The results of the evaluation, and their implications other formal hepatitis C education programs, will also be presented.

Initiating a trial of syringe vending machines in the Australian Capital Territory
Syringe vending machines are a particularly controversial harm reduction intervention in most jurisdictions in Australia and abroad. The Government of the Australian Capital Territory has initiated a twelve month trial of syringe vending machines which will conclude in early 2006. The policy analysis underlying this intervention is described, along with the challenges facing evaluation research in this field and how they have been address in the trial’s evaluation. The preliminary findings of the trial will also be presented. This was a poster presentation.

Please contact me if you would like more information on any of these presentations.