Melbourne AOD Agency Forum report

Melbourne AOD Agency Forum report

Background

The Australian National Council on Drugs (ANCD) has determined it will hold an alcohol and other drug (AOD) agency forum in conjunction with its meetings in each State and Territory. These forums form part of the ANCD’s strategy to fulfil its role of ensuring the views of non-government, community-based organisations and associated services working with drug and alcohol issues, are considered as part of drug policy advice.

The ANCD produces a report from each forum which aims to provide a brief description of the issues raised by forum participants. These reports are available on the ANCD’s internet site to enable forum participants and interested others to access the issues that were discussed. The ANCD also provides a copy of each report to the Premier or Chief Minister, as well as the responsible Minister in each jurisdiction to ensure the Government is aware of the issues raised.

It should also be noted that all the issues raised at the forums are not necessarily areas that the ANCD agrees with or are able to address. They do however provide ANCD members with an important insight into community concerns and perceptions about specific AOD issues. In addition, the ANCD believes that it has an obligation to participants to report the issues and concerns raised in an unfettered manner.

Melbourne 2002

Approximately 65 people from Melbourne and the surrounding area participated in the ANCD’s AOD agency forum, which was held at The Sebel Suites St Kilda, Melbourne on 5 December 2002. The forum participants included representatives of local drug action groups, non-government organisations, State and Federal Government Departments and the education sector.

The forum was preceded by the launch of the ANCD commissioned report “Drug Policy: the Australian approach”, attended by the principal author of the report, Dr John Fitzgerald.

The Chair of the ANCD, Major Brian Watters, welcomed participants to the forum and explained its purpose. Major Watters then introduced the Executive Officer of the ANCD, Mr Gino Vumbaca.

Mr Vumbaca gave a presentation that:

Explained the role of the ANCD and its position within the National Drug Strategic Framework;
Highlighted some of the projects the ANCD has commissioned;
Outlined progress under the Tough on Drugs Strategy; and
Provided information about a range of AOD issues.

At the conclusion of his presentation, Mr Vumbaca opened the floor for questions and/or comments about current and emerging AOD issues in Melbourne and/or Victoria. The following issues were raised:

Buprenorphine
It was noted that in Victoria, Buprenorphine had experienced a more pronounced uptake as a pharmacotherapy option than it appears has happened in other states. Forum participants discussed this, noting that this may be due to the fact that a significant amount of the initial development and trials was undertaken in Victoria. It was also acknowledged that there is likely to be some reports of the initial attempts at diverting Buprenorphine, given the increase in its prescription and that it is likely to follow a trend where some attempts are made early on, with the rates diminishing over time.|
Services for Young People
The view was expressed that there is a lack of services in Victoria for young people aged 12-17 years. It was further noted that in particular, there is a lack of longer term options where a range of needs for these young people can be met (eg education, welfare, etc). Forum participants discussed the number of services that are available and noted that as with the adult population, a range of options are needed.
Longer Term Funding
Sustained funding for drug and alcohol programs in Victoria was raised as a critical issue for the sector. ANCD members were informed that the whilst the federally funded programs under the National Illicit Drug Strategy (NIDS) received funding for up to four years, 85% of the state funding for drug and alcohol programs was one-off, annualised funding. Furthermore, no allowances for CPI increases are being made. Participants noted that more advocacy on these issues is important, as one-year funding makes managing workforce issues and a range of other things very difficult. The relationship between the government and non-government sector was also raised, specifically that the power imbalance is skewed by the ‘funder-fundee’ nature of arrangements, where as a more genuine partnership was urged as being beneficial.
Access to Needles and Syringes
The issue of the non-availability of needles and syringes in prisons was raised, particularly in relation to the fact that efforts to contain blood borne viruses in the community are being undermined by the lack of services in the prison system. ANCD members recognised the good work being done by NSPs and highlighted the ANCD’s support for them in its position paper. A need was further expressed by forum participants for an increase in the availability of injecting equipment, particularly in rural areas. Vending machines were put forward as a cost-effective means of implementing 24 hour access.
Diversion Funding
While the forum heard of support for the diversion initiative, the view was expressed that the breakdown of diversion funding needs to be reviewed to emphasise treatment. Participants acknowledged and welcomed the philosophy behind diversion; that is, the incarceration of people with addiction problems is unhelpful and that treatment is a far better, more constructive approach.
Availability / Location of General Practitioners (GPs)
Concern was expressed over the limited number of GPs, particularly in rural and regional areas, but also increasingly in the outer suburbs (e.g. western metropolitan area) of Melbourne. Even more concerning was that of these limited number of GPs, few of them are methadone prescribers. Forum participants discussed the fundamental importance of GPs within the methadone program.
Local Government Issues
The difficulty faced by local governments in relation to public amenity and safety and the issues of needle & syringe disposal was raised. Concern was expressed over the cost of collecting used injecting equipment, as well as cooperation from other bodies who may have property responsibilities were noted as significant issues for local government. It was also acknowledged that there are a number of factors to consider with retractable needles, and this may not be the answer, and that community education – both users and the broader community – regarding the importance of disposal and understanding of current NSPs was critical.
Ethnic / CALD Issues
Drug issues within the ethnic community are often put in the ‘too hard basket’ and the needs of these communties too often remain unmet. Forum participants were made aware of a report by the McFarlane Burnett Centre (in collaboration with the Ethnic Community Council) on drugs in the ethnic community. A suggestion was made that Victoria needs a similar service to DAMEC in NSW, which would act to coordinate drug programs and services for CALD groups. Also noted was the lack of CALD representation reflected within the advisory structures for the National Drug Strategic Framework, which means at this level of drug policy and strategy advice, there is no profile for CALD issues.
Alcohol & Illicits
The tension between alcohol and illicit drugs at the policy and political level was noted as an unhelpful distinction for those working in the alcohol and other drug sector. Forum participants were advised that this is highlighted by the levels of poly-drug use, and also by illicit drug users who often report that their primary drug of concern is alcohol.
Doctor Shopping in Rural Victoria
Concern was raised about the emerging problem of doctor shopping in rural Victoria, possibly reflected in the increase in the level of prescribed opiates. Protocols and closer working relationships between doctors and pharmacists were put forward as a practical means by which this issue may be addressed (noting the relevant privacy issues). The concern was essentially that the current independent work practices of these linked professions is doing little to abate the problem.
Alcohol and Tobacco Focus
Alcohol and tobacco seemed to have taken ‘a back seat’ in terms of our priorities in relation to substance abuse and related harm. Participants encouraged governments to re-focus on the two substances that continue to cause the greatest costs to the community (in terms of mortality and morbidity). It was also noted that the alcohol and other drugs sector can play a much bigger role in treating nicotine withdrawal and dependence, and that a culture change is required to improve the situation.
Comorbidity
Comorbidity was raised as an issue of considerable concern. A call was made for ANCD support for additional funding to be made available in this area, and a greater degree of acknowledgement and commitment from government in relation to these complex issues.
Brief Interventions and Economics
It was suggested that the current economically-driven focus on brief interventions may not be as effective as longer-term approaches. There was a feeling that support for brief, opportunistic interventions were an exercise in putting money before people.

5 December 2002

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