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Thursday, 11 September 2003
Page: 19951


Mrs IRWIN (11:53 AM) —When the substance abuse inquiry report of the House of Representatives Standing Committee on Family and Community Services was tabled last Monday I was able to make only a few brief remarks and the time available did not give me the opportunity to fully explain my position on many of the committee's recommendations. In dissenting from 10 of the committee's recommendations and two conclusions, along with the member for Cowan and, in part, the other Labor members of the committee, we have expressed concern for what we saw as a change in the balance of the National Drug Strategy. As the report explains at section 11.22:

One of the features of the National Drug Strategy is its balanced approach. Balance is sought between supply reduction, demand reduction and harm reduction ...

Section 11.22 goes on to say:

The Alcohol and Other Drugs Council of Australia saw the National Drug Strategy's approach as one of its strengths which has contributed to placing Australia at the forefront of drugs policy internationally.

That is a fair assessment of our standing in the international community in terms of our drug policies in Australia. As I mentioned in my speech on the tabling of the report on Monday, I visited several European countries in April this year. I might add that it is a great pity that the committee did not have the opportunity to see the programs that I was able to see in Zurich and Frankfurt. One thing that I can confirm from every agency that I visited overseas is that Australia is recognised as a world leader in the treatment of drug addiction and that our record in minimising harm, particularly the spread of HIV-AIDS and hepatitis C, is the envy of the world. That is why I am so concerned at the prospect of changing the focus of our drug strategy. Here we have the Alcohol and Other Drugs Council of Australia praising the balanced approach of our National Drug Strategy, but government members of the committee want to change the focus from harm minimisation to what they call harm prevention.

As I stated on the tabling of the report, I am suspicious of changes which would seek to bring Australia into line with the approach of the United States, an approach that was very heavily pushed at this year's Commission on Narcotic Drugs in Vienna. Let me be quite open about this: what I sought in recommendation 122 was to include the key principles of harm minimisation within the strategy of harm prevention. The two must go hand in hand—harm prevention and harm minimisation. We need a balanced approach, but that was not to be the case. As I said in our dissenting report:

The consideration of evidence, the conclusions reached and the recommendations made must be seen as coloured by the personal views of committee members (including ourselves). This can be a strength of the political process. After all, elected representatives should be a sounding board for the views of the electorate. What are seen as socially acceptable recommendations can be expected to prevail.

But here we have thrown out the window the results of scientific studies and the reasoned views of the Alcohol and Other Drugs Council of Australia. Our role should be not to echo the voice of the electorate but to temper it with the logic and reason of scientific evidence and the considered views of those charged with the responsibility to deal with these problems. That is what a number of the committee's recommendations fail to accept. We cannot hold health professionals accountable for policies which are imposed on them. It is not just a matter of deciding what is or is not socially acceptable; it is a matter of deciding what works and what does not work. Governments can always claim credit—as government members on this committee have done—when things go right, but they rarely accept the blame when things go wrong. That is why we need to listen to the objective evidence of those who practise in this field. We may not like what they say, but we ignore their advice at our peril.

I turn to some specific recommendations which we dissented from. In recommendation 21 our objection was to the inclusion of the clause `with the ultimate objective being to obtain a drug free status for the client'. In recommendation 52 a similar clause was objected to. It recommends that when providing:

methadone maintenance treatment to save lives and prevent harm to people dependent on heroin, the ultimate objective be to assist them to become abstinent from all opioids, including methadone ...

As you can see, that includes the magic words—`prevent harm', but it insists on the goal of achieving abstinence. This may sound like a worthwhile objective, but is it achievable? Here the scientific evidence is not encouraging. Professor Richard Mattick of the National Drug and Alcohol Research Centre at the University of New South Wales told the committee:

Only one-third of heroin addicts achieve and maintain abstinence. For the remainder, heroin dependence is a chronic, relapsing disease. We have to talk about management not cure.

That is the scientific evidence. We might like to see some glimmer of hope for heroin addicts, but the facts remain: heroin dependence is chronic, it is a relapsing disease and we have to talk about management, not cure. But I have to admire the committee for its optimism. Even knowing what Professor Mattick had to say, the committee goes on, in recommendation 54, to talk about funding for the treatment. It says:

... governments ensure that sufficient funding is available to treatment services to provide comprehensive support to opioid dependent people who are receiving pharmacotherapy:

for as long as it is needed to stabilise their lifestyle;

if possible, to assist them to reduce or eliminate their use of all opioids, including methadone ...

... ... ...

give priority to treatments including naltrexone that focus on abstinence as the ultimate outcome.

I admire the committee's optimism, but naltrexone is not a magic bullet when it comes to treating heroin addiction. Professor Mattick is again quoted in the report:

... in treatment with naltrexone, compliance is poorer, and the risk of death and overdose is higher when treatment is ceased or intermittent.

Behind these recommendations is the moralistic viewpoint that only abstinence based treatment is acceptable. This is very much the case for funding of drug treatment programs in the United States of America. Abstinence based treatment is a zero tolerance strategy by another name. High-threshold methadone maintenance, which ceases when a client relapses, and constant pressure to move on from methadone maintenance lead to a revolving door cycle with addicts moving in and out of treatment. That is what is already happening with long waiting lists and reduced funding for methadone programs. That is what a focus of harm prevention leads to. That is what happens when the focus of harm minimisation is dropped: other key parts of harm minimisation will always be affected. Needle and syringe programs are already under attack.

The most effective measures in reducing the spread of HIV-AIDS and hepatitis C are facing cuts in funding and restrictions on supply sites. HIV-AIDS infection rates for intravenous drug users are less than three per cent in Australia—thanks to harm minimisation. In the USA, they are 10 times greater—more than 30 per cent. That is the result of harm prevention strategies. That is where Australia is heading if we go down that path.

The committee's refusal to even consider the benefit of safe injecting room trials is an indication of this hardening attitude towards one of the most effective means of reducing deaths from overdose. The only people who are concerned that harm minimisation is sending the wrong message are those with moralistic viewpoints who cannot see reason when it comes to setting a workable strategy for saving lives and minimising the risk of harm to the greater community. But they do not care about the lives of the victims of substance abuse. Their view is that `the wages of sin is death'. That is the consequence of taking illicit drugs.

This report sends a disturbing message to the many dedicated professionals in the field of drug and alcohol treatment. The social workers, the doctors and nurses, the counsellors, and even the nuns who visit people in jails, are already facing cuts to their funding, which severely limits what they can achieve. The message this report sends them is that they are not making a worthwhile contribution. The people who work with alcohol and illicit drug victims work in some of the worst conditions imaginable. Their work is far from glamorous. They do not provide miracle cures, but they do keep people alive. This report is a slap in the face to them. It fails to recognise the value of their work and condemns them to a future of meagre funding and the frustration of being forced to turn away so many clients who are desperate for help.

The big dollars will go to the public relations firms to dream up another fridge magnet to fight the war on drugs. This report is a great disappointment to those many dedicated people in the field of drug and alcohol treatment. Those people came before the committee in the honest belief that their concerns would be listened to, but it seems they were just wasting their time. After years of fighting for every scrap of funding, they feel like they have just fallen down the biggest snake on the board of the drug-funding game of snakes and ladders. The ray of hope that this inquiry offered has been snuffed out by the blinkered vision of political opportunism of some members of this committee.

This inquiry covered many other areas of concern, and I know I have concentrated on only one part. Of the 128 recommendations, our dissenting report only covered 10, but they were some of the most important and far reaching in their impact on drug policy in Australia.

In conclusion, I note that Australia's National Drug Strategy is at present under review. That review will include an assessment of the national drug strategic framework on reducing supply, demand and harm to individuals and the community. The final comments of the committee's report makes a recommendation seeking to change that strategy from harm minimisation to harm prevention. The report asks that its recommendations assist in the formulation of the next stage of the National Drugs Strategy. Our dissenting report makes it clear that the committee's view is not unanimous and that an alternative view on drug strategy is strongly advocated. I ask that the Ministerial Council on Drug Strategy give due consideration to the views expressed in the dissenting report. This government and this Prime Minister are closing the doors on the lives of people with a drug addiction. Those doors should remain open.

I would like to extend my thanks to a number of members of the committee's secretariat, especially in the 39th Parliament when we did the bulk of our work. To Trevor Rowe and to Shelley McInnis, who did an excellent job, and to the 40th Parliament staff, Beverley Forbes, Margaret Atkin and Belynda Zolotto: thank you.