The “d-word” didn’t even pass the lips of the NSW premier in his opening address, despite heartfelt pleas from veterans of the field.
Dr Annie Madden, executive director of Harm Reduction Australia and a 30-year veteran of drug policy, had a heartfelt and uncompromising message for attendees at the Sydney leg of the NSW Drug Summit today.
“Don’t ask for what you think you can get,” she said. “Ask for what we need.”
Dr Madden was one of only two people with lived experience of drug use invited to speak at the first NSW Drug Summit in 1999, an opportunity that was life-changing, but also brutalising as she was personally vilified in the press.
“I was variously characterised as sick and pathetic, that I had serious mental health issues and I was kidding myself, and that my contribution to the discussion fell somewhere between repugnant and repulsive – all that because I didn’t represent their stereotypes of people who use drugs, and because I dared to say what needed to be said on behalf of the hundreds of thousands of people who use drugs [who were] not in the room.”
She had seen compromise too many times, she said.
“When the opportunity to provide best advice comes, way too often the best advice quickly turns into the best compromise we could muster up on the day, and we wonder why we aren’t getting the results we need.”
Dr Madden challenged the summit to produce six outcomes:
- Increased funding for harm reduction, which receives less than 2% of the total drug budget spend
- A strong recommendation on pill testing and an end to the “harmful and ineffective” police practices of strip searching and drug dogs
- More funding for drug treatment, especially that provided by NGOs, which do “most of the heavy lifting”
- Urgent action on overdose deaths including more awareness of take-home naloxone, especially with the presence of nitazenes, and community-led injecting rooms
- Changes to roadside drug testing that focused on impairment, not the mere presence of a drug, and to “repeal the current discriminatory drug driving laws for people on medicinal cannabis”
- Full decriminalisation of small amounts of drugs for personal purposes
“Like anything, decrim can be done well and it can be done poorly, and one of the ways to do it well is to take proper account up front of the extent of the harms that any decriminalisation model will invariably inherit from – guess what? – prohibition.”
This included the effects of decades of criminalisation and incarceration.
Dr Madden said only full decriminalisation could prevent tragedies seen with unregulated markets such as the recent methanol deaths in Laos and the US opioid epidemic.
She said the 1999 drug summit had produced 172 recommendations, all of which were accepted but three, all about drug law reform.
“Here we are again, 25 years later, set to debate the very same ground: the need for pragmatic, sensible law reform that shifts us from these repetitive cycles of disproportionate punitive and criminalising responses leading to unacceptable levels of preventable harm for people and communities, to a new approach where all of our drug laws must meet the very simple test of whether they are just, humane and effective.”
Dr Madden can be forgiven for thinking “here we are again”, since her call – and that of the Royal Australian College of Physicians – for decriminalisation was already effectively off the table before the summit convened.
Related
Yesterday the RACP, fronted by president Professor Jennifer Martin, presented its list of reform demands on the ABC’s 7.30 program, including decriminalisation of currently illicit drugs, trials of regulated cannabis markets, expanding drug-checking services and pill testing trials, more free syringe programs and medically supervised injecting centres.
NSW health minister Ryan Park told 7.30 the government “probably wouldn’t be going down that path per se”, and Premier Chris Minns did not respond to the RACP’s call or mention the word decriminalisation in his opening address to the summit this morning.
Associate Professor Amy Peacock, Deputy Director of the National Drug and Alcohol Research Centre (NDARC) then spoke about trends in use and harms.
Alcohol and tobacco drive most of the drug-related harms and costs, she said, with tobacco accounting for about $160 billion of the $265bn cost to the country each year.
About 10% of those costs were from illicit drugs, but the burden of harm was still substantial and mostly experienced by marginalised populations.
Professor Peacock summarised some trends in specific drug classes:
- Opioid harms have been largely declining, apart from a rise in harm from heroin
- Methamphetamine harms have risen since 2010 but now appear to be stabilising; but there is significant unmet demand for methamphetamine treatment especially in regional areas
- Non-prescribed cannabis use has remained stable, with one in 10 adults using; hospitalisations are slightly up but still low in absolute terms and often involve other drugs; there has been increasing harms from edibles
Professor Peacock said opioid agonist therapies had saved 4000 lives in NSW over two decades and other harm-reduction strategies including supervised injecting and take-home naloxone had prevent 11,000 overdose deaths.
Methamphetamine harms had peaked in NSW around 2020, thanks to increased availability and drops in price, but had now plateaued.
She stressed the dynamic nature of illicit drug markets, with the following trends seen around the world and in Australia and NSW:
- Increased manufacture and availability
- New psychoactive substances always in development
- Increased diversity of drug forms and routes of administration
- Increased polydrug use, including drug mixtures the user is not aware of
- More novel synthetic drug overdoses
- Increased harms for marginalised groups
“The landscape around drug use is evolving,” she said. “It’s complex and it’s dynamic. It’s not the same as it was 20, 10 or even five years ago.
“In New South Wales, we see increasing reports of clusters of overdoses related to [novel psychoactives], related to adulteration and substitution, related to counterfeit medicines, related to high-dose drugs. Illicit drugs’ contents are more unpredictable than ever before, and without information about the content of illicit drugs, it leaves people who use these drugs ill equipped to make decisions around their use.”
Professor Maree Teesson AC, director of the Matilda Centre for Research in Mental Health and Substance Use, said more funding was needed for prevention – which currently gets 2% of the total drug budget – especially in young people, where the peak age of drug use onset was 14-18.
She said NSW was leading the world in innovative responses to drugs and drug harms.
“We have incredible programs that have been tested thoroughly in large randomised controlled trials. We have innovative school-based drug education. We have skills-based programs that have been shown to halve drug use and the onset of drug use and prevent harm.
“[We have] community-based programs, digital platforms that support families and that address stigma, programs that provide early intervention for trauma and mental health and drug use. We have programs for children. We have the medically supervised injecting centre … but clearly more can be done in New South Wales to increase access to these.”
Professor Teesson said she had just returned from presenting work to the US National Institute of Drug Abuse.
“I saw firsthand the impact of fentanyl, the impact of the failure to implement evidence-based and effective programs in the US, the devastation of an increasing number of young people with criminal records … children born into families with extensive drug use. We have a chance to lead the world. We have a chance to tell a different story.”
