05 April 2018

Drug Law Reform

The Victorian Parliament's Law Reform, Road and Community Safety Committee report on Drug law reform, concerned with
the effectiveness of drug control laws and procedures in minimising drug‑related harms, as well as drug law reform in other Australian and overseas jurisdictions 
comments that
the use of illicit substances and the misuse of pharmaceutical medication is a strong source of community concern. The Committee understands that most people who use substances do so infrequently, and only a small proportion use them in highly harmful ways. However, the adverse consequences arising from such use are far‑reaching and affect individuals, families and the community. Further, a common theme throughout the inquiry was the need to acknowledge the different types of substance use and understand why people engage in certain behaviours. This dialogue has been missing from Australia’s current approach to drugs despite these being important considerations when thinking about the types of strategies to prevent use and minimise harms. There is also growing recognition among governments and the community that greater balance between traditional law enforcement and health‑based responses will have a broader positive effect on the health and safety of communities. 
The report features the following  recommendations
R1: The Victorian Government’s approach to drug policy be based on effective and humane responses that prioritise health and safety outcomes, be in accordance with the United Nations’ drug control conventions, and informed by the following principles:
• promotion of safe communities – reduce drug‑related crime and increase public
• evidence‑based – empirical and scientific evidence to underpin change
• supportive and objective approach to people who use drugs and of drug addiction
• cost‑effective – ensure money spent on drug policy is working to reduce harms
• responsive – flexible and open to change, new ideas and innovation.
R2: In recognition of the imbalanced investment in drug‑related expenditure under the three pillars of demand reduction, supply reduction and harm reduction, the   Government develop a new drug strategy based on the four pillars of: • Prevention • Law enforcement • Treatment • Harm reduction
R3: The  Government establish a new Victorian governance structure to oversee and monitor the four pillars drug strategy. It should include: • Ministerial Council on Drugs Policy – comprising relevant Victorian Ministers responsible for the portfolios of health, mental health, police, education, early childhood education, road safety, corrections, multicultural affairs, and families and children • Advisory Council on Drugs Policy – comprising experts to advise the Victorian Government on drug‑related issues and research in Victoria, in addition to individuals (current users, recovering users, affected families) who actively work with and support people affected by substance use.
R4: The  Government commission an independent economic review into drug‑related expenditure and outcomes in Victoria. This should include a cost‑benefit analysis of all key initiatives and be made publicly available.
R5: The  Government advocate to the Commonwealth Government to conduct a similar review at the national level.
R6: Through the Victorian Centre for Data Insights, the  Government encourage and facilitate a system of strong drug‑related data collection and information sharing across all government departments and agencies. The purpose of this data collection and sharing is to: • build a sound knowledge base to inform drug research and policy efforts • support the development of timely interventions following specific drug‑related events or ongoing incidents • measure the effectiveness of Victoria’s four pillars drug strategy, with regular progress reports to be made publicly available • enhance capabilities and intelligence efforts of Victoria’s law enforcement agencies.
R7: The  Government establish an early warning system (EWS) to enable analysis, monitoring and public communications about new psychoactive substances (NPS) and other illicit substances of concern. This will require greater information sharing and collaboration between Victoria Police, the Victorian Institute of Forensic Medicine, the Department of Health and Human Services, coroners, hospitals, alcohol and other drug sector organisations (particularly harm reduction and peer based services) and other interested stakeholders. Essential components of the EWS should include: • real time public health information and warnings where required • developing a drug registry to understand the NPS market • a rapid response clinical toxicology service for hospitals and poison centres.
R8: The  Government develop specific guidelines on the use of appropriate, objective and non‑judgemental language regarding substance use disorders, addictions and those who use drugs for public policy‑makers, law enforcement agencies and health care professionals. The Government should consult with the appropriate agencies to ensure the guidelines are implemented throughout the working practices of these identified groups. In addition, the guidelines be conveyed to the media and non‑government agencies.
R9: The  Government develop a public awareness campaign on substance use and disorders in order to reduce negative labelling of people who use substances, both illicit and prescription medications, and to reduce the harms associated with substance misuse.
R10: The  Government enhance its existing prevention measures that target children and young people including: • School education programs and resources for young people around resilience and life training skills, in addition to appropriate, age‑specific and evidence‑based drug education programs that focus on preventing drug use, as well as being relevant to young people’s real life experiences and perspectives. This should also include ensuring that school policies align with prevention goals. • Specific programs within schools that aim to build protective factors, particularly for young people identified as at‑risk or requiring enhanced support. • Programs and resources for parents to build resilience and life skills, and enhance protective factors. • Explore the effectiveness of the Iceland model further, particularly the role of communities and families in prevention, in addition to encouraging participation of young people in meaningful recreational opportunities.
R11: The  Government, in consultation with the Victorian Multicultural Commission, conduct research into substance use prevalence among culturally and linguistically diverse communities to inform the development of appropriate prevention measures.
R12: With the intention to develop a primary health care early intervention strategy, the  Government commission an appropriate peak medical body to review the network of general practitioners (GPs) and public hospitals across Victoria and their role in screening and intervening early in people presenting with substance use issues and guide them accordingly. This review should map the current network including identifying GPs knowledge of and attitudes towards substance use and disorders, and barriers to effectively respond to these issues. The strategy should comprise practical responses to overcome identified barriers.
R13: The  Government, while maintaining all current drug offences in law, treat the offences of personal use and possession for all illicit substances as a health issue rather than a criminal justice issue. This approach will ensure appropriate pathways are in place for the referral of people to health and treatment services in a timely manner where required. Mechanisms to achieve this should include: • exploring alternative models for the treatment of these offences, such as the Portuguese model of reform • removing the discretion involved with current Victoria Police drug diversion processes by codifying them  • reviewing all threshold amounts for drug quantities in order to appropriately distinguish between drug traffickers and people who possess illicit substances for personal use only • conducting education and awareness programs to communicate with the public about the need to treat drug use as a health issue.
R14: The  Government expand access to the Magistrates’ Court of Victoria Court Integrated Services Program (CISP) and CREDIT/Bail Support Programs, to ensure consistency in access and equity throughout Victoria. This should be accompanied by enhanced funding to ensure that appropriate support services and alcohol and other drug treatment is available to people diverted from the court system into these programs. The expansion should also include exploring options for the CISP to be available in the County Court of Victoria.
R15: The  Government expand the number of Drug Courts in Victoria, accompanied by funding to ensure appropriate support services and alcohol and other drug treatment is available for program participants.
R16: The  Government explore other court programs for potential implementation in Victoria, including the Hawaii Opportunity Probation with Enforcement (HOPE program).
R17: As proposed by the Adult Parole Board of Victoria, the  Government provide the Adult Parole Board with the power to suspend parole for longer‑term parolees who have been found to use illicit substances but whom have not reoffended. Suspension could be up to three months, and parolees offered treatment during that time. Following the period of suspension, the Board would assess whether they can continue on parole.
R18: The  Government work closely with the Commonwealth Government to improve patient access to medicinal cannabis products, particularly in relation to streamlining requirements at federal and state levels to ensure patients who will benefit from medicinal cannabis treatment in appropriate circumstances have proper access to it.
R19: The  Government continue to work with the Commonwealth Government to explore ways to improve understanding among the medical profession and the public of the current evidence base and situations where medicinal cannabis products may be considered as an appropriate treatment option.
R20: The proposed Advisory Council on Drugs Policy should investigate the role of general practitioners in providing access to medicinal cannabis, and consider how they can be best supported in this area.
R21: To assist health professionals and patients to access this form of treatment, the work of the Independent Medical Advisory Committee be made publicly available.
R22: The  Government facilitate continued investment for research and clinical trials into the use of medicinal cannabis and its effects, including its role in working alongside prescription opioids for pain management and reducing reliance and dosage levels of medication prescribed for pain relief.
R23: The proposed Advisory Council on Drugs Policy investigate international developments in the regulated supply of cannabis for adult use, and advise the Victorian Government on policy outcomes in areas such as prevalence rates, public safety, and reducing the scale and scope of the illicit drug market.
24: The proposed Advisory Council on Drugs Policy investigate the current drug driving laws and procedures to determine their effect on road crashes and as a deterrent strategy. The Council should also explore: • alternative drug driving regimes that use impairment limits/thresholds, and their potential applicability in Victoria • options for expanding the types of drugs captured under the regime • likely changes to drug driving laws resulting from medicinal cannabis use in Victoria.
R25: The  Government review the implementation and enforcement of the recently enacted Drugs, Poisons and Controlled Substances Miscellaneous Amendment Act 2017 in mid‑2019 to evaluate its effectiveness in eliminating the emergence of new psychoactive substances (NPS), and identify any unintended consequences. Other areas for review should include enforcement, NPS‑related harms, NPS availability and prevalence. It should also review the implementation and workability of the definition of ‘psychoactive effect’.
R26: The  Government, in conjunction with Turning Point and other relevant agencies, develop a practice‑friendly treatment pathway tool/resource for general practitioners (GPs) to enhance their awareness and understanding of referral to the alcohol and other drug treatment sector. To accompany this, the Victorian Government also review how Turning Point’s Drug and Alcohol Clinical Advisory Service (DACAS) could be better utilised among GPs, including through increased funding.
R27: The  Government via the Alcohol and Other Drug Sector Reference Group provide expert advice to the Government, the alcohol and other drug (AOD) treatment sector, and the broader medical community on ways to enhance their capacity to effectively respond to people presenting with substance use issues. Specific areas for action might include:   • identify further funding options through mapping the current capacity and gaps within AOD service delivery against existing and future demand for services. Particular attention to be provided to all treatment options to ensure flexibility in service delivery, acknowledging diversity and differing needs among potential clients. Specific opportunities should be identified for different cohort groups such as clients with co‑existing mental health issues and substance use disorders, culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities, and those from rural and regional areas • explore effective and workable measures to expand Victoria’s specialist addiction medicine capacity, in addition to ensuring the AOD treatment sector is adequately supported by its existing workforce • explore options for a public multidisciplinary health clinic model that comprises access to opioid substitution therapy prescribing doctors, addiction specialists, mental health services, support and other allied health services • develop a model of care for public hospitals when treating patients presenting with substance use issues, which could include medical staff undertaking drug screening and developing clear treatment pathways and reintegration with specialist AOD treatment services.
R28: The  Government note ongoing considerable concerns within the community about private unregistered providers of alcohol and other drug (AOD) treatment and continue to advocate for the development of a national regulatory framework and standards for private AOD treatment.
R29: The  Government provide increased support and funding to family support programs to minimise the adverse impact of substance misuse on family and friends, and to contribute to the effective reintegration of people with substance use disorders back into the community.
R30: The  Government evaluate prison alcohol and other drug programs based on their effectiveness in reducing recidivism, particularly where offending is directly related to substance use issues. Inquiry into drug law reform
31: The  Government establish a dedicated arm of government to actively manage opioid substitution therapy (OST) policy in Victoria. The dedicated unit should explore options for enhanced data collection on OST, including current take‑up, compliance rates, people who have ceased treatment and why. It should also explore an OST registry for general practitioners and pharmacies where they can seek information on current prescribers/ dispensers in specified areas.
32: The  Government fund opioid substitution therapy (OST) dispensing fees to enhance access and remove barriers to a person entering and remaining on OST.
33: The  Government expand access to opioid substitution therapy (OST) through a range of measures including: • the provision of financial incentives to general practitioners and pharmacists to prescribe OST, particularly as the current cohort of prescribing doctors is ageing and a shortage is expected • enhancing the role of nurse practitioners to prescribe OST • exploring models for hospitals to provide OST to suitable patients as part of emergency department treatment.
34: The  Government trial the expansion of the opioid substitution therapy program to include other controlled and pharmaceutical grade opioids (such as hydromorphone), for a small group of people for whom other treatment types have not been successful. This should be accompanied with robust evaluation.
R35: In the short term, the  Government, in conjunction with the Australian Medical Association and other relevant medical bodies, develop prescription opioid medication guidelines for general practitioners and training on appropriate prescribing practices. This should include guidance on monitoring patients, lowering dosages when appropriate, education on the risks of dependence, and effective pain relief alternatives to such medication.
R36: The  Government develop and promote a sector‑wide stewardship trial program for the medical profession (hospitals, specialist services and general practitioners) based on the Alfred Health model to promote and audit best practice regarding the prescribing and use of medications with potential for misuse (such as analgesics and benzodiazepines). This should be accompanied with promotion and education of best practice in this area and of appropriate attitudes towards pain relief among health professionals. The program should also be accompanied with an evaluation.
R37: The  Government develop resources and support or conduct awareness raising campaigns targeting the broader community about the safe and appropriate use of prescription medications for pain relief and promoting the role of non‑pharmacological treatments for certain conditions (e.g. stress, anxiety and chronic pain). This could start with a targeted campaign that aims to reach patients in health settings and expand to a broader audience if required.
38: The  Government work with the Commonwealth Government to review the fee structure for dispensing medication with potential for misuse, so that the volumes prescribed and dispensed be based on individuals’ needs. Fee structure changes could include: incentivising pharmacies to dispense fewer tablets and subsidising patients who receive smaller amounts of medications. As part of this, the Victorian Government should work with the Pharmacy Guild of Australia and other relevant bodies regarding the role of pharmacies in improving dispensing practices.
R39: The  Government adopt measures to ensure the effectiveness of the real‑time prescription monitoring (RTPM) system and prevent the diversion of patients with prescription misuse issues to the illicit drug market, including: • adequately resourcing the alcohol and other drug public treatment sector to accommodate the likely influx of demand resulting from patients identified in the RTPM system with opioid dependency • as part of Department of Health and Human Service’s workforce development and training, ensure that health professionals are equipped to appropriately deal with patients identified in the RTPM system with substance use issues, for example through providing immediate and seamless access to harm reduction and/or treatment services, such as opioid substitution therapies.
R40: The  Government review Victoria’s needle and syringe program (NSP) in order to strengthen the aims, coverage, service models, harm reduction information and equipment distributed to people who use illicit substances. This should include: • exploring avenues to increase NSP availability in areas where there is an identified shortfall particularly after‑hours, such as in public hospitals, vending machines/dispensing units, and community pharmacies • ensuring that staff of NSPs are culturally aware and sensitive to the needs of people who identify as Aboriginal and Torres Strait Islander and others from culturally and linguistically diverse communities • enhancing the capacity of the NSP workforce to engage with people with hepatitis C to educate them about potential treatment options and refer them accordingly.
R41: The  Government remove the prohibition of peer distribution of sterile needles and syringes in the Drugs, Poisons and Controlled Substances Act 1981.
R42: The proposed Advisory Council on Drugs Policy review harms arising from current laws that prohibit or discourage non‑injecting routes of drug administration, such as increased injecting use of methamphetamines and other drugs, and make recommendations to the Government accordingly.
R43: The  Government review its screening policies for blood borne viruses in prisons to: • offer screening to prisoners upon release, in the same way they are offered screening upon entering prison or transferring between prisons • explore the feasibility of introducing compulsory blood screening of prisoners upon entering and exiting prisons to determine transmission of blood borne viruses within prisons. This review should consider all human rights implications associated with mandatory screening.
R44: The  Government monitor data from screening processes, as recommended above, and monitor international needle and syringe prison programs to consider their potential value to minimise transmission of blood borne viruses. The Victorian Government share information with prison staff and relevant bodies to increase awareness and open dialogue about the benefits and risks of needle and syringe programs in prisons.
R45: The  Government explore avenues to distribute naloxone more effectively. Such avenues might include: • needle and syringe programs and other community health services where staff are trained to educate others in administering naloxone • making naloxone available in appropriate settings where people who use opioids may frequent, such as treatment services (detox and residential rehabilitation services), crisis and emergency accommodation, which staff can administer when necessary • making naloxone available to first responders to overdose calls in areas with high concentrations of injecting heroin use, accompanied with appropriate training • other ways to make naloxone available, including through enhanced peer distribution.
R46: The  Government make naloxone available to prisoners with a history of opioid use upon their release from prison to minimise the high risk of overdose deaths among this cohort of people, and provide them with appropriate information and support services available in the broader community to minimise the likelihood of overdose.
R47: The  Government develop an emergency action plan to respond to a potential increase in deaths or overdoses as a result of high strength and purity of illicit substances, for example the presence of fentanyl and carfentanil in the drug market. This could include: • targeted strategies for specific cohorts of people that use substances, such as those based in regional and rural areas, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse communities, and people experiencing mental health issues • wider distribution of naloxone to people who inject drugs (recommendations 45 and 46) • explore avenues to enhance availability of opioid substitution therapies, such as lowering thresholds for access and reducing costs (recommendations 32 and 33), and expanding opioid‑based treatment for people with a chronic heroin addiction (recommendation 34) • possible establishment of temporary medically supervised injecting facilities in areas with high concentrations of injecting drug use and overdoses • drug checking at the Medically Supervised Injecting Centre to test for heroin purity and other contaminants.
R48: The  Government work with the Department of Health and Human Services, Victoria Police, Ambulance Victoria and DanceWize to facilitate the availability of an onsite drug testing unit for health and law enforcement authorities at an appropriate music festival to be used in the event of a suspected overdose or other serious adverse effects due to an illicit substance. The unit would not be public facing and its purpose is to test substances to determine their composition to assist health authorities treat the patient and, where appropriate, release a public alert to prevent further incidents. The unit will operate as part of the early warning system as recommended in chapter four.
R49: The  Government refer to the proposed Advisory Council on Drugs Policy the issue of drug checking services, and request that it monitor overseas and domestic models to obtain relevant evidence to inform consideration of a trial in Victoria. If appropriate, the Council should develop guidelines for such a trial (and include appropriate messaging e.g. not condoning drug use nor indicating that drug use is safe, appropriate technology, data collection and clear liability safeguards). The Council should also consider an evaluation framework to measure the future trial’s effectiveness in minimising drug‑related harms.
R50: Victoria Police commission an independent evaluation of the use of drug detection dogs at music festivals and other public spaces to determine their effectiveness in deterring the use and trafficking of illicit substances, and any unintended consequences or risk of harms resulting from this strategy.