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Illicit drugs in Australian society are associated with health, social, and economic burdens. Governments respond to the wide-ranging implications of illicit drug use and supply by mobilising the substantial social and economic resources represented across four different domains – law enforcement, prevention, treatment, and harm reduction.
This new Monograph provides an analysis of government spending in those four domains for the financial year 2021/2022. The results reveal that Australian governments spent $5.5 billion on illicit drug countermeasures, with the largest proportion in law enforcement (64.3%).
It is the third such ‘drug budget’ (the first was in 2002/2003, DPMP Monograph #1; the second was for the financial year 2009/2010, DPMP Monograph #24). A top-down approach was employed to derive estimates, which was possible for prevention, treatment, and law enforcement. A bottom-up approach was employed to derive estimates for the domain of harm reduction.
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COVID-19 has precipitated significant policy changes to many health and social welfare services. One area of policy change has been the opioid pharmacotherapy maintenance program. In this report we consider the policy change processes for the opioid pharmacotherapy program in three Australian jurisdictions. This case study of opioid pharmacotherapy maintenance policy-making in a time of crisis revealed that policy-making processes can adapt and change. In the context of a public health emergency, that emerged in the context of wider recognition of shortcomings in the policy settings regulating opioid pharmacotherapy treatment, seemingly intractable policy problems were addressed rapidly, in ways that were flexible and inclusive. A number of insights have emerged that can inform policy-making under routine conditions. There is little reason to think that these insights do not also apply to other aspects of alcohol and other drug policy, and also to health policy more generally, and indeed to all domains of policy work: education, transport, social welfare and so on.
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Non-government organisations (NGOs) are one of the main providers of alcohol and other drug treatment in Australia alongside government services. Around 70% of all episodes of treatment were provided by the NGO sector in Australia (although this division varies by jurisdiction). Considering the important role of NGOs in providing treatment, the aim of this study was to examine how COVID-19 has impacted on 1) business practices; 2) the workforce; 3) service delivery; and 4) treatment demand.
Priority actions, covering the immediate, medium-term (next 12 months) and long term (next five years), have been derived from the analysis of the survey, focus groups and administrative data. These immediate, medium and long-term actions are underpinned by the two long-standing systemic issues for the sector: the chronic underfunding of treatment; and the challenges in recruiting and retaining a specialist workforce.
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The Involuntary Drug and Alcohol Treatment (IDAT) program commenced in New South Wales in 2012 under the legislative basis of the NSW Drug and Alcohol Treatment Act 2007 (Act). The Act provides for the involuntary detention, treatment and stabilisation regime (for 28 days) for persons with severe substance dependence, with the stated aim of protecting the health and safety of such persons, while also aiming to address all human rights aspects that were the subject of criticism of the previous legislation.
This IDAT Data Linkage Study aimed to compare IDAT patients to a comparison group comprised of people in similar circumstances to those of IDAT. It used administrative health and mortality records, rather than directly collected patient data. The key comparisons were conducted on changes in health service usage (12 months before and 12 months after IDAT, in comparison with a control group), including changes in emergency admissions, unplanned hospital admissions and differences in mortality between the two groups.
The primary aims of the “IDAT Data Linkage Study” were to:
- Determine if IDAT patients have a significant reduction (12 months after treatment compared to 12 months before treatment) in emergency department admissions, unplanned hospital admissions, and the costs associated with these in comparison to a suitably matched control group
- Determine if, in comparison to a suitably matched control group, those in IDAT have on average a lower mortality rate in the 12 months after IDAT treatment.
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The Involuntary Drug and Alcohol Treatment (IDAT) program commenced in New South Wales in 2012 under the legislative basis of the NSW Drug and Alcohol Treatment Act 2007 (Act). The Act provides for the involuntary detention, treatment and stabilisation regime (for 28 days) for persons with severe substance dependence, with the stated aim of protecting the health and safety of such persons, while also aiming to address all human rights aspects that were the subject of criticism of the previous legislation.
The aim of this outcome evaluation was to assess the effectiveness of the IDAT program in reducing alcohol and drug use and improving health and social outcomes. The effectiveness of the IDAT program is not only determined by the clinical intervention but by a combination of components:
- referral to IDAT and the procedural justice practices involved in referral and admission
- perceptions and impacts of coercion
- medical, clinical and psychological interventions provided in inpatient treatment, and
- services linking patients to community aftercare.
For involuntary treatment, it is important to include perceived coercion and associated negative emotional reactions. As such, this evaluation also examines if patients perceive coercion and negative emotional reactions may have negative impacts on treatment outcomes in addition to the clinical treatment outcomes.
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The Involuntary Drug and Alcohol Treatment (IDAT) program commenced in New South Wales in 2012 under the legislative basis of the NSW Drug and Alcohol Treatment Act 2007 (Act). The Act provides for the involuntary detention, treatment and stabilisation regime (for 28 days) for persons with severe substance dependence, with the stated aim of protecting the health and safety of such persons, while also aiming to address all human rights aspects that were the subject of criticism of the previous legislation.
The overall objective of this cost assessment was to report on the estimates of the costs of delivering the IDAT program across four years – from the commencement of the program (July 2012) to June 2016. The perspective of this study was the clinical costs associated with delivery of IDAT, excluding infrastructure costs. Wherever possible this study used cost estimates of actual program delivery rather than the funding allocated to the program. The focus on actual costs is important for understanding the real costs of service provision, planning for future budget allocations and providing the basis for potential future comparative analyses.
Specifically, the cost assessment involved understanding and estimating the costs of the three program components of the IDAT program:
- Referral and assessment: Cost items include a) the cost of time devoted by the Involuntary Drug Treatment Liaison Officer (ITLOs); and b) the cost of transporting patients to the IDAT units for admission (Transport Fund). The ITLO has a key role in the process of ensuring that the four IDAT eligibility criteria are met
- Inpatient treatment: The costs of inpatient treatment includes all costs related to the inpatient stay (patient care, any medical, clinical and medication services)
- Six-month community aftercare: The costs here include: a) the cost of time devoted by community case managers/care coordinators; and b) expenditure of the Brokerage Fund to support the patients’ ongoing aftercare.
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The Involuntary Drug and Alcohol Treatment (IDAT) program commenced in New South Wales in 2012 under the legislative basis of the NSW Drug and Alcohol Treatment Act 2007 (Act). The Act provides for the involuntary detention, treatment and stabilisation regime (for 28 days) for persons with severe substance dependence, with the stated aim of protecting the health and safety of such persons, while also aiming to address all human rights aspects that were the subject of criticism of the previous legislation.
The process evaluation aimed to provide descriptive information about the IDAT program operations, its reach, strengths and weaknesses, patient progression though the model of care, and the feasibility and appropriateness of the model of care. In providing this description, it also aimed to evaluate whether the Act was being implemented according to how it was originally conceived, and the extent to which the implementation of the IDAT program was consistent with the Model of Care and the legislative basis for the program, at the time of the process evaluation.
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This study sought to:
- Detail the NSW policy and retail changes to alcohol availability from early February through to end July 2020
- Examine changes in alcohol consumption associated with the lockdown measures in NSW
- Assess the extent to which changes to alcohol consumption during lockdown were subsequently sustained
- Evaluate the links between alcohol policy changes and changes in alcohol purchasing and consumption patterns to inform future alcohol policy.
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This Monograph (No.28) provides an examination of the barriers to GP access by people who use alcohol and other drugs (AOD) in Brisbane North Primary Health Network, and identifies practical recommendations and initiatives that could be undertaken in this region in order to improve GP engagement with people around their AOD use. The approach taken in this Monograph deviates from previous studies in this area as it considered the many different contact points a patient might have with a general practice. GPs and other practitioners, namely Practice Nurses, were approached to participate in our study, as well as administrative staff including receptionists and Practice Managers. This study also included the voices of people who use AOD in order to explore the types of practice that would encourage them to engage with GPs around their AOD use.
Our study found a range of experience and practice across Brisbane North PHN in relation to GP engagement of people with AOD use – both good and bad – that broadly fell under one of six themes:
- Innovations, positive experiences and successful engagement
- Getting in to see a GP
- Quality of general healthcare provided to patients
- Quality of AOD care provided
- Referrals and links to specialist services, and
- Broader structural issues in healthcare.
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This project sought to provide the first comprehensive analysis of Australian criminal justice responses relating to personal use and possession of illicit drugs and the reach of Australian drug diversion programs. The specific aims of the project were:
- To outline current Australian laws and approaches taken to illicit drug use and possession in each jurisdiction (including programs on alternatives to arrest).
- To assess the scale of criminal justice responses to use/possession in Australia over the period 2010-11 to 2014-15, including the number of people detected, prosecuted and/or sentenced for use/possession, the number of people diverted away from criminal justice proceedings, and the populations that are most and least likely to receive a drug diversion by state/territory and demographic factors.
- To identify barriers and facilitators to the diversion of use/possess offenders in Australia, eg. legal barriers, program design, resourcing.
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This project aimed to understand experiences of stigma and discrimination for people experiencing problematic alcohol and other drug (AOD) use in Queensland. Specifically, the research examined:
- Experiences of stigma and discrimination
- The potential for legislation to be stigmatising
- The settings and sectors in which stigma and discrimination occur
- The impacts of stigma and discrimination on health and wellbeing and in particular on recovery and the ability to reconnect with the community
- Circumstances where stigma is not experienced, and evidence of what works to address stigma and discrimination.
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Drug diversion is one of the most utilised policy interventions in responding to drug and drug-related offenders in Australia (Hughes and Ritter 2008; Ritter et al. 2011): and is used to divert alcohol and other drug (AOD) offenders away from the traditional criminal justice response and/or into drug education and treatment.
This monograph (No. 25) provides an evaluation of the ACT alcohol and other drug diversion system (including five different programs that operate via police and courts). The evaluation was funded by the ACT Health Directorate and undertaken in 2012. It employed a systems approach: accordingly, it focused on how the five programs operate together, rather than merely the inputs and outcomes of individual programs. Key elements included:
- A conceptual map of the current system: What is the current map of the ACT drug diversion system in its entirety taking into account its contexts and the full range of programs? How are the programs delineated? How do clients move around the system?
- Resources: What resources are being allocated and what are the costs of service provision?
- Evaluation roadmap: What indicators and evaluation designs can be established so as to assess implementation, outputs and outcomes (positive and negative, intended and unintended) from the ACT drug diversion system?
- Future system: Where can improvements be made, including but not limited to program access, program barriers to be overcome, referral systems, program components and so on?
The evaluation identified many strength of the ACT diversion system, including a breadth of diversionary options, a high rate of referrals and treatment assessment and completion for most programs and the adaptability of the system/system players to perceived gaps/needs. But it also identified opportunities for improvement, including the need for clearer direction for the system, instances of program creep/resource wastage and that a number of sub-groups of AOD offenders were being excluded from the diversion system.
Addendum: In October 2014 the ACT Attorney General announced reforms to the ACT police and court diversion system, including the development of a new ACT Police and Court Drug Diversion Strategy and prioritising space for AOD assessments of drug and drug-related offenders in the courts.
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In responding to illicit drugs, Australian governments expend resources in providing proactive responses, such as drug treatment or policing of drug-crimes. Governments also expend considerable resources on the indirect consequences of drug use, such as emergency department admissions for overdose, or crimes that are committed to obtain income to purchase drugs. This second category of indirect or reactive spending is generally known as the social cost approach. International experts have emphasised that drug budgets should concentrate on the direct, proactive spending by governments, and this approach is taken here.
This study provides a new estimate of Australian governments’ direct or proactive spending on illicit drug policy for 2009/10. Four drug policy domains were examined: prevention, treatment, harm reduction and law enforcement. Federal and state/territory expenditure estimates were derived for each of the four domains. A top-down approach was adopted wherever possible and consistency in method across the four domains was of central concern.
The results reveal that Australian governments spent approximately $1.7 billion in 2009/10 on illicit drugs. This included programs to prevent or delay the commencement of drug use in young people, drug treatment services including counselling and pharmacotherapy maintenance, harm reduction programs such as the needle syringe program, police detection and arrest in relation to drug crimes, and policing the borders of Australia for illegal importation of drugs and their precursors.
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In April 2014 the ACT Government enacted new legal thresholds for serious drug offences. To read about the changes please see here.
Public release of DPMP Monograph 22 was delayed until after enactment of the new laws.
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This work aims to provide an accessible description and assessment of drug policy in Australia from 1985 to 2010. Approaches to drug policy are constantly changing as a result of international and domestic factors, the comings and goings of governments, political imperative and the uptake of new knowledge. Consequently, this report represents the situation as it stands in Australia up to mid-2010. We take the Australian context (section 1) as our starting point, then summarise Australia’s National Drug Strategies over time comparing them to those of other nations (section 2). We then provide analysis of trends and patterns of drug use and harms in Australia (section 3), government action on drugs (section 4), and finish with an analysis of the roles of some of the many actors in the Australian drug policy landscape (section 5).
We take the Australian context as our starting point because drug policy does not sit within a vacuum and is connected with broader economic, social and welfare policies. Using this as our foundation, we then focus on the development of the national drug strategies to examine the ways in which Australia’s drug policy from 1985 to 2010 has been distinctly characterised by harm minimisation, partnership approaches, a balance between policy elements and a commitment to evidence-informed policy. We discuss these features by placing each in the context of the similar and contrasting approaches of the international community.
We examine trends in drug use and associated harms in Australia by analysing data from key population surveys, sentinel surveys of active drug users and data routinely collected, and consider what may account for these changing patterns. We note especially the changing rates of cannabis use in Australia and consider the impact of the notable Australian heroin drought (2000/2001). In this context we make international comparisons, and although the data are limited, we can draw some conclusions about Australia’s drug use and associated harms compared to other nations and how these have changed over time.
We know that drug policy is but one of many factors affecting prevalence of drug use and harms. Due to the complexity of drug policy analysis, we seek to understand how the many competing ‘voices’ within the Australian drug policy landscape shape and influence the nature of drug policy in Australia. In doing so, we consider the ways that advocacy coalitions have translated their beliefs and agendas into policy impact over time, and begin to contemplate possible future impact on choice of policy solutions. We concentrate particularly on the roles played by the research community, the state, international regulatory bodies, and the ‘third sector’, as well as the general public more broadly.
What is perhaps striking about Australian drug policy is the degree of consistency and coherence in the overall approach since 1985 – that is almost 25 years of a consistent approach, without deviation. But despite Australia’s historical position as a champion of ‘harm minimisation’, it appears that Australia is now falling behind some other nations in terms of innovation and continuous development of harm minimisation strategies.
Note on coverage:
This report concerns itself with illicit drugs. Illicit drugs refer to cannabis, heroin, cocaine, amphetamines, ecstasy, hallucinogens and ‘designer’ drugs. Excluded from the term ‘illicit drugs’ are tobacco, alcohol, pharmaceuticals (e.g. benzodiazepines), performance enhancing drugs (e.g. anabolic steroids) and other common substances which may be inhaled for psychoactive effects (e.g. petrol), even when these substances are used illegally. We appreciate that this distinction is artificial and problematic for a number of reasons; for example polydrug use is the norm. However there is a concentration of harms in relation to illicit drugs, limited instruments available for control or regulation and a greater prominence of supply reduction as a mode of control lending itself to policy analysis confined to this frame.
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Aims
The aim of this monograph is to estimate the costs of treatment and health care related to cannabis use disorders in New South Wales (NSW) for the year 2007. It describes the costs associated with treatment for cannabis use disorder and the health care costs attributable to cannabis use. The rationale for this study was to identify these costs for policy and other research purposes as comprehensive studies on cannabis treatment costs have not been undertaken.
Specifically, the types of treatment are:
- Treatment in drug treatment agencies
- Counselling
- Withdrawal management (detoxification)
- Residential rehabilitation
- Assessments (a precursor to treatment)
- Information and education
- Treatment in general practice (provided by general practitioners (GP))
- GP consultations
- Treatment in hospitals
- Cannabis-related hospital admissions
- Treatment of health consequences attributable to cannabis use
- Schizophrenia/psychotic disorders
- Low birth weight (LBW) babies in hospitals
- Road traffic accident casualties
- Treatment in drug treatment agencies
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The authors of this monograph had the following aims:
- To identify the dominant media portrayals used to denote illicit drugs in Australian news media and dominant portrayals by drug type (cannabis, amphetamines, ecstasy, cocaine and heroin)
- To identify the extent to which media portrayals have changed over time (from 2003-2008): measured in terms of the number and type of media reports on illicit drugs
- To explore the impacts of different media portrayals on youth attitudes to illicit drug use: namely their perceptions of the risks and acceptability of use and their likelihood of future use
- To determine if the media differentially affects sub-populations of youth, and if so, to identify the sub-populations of youth that are most responsive to media reporting on illicit drugs.
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EXECUTIVE SUMMARY
Since the adoption of the National Campaign Against Drug Abuse (NCADA) in 1985 coordination has been one of the key mechanisms in the development of effective drug policies in Australia. Coordination, which is defined as the process of synchronising activities towards a common goal with the ultimate aim of attaining more integrated and effective policy outcomes, is not an easy task. Responding to drug use and its attendant harms requires complex, inter-governmental, inter-departmental and inter-sectoral responses. It requires solutions that involve multiple stakeholders: Federal, state, territory and local governments; diverse sectors, particularly health, law enforcement and education; government and non-government service providers and the involvement of business, industry, the media, research institutions, local communities and individuals.
Australia’s reputation for coordination of alcohol, tobacco and illicit drug policies, as exemplified through NCADA and its various iterations, have led to international praise, particularly for the partnership between the health and law enforcement sector (Single, 2001, p. 65). But it is increasingly being recognised that while well coordinated systems can facilitate the capacity for integrated policy development and implementation, poorly coordinated systems may be more deleterious than systems that provide no coordination. Poorly coordinated systems may increase fragmentation, reduce accountability, increase the time and cost of responding, create barriers to services for drug users, reduce public respect for policies and lead to internal conflict between governments, sectors and service providers (Peters, 1998). Indeed in 1997 Single and Rohl (1997) argued that the national system for managing and coordinating the National Drug Strategy was in need of major reform since both its legitimacy and the ability to operate effectively were in serious doubt.
While we note the valuable research that has been conducted into Australian drug policy processes, (see particularly Fitzgerald, 2005; Fitzgerald & Sewards, 2002) to date there has been no explicit study that has focused on the coordination of Australian drug policy. This project rectifies this need by examining the processes and structures for illicit drug policy coordination in Australia. We focus on Australian illicit drug policy coordination in the broadest sense, whether guided and influenced by the National Campaign Against Drug Abuse strategies or National Illicit Drug Strategies and/or both. For reasons of simplicity this project focuses on coordination within and between our national structures and advisory groups, represented at the peak by the Ministerial Council on Drug Strategy. The national advisory processes and structures warrant particular attention given they are the only formal mechanisms at which all levels of government and sectors come together to direct and coordinate Australian drug policy.
This study provides a new approach to looking at coordination, through the lens of “good governance”. Such an approach was adopted both due to the absence of any specific theories or frameworks on coordination, and because of the strong links between coordination and governance.
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Public opinion can be an important determinant of social policy – governments are more likely to pursue policy options when they perceive public opinion to be supportive. In the illicit drugs area public opinion may be a more important factor in contributing to government policy because it is an area that often carries high emotional valence. The aims of this review are threefold:
- To identify the current state of public opinion in relation to illicit drugs in Australia by examining recent public opinion research
- To determine how the public’s opinion has changed over time
- To compare different public opinion surveys and to understand why the results may differ.
To achieve these aims, we sought to identify comparable public opinion surveys related to illicit drugs conducted in Australia over a 23-year reference period (1985-2007). Each survey included in the review is described and reviewed. We then examine how public opinion has changed over that time, using a combination of different survey results. The report concludes with a discussion about the overall trends.
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EXECUTIVE SUMMARY
Aims: The diversion of illicit drug users and drug-related offenders comprises an important component of Australia’s policy response to illicit drugs. Identifying the programs and their key characteristics poses a formidable task for policymakers and researchers, particularly following the recent expansion of diversionary responses. This project aimed to summarise the current state of diversion in Australia: its nature and design. The analysis was guided by the following questions:
- What programs are currently utilised for the diversion of illicit drug users and drug-related offenders?
- What are the key characteristics of the diversion programs?
- What are their similarities and differences?
Results: This project identified 51 programs operating for the diversion of drug and drug-related offenders throughout Australia. By examining their key features we noted that diversion expanded considerably since 2000, and that there was an expansion not only in the number, but also the type of programs.
Diversion is now provided across the full spectrum of the diversion system, via police, courts and specialist courts. Accordingly 31% programs were for police diversion, 22% for court diversion and 18% drug courts (29% were multi-targeted). Some programs targeted drug offences. But the majority either targeted drug-related offenders or were accessible for any offender. This was just one indication of the diversity of program features.
In spite of the diversity an increasingly similar set of diversionary responses was provided in Australia. The five major types ranged from police cautioning to drug court mandated treatment programs. In most jurisdictions three forms of police drug diversion were offered:
- Police diversion for cannabis (29% programs)
- Police diversion for other illicit drugs (25% programs)
- Police diversion for drug or drug-related offenders (46% programs)
Police diversion programs were complemented by two main types of court diversion programs, which targeted primarily minor drug users/drug-related offenders:
- Court diversion for minor drug/drug-related offenders (63%)
- Court diversion for serious drug/drug-related offenders (37%)
Each program type had a unique design, not only in diversionary mechanism, but also in terms of who could access the program and their typical program requirements. In theory this facilitated the provision of diversion across a spectrum of people. It became increasingly clear through this project that while there was a movement towards having five main types of diversion in each jurisdiction, there remained considerable differences in jurisdictional systems. Jurisdictions differed in their priorities towards for example the provision of court or police diversion and in the level of emphasis upon drug courts. Moreover, we identified gaps in some systems for particular types of users. Both factors have potential impacts upon who accesses diversion, the types of outcomes and the overall cost-effectiveness of diversion systems.
Research and policy implications: There has been a concerted commitment to provide diversionary responses across Australia and to the development of a more systematic and targeted approach. This bodes well for the improvement of current designs.
This project also enabled better insight into the nature of diversion in Australia today. It is clear that Australia’s diversionary response has shifted in recent years, in an arguably positive direction. Key features of the current response include firstly that diversion is predominantly used for therapeutic purposes – to divert drug and drug-related offenders into drug education and treatment, rather than out of the criminal justice system. Second, diversion is increasingly systematic. Jurisdictions provide a range of programs for different types of drug users and offenders. Third, jurisdictions have used eligibility criteria and program requirements to target the level and type of intervention according to the type of drug users (cannabis versus other drug users) and severity of drug use/drug-related offending. Such a system brings many advantages including increased potential to address the causes of drug use and offending, to provide a more equitable response, and to maximise the cost-effectiveness of diversion. But there are also potential dangers particularly of complacency or assuming that Australia’s diversionary response is working as best it can.
By documenting the major types of diversion and their unique features we have identified key similarities and differences. The challenge is to facilitate the improvement of Australia’s diversionary response by increasing knowledge of what design features contribute towards the provision of effective diversion and which do not. This demands attention not only to the major types of diversion, but also to the diversionary systems. This represents key challenges, not least of which is the need for new tools and methods to expand this knowledge and provide practical guidance as to the future of Australia’s diversion system.
A number of avenues for future consideration include:
- For whom are drug diversion systems most effective and most ineffective?
- To what extent and how do programmatic features, eg. eligibility criteria and minimum requirements, impact upon program outcomes?
- To what extent are current systems meeting current needs?
- How can jurisdictions best meet future needs?
- How can jurisdictions maximise the cost-effectiveness of drug diversion systems?
It is hoped this document will spark future research and debate concerning the nature and effectiveness of Australian drug diversion programs, and inform Australia’s diversionary response to drug and drug-related offenders, now and in the future.
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When faced with the opportunity to conduct policy-relevant research on illicit drugs, the most obvious question is: What are the current priorities? This project set out to identify the priority areas in illicit drugs from the perspective of government policy makers.
The impetus for the work was the second stage of the Drug Policy Modelling Program (DPMP), a research program aimed at improving the evidence-base for Australian drug policy. The identification of priority areas can inform the DPMP workplan for the next five years. Whilst the project had this overt purpose, the findings are also useful for a number of audiences other than the DPMP research team.
It will be of interest to funding bodies and committees that consider illicit drug policy – to review the extent of concordance between the priorities raised here by bureaucrats and those of their own funding body or committee.
It is also rich fodder for those seeking a relevant research topic – it will hopefully engage and excite a researcher or new student to pick up a drug-related research area.
Finally, it provides a snapshot of the state of play as at 2006 – hopefully in a few years time we will be able to tick off some of the areas, assess progress on relevant research or review the extent to which priorities have changed over time.
A restricted definition of ‘policymaker’ was used here – government officials (bureaucrats) who develop and implement policy. This is not to imply that there are not others substantially influential in the “policy community” including practitioners and researchers, members of government advisory bodies, elected officials and other significant policy advice groups (such as the ANCD). Indeed, other exercises in establishing research priorities have frequently encompassed the research community or broader policy community. The choice to focus only on public servants was deliberate: policymaking is core business for this group; theirs is a voice often not solely focused on; and they are an important key stakeholder to the DPMP. It would be interesting to conduct a corollary study of the other members of the policymaking community and assess the degree of similarity and difference from the views identified here.
The report focuses on illicit drugs, and excludes alcohol and tobacco. A few respondents noted that the licit drugs had a higher priority overall than the illicit drugs.
Australia has a good policymaking track record in illicit drugs, with the use of evidence, solid processes within the structures and a number of important and unique features, such as the cooperation between health and police that make Australia stand out. This report identifies what is not known and problems associated with policy development processes, but should not be taken to be critical of current Australian drug policy.
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This work represents a first step in estimating the different social costs associated with different illicit drugs. More specifically, the report sets out in detail the annual costs in Australia (circa 2004) associated with opiates, amphetamines, cocaine, and other illicit drugs separately across two major classes of social costs: health and crime. The cost estimates are further broken down between dependent users and non-dependent users. These are then combined with prevalence and consumption to generate estimates of the:
- social costs per drug user by drug type; and
- social costs per kilogram (or gram) for each drug type.
The work is important because, by generating estimates such as these, we can begin to evaluate different policy responses in terms of cost savings to the community. Being able to specify the social costs per gram and per user for the main classes of illicit drugs means that we can then evaluate policy responses – such as the potential cost savings of reducing the supply of a specific drug by X kilograms; or the cost savings of decreasing the number of dependent drug users by Y.
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This monograph (No. 13) summarises pilot work to scope the potential uses of systems thinking for developing illicit drug policy. Systems approaches have the potential to offer much to drug policy analysis through their use of participatory methods, capacity to deal with multiple simultaneous policy options, and appreciation of the complexity, interconnectedness and dynamic feedback loops associated with policy decisions. The monograph outlines six systems approaches used by the New Zealand team in exploring illicit drug policy. The results of in-depth interviews with five experienced policymakers and a demonstration project around a policy issue are described. The potential utility of systems approaches in illicit drug policy are demonstrated.
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This Monograph (No. 12) describes the work of the team at ANU in exploring the relationship between popular music and drug use. Popular culture has significant potential to influence drug prevention efforts. Popular culture represents and can create the norms and cultural milieu that can either encourage or discourage drug use. To date, there has been little systematic endeavour to study the relationships between popular culture and the milieu it creates around drugs. This pilot study concentrated on one aspect of popular culture – music. The team interviewed a small group of young people and people from the music industry to begin to explore the complex set of potential associations between music and drug use.
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This monograph (No. 11) reports on the work of the complex systems scientists at ANU. Complexity Theory is a loose cluster of theories and methodologies aiming at understanding the properties of complex adaptive systems. Complex adaptive systems (CAS) are ones characterised by: emergence, path dependency, non state equilibrium and adaptation. The heroin drug market fits these characteristics nicely. The features of the agent-based model, called SimDrug, include the spatial environment, time scale and social agents. SimDrug includes different types of social agents: users, dealers, wholesalers, police constables and outreach workers. Each type represents a minimum set of characteristics and dynamics that allow the whole artificial population to display most of the properties observed in real societies. The model has proved robust and stable. SimDrug has demonstrated the plausibility of using a multi-agent system model to describe the relationships between heroin users, dealers, their surroundings and the two interventions modelled (outreach workers and police). In future developments, we hope that policymakers will be able to use the model to determine potential scenarios as a result of their intervention.
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This Monograph (No. 10) provides a description and review of the routinely collected data sources available in Australia that capture information on illicit drug use and related harms. Based on work undertaken at the National Drug and Alcohol Research Centre and Turning Point Alcohol and Drug Centre, it is intended as a reference document to provide interested persons with a guide to the type and nature of the information available in Australia. It reviews available data across four main domains: patterns and prevalence of use, health consequences, market characteristics and drug crime. For a review of information available on the economic aspects of illicit drug use and harm see Monograph 09 of this series.
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This Monograph (No. 9) approaches drug markets from an economic perspective. It outlines central economic concepts in an accessible form for the non-economist, then reviews four key aspects of the Australian heroin drug market. These are: measuring the size of the heroin market, heroin prices, the heroin distribution network (using a risk and prices framework), and the relationship between heroin price and harm (in this case overdose).
The monograph sets out to summarise the existing information and data, and identify what we don't know about the heroin drug market. The authors conclude with a number of insights about the heroin market in Australia. We have much information to inform our understanding but it appears to be underutilised. The amount of heroin consumed may be substantially less than is commonly thought (potentially attributable to the heroin 'shortage'). Price is responsive to market changes – large increases in heroin price occurred with the decreased availability of heroin. The authors also demonstrate a strong relationship between heroin price and non-fatal heroin overdose – as price increases, overdoses decrease. Future research into heroin markets in Australia could provide more detailed examination of causal relationships (and move away from descriptive research).
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This Monograph (No. 08) provides a reflective account of the different disciplinary approaches to studying illicit drug markets. The term ‘drug market’ is used widely in illicit drug research, and means different things to different researchers. An economist may have a very specific view of what is meant by a drug market, and that will differ from one held by an ethnographer. The monograph endeavours to describe and explain five different disciplinary approaches to studying drug markets – ethnographic and qualitative approaches; economic approaches; behavioural and psychological research; population-based and survey research; and criminology and law enforcement evaluation. Each discipline has strengths and limitations. I do not argue for the supremacy of one approach, but that we need to appreciate the different approaches and develop better multi-disciplinary models.
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This Monograph (No. 7) outlines a systematic review of school-based drug education. Whilst the Griffith team started with the broad brief of prevention, it became clear that a focus on school-based drug education would be most useful, particularly as a systematic review in relation to its impact on illicit drugs had not been previously conducted. The review identified 58 relevant studies, and both a qualitative (narrative) and quantitative (meta-analytic) review were undertaken.
Those programs demonstrating most effectiveness were social influence and competency enhancement programs. Less promising and iatrogenic effects were found for affective education and knowledge dissemination. In contrast to previous research on school-based drug education, this review found that professionals were less effective than teachers, that multifaceted programs did not demonstrate substantially greater efficacy; and involvement of peers or booster session had minimal impact. Programs with a greater number of sessions were more effective, and interactive programs were associated with greater effectiveness.
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This monograph (No. 6) reports on the systematic review of harm reduction. Harm reduction was defined as policies and interventions that focus on reducing the harms associated with drug use, not the amount of drug used. The following interventions were reviewed: needle syringe programs; supervised injecting facilities; non-injecting routes of administration; outreach; HIV education and information and HIV testing and counselling; brief interventions (aimed at harm reduction); overdose prevention interventions and legal and regulatory frameworks.
There is substantial evidentiary support for NSP – as an efficacious, effective and cost-effective intervention. There is also good evidentiary support for outreach. The other harm reduction interventions (supervised injecting facilities, non-injecting routes of administration, overdose prevention, and brief interventions) do not currently have a sufficiently large body of research knowledge to draw strong conclusions. There is little evidence for HIV education and information and HIV testing and counselling as behaviour change interventions.
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This monograph (No. 05) provides an annotated bibliography of all the relevant drug law enforcement literature. The team at Griffith University have collated and summarised the extant research literature and completed two systematic reviews – a narrative review and a meta-analytic review. These have both been published in peer review journals. This monograph provides the reader with a detailed list of all the published law enforcement literature, broken down into categories of: international/national interventions; reactive/aggressive interventions; proactive/partnership interventions; individualised interventions; and combination of reactive/aggressive & proactive/partnership interventions.
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This Monograph (No. 4) focuses on the policy making process. To achieve our overarching goal of improving illicit drugs policy activity in Australia, we need to improve the evidence base used by policy makers and to facilitate their use of it. Our limited understanding of how policies are made is one of the barriers to providing good decision support resources and processes. In this feasibility research, the ANU team trialled three approaches that are standard in political science but little used in illicit drugs research: 1) structural and institutional analysis; 2) reputational influence mapping; and 3) interviews with influential policy makers and researchers.
Over the last two decades, a set of structures has been put in place at various levels with the explicit goal of facilitating policy activity on illicit drugs. The team identified over 100 organisations involved in creating Australian illicit drugs policy. The reputational influence mapping research explored methods for gaining a clearer understanding of which people are perceived to be the most influential in shaping policy on illicit drugs in Australia. The social network of people regarded as influential does not have a random topography. The interviews with senior policy makers revealed much about policy processes and the research-policy nexus. The insights from this research will lead to more detailed research on policy processes.
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This monograph (No. 3) reports on work that tested new methods for estimating the prevalence of problematic heroin use in Melbourne. Using the non-fatal heroin overdose data, three different capture-recapture methods were employed. Estimates were derived for the year 2000 and the year 2003/2004. The lack of plausibility of some estimates coupled with the poor ‘goodness-of-fit’ of some models points to the need to continue to develop new methods for estimating problematic heroin use.
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This Monograph (No. 2) provides a comprehensive list of drug policy interventions. The authors identify a total of 107 different drug policy interventions, whilst also noting that some interventions may still be missing, and that others may describe and document drug policy interventions with different terms. With such an undifferentiated and long list of drug policy interventions, the issue of the ways in which these interventions are then coded and classified is also addressed. Ten different taxonomies (classification schemes) are reviewed and conclusions drawn in relation to which taxonomies prove useful in describing the array of drug policy interventions.
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This Monograph (No 1), the first in the series, outlines work by Tim Moore to establish estimates of government spending for the year 2002/03. This is not a social cost (or burden of illness) study but an examination of how much governments (federal, state and territory) spend on responses to illicit drugs.Two types of spending have been identified: spending on direct policy actions (such as drug treatment, or policing drug offences) and spending on the indirect or consequential aspects of illicit drug use (such as ambulance attendance at overdose). The former are referred to as ‘proactive’ spending; the latter as ‘reactive spending’. Proactive spending, the direct actions of government in relation to drug policy, are broken down by type of intervention: prevention, treatment, harm reduction, law enforcement and interdiction. The total estimate for proactive illicit drug spending is $1.3 billion for 2002/03. Law enforcement represents 42% and interdiction 14%, together comprising the majority of spending. Prevention represents 23% and treatment 17%. Sensitivity analyses reveal large plausible ranges for some of the figures.
This work is vital to understanding the current government investment, but it does not permit judgements about what the spending should be, nor its distribution. In order to take it to the next step, dynamic models of policy impacts are required. These models use as their foundation the potential cost savings if policy is shifted.