10 Dec 2010
Submission by Dr Khim Harris (Fresh Start Recovery Programme)
Introduction and Mission
Overall, we believe that the 2010-2015 Strategy needs to have a more recovery-focussed approach to treating addictions, much like the new UK Drug Strategy, launched by the British Government on 8 December 2010.
The Pillars: Supply Reduction
The Pillars: Demand Reduction
On page 21, the Draft Strategy mentions “A range of appropriate, specialised services should be available to anyone with a drug problem, irrespective of personal history, complex circumstances or socioeconomic status.” In the actions below, the report mentions only to “sustain efforts to increase access to, and links between, a greater range of treatment and other support services.”
We believe that emphases should be placed on the use of antagonist pharmacotherapies in the role of helping those individuals that are seeking a method of cessation of drug addiction. Currently this is only available to individuals living in Australia if they are prepared to travel to Western Australia.
The Pillars: Harm reduction
On page 28 of the Draft Strategy, under the "actions for Objective 3: Reduce harms to individuals
• Sustain efforts to prevent drug overdose and other health harms through continuing substitution therapies and withdrawal treatment.";
As the current level of those addicted to illegal opiates remains the same (2007 National Drug Strategy Household Survey), the current efforts don’t seem to be reducing the number of individuals using illegal opiates, only increasing those taking government funded legal opiates (Since 1998 the number of pharmacotherapy clients receiving pharmacotherapy treatment on a ‘snapshot/specified’ day, has increased from 24,657 to 43,445, National Opioid Pharmacotherapy Statistics Annual Data collection: 2009 report). Surely the drug strategy should be to increase the effort to reduce health harm, by focusing on helping those to become drug free by promoting abstinence therapies over maintenance therapies.
Evidence base and Performance measures
We would like to ask why is it that in the Draft there is not a measure of the reduction of individuals being prescribed government funded opiates. For example, there are currently some 43,445 people in Australia receiving pharmacotherapy treatment, with 30,000 of them receiving methadone (source: National Opioid Pharmacotherapy Statistics Annual Data collection: 2009 report). Whilst this helps in reducing the prevalence of people using an illegal drug (opiate), there is no performance measure to record the number of people ceasing their drug use. This should be the priority of any government in its drug strategy to help people to move from a situation of drug abuse to a drug free lifestyle in the shortest period possible. If there is no measure to reduce the no. of individuals on these programs, then there is no pressure or incentive in helping people to become opiate free. W
A recent paper published in the British Medical Journal reported that “exposure to opiate substitution treatment was inversely related to the chances of achieving long-term cessation”. For patients who did not start opiate substitution treatment, the median duration of injecting was five years – with almost 30% ceasing within a year – compared with 20 years for those with more than five years’ exposure to treatment (Kimber et al, 2010). As most patients on methadone maintenance are still likely to inject illegal opiates, albeit at a much reduced level pre methadone, they are likely to inject illegal opiates over a greatly increased period and are less likely to gain abstinence from opiate addiction. Is it not in the best interest of everyone involved, to provide alternative pharmacotherapies that help the individual to attain abstinence from all opiates and the risks associated with opiate use?
We wish to propose that a better measure of the success of the drug strategy is to measure the number of individuals who achieve a drug free lifestyle from both illegal and legal substances. This would then focus all those involved in implementing the drug strategy to work towards helping people wanting to become drug free.
Overall the draft strategy is vague and non-specific on how the government is going to reduce the number of individuals who are addicted to illegal and government funded legal drugs. More resources need to be directed towards helping people to become drug free in as short as time as possible.
In the 2006 paper entitled “Australian Government Response to the House of Representatives inquiry into substance abuse in Australian communities - Road to Recovery: Report on the inquiry into substance abuse in Australian communities”, there was a recommendation to “give priority to treatments including naltrexone that focus on abstinence as the ultimate outcome.” We would like to see this recommendation actioned by the current Government.
The Draft Strategy makes no reference to individuals addicted to both legal and illegal opioids who wish to become drug free and ultimately an active, functioning member of their community. Why is it that antagonistic pharmacotherapies are not included in the Government’s Draft Strategy, when there is clear evidence for their effectiveness?
2007 National Drug Strategy Household Survey: first results http://www.aihw.gov.au/publications/index.cfm/title/10579
National Opioid Pharmacotherapy Statistics Annual Data collection: 2009 report http://www.aihw.gov.au/publications/index.cfm/title/11417
Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D, et al. Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitute treatment. BMJ 2010:341:c3172.
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