The National Drug Strategy 2010-2015
1. About the National Drug Strategy
The National Drug Strategy provides a national framework for action to minimise the harms to individuals, families and communities from alcohol, tobacco and other drugs.
At the heart of the framework are the three pillars of demand reduction, supply reduction and harm reduction, which are applied together to minimise harm. Prevention is an integral theme across the pillars.
The 2010–2015 framework builds on longstanding partnerships between the health and law enforcement sectors and seeks to engage all levels and parts of government, the non-government sector and the community.
Australia has had a coordinated national policy for addressing alcohol, tobacco and other drugs since 1985 when the National Campaign Against Drug Abuse was developed. In 1993 it was renamed the National Drug Strategy. This 2010–2015 iteration is the sixth time the strategy has been updated to ensure it remains current and relevant to the contemporary Australian environment.
To build safe and healthy communities by minimising alcohol, tobacco and other drug-related health, social and economic harms among individuals, families and communities.
Throughout this strategy, these terms are used:
- Illegal drug
- Other substances
The harms from drug useThe harms to individuals, families, communities and Australian society as a whole from alcohol, tobacco and other drugs is well known.
- The cost to Australian society of alcohol, tobacco and other drug misuse 2 in 2004–05 was estimated at $56.1 billion, including costs to the health and hospitals system, lost workplace productivity, road accidents and crime. Of this, tobacco accounted for $31.5 billion (56.2 per cent), alcohol accounted for $15.3 billion (27.3 per cent) and illegal drugs $8.2 billion (14.6 per cent).
- The excessive consumption of alcohol is a major cause of health and social harms. Short episodes of heavy alcohol consumption are a major cause of road and other accidents, domestic and public violence, and crime. Long-term heavy drinking is a major risk factor for chronic disease, including liver disease and brain damage, and contributes to family breakdown and broader social dysfunction. Drinking during pregnancy can cause birth defects and disability, and there is increasing evidence that early onset of drinking during childhood and the teenage years can interrupt the normal development of the brain.
- Tobacco smoking is one of the top risk factors for chronic disease including many types of cancer, respiratory disease and heart disease.
- Illegal drugs not only have dangerous health impacts but they are a significant contributor to crime. They are a major activity and income source for organised crime groups. Like alcohol, illegal drugs can contribute to road accidents and violent incidents, and to family breakdown and social dysfunction. Unsafe injecting drug use is also a major driver of blood-borne virus infections like hepatitis C and HIV/AIDS.
- Other drugs and substances that are legally available can cause serious harm. The harmful use of inhalants, like petrol, paint and glue, can cause brain damage and death. The misuse of pharmaceutical drugs can have serious health impacts and their trafficking contributes to illegal drugrelated crime.
- Alcohol, tobacco and other drug use can contribute to and reinforce social disadvantage experienced by individuals, families and communities. Children living in households where parents misuse drugs are more likely to develop behavioural and emotional problems, tend to perform more poorly in school and are more likely to be the victims of child maltreatment. Children with parents who drink heavily, smoke or take drugs are more likely to do so themselves—leading to intergenerational patterns of misuse and harms. Family breakdown and job loss is also associated with problematic drug use.
- Disadvantaged populations are at greater risk of harms from alcohol, tobacco and other drug misuse. For example, Aboriginal and Torres Strait Islander peoples experience a disproportionate amount of harms from alcohol, tobacco and other drug use. Drug-related problems play a significant role in disparities in health and life expectancy between Indigenous and non-Indigenous Australians. Indigenous Australians are more likely to die of smoking-related illnesses, such as diseases of the respiratory system and cancers, than other Australians.
Harm minimisationSince the National Drug Strategy began in 1985, harm minimisation has been its overarching approach. This encompasses the three equally important pillars of demand reduction, supply reduction and harm reduction being applied together in a balanced way.
- Demand reduction means strategies and actions which prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs; reduce the misuse of alcohol and the use of tobacco and other drugs in the community; and support people to recover from dependence and reintegrate with the community.
- Supply reduction means strategies and actions which prevent, stop, disrupt or otherwise reduce the production and supply of illegal drugs; and control, manage and/or regulate the availability of legal drugs.
- Harm reduction means strategies and actions that primarily reduce the adverse health, social and economic consequences of the use of drugs.
The National Drug Strategy 2010–2015 seeks to build on this multi-faceted approach which is recognised internationally as playing a critical role in Australia’s success in addressing drug use.
Figure 1: Harm minimisation approach
Text-based description of image:
The diagram is a three column design, with each column containing five separate boxes.
The middle column consists of five boxes. Box 1 is the largest of the diagram and is labelled Harm Minimisation. This box contains three interlinking circles in a triangular pattern labelled Demand Reduction, Supply Reduction and Harm Reduction. Below Box One, Column 2 is four boxes labelled Workforce, Evidence base, Performance measures and Governance. The fifth box also includes the wording "including partnerships and consumer participation".
All boxes in Columns 1 and 3 are equally spaced down the sides of Box 1 and Column 2 and have arrows pointing towards the first box in Column 2.
The first box (Column 1) is labelled Alcohol. The remaining four boxes sit below box 1 and are labelled; Tobacco, Illegal drugs, Pharmaceuticals, and Other substances.
Column 3 consists of 5 boxes that are the same shape and size as Column 1. The first box of Column 3 is labelled Disadvantaged populations with the remaining four boxes below labelled Age/stage of life, Settings, Partnerships, and Other frameworks.
Figure 1 illustrates the approach that will be taken to implement the harm minimisation framework under the National Drug Strategy 2010–2015:
- The three pillars apply across all drug types but in different ways. For example, supply reduction of legal drugs refers to regulation of supply, but for illegal drugs means disruption of supply. This is covered in more detail against each pillar.
- The approaches within the three pillars need to be sensitive to age and stage of life, disadvantaged populations and settings of use and intervention. People may be more vulnerable to experimenting with drugs at transition points such as moving from school to work. The workplace, schools, licensed premises and communities need to be considered as settings for possible interventions. The potential of new media, such as social networking sites on the internet, to deliver interventions also needs to be considered. Integrated cross-sectoral approaches may be needed for disadvantaged populations such as people with cooccurring mental health and alcohol and other drug-related problems. These are explained in more detail below and against each pillar.
- The three pillars will be underpinned by commitments to:
- partnerships across sectors
- consumer participation in governance
- building the evidence base, evidence-informed practice and innovation
- monitoring performance against the strategy and its objectives
- developing a skilled workforce that can deliver on the strategy.
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Successes of the National Drug StrategySince the inception of the National Campaign Against Drug Abuse in 1985, Australia has had major successes in reducing the prevalence of, and harms from, drug use.
- Far fewer Australians are smoking and being exposed to second-hand smoke as a result of comprehensive public health approaches, including bans on advertising, bans on smoking in enclosed public spaces and significant investments in public education and media campaigns. The daily smoking rate among Australians aged 14 years and over has fallen from 30.5 per cent in 1988 to 16.6 per cent in 2007.
- Far fewer people are using illegal drugs. The 2007 National Drug Strategy Household Survey shows the proportion of people reporting recent use of illegal drugs fell from 22 per cent in 1998 to 13.4 per cent in 2007. The recent use of cannabis—the most commonly used illegal drug—fell from 17.9 per cent in 1998 to 9.1 per cent in 2007.
- Law enforcement agencies have continued to be effective in detecting and seizing illegal drugs to disrupt supply. The number of illegal drug seizures increased by almost 70 per cent between 1999–2000 and 2008–09, and the collective weight of seizures increased by about 116 per cent.
- The heroin shortage that began in 2000 has been sustained, with heroin use remaining at low levels since then.
- Harms associated with injecting drug use have also been reduced. It is estimated that from 2000–2009 needle and syringe programs, which ensure the safe supply and disposal of syringes to injecting drug users, have directly averted over 32 000 new HIV infections and nearly 97 000 hepatitis C infections.
- Since its introduction in September 2005 non-sniffable Opal fuel has contributed to a 70 per cent reduction in petrol sniffing across 20 regional and remote communities in Western Australia, South Australia, the Northern Territory and Queensland.
- Early intervention and diversion programs, which help prevent young people and adults apprehended for drug use from getting caught up in the criminal justice cycle by diverting them to treatment interventions, have become an established and successful part of the harm minimisation approach.
- Drink driving has become largely unacceptable within the general Australian population. There was a substantial reduction in alcohol-related road deaths between the mid 1970s and the early 1990s through mass breath testing of drivers, lower and nationally consistent driver blood alcohol content limits, zero limits for special driver groups, a system of penalties, mass public education and media campaigns and other road safety initiatives.
- Far more is known about what works in the treatment of alcohol and other drug dependence, including through brief interventions, detoxification, pharmacological and psychosocial treatment approaches.
Challenges for 2010-2015Many challenges still remain. The following have been identified as drug-specific priorities for 2010–2015:
- Risky drinking, drinking to intoxication and alcohol-related disease, injury and violence continue to cause significant harms in the community. An estimated 813 072 Australians aged 15 years and older were hospitalised for alcohol-attributable injury and disease over the 10-year period 1995–96 to 2004–05. Rates of alcohol-attributable hospitalisations increased in all states and territories. Alcohol remains a leading cause of Australian road deaths, particularly among young people.
- Smoking rates continue to be unacceptably high in the general population—16.6 per cent smoked daily in 2007—and particularly among Aboriginal and Torres Strait Islander people, of whom around 45 per cent smoked daily in 2008. The Council of Australian Governments (COAG) has agreed in the National Healthcare Agreement 2008 to targets of reducing the prevalence of smoking in the Australian population to 10 per cent by 2018 and to halving the smoking rate among Aboriginal and Torres Strait Islander peoples.
- Changing patterns of use of, and harms from, illegal drugs need to be continually monitored and responded to. At the time of writing in 2010, emerging trends included:
- increasing harms from cannabis. The number of older users presenting to hospital with dependence and other cannabis-related problems increased markedly between 2002–07 and nearly doubled among users aged 30–39. Hospital presentations for cannabis-induced psychosis were highest among users aged 20–29. The number of hospital outpatient treatment episodes for cannabis-related problems increased by 30 per cent. Cannabis cultivation continues to be an activity of interest for organised crime.
- continuing high demand for ecstasy and domestic production of amphetamine type stimulants (ATS). Self-reported recent use of ecstasy increased from 2.4 per cent in 1998 to 3.5 per cent in 2007 with particularly concerning increases among young women. ATS arrests more than doubled between 1999–2000 and 2008–09. Manifestations of extreme behaviour in ATS users, including violence, increases risks for police, ambulance, and hospital emergency department workers, as well as users and the community. Organised crime involvement in manufacturing and trafficking ATS is also a concern.
- an expansion of the cocaine market is reflected in recent increases in cocaine arrests, seizures and reported use. Two distinct user groups have been identified. The first is employed, well-educated and socially integrated individuals and the second injecting drug users.
- while rates of heroin and other injecting drug use have stabilised at low levels, harms from ongoing heroin and other injecting drug use persist, particularly in relation to blood-borne virus infections and overdose.
- new ‘analogue’ drugs—derivatives or substances similar in chemical structure to illegal drugs—are emerging, particularly in sales over the internet. Many of these substances have not yet been captured under the drug law schedules which govern their legal status.
- The harms from drug use are potentially amplified by the increasing pattern of poly-drug use—the concurrent use of more than one drug. Alcohol is the drug most commonly used in this way. For example, it is often used with legal drugs resulting in unpredictable consequences. More recently it is increasingly mixed with highly-caffeinated products/other stimulants (‘energy drinks’). Mixing of drugs can multiply the effects of each drug, increase adverse reactions and the unpredictability of the reactions and even increase the risk of overdose.
- Pharmaceutical drug misuse. The most commonly misused pharmaceuticals include opioids, benzodiazepines, codeine, the stimulants methylphenidate (Ritalin) and dexamphetamine and performance-enhancing drugs such as steroids. Diversion and misuse of opioid drugs is widespread and prevalent where heroin is not readily available. Misuse also occurs among poly-drug users and those with chronic pain. An extra challenge is balancing the legitimate use of, and access to, pharmaceuticals with the need to prevent harms caused by misuse.
There are a number of structural priorities for 2010–2015:
- The internet poses both challenges and opportunities for the National Drug Strategy. It is an efficient channel for information on illegal drug manufacture and use, and a difficult to regulate advertising medium for alcohol and tobacco. However, it also provides opportunities for providing information, and potentially treatment, to audiences who may not be reached through other media.
- Planning and quality frameworks for treatment services need to incorporate evidence into successful drug treatments.
- Continued work is needed with the mental health sector to improve links and coordination between the two sectors to support individuals with co-occurring mental illness and alcohol and other drug use, and their families.
- Data collection and management is vital to the delivery and evaluation of services and broader policy development. Enhancing the data that is available and how it is used will help inform efforts under the National Drug Strategy.
Age and stage of lifeIt is well recognised that people are at greater risk of harm from drugs at points of life transition. These include transitioning from primary to high school, from high school to tertiary education or the workforce, leaving home and retiring.
- Drinking alcohol in adolescence can be harmful to young people’s physical and psychosocial development. Alcohol-related damage to the brain can be responsible for memory problems, an inability to learn, problems with verbal skills, alcohol dependence and depression.
- The Australian Secondary School Students Alcohol and Drug Survey has consistently shown that fewer students are smoking overall. However, the secondary school years remain a key risk period for the uptake of smoking, with higher rates in each age group from 12 years onwards through adolescence.
- The adolescent drive to take risks and the need for coping mechanisms during adolescence can be major influences on the uptake of illegal drugs by teenagers.
- Young people are more at risk of motor vehicle accidents, injuries, accidental death and suicide whilst under the influence of alcohol and drugs. They are also highly susceptible to being victims of crime.
- Daily cannabis use is most common amongst 40–49 year olds. This age group is nearly twice as likely as 14–19 year olds to report daily use. This is despite an overall decline in the proportion of the population reporting recent use of cannabis.
- The proportion of Australians aged 65 years or older is expected to increase from 12.1 per cent currently to 24.2 per cent by 2051. Older people face particular issues with drug misuse including interactions with prescribed medications, underrecognition and treatment of alcohol and drug problems, unintentional injury and social isolation. Alcohol can increase the risk of falls, motor vehicle accidents and suicide in older people.
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Disadvantage and social isolationDrug use can have a significant impact on disadvantaged groups and lead to intergenerational patterns of disadvantage.
- There is strong evidence of an association between social determinants—such as unemployment, homelessness, poverty, and family breakdown— and drug use. Socio-economic status has been associated with drug-related harms such as foetal alcohol syndrome, alcohol and other drug disorders, hospital admissions due to diagnoses related to alcoholism, lung cancer, drug overdoses and alcohol-related assault. In the 2007 National Drug Strategy Household Survey the highest prevalence of recent illegal drug use was reported by unemployed people—23.3 per cent compared with 13.4 per cent of the general population. Alcohol, tobacco and other drug use among homeless people is common. One study estimated the overall 12-month prevalence of harmful alcohol use for homeless people in Sydney at 41 per cent and the prevalence of drug use at 36 per cent. Family factors—including poor parent–child relationships, family disorganisation, chaos and stress and family conflict and marital discord with verbal, physical or sexual abuse—also have a strong association with drug use. There are a number of strong protective factors that guard against problematic alcohol and other drug use. These include having a job, a stable family life and stable housing. These factors can be important in preventing or overcoming drug-related problems.
- Smoking is the primary cause of chronic disease among Aboriginal and Torres Strait Islander peoples. In 2003 smoking was responsible for one-fifth of deaths and accounted for 12 per cent of the total burden of disease among Aboriginal and Torres Strait Islander peoples. In 2004–05, 55 per cent of Aboriginal and Torres Strait Islander peoples aged 18 years and over reported drinking at shortterm risky or high risk levels on at least one occasion in the previous 12 months.
- Despite a sustained decline in the prevalence of smoking among people in major cities, the decline has been slower among people living in regional and remote areas. Men in these areas were significantly more likely than those in major cities to report risky or high-risk alcohol consumption.
- Thirty-five per cent of people who use drugs also have a co-occurring mental illness. Although people with mental illness benefit from alcohol, tobacco and other drug treatment, they have poorer physical and mental health and poorer social functioning following treatment than other people.
- People in prison have underlying high rates of drug use. In 2009, 81 per cent of prison entrants were current smokers and 74 per cent smoked daily, 52 per cent of prison entrants reported drinking alcohol at levels that placed them at risk of alcoholrelated harm and 71 per cent of prison entrants had used illegal drugs in the 12 months prior to their current incarceration. Injecting drug use and the associated risk of blood-borne virus infection is a particular issue for prison populations. Among prison entrants, 35 per cent tested positive for hepatitis C.
- Some culturally and linguistically diverse (CALD) populations may have higher rates of, or are at higher risk of, drug use. For example, some members of new migrant populations from countries where alcohol is not commonly used may be at greater risk when they come into contact with Australia’s more liberal drinking culture. Some types of drugs specific to cultural groups, such as kava and khat, can also contribute to problems in the Australian setting.
- People from disadvantaged or marginalised groups, such as gay, lesbian, bisexual, transgender and intersex populations, may also experience more difficulty in accessing drug treatment and achieving successful outcomes from that treatment unless it is appropriate for their particular needs. Those who are most at risk are people with multiple and complex needs. This may involve a combination of drug use, mental illness, disability and injury, family breakdown, unemployment, homelessness and/or having spent time in prison.
Under the National Drug Strategy 2010–2015, socially inclusive strategies and actions are needed that recognise the particular vulnerabilities and needs of these disadvantaged groups.
SettingsSettings-based approaches are also a key feature of the National Drug Strategy 2010–2015.
Priority settings for possible preventive interventions on alcohol, tobacco and other drugs will include families, educational settings, workplaces, licensed premises and communities.
More attention is needed to address drug use among prison populations. This includes addressing supply reduction in the prison environment, reducing demand through education and treatment and approaches for reducing harm. Attention is also needed to help prevent drug use from continuing or recurring when people leave prison.
More focus will also be placed on the internet as an important emerging medium for prevention and treatment approaches and as a potentially effective tool for reaching new or hard to reach settings.
PartnershipsSince its inception the National Drug Strategy has been underpinned by strong partnerships, particularly across the health and law enforcement sectors, between the government and nongovernment sectors, and among policymakers, service providers and experts.
For 2010–2015 the health–law enforcement partnership will remain at the centre of the strategy. However, this partnership will be extended to other sectors as appropriate, including education, particularly to help tackle the more complex causes of, and harms from, drug use in the present environment (see Supporting approaches: Governance).
In relation to alcohol, partnerships continue to be needed with liquor licensing authorities, local governments including town planners and transport authorities and local communities to help reduce potential harms. Collaborative partnerships with business also need to be maintained both for regulatory issues and preventative approaches in workplaces.
Strong partnerships and integrated service approaches with alcohol and other drug treatment, social welfare, income support and job services, housing and homelessness services, mental health care providers and correctional services are needed if people with multiple and complex needs are to be assisted to stabilise their lives, reintegrate with the community and recover from alcohol and other drug-related problems.
Closer integration with child and family services is needed to more effectively recognise and manage the impacts of drug use on families and children.
Ongoing partnerships with Aboriginal and Torres Strait Islander communities are also needed to help reduce the causes, prevalence and harms of alcohol misuse and tobacco and other drug use among Aboriginal and Torres Strait Islander peoples.
Finally, Australia needs to engage in international partnerships to maximise the effectiveness of law enforcement efforts, to learn and share best practice demand, supply and harm reduction approaches and to help enhance our regional neighbours’ efforts to respond to the problem of drug use. Under the National Drug Strategy 2010–2015, Australia will continue to actively engage in multilateral forums for international cooperation on alcohol, tobacco and other drug issues, including the World Health Organization and its implementation of the Global Alcohol Strategy, the United Nations Office on Drugs and Crime, the Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control and the United Nations Commission on Narcotic Drugs. The Australian Federal Police and the Australian Customs and Border Protection Service will continue to cooperate with their international counterparts on drug investigations. Australian health and law enforcement agencies and non-government organisations will also continue to engage with developing countries, particularly in the Asia-Pacific region, to provide assistance on drug-related problems where such assistance is needed.
Sub-strategiesA number of sub-strategies sit under the umbrella of the National Drug Strategy 2010–2015. These sub-strategies provide direction and context for specific issues, while maintaining the consistent and coordinated approach to addressing drug use, as set out in this strategy. In particular, the National Drug Strategy Aboriginal and Torres Strait Islander Peoples Complementary Action Plan was developed to provide national direction on drug-related problems that concern Aboriginal and Torres Strait Islander peoples.
During the life of the National Drug Strategy 2010–2015, seven sub-strategies will be updated or developed to address specific priorities:
- National Aboriginal and Torres Strait Islander Peoples Drug Strategy
- National Alcohol Strategy
- National Tobacco Strategy
- National Illicit Drugs Strategy
- National Pharmaceutical Drug Misuse Strategy
- National Workforce Development Strategy
- National Drug Research and Data Strategy.
There are also national strategies and frameworks in other sectors relevant to the work of the National Drug Strategy 2010–2015, where efforts are needed to integrate and leverage complementary approaches. These frameworks are listed in Appendix A.
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