The National Drug Strategy 2010-2015
Pillar 3: Harm reduction
Harm reduction works to reduce the adverse health, social and economic impacts of drug use on communities, families and individuals.
An individual’s engagement in drug use, illegal drug supply or illegal drug manufacture generally has flow-on health, social, economic, environmental and other consequences. These consequences extend to family, the workplace, neighbourhoods, the community and the individual.
In relation to alcohol, efforts to prevent drink driving and reduce the incidence of alcohol-related road accidents have been a key harm-reduction approach over a long period. Programs and interventions to tackle risky drinking, including liquor licensing and responsible service of alcohol, education and information programs and community-based approaches, have aimed to reduce alcohol-related public violence. Brief interventions, treatment for alcohol dependence and family support services can help reduce the incidence and impact of family conflict and violence.
In relation to tobacco, harm-reduction efforts have included minimising exposure to second-hand smoke through bans on smoking in workplaces and enclosed public spaces and, in some jurisdictions, bans on smoking in cars where children are present.
In relation to injecting drug use, needle and syringe programs have been the main harm-reduction approach, helping to slow the spread of blood-borne viruses like HIV and hepatitis C. Readily available needle disposal facilities and other strategies as simple as well-lit streets have helped improve community amenity in areas where injecting drug use takes place. Some jurisdictions have used innovative approaches, including a medically supervised injecting centre in one jurisdiction.
For illegal drugs more generally, programs to divert offenders from the criminal justice environment into treatment or other health interventions have helped increase the chances of recovery and reduce the likelihood of individual recidivism harming the community. Strategies to prevent and effectively manage drug overdose have also been important harm-reduction responses. In addition, some jurisdictions have implemented road-side drug testing to detect and deter drug-impaired driving.
Other harm-reduction approaches have included the provision of chill-out spaces, water, information and peer support and emergency medical services at events where drug use may be occurring.
Objective 1: Reduce harms to community safety and amenityA significant and sometimes overlooked harm from drug use is the impact it can have in reducing the extent to which people feel safe in their communities. Heavy alcohol consumption can lead to threats and assaults, vandalism, public disorder and road accidents. Illegal drug use—particularly injecting drug use—can affect people’s perceptions of the safety of their community and the business confidence of an area. The illegal drug trade and drug use contributes to significant social costs through property crime and violence.
As higher-density living becomes the norm in our cities, greater attention is needed on public safety and health services, and supporting social connectedness. This also involves improving perceptions of public safety and amenity.
Rural and remote communities, and Indigenous communities, are also affected by the impact on safety and amenity generated by alcohol, tobacco and other drug use.
- Make local communities and public places safer from alcohol-related violence and other incidents through stronger partnerships between health, law enforcement, liquor licensing, local government and planning and transport authorities.
- Continue to work within jurisdictions on transparent approaches on alcohol outlet density and takeaway hours and share examples of best practice.
- Consider further reforms to drink-driving laws and develop effective evidence-informed responses to driving under the influence of illegal and pharmaceutical drugs.
- Provide new supports for frontline workers (such as police, emergency medical service workers, paramedics, emergency department personnel and welfare workers) to manage poly-drug use and related aggressive behaviours in public places.
- Continue existing harm-reduction efforts including needle and syringe programs and safe disposal of used injecting equipment and improve access for disadvantaged populations.
- Improve community and workforce awareness of the health dangers of clandestine laboratories and the need for remediation of sites.
- Work with industry and consider regulation and other ways to reduce harms from emerging substances of concern, for example addressing the potential for energy drinks to exacerbate alcohol-related problems in public places.
Objective 2: Reduce harms to familiesThe families of people using drugs—their parents, partners and children—often suffer significant impacts from their drug use. Support needs to be available to families, particularly with children, to help them manage the stresses they may be experiencing from a family member’s drug use and help engage them in managing the individual’s drug-related problem. Families also aid in recovery. Services for people with drug-related problems need to recognise the impact of drug use on families and help ensure they are provided or connected with the right support. This applies both to specialist alcohol and other drug treatment services and to policing, social welfare and other services that may be interacting with people with drug-related problems.
Alcohol is most commonly supplied to minors by parents and other family members. There are mixed community views on introducing teenagers to alcohol, with some support for introduction in a safe family environment. However, emerging health evidence highlights the importance of delaying introduction to alcohol as long as possible.
Drinking during pregnancy can have a significant impact on children in utero and cause a range of disorders known as foetal alcohol spectrum disorders (FASD). These include birth defects and developmental difficulties. FASD has been a particular issue in some Indigenous communities. Coordinated education and information campaigns and other clinical and community-led strategies are needed to help prevent FASD, and action is needed to improve the diagnosis and clinical management of affected children and to make available appropriate supports to those children and their families.
In relation to tobacco, families and communities have an ongoing responsibility to protect children from second-hand smoke and to help prevent children learning to smoke by example from parents and other respected elders. Efforts to reduce smoking among pregnant women, and prevention of the exposure of pregnant women and babies to second-hand smoke should be particular priorities.
- Enhance child and family sensitive practice in alcohol and other drug treatment services and build links and integrated approaches with community, family and child welfare services.
- Review existing national frameworks which address some of the causes of drug use, for example domestic violence strategies, and consider related actions that could be taken under the National Drug Strategy.
- Develop initiatives to reduce the secondary supply of alcohol to minors including through community education and information campaigns advising parents of health and social harms from alcohol and potential criminal justice outcomes.
- Continue preventive approaches to alcohol, tobacco and other drug use during pregnancy, including community education.
- Develop coordinated measures to prevent, diagnose and manage foetal alcohol spectrum disorders and make available appropriate supports to affected children and families.
- Consider the introduction of health warning labels, including pregnancy health warnings, on alcohol products.
- Introduce regulation and other appropriate measures to reduce the exposure of children to tobacco smoke in cars and other places.
Objective 3: Reduce harms to individualsSome of the major challenges in responding to the harms to individuals caused by drug use and poly-drug use lie in making individuals aware of the harms to their health, safety and wellbeing from drug use, motivating them to seek and engage with treatment, and connecting them with appropriate treatment and other support services.
For many individuals this requires a change of perspective and self-acknowledgement of a drug-related problem before there is a willingness to enter treatment.
Injecting drug use carries additional risks and harms for the individual, requiring particularly focused approaches. Disadvantaged populations may also be at greater risk of harm from drug use.
- Strengthen evidence-based drug education initiatives to ensure they are appropriately targeted in terms of patterns of drug use through the life span and mode of delivery.
- Enhance treatment and associated service systems across settings to provide help at all stages of drug use, particularly for disadvantaged populations.
- Raise awareness of the harmful impacts of drug use in the workplace including through resources that promote improved practice and better links to treatment and other support.
- Develop and implement internet-based approaches to target individuals with problematic drug use who do not think they have a problem and encourage them into treatment and/or other service supports.
- Continue successful illicit drug diversion programs and extend their application to alcohol and other substances where indicated.
- Sustain efforts to prevent drug overdose and other harms through continuing substitution therapies, withdrawal treatment and other pharmacotherapies.
- Support peer-based approaches to reducing harms associated with an individual’s drug use.
- Continue support for needle and syringe programs and encourage safe injecting practices.
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