The National Drug Strategy 2010-2015
3. Supporting approaches
The three pillars of the National Drug Strategy 2010–2015 are underpinned by the development of a qualified workforce, maintaining and improving the evidence base, monitoring performance and enhancing governance.
Commitment to workforce developmentAn appropriately skilled and qualified workforce is critical to achieving and sustaining effective responses to drug use.
The National Drug Strategy 2010–2015 is committed to addressing a range of factors affecting the ability of the workforce to function with maximum effectiveness.
Who is the workforce?The Australian alcohol and other drug workforce involved in the prevention and minimisation of drug misuse is highly varied, spanning a diverse range of employment sectors, industries and communities.
Exposure to people who misuse drugs and the consequences of their drug use varies across the workforce. Each of the following groups has unique and specific workforce needs that require comprehensive and systematic development:
- Alcohol and other drug workers in treatment, prevention, health promotion and community services comprise multiple occupations that are engaged in a wide variety of roles. These include alcohol and other drugs specialists, generalist workers, needle and syringe program workers and peer workers. Appropriately qualified, skilled and experienced alcohol and other drug workers also have a role in partnering with and advising other services who encounter people who use drugs.
- In their day-to-day operations, the law enforcement workforce, including police, customs and border protection officers and corrections officers regularly engage with the consequences of drug misuse.
- Emergency medical services, paramedics, emergency department personnel, police and corrections officers are faced daily with the traumatic effects of drug misuse.
- The mental health workforce has a close professional affiliation with the alcohol and other drug workforce, often sharing an overlapping client base.
- The health and medical workforce, including general practitioners and other primary healthcare workers and hospital workers, has regular exposure to alcohol, tobacco and other drug use and its consequences and responsibility for treating a range of associated medical problems and the appropriate prescribing of pharmaceuticals.
- Indigenous health and law enforcement workers are at the front line for delivery of services related to preventing and minimising drug use and associated problems in their communities.
- Specialist groups such as culturally and linguistically diverse health workers and those working in other areas such as child protection and disability services deal with a range of complex community needs.
- Pharmacists and the pharmacy workforce often have close contact with drug use through their commitment to the provision of opioid substitution treatment and needle and syringe programs. They also have an important role in precursor control, preventing pharmaceutical misuse and providing nicotine replacement therapies.
- The education sector plays a key role in prevention and early intervention of drug use.
- Community and support services, including workers from the welfare, child protection, homelessness, unemployment, income support and youth sectors all regularly encounter people experiencing the harms associated with drug use.
- Hospitality workers encounter the harms associated with alcohol, tobacco and other drug use on a day-to-day basis.
What challenges face the workforce?The following have been identified as workforce development priorities for the strategy:
- Promote minimum qualifications of alcohol and other drugs specialist service workers and accreditation of services. Work has commenced in a number of jurisdictions to examine ways to ensure minimum qualifications for workers. This will include feasible options for upskilling workers and accrediting services.
- Promote the inclusion of education on alcohol, tobacco and other drugs in the training of health professionals.
- Support the workforce in establishing and maintaining worker wellbeing.
- Build the capacity of the workforce to respond appropriately, provide support and refer people to relevant services.
- Build the capacity of the workforce to identify inappropriate use of substances and to act appropriately to prevent diversion.
- Build the capacity of the alcohol and other drugs specialist workforce to effectively respond to current and emerging alcohol, tobacco and other drug issues including as they relate to older populations, youth and the opportunities and challenges of new technologies.
- Build the capacity of the treatment workforce to strengthen outcomes from its work.
- Build the capacity of the general health workforce to identify drug-related problems and perform brief interventions.
- Use new technologies to make workforce development more accessible.
- Enhance workers’ research literacy by facilitating research partnerships between clinicians, policy makers and researchers.
- Address specific issues of workforce supply such as attracting and retaining alcohol and other drugs specialist workers, the impact of the ageing workforce and the small Indigenous workforce.
A systematic approach to the workforceThe National Drug Strategy 2010–2015 will continue to support the development of a qualified workforce. The Intergovernmental Committee on Drugs will establish a working group drawing in experts to develop a national workforce development strategy to help address these challenges with a particular focus on the alcohol and other drugs specialist workforce.
Commitment to evidenceAn important aspect of Australia’s approach to drug use has been the commitment to a comprehensive evidence base. Under the National Drug Strategy 2010–2015 there is a continued commitment to evidence-based and evidence-informed practice. Evidence-based practice means using approaches which have proven to be effective. For example, the continuing provision of detoxification, pharmacological therapies including opioid substitution therapies and cognitive behavioural therapies for alcohol, tobacco and other drug treatment is based on an extensive body of evidence in Australia and internationally.
Evidence-informed practice involves integrating existing evidence with professional expertise to develop optimal approaches, including new or innovative approaches in a given situation. The National Drug Strategy 2010–2015 includes a commitment to innovation and trialling new approaches. For example, the introduction of the Illicit Drug Diversion Initiative (IDDI) supported police-based diversion in early intervention and prevention programs before there was comprehensive evidence supporting this approach. The success of IDDI was a catalyst for its expansion into court-based diversion and treatment at correctional centres. IDDI demonstrates that where there is little evidence, leadership is needed to support innovation. Allowing room for the development of such creative approaches to be developed in the future will require new evidence to be collected so that the impact and quality of new interventions is well-understood.
Ongoing evaluation of approaches is also critical to the success of the National Drug Strategy 2010–2015. Evaluation ensures that existing programs and policies are appropriate, effective and efficient in the context of contemporary drug use patterns, trends and settings. For example, the long-standing needle and syringe programs have been regularly evaluated. The results have supported the expansion and evolution of the types of needle and syringe program services offered and demonstrated its ongoing efficacy, cost-effectiveness and public health value.
Generating evidenceUnder the National Drug Strategy a strong evidence base has been built over the past 25 years. This includes health, law enforcement, education, social and cultural evidence that contributes to the application of harm reduction, demand reduction and supply reduction. Three national drug research centres of excellence—the National Drug and Alcohol Research Centre, the National Drug Research Institute and the National Centre for Education and Training on Addiction—funded by the Australian Government under the National Drug Strategy provide and disseminate high-quality research that contributes to evidence-informed practice by health, law enforcement and education services. The research centres undertake work in a number of key priority areas including treatment, prevention, drug use and young people, workforce, Aboriginal and Torres Strait Islander peoples, and emerging trends.
The National Drug Law Enforcement Research Fund is an important contributor to the evidence base for drug law enforcement practices at an operational level. Agencies that contribute to intelligence and research in this area include the Australian Institute of Criminology and the Australian Crime Commission. Most jurisdictions also have centres for criminal statistics and research that identify crime trends.
Other academic institutions contribute to the evidence base with support from the National Health and Medical Research Council, the Australian Research Council, universities and other sources.
It is also important that Australia learns from international evidence relevant to Australian conditions. The introduction of buprenorphine into the Australian treatment repertoire in 2005 was based on substantial international evidence, particularly from Europe, and then rigorously tested in Australia in a multi-centre trial. International sources of research will continue to contribute to the National Drug Strategy 2010–2015.
A systematic approach to research and dataThe National Drug Strategy 2010–2015 will continue to support the development of a strong evidence base including clinical, epidemiological, criminological and policy research. In areas where the evidence base requires further development, a systematic approach is necessary. In response to the recommendation of the evaluation of the National Drug Strategy 2004–2009, the Intergovernmental Committee on Drugs (IGCD) will establish a working group drawing in experts from the national research centres and other institutions to develop a national drug research and data strategy (see also Section 5 on performance measures). This will ensure a systematic approach to drug research by:
- identifying priority areas for new research and areas where evidence needs updating and/or validating
- coordinating research efforts
- facilitating the identification of emerging issues for research
- encouraging the testing and validation of new interventions
- guiding the dissemination of findings and assisting the translation of those findings into practical policies and programs.
Performance measuresAustralia has a rich set of data sources relating to alcohol, tobacco and other drugs. This information contributes to a better understanding of drug markets, patterns of use, associated harms and patterns of treatment. Under the National Drug Strategy there is a strong commitment to improving data collections and using them to guide implementation. This section identifies three high-level performance measures that will help gauge progress and guide implementation of the National Drug Strategy 2010–2015. These measures build on existing performance measures identified in other national agreements such as those identified in the National Partnership Agreement on Preventive Health, the National Healthcare Agreements, the Fourth National Mental Health Plan and The Road Home: A National Approach to Reducing Homelessness.
The performance measures are high-level for several reasons:
- Data are not always comprehensive enough to provide robust national measures of activity and progress.
- It is not possible to directly match the objectives of the strategy, or each drug type, to a performance measure.
- The proposed measures use existing published data sources to help ensure continuity of approach.
The performance measures are intended to provide a broad indication of progress against the three pillars of the National Drug Strategy 2010–2015.
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Performance measure 1: Indicators of drug usePrevalence of drug use is a rough proxy measure of progress in demand reduction. Under the National Drug Strategy measures of prevalence vary according to drug type.
- For illegal drugs—prevalence is defined as the proportion of people who used an illegal drug in the previous 12 months, for each drug type.
- For tobacco—prevalence is defined as the proportion of people who smoke daily.
- For alcohol—prevalence is defined as the proportion of people who consume alcohol at risky levels.
- For all drug types—average age of initiation of drug use is also an important indicator.
Progress against this measure will be indicated by falls in prevalence and increases in ages of initiation. However, there is not necessarily a straightforward relationship between prevalence data and success or otherwise in demand-reduction strategies. Fluctuations in prevalence may be unrelated to underlying demand. For example, increases in the supply of a particular illegal drug may result in increases in opportunistic use. Prevalence data should be considered alongside other performance measures, and complemented by qualitative and quantitative research and contextual information to provide a broad interpretation of the data.
It is also useful to examine prevalence within sub-populations to help guide policy and program responses. For example, in 2007 general population data showed recent use of ecstasy as relatively stable, but closer examination showed a significant increase in use amongst 14–19-year-old females.
Patterns of drug use should also be considered. There may be instances where the general population prevalence of a drug may be decreasing, but among regular users the frequency of use, and potentially associated harms, may be increasing.
Existing published data that will inform this performance measure includes: the National Drug Strategy Household Survey and the National Health Survey for the general population; the Australian Secondary Students Alcohol and other Drug Survey for youth-specific prevalence measures; and the National Aboriginal and Torres Strait Islander Health Survey for this population group. Jurisdictions will also use major statebased population health surveys.
Over time, consideration should also be given to including treatment data in this measure, as the Alcohol and Other Drug Treatment Service National Minimum Dataset is reviewed and enhanced.
Performance measure 2: Disruption of illegal drug supplyMeasures which demonstrate progress in disrupting the production and supply of illegal drugs include:
- purity levels for illegal drugs by drug type
- the price for illegal drugs by drug type
- the number and scale of clandestine drug laboratories disrupted in Australia.
Progress against this measure will be indicated by falls in purity levels and increases in prices. However, there is not necessarily a straightforward relationship between price or purity and success or otherwise in supply-reduction strategies. For example, increases in price could reflect increases in demand as well as decreases in supply.
This measure needs to be interpreted alongside Performance measure 1 and in the context of both domestic and international law enforcement activities, such as the destruction of illicit drug and precursor stockpiles or the dismantling of criminal organisations or distribution/ trafficking networks.
Data to support these measures can be sourced from existing data sets published by Australian and state and territory police agencies, the Australian Customs and Border Protection Service, the Australian Institute of Criminology and the Australian Crime Commission.
Performance measure 3: Harm associated with drug useMeasures of harm associated with drug use include:
- the social costs of alcohol, tobacco and other drug use to the Australian community
- trends in drink-driving and drug-driving related deaths and injuries, and alcohol-related violent incidents
- perceptions of community safety regarding illegal drugs, and drunk and disorderly behaviour
- the prevalence and incidence rates of HIV and hepatitis C among injecting drug users
- trends in opioid overdose related ambulance call-outs and overdose mortality
- trends in alcohol-related emergency admissions and hospital separations.
Decreases and falling trends against all these measures (except community safety perceptions, which the strategy seeks to improve) would demonstrate progress against this measure.
Careful interpretation is needed. For example, a statistical increase in arrests for drink or drug-driving may be related to intensification of police operations rather than an actual increase in these behaviours.
Comprehensive national data are not available on all of these measures. Existing sources include state and territory policing data, and Australian Bureau of Statistics and Australian Institute of Health and Welfare reports. National surveys such as the National Survey of Community Satisfaction with Policing, as well as commissioned research on social costs of drug use will help inform these measures.
The National Research and Data Working Group will prepare an annual report on data against these measures to be included in the annual report of the Intergovernmental Committee on Drugs. This group will examine improving the quality of the data sources that inform these measures.
GovernanceThe governance structure to support the National Drug Strategy 2010–2015 is detailed in Figure 2. This structure represents the successful partnership between law enforcement and health and strengthens the engagement of other stakeholders.
Continued partnership between health and law enforcement portfoliosThe Ministerial Council on Drug Strategy (MCDS) was established at a Special Premiers’ Conference on 2 April 1985. It was agreed that the MCDS would coordinate and direct the then National Campaign Against Drug Abuse (1985–92) and have authority to deal with all drug-related matters. It was also agreed that the National Drug Strategy would take a balanced approach on demand and supply and on minimising the harms drugs cause.
The establishment of the Council as the auspicing group for the strategy set up a unique and new partnership between law enforcement, health and education which has enabled great strides to be taken in demand, supply and harm reduction through integrated approaches. This partnership approach will be maintained under the National Drug Strategy 2010–2015.
On 13 February 2011, the Council of Australian Governments (COAG) approved a comprehensive reform plan for a new system of ministerial councils. These changes will see a fundamental shift towards a council system focused on strategic national priorities and new ways for COAG and its councils to identify and address issues of national significance. The new arrangements for COAG and its councils will be in place from 1 July 2011. Standing councils on health and on police and emergency management will progress priority issues relevant to their portfolio areas. The MCDS met for the last time on 25 February 2011 and agreed that the Intergovernmental Committee on Drugs would identify strategic issues for discussion that could be addressed at annual informal meetings of interested health, police, attorneys-general, education and other relevant ministers.
Intergovernmental Committee on DrugsThe Intergovernmental Committee on Drugs (IGCD) will manage the ongoing work of the National Drug Strategy. The committee is a Commonwealth, state and territory government forum of senior officers who represent health and law enforcement agencies in each Australian jurisdiction and in New Zealand, as well as representatives of the Australian Government Department of Education, Employment and Workplace Relations.
The committee provides policy advice to relevant ministers on drug-related matters, and is responsible for implementing policies and programs under the National Drug Strategy framework.
The IGCD will prepare an annual report on its activities that will be provided to health, police, attorneys-general, education and other relevant ministers.
Members of the IGCD form the health officials and law enforcement officials subcommittees, which facilitate a focused approach on relevant health and law enforcement issues.
IGCD standing committees and working groupsThe IGCD will be supported by four standing committees. These will focus on alcohol, tobacco, illicit drugs and pharmaceutical drug misuse. The standing committees will provide ongoing guidance and expertise to the IGCD on issues relevant to their respective drug types, and will lead the updating or development of their respective substrategies.
Time-limited working groups will also be established during the life of the strategy. The working groups will be given discrete, time-limited tasks which align with priority areas identified in the strategy. The three immediate priority areas are the development of the Aboriginal and Torres Strait Islander Peoples Drug Strategy, a national drug research and data strategy, and a national workforce development strategy.
The working group structure will allow for additional groups to be established as new priorities are identified.
The IGCD will invite relevant representatives of intergovernmental councils, government agencies, nongovernment organisations, the research sector, peak organisations, consumers, carers and industry to participate in these committees and groups.
Stakeholder engagementThe IGCD will convene an annual stakeholder forum to discuss issues related to drug policy. The forum will engage a range of drug and alcohol experts and a broader selection of stakeholders including consumers, carers, consumer representative groups, peak bodies, non-government organisations and industry.
Outcomes from the forum will inform discussion at the annual IGCD strategic workshop.
Australian National Council on DrugsThe Australian National Council on Drugs (ANCD) will continue to provide ministers and senior government officials with independent, expert advice on matters connected with legal and illegal drugs. The ANCD is also tasked to facilitate enhanced partnership and communication between government and the community in the development and implementation of policies and programs to redress drug-related harms.
Members of the ANCD are appointed by the Prime Minister. They include people with a wide range of experience and expertise in various aspects of drug policy such as treatment, rehabilitation, education, family counselling, law enforcement, research, and work at the coalface in community organisations.
The ANCD will develop a work plan and report annually to the Prime Minister. It will also provide reports to relevant ministers and the Intergovernmental Committee on Drugs.
Figure 2: Governance structure to support the National Drug Strategy 2010-2015
Text-based description of image
The structure represents parternships between law enforcement, health, education and stakeholders.
The diagram structure is headed by a box labelled Ministers. To the right on the same level is a separate box labelled Prime Minister. At the centre of the diagram is a box lablled Intergovernmental Committee on Drugs (IGCD). Inside the IGCD box are two separate boxes labelled Health officials and Law enforcement officials.
Abiove the IGCD box an arrow branches to two separate boxes lablled Annual informal meetings to discuss strategic issues as required and Annual reports. From these two boxes are arrows pointing up to the box labelled Ministers. To the left of the IGCD box is a separate box lablled Annual stakeholder forum. The Annual stakeholder forum box has an arrow pointing towards the IGCD box. On the right hand side of the IGCD is a box labelled Australian National Council on Drugs (ANCD). The ANCD box has an arrow pointing towards the IGCD box. The ANCD box also has arrows pointing up to a box labelled Prime Minister and across to the box labelled Ministers.
In the bottom left is a box labelled Time-limited working groups than contains three separate boxes labelled Research and Data Working Group, Workforce Development Working Group and the Aboriginal and Torres Straite Islander Peoples Complementary Action Plan Working Group. In the bottom right is a box labelled Standing committees that contains four separate boxes labelled Alcohol, Tobacco, Illicit drugs and Pharmaceutical drugs misuse. Each box is linked with an arrow pointing to the IGCD box. In between the Time-limited working groups and Standing committees boxes is a smaller box lablled Stakeholder and expert representation that has an arrow pointing to the Time-limited working groups and Standing committees boxes.
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