Wednesday, 22 February 2023

Committees

Legal and Social Issues Committee

Reference

David LIMBRICK (South-Eastern Metropolitan) (16:34): I move:

That this house:

(1) notes that:

(a) Melbourne will host the 27th Harm Reduction International Conference from 16 to 19 April 2023;

(b) despite the government implementing some of the recommendations from the 2018 inquiry into drug law reform, there remains significant problems and opportunities;

(2) requires the Legal and Social Issues Committee to inquire into, consider and report, within six months of the house agreeing to this resolution, on drug harm reduction policies, including:

(a) improvements in opioid substitution therapy service delivery;

(b) the establishment of a drug-checking service;

(c) safe consumption sites and prescription hydromorphone program;

(d) nicotine harm reduction including e-cigarettes and their role in smoking cessation; and

(e) any other related matters.

The government has made some significant and some minor improvements in drug policy and harm reduction: legalising medical cannabis, setting up a medically supervised injecting room and improving health alerts for novel and emerging psychoactive substances. There have been inquiries that have looked at drug policy, including those outlined in this motion, over previous years, but some of the recommendations have been left to languish. Stakeholders in the sector described issues with the opioid substitution therapy program as a ‘looming crisis’ back in the 2018 inquiry into drug law reform. I have been informed that the crisis is now no longer looming but is here. For people with serious opiate addiction problems, there is more need than service availability. Several of the doctors managing clients have delayed their retirement because there is nobody to replace them. It is an urgent issue that needs action now.

The need for a drug-checking service to be established or at least trialled in Victoria was highlighted recently with yet another tragic death of a young person at a festival in New South Wales. The ACT have got on with it. After successful trials they have now established a fixed service already identifying novel substances circulating in the community and ensuring that health services and consumers are alerted.

While the government have established a medically supervised injecting service which is preventing deaths from overdose and supporting people to access treatment not just for addiction but for other health issues and services, it is a half measure, as the illicit market and the organised crime that funds it are maintained. An alternative would be to trial prescription hydromorphone. No solution is perfect, but jurisdictions such as Switzerland that have trialled a similar approach have seen very good outcomes.

Another issue that we seemingly cannot go a day without some media mention of is the issue of vaping – or, as it should be more accurately referred to in a public health context, tobacco harm reduction. Harm reduction is supposed to be a complementary approach that does not replace other approaches, such as dissuading people from taking up harmful or risky practices or approaches that encourage abstinence. Rather it is an approach that acknowledges that some people will persist with these activities, and if there are ways to reduce the harms then they should be encouraged.

No-one would deny that nicotine is addictive. Quitting smoking is really hard. I have done it myself. Even people who manage to quit often fail multiple times first. There is an option available for people that did not exist 20 years ago that many smokers credit with allowing them to manage their nicotine use while avoiding many of the harmful effects of smoking. But let us be clear: we are talking about harm reduction, not harm elimination. Vaping is not without harm, but the vast majority of experts acknowledge that it is significantly less harmful than smoking. We have a strange approach though, with vaping being far more restricted than smoking itself. You can buy smokes when you fill up your car with petrol or when you buy your groceries, but if you prefer the less harmful alternative you need to get a prescription and import products from overseas, with no liquid nicotine products being able to be legally sold here. That does not mean they are not sold, and we have been inundated with reports of teenagers accessing these products from a range of retail outlets selling them, despite the laws, through the black market. It is vital that we find a better way to regulate this industry, and we need to hear from all of the experts, not just the ones that support further restrictions.

On these issues, restrictive government regulations are preventing effective solutions, and we need to get to work so that these solutions can be implemented as soon as possible. It is my view that an inquiry of this type to look into a range of these issues around drug harm reduction would set us on a course so that we can better inform ourselves of things that may have happened since the drug inquiry in 2018, and I urge others in the house to support this inquiry.

Sheena WATT (Northern Metropolitan) (16:38): I rise to give my contribution to this motion about harm reduction, and in doing so I would like to note that the Andrews Labor government takes a health-led approach to alcohol and drug use and is committed to preventing and reducing associated harms. As a case in point of our commitment to harm reduction, we are hosting the flagship Harm Reduction International Conference in Melbourne this year in April. Opened by former New Zealand Prime Minister Helen Clark, the conference will have over 1000 delegates from over 80 countries in attendance, including frontline service workers, some policy and decision makers, some UN officials, researchers, activists and people who use drugs, among others. It will also be a great chance to showcase our great city and our great state to the world.

As a demonstration of our commitment to harm reduction, in the most recent budget we provided and committed over $300 million in alcohol and other drug services, including supporting Victorians to access information and advice, treatment and harm reduction services. This includes $1.4 million to maintain alcohol and drug support services for Aboriginal Victorians, $6.6 million to respond to alcohol and other drug treatment demand, $1.3 million to respond to global supply pressures for critical harm reduction products and $35 million over three years to support the establishment of a 30-bed alcohol and other drug residential treatment facility in Mildura. I do know that there are certainly places in our state that do not have as easy access to treatment facilities as some of us here in metropolitan areas, so it is really good to see that commitment being made to regional services. I will just have that noted. These services reach approximately 40,000 Victorians every year, ensuring that support reaches those that need it most.

However, overdose deaths cannot stop at investment alone. We know, for example, that some Victorians have a dependence on high-risk prescription medicines. That is why we launched SafeScript in Victoria to help clinicians make safer clinical decisions and reduce the incidence of harm among their patients. SafeScript is Australia’s first real-time prescription monitoring system, developed and implemented in 2019, keeping more Victorians at risk of overdose safe from harm.

We support evidence-based, innovative approaches for those who need us to work differently, like our medically supervised injecting room and funding Harm Reduction Victoria’s DanceWize program. DanceWize peer educators engage with attendees at Victorian music festivals and nightclubs, providing chill spaces, discussing safer drug use with patrons and handing out health resources.

We are progressing implementation of the commitments we made in response to the inquiry, including access to the life-saving medicine naloxone, with the expanded take-home naloxone program commencing later this year. We recognise the impact of drug harms on the Victorian community and are working tirelessly to prevent and reduce these harms. Every single life lost to drugs is a terrible, terrible tragedy for the families and friends affected and for our wider community.

The supervised injecting room in North Richmond is doing exactly what it is designed to do; it is saving lives. We are trailing a medically supervised injecting room, a safety-first medical approach which aims to reduce overdose deaths and harm. It is a comprehensive health service supporting clients to access health and social support services from housing to treatment to hepatitis C diagnosis and medication. It has safely managed more than 5000 overdoses, saved lives and taken pressure of hospitals, reduced ambulance call-outs and led to a decrease in public injecting. The coroner’s 2022 report into overdose deaths showed a significant reduction in fatal heroin overdoses in the City of Yarra since the facility opened. The trial has also shown that drug overdoses in our community are preventable, and it is incumbent upon us in this place to do what we can to prevent them.

Naloxone is a safe and effective treatment to reverse opioid overdose and a crucial part of the government’s harm reduction strategy. In Victoria naloxone has previously only been available when prescribed by a medical or nurse practitioner or when supplied over the counter by a pharmacist. Victoria’s take-home naloxone program will increase community access to this medication. Workers in approved organisations will be able to supply naloxone to people who are at risk of or more likely to witness an opioid overdose, including family, friends and supporters of people who use opioids. In response to the 2018 inquiry into drug law reform, we have reformed legislation governing the supply of naloxone. The new regulatory framework will reduce opioid overdose related morbidity and mortality by removing barriers to this life-saving medicine.

Pharmacotherapies like methadone are a key part of treating addiction. These treatments save lives lost to overdose. They also bring stability and choice to people’s lives, an important step that allows people to take better care of themselves. We are aware of longstanding challenges in this pharmacotherapy service delivery, especially regarding primary care workforce capability and capacity. That has not gone unseen. These problems have intensified recently alongside broader pressures in primary health care.

The Commonwealth government is currently conducting a review of how pharmacotherapy medicines are made available in Australia under the PBS. This review and subsequent changes to Commonwealth pharmacotherapy arrangements are expected to be finalised later in 2023. The Department of Health is also exploring opportunities to trial hydromorphone and similar effective medicines for people who have not found success with existing treatments. This is a direction recommended by the 2018 inquiry into drug law reform. Any trial will require careful consideration of appropriate science and medication subsidies as well as close engagement with clinical experts and people with lived experience.

We know it is crucial to monitor emerging drugs and drug harms to help protect public health and community safety. Our work to increase understanding of emerging drug-related harms incorporated both state and national activities. Since 2020 the Department of Health has supported a number of research trials that aim to develop Victoria’s drug early warning capability. These have involved significant collaboration with a network of hospital emergency departments, community health services, people with lived experience and scientific experts. This work has enabled the Department of Health to issue public drug alerts when it becomes aware of especially hazardous products circulating in the community – a trusted form of information for people is available to make more informed decisions about their health. We also know that illegal drug taking can have a devastating effect on a person’s health and wellbeing, especially their mental health. We have currently no plans to implement a drug-checking service in Victoria but will continue to consider evidence for additional harm reduction approaches.

While the long-term impacts are still unknown, e-cigarette products contain a variety of chemicals and toxins that have the potential to cause adverse health effects. I will just say that most smokers that use e-cigarettes to quit do not do so in a controlled way and often continue to also smoke – look, there are all sorts of different impacts. I think there is a lot more work to be done on that, and I look forward to hearing more from our experts as time goes on.

I know that my time is about to come to an end, but I just want to say that there is no silver bullet here. Together the measures being introduced by the Andrews Labor government will save lives and keep Victorians safe.

Georgie CROZIER (Southern Metropolitan) (16:48): I am pleased to rise and speak to motion 27 under Mr Limbrick’s name. He has put an important motion to the house, which we are debating this afternoon. The motion notes that:

(a) Melbourne will host the 27th Harm Reduction International Conference from 16 to 19 April 2023 –

that is in only a few weeks time –

(b) despite the government implementing some of the recommendations from the 2018 inquiry into drug law reform, there remains significant problems and opportunities;

(2) requires the Legal and Social Issues Committee to inquire into, consider and report –

on a number of issues relating to harm reduction policies, including –

(a) improvements in opioid substitution therapy service delivery;

(b) a drug-checking service;

(c) safe consumption sites and prescription hydromorphone program …

I am particularly interested in that last bit. As Mr Limbrick is aware, going into the election of last year the Liberals and Nationals had a policy on this very important area – and thank you, Mr Limbrick. It was an excellent policy put forward to the Victorian people by my colleague Emma Kealy in the other place, who has done an enormous amount of work in this space. She really is very much across her brief. She understands the issues extremely well, and she has been speaking to the agencies and so many people that have been affected by drug and alcohol abuse and looking at ways to support people.

We know that there are many people that have, sadly, succumbed to drug addiction, and that has led to some dreadful outcomes – some very serious and sad outcomes. I do not think anyone in this chamber is not familiar with having their own personal experience and being touched by the very severe effects of drug abuse and how it can just simply ruin lives and ruin families. It has a massive impact on communities, and of course we must do everything we can to support those people to minimise harm and to get them off those horrendous addictions. I know too many instances where tragic outcomes have occurred from accidental overdose. Obviously there is ongoing abuse and violence, there is getting on the terrible treadmill of crime at a young age and not being able to get off and there are just so many other implications that have health, mental health and economic impacts both for the individual and for society as a whole.

My colleague Emma Kealy was pointing out that in Victoria in particular we have a problem around this area. What we know is that the waitlist for people to get treatment has grown. At the end of 2021 there was an increase of 60 per cent on the year prior, so there were more than 4000 people waiting for this vital treatment and support in these facilities. Of course that came off the back of Victoria’s lockdowns and the restrictions that were in place. I have spoken many times about the extensive lockdowns that Victoria had to endure, and we are seeing the result of that. We had the harshest restrictions, but we have also had the worst outcomes. Lockdown after lockdown has not been good for all Victorians and especially those Victorians who need mental health and drug and alcohol treatment and support. We also know that Victoria has had the greatest number of deaths, so the lockdowns did not stop all the tragic deaths that occurred. I am not going to reprosecute that case because I have done it to death, but I am still very concerned about the impacts of those lockdowns. I am particularly concerned about how they have affected those people seeking these vital treatments.

The other point that my colleague Ms Kealy was making when she was putting some policies forward was that the budget had been cut by $40 million and there was the cutting of 100 FTE jobs in the sector. There has been a huge cut to the budget for many, many years. These are real issues and we want to address them. We know that regional parts of Victoria in particular that do not have access to these services sometimes are the worst affected, and we were putting forward solutions in terms of establishing 180 withdrawal and residential rehabilitation beds across Victoria. That would have been a step in the right direction to get more people off these drugs. The other thing I want to make note of which is particularly interesting, as I said, around the hydromorphone program that Mr Limbrick has highlighted in his motion is that we were committed to establishing an Australian-first hydromorphone treatment program that would break the addiction of heroin.

Again, I have raised the issue in this place around the injecting room in North Richmond. Whilst we want to see those addicts supported, treated and not succumbing to overdose – well, they still are overdosing – there are crimes and social impacts in that local community because they put this injecting room next to a school in a residential area. It is the wrong place. Where is the Lay report, while I am on this? The Lay report was due out last December 2021, and it is now 2023. The government has stalled on this issue and those people in North Richmond are none the wiser, although I am aware that people are talking to North Richmond from high places within the department, so it will be interesting to know what the government’s plans are if they have got the bigwigs going down to talk to people down there. I think every Victorian deserves to understand exactly what is going on with the North Richmond injecting centre and what the government is going to do with a second injecting room.

We think that hydromorphone programs to get people off heroin, not providing more facilities that provide people with the opportunity to go and inject ice and heroin, is the way to go. And we certainly do not think we need a second injecting room in Flinders Street in the Yooralla building that was bought for over $40 million and is sitting there idle. Well, what on earth are they doing with that? All of these questions the government has refused to answer, and I say again, where is the Lay report? I am sure as a former policeman he would be absolutely horrified that this report is sitting on someone’s desk gathering more dust without being acted upon, and I think that all Victorians deserve to understand exactly what the government’s intentions are.

Going back to this important motion, it does call for the Legal and Social Issues Committee to look at these issues. I think that is the right place for this sort of issue to be addressed – in this parliamentary committee. That parliamentary committee, of which I have been a member, has done some excellent inquiries in the past on many important issues, and I do agree with Mr Limbrick that this is an important issue to bring to the chamber today. This committee can look at these particular issues around opioid substitution and other aspects that have been highlighted in the motion.

In conclusion, I know there are many organisations, like the Victorian Alcohol and Drug Association and other drug and alcohol organisations, that are doing great work in this space. They need more support as well, particularly with the growing number of Victorians who have, sadly, succumbed to addiction and who need this support. They need to be able to be treated. They do not need to be waiting on a waitlist to be seen for months, even years, before they can get that vital treatment that they are able to have. I am hoping that this inquiry will look at some of these aspects and really drill down on what we need to do and what is really happening across our society to understand, particularly, the impacts, as I have mentioned, and some of the issues – the cost of living rises, the financial pressures that are across our communities – that sometimes become the triggers for people to become further addicted. We need to understand those impacts, and I look forward to this committee getting underway.

Melina BATH (Eastern Victoria) (16:58): I am pleased to rise to put my name in association with Mr Limbrick’s motion 27 on the notice paper. In particular my interest lies around an inquiry into and consideration of the drug harm reduction policies, opioid substitution therapy service delivery – how is that going? – the establishment of a drug-checking service, the safe consumption sites, a prescription hydromorphone program and also nicotine harm reduction, including e-cigarettes and their role in smoking cessation – we have had debates on that in past parliaments – and also any other related matters. The ‘any other related matters’ that I would like to see included in that are also to include people who have been drug affected and alcohol affected as well, because alcohol certainly places a significant burden on human lives. Those that become addicted can devastate their families, devastate themselves and really impact very heavily on not only the fabric of society but also the economics of our towns and communities.

The other day I was pleased to have with the shadow minister in this space Emma Kealy a briefing with the Victorian Alcohol and Drug Association, and I was very pleased to gain some understanding and insight from their in-depth knowledge of this topic. They are really, as we call it, at the coalface of support. They are down in the pit with people, working out those strategies, working out harm minimisation treatments and doing a most amazing role. And I thank all those people who work in this area because, let us be honest, it is a very challenging space for people to operate in. It is often very highly committed people – they may not always be, but sometimes they can be reformed drug users and alcoholics – but it is still a very, very important area, and we thank all of those people who work in this space.

One of the things that was impressed upon me – and I would like to just put on record some of the learnings that I took out of that briefing – was that substances which are licit, so prescription drugs and things that come across from doctors who write them out and those sorts of things, can heavily impact on people’s lives and health as well as illicit substance abuse. Again they went into the detail around harm minimisation frameworks, which can include the physical – certainly if someone comes in and they are addicted, they have a physical addiction to whatever that drug may be, but their psychological state is altered. They are working in an impaired state. They may be functioning in the community at some stage, but the back end of their life is often falling apart. Their emotional state is heightened, reduced or bouncing all over the place. But it is also that wider ripple effect that they have on their families and on their communities, whether they become then a danger of violence within their family unit – whatever that looks like – or within the local street that they live in, or whether there is that crime ripple effect that then can occur if you are talking about illicit substance abuse and the need to have access and the need to keep those funds flowing through. One of the things that made sense – it totally hit the mark from the people I see coming into my electorate office and families who are highly distressed – is that 35 per cent of all suicides in Victoria have alcohol or drug related dependencies. So one-third of everyone who commits suicide has already got this propulsion due to abuse of either alcohol or drugs.

The other point is that with those fatalities – and this is not something I enjoy reading, but I think it is important to say – it is not only in the city; it certainly happens in rural and regional Victoria and in our larger regional centres. Let me read you the very sad lists of fatalities from alcohol and drugs through the LGAs and who is topping those charts. From alcohol, pharmacological drugs as well as illicit drugs, the highest deaths have occurred – and this is fairly consistent too; this is a nine-year cycle here, and unfortunately Geelong has a very high quota. Bendigo has also got 12 per year roughly. The Hume LGA and then unfortunately the Latrobe local government area also have around probably 10 to 11 fatalities annually through drugs and alcohol. And they were saying these are direct responses. These are not people crashing their car being high or the like; these are direct fatalities due to an overdose. So there are some startling statistics that I wanted to put on record about the need to look into regional Victoria as well when we look into this inquiry. I hope this motion gets up, and then I hope we can travel out into the regions – where it is warranted – to come out and listen to responses.

The other thing that I found quite alarming – and these statistics are off aodstats.org.au – was ambulance attendances in regional Victoria. They highlighted three separate locations. One was Latrobe, and again this was alcohol-related ambulance attendances. Between 2021 and 2022 they were 68 per 10,000 head of population – that is, double the state average. Horsham had 125 per 10,000 head of population, and Ballarat, looking in terms of pharmaceutical-related ambulance attendances, was 70 per cent higher than the state average. So that is saying that there is certainly something going on there. Interestingly, when they looked at Mildura for alcohol and other drug treatment, Mildura had illicit drug treatment at twice the state average, but pharmaceutical and AOD treatments were 20 times the state average. Certain pockets have certain issues that are really prevalent, and I think it is quite important for this committee to be region specific, to drill down and to see what is going on.

The other thing that I felt really saddened to understand was in terms of rehabilitation centres. Victoria unfortunately has a ratio of only 0.74 beds per 10,000 head of population, and we lag far behind Queensland, New South Wales, Western Australia, Tasmania and the ACT. So you have to ask why that is not serving these statistics that I have read out. I know my shadow minister Emma Kealy had a very important policy going into the election which was around an increase of 180 detox and residential rehab beds across the state and they were in pockets, some of which I have described today. It is important that when people are ready to get treatment there is that treatment available, there is funding towards that treatment but also there are beds. There are many mechanisms and different ways to have treatment, and that was outlined. They can be in the home and attached to a hospital, but sometimes it is very important to actually get people into a residential detox and then rehabilitation centre. We want to see outcomes and we do not want to see families crushed by this.

The other thing – and I think Mr Limbrick actually brought it up – that was really quite shocking and there needs to be new models to look at, was that very few GPs actually prescribe that pharmacotherapy. There are a few of those GPs carrying a huge burden to write those scripts out and get people on alternative treatments to get them off those hard drugs – heroin et cetera. They also were talking about alternative models such as a nurse-prescribed way of presenting those. Certainly it has to be monitored well and prescribed and followed up, but I think that is also another area to look at in this inquiry.

Lee TARLAMIS (South-Eastern Metropolitan) (17:09): I move:

That debate on this motion be deferred until later this day.

Motion agreed to.