ISCHS Position Paper: Reducing Harm from Alcohol, Tobacco, and Illicit Drugs, Schemes and Mind Maps of Public Health

Download ISCHS Position Paper: Reducing Harm from Alcohol, Tobacco, and Illicit Drugs and more Schemes and Mind Maps Public Health in PDF only on Docsity! Page 1 of 7 U:\CEO\Board\Board Papers 2013\Aug\AOD Position Paper for Board August 2013.docx Position Paper - Alcohol and other Drugs August 2013 The Inner South Community Health Service (ISCHS) is a major provider of primary health care services including alcohol and other drug (AOD) services, and has been for over 20 years. The service model is based on the social model of health. Principles of harm minimization are adopted in relation to all AOD work. 1. Purpose This paper outlines ISCHS’s positions in relation to alcohol and other drugs (AOD). It includes positions on: 1. Reducing consumption through greater control of access and availability 2. Education and information provision 3. Access to quality treatment services. 4. The use and misuse of pharmaceutical products. The overriding principles of the paper relate to advocating for health and social approaches to reduce harms including a right to access treatment and harm minimization strategies for the whole community with a focus on strategies that are effective for marginalized groups. All policy and reform positions adopted by ISCHS will be evidenced based. Public health interventions are deliberately designed to maximize their effect by appealing to large but relatively lower risk population groups- which means that public health success increases health inequities (Bambra et al, 2010). Although ISCHS supports a public health approach, it equally recognizes the inadequacy of some policies to fully benefit many of our marginalized clients. 2. Background Thirteen percent of the Australian Burden of Disease and Injury in 2003 is directly accountable to the consumption of alcohol, tobacco and other drugs. Alcohol alone accounts for 60 deaths and 1500 hospitalizations weekly in Australia’ (NAAA 2011). ISCHS’s role as community health service incorporates health promotion. This includes working directly with local communities, in conjunction with influencing public health debates. Influencing the public health debates is crucial as there is a significant lobby within Australia who oppose effective public health debate and actions by attempting to categorize any such attempts as promoting a ‘nanny state’. The reality is those behind such campaigns normally stand to benefit from existing patterns of consumption which legislation, regulations, and education are seeking to change. As a public health organisation ISCHS provide an alternative view and seek to influence legislation and regulation, promoting a harm minimization approach, in line with recommendations of peak AOD groups, public health bodies and the needs of the local community. This position paper will provide a clear framework for the Board of Directors, management and staff, students and volunteers of ISCHS. Page 2 of 7 U:\CEO\Board\Board Papers 2013\Aug\AOD Position Paper for Board August 2013.docx 3. Context Government The National Drug Strategy 2010-2015 and the Victoria Whole of Government Strategy “Reducing the Alcohol and Drug toll: Victoria’s Plan 2013-2017’ set the agenda for alcohol and drug management. (See Appendix 1). National and State health budgets are under considerable financial pressure and this pressure will increase over the next 20 years. All levels of Government policy are framed on the effective provision of prevention and harm minimization strategies to reduce the demand on health services and costs on future budgets. It is well recognized that AOD use is a major contributor to Australia’s ‘burden of disease’. The ability to change drug use culture has been demonstrated through tobacco legislation, regulation and education. This has proved to be an effective long term method for supporting prevention and reducing harm. ISCHS Context The ISCHS service model is based on a harm minimization approach. It is recognized that current National and State Strategies to regulation AOD have not had the same benefit for all parts of the community. While rates of smoking have dramatically reduced among the population, among disadvantaged groups smoking rates are up to 5 times higher than the population average (Australian Preventative Health Agency 2013 p.2). ISCHS has a strong commitment to delivering primary healthcare services, complimented by advocacy on issues that influence the health and wellbeing of disadvantaged groups within the community. ISCHS is a member of peak organisations focusing on AOD advocacy. The focus of ISCHS advocacy will be in supporting the advocacy of member bodies. However, ISCHS will advocate independently on relevant local issues, especially where more tailored strategies are required to support change within disadvantaged groups. ISCHS operates within the Social Model of Health (VHA) ISCHS operates under the principles embodied in the Ottawa Health Promotion Charter (WHO). 4. ISCHS Position 4.1 Alcohol 4.1.1 Supporting health, social and planning approaches to reduce harm related to alcohol use including • Taxing alcohol products according to the level alcohol they contain (volumetric alcohol taxation); • Phasing out of alcohol promotion from times and placements which have high exposure to young people aged up to 18 years; • Reduction in the availability of alcohol through more effective control of new outlets, and through reduced trading hours. 4.1.2 Increased awareness through education of what constitutes harmful drinking and binge drinking, and increased understanding of the harms. 4.1.3 Increased awareness of the risk and protective factors for foetal alcohol syndrome. Page 5 of 7 U:\CEO\Board\Board Papers 2013\Aug\AOD Position Paper for Board August 2013.docx Tobacco Facts Smoking is a leading cause of preventable death and disease in Australia (National Tobacco Strategy). In Australia in 2003, tobacco use was responsible for 7.8% of the burden of disease. Smoking was the cause of 15,551 deaths (42 a day) in 2003. It was responsible for 20.1% of the disease burden due to cancer, and 9.7% of the disease burden due to cardiovascular disease (AIHW). Collins and Lapsley (health.gov.au) estimated that in 2004–05 the total cost of smoking in Australia was $31.5 billion. It was considered that this study underestimated the actual costs. In 2007/2008, 23% of males aged over 18 years, and 19% of females smoked. Smoking rates for men and women are continued to drop (down from a peak of 72% for men, and 31% for women). However, people living in the most socioeconomically disadvantaged areas were twice as likely to smoke as people living in the most advantaged areas (AIHW). This is supported by the data from the ISCHS client survey in 2009, which indicated 35% of clients interviewed smoked daily (nearly twice the Australian average). Bonevski and Baker (2012) give current rates of smoking in high prevalence communities as: 50% of Aboriginal Australians, 37% of single parents, 73% of homeless people and people with other drug disorders, 66% of people with a mental illness and 60% of people accessing welfare aid from non- government agencies such as Anglicare and the Salvation Army and 85% prisoners smoke. Positions ISCHS advocacy builds on a continuation and strengthening of the current successful National and State Strategies, to ensure we further reduce the percentage of people still smoking, with a focus on strategies that will be effective with marginalized groups and communities. Illicit Drugs Facts Illicit drug use accounted for 2.0% of Australia’s total burden of disease in 2003. Much of this harm is related to unintended outcomes of drug use or public policy. For example, twenty five percent of this burden of disease is related to Hepatitis (AIHW), which can be contracted by risky injecting practices, particularly the sharing of injecting equipment. Continued and improved access to injecting equipment is critical to reduce harms associated with drug use. The social cost of illicit drug use in Australia was estimated at $8.2 billion in 2004–05, including costs associated with crime, lost productivity and healthcare (AIHW). Positions Our advocacy approach to illicit drugs is driven by the understanding that often the harm associated with illicit drug use is a direct result of the environment in which drug use occurs, as well as the harmful effects of the actual drugs. Our advocacy focuses on the health needs of people using illicit drugs, rather than the illegal nature of their drug use. This response should not be interpreted in any way to support illicit drug use, but as a health service, our focus is on reducing harm, rather than law enforcement. The paper supports decimalization of drugs to reduce criminal behavior and allow greater support and engagement of people engaged in drug use. Page 6 of 7 U:\CEO\Board\Board Papers 2013\Aug\AOD Position Paper for Board August 2013.docx However we also acknowledge the harms associated with all drug use (whether illicit or licit), and at all times support and encourage people to make healthy life choices, which includes abstinence, reduction in consumption, and safer methods of using. Pharmaceuticals Facts There is growing evidence of the misuse of pharmaceuticals in Australia with a focus on opioids and benzodiazepine, where considerable harm is occurring. There are two categories of people misusing opioid or benzodiazepine medications. There are those who intentionally misuse, and there is likely to be a large number of Australians using these medications as prescribed but where such prescriptions do not represent a quality use of those medicines (NCETA p. 4). People from either group may have been using these medications for some time and, in the case of benzodiazepines in particular, withdrawal from them may be very difficult. The number of Australians who recently used pharmaceuticals for non-medical purposes increased by more than 100,000 between 2007 and 2010 (from 640,000 to 770,000). Painkillers/analgesics were used for non-medical purposes by 2.7% of this population in the past 12 months and 1.4% of those aged 12 years or older had used tranquillisers or sleeping tablets for non-medical purposes over this period (NCETA p. 5). The 2010 National Drug Strategy Household Survey (AIHW, 2011) found that 7.4% of Australians aged 14 years and over had ever used painkillers/analgesics, tranquilisers, steroids, methadone/buprenorphine or other opioids (not including heroin) for non-medical purposes in their lifetime. Of these 4.2% of these had done so in the past 12 months, up from 3.7% in 2007. The number of deaths associated with the misuse of pharmaceutical drugs in Victoria in 2012 was 304, compared to our state road toll of 282. VAADA Positions There is a need for a coordinated medication management system in Australia to provide on-line, real time information for prescribers, pharmacists and regulators concerning the medication prescription and dispensing histories of patients. This was one of the major recommendations of The National Centre for Education and Training on Addiction (NCETA) report on Pharmaceutical drug misuse problems in Australia: Complex issues, balanced responses (2011), along with improved access to injecting equipment, and dispenser (pharmacists) access to the Prescription Shopping Program, to help them identify people at risk of overusing prescribed medications. The report also raises concerns in relation to marketing of pharmaceutical drugs. ‘The marketing of pharmaceuticals is an important way in which companies stimulate demand and generate high turnover’ (Choice, 2008 as quoted in the NCETA report p.95). The interest of the community and the interest of the companies do not necessarily align, with over use being one of the potential outcomes. On a different issue, the issue of pharmacy prescribing fees for people on substitute therapies such as methadone remains an inhibitor for many in relation to the effectiveness of this treatment. Normal dispensing fees range from $5 to $7 a day and it can be more expensive. The removal or reduction in these fees would enhance access and therefore the effectiveness of the program, especially for people on low incomes. The recommendation regarding the need for appropriate and accessible treatment and care for people misusing pharmaceutical drugs comes from a recommendation from the Public Health Association Australia (2010). This client groups needs often relate to a range of issues including pain management and need to be targeted. Page 7 of 7 U:\CEO\Board\Board Papers 2013\Aug\AOD Position Paper for Board August 2013.docx References Australian Preventative Health Agency (2013). Promoting a healthy Australia. Bambra et al. (2010) Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence based policy. Billie Bonevski and Amanda Baker JUL 23, 2012 Smoking is a social justice issue. Crikey. Retrieved from http://blogs.crikey.com.au/croakey/2012/07/23/will-social-change-help-reduce-smoking-rates- amongst-disadvantaged-australians/ Collins & Lapsley (2008a). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Australian Department of Health. Commonwealth of Australia. (2012). National Tobacco Strategy. Lawn. S. (2008) Tobacco control policies, social inequality and mental health populations: time for a comprehensive treatment response Australian and New Zealand Journal of Psychiatry; 42:353 NAAA. (2011). Alcohol tax reform is a major public health and social policy issue Nicholas, R., Lee, N., & Roche, A. (2011). Pharmaceutical Drug Misuse in Australia: Complex Problems, Balanced Responses. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide. Public Health Association Australia (2010). Pharmaceutical Drug Misuse Policy