Introduction by Croakey: The upcoming NSW Drug Summit will be held over multiple days – with two days of regional forums in October, followed by two days of forums in Sydney on 4 and 5 December.
It will be an important opportunity for advancing effective, evidence-informed policies to reduce the increasing toll of overdose deaths, according to Dr Steph Kershaw and Dr Jack Wilson, researchers at the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney.
Below they outline five key measures for consideration at the Summit – which are also relevant for other states and territories – and also call for development of a formal National Overdose Prevention Strategy in collaboration with people who have lived experience, health workers and community groups.
Steph Kershaw and Jack Wilson write:
The Minns Labor Government has recently released the dates for its NSW Drug Summit, providing a unique opportunity to review current drug policies.
Following on from International Overdose Day on 31 August, it is particularly timely to reflect on what evidence-based policies can prevent and reduce drug overdoses.
Currently, one Australian dies every four hours from an overdose. An overdose happens when a person has taken a drug, and the body is unable to cope with it. Overdoses are sometimes called drug toxicity or drug poisoning and refers to the negative effects on the body. Overdoses can be fatal, but not always.
The Penington Institute’s Annual Overdose Report 2024 highlights the rising numbers of overdose deaths in Australia. This report found that in 2022, 2,356 Australians died from an overdose and 80 percent of these deaths were unintentional.
Sadly, overdose deaths have nearly doubled in the last 20 years.
A 2022 report of Australian Bureau of Statistics data found the most common drugs involved in overdose deaths were opioids (for example heroin, pharmaceutical opioids), benzodiazepines, and stimulants (for example, methamphetamine). Men, those aged in their 30 to 50s, and First Nations Australians are the most likely to experience an overdose.
Overdoses happen when someone takes too much of the drug, or the drug is stronger (more potent) than expected, the drug wasn’t what was expected (for example, contaminated by other drugs), and if multiple drugs are taken at the same time (such as drinking alcohol and taking drugs).
Drugs also affect everyone differently – a person’s health, weight and gender can alter the effects.
Reforms needed
In 2022, the Australian Government spent $5.45 billion towards addressing illicit drug use under Australia’s National Drug Strategy 2017–2026.
While this may sound like a lot, 64.3 percent of this was allocated to law enforcement, with the rest shared between treatment (27.4 percent), prevention (6.7 percent), and harm reduction (1.6 percent) strategies.
With the strategy due for renewal, it would be a better return on investment if the budget was spread more evenly across areas.
Investment in prevention and harm reduction, particularly the following five key issues, would lead to a significant reduction in drug related harms including overdoses.
1. Access to naloxone
We need to make sure people have access to naloxone, a medicine that reverses the effects of opioids including heroin. Naloxone is extremely effective, but it needs to be administered immediately either via injection or intranasally.
In Australia, under the Take Home Naloxone program people who may experience, or witness, an overdose can obtain naloxone from some pharmacies for free, and others at a cost.
Unfortunately, a lack of pharmacist training, stigma, and disrupted supply chains have been identified as barriers.
There is a critical need for greater community education and engagement along with addressing logistic and economic barriers.
2. Access to supervised injecting clinics
Supervised injecting clinics (SIC) are facilities where people can inject drugs in hygienic conditions under the supervision of qualitied staff. People who use drugs are provided with sterile equipment, non-judgmental care and offered ongoing support.
Unfortunately, despite evidence that they are effective (for example, Australia’s oldest SIC in Sydney has supervised 1.28 million injections, with zero fatalities), there are only two facilities in Australia, one in Sydney and another in Melbourne.
This is partly due to the public controversy that these facilities encourage drug use, and attract crime; however, there is no evidence to support this. They do reduce the burden on the healthcare system and prevent overdoses though.
3. Drug checking
Also referred to as pill testing, drug checking aims to prevent people from taking unusually strong or contaminated drugs by having them test a sample before consumption. This is important as there are no quality control or safety protocols in the production of illegal drugs.
As increasing evidence suggests that drug checking can save lives, community support for harm reduction measures has risen.
An evaluation of CanTEST, Australia’s first and only pill testing service found that one in 10 drug samples were discarded once the client learnt what was in them.
The evaluation also found that 70 percent of clients had never discussed their drug use with a health worker before visiting CanTEST.
This highlights how drug checking and SICs also give people who use drugs a pathway to access healthcare, education and treatment options which they may not be able to access otherwise.
4. Community education
Education and improving access to accurate, up-to-date, evidence-based information and resources about drugs (such as Positive Choices, Cracks in the Ice) will go a long way in preventing and reducing drug-related harms.
Additionally, many overdoses happen at home, and communities can play a role in overdose prevention by creating environments where people feel safe to seek help.
Research shows that people with higher accurate knowledge about a health condition hold fewer stigmatising attitudes.
5. Address stigma
The use of illicit drugs is associated with high levels of stigma and discrimination.
Stigma leads to psychological distress for people who use drugs and has been linked with low self-worth and shame. We know stigma is a barrier to help-seeking and treatment.
Reducing stigma is important as the sooner someone gets help, the better the outcome is and the better for the community (for example,fewer absences from work, less crime, and fewer visits to healthcare).
It is also important to take a compassionate, non-judgemental approach to support, not shame, people who have been affected by an overdose.
Reframing the use of drugs from being a criminal/legal issue, which re-enforces stigmatising attitudes and prevents people from seeking help, to that of a health issue, which supports help-seeking, reduces stigma and promotes meaningful and respectful discourse.
What else can we do?
We also desperately need the development of a formal National Overdose Prevention Strategy in collaboration with people who have lived experience, health workers and community groups to address this crisis.
It is hoped that these issues will be discussed and advocated for at the upcoming NSW Drug Summit. However, these issues are not only relevant for NSW – they are applicable across Australia.
Advocacy and implementation of these strategies will save lives.
See Croakey’s extensive archive of articles on prevention
How very, very sad. It is 32 years since my son died of a heroin overdose at the age of 24. This alerted me to the injustice of our prohibition drug laws and I became a strong advocate for change. So, so very disappointing that there are now more deaths than there were back then. Governments know what the research and evidence shows will save lives but all they can do is have more summits, more enquiries, more research while people continue to die. We needed action many years ago. A drug summit is just another way of putting off change. I guess there is no option but to hope that this summit will at last be the light at the end of a long tunnel manyof us have been waiting for.