(Part 2 of a Croakey series on health reform)
As per the previous post, many in the mental health sector are less-than-impressed (to put it politely) about the direction of health reform.
Another neglected area is alcohol and drug services, argues Dr Alex Wodak, President of the Australian Drug Law Reform Foundation. The neglect of this area doesn’t only mean that patients are suffering – but has implications for police corruption, amongst other problems, he says.
“Critics lost no time pointing out that the brand new hospital reform package includes only a derisory and last minute new funding component for improving mental health services. But at least there is some new mental health funding.
In contrast, the notion of increasing funding for alcohol and drug services has not even been considered. Yet patients with severe alcohol and drug problems, like patients with severe mental health problems, contribute to a great deal of the workload of general practice, community services and hospitals.
At present, only about half the heroin users in Australia who want methadone or buprenorphine treatment and meet the approved criteria are able to enter treatment. Once in this treatment, they will have to front up with about 30% of the costs.
This is the highest co-payment for any chronic health condition in Australia. The people required to pay this co-payment almost invariably have low incomes. So, with a heroin shortage and a treatment drought, our would-be heroin users turn to prescription opiates.
Australia’s consumption of prescription opiates is increasing rapidly and has now reached the equivalent of 60 kg of morphine per million per year. The USA reached a consumption of 60 kg of morphine per million per year in 2000 and that was when the proverbial starting hitting the fan.
Since 2000 in the USA, overdose deaths from prescription opiates have outnumbered heroin overdose deaths and cocaine overdose deaths. And the gap continues to widen. Also, requests for help in the USA from people struggling with prescription opiate dependence are climbing much faster than requests from heroin users. Opium production is increasing again in Burma, source of Australia’s heroin.
That suggests that heroin availability in Australia is going to start increasing again. The only reasons to increase funding for drug treatment in Australia * to reduce deaths, disease, crime, and save resources * are logical and rational. And logical and rational reasons have never been enough.
Of course, alcohol is, and always has been, a much bigger problem than illicit drugs in Australia. And the same justifications apply in spades for increasing treatment for people struggling with alcohol problems. Ever tried getting a loved one into simple detoxification?
One of the staple drugs used in treating alcohol dependence, disulfiram (Antabuse), is still not on the Pharmaceutical Services Branch although it’s an amazingly effective treatment if the disulfiram is supervised.
Alcohol and tobacco featured strongly, and rightly so, in the Preventative Health Task Force report. The Henry Tax Review has recommended alcohol and tobacco tax reform.
Tax reform is the most important prevention strategy for alcohol and tobacco and a milligram of prevention is still worth a kilogram of cure.
Victoria has now witnessed almost 30 gangland murders in recent years. At least three of these murders seem to have required some degree of police complicity.
Four Royal Commissions in Australia in the last 25 years have documented extensive police corruption linked to unsuccessful attempts to enforce our drug laws (Costigan 1985; Fitzgerald 1987; Wood 1997; Kennedy 2004). NSW now has three external bodies looking for police corruption.
Surely it would be more effective and much cheaper to not just be tough on police corruption, but also get tough on the causes of police corruption.
But it won’t be possible to be tough on the causes of police corruption unless governments start funding alcohol and drug treatment seriously.”