LEGISLATIVE ASSEMBLY OF THE NORTHERN TERRITORY
Select Committee on a Northern Territory Harm Reduction Strategy for Addictive Behaviours
Chair’s Preface ... 5
Committee Members ... 6
Committee Secretariat ... 7
Acknowledgments ... 7
Acronyms and Abbreviations ... 8
Terms of Reference ... 9
1 Introduction ... 10
Scope of the inquiry ... 11
Resources for the inquiry ... 11
Work undertaken to date ... 12
Meetings on Canadian reforms ... 13
2 Scale and Trends Of Illicit Drug Use In The Northern Territory ... 15
Overview of Illicit drug use in the NT ... 15
Cannabis ... 17
Ecstasy ... 17
Methamphetamine ... 17
Cocaine ... 18
Heroin ... 19
Illicit pharmaceuticals ... 19
3 Policy Context ... 20
Framing drug policy as a health issue ... 20
Northern Territory policy context ... 21
National Drug Strategy ... 22
Drug management strategies in other Australian jurisdictions ... 23
Drug Management and Reform at the International Level ... 23
Portugal ... 24
Switzerland ... 25
Addiction and Drug Strategies ... 25
4 Preliminary Findings ... 27
Key issues of concern ... 27
Insufficient funding for treatment providers ... 27
Unaddressed but underlying social disadvantage ... 28
Alternatives to incarceration ... 29
Gaps in service provision ... 30
Lack of family-inclusive treatment ... 30
Expansion of NSP services ... 30
Lack of treatment coordination ... 31
Harm reduction initiatives identified ... 32
Workforce training ... 32
Pill-testing ... 33
5 Future directions for the inquiry ... 35
Appendix 1: Submissions received ... 37
Appendix 2: Public Hearings and Forums ... 38 Appendix 3: Datasets on illicit drug use in the NT ... 42 Bibliography ... 43
The Select Committee on a Northern Territory Harm Reduction Strategy for Reducing Addictive Behaviours (the Committee) was established on 10 May 2018 to investigate how best to prevent or mitigate the harms that stem from addictive behaviours in the NT. This interim report outlines the activities and preliminary findings of the Committee to date and identifies the actions required to complete the inquiry.
Addictive behaviours and related harms are a significant problem in the Northern Territory, with consumption of a range of licit and illicit drugs being substantially higher than elsewhere in Australia. A central aim of this inquiry is to identify an approach to reducing drug-related harms that takes account of new innovative approaches to harm reduction but which will also be effective in the unique NT environment.
The Committee is reviewing health focused strategies and regulatory changes that have been implemented both locally and internationally. Some countries, such as Portugal, have made significant changes to the regulatory environment and combined this with substantial investment in drug treatment, harm reduction and social reintegration policies. By contrast, Switzerland has focused primarily on the strengthening of health strategies through a four pillar approach which emphasises prevention, treatment, harm reduction and law enforcement. The four pillar model has also recently been recommended by the Victorian Parliamentary Inquiry into Drug Management and Reform.
The Committee has collected a substantial amount of evidence regarding the specific needs of the NT, the services being provided, the gaps in services and the unique challenges that service providers face when delivering programs to a widely dispersed population characterised by cultural diversity.
The next step for the inquiry is to hear from people in more remote parts of the Territory to better understand their particular needs and challenges. The evidence collected at a local Northern Territory level will be considered in conjunction with the broader review of health focused strategies and regulatory reforms to determine new approaches that are appropriate to the Northern Territory. The combined evidence will be used to develop options for a strategy to reduce addictive behaviours.
Mr Jeff Collins MLA Chair
Jeff Collins MLA Member for Fong Lim
Select: Northern Territory Harm Reduction Strategy for Addictive Behaviours
Chair: Northern Territory Harm Reduction Strategy for Addictive Behaviours
Sandra Nelson MLA Member for Katherine
Party: Territory Labor
Parliamentary Position: Acting Deputy Speaker Committee Membership
Standing: House, Public Accounts
Sessional: Social Policy Scrutiny
Select: Northern Territory Harm Reduction Strategy for Addictive Behaviours
Chair: Public Accounts
Gary Higgins MLA Member for Daly
Party: Country Liberals
Parliamentary Position: Leader of the Opposition Committee Membership
Standing: House, Standing Orders, Members’ Interests Sessional: Economic Policy Scrutiny
Select: Northern Territory Harm Reduction Strategy for Addictive Behaviours
Lawrence Costa MLA Member for Arafura
Party: Territory Labor
Sessional: Economic Policy Scrutiny
Select: Northern Territory Harm Reduction Strategy for Addictive Behaviours
On 3 December 2018, the Member for Goyder, the Hon Kezia Purick MLA, was discharged from the Committee.
On 1 February 2019, the Member for Port Darwin, the Hon Paul Kirby MLA, was discharged from the Committee and replaced by the Member for Arafura, Mr Lawrence Costa MLA.
First Clerk Assistant: Russell Keith Committee Secretary: Jennifer Buckley
Senior Research Officer: Neil Wright (7/8/2018 – 19/10/2018) Senior Research Officer: Victoria Ikutegbe
Administration Assistant: Kim Cowcher
Contact Details: GPO Box 3721 DARWIN NT 0801
Tel: +61 08 8946 1501 Email: [email protected]
The Committee acknowledges the individuals and organisations that have provided written submissions to this inquiry or who have provided evidence at public forums and hearings. The Committee also acknowledges the Northern Territory Police, Department of Attorney-General and Justice and the Department of Health for providing input at a public briefing.
Acronyms and Abbreviations
AADANT Association of Alcohol and Other Drug Agencies NT ACT Australian Capital Territory
ACCHO Aboriginal Community Controlled Health Organisation ADF Alcohol and Drug Foundation
ADU Automatic Dispensing Unit
AMSANT Aboriginal Medical Services Alliance NT AOD Alcohol and Other Drugs
CAAC Central Australian Aboriginal Congress
CAAPS Council for Aboriginal Alcohol Program Services CDC Centre for Disease Control
CLANT Criminal Lawyers Association of the Northern Territory CRTIC Culturally Responsive Trauma Informed Care
DORA Drugs and Poisons Information System Online Remote Access HASI Housing Accommodation Support Initiative
HRA Harm Reduction Australia IDRS Illicit Drug Reporting System
NAAJA North Australian Aboriginal Justice Agency NDSHS National Drug Strategy Household Survey NGO Non-government Organisation
NSP Needle and Syringe Program NT Northern Territory
NT DOH Northern Territory Department of Health NT PHN Northern Territory Primary Health Network NTAHC Northern Territory AIDS and Hepatitis Council RTPM Real-Time Prescription Monitoring
Terms of Reference
Terms of Reference
The Legislative Assembly resolved on 10 May 2018 that:
1. A Select Committee on a Northern Territory Harm Reduction Strategy for Addictive Behaviours be appointed comprising three (3) Government Members, one (1) Opposition Member and one (1) independent Member to be nominated in writing to the Speaker by the relevant Whip or non-party aligned Member by 18 May 2018 (1) Best practice, humanitarian approaches that effectively reduce the damage
caused by illicit drug-use through effective harm reduction policies and legislation; and
(2) Identify best practice strategies that have a coordinated treatment approach to deal with the broad-range of addictive behaviours; including, but not limited to, alcohol, tobacco and gambling.
2. The Inquiry is established in the May Sittings 2018 and is to provide and interim report by 12 March 2019, and finally report back to the Assembly by 31 August 2019.
Proposed scope of Inquiry:
The Inquiry is to review the available evidence regarding effective harm reduction strategies used to address health problems associated with illicit drug-use and other addictive behaviours and, also, strategies for reducing the impact of these behaviours on families and the broader community.
The proposed Inquiry will look at:
1. The current scale and trends of illicit drug-use in the Territory and its impacts upon health, justice, drug and alcohol and law enforcement activities;
2. Current harm reduction measures available in the Northern Territory and other jurisdictions and their alignment with the National Drug Strategy;
3. A review of best practice evidence in the following areas to support the
development of a revised harm reduction framework for the Northern Territory:
(1) Medical response and ongoing treatment, (2) Health interventions such as:
i. Needle and syringe programs;
ii. Medically supervised injecting facilities; and iii. Pill testing.
(3) The adoption of culturally relevant health and education interventions;
(4) Police and criminal justice responses to drug-related offending;
(5) Police and court diversion programs;
(6) Drug driving programs;
(7) Public awareness campaigns, including school-based education; and (8) Support for affected families and communities.
4. Effective strategies for coordination across treatment facilities to also provide for addictive behaviours more broadly.
Resolved by the Legislative Assembly on 10 May 2018 and amended on 14 February 2019.
1.1 The Select Committee on a Northern Territory Harm Reduction Strategy for Reducing Addictive Behaviours (the Committee) was established on 10 May 2018 in response to growing concerns about the adverse impacts of licit and illicit drug use in the Northern Territory (NT). These concerns are real and justifiable, with data showing that the NT consistently reports higher rates of daily smoking, risky alcohol consumption and cannabis use than is evident in other Australian jurisdictions1. The seriousness of the issues facing the NT indicate the importance of exploring emerging new approaches to the management of drug related harms, such as those being applied in some overseas jurisdictions where the trend is to treat illicit drug use as a health issue rather than a criminal behaviour.2 Similarly, a recent Victorian parliamentary inquiry has emphasised the need to better balance health and law enforcement approaches to drug use, with the emphasis on a health oriented approach.3
1.2 A central task of this inquiry is to identify the approach that is most likely to be effective in reducing drug related harms in the NT. In doing this, the Committee is taking into consideration innovative approaches and best practice harm reduction and treatment strategies being implemented in both Australian and overseas jurisdictions. However, it notes, also, the importance of assessing the extent to which such approaches can be successfully adapted to the NT, given its unique characteristics. For instance, the dispersal of a small population across a large geographic area, and the high proportion of Aboriginal residents in the NT, pose significant challenges to the development of a cost effective, culturally appropriate, and humane strategy for managing the harms associated with drug related and other addictive behaviours.
1.3 The purpose of this Interim Report is to describe the work undertaken to date and to identify the actions required to complete the inquiry. Although the report presents preliminary findings, it does not provide an analysis of the findings. The analysis is a critical next step in the inquiry and will form the basis for recommendations to Government regarding the development of a Harm Reduction Strategy for Addictive Behaviours.
1.4 The remainder of this chapter outlines the scope of the inquiry and the work undertaken to date. Chapter 2 provides an overview of the scale of licit and illicit drug use in the Northern Territory and how this has changed over time, while chapter 3 examines the policy context for drug management in the NT and other jurisdictions, both in Australia and overseas. Preliminary findings are presented in chapter 4, with evidence drawn largely from submissions and discussions during public hearings and
1 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, Drug Statistics series no. 31, Cat. no. PHE 214, Canberra: AIHW, 2017.
2 European Monitoring Centre for Drugs and Drug Addiction, Portugal, Country Drug Report 2017, Publications Office of the European Union, Luxembourg, 2017.
forums. Chapter 5 concludes the report with a summary of future actions required to meet the objectives of the inquiry in line with the Committee’s Terms of Reference.
Scope of the inquiry
1.5 The term ‘addiction’ is often understood in various ways according to particular contexts and specific objectives.4 However, a synthesised definition describes it as
‘a strong and habitual want that significantly reduces control and leads to significant harm’.5 In other words, addiction is a continually repeated behaviour that, over time, diminishes an individual's self-control and ultimately results in harm to self and/or others. It is in this context that the report applies the term ‘addictive behaviour’ when referring to harms associated with the consumption of alcohol, tobacco, other drugs and gambling.
1.6 The Terms of Reference (ToR) for the inquiry are very broad and specify a focus on illicit drug use and other addictive behaviours. In addition, the ToR state that the inquiry should identify best practice harm reduction strategies and strategies that have a coordinated treatment approach for dealing with addictive behaviours.
1.7 It is the Committee’s view that the intent of the ToR is for the inquiry to focus on addictive behaviours associated with misuse of licit and illicit drugs and gambling.
Consequently, while acknowledging the importance of other addictive behaviours, the scope of the inquiry will be limited to substance use issues and gambling. Within this broad scope, the inquiry will address:
• The current scale and trends of licit and illicit drug use in the Territory;
• Policy and legal frameworks for drug management in the NT, Australia, and overseas;
• Current harm reduction measures being applied in the NT and other Australian and overseas jurisdictions;
• Treatment programs; and
• Coordination of treatment programs across government agencies and non- government organisations.
Resources for the inquiry
1.8 Taking into account the volume of work which is currently managed by the Committee Office, the Committee wrote to the Minister for Health on 5 June 2018 requesting additional resources to assist with the inquiry. The request was granted on 6 July 2018 through the secondment of a Senior Research Officer whose primary role is to assist with the collection and analysis of evidence and the preparation of the final report. This position remains wholly funded by the Department of Health. All other
4 RA Wise & GF Koob, ‘The development and maintenance of drug addiction’, Neuropsychopharmacology, vol. 39, 2014, pp. 254-262.
5 W Sinnott-Armstrong & H Pickard, ‘What is addiction?’, in KWM Fulford, M Davies, RT Gipps, G Graham, J Sadler, G Strangellini & T Thornton (eds), The Oxford Handbook of Philosophy of Psychiatry, OUP Oxford, 2013, pp. 851-864.
aspects of the Committee’s work will be managed through the usual Committee Office processes.
Work undertaken to date
1.9 The Committee’s initial focus has been on collecting evidence from a wide range of sources including: drug related datasets; academic literature; submissions; and public briefings, hearings and forums.
1.10 The Committee called for submissions on 23 July 2018 by advertising through the Legislative Assembly website, Facebook, Twitter, media release and the Committee’s email subscription service. The Committee also directly contacted relevant stakeholders to advise them of the call for submissions. A total of 33 submissions were received from a wide range of organisations and individuals (Appendix 1).
1.11 In addition to the call for submissions, the Committee developed a comprehensive program of public hearings and forums. These were planned for both urban and regional locations to ensure that the inquiry captures and considers the viewpoints and experiences of stakeholders from across the Northern Territory. To date, public hearings and forums have been held in Darwin, Katherine, Tennant Creek and Alice Springs. The list of attendees at these public hearings and forums is provided in Appendix 2. Four more public forums are scheduled, three in the East Arnhem region and one in the Tiwi Islands. Tables 1 and 2 provide a summary of the Committee’s past and planned activities, from its establishment in May 2018 to the tabling of the final report in August 2019.
Table 1: Committee activities - completed
1 June 2018 Deliberative meeting 23 July 2018 Call for submissions 23 July 2018 Deliberative meeting 16 August 2018 Deliberative meeting
30 August 2018 Public briefing with Police, Fire and Emergency Services; Department of the Attorney-General and Justice; and Department of Health 7 September 2018 Submissions due
September 2018 Consideration of submissions 25 September 2018 Deliberative meeting
27 September 2018 Public forum in Darwin 31 October 2018 Deliberative meeting
5 November 2018 Public hearing in Tennant Creek 5 November 2018 Public forum in Tennant Creek
6 November 2018 Public hearing in Alice Springs 6 November 2018 Public forum in Alice Springs 15 November 2018 Deliberative meeting 15 November 2018 Public hearing in Darwin 28 November 2018 Deliberative meeting 10 December 2018 Public hearing in Katherine 10 December 2018 Deliberative meeting 15 February 2019 Public hearing in Darwin 15 February 2019 Deliberative meeting 6 March 2019 Deliberative meeting
12 March 2019 Public hearing with Dr Nuno Capaz, Vice-President, Commission for the Dissuasion of Drug Addiction of Lisboa, Portugal
Table 2: Committee activities - in progress
28 March 2019 Public forum in Nhulunbuy 28 March 2019 Public forum in Gunyangara 29 March 2019 Public forum in Yirrkala
April 2019 Public forum and hearings in Tiwi Islands
May - July 2019 Consideration of evidence and development of recommendations July 2019 Revision of first draft report
August 2019 Adoption of final draft report and tabling of report in the Assembly
Meetings on Canadian reforms
1.12 In addition to the Committee activities described above, the Chair of the Committee took advantage of travel to Canada for other business to set up meetings with key stakeholders involved in Bill C-45. Bill C-45 legalised the personal use of marijuana in Canada and was enacted on 17 October 2018, during the Chair’s visit. Meetings were held with:
• Members of the Standing Committee of Social Affairs, Science and Technology which conducted the inquiry into Bill-C45;
• Dr Mark Ware, Vice Chair of the Task Force on Cannabis Legalisation and Regulation;
• Valerie Gideon, Senior Assistant Deputy Minister, First Nations and Inuit Health Branch; and
• Dr Amy Porath, Director of Research and Policy at the Canadian Centre on Substance Use and Addiction.
These meetings, which took place between 12-23 October 2018, provided useful insights into the challenges associated with drug management and reform, with minimal expenditure by the Committee.
Scale and Trends Of Illicit Drug Use In The Northern Territory
2 Scale and Trends Of Illicit Drug Use In The Northern Territory
2.1 Establishing the scale and trends of illicit drug use in the Northern Territory poses significant challenges as the NT does not currently have a discrete system for collecting this type of data. Publicly available data on illicit drug use in the NT are primarily sourced through national datasets, with states and territories providing local input. As there is no single data source that provides comprehensive and accurate data on prevalence, the inquiry has drawn on several different types of datasets in order to build as accurate a picture as possible of the scale and trends of illicit drug use in the NT. The type of information contained in these datasets is included in Appendix 3.
2.2 This chapter provides a brief overview of drug use in the NT in relation to the following illicit drugs: cannabis, methamphetamine (e.g. ice, speed, uppers, crystal), MDMA (ecstasy), cocaine and heroin. In order to provide a comparison with licit drugs it also briefly examines data on alcohol and tobacco use. Illicit drug use encompasses:
• Illegal drugs such as cannabis, heroin, hallucinogens and methamphetamine;
• Pharmaceutical drugs that are misused or used illicitly, such as morphine, oxycodone, fentanyl, tranquilisers/sleeping pills, methadone and buprenorphine; and
• Other psychoactive substances which can be legal or illegal such as kava, synthetic cannabis, and inhalants.6
Overview of Illicit drug use in the NT
2.3 Based on findings from the 2016 National Drug Strategy Household Survey (NDSHS), the percentage of people using illicit drugs in the NT has remained consistently higher than that in other Australian jurisdictions.7 This is despite the fact that the rate of illicit drug use in the NT has decreased considerably, from 28.7% in 2001 to 21.6% in 2016 (Table 3).
2.4 The 2016 NDSHS survey found that recent illicit drug use8 in the NT was higher among males (25.4%) than females (17.3%). In terms of age groups, recent use was highest among Territorians aged 20-29 (28.7%), followed by those aged 14-19 (25.6%). However, the 30-39 and 50-59 age groups also had quite high usage at 22.0% each. Data for the 14-19 age group should be treated with caution due to a high level of sampling error.
6 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 53.
7 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 15.
8 In the NDSHS, recent illicit drug use refers to drug use within the 12 months preceding the survey.
Table 3: Percentage of people aged 14 years or older who recently used illicit drugs(a), by state/territory (2001 – 2016)
State/territory 2001 2004 2007 2010 2013 2016
NSW 15.6 14.6 12.1 13.8 14.2 14.7
Vic. 15.9 14.3 12.8 13.7 14.3 15.0
Qld 16.3 15.9 13.7 15.1 15.5 16.8
WA 21.7 17.3 16.2 18.6 17.0 16.8
SA 17.6 15.4 14.7 14.9 15.7 15.7
Tas. 14.4 15.4 14.8 12.0 15.1 17.4
ACT 17.8 17.6 13.8 13.9 15.3 12.9
NT 28.7 26.0 20.4 21.3 22.0 21.6
Australia 16.7 15.3 13.4 14.7 15.0 15.6
Source: NDSHS 2016. (a)Used at least 1 of 16 illicit drugs in 2016 – the number and type of illicit drugs used varied between 1998 and 2016 (includes pharmaceuticals).
2.5 Figure 1 shows that alcohol continues to be the most commonly used drug in the Territory. Similarly, a substantial proportion of Territorians continue to use tobacco, however, there have been significant decreases in tobacco use, from 40% in 1998 to 17% in 2016.9 In 2016, the percentage of Territorians using any illegal drug was slightly higher than the percentage using tobacco. Similar findings regarding alcohol and tobacco are available from the National Wastewater Drug Monitoring Program (Wastewater Analyses) which found the Northern Territory to have the highest consumption of nicotine and alcohol.10 By contrast, misuse of pharmaceutical drugs has increased from 3.8% in 2013 to 5.1% in 2016.11
Figure 1: Licit and Illicit Drug Use in the NT, 2013 and 2016
Source: NDSHS 2016. *Single occasion risk includes weekly, monthly and yearly;
**Excludes pharmaceuticals; ***Excludes over the counter (OTC) drugs
9 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 18.
10 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, December 2018, p. 12; note that Wastewater Analyses measures nicotine instead of tobacco.
11 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed
0 10 20 30 40 50 60
Pain-killers/analgesics and opioids Misuse of pharmaceuticals Cannabis Illegal drugs Tobacco Lifetime risk alcohol Single occasion risk alcohol
Licit and Illicit Drug Types
Scale and Trends Of Illicit Drug Use In The Northern Territory
2.6 Findings from both the 2016 NDSHS and the Wastewater Analyses12 indicate that cannabis use is higher in the NT than any other Australian jurisdiction, with 16% of Territorians reporting recent use in 2016 compared to 10.4% for Australia overall.13 Wastewater analyses similarly showed that, of all the sites tested across the country, regional NT has the highest overall use, with this far exceeding the national average.14
2.7 Cannabis use is substantially higher among injecting drug users in the NT than in users who do not inject drugs, with 60% of survey respondents reporting use of cannabis in the last six months.15 Daily use of cannabis is common (46% of recent users) and the majority most often use hydroponic (86%) rather than ‘bush’ cannabis (9%).16
2.8 Cannabis accounts for the largest number of charged drug offences in the NT: 51%
in 2017-18 and 61% over the period 2000-01 to 2017-18.17 Analyses of the overall figures show a 40% increase in cannabis-related offences in the 2017-18 period compared to 2000-01.
2.9 Data from both NDSHS and Wastewater Analyses suggest that, proportionally, ecstasy use is more common in the Territory than in other Australian jurisdictions, with 2.9% of participants reporting ecstasy use compared to 2.2% nationally.18 2.10 In all jurisdictions, more males than females used ecstasy, however, the gender
difference in the NT is considerably larger than elsewhere. Nationally, 2.6% of recent ecstasy users were male and 1.8% female, while in the NT 4.3% were male and only 1.3% female.19
2.11 Methamphetamine is available as powder/pills (speed), crystal methamphetamine (crystal meth or ice) and a sticky paste (base), with ice being the most pure form.20 Although the 2016 NDSHS survey reported a significant decline in recent
12 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018.
13 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings.
14 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018.
15 C Moon, Northern Territory Drug Trends 2018: Key Findings from the Illicit Drug Reporting System Interviews, National Drug and Alcohol Research Centre, UNSW Sydney, 2019, p. 20.
16 C Moon, 2019, p. 21.
17 Department of the Attorney-General And Justice, Submission No. 6, 2018, p. 9; These are drug offences that were charged at apprehension (not including infringement notices) and proceeded to court.
18 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 16.
19 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings.
20 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings.
methamphetamine use across Australia, the use of ice as the predominant form has increased from 22% in 2010 to 57% in 2016.21 Ice poses higher risks than speed in terms of the potential for dependence and physical and mental problems, and data suggest that a preference for ice tends to correspond with more frequent use.22 2.12 Based on 2018 Wastewater Analyses, regional NT had the lowest levels of
methamphetamine use of all Australian test sites.23 However, in the capital city site, methamphetamine use was on a par with or above the national average and was only surpassed by South Australia and Western Australia.24
2.13 Recent use of any methamphetamine in the NT injecting drug user population declined substantially between 2002 and 2014 but recent results show that it has increased beyond 2002 levels (73%) to 75% in 2018.25 The majority of NT respondents reported use of ice rather than speed or base.26 NT Illicit Drug Reporting System (IDRS) survey data suggest that ice is easier to obtain than other forms of methamphetamine, with 93% of respondents reporting that it was ‘easy’ or ‘very easy’
to obtain.27 Cocaine
2.14 Based on NDSHS data, cocaine use has increased both nationally and in the NT between 2010 and 2016. These data place cocaine use in the NT on a par with Victoria, with usage increasing from 0.5% in 2010 to 2.5% in 2016. New South Wales is the only state/territory with a higher proportion of users (3.4%).28 These findings are echoed in Wastewater Analyses which found that the number of doses per 1000 people in the NT capital city site was higher than the average of capital city sites elsewhere in Australia, with only NSW having higher consumption in capital city sites.29
2.15 Cocaine use in the NT occurs primarily in the city, with the NT having the lowest regional rate of use. Although NDSHS data suggests that, nationally, cocaine is the second most commonly used illegal drug after cannabis30, the 2018 Wastewater Analyses suggest that methamphetamine is the highest consumed illegal drug across
21 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 8.
22 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 69.
23 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018.
24 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018, p. 45.
25 C Moon, 2019, p. 14
26 C Moon, 2019, p. 15
27 C Moon, 2019, p. 18
28 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings, p. 91.
29 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018, p. 28.
30 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed
Scale and Trends Of Illicit Drug Use In The Northern Territory
all Australian jurisdictions.31 In the NT, the increase in cocaine use has been for males, with use among females decreasing from 1.6% in 2013 to 0.8% in 2016.
2.16 Data from the NDSHS indicates that the number of injecting drug users is relatively small across Australia and in the NT, and has generally been stable between 2013 and 2016. Although recent use of heroin and other injecting drugs is low in the NT, these drugs are highly addictive and are associated with risk factors for transmitting blood borne viruses. In addition, the frequency of use is much higher than for other drugs, with users often injecting twice a week or more.
2.17 Only 8.0% of participants in the 2018 NT Drug Trends Survey injected heroin in the previous six months, of these, 22% injected heroin daily compared to 67% who injected weekly or less.
2.18 Comparing results on misuse of pharmaceuticals across different data sources is difficult as each source examines different drugs. Broadly, the pharmaceutical drugs most likely to be subject to misuse can be divided into the following categories:
painkillers/analgesics and opioids; tranquilisers/sleeping pills; drugs to treat opioid dependence (e.g. buprenorphine, methadone); and steroids.
2.19 Based on NDSHS data, misuse of pharmaceutical drugs is highest in states and territories with older populations, such as Tasmania (5.6%) and South Australia (5.5%). However, despite its young population, the NT proved the exception to this trend, and had the third highest percentage of people misusing pharmaceutical drugs (5.1%).32 This contrasts with data from Wastewater Analyses which suggest misuse of pharmaceutical drugs is comparatively low in the NT compared with other Australian jurisdictions.
2.20 In the Territory, misuse of these pharmaceuticals is primarily related to drugs classified as painkillers/analgesics and opioids (excludes over the counter drugs), with 4.2% misusing these types of drugs, compared to only 1.8% misusing tranquilisers/sleeping pills, and negligible numbers misusing steroids or methadone/buprenorphine.33 Data from the NT Drug Trends Survey of injecting drug users indicates that morphine is the most commonly misused opioid (76% in 2016), with the percentage misusing other opioids considerably smaller.34
31 Australian Criminal Intelligence Commission, National Wastewater Drug Monitoring Program Report 6, 2018.
32 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings.
33 Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: detailed findings.
34 C Moon, Northern Territory Drug Trends 2017: Findings from the Illicit Drug Reporting System, Australian Drug Trend Series No. 188, National Drug and Alcohol Research Centre, UNSW Sydney, 2018, p. 20.
3 Policy Context
Framing drug policy as a health issue
3.1 There is an emerging global trend to approach the management of drug misuse through a health lens. Methods for implementing this concept vary but include both the development of more sophisticated strategies to manage the adverse impacts of drug use and, to varying degrees, the decriminalisation of drugs. For example, Switzerland has introduced a four pillar drug policy framework which facilitates a more focused approach to strategies related to prevention, treatment, harm reduction and law enforcement. Although it has introduced a low level of decriminalisation with respect to cannabis, the possession and consumption of all other illicit drugs continues to be a criminal offence. Portugal has combined decriminalisation of all illicit drugs for personal use with intensive investment in drug treatment, harm reduction and social reintegration policies. At a more local level, recommendations made by the Parliament of Victoria, Law Reform, Road and Community Safety Committee strongly emphasise the adoption of a health approach to drug management and specifically recommend the adoption of a four pillar model.
3.2 Drug-related strategies and programs are framed and influenced by the legislative environment in which they are developed and implemented. Consequently, the development of recommendations for the formulation of a harm reduction strategy for the Northern Territory also requires consideration of the current legislative environment.
3.3 From a legislative perspective, drugs are generally managed through prohibition, decriminalisation or legalisation. Under prohibition, the production, sale and possession of illicit drugs is a criminal offence.35 By contrast, legalisation removes any criminal and civil penalties for the possession, use, production and/or supply of drugs that would otherwise be deemed illegal.36 Decriminalisation functions as a mid- way point and reduces, rather than removes, the legal penalties for specific drug offences, usually possession of drugs for personal use and, in some instances, cultivation of drugs.37
3.4 Traditionally, prohibition has been the most common model both in Australia and overseas, however, there is growing debate as to whether this is the most effective model for managing drug use and addiction. The decriminalisation and legalisation of drugs is a contentious subject with vociferous advocates on both sides of the debate. A key concern is that a move away from prohibition will result in an increase in drug use. Conversely, advocates for decriminalisation and legalisation argue that these models would have positive effects by removing the stigma and fear of prosecution associated with drug use and thereby encouraging users to seek
35 HG Levine, ‘Global drug prohibition: its uses and crises’, International Journal of Drug Policy, vol. 14, 2003, pp. 145-153.
36 Commonwealth, Joint Committee on Law Enforcement, Inquiry into crystal methamphetamine (ice) Final Report, 2018, Chapter 6.
37 Commonwealth, Joint Committee on Law Enforcement, Inquiry into crystal methamphetamine (ice) Final
treatment. Central to the debate is whether drug use and addiction should be treated as a health problem or a crime.
3.5 Australia predominantly operates under a prohibition model except for alcohol, tobacco and, to some extent, cannabis. Cannabis is largely decriminalised in Australia through a mix of de jure and de facto schemes,38 with the ACT, NT and South Australia operating de jure decriminalisation schemes and the remaining jurisdictions operating de facto schemes.
3.6 The type of legislative framework in place affects the type of programs that can be implemented, the nature of the strategies that are developed, and the allocation of funding. In this respect, a recent report by the Victorian Law Reform, Road and Community Safety Committee noted that:
While Australia’s official approach to drugs is based on harm minimisation, the predominant focus is law enforcement to reduce the supply of illicit drugs in the community.39
3.7 Although supply reduction through law enforcement is a legitimate focus it has been argued that it receives a disproportionate amount of funding compared to harm reduction, treatment and prevention initiatives.40 In this respect, Professor Lee noted the following:
When you look at the implementation of the policy across Australia, and implementation is largely a matter for the states and territories, it is quite unbalanced. An analysis from the Drug Policy Modelling Program based in New South Wales, showed that only about 2% of drug funding is explicitly spent on harm reduction activities and about 66% on law enforcement or supply reduction.
The remainder is on prevention and treatment. Harm reduction itself as an exclusive strategy is poorly resourced.41
Northern Territory policy context
3.8 The legislative framework in the Northern Territory is effectively a prohibition model, with all drugs other than alcohol and tobacco classed as illegal. Alcohol is dealt with under a range of Acts including the Liquor Act 1978 (NT), the Liquor Commission Act 2017 (NT) and the Alcohol Harm Reduction Act 2017 (NT). Tobacco is covered under the Tobacco Control Act 2002 (NT). Use of Illicit drugs is dealt with under the Misuse of Drugs Act 1990 (NT) (the Act). Cannabis continues to be classed as an illicit drug but has been decriminalised for personal use.
3.9 In relation to cannabis, the Act provides that a police officer may issue a drug infringement notice to a person found cultivating not more than 2 cannabis plants or in possession of up to 50 grams of cannabis plant material (or up to 10 grams of
38 de jure schemes entail legislation that removes or replaces criminal penalties with civil or administrative penalties; de facto schemes occur through non-enforcement of the law through permitted police discretion or police or prosecutorial guidelines.
39 Parliament of Victoria, Law Reform, Road and Community Safety Committee, Inquiry into Drug Law Reform, 2018, p. 2.
40 Parliament of Victoria, Law Reform, Road and Community Safety Committee, Inquiry into Drug Law Reform, 2018, p. 79.
41 N Lee, 360Edge, Darwin Public Hearing transcript, 15 November 2018, p. 39.
cannabis resin, 10 grams of cannabis seed, or 1 gram of cannabis oil).42 The prescribed amount for an infringement notice offence is 2 penalty units which is currently $308. It is important to note that Part IIB of the Misuse of Drugs Act 1990 (NT) does not require an infringement notice to be issued, therefore it is at the discretion of the police officer whether a notice is issued or the person is charged with an offence.
3.10 To avoid any further action after an infringement notice has been issued, offenders must pay the prescribed amount within 28 days. Alternatively they may elect to have the matter dealt with by a criminal court. If they do not respond to the infringement notice and the offence has not been expiated, criminal proceedings may be initiated.
3.11 The Northern Territory does not currently have an overarching alcohol and other drugs strategy. In 2015, it released a methamphetamine specific action plan, Tackling Ice in the Northern Territory and, more recently, the Northern Territory Alcohol Harm Minimisation Action Plan 2018-2019. Both of these action plans are based on the three pillar model as described in the section below.
National Drug Strategy
3.12 The overarching policy framework for the formulation of national and jurisdictional alcohol, drug and tobacco policies in Australia is the National Drug Strategy (NDS).
The NDS is underpinned by the objective of minimising the harms associated with alcohol, illicit drugs, tobacco and pharmaceutical drug use. In contrast to some European addiction strategies, and recommendations contained in the recent Victorian Parliament’s Inquiry into Drug Law Reform, Australia’s national harm minimisation framework continues to be based on the three pillars of harm reduction;
supply reduction; and demand reduction.
3.13 Demand reduction strategies aim to prevent uptake and delay first use, reduce harmful use and support people to recover from drug-related problems. Demand reduction can include: reducing the availability of licit drugs through price mechanisms; building community knowledge of the impacts of substance use;
reducing stigma and promoting help seeking; restrictions on marketing; treatment services and brief interventions; targeted approaches to at risk groups; addressing underlying social, health and economic determinants of substance use; and diversion initiatives.
3.14 Supply reduction strategies are based around controlling licit drug and precursor availability, and preventing and reducing the availability and accessibility of illicit drugs. Supply reduction strategies include: regulating retail sale of licit substances;
age restrictions; border control; regulating or disrupting production and distribution;
and real-time monitoring of prescription drugs.
3.15 Harm reduction strategies aim to reduce risk behaviours and provide safer settings.
These strategies can include: safe transport and sobering up services; promoting safer injecting practices and preventing the spread of blood borne viruses; reducing
driving under the influence of alcohol or drugs; and pharmacotherapy for opioid maintenance and other drug use.
Drug management strategies in other Australian jurisdictions
3.16 Drug and alcohol strategies vary between states and territories in terms of whether they focus solely on drugs; alcohol and drugs; or mental health, alcohol and drugs.
In addition to an overarching alcohol and other drugs strategy, a number of jurisdictions have also developed methamphetamine specific action plans. Most alcohol and other drugs strategies in Australian jurisdictions are predominantly based on the three pillar harm minimisation model espoused in the National Drug Strategy.
3.17 Table 4 provides an overview of the alcohol and other drugs strategies and action plans currently in place.
Table 4: Alcohol and drug strategies by jurisdiction Jurisdiction Strategy
Commonwealth • National Drug Strategy 2017-2016
• National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy 2014-2019
• National Tobacco Strategy 2012-2018
• National Ice Action Strategy (2015)
• National Alcohol and Other Drug Workforce Development Strategy 2015-2018
Victoria • Reducing the alcohol and drug toll: Victoria’s plan 2013-2017 (lapsed)
• VicHealth Alcohol Strategy 2016-2019
• Ice Action Plan (2015)
• Drug Rehabilitation Plan (2017)
• Victorian Health and Well-being Plan 2015-2019
New South Wales • The Centre for Population Health is finalising the NSW Health Alcohol and Other Drugs Strategy
South Australia • South Australian Alcohol and Other Drug Strategy 2017-2021
• Stop the Hurt: South Australian Ice Action Plan (2017)
Western Australia • Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025
• Western Australian Methamphetamine Action Plan (2017)
Queensland • Queensland Mental Health, Drug and Alcohol Strategic Plan 2014- 2019
• Actions on Ice (2018)
Tasmania • Tasmanian Drug Strategy 2013-2018 Australian Capital
• ACT Alcohol, Tobacco and Other Drug Strategy 2010-2014 (lapsed)
• ACT Drug Strategy Action Plan 2018-2021
Drug Management and Reform at the International Level
3.18 Over the last two decades, there has been a global trend to decriminalise the possession of illicit drugs for personal use, particularly cannabis. To a lesser degree, there is an emerging global trend to legalise cannabis for recreational use, with this already implemented in Uruguay, Canada and a number of jurisdictions within the United States of America. Of the countries that have decriminalised drug use, the
majority have only applied the decriminalisation to cannabis, while a smaller number have applied the policy to possession of all illicit drugs for personal use.43 Advocates for drug policy reform argue that prohibition has failed, and drug use and addiction should not be criminalised but treated as a health issue.
3.19 The trend towards treating addiction as a health problem, rather than a crime, has resulted in a number of countries implementing substantial reforms to enable the implementation of new and innovative approaches to managing addictive behaviours associated with drug use. Given the relevance of these reforms for the inquiry, two examples have been included below.
3.20 In 2001, Portugal decriminalised the use and possession of all illicit drugs in response to the country’s prolific heroin addiction and high rates of HIV infection. The law stipulates a personal possession threshold for each drug, based on a ten day supply of the drug for personal consumption. When a person is found in possession of drugs under the personal use threshold, police issue a citation referring the person to the local Commission for the Dissuasion of Drug Addiction (CDT). The CDT is a three person panel comprising one legal professional and two members with a clinical or social work background. Each CDT is supported by a multidisciplinary staff with expertise in drug addiction. The CDT aims to provide information about the consequences of drug use and to dissuade people from using drugs. The drug user is assessed to determine: whether they are drug dependent; the circumstances surrounding the drug use; and whether they have had contact with police.44
3.21 There are a range of legislated sanctions that can be imposed by the CDT based on their assessment of the drug user. Sanctions include treatment for drug dependent users, regular reporting to the panel, community service, suspension of driving or professional licence and, as a last resort, fines. The panel will almost always suspend proceedings for a non-dependent first-time offender and impose no sanction, with this occurring in 83% of cases in 2013. Approximately 82% of cases referred to a CDT in 2013 were for cannabis possession alone, 6% involved heroin, 6% involved cocaine and the remaining referrals involved poly drug use.45
3.22 The decriminalisation of illicit drugs in Portugal reframed the drug policy approach from a criminal justice framework to a public health model with a focus on, and substantial investment in, drug treatment, harm reduction and social reintegration policies. The broad range of health interventions provided to drug users include counselling, needle exchange programs and opioid substitution treatment. Many of these are publicly funded, making them accessible to drug users.
43 C Hughes, A Ritter, J Chalmers, K Lancaster, M Barratt & V Moxham-Hall, Decriminalisation of drug use and possession in Australia––a briefing note, UNSW, Sydney, 2016, p. 4.
44 CR Fonseca, The implementation of Portuguese drug policy: issues for CDTs, meeting on Portuguese drug policy – Domestic and International perspectives, 2015, http://www.issdp.org/wp-
45 N Eastwood, E Fox & A Rosmarin, ‘A quiet revolution: Drug decriminalisation across the globe’, Release –
3.23 The Portugal model is underpinned by the core principles of humanism and pragmatism where drug users are viewed as people in need of treatment, rather than as criminals. It considers that a drug free society is not obtainable and that better results are more likely to accrue from implementing policies that focus on reducing drug use and related harms through education, harm reduction and treatment than through prohibition. Portugal no longer has national drug and alcohol strategies, these have been replaced with the National Plan for Reducing Addictive Behaviours and Dependencies 2013-2020.
3.24 The catalyst for drug policy reform in Switzerland was the proliferation of heroin injecting in public spaces and resulting high rates of HIV infection. In response to this crisis, harm reduction strategies, including safe injecting rooms and needle exchange programs, were introduced in the late 1980s. In 1994, Switzerland developed a four pillar drug policy focussed on prevention, treatment, harm reduction and law enforcement. In the 1990s, the federal government approved heroin assisted treatment which consists of the prescription of diamorphine as a substitute for heroin.46
3.25 Between 1991 and 2016, the four pillar drug approach was adopted through three iterations of the ‘Package of measures to reduce drug problems’. In 2017, Switzerland introduced the National Strategy on Addiction and Action Plan 2017- 2024. The strategy’s key objectives include: prevention of addictive disorders;
provision of help and treatment for individuals with addiction problems; mitigation of social harms and damage to health; and reduction of negative impacts on society.47 3.26 The possession and consumption of all illicit drugs remains a criminal offence in Switzerland, however, in 2013 the Swiss Parliament changed the penal code so that an adult found in possession of less than 10 grams of cannabis is not subject to prosecution and would, instead, be issued with an administrative fine of CHF 100 (approximately AUD$130). Heroin assisted treatment has continued for users who have been unresponsive to other treatments and is now classified as a ‘regular medical treatment’. Although public support for this type of treatment was expressed through a 2008 referendum, it is still significantly less common than opioid substitution treatment.48
Addiction and Drug Strategies
3.27 The decriminalisation of drugs for personal use has shifted perceptions of drug use, at both the policy and community level, from drug users as criminals, to people with a health problem. This has led to an increased emphasis on the development of interventions to reduce the individual and societal harms that can result from drug use. Drug policy reform has contributed to the emergence of addiction strategies as
46 N Eastwood, E Fox & A Rosmarin, 2016, p. 33.
47 Swiss Confederation, National Strategy on Addiction and Action Plan 2017-2024, p. 10.
48 N Eastwood, E Fox & A Rosmarin, 2016, p. 34.
a replacement for traditional drug and alcohol strategies, with these used in Portugal, Germany, Austria and Switzerland. Addiction strategies emphasise that addiction is, and should be, treated as a disease and health issue, not one of personal or moral failure, or a lack of will power. The Austrian Addiction Prevention Strategy states:
Prevention and addiction policy is neither moralistic nor dogmatic, but oriented towards the needs of both the general public and those people who use psychotropic substances, or show other patterns of addiction-related behaviour.
The goal is to reduce to a minimum the negative consequences and harm related to substance use or behavioural addictions for the persons concerned, as well as for society. This includes endeavours to preserve or achieve the social integration of those who have displayed risky or harmful patterns of substance use or addiction-related behaviour.
Stigmatisation, discrimination and exclusion make people ill, and constitute a risk both to the success of individual treatment and to social cohesion.49
3.28 Although the terminology varies, a number European addiction strategies have adopted the four pillar model which focusses on: (1) prevention and early detection;
(2) treatment and counselling; (3) harm reduction and risk minimisation; and (4) regulation and enforcement. These strategies place a higher emphasis on prevention and harm reduction than on regulation and enforcement.
3.29 In Australia, the three pillar model continues to be the model of choice for nearly all jurisdictions. As part of this inquiry the three pillar model and its relevance for the Northern Territory will be assessed. The inquiry will also examine the potential benefits associated with a four pillar model as adopted in some overseas jurisdictions and as recommended in the Parliament of Victoria’s Law Reform, Road and Community Safety Committee in their Inquiry into Drug Law Reform. 50
49 Austrian Federal Ministry of Health, The Austrian Addiction Prevention Strategy, 2015, p. 8.
50 Parliament of Victoria, Law Reform, Road and Community Safety Committee, Inquiry into Drug Law Reform,
4 Preliminary Findings
4.1 Early analysis of evidence collected to date has identified a number of recurring themes. These have been categorised under the following three headings: key issues of concern; gaps in service provision; and harm reduction initiatives. Each area is discussed below.
Key issues of concern
Insufficient funding for treatment providers
4.2 Lack of sufficient funding was one of the most frequently mentioned issue of concern for service providers, many of whom described it as a source of ongoing frustration.
The consensus among service providers is that the funding allocated to harm reduction efforts is minimal compared to what is provided for demand and supply reduction strategies. The Centre for Disease Control (CDC) calls for this imbalance to be redressed in order for harm reduction efforts to yield maximum success.
4.3 Of particular concern to some organisations is the lack of ongoing funding which means that service providers spend time that should be put into treatment provision reapplying for short-term funding. For the Aboriginal Medical Services Alliance NT (AMSANT), funding is the main impediment to the broad-scale delivery of their Culturally Responsive Trauma Informed Care (CRTIC) workforce training program:
Funding for an expanded social emotional wellbeing service within Aboriginal primary health care is not secure and is not sufficient to meet the needs, with many areas under resourced… We have been working with our member services.
At the moment we are working with seven of the member services… It is a capacity issue in that we are a small team and there is only so much funding…
At the moment we only have funding until 30 June .51
4.4 Others face the frustration of not being able to retain staff due to lack of ongoing funding.52 As the regional leader for Mission Australia commented:
Year on year funding is the bane of every organisation’s and every NGO’s existence. We spend six months writing up tenders and processes only to be granted and then have to start the process again… Often we are in a position where we are not sure whether the funding is going to continue and whether they [our Staff] have any job security. It is a constant churn in the Territory for staff.53
4.5 Central Australian Aboriginal Congress (CAAC) commented that this type of tendering process inevitably leads to ‘fragmented, complex service delivery environments with multiple providers of health services’54. Organisations would prefer programs to be given long term sustainable funding, so as to maximise effectiveness and build relationships in communities. At present, some communities face situations
51 Aboriginal Medical Services Alliance (AMSANT), Darwin Public Hearing transcript, 15 November 2018, p.
52 CatholicCare, Submission No. 21, 2018.
53 M Soler, Mission Australia, Darwin Public Hearing transcript,15 November 2018, p. 30.
54 Central Australian Aboriginal Congress (CAAC), Submission No. 32, 2018, p. 7.
of ‘overuse and oversupply’ whereby funding is so dispersed among multiple agencies, and effort so replicated, that it renders services ineffective.
I did hear something earlier around small communities where there are 16 services providing 400 people. I have seen that and it is just a procession of banners on cars coming in and out… There are some communities where there are four services delivering exactly the same program just in a different name…
It is overuse and oversupply.55
Unaddressed but underlying social disadvantage
4.6 Several service providers expressed concerns that current approaches for treating substance misuse are less effective than they could be because they tend to ignore the factors that either lead to or perpetuate the addictive behaviours.56,57,58 As the Northern Territory Primary Health Network (NT PHN) explained:
We know that addressing the social determinants that underlie these issues, and that includes things like providing good education, housing and health support and family support, all of those aspects play into the symptom of AOD [alcohol and other drugs] coming out… As long as we focus and address the symptoms and do not address the causative factors, we will really struggle.59
4.7 Sharing the same view, AMSANT and North Australian Aboriginal Justice Agency (NAAJA) recommend that AOD organisations adopt a culturally responsive trauma- informed care model which accounts for the social determinants of health.60 AMSANT adds that something as fundamental as housing can provide users with the stability they need to successfully overcome their addiction. Homelessness, on the other hand, is deleterious to treatment efforts and has been identified as a common factor in the commission of crimes by people with addictive behaviours.61
4.8 In recognition of the importance of housing in resolving addictive behaviours, the NT Department of Health (NT DoH) has identified a model that has been used to support people with mental illness and which might have some utility for people undergoing treatment for substance misuse.62 This model, Housing Accommodation Support Initiative (HASI), is a partnership between multiple agencies including the NT DoH, Anglicare NT, Top End Mental Health Services and the Department of Housing and Community Development, among others. The driving objective of the initiative is to help people with mental illnesses to retain their tenancies in public housing so that they do not become homeless. The same could be replicated for people undergoing treatment for substance misuser.
55 M Soler, Mission Australia, Darwin Public Hearing transcript,15 November 2018, p. 30.
56 Northern Territory Primary Health Network (NT PHN), Submission No. 18, 2018.
57 Mission Australia, Submission No. 23, 2018.
58 North Australian Aboriginal Justice Agency (NAAJA), Submission No. 29, 2018.
59 P Burnheim, NT PHN, Darwin Public Hearing transcript,15 November 2018, p. 69.
60 AMSANT, Submission no. 24, 2018; NAAJA, Submission No. 29, 2018.
61 Department of the Attorney-General and Justice, Submission No. 6, 2018.
Alternatives to incarceration
4.9 CatholicCare expressed a view held by many organisations that there is a need for greater investment into alternatives to incarceration.63 Submissions especially called for the reintroduction of specialist courts like the SMART Court which allowed for people who commit crimes as a result of their addictive behaviours to be dealt with using therapeutic rather than punitive means.64 As the president of Harm Reduction Australia (HRA) put it, ‘criminal convictions for drug use can leave ongoing and permanent stains on people’s lives’, a burden that he believes is borne mostly by the young and poor.65
4.10 The president of the Criminal Lawyers Association of the Northern Territory (CLANT) expressed a similar viewpoint based on his experience with the justice system:
What we want to try to do is have fewer people in the criminal justice system by addressing these issues earlier… For the ones who do ultimately slip through the cracks, we want to set up a system in which the criminal justice system acknowledges addiction as a health issue primarily and, as a consequence, finds a more therapeutic and needs-based approach to dealing with people who offend, where the underlying issue is an addictive issue.66
4.11 The Alcohol and Drug Foundation (ADF) recommends the reintroduction of drug courts to the NT as ‘a matter of urgency… to reduce preventable, long term drug- related harm’.67 The ADF identified several evaluations which demonstrate the efficacy of drug courts in Victoria and New South Wales. Among other benefits, the courts were found to reduce recidivism among participants, improve their employment prospects and facilitate their recovery from substance misuse. One of the identified merits of drug courts over imprisonment is that offenders are not isolated from society, so the period of readjustment upon completion is far less than is the case with incarcerated offenders.
4.12 Similarly, Amity Community Services points out that a measure of the success of drug courts is that offenders are forced to ‘confront their addiction and repair the damage they have done to themselves, their families and their community’.68 This gives them a better chance at rehabilitating than imprisonment would, since that approach keeps them isolated from society. Amity commented that drug courts are not only effective at achieving rehabilitation of offenders, but they are also a more cost-effective harm reduction measure than imprisonment.
63 CatholicCare, Submission No. 21, 2018.
64 Criminal Lawyers Association of the Northern Territory (CLANT), Submission No. 30, 2018.
65 G Vumbaca, Harm Reduction Australia, Darwin Public Hearing transcript,15 February 2018.
66 M Aust, CLANT, Darwin Public Hearing transcript,15 November 2018, p. 56.
67 Alcohol and Drug Foundation, Submission No. 15, 2018, p. 17.
68 Amity Community Services, Submission No. 28, 2018, p. 7.