INTERIM REPORT - Legislative Assembly
LEGISLATIVE ASSEMBLY OF THE NORTHERN TERRITORYSelect Committee on a Northern Territory Harm ReductionStrategy for Addictive BehavioursINTERIM REPORTMarch 2019
ContentsContentsChair’s Preface . 5Committee Members . 6Committee Secretariat . 7Acknowledgments . 7Acronyms and Abbreviations . 8Terms of Reference . 91 Introduction . 10Scope of the inquiry. 11Resources for the inquiry . 11Work undertaken to date . 12Meetings on Canadian reforms . 132 Scale and Trends Of Illicit Drug Use In The Northern Territory . 15Overview of Illicit drug use in the NT . 15Cannabis . 17Ecstasy . 17Methamphetamine. 17Cocaine . 18Heroin . 19Illicit pharmaceuticals . 193 Policy Context . 20Framing drug policy as a health issue. 20Northern Territory policy context . 21National Drug Strategy . 22Drug management strategies in other Australian jurisdictions . 23Drug Management and Reform at the International Level . 23Portugal . 24Switzerland . 25Addiction and Drug Strategies . 254 Preliminary Findings . 27Key issues of concern . 27Insufficient funding for treatment providers . 27Unaddressed but underlying social disadvantage . 28Alternatives to incarceration . 29Gaps in service provision . 30Lack of family-inclusive treatment . 30Expansion of NSP services . 30Lack of treatment coordination . 31Harm reduction initiatives identified . 32Workforce training . 32Pill-testing . 335 Future directions for the inquiry . 35Appendix 1: Submissions received . 373
Inquiry into a Northern Territory Harm Reduction Strategy for Addictive BehavioursAppendix 2: Public Hearings and Forums . 38Appendix 3: Datasets on illicit drug use in the NT. 42Bibliography . 43
Chair’s PrefaceChair’s PrefaceThe Select Committee on a Northern Territory Harm Reduction Strategy for ReducingAddictive Behaviours (the Committee) was established on 10 May 2018 to investigatehow best to prevent or mitigate the harms that stem from addictive behaviours in theNT. This interim report outlines the activities and preliminary findings of the Committeeto date and identifies the actions required to complete the inquiry.Addictive behaviours and related harms are a significant problem in the NorthernTerritory, with consumption of a range of licit and illicit drugs being substantially higherthan elsewhere in Australia. A central aim of this inquiry is to identify an approach toreducing drug-related harms that takes account of new innovative approaches to harmreduction but which will also be effective in the unique NT environment.The Committee is reviewing health focused strategies and regulatory changes that havebeen implemented both locally and internationally. Some countries, such as Portugal,have made significant changes to the regulatory environment and combined this withsubstantial investment in drug treatment, harm reduction and social reintegrationpolicies. By contrast, Switzerland has focused primarily on the strengthening of healthstrategies through a four pillar approach which emphasises prevention, treatment, harmreduction and law enforcement. The four pillar model has also recently beenrecommended by the Victorian Parliamentary Inquiry into Drug Management andReform.The Committee has collected a substantial amount of evidence regarding the specificneeds of the NT, the services being provided, the gaps in services and the uniquechallenges that service providers face when delivering programs to a widely dispersedpopulation characterised by cultural diversity.The next step for the inquiry is to hear from people in more remote parts of the Territoryto better understand their particular needs and challenges. The evidence collected at alocal Northern Territory level will be considered in conjunction with the broader reviewof health focused strategies and regulatory reforms to determine new approaches thatare appropriate to the Northern Territory. The combined evidence will be used todevelop options for a strategy to reduce addictive behaviours.Mr Jeff Collins MLAChair5
Inquiry into a Northern Territory Harm Reduction Strategy for Addictive BehavioursCommittee MembersJeff Collins MLAMember for Fong LimParty:Committee MembershipSelect:IndependentNorthern Territory Harm Reduction Strategy forAddictive BehavioursNorthern Territory Harm Reduction Strategy forAddictive BehavioursChair:Sandra Nelson MLAMember for KatherineParty:Parliamentary Position:Committee MembershipStanding:Sessional:Territory LaborActing Deputy SpeakerHouse, Public AccountsSocial Policy ScrutinyNorthern Territory Harm Reduction Strategy forAddictive BehavioursPublic AccountsSelect:Chair:Gary Higgins MLAMember for DalyParty:Parliamentary Position:Committee MembershipStanding:Sessional:Select:Country LiberalsLeader of the OppositionHouse, Standing Orders, Members’ InterestsEconomic Policy ScrutinyNorthern Territory Harm Reduction Strategy forAddictive BehavioursLawrence Costa MLAMember for ArafuraParty:Committee MembershipSessional:Select:Territory LaborEconomic Policy ScrutinyNorthern Territory Harm Reduction Strategy forAddictive BehavioursOn 3 December 2018, the Member for Goyder, the Hon Kezia Purick MLA, was discharged from theCommittee.On 1 February 2019, the Member for Port Darwin, the Hon Paul Kirby MLA, was discharged from theCommittee and replaced by the Member for Arafura, Mr Lawrence Costa MLA.6
Committee SecretariatCommittee SecretariatFirst Clerk Assistant:Russell KeithCommittee Secretary:Jennifer BuckleySenior Research Officer:Neil Wright (7/8/2018 – 19/10/2018)Senior Research Officer:Victoria IkutegbeAdministration Assistant:Kim CowcherContact Details:GPO Box 3721 DARWIN NT 0801Tel: 61 08 8946 1501Email: RAB@nt.gov.auAcknowledgmentsThe Committee acknowledges the individuals and organisations that have providedwritten submissions to this inquiry or who have provided evidence at public forums andhearings. The Committee also acknowledges the Northern Territory Police, Departmentof Attorney-General and Justice and the Department of Health for providing input at apublic briefing.7
Inquiry into a Northern Territory Harm Reduction Strategy for Addictive BehavioursAcronyms and AbbreviationsAADANTAssociation of Alcohol and Other Drug Agencies NTACTAustralian Capital TerritoryACCHOAboriginal Community Controlled Health OrganisationADFAlcohol and Drug FoundationADUAutomatic Dispensing UnitAMSANTAboriginal Medical Services Alliance NTAODAlcohol and Other DrugsCAACCentral Australian Aboriginal CongressCAAPSCouncil for Aboriginal Alcohol Program ServicesCDCCentre for Disease ControlCLANTCriminal Lawyers Association of the Northern TerritoryCRTICCulturally Responsive Trauma Informed CareDORADrugs and Poisons Information System Online Remote AccessHASIHousing Accommodation Support InitiativeHRAHarm Reduction AustraliaIDRSIllicit Drug Reporting SystemNAAJANorth Australian Aboriginal Justice AgencyNDSHSNational Drug Strategy Household SurveyNGONon-government OrganisationNSPNeedle and Syringe ProgramNTNorthern TerritoryNT DOHNorthern Territory Department of HealthNT PHNNorthern Territory Primary Health NetworkNTAHCNorthern Territory AIDS and Hepatitis CouncilRTPMReal-Time Prescription Monitoring8
Terms of ReferenceTerms of ReferenceThe Legislative Assembly resolved on 10 May 2018 that:1. A Select Committee on a Northern Territory Harm Reduction Strategy for AddictiveBehaviours be appointed comprising three (3) Government Members, one (1)Opposition Member and one (1) independent Member to be nominated in writing tothe Speaker by the relevant Whip or non-party aligned Member by 18 May 2018(1) Best practice, humanitarian approaches that effectively reduce the damagecaused by illicit drug-use through effective harm reduction policies andlegislation; and(2) Identify best practice strategies that have a coordinated treatment approach todeal 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 interimreport by 12 March 2019, and finally report back to the Assembly by 31 August2019.Proposed scope of Inquiry:The Inquiry is to review the available evidence regarding effective harm reductionstrategies used to address health problems associated with illicit drug-use and otheraddictive behaviours and, also, strategies for reducing the impact of these behaviourson 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 uponhealth, justice, drug and alcohol and law enforcement activities;2. Current harm reduction measures available in the Northern Territory and otherjurisdictions and their alignment with the National Drug Strategy;3. A review of best practice evidence in the following areas to support thedevelopment 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; andiii. 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 foraddictive behaviours more broadly.Resolved by the Legislative Assembly on 10 May 2018 and amended on 14 February2019.9
Inquiry into a Northern Territory Harm Reduction Strategy for Addictive Behaviours1Introduction1.1The Select Committee on a Northern Territory Harm Reduction Strategy for ReducingAddictive Behaviours (the Committee) was established on 10 May 2018 in responseto growing concerns about the adverse impacts of licit and illicit drug use in theNorthern Territory (NT). These concerns are real and justifiable, with data showingthat the NT consistently reports higher rates of daily smoking, risky alcoholconsumption and cannabis use than is evident in other Australian jurisdictions 1. Theseriousness of the issues facing the NT indicate the importance of exploringemerging new approaches to the management of drug related harms, such as thosebeing applied in some overseas jurisdictions where the trend is to treat illicit drug useas a health issue rather than a criminal behaviour. 2 Similarly, a recent Victorianparliamentary inquiry has emphasised the need to better balance health and lawenforcement approaches to drug use, with the emphasis on a health orientedapproach. 31.2A central task of this inquiry is to identify the approach that is most likely to beeffective in reducing drug related harms in the NT. In doing this, the Committee istaking into consideration innovative approaches and best practice harm reductionand treatment strategies being implemented in both Australian and overseasjurisdictions. However, it notes, also, the importance of assessing the extent to whichsuch approaches can be successfully adapted to the NT, given its uniquecharacteristics. For instance, the dispersal of a small population across a largegeographic area, and the high proportion of Aboriginal residents in the NT, posesignificant challenges to the development of a cost effective, culturally appropriate,and humane strategy for managing the harms associated with drug related and otheraddictive behaviours.1.3The purpose of this Interim Report is to describe the work undertaken to date and toidentify the actions required to complete the inquiry. Although the report presentspreliminary findings, it does not provide an analysis of the findings. The analysis is acritical next step in the inquiry and will form the basis for recommendations toGovernment regarding the development of a Harm Reduction Strategy for AddictiveBehaviours.1.4The remainder of this chapter outlines the scope of the inquiry and the workundertaken to date. Chapter 2 provides an overview of the scale of licit and illicit druguse in the Northern Territory and how this has changed over time, while chapter 3examines the policy context for drug management in the NT and other jurisdictions,both in Australia and overseas. Preliminary findings are presented in chapter 4, withevidence drawn largely from submissions and discussions during public hearings and1Australian 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, 2017.3 Victorian Government, Response to the Parliamentary Inquiry into Drug Law Reform, August 2018, p. 5.10
Introductionforums. Chapter 5 concludes the report with a summary of future actions required tomeet the objectives of the inquiry in line with the Committee’s Terms of Reference.Scope of the inquiry1.5The term ‘addiction’ is often understood in various ways according to particularcontexts and specific objectives. 4 However, a synthesised definition describes it as‘a strong and habitual want that significantly reduces control and leads to significantharm’. 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/orothers. It is in this context that the report applies the term ‘addictive behaviour’ whenreferring to harms associated with the consumption of alcohol, tobacco, other drugsand gambling.1.6The Terms of Reference (ToR) for the inquiry are very broad and specify a focus onillicit drug use and other addictive behaviours. In addition, the ToR state that theinquiry should identify best practice harm reduction strategies and strategies thathave a coordinated treatment approach for dealing with addictive behaviours.1.7It is the Committee’s view that the intent of the ToR is for the inquiry to focus onaddictive 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. Withinthis 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, andoverseas; Current harm reduction measures being applied in the NT and other Australianand overseas jurisdictions; Treatment programs; and Coordination of treatment programs across government agencies and nongovernment organisations.Resources for the inquiry1.8Taking into account the volume of work which is currently managed by the CommitteeOffice, the Committee wrote to the Minister for Health on 5 June 2018 requestingadditional resources to assist with the inquiry. The request was granted on 6 July2018 through the secondment of a Senior Research Officer whose primary role is toassist with the collection and analysis of evidence and the preparation of the finalreport. This position remains wholly funded by the Department of Health. All other4RA 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, JSadler, G Strangellini & T Thornton (eds), The Oxford Handbook of Philosophy of Psychiatry, OUP Oxford,2013, pp. 851-864.11
Inquiry into a Northern Territory Harm Reduction Strategy for Addictive Behavioursaspects of the Committee’s work will be managed through the usual CommitteeOffice process
Portugal, Country Drug Report 2017, Publications Office of the European Union, Luxembourg, 2017. 3: Victorian Government, Response to the Parliamentary Inquiry into Drug Law Reform, August 2018, p. 5. Introduction . 11 : forums. Chapter 5 concludes the rep
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These interim statements include the interim mana-gement report, the condensed consolidated inte-rim financial statements and, pursuant to art. 154a, paragraph 5 of Legislative Decree 58/1998 of the TUF (Consolidated Law on Finance). As provided for by article 154 of the TUF, the interim statements are
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