Evidence Based Policy in Drug Harm Minimisation

Policy: Drug Harm Minimisation

Using one of the case studies/issues presented by the guest lectures as the case study for your essay, do you think that politicians should base their policy decisions on evidence? Why do you believe that the use of evidence-based policy would be a good or bad thing?

Introduction:

The literature surrounding the use of evidence-based policy as the preferred method of decision making for governments and organisations has seen much support. ‘Gary Banks, The Chairman of Productivity Commission argues that: ‘It is as important that we have a rigorous, evidence-based approach to public policy in Australia today as at any time in our history’ (Banks 2009 in Kay:236). As I analyse the various literature surrounding the use of evidence-based policy, the notion that research has a significant role in providing information to policymaking (Hammersley 2005:86) is one that I strongly support. I do believe that politician should base their policies on the evidence and data available. This is because there is a belief that governments should use evidence not only to justify but critically analyse the consequential effects of the policy and to maximise its utility (Haigh 2012: 154). I will justify this stance through the Drug harm minimisation policy. However, due to its complexity as the policy involves innumerable variables to which success of the policy is determined, one can see the various limitation of evidence based policymaking. As such this challenges the application and reliability of research as a basis for policy makers. However, it does not discredit its use as a platform to inform policy makers. From my observation the term ‘evidence informed policy’ is often used when policy is overshadowed by political and/or practical influences. Within the context of this essay it is still relevant to this discussion, however, I will acknowledge evidence informed policy as a limitation and as a counter argument to evidence based policy to simplify my stance and will not express the distinction in any great length. Despite the complexity of the drug harm minimisation policy, there is still relevant evidence to suggest that evidence-based policymaking is still the ideal method in dealing with this issue. This will be evaluated by the three main principles of drug harm minimisation discussed later in the essay.

Evidence Based Policy:

Evidence-based policymaking is the utilisation of various studies and research methods to critically analyse the subsequent effects of a particular action (Bank 2009 in Haigh 2012: 154). The application of it can be further analysed when dissecting the various ‘lens’ which influence policymaking. According to Head the three lens are the scientific knowledge, political knowledge and practical knowledge (Head 2008 in Haigh 2012:154). The scientific knowledge includes the quantitative and qualitative data collect through various research methods. The political knowledge is the ideological stance of an individual or organisation, which would ultimately determine how the data will be utilised. Finally, the practical knowledge is a general understanding to the relevant field and its various mechanisms. Whilst these lens allow for closer inspection into certain issues, it does not always ‘produce the most efficient and effective outcomes’ (Haigh 2012:155) as we will see when evaluating the drug harm minimisation policy.

Harm Minimisation:

The policy of drug harm minimisation took effect during the late 20^th century. A primary ethos of a liberal democracy such as Australia, assumes that individuals are rational entities responsible for their own actions (Haigh). Subsequently, this initially created the view that the use of drugs was one that was done voluntary which, to an extent, allowed it to be criminalised. (Sendziuk 2001:56) As such there were attempts made to to deter such drug use by punishing drug users (Hall 1995: 74) There was however, strong evidence to suggest the ineffectiveness of this approach as seen within the United States, as criminalising drug use became highly criminogenic. As such as Hall (1995) remarked that “Australian society has shown a long-standing uncertainty about whether to adopt a moral or a therapeutic approach to illicit drug users”(Hall:74).  Subsequently there was a shift in the statues quo following the Williams Royal Commission, which prompted the Hawke administration along with the Alcohol and other Drugs Council of Australia (ADCA) to initiate the ‘Harm Minimisation Policy’ (Siggens Miller 2009: 16). The objectives were clearly outlined in the 1985 Drugs in Australia: National Action Workshop which stated that the objective ‘of a national drug policy on drug use should be to minimise the harmful consequences of the use of drugs to individuals, their families, and the community as a whole including the needs of special groups. Therefore, a national, comprehensive approach will be required’. (Dillon 1995: 2 Emphasis in Original).

To understand how the drug harm minimisation policy is evaluated and implemented, we must first outline the ‘Three Pillars of Harm Minimisation’(NDS: 1). These include the demand reduction, supply reduction and harm reduction principle (Haber et el 2011: 117). The demand reduction is an early intervention measure used to prevent or delay the onset use of drugs. This can be achieved primarily through government subsided education in schools and advertisements (Lennings 2000: 58). Whilst this may be the primarily method, (Lennings 2000: 58) notes a secondary form of demand reduction and that is the removal of addicts from the community in order to rehabilitate them. Supply reduction is achieved through legislative and regulatory means. This should lead to a reduction in the production and supply of illegal drugs thus limiting its availability (AMSA:2). Subsequently, supply- side policies are largely centred on the development of improved policing methods, increased surveillance and Customs activity in Australia (Lennings2000: 58). Finally, the harm reduction principle aims to reduce the socioeconomic and health consequences of the use of drug to the individual, family and community (NDS: 1). Policies to assist in harm reduction have involved needle exchanges, campaigns advertising sensible ways of using drugs and, for opiate abusers, and drug substitution programmes. (Lennnigs 2000: 58).

Medically Supervised Injecting Centres:

To represent the harm reduction principle, arguably the best applied policy is the creation of Medically Supervised Injecting Centres (MSIC). This provides a safe environment where individuals may inject controlled levels of illicit substances under trained supervision (AMSA 2017:5). The rational behind this policy was to attempt to make contact with hard to reach or vulnerable drug users including people with HIV, HCV, the homeless. Furthermore, it attempted to promote safer injecting practices as well as reducing overdose risks, preventing HIV infection decreasing discarded needles and syringes in public areas reducing crime and, reducing public drug use. (Hunt 2003: 33) With 81% of HCV being transmitted through unsafe injecting practices, the injecting rooms have seen some success in reducing the numbers due to the proper use and serialisation of needles available at the centre. Furthermore, there appeared to be a direct correlation to the decreased need for ambulance services with the opening of the MSIC. On the international level there is circumstantial evidence suggesting that supervised injecting rooms have managed reduced the number of heroin-related deaths in German and Swiss cities by more than 50 per cent(Sendziuk 2001:55). Subsequently, the evidence suggest that the MSIC is a practical and effectiveness policy for harm reduction. Following a 2017 review by the Ambulance Employees Australia Victoria following the success of the Kings Cross MSIC, they had recommended the construction of a secondary facility in North Richmond which would save lives and reduce other risk associated with intravenous injections. (AEA 2017: 9) It is evident from this policy that evidence not just from the trial period but from international research, suggest the effectiveness of this policy to conform with the harm reduction principle. Whilst there are a several limitations such as the limited literature the respectively small control group and practical knowledge and experts of their field have come to a general consensus that more injecting rooms are required.

Needle and Syringe Programs (NSP):

In conjunction to the MSIC, the Needle and Syringe Programs (NSP2005) is arguable one of the most successful and cost beneficial investment in Australian History (AMSA 2017:8). This program provides sterile injecting equipment, health information and voluntary referral to welfare and health services to people who use drugs and this program has been doing so since the late 20^th century. A review conducted for the World Health Organization of the effectiveness of syringe vending machines in preventing HIV infection among injecting drug users identified no negative studies and no evidence that syringe vending machines caused non-injecting drug users to become injectors. Furthermore, the Australian Governments invested $130 million in Needle and Syringe Programs between 1991 and 2000. This resulted in an estimated 25,000 cases of HIV infection being prevented an estimated 21,000 cases of hepatitis C infection being prevented an estimated 4,590 lives being saved by 2010 and an estimated saving to the health system in avoided treatment costs over a lifetime of between $2.4 and $7.7 billion (NSP2005:16). Whilst there has been ample funding to support this program, Sendziuk (2001) makes reference to the significance contributions of ‘medical professionals, sex workers, drug users, and gay activists whose dedication to ‘harm minimisation’ measures, such as the provision of free sterile needles and syringes which prevented the loss of hundreds of lives from AIDS in the 1990s’, he further remarks them as being ‘modern Heroes’. It is clear that the balance between the different evidence lens are working in parallel to each other. The scientific data reflects the practical knowledge given by the aforementioned individuals, and the limited political opposition to the distribution of syringes allow ample funding and progress. Evidence of the effectiveness of Needle and Syringe Programs has been consistent provides sufficient support for governments to act on a policy based on the evidence provided. The evidence has been sufficient to persuade the government about the substantial benefits of these programs. Needle and Syringe Programs are a critical component of strategies to reduce the spread of HIV, hepatitis C and other blood borne viral infections among injecting drug users and the wider community. However, this is not reflected in the investment in resources for NSP centers as we will see in comparison to the supple reduction policies.

Supply Reduction Policy:

Despite the success of the MSIC and (something) and increasing scientific support which has produced positive results from the harm reduction stance, there are agencies who still advocate strongly for and invest heavily in ‘conventional criminal justice approaches’ (wood at el: 142). This is evidently the there is still a reliance on ‘legislative and punitive’ measures (Kisely 2005:155). This is in spite of the fact that many countries in the world and including the United Nations have concluded that the evidence-backed view is that drug use and abuse is predominantly a health issue, not a criminal issue (AMSA 2017:10). Despite this according to the 2017 drug expenditure report, 66% ($1.1Billion) of the $1.7billion budget be used to support law enforcement agencies whilst only 2.1% was funded toward harm reduction. (PHA 2017: 2). This policy, which focuses on the improvement of policing and surveillance methods have been seen as mostly ineffectual (Lennings 2000: 58). An example of this is the usage of cannabis, which has seen no decrease in its use despite the increased expenditure on supply reduction policies. Within a few years there was a 5% increase in the consumption of cannabis from 5.4% to 10.4% from Australian over the age of 14 using it on weekly basis and it continues to increase irrespective to the strictness of the law (Kisely:155,.PHA 2017:2) 

The question remains, despite the obvious misplacement and ineffective use of funding, why is supply side policy so popular? According to (Lennings 2000:58) one such reason is that the ‘policing of the drug trade is a necessary requirement to develop a creditable drug policy’. In other words, it is dependant on the political landscape and the ‘political knowledge’. Clearly the commentary made by Haigh on the presumption that evidence-based policymaking will likely to be efficient and effective hold merit in this instance. However, it also provides a suitable reason as to why politicians should not make informed decision based on evidence rather, should rely purely on the evidence to justify their actions. It is clear, there are political constraints which inhibit politicians to maximise the utility of the data available, hence why it may have more potential as seen in the aforementioned policies.

Conclusion:

When analysing the application of evidence based policymaking, one can see both the utility and limitation of its use. Whilst evidence does indeed provide a platform for which politicians can make informed decision, it is evident that data alone cannot provide the necessary material for informed decision making. The drug harm minimisation policy is one such field that is incredibly complex due to the limited data available and the political burden associated with the policy. The present case analysis illustrates the high level of demand for data and research. (Topp and McKetin 2003: 23) suggest that continual data collection done on a routine basis can be useful at a policy level. Following the analysis of the available literature, we can see that overfunding of supply reduction has been ineffectual whereas despite the limited funds, harm reduction policy as seen with the MSIC and NSP has been somewhat successful. This, I believe, is evidence to suggest that should adequate funding is to be given, and purely evidence-backed policymaking which is free of political constraints are allowed to happen, one should be able to observe an increase in the data available, or perhaps even witness a positive reduction in drug harms.

References:

• Hall, W. (1995) ‘Variations in Prohibition: Harm Minimisation And Drug Wars In Australia And The United States’, Australian & New Zealand Journal of Criminology 28: 74–77.
• Hammersley, M. (2005) ‘Is the evidence-based practice movement doing more good than harm? Reflections on Iain Chalmers’ case for research-based policy making and practice’, Evidence and Policy 1(1): 85-100
• Sendziuk, P. (2001) ‘Diving under the ‘Second Wave’: Harm Minimisation Approaches to Drug Use and HIV Infections in Australia’, Health and History 3(2): 55-79
• Lennings, C. J. (2000). ‘Harm minimization or abstinence: an evaluation of current policies and practices in the treatment and control of intravenous drug using groups in Australia’, Disability and Rehabilitation 22(1–2): 57–64
• Kisely, S. (2005) ‘A tale of two jurisdictions. Can Australia and Canada learn from each other’s experience with cannabis control?’, Australian and New Zealand Journal of Psychiatry 39:154-160
• Siggins Miller: Research and Evaluation in Health and Human Services (2009) Evaluation and Monitoring of the National Drug Strategy 2004 – 2009 Final Report
• Topp, L., & McKetin, R. (2003) ‘Supporting evidence-based policy-making: A case study of the Illicit Drug Reporting System in Australia’, Bulletin on Narcotics, 55(1–2): 23–30.
• Haber, Paul, S., & Murnion, Bridin P. (2011) ‘Training in Addiction Medicine in Australia’, Substance Abuse, 32(2): 115–119. 
• Wood, E., Montaner, J. S., & Kerr, T. (2008). Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. The Lancet. Infectious Diseases, 8(3), 142–143. 
• Kay, A. (2011) ‘Evidence-Based Policy-Making: The Elusive Search for Rational Public Administration’, Australian Journal of Public Administration 70(3): 236-245
• Australian Medical Students Association (AMSA) (2017) Harm Minimisation is Illicit Substance Use,(unknown)
• Dillon, P. (1995) ‘The National Drug Strategy: The First Ten Years and Beyond’ Proceedings from the Eighth National Drug and Alcohol Research Centre Annual Symposium 27: 1-230
• Ambulance Employees Australia Victorian Submission(AEA) (2017) Inquiry into Medically Supervised Injecting Centres: Unknown
• Department of Health (DOH)(2017) National Drug Strategy 2017-2026 (NDS) :Canberra
• Hunt, N. (2003) A review of the evidence-base for harm reduction approaches to drug use. Forward Thinking On Drugs a Release Initiative 2:1-55
• Public Health Association of Australia (PHA)(2017): Policy at a glance- Illicit Drug Policy. PHAA’s Health Promotion Special Interest Group: Deakin
• Australian Government Department of Health and Ageing (2005) Needle and syringe programs: A review of the evidence. (NSP) Canberra: Australian Government Department of Health and Ageing.