Having exposed the flaws in the current approach to Drugs and public intoxication https://caainc.org.au/how-could-we-be-so-wrong/ the CAA has applied its depth of experience to develop workable and practical solutions.
The proposed solutions aim to strike a pragmatic balance between compassion for those entrapped by addiction to drugs or alcohol and those who lack the moral fortitude to control their addiction and the danger to themselves and the whole community.
As a society, our social obligation transcends the current narrow obligations to addicts and users. Current strategies substantially favour addicts, and that must be adjusted.
The focus in managing the drug and alcohol addiction problems must balance the community’s rights against the need to look after addicts, either addicted to drugs, alcohol or both.
Central to achieving this is transparent reporting to build integrity and the confidence of the community.
The Medically Supervised Injecting Room (MSIR)
The highest profile resource, seen by many as compassionate and caring, is the antithesis of what caring should be about. The MSIR provides services that promote and further the abuse of illicit drugs of addiction, not manage or reduce dependence. Additionally, the MSIR creates a substantial risk to other citizens by its location and function.
The MSIR is underperforming for drug addicts, has an adverse impact on the local community and must be closed or repurposed.
Staff from the room collect huge quantities of used needles in the immediate surroundings and then claim needles are a reducing problem. https://www.heraldsun.com.au/news/victoria/north-richmond-community-health-new-mums-request-transfer-away-from-injecting-room/news-story/
This tells another story. The MSIR is not being used by a large percentage of the addicts/users frequenting the area. Therefore, its purpose is questionable. The community is instead exposed to needle use and all the negative behaviours associated with drugs.
The impact on community amenity and the long-term impact on children growing up in a locality where drug abuse is normalised is unacceptable, particularly in a Housing Commission Estate next door to a Primary School and as part of a Community Health Centre complex.
Unfortunately, the Government has just announced the location of the new Drunk Tank, near a Primary School and in the middle of another housing precinct.
The Canada is Dying Documentary is essential viewing to understand appropriate responses to the issue.
The MSIR is a drug facilitator, and its function promotes drug use (claiming the use of drugs in the facility is safe) and has created a hub for dealers to ply their trade, increasing the drug scourge, not reducing it. It is the equivalent of the Chadstone in our world, attracting customers.
Ethics of the MSIR
Primum non- nocere, is the Latin phrase that means “first, do no harm.” This is a commonly taught principle in healthcare, the Hippocratic Oath.
We fail to see how medical professionals, at any level, can assist/facilitate/supervise addicts in the ingestion of illicit drugs, knowing the harm their actions inflict on the addict is contrary to the ethics of the medical profession.
The size of the problem
The City of Yarra says it collects 90,000 improperly disposed of used syringes a year, excluding those disposed of in local sharps containers and those collected twice a day by MSIR staff near the MSIR. The MSIR is feeding the growth of the problem, not reducing it, which surely must be its primary aim.
MSIR, an alternative
The current MSIR must be closed as a priority, and alternate facilities established to manage and look after addicts.
Drunk Tanks could be integrated with the Drug rooms and serve a dual purpose in caring for people under the influence of either substance.
A person under the influence of drugs or alcohol is moved to a facility, a Medically Supervised Recovery Centre (MSRC), for assessment by the authority of an Interim Health Order.
A doctor then determines an immediate management plan, and any health issues addressed. The Health Order is to remain in effect until a medical practitioner is satisfied that the person no longer poses a threat to themselves or others and has regained cognitive acuity.
Essentially, before discharge, the patient must be assessed and exposed to a pathway out of their demise.
Interim Health Orders are, as the name implies, a temporary authority to allow Authorised Officers to secure and transport illicit drug-affected persons to the MSRC.
Similarly, an Interim Heath Order would be an appropriate method to protect a drunk taken to the Drunk Tank facilities.
Authorised Officers would be a member of the Police Force, Ambulance personnel and other officers employed by the Health Department.
Most addicts or over-imbibers are incapable of rational thought. Moreover, it can be difficult to determine whether a person is inebriated on drugs or excessive alcohol, with many using both.
Because the new facilities would have a more holistic health solution orientation, the attraction for drug dealers to hover around such a facility would be minimised.
A person who has been subject to an IHO or a HO when discharged from the MSRC should be transported to a mutually agreed location. This is critical to disperse dealers from hovering near an exit waiting for customers.
A joint report released in November 2022 between KPMG and Rethink Addiction has revealed:
‘The cost of addiction in Australia was an estimated $80.3 billion in 2021. In addition to this, the value of lost life was reported at a staggering $173.8 billion.’
Prescription and illicit drugs recorded 16% or $12.9 billion of that amount.
(We believe this figure may be a gross underestimation given the number of addicts.)
The National Framework for Drug and Alcohol Treatment Services says.
“It is well recognised that alcohol and other drugs (AOD) treatment is a good investment for governments and other funders with direct savings in future health costs, reduced demands on the criminal justice system and productivity gains. More importantly, evidence-informed treatment contributes to individual, social and economic goals by reducing the harms from alcohol or drug use and improving the well-being of individuals and families.”
The Salvation Army in San Francisco has developed a system of care, ‘The Way Out’, and this concept could well be integrated into the MSRC and applies equally to the homeless, and addicts.
It is essential that for this new approach to succeed, nearly as much emphasis needs to be placed on taking the community along on the journey as creating the project.
It is imperative that well-thought-out and targeted marketing strategies aimed directly in a coordinated way at reducing the social acceptance of drug use and alcohol abuse are as essential as the other components.
The CAA recommends that a Working Party be established with the purpose of recommending to the Government how this initiative can be costed and implemented.
We know that where governments have given up on drug and alcohol abuse, crime is rampant, and the amenity of many a city and community is lost.
This proposal is a world first and will satisfy the ‘wolves and the lambs’, of Aesop’s fable.