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The Case for Harm Reduction on Meth

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Last week the WA AIDS Council Manager, Health Promotion Matt Creamer, was invited to speak to the Parliamentary Joint Committee on Law Enforcement Inquiry into Crystal Methamphetamine. We took this opportunity to argue that investment in harm reduction programs is currently ignored in favour of the investment in supply and demand reduction (law enforcement). We advocated for an evidence based response that acknowledges that methamphetamine related harms are most experienced by gay men, injecting drug users and Aboriginal populations, and that investment should be such that responses are community led. Matt concluded by saying that the language and rhetoric around methamphetamine use was unhelpful and discouraged people from seeking assistance. You can read his speech below…

Parliamentary Joint Committee on Law Enforcement Inquiry into Crystal Methamphetamine

Matt Creamer    
Matt Creamer

3 May 2017

Good afternoon Committee Members and welcome to Western Australia.

My name is Matt Creamer, and I am the Manager of Health Promotion at the Western Australian AIDS Council.

I’d like to acknowledge that we are meeting today on the lands of the Wadjuk Noongar people, who are the natural guardians of this beautiful place. I pay my respect to their elders, past, present and emerging.

I am extremely honoured to have been invited to speak today – my first time in front of such a Committee – and we are very grateful for the opportunity to expand on the points raised in our submission of 9 June 2015.

I would like first to tell you a little about our organisation, the work we do and the way we do it, to give further context to our submission.

The WA AIDS Council is a professional health promotion agency in sexual health and blood-borne viruses, and for more than 30 years, we have provided  

  • Support and care services
  • Health promotion, community development, education (including peer education) and prevention services
  • Capacity building and professional support for individuals, communities and sector organisations; and
  • Policy advice and advocacy at a community, state and national level.

Of all the expertise and experience we have developed as an organization over three decades, there are some that are very particular to us. These include:

  • Community engagement and community capacity building using a peer approach
  • Long-term engagement with vulnerable communities; and
  • A deep knowledge of personal and social issues connected with sexual health and blood-borne viruses, and the behavioural and medical science associated with them.

The relevant core principles that underpin our work are:

  • An adherence to the principles of harm reduction;
  • Active participation of affected individuals and communities including peer education and community ownership to increase their influence over the determinants of their health; and
  • An adherence to the principles of multiculturalism and substantive equality.

Perhaps most relevant to this Inquiry, the WA AIDS Council has operated a Needle and Syringe Exchange Program more than 28 years, supplying around two million pieces of sterile injecting equipment annually to injecting drug users in Western Australia.

Around 50% of our clients regularly report methamphetamine as the last drug they injected, and many are long term clients.

Importantly, the nature of our exchange service means that used injecting equipment is returned to us to be destroyed, rather than discarded; we have a 94 per cent exchange rate resulting in improved public health and community health outcomes.

Other services delivered by us to marginalized and vulnerable individuals include one-on-one counselling, care and support with individual clients who report problematic methamphetamine use. 

As you will have already have heard today from Jill Rundle and Ethan James from WANADA, and read within the 2015 submission from the Australian Injecting and Illicit Drug User League) the three pillars of demand, supply and harm reduction are not currently equally distributed.

Each is important, but – perhaps unsurprisingly given our experience and credentials – today I seek to reinforce the importance of a harm reduction framework in the response to crystal methamphetamine use in Australia. 

The Penington Institute’s written submission has previously informed this Inquiry that in 2009-2010, around two thirds of the total drug-related funds were expended on law enforcement, while only 2.2 per cent were spent on harm reduction initiatives. 

We would note three critical points for consideration when determining a harm-reduction response to addressing community’s needs while delivering lasting outcomes.

Firstly, the need for an evidence-based response to address the harms related to methamphetamine use.

You have suggested today the consensus is that methamphetamine use has increased. The evidence available to us does not support that assertion. Rather, the data tells us that the way that methamphetamine is consumed has changed – from a powder and base form to the crystalline form of methamphetamine that is easily smoked and injected. The harms associated with crystalline methamphetamines are more serious and hence more visible, but the amount of methamphetamine being consumed has not changed significantly.

Similarly, the evidence does not support that larger numbers of people are using methamphetamine; the numbers of methamphetamine users has remained stable over time.

Further, and contrary to what you have heard from other submissions today about methamphetamine being a drug that does not discriminate, current evidence shows that there is higher usage amongst specific sub populations, these being:

  • Injecting drug users, who are significantly more at risk of the acquisition of HIV and other blood borne viruses,
  • Men who have sex with men, who use methamphetamine at rates about 4 and a half times the general population; and who often use methamphetamine as a precursor to sexual behavior, heightening their risk of the acquisition of HIV. This increases again for men who have sex with men who are also living with HIV; and
  • Aboriginal and Torres Strait Islander people, who have high rates of drug and alcohol use generally, but often limited access to culturally secure health promotion initiatives and healthcare options, and who have increasing rates of injecting drug use, particularly in rural and remote areas.

There is a need to urgently identify and address the needs of these sub-populations, and to fund the expansion of evidence-based interventions that address methamphetamine related harms such as the spread of blood borne viruses, poor mental health and dependence. Rural and remote populations should not be excluded from such responses. 

Assuming the stance that methamphetamine use is spread evenly across the broad Australian societal landscape risks failing to adequately and appropriately fund interventions in the places – and with the people – that they are most needed.

It is perhaps worth reiterating here that the majority of methamphetamine users are in control of their consumption.

Secondly, a whole of community approach is required.

Our experience as an AIDS Council has taught us that the most successful interventions are a combination of those aimed at an individual, family and community level.

Non-Government organisations with their experience developing harm-reduction programs, and peer-based delivery service models, and with their considerable understanding of the most marginalized and vulnerable members of society, must be included in the response to methamphetamine use.

Further, connections must be supported across sectors, ensuring linkages between non-Government Organisations, the Public Sector, mental health and community welfare services, justice and emergency services, and within the broader community settings in which methamphetamine may be prevalent. 

 And finally today, we consider the language and rhetoric around methamphetamine use likely to negatively impact the chances of methamphetamine users seeking appropriate support and adequate health care.

Our experience shows that negative media attention on similar and related health issues such as HIV, Hepatitis or other chronic health conditions impedes health promotion activities, prevention initiatives, and access to suitable health care and treatment options.

Failure to change the language, perception and depiction of methamphetamine use is likely to result in people accessing healthcare and support services only in times of crisis. 

The importance of thinking of methamphetamine use and its associated harms as a health issue, rather than a criminal one, cannot be overstated.

Once again, I thank the committee for this opportunity, and will endeavor to answer any questions you may have in relation to our submission.

 

Our Mission

To minimise the impact and further transmission of HIV, other blood borne viruses and sexually transmissible infections. To reduce social, legal and policy barriers which prevent access to health information and effective support and prevention services.