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Messages for health professionals & policymakers

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of drug use]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

The people whose stories are presented on this website share their messages for policymakers and health professionals. Drawing on their own experiences, they identify gaps in alcohol and other drug services and possible barriers to accessing services. They make suggestions for improving treatment and harm reduction services such as ensuring wider access to services, improving drug education and addressing the stigma surrounding drug use. Some highlight the need for culturally accessible services. Several question the effectiveness of prohibitionist drug laws and call for drug law reform, with some expressing support for the legalisation of cannabis.

Improving services

Participants suggest a range of ways alcohol and other drug services and allied health services could be improved. Suggestions include ensuring treatment addresses the many different aspects of life that shape consumption, developing more peer-led services, expanding pharmacotherapy programs and providing better continuity of care (see also Consumption in everyday life, Pharmacotherapy/medication treatment and Residential treatment).

Improving access to information & addressing the context of consumption

 

Lala (F, 35, works in health services, cannabis) highlights the need for person-centred care, which addresses the ‘emotional and spiritual’ aspects of life that shape drug use. (Played by an actor)

I think having more information about how people approach [drug use] is really important […Like] my impression of services is that there’s not much support for the emotional and spiritual stuff that underlies problematic drug use. And I feel like that’s what I need help with […but] I don’t see any information around coping mechanisms […or] how to deal with uncomfortable emotions, or strategies [for coping] when relationships are dysfunctional.

Helen (F, 53, not working due to injury, heroin) finds the highly structured nature of residential rehabilitation programs can make it hard to return to everyday life afterwards, suggesting a need for aftercare and community integration programs. (Played by an actor)

I think there’s a lot of problems with the whole rehab system here […] They’re incredibly structured environments and I don’t think they really set people up for the real world afterwards. You meet people who have been through three or four rehabs. They’ve spent the last 10 years of their lives in and out of these places, and it hasn’t really achieved anything […] There’s not enough focus, I don’t think, on putting all those parts of your life together: accepting that a lot of people who are using drugs also have issues around mental health, homelessness, stuff around their kids, abusive partners. All sorts of other issues are going on that need to be dealt with holistically, like the whole person […] Just taking someone out [of their normal life] and putting them in a rehab, where everything’s lovely and the meals come three times a day, the washing gets done for you. It’s a very unreal environment […] It’s like people who come out of jail who have become institutionalised, they have nowhere else to go but the environment that put them in jail in the first place, with the abusive […] partner, and the screaming kids.

Non-stigmatising, compassionate care

The stigma associated with illicit drug use is also a key concern, with many people saying it’s important for health professionals to treat people with compassion and not judge them (see also Dealing with stigma & discrimination).

Zadie (F, 33, works in the health sector, heroin) highlights the need for stigma and discrimination training as a core part of workforce training in the health sector. (Note: strong language) (Played by an actor)

I’ve overdosed quite a number of times, actually, and one time it was so bad that I was in intensive care for two weeks. Actually, when I came in, apparently I was dead for about eight minutes. You know, all the Narcan [naloxone: used to reverse the effects of opioid overdose] they gave me didn’t bring me around. I was unconscious and I came to in the hospital […] I became conscious but I couldn’t move a muscle […] I could feel pain but I couldn’t move, and I could hear what the doctors and the paramedics were saying about me, [it was] just really derogatory, you know: ‘Stupid fucking junkie, get them all the time’. It upsets me even thinking about it. They were being very, very rough with my body. There was no care.

[…]

The whole time I was in there […] they treated me like shit […] I mean there’s clearly such a high level of stigma and discrimination, and misunderstanding of drug users and drug use. And they’re professionals, they need to work that out. I mean, you know, that’s just unprofessional. I think there needs to be much more training for healthcare professionals.

Availability of services

Several people comment on the need for information and services to be more widely available, and offer concrete suggestions for how this might be achieved. Related to the issue of accessibility, a few argue that funding for alcohol and other drug services, especially harm reduction services, is insufficient, and suggest the cost of services deters people on low incomes.

Kate (F, 36, works in the health sector, prescription drugs and ice) suggests expanding pharmacotherapy programs, greater investment in harm reduction and decreasing the cost of treatment. (Played by an actor)

I really think there needs to be more pharmacotherapy places, not just for opiate users, but for stimulant users as well. I think that pharmacotherapy is very lacking in that area […And with opioid pharmacotherapy treatment, more options are needed] even with the current pharmacotherapy system […] And yeah, there’s private clinics around that you can get into, but like on the dole, if you’re just starting out on a treatment journey, then you don’t have like $80 […] a week to have to fricking pay for that […so the cost of treatment is] a big deterrent.

Zoe (F, 30, studying, ice) recommends making information on treatment services more accessible, and speeding up intake and assessment times for people seeking treatment. (Played by an actor)

[I wasn’t given] a lot [of treatment options] to be honest. It was the detox and that was about it […] Nobody really wants to give you a lot of information to begin with when you’re on the drug. If you try a little bit and you hit dead ends, you just stop. So you have to be really pushed or it has to sometimes be court appointed […] for you to fully get engaged with those services […] For me personally, I wish there was a lot more of that [information] in the community, because to start with I had absolutely no idea where to go, where to start.

[…They also need to reduce] the long waiting lists […] Like, even just to have your first initial assessment, I think that was about three or four weeks that I was on a waiting list for that, and then it was, I think, another six weeks on the waiting list to get into the detox […] I mean, it’s a lengthy process, so it would be good to see more funding put back into [alcohol and other drug services…] to get things rolling a lot quicker, rather than going, ‘Ah, yeah, okay, so you’ve taken that first step, you want to get off drugs, so we’ll see you in three months’ time when we’ll have another look at it’, you know. To me, that seems extremely insufficient.

Addressing diverse healthcare needs

A key concern for some is the need for services that address people’s diverse healthcare needs, including those of sexual and gender minorities, Aboriginal and Torres Strait Islander clients, and other culturally and linguistically diverse clients. Their comments suggest a need for workforce development to ensure the delivery of culturally sensitive services.

Renee (F, 35, works in hospitality, ice) suggests making services more culturally sensitive and tailoring them to the needs of Indigenous clients.

I’m Aboriginal-identified, yeah, so my culture is a big part of me. So I would really love [it] if all rehabs were Aboriginal-identified culturally friendly, if that makes sense […] [For example, rehabs could] have an Aboriginal worker, get their culture in their programs where they can just be Aboriginal and do their thing. Here [at this rehab] I just pray a lot to my ancestors here because that’s all I can do at the moment, because there’s no programs within these programs about my culture. If I come up with anything, you know, the staff is more than willing to work around me, and if they can help me out with anything to do with my culture, they are more than willing to help us. But yeah, that’s all I can do at the moment and that’s keeping me grounded, like just knowing that my ancestors are watching over us. I mean most hospitals and institutes and jails, they are all built on burial grounds, so I’ve really got to watch where I tread and how I’m reacting and things like that, like for my culture, my cultural ways. In that respect, I would just like to see like an Aboriginal flag out the front with an Australian flag, you know. [I would like to see] a few Aboriginal paintings and get the message stick in there, you know. The message stick is exactly that: it just carries on the message to the next lot [of people].

[…]

I’m really having a hard time finding a common ground between like rehab rules […] and my Aboriginal culture. I’m really finding it hard to have that common ground, but they keep telling me, you know, ‘Just whatever you can work out’. And my mum and dad are working with me, to work out like what I can bring my culture to here, as well as abide by the rehab’s rules and regulations too, because it’s really important that I follow rehab. Their way of doing [things] is for my recovery and I’ve got to work out how to bring my culture into my recovery, you know what I mean?

Jenna (F, 31, studying, cannabis) attends a health service that caters for her needs by assuring anonymity and offering discreet, non-judgemental care.

If I was going to talk to the [Health Minister] about [the] service [I attend] I would say they’re amazing because anyone can use them without needing ID. You know, it’s amazing to have this healthcare service where people can go without judgement, without fear of being identified [and] without needing to be [a] resident [of Australia]. It’s really important that there’s healthcare for everyone and for me personally, I don’t have to explain myself around sexuality, or drug use or sex work, or any of those things. And if I did feel judged on those sorts of things, then I wouldn’t be as honest with a healthcare person […] I would go [to that health service if I needed help with anything] because even if they couldn’t help me, I feel like they’d make a good referral.

[With] drug use [I’m…] not sure where I’d start […] There’s, like, a queer kind of alcohol and other drugs program at [my local LGBTIQ health promotion organisation] which is maybe where I’d start […] I don’t know that I’d be excluded [from other mainstream health services] but I just feel like the assumptions will be wrong probably, and I don’t want to have to explain stuff to them […I mean] assumptions that I’m straight, about the kind of sex that I have, about the kind of people I have sex with, those sorts of things.

Drug law reform

Several question the effectiveness of current alcohol and other drug policy approaches and call for drug law reform. As Andrew (M, 41, works in education, cannabis) puts it in advocating for the legalisation of cannabis, ‘I think it’s just really the worst law in the world to make cannabis illegal […] It’s stupid, it’s self-defeating […] I’d be happy to see it legalised, not just decriminalised, but legalised. And if I had to buy it over the counter […] then I guess I’d probably settle for that. You know, at this point it’s all about baby steps. So yeah, I’d probably settle for that’.

Jacob (M, 33, works in hospitality, cannabis) comments that smoking cannabis regularly doesn’t impair his ability to function, adding that he hopes in the future cannabis will be legalised.

I do think, especially if this website is going to go to lawmakers and stuff, I do want people to know that living with weed dependency (or habit) is not that bad. You can still function like a normal person in society, and go to work, and pay your taxes, and have a family, and do everything perfect.

[…]

People that think [cannabis] is like the devil and all that stuff, it’s not [like that]: it’s okay. Cigarettes are heaps worse than marijuana, and they are fully legal and taxed, and being stuffed in everybody’s face, so it’s really important to me [that cannabis be legalised], especially as a smoker, especially because what I’m doing on a day-to-day basis is illegal and I don’t want to break the law. I’m not out there, you know, to cause trouble and stuff. Like, I just want to smoke my joint and be left alone so it is very important for me the whole legalisation thing, which I’ve been into for lots and lots of years. [I’ve been] trying to sign whatever petition I can and go to meetings, and go to gatherings. But again, I will never go to a four twenty gathering [a pro-cannabis event] in the city and smoke a joint because it’s still illegal, and I don’t want to get into trouble. But I do want it to be legal because I think it’s not such a bad thing.

Zac (M, 53, works in health services, party drugs) suggests that law enforcement resources would be better spent on drug education to teach ‘people […] to use drugs […] in a sensible and smart way’.

I don’t think it’s a good idea to criminalise drugs. I don’t think it helps that police run around with sniffer dogs. [They’re] spending all those resources at big parties or at Mardi Gras, or whatever, to find someone carrying a few ecstasy tablets […] or people […] using a bit of cocaine […] I don’t think that helps anyone […] I think you need to decriminalise [drugs] for users, and you need to then take the resources that exist there and put them into education […] and try and teach people if they’re going to use drugs, to use them in a sensible and smart way.

Jason (M, 34, studying, ice) calls for drug law reform and harm reduction approaches to drug use.

The war on drugs – that whole thing in Australia and across the world – is not working and I’d like to see that change. Rather than have a war on it, why not have a harm minimisation approach? At dance parties, for instance, have drug testing so people know what they’re taking, so they’re not taking them all before the sniffer dogs come along. So that’s where I would like to see [drug policy and law] go, yeah.

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