Health Speeches | November 15, 2017
Drugs, Poisons And Controlled Substances Amendment (Medically Supervised Injecting Centre) Bill 2017 - Second reading
Debate resumed from 1 November; motion of Mr FOLEY (Minister for Mental Health).
Victorian Parliament - 15 November 2017 - Ms KEALY (Lowan) — I rise today to add my contribution as the lead speaker for the Liberals and The Nationals on the Drugs, Poisons and Controlled Substances Amendment (Medically Supervised Injecting Centre) Bill 2017. From the outset I would like to make it clear that we will be opposing this bill. There are a number of reasons for this, which I will go into in great detail, but it is clear that this is drug policy on the run. It is concerning that this is the result of a serious backflip that started happening about a month ago. About a month later we hear that we now have injecting rooms planned for Victoria — not just one, but many, many across the state.
Ms Thomas interjected.
Ms KEALY — I would like to just take this time to say that this debate should be respectful. I am already being called a liar across the chamber by the member for Macedon and I ask her to withdraw.
Ms Thomas — On a point of order —
The DEPUTY SPEAKER — The member for Macedon has been asked to withdraw.
Ms Thomas — I withdraw.
Ms KEALY — As I was saying, I hope this is a respectful debate. We are talking about people’s lives when we talk about this policy. We are talking about the terrible tragedy of lives lost to drug addiction, whether it is through injectable drugs — intravenous drugs — whether it is through terrible vehicle accidents that occur when people are drug‑affected, whether it is through family violence which occurs when people are drug‑affected, so I think it is entirely appropriate that we should be respectful and not just completely dismiss other people’s views. This is a sensitive issue, and I ask members on both sides of the chamber to respect the debate that will occur during discussion around this bill.
As I said, there are people involved in this. So many times we hear about the statistics involved in drug overdose deaths, whether it is in this state or nationally. Everybody who is linked to an addict knows the tribulations and the trials that they have to go through. It is unlikely that there is ever somebody who has a drug addiction who has not got a story behind them.
I recall I went to Odyssey House earlier in the year where I spoke to some people who were in for treatment at that facility. They talked through some of the extreme challenges that they had faced through their early life. They even made the remark, ‘You’re pretty lucky if you’ve just got an addiction. So many times there are other aspects to it’, and that is what we need to pay respect to. We need to pay respect to those people who are challenged by addiction, we need to pay respect to their families, to their friends and to their loved ones who see them go through this journey. We also need to pay respect to the alcohol and drug treatment workers who work with these people and see the ups and downs and who unfortunately lose some of the people they work with. I certainly respect everybody who is involved in trying to help people through the awful scourge of drugs that we have and which we have seen more and more of in the state at the moment.
Injecting rooms, as I said, are a very contentious issue. There are many people who have contacted me who strongly support injecting rooms in Victoria. There are many that strongly oppose injecting rooms. Whether you support or you do not support injecting rooms in this state, I will point out that this bill is highly flawed. It is quite clear that this is a last‑minute policy decision, and we all know why that is. We know that there is a by‑election in Northcote. This is a touchy topic, and it is deeply disappointing that during the bill briefing we asked so many questions but the responses just were not there. This has not been thought through. It has been designed as trying to be a same but different policy of the Reason party and being same but different to the Greens party position.
It is extremely disappointing that the bill has not just fallen short of what the supporters are looking for in an injecting room in Victoria but also certainly fallen short for people who listened to the Premier when he promised back in 2014, before the election, that there would not be an injecting room in this state. Earlier this year, when we heard the coroner’s findings, we were promised there would still not be an injecting room for Victoria. After the parliamentary inquiry was handed down we were promised there would not be an injecting room in Victoria. As recently as in September we were promised there would not be an injecting room in Victoria. And now that we have got this very, very rapid backflip and a piece of legislation that has been pulled together so quickly, there are more questions than there are answers. It is disappointing that something that changes Victoria’s strategy on how we manage drugs in this state is deviating so quickly and so significantly from the previous plans, and it is being done poorly on the way through. That is disappointing for people who are supporters of the injecting rooms, as I said.
Just in regard to this bill, as I said, the way the bill has been drafted and the lack of thought about the way it will operate are exceptionally disappointing. I think the best example of this is the huge confusion on the day that this policy was announced as to whether ice was in or out in terms of the drugs that were allowed to be used in this injecting room. In the morning we saw the press release come out, where it referred to skyrocketing ice and heroin deaths in Victoria. Later that day we heard from the minister on 3AW, who made the statement that it would be up to Victoria Police to determine which drugs would be in or out in the centre. Later in the day we heard clarification that ice would be out. We look at the legislation, and there is no indication that ice is not included. In fact it is up to the secretary to determine what drugs and in what quantities will be allowable within the centre. This is the sort of confusion that just shows that this is drug policy on the run. It has not been thought through.
If you are going to base it on the Kings Cross model of an injecting room, Kings Cross includes all different types of drugs. Other injecting rooms around the world have an inhaling area so that staff are not exposed to, for example, ice smoke. Those toxic fumes are related to that. In terms of staff security, I think before you undertake any recruitment to the injecting room there needs to be strong clarification about which drugs are being used. There is an enormous difference between somebody who is using heroin — it is a depressant, and people are likely to fall asleep if anything — as opposed to ice, where people get the strength of 10 men and can become extremely aggressive. There is no way for staff to know what drugs are going to be used in the centre. They have got no way to police or monitor it. If it is not set up to be able to manage people who are heavy ice users becoming aggressive, then it is a workplace issue. You are not providing full and effective support to your staff and not giving them a choice before employment to understand what sorts of conditions they are going to be working in.
This confusion about what drugs will be used in the centre has flowed through even from people who are supporters of the bill. They want to see ice use in there. If we go back to some of the coronial findings over recent times and when we look at the people who have suffered from a drug overdose death in Victoria, 70 per cent of the time they are multidrug users. It is never just heroin. If this is just a heroin injecting room, we are going to miss out on many, many opportunities where these people would be using other drugs and even alcohol. It has been cobbled together, I think, in terms of trying not to freak people out and saying, ‘All of a sudden we’re condoning ice use after we spent $184 million on an Ice Action Plan, where all we’ve seen is drug use skyrocket’. We are seeing drug deaths increase. We are seeing more and more drug crime in the state. The Ice Action Plan has been a complete and utter failure. The only reason I can see for why ice has been excluded is that it is, again, about politics. They are not following another model. They are following the feedback that they are getting in polling rooms behind closed doors of what they need to do to win the Northcote by‑election. That is not the way we should be making drug policy decisions in this state.
There is also enormous confusion around the elements of police discretion, and I have received feedback from supporters and opponents of injecting rooms in Victoria around this issue. On one side there is absolute confusion over what that police discretion might look like in terms of whether police will be told to turn a blind eye to any drug dealing or people walking into the centre. This is a centre where there is a primary school next door. It is actually in the same building as a child health and development service. There are going to be people, probably mostly women, who are walking their babies in prams into the centre. There are going to be children of primary school age walking into their school next door.
Potentially we have got people who are leaving the injecting room, where police have been told to turn a blind eye, and they are at risk of being hit if the police see somebody get behind the wheel of a vehicle after they have left the injecting room and are high. That is when we are at complete and utter risk of creating more deaths. I would hate to see a tragedy where a pram was run over by somebody who had left the injecting room because the police were told to turn a blind eye to drug use in that region.
On the other hand, supporters of the injecting room are absolutely concerned that this could be taken the other way — that police could actively police in the area because they know it will be a hotspot for people who are carrying drugs. There are going to be drug deals in the region because people use where they buy drugs, and therefore people will be discouraged because they will know that it is a hotspot for police. That will discourage them from entering through the doors.
Mr Howard interjected.
Ms KEALY — This is feedback that I have received from stakeholders. This is not something that is made up. I am more than happy to talk to the member for Buninyong about that, but I am actually speaking to stakeholders about it. I know that he would like an injecting room in his part of the state —
The DEPUTY SPEAKER — Order! The member for Lowan will not respond to interjections.
Ms KEALY — Perhaps the Deputy Speaker would like to ask the member for Buninyong to refrain from making interjections in the first place.
There is no direction around police discretion and how that may be interpreted, and as I said, that creates great concern for supporters of injecting rooms but also for opponents of injecting rooms. The information within the bill certainly provides no comfort to either side. I reiterate that there has not been full thought and consideration given to these elements of the bill and how this will operate and how it will impact on local people — the local community, the workers within the North Richmond Community Health centre and also drug users who may enter the facility — and police.
The other element around the injecting room which is a key component of a review of the trial is around consideration of the key performance indicators (KPIs) or the data that will be collected by the injecting room staff in relation to the success or otherwise of the injecting room. It is extremely concerning that when we went through elements of those KPIs, or those measurements, during the bill briefing there had not been any consideration at all given to how these may be measured. If we are going to undertake a review, we need to make sure that we get the data right from the start. You cannot retrospectively collect data. There has been no thought given as to what data will be collected to actually get a true measurement of the success or otherwise of this injecting room.
I asked about whether there would be any longitudinal studies to get an understanding as to whether people who go to the injecting room have not had an overdose elsewhere at another time. Unfortunately that is what we have seen in other areas — that is, that people who use an injecting room do use drugs in other areas 80 per cent of the time; they do not use an injecting room for each and every hit that they take. So there are no lives lost in an injecting room — absolutely; nobody denies that. That is exactly what should be happening when you are surrounded by clinical staff who have the skills and the ability and the instruments around them to resuscitate people. But to resuscitate somebody and then to follow their journey through to make sure not just that they are given some information about rehab but that they successfully complete treatment, that they are no longer using after six or 12 months or some period of time, that is saving somebody’s life, that is helping them get their life back on track, and that is what we should be measuring.
I do not think that the data capture of this has been properly thought through, and it needs to be done from the outset. I am also concerned that the data could easily be skewed. I mean, just saying how many people have been referred to rehab does not really tell us anything. We need to get an understanding of how many people have managed to get their life back on track. It might be how many people have been referred to a mental health professional and seen them for X period of time and have been compliant with their medication, or how many people have found a home after being homeless for a period of time and have been in a permanent residence for longer than six months — that may be the measurement. But that is not what is being looked at. So I question what the ‘success’ will be of the injecting room if we are not actually collecting the data that will tell us whether people are getting a better life and managing their addiction to make sure that their life has been saved. It is not saving a life if somebody’s life or thoughts revolve around addiction — whether it is about where they get their next drug deal from, where they get the money to buy it, using and enjoying the high and going back and thinking, ‘Where am I going to get my next hit? Where do I get the money from?’. That is no way to live, and that is the critical issue that we need to make sure we support.
There are elements of this bill which talk about internal management, and there are elements of this which concern me, because again, I do not think that it has been thought through. There is no mention of clinical protocols in here, and given that it is effectively a health centre where there will be medical intervention provided, I am concerned that there is a heavy loading upon internal management protocols but no reference to clinical management protocols. There is no discussion around, for example, credentialing and privileging and what sort of drugs might be available on site. I realise that some of that will come through regulation, but to go so heavily into internal management and administration without looking at the clinical side and what this health centre will effectively be doing is deeply concerning.
I would like to quote now some feedback that I received from David Penington. Obviously David has been a strong advocate of injecting rooms and has done a lot of work in this area and is highly respected in terms of not only his knowledge of injecting rooms but also the drug and alcohol sector. I quote:
My major concern is that the director is only accountable to the departmental secretary, who is the only one with responsibility for modifying ‘management protocols’. Management of the facility will not be simple: it must evolve. It needs to be managed in the best way to achieve high‑quality outcomes amongst a difficult clientele. Heavy IV heroin users frequently also use other drugs, and if some are also heavily into ice methamphetamine, aggressive behaviour may often occur. If the director or the supervisor find themselves seriously challenged, they may need local support, especially if they have to refuse accepting some clients on behavioural grounds. Conflicts could also arise between staff members. Local resolution may become essential. For these reasons, I believe it is important to have a supervisory committee, however styled, to which the director reports and which can then report as necessary to the secretary, not only on matters in dispute, but on overall quality of performance of the facility.
I think this is an important recommendation for the government to take on board. David Penington would have to be one of the strongest reference points that the government should have talked to when they were creating a bill, and it is very disappointing that either the government have not consulted with David Penington or they have not listened to his advice.
There are a number of elements related to internal management protocols which also raise concerns for me. There has been no discussion or decision or even thought around what may preclude employment at the facility. When talking about what might be examples of internal management protocols, there was discussion around criminal history checks of staff members during the recruitment process and making sure they had the right skills and qualifications. It was actually recommended that it may be good for somebody to have a criminal history in drug possession or dealing because they would have a lived history in the drug and alcohol sector.
An honourable member interjected.
Ms KEALY — That was given to me during the bill briefing. It concerns me that it is thought that that would be an appropriate background. It was again put forward that this was something that could come up during the review. This needs to be thought through beforehand. This bill provides for specific exemptions from criminal charges for staff for the supply and use of drugs within the centre. We need to make sure that the people who are working in this injecting room do not have a criminal history of drug dealing, because they could easily see this as an opportunity to make a quick buck.
The fact that this has not been thought through is really concerning. Again, this is another example of a bill that has been devised on the run. It is drug policy on the run, and it is representative of a Premier who is panicking about the possible Northcote by‑election. He has backflipped on a pre‑election commitment to not have injecting rooms in Victoria and on multiple commitments given over this year, as recently as in September, and he has broken that promise.
Business interrupted under sessional orders.
Ms KEALY — I continue my contribution. Prior to the break I raised my concern about the lack of detail, planning and understanding around this policy to introduce injecting rooms into Victoria. I do not have time, unfortunately, to go through all of those pieces of evidence. Questions were asked during the bill briefing where information was simply not forthcoming and it seemed like it was a new idea. This reflects what I have heard from people who are in support of injecting rooms and those who oppose them. Even those in favour of the bill have concerns and criticisms around this bill and have concerns in particular about how it will operate in practice.
There is broad support within the drug and alcohol sector, that they want all drugs in. As I referenced earlier, the coroner recently reported that 70 per cent of Victorian overdose deaths involve the use of multiple drugs. There has not been a clear line from Labor as to whether ice is in or out. This will make an enormous difference to the operation of the facility and the impact it will have on staff and on the surrounding services in that area, whether it is a maternal child health centre in the building or the nearby primary school. Nearby businesses have concerns around the injecting room. There is not a 100 per cent consensus around this. There are people within the community that do not want the injecting room locally. They are concerned, but they are too scared to come forward because the support for it is very, very strong by some within that community as well.
The other criticism of the bill by those who are in support of injecting rooms is that they want many injecting rooms right across the state. They do not want to be limited to one injecting room. We know that this is a view that is shared by some Labor MPs, and two weeks ago we saw the member for Geelong make the comment that she wanted to see an injecting room open in that region. The minister then had to quickly get on the phone and hose that idea down, although we know that there are local members of Parliament who are desperately pushing for more injecting rooms across the state.
We have heard before from the Premier and from the Minister for Mental Health that we are not going to get injecting rooms in the state. It was a promise before the 2014 election. It was promised on many occasions over this year, as recently as September, and now we are getting an injecting room. How can we trust somebody who said there would be no injecting rooms in Victoria to now say there will not be more than one injecting room in Victoria and that we will not have many, many injecting rooms across Victoria? How can we trust that ice will not be able to be used within the injecting room when that was included in the media release, which was put out less than 10 days ago? There are deep concerns around this, and we simply cannot trust what the minister or the Premier are going to do around this, because they are saying one thing and are doing something completely different.
We have also heard from the sector that they think the model is wrong. They do not agree with this model. They prefer the model that was put forward by the Reason party earlier this year. They prefer the Kings Cross model. They think that Labor have got this model wrong in the structure and in not giving enough detail, particularly with the restriction of some drug types. So nobody is happy with how this policy has been delivered. Nobody is happy with how this bill is being constructed.
We know, and there is absolutely no doubt, that there have been no lives lost in an injecting room. That is the great work of the staff involved in injecting rooms right around the world. That is their job. It is their job to resuscitate people who have had a drug overdose. The problem is that people do not use injecting centres 100 per cent of the time when they are drug users. In fact the evidence states that 80 per cent of the time they inject elsewhere. This is where we have the risk. A life addicted to heroin is no way to live a life. That is where we really need to make the key difference — making sure that we provide those interventions to try to avoid people getting into that drug cycle wherever possible and that we provide support and make sure that they are able to get the support they need when they need it.
We have got waitlists for rehab of over a year. The first thing that Labor did when they came to government was scrap funding for three rehabilitation centres. We would have had more residential rehab beds today if Labor had not scrapped that funding. We had a pre‑election commitment as well, and we actually had money within the budget which Labor pulled. I think that is a disgrace. When we see no response from Labor in over three years in government and now the government are thinking, ‘We made a mistake. We should’ve actually built those three rehab centres that the Liberals and Nationals promised’, it is another backflip. At least they are catching up, but they cannot say that we did nothing when they are the ones who scrapped the funding.
We know that the greatest reduction in heroin deaths actually occurred in 2001. There has been a reduction in heroin deaths in Victoria by 80 per cent. This is because of immense work by police. They had a huge task force which broke up heroin trafficking rings in the state. In fact right across Australia there was this disruption. At the same time, in 2001 the Kings Cross medically supervised injecting centre was opened. However, even with the injecting centre, New South Wales only achieved a 50 per cent reduction in heroin deaths. Victoria managed to save more lives by having a strong task force and focus on breaking down the trafficking rings, breaking down those people and making sure the people who are preying on our most vulnerable and making money out of it are behind bars. That is where we need to target our resources, and Labor have completely ignored that there is an element within this where we need to tackle the supply of drugs. There is a lot of Afghani heroin in the state at the moment. We need to shut down that supply, limit that supply and provide support to people who need it most.
I was speaking to someone from the Police Association Victoria just under a year ago. In South Australia there are 250 police allocated to their drug task force team. I was shocked to hear that in Victoria we had just 20 police officers on our drug task force. And we wonder why we have got this flood of heroin throughout our drug market. It is no surprise when we are not willing to take a harder and tougher approach to crime and breaking down these drug syndicates. That is what we need to do. There has been the comment made that there is no increase in crime where there is an injecting room. That may be the case, but the evidence again is that there is no decrease either. Unfortunately people buy drugs near the injecting centre. They use drugs — obviously they will in the injecting centre — and they commit crimes in that area so they can fund their next hit. That is how it works. It does not decrease crime.
There are also many opportunities for our hardworking drug and alcohol workers to engage with addicts now. I think the work that drug support workers do is great. I am so impressed that they work with people and put in tireless hours. They always work long hours. They know people by name. They know when they are in trouble and when they have got homelessness issues. They know when they need further assistance. We need to support them through better access to rehab. We need to make sure that we have a targeted approach to education to make sure that people are supported and do not get into that horrific drug cycle, that they can get through those tough times so that they are not self‑medicating and that we can deal with their mental health issues.
I would like to thank everybody involved in the drug and alcohol sector because it is a tough gig, and they do a very, very good job. I would like to extend my deepest sympathies to all of those who have been impacted by a drug addiction and particularly those who have been impacted by the loss of life due to a drug overdose. Yes, we need to do more to tackle drugs. After three years under Labor we have seen absolutely nothing, and now this short‑sighted drug policy on the run is not going to do what we need to see. What we need to see is more police to break up those drug trafficking rings. We need to make sure that we have better targeted education for those most at risk, and we need to make sure people have got better access to drug treatment. Only the coalition will deliver on that.
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