Michael Short: Sam Biondo, welcome to The Zone and thank you for your time.
Sam Biondo: Thank you.
MS: You are the chief of the Victorian Alcohol and Drug Association which we will refer to as VAADA from here on in. You are here to talk about methamphetamine, into which the Victorian Parliament is conducting an inquiry right now. VAADA has had input to that process. Can we start please by explaining to people who might not be aware of what precisely methamphetamine is?
SB: Methamphetamine is essentially a chemical stimulant and can provide a sense of euphoria and excitement. It also keeps people awake for long periods of time. It is an appetite suppressant. Regular use can lead to a whole range of unintended consequences and longer term harms.
Treating methamphetamine dependence can be tricky, as the withdrawal phase is considerably longer than that for many other drugs.
MS: The very fact of the inquiry, Sam, reflects that there is increasing community concern about methamphetamine. There have been quite a lot of reports that it is having a very negative impact, for example, on rural and regional communities. What is the big picture?
SB: If we look at this problem on an international basis, it is a problem in many countries around the world. It is not just Australia. It is not just Victoria. There has been significant police activity and interventions which has highlighted the local manufacture of this substance.
There is a whole range of distribution networks that are able to filter it out into the community. Victoria is not immune from this. In fact, what we’re trying to grapple with in Victoria, and the Victorian government is correctly looking at, is what is the significance of this problem, where is it occurring and what can be done about it.
MS: We will come back to all of those points in a moment, but before we do can we just talk a bit about VAADA? This is to help people understand what VAADA is and what it does. Can you outline that please?
SB: The Victorian Alcohol and Drug Association is the peak body for the Victorian alcohol and drug treatment sector. The sector up until recently had 105 providers – 105 agencies that were funded and they are spread across Victoria. Recently, with the recommissioning of this sector, the number of remaining agencies has been reduced.
VAADA is the peak organisation for the Victorian system. Our member agencies deal with people who have drug and alcohol problems, and provide all sorts of support, from counselling to day programs to residential rehabilitation facilities. We have members who are doctors and specialists, nurses, clinicians, counsellors and youth workers, for example.
MS: Let’s look at some facts and figures, Sam. Can you please go over the size and scope, relative and nominal, of the use of methamphetamine? What research has been done and what do we actually know?
SB: We have been able to observe over the last 10 years that there has been an increase of the impacts of methamphetamine in Victoria. Some of the figures arising from the National Drug Strategy Household Survey Report indicate that, from 1995 to 2013, we have seen a growth in recent use of methamphetamine from 2.2 per cent of Australian adults in 1995 to 4.2 per cent in 2013.
On an Australian basis, there are similar trends. The Australian Institute of Health and Welfare recently published reports indicated that the issue is impacting on all Australian states more or less to the same extent. In terms of the impacts on the ground, treatment services in Victoria saw an increase from 2918 treatment episodes in 2003-04 with amphetamines being the principal drug of concern; this has increased to 6778 in 2012-13.
This increase has had to be dealt with by changing systems and the introduction of special programs and activities to cater to the demand. This includes flexible models of detox and treatment, which cater for the particularities specific to methamphetamine. This necessitates, in many cases, extended periods in treatment; unfortunately, many funded agencies are not resourced to provide treatment for the duration necessary to derive optimal results. We’re also extremely concerned that the demand far outweighs the capacity of the system to deal with it. This is a constant issue of debate with government and with departments around the appropriate level of resources to meet community demands and needs.
MS: In that context then let’s look at the inquiry. Do you think that will lead to a good outcome? Will that help increase the resources? Should it?
SB: The inquiry should come up with a range of recommendations which have a positive impact on reducing the harms arising from methamphetamine.
However, if it follows in the footsteps of other similar inquiries on similar substances, such as the Victorian Parliament did with alcohol for example, or benzodiazepines, with many, many recommendations, none of which were adopted, then neither the individuals affected, nor the community or the treatment system will be any better off.
That this inquiry should be fitting into an election frame should indicate that there is some degree of seriousness. But the devil is in the detail and what gets rolled out.
We’re hopeful that we will actually get traction on this significant community issue, but we are concerned that what needs to be done won’t be done, and it simply becomes what is politically feasible that does get done. In terms of what is needed to enhance the effectiveness of the treatment sector in reducing the harms and spread of methamphetamine use, extended periods of withdrawal, reduced waiting times for treatment, flexibility to cater for extended duration of counselling and day and residential rehabilitation are required.
We also need to look at means of reducing the harms associated with consuming methamphetamine. It is a commonsense notion that some individuals will use drugs irrespective of any policing, treatment and prevention initiatives. In line with this, we need to look at means to reduce the harms associated with use, including access to sterile injecting equipment, alternate (less risky) means of administering methamphetamine and information on minimising the risk to physical and mental health. Some populations of methamphetamine users may not be cognizant of harm reduction messaging.
We need to extend the Drug Court to all Magistrate Courts throughout the state, which will divert many individuals with methamphetamine dependency away from the prison system and into treatment. This still punitive measure has the dual benefit of eliciting better health and wellbeing outcomes for the offender, and diverting people from the prison system, which is currently overburdened, ineffective, and a significant cost burden for the state.
MS: Are you confident about politicians’ understanding of the issues surrounding substance use in our community, and are you optimistic about and confident in their ability to facilitate, if not create, harm minimisation change?
SB: You would have to be a very narrow-sighted and ignorant person not to realise the impact that alcohol and drugs are having on our community. The problem as I see it in terms of political solutions and the role of politicians is that they are often risk-averse and fail to grasp what needs to be done in critical areas of social welfare and the health problems arising from these substances.
We know what the solutions are to reduce the harms and address the challenges associated with alcohol and other drugs. But there is an abject failure to address these issues because of political considerations, not because of a lack of evidence. The evidence is there. It is very clear. There are a range of effective measure to reduce harm which have been piloted, evaluated and proven to be effective. Many have been implemented and shown to work not only in other countries but also in other Australian states.
But there is often a failure to address these issues. We can look at examples of prison hepatitis C rates. Approximately 80 per cent of hepatitis C infections are the result of intravenous drug use. It is very significant. In Victoria we have 41 per cent of prisoners, according to the Ombudsman, who are infected with hepatitis C. Yet there are only three prisons out of 14 prisons that actually are delivering any hepatitis C treatment.
We have widespread injecting within these facilities, yet we are unable to introduce a needle and syringe program such as in the rest of the community. There is a concern that this equipment could be used to assault prison staff, however, this has not occurred in any other international jurisdictions which provide this vital, cost effective service. These people are being denied not only their human rights, but the same medical and harm-reduction facilities that exist in the community. We have been unable to stop the introduction of drugs into the prison system.
So we need to get real about some of these issues. If we put these issues on the table and individually went through what will make a difference there are solutions there for every single topic.
Yet there is a failure to try to implement what is required to be done. We could be saving hundreds and hundreds of people’s lives.
MS: At the political level and public policy level the response has been in Australia and elsewhere – although places, as you have indicated, have moved away from this in the face of the evidence, but we’re yet to – the main response has been prohibition.
It clearly does not work. What should the public policy response to the harm caused by substance abuse, abuse of illicit and illicit substances, actually be?
SB: Quite interestingly, Australia was the leader in the area of harm minimisation and harm reduction in the 1980s and 1990s. This has led to thousands upon thousands of people’s lives being saved. The changes which were implemented then, arose out of an abject fear of the impact of HIV and blood-borne disease in our community.
The courageous introduction of such harm-reduction measures has had a lasting benefit, not only for Australia but for many other countries where these programs have been introduced. So we can do it if we have the guts to do it, there are so many areas requiring attention. All it needs is political will and community support.
MS: What sort of programs in particular are you talking about?
SB: Needle and syringe exchange programs are a key feature. It has saved many thousands of lives, as have supervised injecting facilities.
MS: Do you think that illicit substances should be moved from the criminal justice system to the health system and should be decriminalised and regulated? This is not to say in any way that we’re talking about anything else than harm minimisation.
This is not about tacit endorsement of or encouragement of harmful use of substances. Do you think that decriminalisation is something that ought to occur?
SB: I think everything should be on the table. And that includes a discussion around decriminalisation. The United States is having a very interesting conversation at the moment around medical use of marijuana (as is Victoria). Now, people say that is a backdoor way to open up the floodgates for marijuana.
I say it is a recognition of the failure of prohibition over the years and a recognition by governments that it is futile spending so much money on criminal justice and policing resources to control a substance which for many the harm is minimal and for many has no real impact.
So prohibition and the criminal justice system issues go hand-in-hand. In fact, prohibition has led to huge wealthy mobster cartels being developed. It has criminalised otherwise peaceful individuals who create no other harm but to themselves. The whole system actually sticks with this glue of prohibition and the impact of criminal justice on innocent people’s lives.
I think we should put it on the table and have a conversation and say what should we do with these resources. Why not put them into schools? Why not take it out of the prison system and put it into treatment facilities? Why not take it out of prison systems and put it into education and hospital systems? That is the sort of discussion we should be getting into.
MS: Part of the context of that discussion, is it not Sam, is that most people who use substances, licit and illicit, do so in the privacy of their own homes relatively harm-free?
SB: That is correct. Many people use substances and harm no one else. What I am really concerned about is that they may be using these substances in ignorance. They need to understand the potential impact to themselves and in the long-term to others and to the community. Those who use illicit substances need to be informed of the risks and importantly how to minimise these risks.
So I am an adherent to harm-reduction policies which inform people how to use safely, how not to impact on others. Society has no other option but to educate people and inform people what the hazards are and how to reduce the harms.
Otherwise, what do we do? Prohibition? Do we let people die on the streets, as they were at the turn of the century? Do we let people fill up jail cells? Do we put all our policing resources into an unwinnable war on drugs?
MS: Prohibition has created a very, very lucrative business for criminal gangs, has it not?
SB: Ironically, our pursuit of prohibition has distorted many things including what the evidence says. Our laws create perverse incentives, take resources away from schools, hospitals and needy communities and place ever increasing amounts into prisons and unwinnable wars on drugs. More often than not such an approach creates more harm than good. It’s clear that the current way of addressing many of the issues arising from prohibition has led to a range of dysfunctionality in the operation of our justice system.
Prohibition has led to huge money being made by cartels and criminal syndicates that have reinvested that money in other nefarious activity and it is nothing short of a vicious cycle. Let’s just deal with this in a completely different way for the benefit of our community, rather than persistently using a flawed single minded approach.
MS: With your use of the word there, Sam, corruption are you suggesting that some of the proceeds of this supply industry of illicit substances are being used to prevent enlightened policy by going directly into the pockets of lawmakers?
SB: To tell you the truth, I don’t know. I am in no position to be definitive about this and have no reason to believe this would be the case locally. But the money has got to end up somewhere. Occasionally the media report how well established and influential institutions such banks and other financial intermediaries come to be used to launder the proceeds of drug money. Obviously I am not the police. I do not know where the money ends up, but it has got to end up somewhere. Does it end up in building site or in yachts, cars and a range of others assets? Maybe it just ends up in banks that are controlled by very wealthy people which are publicly listed and accountable. I am fairly certain that sooner or later the money ends up back in the system somewhere. That is the sort of corruption I am seeking to raise.
MS: So when you’re talking about corruption you are talking about it corrupting our general system?
SB: Absolutely. If governments were honest they would see the negative impacts the prohibition approach is creating.
MS: OK, so part of the route to change here is transparency, facts, education. What would you say to parents who are concerned about drugs in general and methamphetamine in particular, given the increased potency of the methamphetamine on the street and the addictive nature of it, or the amount of dependency that is occurring?
SB: I think it is very important for parents and carers and loved ones to be aware of the impacts of this very powerful substance, methamphetamine. People need to know, the user needs to know, how the harms arise, what can happen, the signs to look out for, what to do, where to go, who to speak to.
We need to make sure that it is easy for an individual to pick up the phone and say ‘hey, I have been using this in this way what is going to be the impact for me?’.
MS: What are the signs to look for as a loved one or as a user?
SB: It depends on what stage you are at, how much you are using, how you are using it, what the symptoms are. For many people who use it sparingly there is not a great deal of effect at least initially. For people that get trapped into using it more often, then it does create considerable problems.
These include lack of sleep, weight loss, potentially even psychosis. It can become very dangerous for them. This goes for anybody out there in the street who thinks that casual usage is fine. Well, it may be for some people, but for others it can be very problematic, we see people all the time, that thought they had it under control.
It is obviously very difficult for parents that are watching their loved ones undergo a transformation. In the long term it is really important to keep the conversation going, to be there to assist when a person realises that its time to deal with the issues. And that does to a certain extent require courage, both on behalf of the individual user but also for the parent who is watching someone who is dabbling and going in and out of particular substances.
MS: Are you able to give some key indicators that people should be looking for about a problematic use, particularly of meth? You mentioned the potential for psychosis, sleeplessness, lack of appetite. They are clear signs. Is that the top of the indicators?
SB: Repeated and prolonged use is something that someone should be very careful about. I think signs of sleeplessness and delusional thought patterns and cravings are signs that people should be looking for, as well as paranoid behaviour.
MS: As we talked about over lunch Sam, The Zone is a little bit about ideas and a little bit about the people who have them. So let’s move to you. What is your personal story? What motivates you? Why do you do what you do?
SB: I suppose I have a very strong commitment to social justice. Irrespective of where you were born and what your education has been and what you have done in life, your opportunities should be the same as someone else’s. I believe in a system that treats people equally and is inclusive of all.
I have real issues about some of the debates I’m hearing currently that seem very exclusive about those that have and very critical of those that don’t. I think that actually indicates arrogance and a failure to look after the lot of people who’ve not had good life chances and opportunities.
And I would like to think that in the work that I have done and the work I am doing that I have been able to make a little bit of a difference. But it is along with many, many other people out there who make a little bit of a difference as well.
MS: Why do you believe in social justice? Is it something that is intellectual or is it something received from your upbringing or is it a bit of both, or is it just having a bit of a think about the world?
SB: Well, I suppose I used to hear stories of the misery that used to occur during the war years and the suffering that people experienced.
Being born to migrants, or refugees as you would call it, in a pretty small community and experiencing some of the issues of growing up different from everybody else, you get a certain perception of things that should not be impacting on people but are.
As you grow up you recognise some limited life chances you have had compared to others and you think that it would be good if the system was able to be equal in its distribution of opportunity to all.
MS: It is interesting to me that you say that, because so many people who have not been interviewed here in The Zone believe so strongly in equality of opportunity, not equality of outcome, but quality of opportunity.
And I think that it is one of those unimpeachable first principles. I just cannot see any way you can not support that. With that in mind, can you identify some key turning points in your life?
SB: I had an opportunity when I was young to participate in some educational sessions at Melbourne University that were being run for kids. It was in about 1974 or 1973 and it opened my eyes to what existed for others and I thought it was great to have an opportunity there.
Then I started to realise it was kids from disadvantaged school environments and that sort of thing, so it actually heightened my awareness of the gap between where I was and where other people were. But it also created some heightened aspiration that if I worked hard I could get there.
That opened up my eyes to a different world. And it took a while to pursue it, and there were failures along the way, but that was one turning point. Another turning point was actually having the experience to work at a place called the Fitzroy Legal Service.
MS: How did that come about?
SB: That was originally a student placement, and then I was employed there as a social worker and a community development worker. That put me in contact with many, many issues around social justice and the failure of the system. Essentially the legal service was established out of the failures of the formal legal system.
It also, I assume, grew out of the New Left movement of the 1970s, where we were building a system that was fairer and more equitable and that led to a whole range of activities around domestic violence, the environment and welfare rights and numerous other social areas.
MS: The final question, Sam, to everyone in The Zone is what is the hardest thing you had ever had to do?
SB: Having to have a conversation about turning off someone’s life support.
MS: Do you want to talk more about that? Not necessarily about who it was, and I know who it was, but about what that meant for how you live your life?
SB: Well you certainly come to question the authority of people in different professions. And you come to realise that mistakes can be made. Failure to pick up simple things is really easy to do. And those simple failures can have enormous consequences.
MS: Do you think that has made you a more thoughtful and careful person?
SB: I would hope so. I’m generally someone who deals with big issues and big problems but I know the consequences can be different for different people. And as much as I try to be sensitive to all positions, I do take a position in terms of some of the guiding principles.
Now, if one is talking about harm reduction for an individual but someone who is continuing to use, a parent or loved one might not understand that position, because they just want someone to be abstinent.
But if you look at the nature of addiction on a continuum, there are many positions you can be on and the mere fact that you keep someone alive on that continuum is a success. But if you insist on abstinence and that leads to death, it is a failure.
So there is all sorts of shading on this continuum with a whole range of different impacts for different people. It is a very difficult circumstance and hopefully we can have that conversation with people with different positions on this, but hopefully also lead to a better end result for all parties concerned.
MS: Well, let’s hope that our collaboration today might be a small part of that. Sam, thank you so much for your time.
SB: Thank you.