Name

Address

Occupation

Special Commission of Inquiry into the Drug ' Ice'

STATEMENT OF Mary Ellen Harrod

30 April 2019

Mary Ellen Harrod

414 Elizabeth Street, Surry Hills NSW 2010

CEO, NSW Users and AIDS Association

On 30 April 2019, I, Mary Ellen Harrod, state:

This statement made by me accurately sets out the evidence that I would be prepared, if

necessary, to give in court as a witness. The statement is true to the best of my knowledge

and belief and I make it knowing that, if it tendered in evidence, I will be liable to prosecution

if I have wilfully stated in it anything that I know to be false, or do not believe to be true.

1. What is the NSW Users and AIDS Association?

The NSW Users and AIDS Association (NUAA) is the peak body representing drug users

in NSW. We are a member of the national network of drug user organisation with

funded representative bodies in Queensland, Western Australia, Victoria, Canberra and

a national peak. NUAA is a peer-based organisation, meaning it is staffed, led and

governed by people with lived experience of drug use. NUAA was established in 1989

as part of the NSW response to the HIV crisis and has been continuously funded since

this time. Our core funding is provided by the NSW Ministry of Health to work on

delivering the hepatitis C strategy but in the past four years our funding base has

diversified and we hold two ongoing contracts with the Minist ry of Health to work

across hepatitis C and alcohol and other drugs; two contracts with Primary Health

Networks and two contracts with Local Health Districts.

In this submission, I will be speaking primarily from an organisational perspective,

drawing on information I have received from the community and will use the "we"

pronoun. At times I will speak from a personal perspective and use " I".

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2. Who does NUAA represent?

NUAA represents people who use or have used drugs. Our work, and our community,

is diverse. Below are some of the examples of our representation.

• Participation in the NSW Hepatitis B and HIV Strategy Committees.

• Participation in NSW AOD Committees - the Drug and Alcohol Program Council

and Quality in Treatment.

• Leading role in developing policy and guidelines in the music festival space via

a meeting with Dr. Chant and a request for a submission to the Expert Panel

convened by Premier Berejiklian in 2018. We have also provided extensive

commentary on the current Music Festival Guidelines.

• Extensive input into the Opioid Treatment Guidelines and in the final stages of

producing a consumer guide to opioid treatment in partnership with the NSW

Ministry of Health

• Extensive media presence representing the view of people who use drugs

across a number of areas1

3. What services · does NUAA provide for people who use crystal methamphetamine and other A TS?

NUAA provides a number of services for people who inject drugs and other people who

use drugs. These services are outlined below:

Advocacy: Details of our advocacy work are outlined above. Examples of how

effective NUAA is in this space include:

• the upcoming consumer guide to opioid treatment developed by consumers

for consumers;

• the prominent role peer-based harm reduction services are now playing in

NSW policy, and current guidelines for music festivals that feature peer-based

1 see for example https: //www.smh.corn.au/opinion/those-on-methadone-dont-deserve-stigma-20180101-h0c 17 g .html; https: //www.news.com.au/lifestyle/real-life/news-life/ dancewize-nsw-offering-peerdelivered­prevention-and-harm-reduction-services-at-festivals/news-story/09da9 3 l 9efDc3 c3 2aa829fce8 9b4ec44; https: //www.smh.corn.au/opinion/pill-testing-needs-to-start-now-but-is-not-a-silver-bullet-20190 l l 4-p50r8a.html

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harm reduction services as a key part of the response (NUAA founded the first

NSW peer-based music festival service in November 2017);

• the expansion of take-home naloxone programs across NSW as the result of a

research project in which NUAA played a key role and the inclusion of non­

government services in the upcoming credentialing framework for take home

naloxone allowing peer-to-peer distribution.

Needle and Syringe Program: The NUAA NSP services drug users in inner Sydney

and beyond through postal orders. This peer-run service has a very strong track record

of success. 2 In addition to supplying over 400,000 units of sterile injecting equipment

each year, we provide brief interventions, referrals to other health services and host a

primary care clinic in partnership with Kirketon Road Centre that operates for 20 hours

per week. Approximately 40% of NSP attendees use crystal methamphetamine, a

figure that has risen by approximately 10% in the past 5 - 10 years.

Publications: NUAA has two flagship publications, Users News and Insiders News.

Users News has been publishing for many years and will be producing it's 92nd edition

in May on the topic of opioid treatment. Insiders News is produced in collaboration

with Justice Health and Forensic Mental Health Network and Corrective Services NSW

and is only available within the prison system. It has become highly regarded in a very

short period of time both with our service partners and people currently in prison. Both

publications include targeted advice on safer injecting and safer using in general

including specific harm reduction information for people using ATS. We also produce

a number of standalone resources. The most recent suite of resources can be seen on

the DanceWize NSW website (www.dancewizensw.org.au); these are targeted at

people who use drugs in the festival space.

Peer Education: We have three primary peer education projects, Peerlink, Consumer

Academy and DanceWize NSW. Each maintains a distinct focus - Peerlink is a long­

established program that educates highly marginalised drug users in safer injecting,

2 Harrod ME, Bryant J, Cama E, Brener L, Pepolim L. Patterns of Peer Distribution of Injecting Equipment at an

Authorized Distribution Site in Sydney, Australia. Substance Use and Misuse 2018; Harrod (2017) Peer­Delivered Needle And Syringe Program Delivers Reduced Level Of Receptive Syringe Sharing, APSAD, Melbourne.

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access to hepatitis C treatment and aims to empower community to access health care;

Consumer Academy currently works with two Primary Health Networks to upskill

people attending services in Sydney to participate in health service delivery as

consumer representatives and advocates; DanceWize NSW is a multi-faceted program

with a strong peer education component that provides practical advice on reducing

and avoiding the harms of drug use at music festivals.

4. Does NUAA work with any specific communities?

NUAA does focussed work with people in custody via our close work with the Justice

Health and Forensic Mental Health Network. This work includes Insiders News

described above; working with people in custody around story-telling and art; the HIPE

(Hepatitis in Prison Elimination) project where we support forums aimed at

encouraging people in custody to take up treatment for hepatitis C. We are also

developing a pilot peer support program for people in custody.

We work regionally in Western NSW (Orange, Katoomba, Wagga Wagga project under

development) and have worked to run focus groups in a number of regional centres

over the past two years. We do not have nor are we funded for specific programs

aimed at Aboriginal or CALO populations.

Over the past two years, NUAA has become intricately involved in the festival

community. Our team of volunteers has 150 people aged 18 to about 35 and our staff

on this project are drawn from this community. We have an extensive and growing

network of contacts with promoters, emergency medical teams, security organisations

and other festival service organisations.

5. Based on your experience at NUAA, have you noticed any trends in use, or those who use, crystal methamphetamine or other A TS { e.g. changes in prevalence, changes in mode of use, location, etc}

NUAA is not a research organisation so any information provided here is based on peer

information and is based on the impressions and feedback of individuals and our

observations through service delivery.

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Crystal methamphetamine

The observations of NUM staff on crystal methamphetamine use are consistent with

the statistical evidence - that overall use is decreasing but harms are increasing. Our

feedback from NSP clients is that they are injecting multiple times in short periods of

time causing a range of issues including vein damage, disruption of relationships,

housing issues and even psychosis to name a few of the consequences we've seen.

The people who are experiencing the most harm from methamphetamine use are those

who are already marginalised and not easily able to access health services and this

group of people remain unable to access early intervention or treatment services in

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spite of new centres opening and a recent increase in funding. Our observation is that

they are largely unaware of the services that exist and when they do try to access

them, they face additional barriers such as mental health issues, homelessness, other

drug use and other prescribed treatment. While we appear to have addressed some

of the issues in the community through steps taken to date, the most vulnerable group

of users is still experiencing significant harm in part caused by poor access to

treatment. We urgently need to lower the threshold for people trying to access

treatment services by providing medicated detox, easier to access referral pathways,

peer support/navigation for treatment access and the inclusion of people on opioid

substitution therapy or prescribed treatment for anxiety in existing treatment programs

or the development of specialist centres to allow tbis group to access treatment.

Another significant barrier to treatment access is the current punitive approach taken

by opioid treatment programs to other drug use. Because opioid treatment clients

cannot talk about other drug use with their treatment providers, they cannot access

treatment through the one channel that is the most accessible and problems frequently

spiral out of control rather than enabling clients to address them early as might be the

case if we took a more rational approach to these issues.

MOMA/other party drugs

NUAA employees and volunteers have attended close to 40 music festivals in the past

year across NSW. Our observations and experiences largely agree with data gathered

by NSW Health - that we are having significant issues with people taking excessive

doses and pre-loading. We believe these issues contributed to the deaths and hospital

admissions we saw in the 2018-2019 festival season. Research is needed to understand

why drug use patterns have shifted but policing and costs are significant factors. The

policing currently in place at many NSW festivals mean that people either

pre-load or take excessive doses at the gate if there is a risk of detection.

The purity of MOMA is increasingly and issue and has contributed to harms. We need

to do on site and off-site drug checking that will allow people to moderate their doses

according to purity. These services must be supported by peer education on reducing

the harms of drug use .

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Stigma/criminalisation

I will cite one example in how stigma increases drug use. I know of a person who

takes prescribed ATS for ADHD. In spite of a sound track record of using this

medication, the person was required to attend a psychiatrist appointment every two

weeks after disclosing that they use party drugs. This restriction is unjust. Making

access to treatment more difficult, raising the bars, creating barriers, pushes people

into riskier illicit use.

6. In your opinion, based on your experience, what are the underlying drivers of crystal methamphetamine and other A TS use?

Crystal methamphetamine and other ATS are used differently in different communities

and the underlying drivers of use vary. Stimulants are used for work, study, to enhance

sexual pleasure, to cope in general, to feel good in general. Each individual who uses

these drugs has a reason for their use.

The market forces vary with various substances. The cost of crystal methamphetamine

has remained consistent for a long time - at least ten years. At the moment, the drug

is readily available with quality varying from very good to not good.

We need to recognise that the drivers of drug use are not always external factors such

as cost and supply but can be social and emotional and vary from person to person.

Often people use drugs to connect with their community, to enjoy a shared exp·erience,

to relax, to bond. People always have, and always will, use drugs in this way and the

best health response is to support and empower people who use drugs to do it in a

way that minimises risk and reduces harm.

In the marginalised community served by the NUAA NSP (for example), a large number

of people have entered the supply market to support their own use, a logical outcome

of increased use in this community who are frequently on low incomes or social welfare

benefits.

It's my view that we need to start to seriously consider social disadvantage and stigma

as key underlying drivers of methamphetamine use in highly marginalised communities

of people who .use drugs. Crystal methamphetamine makes you feel invulnerable -

"like Superman". In people who have difficulty, complex lives - who are frequently

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experiencing issues such as being homeless or in insecure housing, incarceration,

undergoing treatment for other drug dependence, family separation or violence,

mental health issues - the driver of crystal methamphetamine use is that you feel

good when you use it.

We have extensive and rich data describing the humiliations that people on methadone

treatment (for example) undergo on a daily basis. Even in well-managed public clinics,

people on this treatment feel disempowered by daily dosing and the rules that

treatment with this drug require. We then, as a society, routinely target and shame

this group of people for being on medical treatment as happened in January-February

2018 after a tragic road accident on the south coast of NSW. Extensive media and

comment demonising people on treatment resulted in many people across the state

fearing that their drivers licenses and ability to earn a living would be taken away from

them. This is one example of many of the challenges people on methadone face.

Feeling good for a few hours by using crystal methamphetamine can seem like the

best solution.

It is a long and difficult piece of work, but we must aim to empower consumers of

drug health services and reduce stigma not only in our health services but in society.

We need to change the conversation from one that works on the mistaken assumption

that telling people to "say no" is somehow helpful and that "if people take the pill they

are responsible for the consequences" to one that recognises that drug use is a public

health issue and we can and must take rational, evidence based steps to educate

people on safe drug use and reduce the harms that they experience as a result.

7. In your opinion, based on your experience, what are some of the barriers to treatment if use of crystal methamphetamine and/or other ATS that has become problematic to a user.

There are multiple, significant, barriers to treatment for people who use drugs, some

of them are specific to ATS and some are systemic. I am assuming that other

organisations will address the chronic underfunding of treatment services.

Stigma

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Stigma is pervasive across the health system3 and takes many forms.

Stigma, and the resultant politicisation of health issues such as drug use are significant

barriers to treatment at a number of levels.

It is well-documented that stigma is pervasive within the health system. Drug users

are frequently treated very poorly in hospital, clinic and general practice settings. This

stigma is killing people by decreasing access to services. These issues have been well

documented in a recent report to the Queensland Mental Health Commission and are

well-understood in NSW and within the AOD Branch of NSW Health.

3 See for example Lancaster K, Sear K, Ritter A (2017). Reducing stigma and discrimination for people experiencing problematic alcohol and other drug use. Brisbane: Queensland Mental Health Commission and Australian Injecting and Illicit Drug Users League {2015) . We live with it almost every day of our lives - an AIVL report into experiences of Stigma and Discrimination. Canberra : AIVL. 45yd ney Morning Hera Id, https://www .sm h .corn .a u/politics/nsw /nsw-prem ier-la unches-new­

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Lack of education and prevention

'Just say no' isn't working. Healthy Harold isn't working. We need ·an open, honest

dialogue around drug use and harm reduction starting in high school as this is the

point where many young people are initiated into drug use (within their schools). An

open dialogue allows people to get help early, to admit they use drugs and seek

assistance without fear of condemnation and all the future repercussions around

reputation, employment etc. Many, many young people will not disclose their drug use

to their parents - people who should be their first means of support.

Lack of treatment options

I have discussed this previously but our most marginalised community members, who

need treatment the most, can't access it.

Lack of wholistic models of care/ consumer involvement in care and research

Treatment for issues related to drug use is very often punitive and shaming.

Involvement of peers and consumers in the development of treatment models in

necessary to change this dynamic.

Key recommendations:

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