Mandatory Drug Testing for Welfare Recipients - The Sequel (an unwanted policy that keeps coming back)

So I haven't blogged for a while - a circumstance that I'll attribute to the fact that life happens and other priorities like having a family and moving house have preoccupied my time. However, looking at what is in the medical and general news media recently, I feel compelled to take to the keyboard once again...

The Coalition Government here in Australia are yet again proposing to drug test welfare recipients (Newstart and Youth Allowance), and putting any who test positive for drugs on an income management program which quarantines payments on to a cashless debit card. This is despite similar proposals being ditched after facing criticism from experts in the health and welfare sectors, and the lack of evidence that similar programs overseas have achieved any meaningful outcomes.

Government rhetoric is full of emotive statements about ensuring welfare recipients using money to "put food on the table, send the kids to schools and pay the bills rather than on drugs", and how "[b]eing on drugs stops you getting a job". This is clearly a simplistic view of the factors that contribute to inequality in our community.

With the current levels of Newstart payments, affording the basics like housing, food, clothing and health care is already a struggle. Not only will mandatory drug testing cause further stigma for people on welfare, income management with a cashless debit card would prevent people from engaging with the more flexible cash economy that helps them to make ends meet. Buying second hand goods like clothing is more difficult without cash; buying cheaper fruits and vegetables at the end of the day from a market couldn't be done without cash.

And what of the testing itself. Only a minority of welfare recipients use drugs. Mandatory testing would have to test many people to get a single positive result. Screening tests (usually immunoassay based) have significant false positive and false negative rates; confirmation tests (usually GCMS) are expensive. Testing is intrusive - formal urine drug screening involves passing urine whilst being observed by a worker in the collection centre. A testing program would be a costly way to achieve very little.

As an Addiction Medicine Physician, I am appalled by how hard the government is pushing this policy in the absence of any evidence to support their position and in defiance of the many voices (many of whom come from a background of significant expertise) raised against it. As a taxpayer, I am appalled by the utter waste of money that this proposal represents.

My thoughts on Ben Cousins and his retirement from football

I admit it, I was one of the many glued to the television watching the Ben Cousins documentary.

As I listened to his narrative, I couldn't help but reflect on the interactions I have on a day to day basis with people who struggle with addiction but are not in fame's spotlight. His words rang true in many ways, but I feel that there are still aspects of his condition that he has yet to face.

Ben Cousins certainly speaks like someone who has been in therapy and dealing with treatment services for a long time. The repetition of the statement "addiction is a chronic, relapsing condition" is certainly a concept that treatment services work hard to impart to people - it is a health condition that can be managed with ongoing treatment, but we don't have a cure for. He clearly has an intellectual appreciation for what addiction is; time will tell how well he translates the information he has been given into real life changes.

Growing up in Western Australia, and being a West Coast Eagles supporter for many years, I remember clearly the draft when Ben was picked up under the Father/Son provisions inot the Eagles squad. From the beginning he was a high profile draft pick, with the media waxing lyrical about his football talent and the sheer good fortune of the Eagles recruiter that his father Brian played for the WAFL. What is the real impact of throwing that much adulation (not to mention the money) toa 17 year old?

In part 2 of the documentary, the story of recovery is closely linked to the story of returning to footy. Being an AFL player is what has given Ben Cousin's meaning in his life. The striving and the adrenalin of the competition is something that obviously lifts him and gives hims a rush.The structure and discipline of training clearly helps to impose structure on his life in general. What does a person do when the thing that gives life meaning is no longer there? There is bound to be a period of grieving and a sense of loss - how will he respond to this?

One of the concepts I discuss with the patients I see who see me for addiction related issues is readiness to stop using. When the drug is taken out of someone's life (removing all the rituals that go with obtaining and using the drug, all the social contacts that are held together by drug use, the pleasant sensations of euphoria or relaxation or absence of pain related to drug use) it leaves a whole, a gap. Filling that gap with positive things is a key element in the prevention of relapse into drug use. To my eyes, Ben filled the gap by working harder on his footy - take away the footy and what else will take its place? What will he do with the time that he used to train in? If he doesn't have the rush of getting out on the paddock on game day, what else in his life will give the rush and buzz? When the AFL isn't looking over his shoulders monitoring him for drug use, will he let his guard drop?

This is a critical time in his recovery. I wish him well in his recovery and with building good things in his life.

Legalising Heroin?

<http://www.theage.com.au/national/legalise-addicts-heroin-experts-20090922-fyse.html>

I had a sense of deja vu reading this article in The Age this week. There have been murmurings about legalisation of heroin in Australia for years now.

The arguments for legalisation are sound. Take away the illegality and the black maket prices should be less astronomical, and the people who do use the drug are less exposed to legal harm and more likely to seek help when they need it.

However, there also has to be a balance with retaining enough control so that the legal supply doesn't end up being diverted in large amounts into the black market.

The experience overseas has looked at models where people on heroin treatment had to use the drug onsite at a drug treatment clinic. This has the advantage of being supervised therefore reducing the risk of diversion into the black market. It does require adequate resourcing to provide appropriate staff and facilities, especially considering the fact that heroin is relatively short acting and the frequency of injecting is sometimes several times per day.

Certainly worth at least considering as an option...

Deja Vu

I sat in a 2 hour meeting today discussing, amongst other things, the lack of resources in the Alcohol and other drug (AOD) treatment sector. I had a distinct sense of deja vu - I'm sure I've had the same discussion before, several times.

Working in AOD treatment in Australia is interesting. Each of the state and territories does things differently. Even the laws regulating the provision of treatment are significantly varied. Unlike any other part of the health industries, where the structures for providing treatment are fairly consistent, AOD services are diverse at best and inconsistent at worst. The only thing that the various treatment services share is that they are all horribly under resourced.

... and yet ... alcohol and tobacco use are amongst the most significant causes of disease and death in our community ...