NPYWC Opal Fuel Analysis Report

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NPYWC Opal Fuel Analysis Report

  1. 1. OPAL COST BENEFIT ANALYSIS REPORT BY ACCESS ECONOMICS PTY LIMITED FOR THE OPAL ALLIANCE 23 FEBRUARY 2006
  2. 2. Opal cost benefit analysisTABLE OF CONTENTSAcknowledgements and disclaimer ....................................................................................4Glossary of terms and acronyms........................................................................................5Executive summary...............................................................................................................iIntroduction ..........................................................................................................................11. Petrol sniffing ..............................................................................................................2 1.1 Definitions and symptoms.......................................................................................................2 1.2 Impacts ...................................................................................................................................2 1.2.1 Physical impacts and health service utilisation ..............................................................2 1.2.2 Criminal behaviour and justice system impacts .............................................................4 1.2.3 School and employment performance ...........................................................................6 1.3 Causes ....................................................................................................................................7 1.3.1 Cultural disruption and erosion of traditional values ......................................................7 1.3.2 Trans-generational dysfunction, mental illness, isolation ..............................................8 1.3.3 Socioeconomic: low employment, education and economic structures ........................9 1.4 Interventions .........................................................................................................................10 1.4.1 Awareness and harm minimisation health strategies...................................................11 1.4.2 Youth and recreational programs.................................................................................13 1.4.3 Employment, education and training services .............................................................13 1.4.4 Outstations ...................................................................................................................14 1.4.5 Deterrence (legal sanctions, police presence).............................................................16 1.4.6 Community action programs ........................................................................................19 1.4.7 Supply reduction strategies..........................................................................................192. Fuel substitution policies .........................................................................................20 2.1 Unleaded petrol (ULP) ..........................................................................................................20 2.2 The Comgas Scheme and Avgas .........................................................................................20 2.2.1 Comgas Scheme..........................................................................................................20 2.2.2 Avgas ...........................................................................................................................21 2.3 Opal.......................................................................................................................................22 2.3.1 Background ..................................................................................................................22 2.3.2 Proposed Rollout Region .............................................................................................24 2.3.3 Estimation of supply volumes.......................................................................................25 2.3.4 Subsidy rates by volume ..............................................................................................26 2.3.5 Implementation challenges ..........................................................................................273. Prevalence and regional demographics ..................................................................29 3.1 Population analysis ...............................................................................................................29 3.2 Prevalence ............................................................................................................................31 3.3 Comorbidity and mortality .....................................................................................................36 3.3.1 Other drug abuse .........................................................................................................36 3.3.2 All cause mortality ........................................................................................................36 3.4 Prevalence approach to cost measurement .........................................................................374. Costs of sniffing........................................................................................................38 4.1 Health system costs..............................................................................................................38
  3. 3. Opal cost benefit analysis 4.1.1 Sniffing-related hospitalisations....................................................................................38 4.1.2 Other sniffing-related health system costs ...................................................................40 4.2 Burden of disease .................................................................................................................42 4.2.1 Methodology .................................................................................................................42 4.2.2 Estimation of DALYs and the value of healthy life lost.................................................47 4.3 Crime and justice system costs ............................................................................................49 4.3.1 Police, legal costs and incarceration ............................................................................49 4.3.2 Vandalism and property damage .................................................................................53 4.4 Other costs of sniffing ...........................................................................................................55 4.4.1 Production losses .........................................................................................................55 4.4.2 Accommodation and community care ..........................................................................57 4.4.3 Counselling and rehabilitation ......................................................................................58 4.4.4 Deadweight losses .......................................................................................................59 4.4.5 Second generation and other impacts..........................................................................60 4.5 Summary of the costs of petrol sniffing.................................................................................615. Evaluation of costs and benefits..............................................................................63 5.1 Cost of adjunctive policies.....................................................................................................63 5.1.1 Package of policies.......................................................................................................63 5.1.2 Estimated cost of a four-government program .............................................................64 5.2 Cost benefit and effectiveness analyses...............................................................................66 5.2.1 Results..........................................................................................................................66REFERENCES.....................................................................................................................68FIGURESFigure 2-1: Proposed Rollout Region, by SLA 25Figure 3-1: Prevalence and incidence approaches to cost measurement 37Figure 4-1: Distribution of health costs, by type, all drug abuse 41Figure 4-2: Petrol sniffing, healthy life lost, % share by cause, 2005 49Figure 4-3: Ratio of indigenous to non-indigenous age-standardised rates of imprisonment(a), 2004 51Figure 4-4: Average cost per criminal incident, 2003 ($) 54Figure 4-5: Costs of petrol sniffing, 2005, % share 62TABLESTable 1-1: Attributable fraction of crime, three case studies 5Table 1-2: Levels of intervention and associated strategies 11Table 2-1: Derivation of petrol volumes, Rollout Region, 2005 26Table 3-1: Population, Rollout Region, by State/Territory, age, gender & ethnicity, 2005* 29
  4. 4. Opal cost benefit analysisTable 3-2: Employment, Rollout Region, by State/Territory, age, gender & ethnicity, 2005* 30Table 3-3: Attendance at an educational institution by State/Territory, 2005* (%) 31Table 3-4: Prevalence estimates, inhalation, various studies 32Table 3-5: Prevalence rates of petrol sniffing by State/Territory (%), Rollout Region, by age and chronicity, 2005 34Table 3-6: Prevalence of petrol sniffing by State/Territory (number of people), Rollout Region, by age and chronicity, 2005 35Table 3-7: Mortality from sniffing, 1998-2003, by cause of death and region 36Table 4-1: Petrol sniffing related health costs by type, Rollout Region, 2005 ($) 42Table 4-2: International estimates of VSL, various years 46Table 4-3: YLL, YLD and DALYs lost from sniffing, Rollout Region, 2005 48Table 4-4: Total police costs due to sniffing, by State/Territory, 2005 ($) 50Table 4-5: Estimated cost of property damage, based on Mutitjulu 55Table 4-6: Lost earnings & tax revenue due to sniffing, Rollout Region, 2005 56Table 4-7: Sniffers requiring long term care 57Table 4-8: Deadweight losses due to petrol sniffing ($m), 2005 60Table 4-9: Petrol sniffing cost summry, 2005 ($m) 61Table 5-1: Summary costing of adjunctive policies 65Table 5-2: Cost benefit and cost effectiveness analyses, Opal ($m) 67
  5. 5. Opal cost benefit analysisACKNOWLEDGEMENTS AND DISCLAIMERThis report was prepared by Access Economics for the Opal Alliance. The OpalAlliance consists of the GPT Group, the Ngaanyatjarra Pitjantjatjara Yankunytjatjara(NPY) Women’s Council and the Central Australian Youth Link-up Service (CAYLUS).The GPT Group, owners of the Ayers Rock Resort in Central Australia, has joinedforces with Aboriginal community organisations to lobby the Federal Government toexpand its existing subsidy of Opal to combat the practice of petrol sniffing in CentralAustralia. Access Economics provides independent, high quality economic advice andanalysis and does not form part of this lobbying effort.Access Economics would like to acknowledge with appreciation the comments, priorresearch and expert input from the following members of the Opal Alliance: Vicki Gillick NPY Women’s Council Blair McFarland and Tristan Ray CAYLUS Bruce Morris GPT GroupAccess Economics would also like to acknowledgement inputs from: Greg Andrews Mutitjulu Working Together Project Julia Mitchell Flinders University Gillian Shaw Consultant, Bowchung Pty LtdWhile every effort has been made to ensure the accuracy of this document, theuncertain nature of economic data, forecasting and analysis means that AccessEconomics Pty Limited is unable to make any warranties in relation to the informationcontained herein. Access Economics Pty Limited, its employees and agents disclaimliability for any loss or damage which may arise as a consequence of any personrelying on the information contained in this document.
  6. 6. Opal cost benefit analysisGLOSSARY OF TERMS AND ACRONYMSABS Australian Bureau of StatisticsAIHW Australian Institute for Health and WelfareALOS average length of stayAnangu Pitjantjatjara word for ‘Aboriginal person’APY Anangu Pitjantjatjara Yankunytjatjara1BP British PetroleumCAYLUS Central Australian Youth Link Up ServiceCBA cost benefit analysisCEA cost effectiveness analysisDALY disability adjusted life yearDHA Department of Health and Ageing (Commonwealth)GPT GPT GroupNPY Ngaanyatjarra Pitjantjatjara YankunytjatjaraMWTP Mutitjulu Working Together ProjectNT Northern TerritoryQALY quality adjusted life yearSA South AustraliaULP unleaded petrolYLD years of healthy life lost due to disabilityYLL years of life lost due to premature mortalityVSM volatile substance misuseWA Western Australia1 Formerly AP Lands – name officially changed to the APY Lands (Anangu Pitjantjatjara Yankunytjatjara)since amendments to the Pitjantjatjara land Rights Act in late 2005.
  7. 7. Opal cost benefit analysisEXECUTIVE SUMMARYThis report presents a cost benefit analysis for the subsidised supply of BritishPetroleum’s (BP’s) Opal Unleaded Petrol (ULP), hereafter called ‘Opal’, throughout alarge Rollout Region of Central Australia comprising the statistical areas of TennantCreek and Central NT in the Northern Territory, the Far North area of South Australia,and Laverton, Ngaanyatjarraku, Halls Creek, plus the communities of Kiwirrkurra andKunawarritji in Western Australia. Opal is presently available or approved for rollout inpart of this region.The cost benefit analysis aims to assess the potential economic impact of the use ofOpal throughout the defined Rollout Region.Opal, which was introduced to the market in February 2005, is a fuel produced by BPto combat petrol sniffing in Aboriginal communities. Opal lacks the aromatichydrocarbons and tetraethyl lead that induce a ‘high’ when sniffed and is thereforeconsidered to be an important tool in reducing the incidence of petrol sniffing.Petrol sniffing is a particularly harmful form of volatile substance misuse that isprevalent among Aboriginal communities in Central and other parts of Australia, withsubstantial associated health and social impacts and costs. i
  8. 8. Opal cost benefit analysisThe Comgas Scheme (now the Petrol Sniffing Prevention Program)Opal has been available so far mainly in those communities that qualify for participationwithin the Federal Government’s Comgas (also known as the Aviation fuel or Avgas)Scheme. Prior to the introduction of Opal, the Comgas Scheme utilised Avgas as a“non-sniffable” fuel substitute. Avgas, however is high in lead and, unlike Opal, wasnot suitable for some types of engines.The Comgas Scheme has operated in a number of remote Aboriginal communities inthe Northern Territory, South Australia and Western Australia since 1998. As Opal andAvgas cost approximately 33 cents per litre more than regular unleaded petrol, theComgas Scheme has provided a subsidy equal to the fuel price differential, therebymaking these fuel substitutes the same price for consumers as regular unleaded petrol.The November 2004 evaluation of the effectiveness of the Comgas Scheme,conducted for the Australian Department of Health and Ageing, provides evidence thatfuel substitution and/or supply reduction contributes to a lower prevalence of petrolsniffing in Central Australian Aboriginal communities, with similar findings in otherregions (eg, Arnhem Land). Proximity to supplies of regular unleaded fuel, however,has limited the effectiveness of Avgas and more recently Opal in communities that arerelatively close to alternative sources, such as roadhouses. This study’s proposedRollout Region is thus geographically large and includes major towns in order to reduceaccess to alternative sources of fuel and mitigate this historically limiting factor.MethodologyThe cost benefit analysis of the wider introduction of Opal as described in this reportcompares the benefit from reducing the costly impacts of sniffing and the cost ofeffectively extending the supply of Opal through a package of policies including thesubsidy. Benefit of lower petrol sniffing costs – Cost of Opal rollout = Net benefitPetrol sniffing costs include the lost value of healthy life (‘disease burden’), healthsystem expenditure, crime and justice system costs, production losses, community andinformal care of sick or disabled sniffers, rehabilitation costs and the deadweight lossesthat arise from lower taxation revenues and higher welfare payments. These costs areameliorated to some extent if the prevalence of sniffing is reduced, yielding benefitsrelative to the absence of Opal.The cost of the Opal rollout includes the larger Government subsidy required for anincreased volume of Opal supplied, and the cost of supporting programs (eg, for youth,employment, education, training, prevention, rehabilitation, deterrence and so on)designed to optimise the positive impacts of Opal. Due to the difficulty in obtainingaccurate estimates of petrol usage in the region, low, base and high options were usedto show a range of potential fuel subsidy costs.FindingsThe total cost of petrol sniffing in 2005 in the Rollout Region was estimated as$78.9 million, of which:ii
  9. 9. Opal cost benefit analysis $38.1 million (49%) was the net cost of the disease burden (after reducing the gross cost by the individual’s share of health and productivity costs); $16.2 million (20%) was the crime and justice system impact; $8.3 million (11%) was the productivity loss; the health, long term care and rehabilitation impacts were each about 5% of the total ($4.1 million, $4.2 million and $3.7 million respectively); informal care provided by families and significant others was valued at $2.3 million (3%); and deadweight losses from raising additional taxation revenue to fund transfers was estimated at $1.9 million (2%).The full $78.9 million cost of sniffing in 2005 would not be saved because Opal wouldnot totally eradicate all the impacts of sniffing; some costs of sniffing in 2005 wouldcontinue to be incurred and, as noted above, a small amount of sniffing may continueto be prevalent, so varying prevalence scenarios were modelled. In the base casescenario, prevalence is assumed to be reduced by 75%, with sensitivity analysis at100% (eradication, best case) and 50% (worst case). These scenarios are derivedfrom evidence from communities where Avgas was formerly substituted along withdemand reduction policies. All costs would reduce proportionately except thatresidential and long-term care costs would be expected to continue, while rehabilitationcosts may reduce more gradually than other costs as some of the neurological andcognitive impairment from chronic petrol sniffing ameliorates and to help avoidaddiction swapping, varying from 50% in the base case, with worst case at 100% andbest case at 0% (no more rehabilitation required).The total benefit of lower petrol sniffing costs in the Rollout Region is estimatedin the base case as $53.7 million. Other scenario results are shown in the tablebelow. Prevalence Total Benefit Net Wellbeing Total Financial Scenario ($m) Benefit ($m) Benefit* ($m) Best (100%) 73.5 38.1 35.3 Base (75%) 53.7 28.6 25.1 Worse (50%) 34.9 19.1 15.8 * Note: Total Benefit minus Net Wellbeing Benefit equals Total Financial Benefit..The total cost of the Opal rollout package is estimated in the base case as$26.6 million, comprising two components: The cost of the subsidy is estimated to be between $11.8 million (low or best case) and $19.7 million (high or worst case) in 2005, with a base case of $15.8 million, assuming a subsidy rate of 27 cents per litre and no other significant associated supply costs. Usage Scenario Litres (million) Cost ($m) High (worst) case 73.1 19.7 Base case 58.5 15.8 Low (best) case 43.9 11.8 iii
  10. 10. Opal cost benefit analysis The cost of a package of strategies to address petrol sniffing is estimated to be $10.8 million per annum shared by the NT, SA, WA and Commonwealth Governments. Well-implemented supplementary demand reduction policies are essential to accompany supply substitution and would include: awareness and harm minimisation health strategies; youth and recreational programs; employment, education and training services; preventive and rehabilitative outstation programs; deterrence (legal sanctions, police presence); and community action programs.Cost Benefit AnalysisThe results of the cost benefit analysis show base case petrol sniffing benefits of$53.7 million per annum and base case Opal rollout costs of $26.6 million,producing a net gain of $27.1 million. Scenario results range from a net gain of$4.3 million in the worst case to a net gain of $50.8 million in the best case. Theseextreme upper and lower amounts, however, are considered to represent less likelyoutcomes. TOTAL COST BENEFIT ANALYSIS ($ MILLION) Best Base Net Benefits Worst Costs -40 -20 - 20 40 60 80If the value of the healthy life gained is excluded from the above results and onlyfinancial benefits are considered, the results of the cost benefit analysis show basecase petrol sniffing benefits of $25.1 million and base case Opal rollout costs of$26.6 million, producing a net loss of $1.5 million. Scenario results range from a netloss of $14.8 million in the worst case to a net gain of $12.7 million in the best case.These extreme upper and lower amounts, however, are considered to represent lesslikely outcomes.iv
  11. 11. Opal cost benefit analysis FINANCIAL COST BENEFIT ANALYSIS ($ MILLION) Net Benefits Best Costs Base Worst -40 -20 - 20 40Even in the worst case scenario, the net financial loss is small and represents a cost-effective purchase of the 140 Quality Adjusted Life Years (QALYs) gained, at $105,656per QALY. QALYs are a measure of the healthy life gained from reducing morbidityand premature death. The Australian government already funds therapies in thisrange, and the World Health Organisation recommends funding health initiatives thatcost up to three times Gross Domestic Product per capita per QALY (ie up to$120,000/QALY for Australia). In the base case and best case, the rollout is cost-saving, which means that it not just saves financial costs, but gains the extra years of healthy life as well. Moreover, the results do not take account of the benefits that may flow from any additional strategies, such as a more stable youth population, socio-economic benefits, reductions in other addictions (eg, alcohol, marijuana) and therefore better health, and improved general social, family and community cohesion.Access EconomicsFebruary 2006 v
  12. 12. Opal cost benefit analysisINTRODUCTIONThe Opal Alliance commissioned Access Economics in July 2005 to provide a costbenefit analysis of a rollout of Opal across central Australia. The Opal Alliancecomprises: Vicki Gillick, NPY Women’s Council Blair McFarland, CAYLUS Bruce Morris, GPT Group Tristan Ray, CAYLUSProject methodology has been developed in consultation with the Opal Alliance;members also provided comments on the draft report. A broad range of stakeholderswere consulted in the research stage. This report presents our findings.Chapter 1 defines petrol sniffing and its symptoms, traces its impacts and causes, andoutlines complementary interventions that can help address sniffing and their likelyeffectiveness given past lessons. Establishing an evidence basis for impacts isparticularly important in analysing the costs of petrol sniffing.Chapter 2 traces historical fuel substitution policies including substitution with unleadedpetrol, Avgas and the Comgas Scheme. The emphasis however, is on the nature ofOpal, the proposed Rollout Region, estimation of supply volumes and subsidy rates forthose volumes given economies of scale in supply, and implementation challenges.Chapter 3 provides a demographic review of the Rollout Region, investigating age,gender and ethnicity of the population and employment rates from ABS Census data.This analysis edifies an estimation of the prevalence of chronic and occasional sniffingin the Rollout Region. Comorbidity and all cause mortality are also assessed, and theprevalence approach to cost measurement is outlined.Chapter 4 then estimates the annual costs of sniffing in 2005 including: health systemcosts; “burden of disease” (the cost of morbidity and premature death in human lifeterms); crime and justice system costs; production losses; the cost of informal care forpeople disabled due to sniffing; accommodation, counselling and rehabilitationinterventions; and, as far as possible second generation impacts and other costs.Chapter 5 outlines the nature of adjunctive preventive policies that would need toaccompany a rollout of Opal for maximum effectiveness. The annual cost of anintegrated four government program is then estimated. The final section provides thecost benefit analysis – with the fuel subsidy and implementation program forming thecosts, and the benefits being the reduction in many of the numerous costs associatedwith petrol sniffing, based on estimated prevalence reductions. Cost effectivenessanalysis is also presented. 1
  13. 13. Opal cost benefit analysis1. PETROL SNIFFING1.1 DEFINITIONS AND SYMPTOMSPetrol sniffing is a particularly harmful form of volatile substance misuse (VSM) orinhalant substance abuse)2, which is practised primarily by young Aboriginal people.Petrol fumes can be inhaled directly from a bag, saturated rag or small container, eitherthrough the nose (“sniffing”) or through the mouth (“huffing” or “bagging”). Petrolcontains neurotoxic substances including aromatic hydrocarbons (such as toluene,xylene, benzene and n-hexane) and leaded petrol also contains tetraethyl lead. Wheninhaled, petrol produces immediate effects that may be perceived as positive (the‘high’) of euphoria, relaxation, excitement and hallucination that can last for up to sixhours (Cairney et al, 2002 and 2005). Symptoms range from mild neurocognitivedysfunction to severe irreversible encephalopathy that can be fatal, with thepermanence of brain changes related to the length and severity of the person’s sniffinghistory.1.2 IMPACTSThis section reviews the evidence for linkages between sniffing and various economicand other impacts. Economic impacts are ones that use real resources, which couldotherwise be put to alternative productive use. In addition, less tangible impacts areidentified and, where possible, evidence is presented for quantifying these impacts,which provides the groundwork for estimating the costs of sniffing in Section 4. “In communities where petrol sniffing is endemic, there is a high incidence of property damage, vandalism, social disruption, poor educational performance, sexual promiscuity, sexually transmitted diseases, juvenile crime and an excessive demand on health resources. Consequently, the lives of family and community members can be disrupted substantially. The additional burden to public health is sizeable with morbidity and mortality rates related to petrol sniffing increasing consistently since the 1980s.” Cairney et al (2002:83).1.2.1 PHYSICAL IMPACTS AND HEALTH SERVICE UTILISATIONNegative physical impacts of sniffing are as follows. Short term direct impacts of petrol sniffing result from 15-20 inhalations (larger doses are more likely to cause more harm) and include intoxication, dizziness, auditory and visual hallucination, slurred speech, staggered gait, hunger, irrationality, aggression, impulsiveness/disinhibition, increased libido, confusion, lack of coordination, headaches, poor memory, vomiting, delirium, unconsciousness, seizures, coma and, rarely, sudden death. Longer tem direct impacts include psychological addiction and, for chronic sniffers, cerebellar ataxia, grand mal epilepsy, encephalopathy, low body weight and nutrient deficiency, progressive decline in cognitive ability and chronic2 Other inhalants include glue, aerosols, nitrites and liquid solvents.2
  14. 14. Opal cost benefit analysis disability including mental impairment, acquired brain injury (ABI), central nervous system damage, dementia, persistent psychosis and death from heart failure or lead poisoning. “The number of young people disabled by petrol sniffing, from these figures, represents 58% of the total number of disabled clients identified, and 73% of all adult disabilities. These figures also show that the results of widespread and unchecked petrol sniffing on AP Lands has caused 88% of the incidents of Acquired Brain Injury across the AP Lands. Petrol sniffing would appear to be the single biggest cause of disability amongst the Pitjantjatjara and Yankunytjatjara people.” Tregenza (2002:19). “If nothing is done, 120 sniffers in the NT alone could acquire brain injury over the next few years, with 500 regular sniffers in the broader region at risk of brain injury or death.” MWTP (2005d). “Around 20 regular sniffers in Mutitjulu are at risk of ABI. Two died in 2004. Many are in wheelchairs.” Andrews (2005c). Physical secondary complications of sniffing include burns, infections and pneumonia, increased incidence of STDs, accidents especially asphyxia, injury from violence, homicide, self-harm and suicide. In addition, there can be effects on the unborn children of female sniffers caused by sniffing during pregnancy, including birth deformities, low birth-weight and miscarriage.Health service utilisation due to sniffing tends to be concentrated on acutehospitalisations, often together with aerial medical evacuation, and the longer termimpacts of sniffing and its secondary impacts, which include limited rehabilitative orresidential care for the disabled. Short term health impacts: Aerial medical evacuations have been found to occur at the rate of around 6 per annum per 800 population in sniffing communities (Brady, 1989) or around 4% of all evacuations (Brady, 1992), with an average length of stay (ALOS) in hospital of 25 days (range 4 to 65 days), based on an Arnhem Land study (Chambers, 1989) although longer in a later study – median length of stay 28 days (range 5 to 118 (Cairney et al, 2004) suggesting ALOS of 46 days if the distribution is the same). The average of these two estimates is an ALOS of 36 days. Hospital treatment can include emergency department, intensive care unit admission, other (longer) inpatient treatment, intubation, sedation, brain imaging, saccade (eye movement) and blood testing, and chelation therapy if leaded petrol has been used (costing $700 for medication alone, in 1989) which reduces lead levels by mobilising inorganic lead in the blood. As a result of cranial nerve damage, some petrol sniffers may lose reflexes during therapy that may cause them to ‘inhale’ food and drink, in which case additional paramedical staff become involved in treatment – a dietician, a speech therapist, a physiotherapist and an occupational therapist. Allied health services are also part of standard treatment for sniffers who are hospitalised, with a view to rehabilitation. Outpatient visits in a Canadian study were at the rate of 0.83 visits per sniffer per annum to manage their petrol abuse (Tenenbein, 1997). AIHW cost and burden of disease data by ICD-10 code can be used with these volume parameters to derive health costs in Sections 4.1 and 4.2. Longer term health impacts include the loss of healthy life from disability and premature death due also to the secondary impacts of sniffing – mortality from various causes, long term injuries or infections such as STDs, the 3
  15. 15. Opal cost benefit analysis generational impact of low birth weight, the many health impacts of violence (Access Economics, 2004, identifies increased health risks from smoking, alcohol, polydrug use, depression, anxiety disorders and other impacts), as well as the financial costs of care for people suffering these impacts and disability from sniffing. Three quarters (73%) of adult disabilities on the APY Lands were found to be due to sniffing (Tregenza, 2002:19). While some people with disabilities are able to access residential care services in the formal sector, the majority are looked after by informal carers (see Section 4.4.2). In Central Australia, the number of people with severe brain damage as a result of petrol sniffing is expected to rise to 60, with an annual cost of care of around $9m (Legislative Assembly of the NT, 2004a), implying an average cost of residential care per person of $150,000. This estimate accords with McFarland (1999:19) report of the cost of care (to Territory Health Services) for a profoundly disabled young sniffer of over $160,000 per annum in the late 1990s. Andrews (2005c) estimates less conservatively that the number of disabled sniffers in the NT will rise to around 120 in the next few years, with health costs of maintaining an ex- sniffer with ABI between $150,000 and $300,000 per annum, potentially reaching $750,000 for more serious cases (MWTP, 2005d). Andrews (2005c) concludes that: “The total costs of caring for disabled sniffers in the NT alone could be $36 million per annum. If WA and SA are also included, the figure could be considerably higher - up to $80 million per annum. Capacity for such care is currently very limited and governments will at some stage have to face this issue, including the question of capital costs.” The right-tail skew in care costs is conservatively treated in this report (Sections 4.1 and 4.2) by utilising the official NT estimates of $150,000 per annum and a prevalence of 60 sniffers requiring lifetime care in 2005.In addition, the long term health impacts of conditions secondary to sniffing areincluded in the costing in Sections 4.1 and 4.2. Findings from the literature searchrelevant for these impacts follow. STD prevalence (two third of females and one third of male sniffers3 are infected) is higher than in the general population and the excess can be attributed to sniffing. Deaths from accidents and injuries (intentional and unintentional) can be derived from the mortality distribution (Section 3.3.2), with relative morbidity from these conditions and for low birth weight derived from AIHW data, and with the health system costs mapping the distribution of the disability burden of disease.1.2.2 CRIMINAL BEHAVIOUR AND JUSTICE SYSTEM IMPACTS “In addition to medical costs, delinquency is common among petrol sniffers and is the cause of considerable cost to the community. Petrol sniffing may promote delinquent behaviour due to its intoxicating effects that include a hunger for stimulation, proneness to violent outbursts and a need to release tension. Petrol sniffers have caused substantial damage to property and … interact heavily with the juvenile justice system, particularly in association with vandalism, violence, robbery, rape and sexual promiscuity.” Cairney et al (2002), p83, 85.3 D’Abbs and MacLean (2000), p28.4
  16. 16. Opal cost benefit analysisAs a result of sniffing, 80% of sniffers and ex-sniffers had been involved with the law(Burns et al, 1995). Stojanovski (1999) reports that attempts to stop petrol sniffing tendto be met with violence from gangs of sniffers. In some communities, people leavebowls of petrol on the bonnets of their cars to prevent the cars from being damaged bysniffers stealing petrol. He also reports speaking to a petrol sniffer who witnessed oneof two homicides that occurred within a few months in Central Australia where theperpetrator was sniffing petrol at the time and was hallucinating when he killed theother boy.As observed by Burns et al (1995) in Maningrida, 100% eradication of petrol sniffing ledto reduction of crime to 42% of original levels. The attributable fraction of criminalactivity can be estimated from this evidence as 58%; in other words, 58% of crime inManingrida was committed as a result of petrol sniffing.D’Abbs and MacLean (2000) also summarise two other examples of crime costs – onein the Pitjantjatjara Lands of South Australia, where 40 of 103 cases before the courtsinvolved sniffing, and an earlier Manangrida study where 32 of 71 offences in one yearwere described as “petrol sniffing was involved”. There was no significant differencebetween chronic and occasional sniffing. Table 1-1 summarises the case studies. TABLE 1-1: ATTRIBUTABLE FRACTION OF CRIME, THREE CASE STUDIES Sniffing Total AFManangrida, 1988, offences 32 71 45%Pitjantjatjara Lands, 1979-80, court cases 40 103 39% 1Manangrida, 1987-90 to 1991-1994 , annual court files 85 147 58%Total, three case studies 157 321 49% 1 A ‘before’ and ‘after’ comparison in relation to crime and sniffing.The average attributable fraction of 49% from the three case studies is used toestimate criminal costs in Section 4.3.Andrews (2005b) notes that two very visible impacts of property crime in centralAustralia relate to car dumping and the state of housing.Family violence and abuse, assault (physical and sexual), rape and murder canalso be consequences of sniffing (McFarland, 1999). “In a child sexual assault case that occurred at Amata in 1995, a four-year- old girl was sexually assaulted. She had to be evacuated to Alice Springs hospital for surgery. No offender was identified. The childs mother and her defacto were at the time (and continue to be) chronic petrol sniffers. The childs maternal aunt and uncle were also chronic petrol sniffers. Up to six or more petrol sniffers would stay in the household where this child was living. No charges were laid. Six months after the child was raped her mother was the victim of a serious assault and rape. Alcohol was the main substance featured in this incident. Her husband was in such an inebriated state that he was unaware that another man was raping his wife. When she complained to the husband that she had been raped his response was to punch her about the body and cause her to fall out of a moving vehicle. She was also evacuated to 5
  17. 17. Opal cost benefit analysis the Alice Springs hospital and remained in the intensive care unit for a number of days due to respiratory failure as a result of chronic sniffing. She would not make a complaint to the police for fear of her husband being gaoled. She had already experienced the shame of having her petrol addiction publicly aired in a contested Family Court matter several years before.” Affidavit of NPY Women’s Council Domestic Violence Service Manager Jane Lloyd, to SA Coroner Wayne Chivell in the matter of Hunt, Ken and Thompson (deceased), May-June 2002, Umuwa, quoted in Coroner’s findings (para 6.26).While the health impacts of these behaviours are measurable both in financial termsand in terms of the loss of healthy life (as outlined in the previous section), the socialand cultural impacts are considered too intangible to adequately measure, whilerecognising their importance. The criminal justice costs are measured in terms ofattributing a fraction (49% described above) of total policing, legal and detention costs. Policing costs are able to be estimated based on the police resources in the Rollout Region. Incarceration costs are able to estimated on the basis of trial cases proceeding to a guilty verdict, and interim detention measures. The cost of secure accommodation for a violent ex-sniffer in the Northern Territory cost $750,000 per year (Hudson, not dated:6) reported that the detention of young people with a history of petrol sniffing cost Correctional Services as much as $3 million in 1994. Legal costs are of two main types: the cost of prosecution and defence, although there was no literature evident on the average costs of cases proceeding to trial; and the cost of coronial inquests, which can be reviewed case by case.1.2.3 SCHOOL AND EMPLOYMENT PERFORMANCE “Further behavioural and social problems are caused by irregular school attendance among petrol sniffers.” Cairney et al (2002), p83.Data from the Australian Bureau of Statistics (ABS) quantify the lower rates ofemployment and education among Aboriginal people across the Rollout Region(Section 3.1). However, it is important to note that lower employment and educationare both a cause and effect of petrol sniffing (Section 1.2.3) and that, over time, lowereducational levels result in reduced likelihood of employment and are a predictor offuture lower earnings. That said, d’Abbs and MacLean (2000:29) conclude that: “Sniffing has been associated with poor school attendance and school performance, with the latter described as a result rather than a cause of petrol sniffing”.At Yuendumu, Stojanovski (1999) reported that, prior to the introduction ofinterventions, teachers in the local school were unable to teach their students properlydue to constant disturbances from petrol sniffers. Many children stopped going toschool and sniffed petrol in the day time instead, designing halters so that they couldsniff non-stop while walking around. Other sniffers still attended school but wereunable to study due to the physiological effects of petrol, falling asleep on theclassroom floor hung over. For the students who did not sniff petrol, their schoolingwas interrupted by the visits of kids who are high on petrol dropping into classrooms,6
  18. 18. Opal cost benefit analysisclowning around, and trying to recruit other students to sniff petrol with them.Research from South Australia gives evidence of this sort of behaviour severelydisrupting classes, in some cases students and teachers were barricaded in theclassroom while petrol sniffers pelt the windows and doors of the classroom withstones (Folds, 1987, pp56 -73).In Mutitjulu, census data indicate that 86% of the population has no educationalqualifications at all (Smith, 2001).Burns et al (1995) observed in the Maningrida community in NT that eradication ofpetrol sniffing led to substantially increased school attendance, suggesting that thesecond generation costs of sniffing may be very high (Section 4.4.5).Petrol sniffing can lead to reduced work participation, effects on morale and higher jobturnover (see the employment differential in Section 1.4.3). Differences inemployment rates, standardised by age and gender, are considered and quantified inSection 3.1, with the productivity costs of sniffing then calculated in Section 4.4.1.1.3 CAUSESCauses of sniffing are complex and inter-related. A long history of conflict,dispossession and acculturation has resulted in trans-generational dysfunctionality,particularly manifest in substance abuse. At a personal level, many young Aboriginalpeople cite boredom, social acceptability and peer group pressure as reasons forsniffing, which represents a perceived escape into excitement, risk-taking, danger andaccess to a ‘different world’; this is more similar to reasons cite by young drug users inurban Western culture. However, in many Aboriginal communities petrol sniffing hasgrown to epidemic proportions, and the reasons for this growth warrant carefulinvestigation if interventions are to be successful. Addressing addiction issues isconsidered by many Aboriginal people to be central to improving the quality of life intheir communities. “If we get rid of the addiction problems everything else will fall into place. But if these problems aren’t overcome, nothing else will be successful”. Mr Wilson, Chairman of Mutitjulu Community Council, December 2004.1.3.1 CULTURAL DISRUPTION AND EROSION OF TRADITIONAL VALUESOccupied Territory Syndrome is a phenomenon of societies enduring on-goingoccupation of their land, manifesting a range of behaviours reflecting frustration withlack of sovereignty and control eg, Palestinian youth expressing anger andpowerlessness through violence. Occupation over generations leads to a societalsense of hopelessness where violence against the occupying force turns inwards intoviolence against the self and the community; behaviours consistent with OccupiedTerritory Syndrome include substance abuse, family violence, suicide, vandalism, childabuse, neglect and malicious damage of infrastructure. International experience hasshown that Occupied Territory Syndrome can be addressed by promoting communityownership and control, helping communities to develop and share an honest history oftheir colonisation, and promoting the notion that people can change if they want(Andrews, 2005d).The forced removal of children during the Stolen Generations era has had a significantand proven influence on parenting skills and culture. 7
  19. 19. Opal cost benefit analysisA well documented aspect of Aboriginal culture is the right to personal autonomy andunwillingness to impose one’s will on another, particularly in relation to adhering to theright for others to do with their own bodies what they choose (eg, Brady, 1992, pp72-75). This can make it hard for parents to stop teenage children from sniffing, especiallymales who have been initiated as ‘men’. Sanctions used by non-Aboriginal parentssuch as grounding or curfews are considered foreign and inappropriate in Aboriginalchild rearing. Moreover, young people exploit their right to self autonomy, refusingparental requests for intervention and sometimes threatening them with weapons. Insuch cases, police intervention (removal, court bonds and bail) may be requested byparents: “That kid won’t listen to us, get the police.” (Stojanovski, 1999), since youngpeople recognise that the police have authority over them that their parents do not.Over time, traditional social structures and relationships that govern Aboriginal societyhave been undermined, and traditional cultural values of responsibility and reciprocity(ngapartji ngapartji)4 have been distorted.1.3.2 TRANS-GENERATIONAL DYSFUNCTION, MENTAL ILLNESS, ISOLATIONA family history of mental illness and addiction (particularly alcoholism in parents) iscommon among petrol sniffers. 80% of sniffers in Mutitjulu come from familiescharacterised by social and cultural breakdown associate with alcohol misuse(Andrews, 2005c). In relation to the investigation of the death of one Aboriginal youth,his mother said: “Before he started sniffing, Kunmanara Coulthard said to his father: ‘If you don’t stop drinking grog, we [my brothers and I] are going to start sniffing petrol’”. (Andrews, 2005d).There is greater comorbidity of mental illness with substance abuse. Many sniffershave complex psychological needs that require adjunctive treatment with the abuse. “Children and sniffers have become bosses over their parents. They are running the agenda by their behaviour. They are out of control and people have to react to the behaviour of sniffers rather than keeping to the law and keeping to the culture. Sniffers break their mother’s arms. There is violence against families. Sniffers threaten their parents that they will commit further acts of self-harm. They swear at their parents. They breach traditional secrets by speaking out of turn. They throw rocks at their parents. When I talk about these things I am talking about sniffers generally…” Punch (Kawaki) Thompson, father of the deceased sniffer Kunmanara Thompson, in evidence to SA Coroner Wayne Chivell in the matter of Hunt, Ken and Thompson (deceased), May-June 2002, Umuwa. “A reality of the Young People’s project operating on the AP(Y) lands is that despite the best efforts of the staff to restrict their work to 12 to 25 year olds and concentrate on preventative initiatives, we are constantly asked to assist the many individuals over 25 years of age who are sniffing petrol.4 Ngapartji ngapartji is a Pitjantjatjara expression meaning “mutual reciprocity” – a two-way social systemof sharing by demand rather than unsolicited giving that Anangu traditionally apply to their socialrelationships.8
  20. 20. Opal cost benefit analysis They are often persons in their 30s and 40s who are ‘chronic’ sniffers and many have serious mental and physical disabilities as a result of the sniffing.” Affidavit of Vicki Gillick, NPY Women’s Council Co-ordinator, in the matter of Ward, Ken, Ryan and Cooper (deceased), SA Coronial inquest, Coroner Wayne Chivell, Umuwa November 2004.Stojanovski (1999, p9) reflects that the most chronic sniffers “are kids who are often theabandoned children or the street kids… these kids carry with them a lot of personalhurt and have significant members of their families and role models (often theirparents) who live lives of chronic substance abuse”. Neglect, hunger, loneliness,sadness and experimentation are other reasons cited by Stojanovski for sniffing.1.3.3 SOCIOECONOMIC: LOW EMPLOYMENT, EDUCATION AND ECONOMIC STRUCTURESPetrol sniffing most frequently occurs in Australia among Aboriginal adolescents whoare from low-income, isolated communities, since petrol is relatively cheap, readilyavailable and there is limited access to other drugs (eg, heroin) that are favoured bysimilar groups in the wider community (Cairney et al, 2002).Section 1.2.3 notes that low education and employment are both a cause and impact inthe vicious circle of petrol sniffing, quantified through ABS data for the Rollout Regionin Section 3.1. There is less motivation for children to learn at school or study hard toget a job if there is little expectation of future reliance on employment for income.Andrews (2005b) describes “four economies” in many remote Aboriginal communities. The welfare economy: a range of Centrelink payments together with free or subsidised provision of goods and services eg, rent, electricity, water. The market economy: commercial markets for labour, products and services. The customary economy: wild resource harvesting (hunting and gathering). The grey economy: income earned from illicit activities eg petrol trafficking, drug or contraband alcohol sales, often at very high prices eg, $50 for a 750ml bottle of petrol (MWTP, 2005d), prostitution.The value of the customary economy to an Aboriginal Community in NSW has beenestimated at around 5% of total income (Gray et al, 2005). Employment in the marketeconomy also represents a relatively small proportion of total income (estimated asone-third of total income in the Mutitjulu area in Andrews, 2005b). In contrast, thesame source estimates that the majority of income (60-70%) is derived passively from: welfare payments (nearly half of passively derived income); trust royalties and gate monies5 (20%); and5 Royalties include rent and other disbursements from trust fund earnings such as the Ininti Trust. “Gatemonies” refer to entrance fees paid by visitors to the National Parks that comprise many tribal lands, forexample, the Uluru Kata Tjuta National Park (UKNP). Royalties, in particular, vary from year to year andrepresent compensation for foregone rights to land under lease agreements. They are not taxed aspersonal income and do not reduce recipients’ entitlements to Centrelink payments. However, theseresources are often not directed to community development activities but rather, diverted to individualpurposes. 9
  21. 21. Opal cost benefit analysis subsidised services and utilities (32%).These income shares do not include the unknown (overall) size of the grey economy.However, some members of the community earn significant monetary income from thisgrey-market activity. Others are reported to exchange petrol or other addictivesubstances for sex or other barter transactions.Many Aboriginal people agree that “if we are to survive… we have to get rid of thepassive welfare mentality that has taken over our people” (Pearson, 2000). “In my Grandfather’s day we were strong… we ate bush tucker and were not dependent on sit-down money, marijuana or grog”. Elsie Malbunka, 18 February 2005. “We need to stop relying on sit-down money, the young fellas need to work rather than humbugging the old people”…“Lack of money is not the problem, if anything there is too much of it”. Community elders, September 2004. “Sit-down money is killing our young people. When the welfare money come in it really killed the work. Now young ones don’t know work, they welfare trained. No more sit-down money. Cut it out. Level-im up, everyone gotta work.” (Smith, 2001).The resources of the passive welfare economy are susceptible to irrationalappropriation and expenditure, resulting in what Noel Pearson has called the humanright to “misery, mass incarceration and early death” (Pearson, 2001). Andrews(2005d) makes the important point that Aboriginal people naturally have every right toenjoy economic returns from their assets (royalties and gate monies) but the issue isone of informed choice about allocation of those returns and greater equity in theirdistribution.1.4 INTERVENTIONSOver the years, a number of interventions have been trialled in attempts to addresspetrol sniffing. “Research indicates that responses to petrol sniffing and other inhalant substance abuse lie in a coordinated and sustained effort by government departments and community agencies in partnership with affected communities… Notably, a small number of communities have eliminated petrol sniffing over the past two years through a concerted community approach to prevention.” NT Department of Health and Community Services (2002). “Now listen, I know some of you have heard about petrol sniffing, but where I come from every single family has a family member affected by petrol sniffing, and we now have a terrible problem on our hands. When our young people sniff petrol they develop all sorts of health problems, such as mental health problems, heart and lung problems and acquired brain injuries. Petrol sniffers sniff all night and do not rest and this affects the whole family. Anangu families are exhausted. These petrol sniffers are our own flesh and blood, yet we have lost them all to petrol... Of course we know that some petrol sniffers cannot be helped. They will live their lives in wheelchairs with acquired brain injuries. But for the new recruits…well we are hoping that with Opal there will be no new recruits to petrol sniffing.” Janet Inyika, NPY Women’s Council staff member, former Executive member and resident of Amata community SA, launching Opal fuel with10
  22. 22. Opal cost benefit analysis Health Minister Tony Abbott, Adelaide, February 2005. Translation by Linda Rive, NPY Women’s Council.D’Abbs and MacLean (2000:Table 2) suggest a structure for thinking of interventions toaddress petrol sniffing (reproduced below). A brief discussion of some interventions ispresented in the following sections. TABLE 1-2: LEVELS OF INTERVENTION AND ASSOCIATED STRATEGIES Level of intervention Strategies Primary intervention Focusing attention and resources on young people or primary prevention: actions to Recreational programs prevent the emergence of a School and training opportunities problem, and/or to prevent it Employment from spreading to new areas or groups (eg supply reduction, Information and education about petrol sniffing education) Substitution of petrol with Avgas/Comgas Use of unleaded petrol Locking up petrol supplies Adding deterrents to petrol Movement to outstations/homeland centres Secondary intervention Using Aboriginal culture and symbolism (also known as secondary Individual and family counselling and care prevention or early Counselling and community development: the HALT intervention): actions targeted model* towards a population either Petrol Link-up deemed to be at risk, or already in the early stages of exhibiting Community action a problem, designed to halt Initiation and other ceremonies further progress of the problem Community-based sanctions (eg, community meetings, individual and family Community wardens, night patrols and police aides counselling) Jail, treatment orders and other statutory sanctions Outstation programs Harm reduction and minimisation Diversionary activities such as sport or discos Tertiary intervention Town-based rehabilitation and respite or treatment: actions targeted Hospital treatment towards persons already misusing drugs, designed to halt further drug misuse or mitigate illness and disability (eg, hospitalisation) Source: d’Abbs and MacLean (2000), Table 2. * Note: HALT – Healthy Awareness Lifestyle Team.1.4.1 AWARENESS AND HARM MINIMISATION HEALTH STRATEGIESEducation aimed towards sniffers is best directed towards effects of sniffing that arelikely to be of concern to young people (eg, impaired coordination preventingparticipation in sport), with emphasis on harm minimisation (eg, preventingasphyxiation through warnings about not lying down with a petrol can on the face) andearly intervention before chronic habits are established. Educational activities are also 11
  23. 23. Opal cost benefit analysisusefully targeted at select groups within the community such as parents or professionalstaff to promote caring capacities, such as by discussing other communities’ successesand fostering linkages with them, eg, Petrol Link Up, who developed the Three Waysmodel combining (1) supply reduction; (2) outstation rehabilitation and respite, with(3) diversionary youth programs. Education of non-sniffing juveniles is sensitive, as insome cases it may precipitate experimental sniffing (Roper and Shaw, 1996:15).Educational materials have taken the form of workshops, films, videos, story-telling andpamphlets in appropriate languages or using Aboriginal culture or symbolism (eg, BrainStory, by Petrol Link Up). However, the research on educational responses to inhalantabuse indicates they are of limited value. The evidence for this position is summarisedin the following quote from d’Abbs and Maclean (2000:49, Section 8.5 “Information andeducation about petrol sniffing”): “Smith (1986, 5), on the basis of a review of petrol sniffing literature, advances two pessimistic conclusions about educational strategies: first, too little is known about the causes and nature of petrol sniffing to enable soundly based educational programs to be designed; and second, few of the programs that have been implemented have been subjected to rigorous evaluations, with a result that little is known about the factors making for success or failure. While the former may no longer be the case, the latter has certainly not changed. The Senate Select Committee on Volatile Substance Fumes (Commonwealth of Australia 1985, 217–18) was a little more hopeful, sounding both a warning and some positive guidelines. There was general agreement, the Senate Committee reported, that juvenile sniffers were well aware of the dangers of petrol sniffing, and that providing information on the dangers of sniffing was not only likely to be ineffective, but might prove counter-productive. This was especially the case, the Senate Committee suggested, with information in the form of scare tactics.”Later in the same section is the following information (d’Abbs and Maclean (2000:50). “Hayward and Kickett’s (1988) findings add weight to the Senate Committee’s conclusions. Hayward and Kickett interviewed 103 school children from seven Western Desert communities. They found that 72 per cent of petrol sniffers considered petrol sniffing to be harmful, and 77 per cent agreed that ‘petrol sniffing can kill you’ (1988, 27). Sandover et al (1997, 122) found that Aboriginal petrol sniffers interviewed in prison knew of the dangers of petrol sniffing but felt powerless to cease the practice. McFarland points out that young Aboriginal people’s lives are full of danger and risk and in this context petrol sniffing does not appear to be particularly hazardous (1999, 5).”Saturation activities (eg, juveniles visiting hospitals, care facilities of prisons where theimpacts of sniffing are evident), have had mixed success (d’Abbs and MacLean,2000:50). Programs that incorporate life and work skills as well as knowledge abouthow to get help in relation to substance abuse offer scope for further development.Funding for substance abuse case workers is another approach which CAYLUS hastrailed and found to be very effective.12
  24. 24. Opal cost benefit analysis1.4.2 YOUTH AND RECREATIONAL PROGRAMSYouth programs and/or the employment of a youth worker have been used in somecommunities to provide diversionary activities including for those exiting treatmentprograms and to foster community youth engagement – for example, sports andrecreation, literacy and numeracy, excursions, bush trips and camps, learningtraditional culture with elders (eg, hunting, bush medicine, stories), discos/dance,catering, clean-up days, music, film, photography, multi-media, community radiostations (useful in disseminating information in cultural settings were language is nottraditionally written; MWTP, 2005a), driver training, drink driving avoidance and otherhealth awareness training.The timing of activities is also important – after school, on weekends and duringholidays, and particularly during ‘crime time’ (6pm to midnight). Staff need tounderstand the issues, provide activities that are exciting and purposeful (eg breakingin horses), include sniffers without being preferential, and provide activities (and/orwomen workers) specifically for females. “In all the AP communities I have observed young people to be very ready to get involved in youth activities, even simple things like swimming and using band equipment. If there is no youth worker there is nothing for young people to do after school and nothing for those who have left school. These 12 to 25 year olds are growing up without the opportunities available to youth elsewhere. This limits their opportunities for social interaction, inter- generational mentoring and for the development of self-esteem, knowledge and skills.” Richard Farrell, NPY Women’s Council Youth Development worker, Affidavit to SA Coroner Wayne Chivell, in the matter of Ward, Ken, Ryan and Cooper (deceased), SA Coronial inquest, Umuwa November 2004.1.4.3 EMPLOYMENT, EDUCATION AND TRAINING SERVICESEducation strategies are required to enhance participation in primary and secondaryschooling. In some communities, when appropriate educational facilities have beenprovided on site, sniffers have begun attending (Mosey, 1997:22). Two effective pastprograms include the Detour Project in Alice Springs, run by Tangentyere Council, andan innovative NT Education Department program in Yirrkala (d’Abbs and MacLean,2000:48). More recently the Yarrenyty-Arltere Learning Centre based in LarapintaTown camp in Alice Springs has been integral in a whole community strategy that hasreduced prevalence of inhalant abuse in the community.As Coroner Wayne Chivell noted in his September 2002 findings in the matter of Ward,Ken, Ryan and Cooper (deceased) young people on the AP(Y) Lands aredisadvantaged in the area of education: “Education levels on the Anangu Pitjantjatjara Lands are appallingly low when compared with the rest of Australia. Mr Tregenza pointed out that there had been no employment training on the Anangu Pitjantjatjara Lands for the last 5 years, and that the Department of Technical and Further Education (TAFE) has only returned this year to resume its operations, although it has not been determined what courses they propose to run. He said: ‘In my view this, along with basically a failed primary education system, means that all of the people leaving school – and particularly the 13
  25. 25. Opal cost benefit analysis boys – they are, in my view, functionally illiterate as they leave school, which leaves the opportunity for them to gain work in the community fairly limited. And, as there is no tertiary education in the communities, their opportunities of training are limited.” Chivell, 2002, para 7.4.Job ready networks/skills training are also essential in complementing a roll-out ofOpal to comprehensively address sniffing problems. Burns (1996:247) concluded thatemployment and skills training programs, together with the introduction of Avgas, wascritical to success at Maningrida in eradicating sniffing. When 27 sniffers fromManingrida were interviewed in 1992 only 7% were employed; by 1994 this had risen to63% (chi squared=11.53, df=1); the difference in employment as a result of theeradication of sniffing, given employment opportunities, was thus 56%.A number of observers have pointed to lower incidence of sniffing in communitiesassociated with the cattle industry or where the youth can be occupied working withcamels or in the tourism sector. An example is the promotion of employmentopportunities for Aboriginal people across Central Australia by the (indigenous)Employment Coordinator at Ayers Rock Resort working with local communities andNgaanyatjarra Aboriginal College.1.4.4 OUTSTATIONSThere is divided opinion on whether outstation programs (sometimes called ‘homelandcentres’) should be used as detoxification/rehabilitation centres or if their focus shouldbe development and diversion for sniffers and young people at risk, or a combination ofboth. Some community decisions are simply that sniffers “be taken to a safe place todetoxify”. However, such actions should not simply be the unsupported removal ofsniffers to provide respite for themselves and their communities but, rather,appropriately resourced programs offering assessment, support and referral in theevent of complex physical or psychological rehabilitation needs. The absence ofsupport at an outstation resulted in the death of an Aboriginal boy who bled to deathafter smashing a window, due to isolation and lack of communications, leading to acoronial inquiry.The Mount Theo Petrol Sniffer Program has been a joint effort of senior Warlpiricommunity members from Yuendumu and extremely dedicated non-Aboriginal workers.Mount Theo has operated since 1994, with the support of the local school, TanamiNetwork and the local Community Government Council and working closely with thelocal Yuendumu Police and the Northern Territory Correctional Services Office in AliceSprings.Mount Theo has been heralded as a model of care and has succeeded in reducingsniffing and its impacts in Yuendumu through a two-pronged strategy of: prevention – a pro-active youth and recreation program in Yuendumu; and rehabilitation – the petrol sniffer outstation program at remote Mount Theo.Mount Theo provides a safe but basic, and by some standards harsh, environment outbush where chronic petrol sniffers and young sniffers are looked after by tribal eldersuntil they are ready to rejoin their community. Some are bonded by the courts to live atMount Theo and take part in the program. While living at the outstation, the youngpeople’s bodies can detoxify with a healthy diet, work and exercise, ‘ring-leaders’ areremoved from trouble-making and recruiting in town, and are instead involved in14
  26. 26. Opal cost benefit analysisgardening, bushwalking, outdoor and educational programs and traditional activitiessuch as making artefacts and hunting.The number of sniffers had permanently decreased from 67 young people to 20 in thefour years to 1998, most of the 70% decline occurring in the early years. Currently,Mount Theo reports there are no chronic sniffers in Yuendumu, and occasional smalloutbreaks in the community are dealt with swiftly and effectively.Removal to the outstation (50 kilometres away from the nearest main road andapproximately 130 kilometres fro Yuendumu, so the young people do not run away, butwith a telephone for safety) is considered an important aspect of the program toprevent a culture of petrol sniffing from becoming entrenched amongst the youngpeople of Yuendumu.Mr Stojanovski explained his view of the importance of the Outstation: “In my opinion, if we didn’t have an Outstation we would not have solved petrol sniffing in Yuendumu. The reason is that you need a deterrent, you need a consequence. Even if there were lots of different fun things to do in Yuendumu and lots of education and anyone could get a job if they really wanted to, it’s a hallucinogenic drug, it’s fun … so because of that, having that Outstation has been really essential in removing the peer group pressure on kids to sniff petrol … I think if we ran that Outstation and did not have those other things happening in Yuendumu it wouldn’t work, but I think that if we didn’t have that Outstation we would still have heaps of petrol sniffing.” From evidence of Stojanovski to SA Coroner Wayne Chivell, Umuwa May-June 2002, Chivell (2002), para 10.42.Mount Theo has worked cooperatively with local police and with courts to ensure bondand bail conditions for petrol sniffers include clauses like: “Not to sniff petrol, and toreside at Mount Theo or elsewhere at the direction of the Outstation Manager.”Sniffers are often relieved to go to Mount Theo instead of gaol, which they see as thealternative. The wording of the clause allows legal flexibility and discretion torehabilitate the sniffers and re-introduce them to Yuendumu to observe their behaviourand monitor relapses as appropriate. However, there are challenges with removalbecause it has strictly been only possible only once crimes are committed, as sniffingitself is not an offence in the NT and it would be better to intervene early and preventoffending. While police can encourage non-sniffers to go to Mount Theo, forcedremoval is a grey area of the law even with written parental direction. This is reportedas the biggest gap in the program by its coordinators, who would like to ‘nip petrolsniffing in the bud… to prevent the young person from developing a pattern of crimeand violence that is so often associated with petrol sniffing.” (Stojanovski, 1999, p19). “There was one young man who began sniffing in 1997, and who had previously not been involved in crime and violence. His parents wanted to send him to Mount Theo but the young man refused to go. Instead he got deeper and deeper into petrol sniffing. He began to hallucinate and see devils. He started walking around at night with a knife and an axe, sniffing petrol and threatening people. He recruited other young people to sniff petrol. Twelve months later he was in prison, serving time for numerous assaults, including stabbing, punching a nurse, escaping from custody, and throwing petrol on a police officer. If we had been able to take him to Mount Theo when he first began sniffing maybe he would never had started this trouble.” Stojanovski, 1999, p19. 15
  27. 27. Opal cost benefit analysis1.4.5 DETERRENCE (LEGAL SANCTIONS, POLICE PRESENCE)Domestic and international experience has proven the critical importance of law andorder as a foundation for sustained community development (MWTP, 2005a). Ingeneral, broad-based and integrated law and order strategies need to be developed by,for and in each community. “Coming from a deeply sad place in their heart and their spirit for their sons and daughters, Women’s Council women are asking the police to live in the community so that they can help us. The police in the Northern Territory and Western Australia have responded really well, they have taken on our thinking about the three states, they built that place, that police station at Kintore, but in South Australia they are not listening.” Nura Ward, NPY Women’s Council Executive member, Affidavit to SA Coroner Wayne Chivell, in the matter of Ward, Ken, Ryan and Cooper (deceased), SA Coronial inquest, Umuwa November 2004. Translation by Suzanne Bryce, NPY Women’s Council.The impact on sniffing of legislative change among the Ngaanyatjarra people in WA isevident in relation to the November 1996 removal by the WA Government of custodialsentences below six months, therefore altering the available penalties for sniffing petrolfrom a fine or a prison term, to a fine only. This change led to a perceived resurgencein sniffing and sniffing related problems in the Ngaanyatjarra communities (PeterRapkins, Ngaanyatjarra Council, personal communication, 1997, cited in Stojanovski,1999, p20).A police presence is considered an important element of any law and order reform,together with more active policing in communities. “I think it was difficult for police to enforce things that, I guess – that we would have liked enforced. And I think also for the community constables in Fregon, they were compromised as well with their policing, especially given that their own sons were sniffing … I would say that it’s very important, police – formal police support in terms of law and order within the communities and I think without that stability of law and order, the violence and things that happen during the day, it’s not just the petrol sniffing, but I guess the violence during the day and what children are growing up with and the trauma that they go through, seeing things on a day to day basis, I think without sort of dealing with those issues, it’s very difficult for services to operate.” John Harvey, then NPY Women’s Council Youth Development worker, in evidence to SA Coroner Wayne Chivell in the matter of Hunt, Ken and Thompson (deceased), May-June 2002, Umuwa. Moran (2003) reports that a Queensland Police Service internal survey of selected officers throughout that state found that 73% of police respondents identified VSM as a problem in their area. Workshops conducted in ten locations provided an overview of the who, where, what and why of VSM usage in each area. Although this study was outside the proposed Rollout Region, it is relevant in terms of potential policy solutions – Queensland Police Service is using a Problem Oriented and Partnership Policing approach to work towards identifying local strategies to address the problem in each area.16
  28. 28. Opal cost benefit analysis In Mutitjulu, increased policing was identified by community members and Working Together project partners as critical for securing a safer and more harmonious environment. The Australian government is funding the capital costs of a police post (around $2 million), while the NT government will fund recurrent costs, recruit two Aboriginal Community Police Officers, provide housing for the ACPOs, and maintain adequate policing support from Yulara (MWTP, 2005a). An important issue that has been raised in this context is the possibility for increased incarceration that may (or may not6) be associated with increased policing, as well as the need for complementary community justice programs and decisions about appropriate punishment. Appropriate facilities and associated services (eg suicide prevention) are also paramount. Police presence can have a significant and badly needed deterrent effect. “Mr Stojanovski said that a constant police presence at Yuendumu (a sergeant, two constables and an Aboriginal community police officer) is ‘really important’ for dealing with sniffing, in that the police will stand behind him during negotiations to take a child to Mount Theo as a deterrent from acting. He said that if the court makes attendance at Mount Theo a condition of a bond or a condition of bail, this gives them even further support in convincing the child to come.” SA Coroner, Wayne Chivell, findings in the matter of Hunt, Ken and Thompson (deceased), September 2002, para 11.8.Definition of property rights is also an important aspect of ensuring responsibility forcareless of malicious damage, for example: rent payments and tenancy agreements;“user pays” for utilities (payment options could potentially include Centrelink deductionsor Smart Cards); conditionality from funding bodies on repairs to criminal damage sothat damaged assets are not repaired or replaced by communities (if at all), but byindividual community members; retrieving and fining illegal dumping of vehicles ratherthan leaving them to degrade.Legal sanctions and bylaws: Stojanovski (1999) emphasises the desire of theYuendumu Community Government Council (reflecting other communities calls also) topass a by-law to make petrol sniffing illegal in the community, so that early interventionand removal of sniffers can have the official back-up of police. In response to critics ofcriminal sanctions, he notes that there are important differences between petrol sniffingand other drugs (where there is a climate of decriminalisation), namely that: “Most crime associated with petrol sniffing occurs as a result of its psychological effects, and there is little crime involved in obtaining and distributing petrol, as it is a cheap legal substance. Thus there is little to suggest that making petrol sniffing illegal would result in the creation of a black market of petrol dealers, or in a change in the purity of petrol used. While concerns about the black market and drug purity are valid in considering the criminalisation of other drugs such as heroin, they have little relevance to the efforts of a small Aboriginal community trying to stop its children from sniffing petrol.”6 The deterrent effect of a permanent police presence may in fact over time result in a lower rate ofincarceration. 17
  29. 29. Opal cost benefit analysisThat said, in practice by-laws have had mixed results. In contrast to the WA examplecited above, in the APY Lands in SA, where possession or supply for the purposes ofsniffing has been illegal since 1981, the benefits are not established. This is in largepart because enforcement options are limited to the imposition of fines or a CommunityService Order, or a treatment or rehabilitation order. The latter is not in fact an option,due to the lack of any such alternatives thus far being available.NT Volatile Substance Abuse Prevention ActThe NT Volatile Substance Abuse (VSA) Prevention Act, due to come into effect inearly 2006, has the potential to make a significant contribution to addressing petrolsniffing, as an adjunctive policy to the rollout of Opal in the Central Deserts.Accompanied by an increase in resources to address sniffing, the Act will: give police and ‘authorised persons’ the powers to search and seize volatile substances; help to keep petrol sniffers safe by giving police or other authorised persons the power to remove petrol and take sniffers to a safe place; assist with the longer-term issue of treatment by giving Magistrates the power to issue treatment orders to sniffers; allow communities to control the sale, supply and use of petrol by developing community management plans; and strengthen provisions as they relate to illegal supply.SA Regulated Substance Amendment BillIn mid-2004, the SA Government introduced an amendment to the Pitjantjatjara LandRights Act to apply to the APY Lands. The Regulated Substance Amendment Bill hasyet to be passed. If and when it becomes law, there will be increased police powers ofsearch and seizure, and increased penalties for the supply of ‘regulated substances’,which now includes petrol. At present, there is only a small fine for those convicted of‘possession for the purpose of inhalation’. It is rarely paid and often converted to aCommunity Service Order, which is often not performed. The other available penaltyfor possession, an order for treatment or rehabilitation (AP Land Rights Act Regulation43(10)) has to date been of little or no use, in the absence of any treatment orrehabilitation services.As SA Coroner Wayne Chivell noted in his findings in the matter of Hunt, Ken andThompson (deceased), September 2002: “Senior Sergeant Wilson (OIC Marla SA Police) said that 20 to 30 bonds are imposed on the Anangu Pitjantjatjara Lands in each court circuit. The circuits occur every two months. The bonds carry a condition to be of good behaviour, but the Magistrate does not make treatment orders or other orders directed at rehabilitation because there are no such facilities available. “This is particularly significant since the maximum penalty for possessing petrol for the purpose of inhalation is only a $100 fine, and the usual penalty imposed in the Magistrates Court is that the complaint is dismissed without conviction, or the defendant is convicted without penalty. I am sure18
  30. 30. Opal cost benefit analysis that more creative and positive opportunities for rehabilitation would be used if they were available.” (Paras 10.51 and 10.52.)1.4.6 COMMUNITY ACTION PROGRAMSThe 1985 Commonwealth Senate Select Committee on Volatile Substance Fumes, thefirst comprehensive enquiry into VSM in Australia, formed the guiding principles ofpolicy thereafter, recommending that “all actions in response to petrol sniffing shouldoriginate from and be controlled by the Aboriginal people in each community affected”.However, the admirable commitment to self-determination unfortunately legitimised astance where perhaps governments did too little, too sporadically, with little evaluationor continuity in responses (d’Abbs, 2005). There was little sharing of information andno dataset for monitoring prevalence or deaths. This has changed with the coronialinquests beginning in 1998, although there is still a long way to go in achieving the rightbalance between sustained ‘external’ support and the integrity of self-deterministicfamily and community-based networks.Subsidiarity, capacity building and peer support are essential elements tosuccessful implementation of any initiative targeted at reducing sniffing. For example,the Mount Theo project has an active Youth Committee (many of whom are formerclients) called Jaru Pirrjirdi, which means “strong voices” in the Warlpiri language. Itmeets weekly to discuss such issues as new members, purchasing furniture for theyouth room, night school program and how to utilise funds generated from discos andother fundraising activities. These meetings recognise and understand youth cultureand can help tailor some of the activities to address particular needs and giveownership to the youth. The Jaru Pirrjirdi Youth Committee assists young Warlpiripeople in addressing issues underlying substance misuse and trying to create positivefutures for both the individuals and their communities.1.4.7 SUPPLY REDUCTION STRATEGIESSupply reduction strategies have included the following. Locking up petrol supplies, which has been described as having ‘been tried in just about every place where sniffing became a problem – with just about universal lack of success” (Commonwealth of Australia, 1985:2003); Adding deterrents to petrol, notably ethyl mercaptan or ‘skunk juice’, which has an offensive smell and induces nausea, vomiting and diarrhoea. The main limitation of this is that the additive can be removed through evaporation (leaving it out in the open) and the strategy has now been abandoned. Substitution of leaded petrol with unleaded petrol (see Section 2.1) and substitution of petrol with Avgas or Comgas (see Section 2.2). These policies have engendered more extensive success. Opal substitution is a supply reduction strategy, although to be effective, supply reduction strategies are best accompanied with demand reduction strategies.Supply reduction policies, when carefully targeted, can be effective in limiting access tosniffable fuel and thus reducing prevalence and costs, as described in the nextsections. 19
  31. 31. Opal cost benefit analysis2. FUEL SUBSTITUTION POLICIES2.1 UNLEADED PETROL (ULP)Both leaded and unleaded petrol (ULP) contain a mixture of aliphatic and aromatichydrocarbons, naphthalenes, paraffins and alkenes. In addition, leaded petrol containstetraethyl lead, an organic hydrocarbon with a lead component which has physical,pharmacological and toxicological characteristics that are more typical of hydrocarbonsthan of inorganic lead. Tetraethyl lead is present in leaded petrol at concentrations of0.15-0.4 grams per litre in Australia, while ULP must not contain more than 0.013grams per litre. The neurotoxicity associated with petrol sniffing is caused by the leadadditives and hydrocarbon components, both independently and in combination, withthe acute impacts attributable to the actions of the volatile hydrocarbons. The half-lifeof hydrocarbons in the body is less than 24 hours, whereas lead components canremain in the body for many years.7 An approximate estimate of the aromatic contentis 30% for leaded petrol and 70% for ULP (Cairney et al, 2002).Leaded petrol has been shown to result in more severe encephalopathy than unleadedpetrol, greater psychotic symptoms and more frequent seizures, although other effectsare similar. In regions where leaded petrol has been phased out completely, therehave been no hospital admissions with lead encephalopathy and medical evacuationsalso appear lower overall (Cairney et al, 2005). However, petrol sniffing and its manyother costs still occurs in communities when only ULP is available, although leadedpetrol is reportedly preferred for the effects of inhalation (Fortenberry, 1985; Galzignaet al, 1973). Thus while switching from leaded to ULP may cause fewer short termhealth impacts, in the medium term there is likely to be limited difference in either theprevalence or costs of petrol sniffing.2.2 THE COMGAS SCHEME AND AVGAS2.2.1 COMGAS SCHEMEThe Comgas Scheme is a Federal Government funded and operated initiative tosubsidise “non-sniffable fuel” in remote Aboriginal communities in the NorthernTerritory, South Australia and Western Australia. The Scheme’s main objective is toreduce the supply of sniffable petrol and therefore, along with other measures, assist tocombat the harmful impacts of petrol sniffing. A subsidy is required as Opal and thepreviously used aviation gas (Avgas) are both significantly more expensive than regularpetrol. The current Opal subsidy is approximately 33 cents per litre. This subsidyequalises the price of regular and Opal/Avgas and underpins the commercialacceptance of these substitute fuels.The Comgas Scheme has operated in a limited way since 1998 and was available to36 small communities by the end of 2004. The Federal Government announced an7 Tetraethyl lead in leaded petrol is absorbed easily by the body and, because it has a half-life in braintissue of more than 500 days and in bone of more than 10 years, it can continue to be re-released into thebloodstream even years after the cessation of petrol sniffing. The specific neurological detrimental effectsof lead have, however, so far not been separated from those of the toxic hydrocarbons (Cairney et al,2005).20

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