DrugInfo seminar: Opioids and related harms in Aboriginal Australia


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Presentation by Peter Waples-Crowe to DrugInfo seminar: Heroin and other opioids, on 27 September 2011 in Melbourne Australia.

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  • Members often referred to as Aboriginal co-operatives (co-ops) and offer more than simply medical services.  Their programs also include services in aged care and disability, housing drug and alcohol management, legal and justice support and the prevention of family violence. They also have cultural and social and emotional wellbeing programs. These Aboriginal Health Organisations are unique in Australia. They are incorporated, controlled by the Community and shape service delivery to meet the needs of the local Community they serve. Each Member Organisation is community controlled which means that all co-ops have annually elected Aboriginal boards, a majority of Aboriginal staff and management including Aboriginal Health Workers who are an integral part to service delivery and carry out a number of roles.  Each organisation is also important as it is a space where people come together to maintain family and community connections
  • Attributed to marginalisation, Type of drug, and the lack of access to Harm reduction services such as NSPs We need to be for ever vigilant in our communities
  • Rural health Support, Education and Training. The project seeks to utilise the strengths within the Aboriginal Community-Controlled Health Organisations/Services and in NSPs, to improve health outcomes for Indigenous IDUs in regional and rural Victoria. Its capacity building and seeks to bring the mainstream and the ACCHOs together to improve outcomes for Indigenous IDUs. We are conducting phone audits starting this week about harm reduction. We want to talk to the ACCHO boards and raise the issue of Harm reduction. We want to inspire debate on this issue and we want to come up with outcomes that improve services for this marginalised group. In the Second project we want to conduct interviews with Indigenous IDUs across the state to ask them about safer using, safer sex and service access for clean Injecting equipment. We have an ethics application in at DHS but don’t expect to be able to start this project until after May. This project will recruit through the community controlled sector and the mainstream sector, and the Indigenous AOD workers. It will be governed by an Indigenous Steering group.
  • DrugInfo seminar: Opioids and related harms in Aboriginal Australia

    1. 1. Opioids and related harms in Aboriginal Australia Peter Waples-Crowe Public Health and Research Unit VACCHO
    2. 2. The Victorian ACCH Sector
    3. 3. Ngwala Willumbong <ul><li>Key service provider offering specialist alcohol and drug rehabilitation and outreach support services to Aboriginal communities in Victoria since 1975. </li></ul><ul><li>Pitjantjatjara for &quot;Dry Place&quot;. </li></ul><ul><li>Approximately 100 Aboriginal AOD workers across Victoria </li></ul>
    4. 4. Australian Needle Syringe Program Survey <ul><li>1995- 2008 ~9% of all clients in survey have identified as Aboriginal and or TSI </li></ul><ul><li>11% of the 2008 survey N= 1632 </li></ul><ul><li>Indigenous background increased 5% in 1995 to 11% in 2010 </li></ul><ul><li>More women & higher rates of recent incarceration </li></ul><ul><li>We know from this survey Aboriginal people featured in the established risk factors i.e. longer drug injecting history, daily or more frequent injection, injecting in public, and injecting cocaine and methadone which were also all significant predictors of HCV antibody positive (NCHECR) </li></ul>
    5. 5. Service figures <ul><li>In 2008 the NSW Opioid Treatment Program had 17,287 clients, of whom 1,657 (9.6%) were Aboriginal. </li></ul><ul><li>In 2009, 18% ( of 417) Aboriginal in the NSW Pharmacy NSP survey </li></ul><ul><li>Heroin use in Australia peaked in 1999 and dramatically dropped by 2001, while injecting drug use has continued and use seems to have shifted to other drugs such as amphetamines (ANCD report) </li></ul>
    6. 6. Incarceration and Aboriginal and Torres Strait Islander Peoples <ul><li>31% of women in Australian prisons </li></ul><ul><li>343% increase in incarceration rates since 1991 </li></ul><ul><li>Longer substance use history + greater mental health outcomes </li></ul><ul><li>24% of men in Australian prisons </li></ul><ul><li>More than half of young people in JJs </li></ul><ul><li>Bridges and Barriers Report NIDAC 2009 </li></ul>
    7. 8. Hepatitis C Virus Projections Working Group - Estimates & Projections of the HCV Epidemic in Australia 2006 <ul><li>Estimated between 13,000~22,000 Aboriginal &/or TSI people have been exposed to HCV </li></ul><ul><li>~16,000 living with chronic HCV </li></ul><ul><li>Equates to 8% of total Australian HCV population </li></ul><ul><li>3-4% of Australian Indigenous population cf. with 1% of Australian population </li></ul><ul><li>Limitations: </li></ul><ul><ul><li>Estimates are based on number of Aboriginal & TSI people participating in Annual NSP survey – accuracy? </li></ul></ul><ul><ul><li>Does not take into consideration over representation of Aboriginal people in prison </li></ul></ul>
    8. 9. HCV Diagnosis Trends Australia 2000-2009
    9. 10. Incarceration – Aboriginal peoples overrepresentation <ul><li>60% of all offenders report drug use at least once in Australian prisons </li></ul><ul><li>33% continue to inject in prisons </li></ul><ul><li>Level of HCV 17X greater than in Australian population </li></ul><ul><li>HIV however the rate is low in Australian prisons, </li></ul><ul><li>HCV is endemic and risks for Aboriginal inmates is understated </li></ul>
    10. 11. HIV diagnoses, 1992 – 2009, by Aboriginal and Torres Strait Islander status Non-Indigenous Aboriginal and Torres Strait Islander
    11. 12. The Canadian Experience <ul><li>Comparing Canada (970000, 3% of pop) </li></ul><ul><li>Australia (490000, 2.4% Pop) </li></ul><ul><li>In Canada 1993 3% of HIV Notifications in Indigenous people (3600-5100) </li></ul><ul><li>In Australia 6% of HIV notifications (300) were Indigenous </li></ul><ul><li>In Canada 2005 21% of the HIV notifications were Indigenous (60%Women 59% IDU) </li></ul>
    12. 13. <ul><li>Australian National Council on Drugs </li></ul><ul><li>Authors </li></ul><ul><li>Meredith Kratzmann </li></ul><ul><li>Elke Mitchell </li></ul><ul><li>Julie Ware </li></ul><ul><li>Linda Banach </li></ul><ul><li>James Ward </li></ul><ul><li>John Ryan </li></ul>NEW REPORT 2011
    13. 14. Background <ul><li>ANCD commissioned report </li></ul><ul><li>Gain an understanding of dimensions and characteristics of IDU among Indigenous people </li></ul><ul><li>NACCHO and ANEX managed project </li></ul><ul><li>Sought to find solutions in a harm reduction framework to make services accessible and available to Aboriginal PWID </li></ul>
    14. 15. Results – four key areas <ul><li>Gaps in knowledge- significant gaps in knowledge understanding of issues for Aboriginal PWID, research, questions </li></ul><ul><li>Improvements in access and quality of health services- workforce, access and Aboriginal input into service delivery </li></ul><ul><li>Improving service models – holistic and referral pathways </li></ul><ul><li>Key populations within Aboriginal community- young people transitioning, geographical, MSM, sex workers and homeless </li></ul>
    15. 16. Recent Projects in Victoria ( yiaga ba wadamba) <ul><li>Partnerships for Better Outcomes for Indigenous Injecting Drug Users (DHS-RHSET grant) </li></ul><ul><li>Action Research - Addressing HIV risks related to injecting drug use in Victorian Indigenous Communities </li></ul>
    16. 17. Results 2009/10 <ul><li>69 APWID, 45 M, 24 F </li></ul><ul><li>Average Age 34 </li></ul><ul><li>51% Regional 49% Metro </li></ul><ul><li>Av length of IDU 13.8 years </li></ul><ul><li>41 where asked about their primary drug of choice and 20 reported heroin, 17 reported amphetamines, 3 reported other opioids (morphine etc.) and 1 reported Cocaine. </li></ul>
    17. 18. Themes <ul><li>SHAME </li></ul><ul><li>Lack of access to syringes: times, lack of transport, (More in regional settings) </li></ul><ul><li>A lot of misinformation about Blood Borne Viruses </li></ul><ul><li>Sharing of body fluids and blood in relationships </li></ul><ul><li>Everybody knew the not to share message but still did due to ‘Hanging out” etc </li></ul>
    18. 20. Recommendations – 3.Service responses <ul><li>Increase workforce capacity in harm reduction </li></ul><ul><li>Support ACCHS in all aspects of NSP set up accreditation, policy development , education and training </li></ul><ul><li>Mainstream services cultural sensitivity </li></ul>
    19. 21. Were to from here? <ul><li>We need the voice of Aboriginal PWID </li></ul><ul><li>Have recently met with Australian Injecting & Illicit Drug Users League (AVIL) </li></ul><ul><li>NACCHO and AVIL are singing an MOU </li></ul>
    20. 22. Acknowledgements <ul><li>James Ward, The Kirby Institute </li></ul><ul><li>[email_address] </li></ul><ul><li>VACCHO </li></ul><ul><li>03 94193350 </li></ul>