Responding to the Urgent Covid-19

Policy And Funding Needs of the Alcohol

and other Drugs Sector

Supplementary 2020-21 Pre-Budget Submission

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ContentsAbout this submission 2

Who we are 2

Our Vision 2

Introduction 3

The impact of COVID-19 on the AOD sector 3

Recommendations 3

Support ongoing telehealth and digital access options 4

Increase access and affordability of opioid pharmacotherapies 5

Increase investment in regional and rural Australia for alcohol and other drug services 5

Improve access and collection of data for evidence-based decision making 7

Establish a national process, similar to that developed for investment in Australia’s mental health needs, for the alcohol and other drugs sector 7

Invest in workforce capacity and capability as this is key to service improvement 8

Support the continued coordination of the AOD sector 9

Conclusion 9

 

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About This Submission InDecember2019,acoalitionoforganisationsrepresentingacross-sectionofthealcoholandotherdrugs(AOD)treatmentfieldslodgedapre-budgetsubmissionwithTreasuryentitledReforming Australia’s alcohol and other drugs treatment sector. A copy of this submission has beenattachedasanappendix.

InlightoftheCOVID-19pandemic,andthesignificantimpactthatithashadonthedeliveryofalcohol and other drug treatment services across the country, this submission will recommend additionalpolicyandfundingrecommendationstofurthersupportthesectornowandintothefuture.

Who we areWeareacollaborationoforganisationsfromacross-sectionofthealcoholandotherdrugstreatmentfields.

We include:

Alcohol and other drug service providers

Consumerandcarerrepresentatives

Professionalsocietiesandresearchcentres

StateandterritoryAlcoholandOtherDrugsPeaksNetworks(representinghundredsoflocal and state-based AOD treatment service providers)

Wehavediverserolesandexperiencesinthesector,butareunitedinourvisionforaflexible,effectiveandefficientsystemtorespondtoalcoholandotherdrugharms.

Our VisionAn Australia where every person requiring alcohol and other drugs treatment can access timely,highqualityservicesattherightlocationandwhichsuitstheirneeds.

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IntroductionThe impact of COVID-19 on the AOD Sector TheCOVID-19pandemichashadasignificantimpactonthedeliveryofAODtreatmentservicesacrossAustralia.Ithasnotonlyaffectedclientsaccessingtreatment,butalsotheworkforcewhodeliverthesevitalservices.

Governments, at both a federal and state and territory level, have responded to the pandemic byincreasingflexibilityinthewayinwhichservicesaredelivered.Webelievethatmanyofthese,ifpermanentlyintroduced,expandedorimprovedupon,couldsignificantlyenhanceresponsestopeopleexperiencingissueswiththeiralcoholandotherdruguseinAustralia,bothnowandintothefuture.

From the outset, we recognise that a well-supported workforce is the key to service improvement.Further,itisalsoimportanttoacknowledgethatperson-centredcareiscritical,becausewhatworksforoneclientmaynotworkforanother,andthismeansthatflexibilityincare,andclinicalexpertise,shouldbeessential.

Forthesereasons,thissubmissionhasbeeninformedbytheviewsandexperiencesoforganisationsspanningacrosstheAODsector.Inparticular,thissubmissionbuildsfromouroriginal submission, Reforming Australia’s Alcohol and Other Drugs Treatment Sector, and providesadditionalrecommendationsinresponsetoCOVID-19.

We’re calling on federal and state and territory governments, to build on reforms introduced duringthepandemicthathavethepotentialtobettersupportpeopleexperiencingissueswithsubstanceuse.Fundamentaltothisisthedevelopmentofanationalresponsetothechanginglevelsofalcoholandotherdruguseresultingfromthepandemicandonethatincludesinvestmentinruralandregionalservices,workforcetraining,andmoreeffectivedatagathering.

RecommendationsFurther to our submission in December, and in light of the COVID-19 pandemic, we have collaborativelydevelopedfurtherrecommendationswhichcomplementourinitialcallforimprovedcoordinationacrossalllevelsofgovernmenttoenhancetheintegrationanddeliveryofalcoholandotherdrugtreatmentservices.Theseare:

1) Support ongoing telehealth and digital access options.

2) Increase access and affordability of opioid pharmacotherapies.

3) Increase investment in regional and rural Australia for alcohol and other drug services.

4) Improve access and collection of data for evidence-based decision making.

5) Establish a national process, similar to that developed for investment in Australia’s mental health needs, for the alcohol and other drugs sector.

6) Invest in workforce capacity and capability as this is key to service improvement.

Thissubmissionwillexpanduponeachoftheseareas. 

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1.SupportongoingtelehealthanddigitalaccessoptionsDuring the pandemic, many treatment services have moved to telehealth and digital accessoptionstoprotecthealthserviceusersandworkers.Thissubmissionrecognisesthatenhancingvideoandtelephone-deliveredspecialistcareanddigitalaccessoptionsforclientsandstaffwillrequireinfrastructure,trainingandguidance,aswellasresearchfordevelopingmodelsofbestpractice.WeacknowledgethefundingcommittedinAprilbytheAustralianGovernmenttosupportAOD online and phone support services1.InvestingintelehealthanddigitalaccessoptionsisimportantnotonlyduringtheCOVID-19pandemicbutalsointhefuture.Aswemaketheserecommendations,wedosowithoursupportforthesemodelsofdelivery,where appropriate, underpinned by the following principles: 1) Deliveryofcareisappropriate,patient-centredandflexible. 2) Cliniciansaresupportedbytelehealthanddigitalguidelinesandtraining. 3) Clientsandclinicianshaveaccesstosuitabletechnology. 4) Digitalaccessoptionscomplement,ratherthanreplace,traditionalface-to-face

services where appropriate 5) Patientoutcomes,includingtheviewsofconsumers,areevaluatedtodrivequality

improvement. 6) AfocusonthosedisproportionatelyrequiringAODservices,suchaspeoplelivingin

regional,ruralandremoteAustralia.Whereappropriatetodoso,accessingtelehealthanddigitalaccessoptionscanexpandaclient’schoiceandpotentiallyimprovetheirengagementandattendancewithaservice.Telehealth,digitalaccessoptionsandtele-mentoringcan: provide an opportunity for clients in regional and rural Australia to access regular high-

quality care that may not be available in their immediate area; helpovercomebarriersofstigmabyprovidingtreatmentoptionsthatarelesspublic; expandsupportforclientsthroughpeerworkers;and supporthealthcareworkersbyprovidingmentoringandsupervision.However,telehealthanddigitalaccesstoservicesisnotappropriateforeveryone.Evenforthosewhopreferit,therearestillanumberofidentifiedbarriersbeforeitsfullbenefitcanbeachieved.Theseinclude,butarenotlimitedto,alackofaccessto: a safe site for clients to receive services; technology,includinginsufficientaccesstodataortheinternet; equipment,technologysupport,andsecure,easy-to-usetelehealthsoftwarefor

service providers; and trainingforstaffwithinserviceproviders.As such, in keeping with the Urgent Policy and Funding Needs in the Alcohol and Other Drug Sector in Response to COVID-192,thissubmissionidentifiesthefollowingpriorities: funding for service delivery; funding for new models of care; workforce development to support high quality delivery; fundingforhardware,softwareandtechnologicalsupport;and thedevelopmentofaclinicalgovernanceguide.This pre-budget submission also acknowledges that funders also need to allow services to utilisetelehealthanddigitalaccessoptionsthroughtheirfundingandserviceagreements.

1 Mediarelease:Additional$6milliontosupportdrugandalcoholservicesduringCOVID-19(24April2020).2

Policy submission: Urgent Policy and Funding Needs in the Alcohol and Other Drug Sector in Response to COVID-19

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2.Increaseaccessandaffordabilityofopioidpharmacotherapies

Duringthepandemic,Australia’sAODsectorhasseenanincreasedflexibilityintheuseofopioidpharmacotherapy,includingareductioninthebarriersfortakeawaydoses.Whilenot appropriate in all instances, this has increased access and the desirability of opioid pharmacotherapyforclients.Asidentifiedintherecentpolicysubmission3:Opioid pharmacotherapy is the first line treatment for people who are dependent on opioids, like heroin. Ample evidence confirms that increasing access to treatment results in a reduction in dependence, poor general health and unemployment. It also reduces the spread of blood and body fluid borne viruses, such as hepatitis and coronavirus.Workinginconjunctionwithstateandterritorygovernments,thereisaneedto: Formalisepracticeguidanceonopioidpharmacotherapyprescribingbasedoninterim

guidancealreadyendorsedbykeysectorexperts4; Establishaprocess,thatincludesconsumers,tolookathowtoexpandflexibilityinthe

system that leads to the permanent establishment of interim changes; and Removedispensingfeesthroughsubsidiestoprimarycaredispensers.Wealsoacknowledgethatinnovativemodelsofcareindeliveringopioidpharmacotherapieshavebeendevelopedandrolledoutduringthepandemic.ThisincludestheStVincent’sHospital Melbourne injectable buprenorphine clinic set up as quick response to individuals in urgentneedduringlockdownandfundeduntilOctober2020byStVincent’sHealthAustralia.InjectablebuprenorphinewasonlymadeavailableinAustraliainSeptember2019.Thisclinicenablespatientstoreceivetheirdoseofbuprenorphineweeklyormonthly,removingthenecessityfordailypresentationstoapharmacyfortheirdose,therebyreducingtheriskofacquiringortransmittingCOVID-19.Theclinichasbeenfoundtostabilisemanypatientsandkeepthem,andthecommunity,saferfromCOVID-19.Itisalsoenvisagedthatlongertermitwillalsoenablethemtoengagebetterineducationoremployment.

3.IncreaseinvestmentinregionalandruralAustraliaforalcohol and other drug servicesIthasbeenestimatedthatbeforetheCOVID-19pandemic,upto500,000AustralianswereunabletoaccessAODtreatmentservices.Thiswasinpartduetoalackofservicesandthelengthofwaitingtimes.Wealsoknowthesituationisworstinregionalandruralcommunities.AccordingtotheAustralianInstituteofHealthandWelfare(AIHW)data5 it is reported that peoplelivinginregionalandremoteareasweremorelikelythanpeoplelivinginmajorcitiestohaveconsumedalcoholatquantitiesthatplacedthematriskofharmfromanalcohol-relateddiseaseorinjury.Further,itwasreportedthattherateofdrug-induceddeathswashigherinregionalandremoteareasthaninmajorcitiesbetween2012and2016.

3 Policy submission: Urgent Policy and Funding Needs in the Alcohol and Other Drug Sector in Response to COVID-19

4 https://www.racp.edu.au/docs/default-source/default-document-library/covid-19/interim-guidance-delivery-of-medication-assisted-treatment-of-opiod-dependence-covid-19.pdf?sfvrsn=e36eeb1a_4

5 AustralianInstituteofHealthandWelfare2019.AlcoholandotherdruguseinregionalandremoteAustralia:consumption,harmsandaccesstotreatment,2016–17.Cat.no.HSE212.Canberra:AIHW..

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According to the AIHW, agencies in regional and remote areas also had a higher rate of clients whosoughttreatment,comparedwithagenciesinmajorcities(in2016-17).Itissimilarlynoteworthy that clients who sought treatment in regional and remote areas were more likely thanclientsinmajorcitiestotravelonehourorlongertoaccesstreatmentservices.

In light of these and other factors, we believe that there needs to be a stronger investment inregionalandruraltreatmentservices.Thisshouldbeginbyidentifyingareasofneedandinvestingininfrastructureandtheworkforcetosupporttheaccesstotreatmentforpeoplelivinginthesecommunities.

According to the AIHW report, Alcohol and Other Drug Treatment Services in Australia 2018-19: Key Findings6,59%ofalltreatmentagencieswerelocatedinmajorcities,and24%wereininnerregionalareas.Therewere3%inremoteand2%inveryremoteareas.TherecentlypublishedNCETAreportfoundonlyone-thirdoftheworkforcewasbasedinrurallocations7.

Thissubmissionalsoacknowledgestheimportantrelationshipthattelehealthand/ortele-mentoring can contribute to the delivery of services to regional, rural and remote communities.Oneexampleisprovidedbelow.

6 AustralianInstituteofHealthandWelfare(June,2020).AlcoholandotherdrugtreatmentservicesinAustralia2018–19:keyfindings.

7 Skinner,N.,McEntee,A.&Roche,A.(2020).Australia’sAlcoholandOtherDrugWorkforce:NationalSurveyResults2019-2020.Adelaide,SouthAustralia:NationalCentreforEducationandTrainingonAddiction(NCETA),FlindersUniversity

Example of Tele-mentoringTele-mentoring refers to the provision of education and professional support for health practitioners using video-conferencing technology.

Victorian Pharmacotherapy Area Based Networks (PABNs) have been trialling the ECHO ModelTM since 2018 for supporting methadone and buprenorphine prescribing to rural and regional areas, where there exists a dearth of addiction specialists. In this model, multidisciplinary support is provided to practitioners (including medical, nursing, pharmacy and allied health) to under-served areas of Victoria. The project commenced in June 2018 as a partnership between Primary Care Connect in Shepparton and St Vincent’s Hospital Melbourne and is funded under the Victorian Government’s PABN program, primarily via the Hume Area PABN, and delivered by Primary Care Connect. Data suggests that approximately 60% of attendees, who dial-in weekly, are from rural/regional Victoria. To date, more than 370 health professionals have registered for the Victorian Opioid Management ECHO. The most frequently represented professional groups attending are GPs (124), nurses (55) and nurse practitioners (22). Since the pandemic, attendance to this online support has grown exponentially as community health providers have sought advice, assistance and peer support to address the challenges posed by the pandemic for people with alcohol and other drug problems.

4.Improveaccessandcollectionofdataforevidence-based decision making

Within the AOD sector, there are many sources of data which are regularly collected and reportedon.Thatsaid,ithasbeenidentifiedthattheutilityofthisinformationisreducedgiventhedelayintimebetweenthedata’scollectionandit’sreporting.

Weknow,however,thatasinotherareasofpolicy,datacanbeanenablerofreal-timeevidence-basedpolicyandpracticedecision-making.

Itisforthesereasonsthatwerecommendareviewbeundertakenofexistingdatasources,theirstrengthsandlimitations,withaviewtoestablishnation-widedatasetsthatenabletimelyaccesstodatatoinformdecision-making.Suchaprocessshouldbeundertakeninconsultationwithconsumers,cliniciansandresearchers.

5.Establishanationalprocess,similartothatdevelopedfor investment in Australia’s mental health needs, for the alcohol and other drugs sector

InvestinginAustralia’smentalhealthduringtheCOVID-19pandemiciscritical.Werecognisethesignificantimpactthatthepandemicishavingonthementalhealthofmanypeoplelivinginourcommunitiesacrossthecountry.Further,itisrecognisedthatthereisarelationship,insome instances, between people who use alcohol and other drugs and who also require care formentalhealthconditions.

WetakethisopportunitytocommendgovernmentsforcollaborativelydevelopingtheNationalMentalHealthandWellbeingPandemicResponsePlan8, as well as the funding commitmentstosupportit.Furtherfundingcommitmentsformentalhealtharenotedbystate and territory governments, as well as recent announcements by the federal government to support Victorians, such as:

To establish 15 dedicated mental health clinics across Victoria9.

Anadditional$12millionfor24/7mentalhealthsupportthroughdigitalandtelephonecounsellingservices.10

Anadditional$2.6milliontosupportpeoplelivingwithseverementalillnessaccessingpsychosocialsupports.11

Anadditional$2.6milliontosupportpeoplelivingwithseverementalillnessaccessingpsychosocialsupports.12

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8 NationalMentalHealthandWellbeingPandemicResponsePlan.AustralianGovernment(2020).

9 Media release: New mental health clinics to support Victorians during the COVID-19 pandemic (17 August 2020)

10 Media release: Further mental health support for Victorians during COVID-19 pandemic (6 August 2020)

11 Mediarelease:AdditionalsupportforpeoplewithseverementalillnessduringtheCOVID-19pandemic(6August2020)

12 Mediarelease:AdditionalCOVID-19MentalHealthSupport(2August2020)

It is important to understand that people who access the alcohol and drug treatment sector haveaddictionastheirprimaryproblemandneedspecialistsectorsupportforthis.Ontheother hand, people who access the mental health system primarily have a mental health conditionastheirmainproblem,withorwithoutalcoholordrugusecomplicatingit.Someindividualshaveboth-significantmentalill-healthandsevereaddiction-thisisshownbytheoverlapinfigureone.

Thepolicyandfundingprioritiesforthementalhealthsectorandthealcoholanddrugsectorarenotwellintegratedwithlittleoftheinvestmentinthementalhealthsectorreachingthealcoholandotherdrugsector.GiventhiswestronglyrecommendthatinvestmentinAustralia’s alcohol and other drugs sector, requires a parallel process to that enabled for mentalhealth.

Figure 1: The relationship between service delivery for mental health and alcohol and other drugs use

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MentalHealthSystem

Alcohol andother DrugTreatment

Overlapbetweenpatient

treatment

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6.Investinworkforcecapacityandcapabilityasthisiskey to service improvement

UnderpinninganeffectiveAODtreatmentservicessectorisawell-supportedandwell-trainedworkforce.

Within the previous pre-budget submission, it was recommended that an Alcohol and Other DrugsTreatmentSectorCapabilityFundbeestablished.Suchafundcouldnotonlyresourceimprovements to the capital works and physical infrastructure of services, but importantly, couldsupporttheeffectivenessoftheworkforce.Someareasthatcouldbeconsideredmayinclude:

Recruitmentandretentionofstaff; Professionaldevelopmentopportunities; Enhancedleadershiptraining; Mentoring programs and stress management; and Predictorsofengagement.

Recently published data in Australia’s Alcohol and Other Drug Workforce: National Survey Results 2019-2013 (the Survey Results) reported that 58% of AOD employees felt constant timepressureduetoheavyworkloads,with41%workingovertimeatleastweekly.Itwasalsoreportedthatnearlyone-in-four(23%)werenotcompensatedfortheirovertime,andthatone-in-five(21%)usuallyfeltexhaustedatthestartofaworkday.

We also know from the Survey Results that 93% found their work meaningful, three-in-four (74%)wereenthusiasticabouttheirjob,70%receivedadequatesupportindifficultsituations,andthatmorethannine-in-ten(93%)wereconfidentintheircapacitytodotheirjob.

Assuch,itremainscriticaltoaddresssomeofthesechallengeswhilealsocontinuingtosupporttheworkforcetofeelconfidentandsupportedintheirroles.

Further,werecognisethataccordingtotheSurveyResults,6%ofworkersidentifiedasAboriginaland/orTorresStraitIslander.Although,itisnotedthatthisisasignificantshortfallwhencomparedwiththe16.5%ofclientsseeninspecialistAODserviceswhoidentifyas Indigenous14.FurtherworkshouldbeexploredforincreasingthenumberofworkerswhoidentifyasAboriginaland/orTorresStraitIslanderandstrengtheningretentionofthisimportantworkforce.

The COVID-19 pandemic has reinforced the crucial role of a well-supported healthcare workforce.Thisappliesinallsectors.ItisforthisreasonthataCapabilityFundwouldprovideprofessionaladvice,aswellasfinancialgrants,toAODtreatmentorganisationsbasedonevidence-basedserviceimprovementandevaluation.

This submission supports the establishment of an Alcohol and Other Drugs Treatment Sector CapabilityFundtosupporttheAODworkforce.

13 Skinner,N.,McEntee,A.&Roche,A.(2020).Australia’sAlcoholandOtherDrugWorkforce:NationalSurveyResults2019-2020.Adelaide,SouthAustralia:NationalCentreforEducationandTrainingonAddiction(NCETA),FlindersUniversity

14 AustralianInstituteofHealthandWelfare.Alcohol,tobaccoandotherdrugsinAustralia.Cat.no.PHE221.Canberra:AustralianInstituteofHealthandWelfare;2020.

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7.SupportthecontinuedcoordinationoftheAODsector

ThissubmissionalsorecognisestheimportantroleofstrengthenedcoordinationandplanningacrosstheAODsector.Assuch,itiscrucialthatgovernments,atbothfederalandstateand territory levels, work together to appropriately fund Australia’s alcohol and other drug treatmentservices.

Aspartofthisimprovedcoordinationitisourrecommendationthatthenationalpeakbodyforalcoholandotherdrugsbewell-resourcedandsustainablyfundedintothefuture.

ConclusionThebenefitsofAODtreatmentservicesarewellestablished.Alcoholandotherdrugstreatmentworkswhenpeoplecanaccesstherightkindofcareattherighttime,intherightplace, and with clinical and social supports tailored to what is best for the individual15.

Further,weknowthatincreasedinvestmentinAODtreatmentisbeneficialforsocietyasawhole:weknowthatforevery$1spentontreatmentservices,thereisa$7returntothecommunity16.

In our previous pre-budget submission, we called for structural reform of Australia’s alcohol andotherdrugtreatmentsector.Thisincludedtoimprovethesizeandfocusofinvestmentinthe alcohol and other drugs treatment sector; invest in service and workforce capability; and improvecoordinationandgovernanceacrossthealcoholandotherdrugstreatmentsector.Theserecommendationsremainimportanttoday,ascurrentfundingonlymatchesaportionofneedanditisexpectedthatthisgapwillgrowThissubmissionrecommendsthatdetailedanalysis should be undertaken by governments on the funding required for AOD treatment services.

Australia’salcoholandotherdrugsectorisatacriticaljuncture.Therehasneverbeenamoreimportanttimeforgovernments,atalllevels,toinvestinalcoholandotherdrugtreatmentservices.Asemergingevidencesuggests17, this pandemic has seen people changing the way theyusealcoholandotherdrugs.Thesectorneedstocontinuetostandreadytorespondswiftlyandflexibly.

Governments,acrossthecountry,havemadesomesignificantpolicyandfundingchangesduringthepandemic.These,webelieve,havesupportedtreatmentservicestorespondinanagileandinnovativewaytotheneedsofclientsduringCOVID-19.Itisnowthetimetocontinuetobuildupon,andexpand,someofthesechanges,andstrengthenAODtreatmentservicesforthefuture.

15 Lubman,D,etal.,2017,InformingalcoholandotherdrugserviceplanninginVictoria,TurningPoint

16 Ettner,SL,etal.,2006,‘Benefit-costintheCaliforniatreatmentoutcomeproject:doessubstanceabusetreatment “payforitself”?’,inHealthServicesResearch

17 Sutherland,R.,Baillie,G.,Memedovic,S.,Hammoud,M.,Barratt,M.,Bruno,R.,Dietze,P.,Ezard,N.,Salom,C.,Degenhardt,L.,Hughes,C.&Peacock,A.(2020).Keyfindingsfromthe‘Australians’DrugUse:AdaptingtoPandemicThreats(ADAPT)’Study.ADAPTBulletinno.1.Sydney:NationalDrugandAlcoholResearchCentre,UNSWSydney.