Evaluation of turning the tide - Final report

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Department of Premier and Cabinet - Executive summary

Illicit drugs and their abuse continue to be major issues for Governments at all levels both in Australia and internationally. In global terms the level of health-related harm caused by illicit drug use and abuse is relatively small compared to the harms associated with the socially accepted and regulated use of licit drugs such as alcohol and tobacco. In reality, apart from cannabis, only a small minority of Australian people use illicit drugs and the majority of these do so for a relatively short period of their life. However, there are substantial burdens of harm among those who abuse illicit drugs, including overdose-related death, involvement in crime, community and family distress and the transmission of HIV/AIDS and other blood-borne diseases. While the absolute number of people dying from illicit drugs is not high compared to mortality relating to the use of alcohol and tobacco, the burden of harm is much more substantial if one considers the years of life lost. More females are using drugs than ever before and the gender gap in incidence and prevalence of use is closing. This has major implications for maternal and child health amongst young women who abuse these substances.

There are a number of reasons in the current Australian context why the community should be concerned about illicit drug-related harm. The international production and supply of illicit drugs has an increasingly global impact. The initiation to illicit drug use appears to be occurring at a younger age, and an increasing proportion of drug-related deaths occur among users within the younger age group. There is evidence of increased drug-related health and social harm, globally as in Australia, particularly (but not only) among young people. The most important is heroin-related overdose deaths. Younger people have less capacity to manage patterns and consequences of drug use in a way that can reduce their risk of serious harm. Multiple drug use has become an established norm among people who use illicit drugs thus increasing the risk of drug-related harm. While there is widespread community concern in Australia about heroin and its adverse effects, the basis of drug-related harm is much more far-reaching and complex than is commonly appreciated.

These realities call for a long-term effort built on the best available evidence and cognisant of the requirements of a humane society. This report cites evidence of increased drug-related harm. It cites evidence that problems with a common set of causes require integrated and coordinated responses. Mental health promotion, youth suicide and crime prevention, broad public health initiatives aimed at infectious diseases such as HIV and HCV, and employment, education, and other social capacity and cohesion-building policy initiatives are all a key part of any response to illicit drugs. It is likely, given the available evidence, that these broad-brush approaches to the social determinants of licit and illicit drug abuse will, in the long term, have beneficial impacts on the level of harm consequent on all types of drug use.

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Background

In December 1995, the Premier of Victoria appointed the Premier's Drug Advisory Council (PDAC), chaired by Professor David Penington, ‘to conduct an intensive public investigation into the trade and use of illicit drugs in Victoria’. In March 1996, the report of the PDAC was submitted to Government. The report made 71 specific recommendations grouped under eight broad thematic categories.

The Government issued a detailed response to the PDAC report in June 1996. The Government response was called Turning the Tide (TTT). In summary, TTT entailed full acceptance of 57 of the detailed PDAC recommendations, acceptance in part or in principle of six recommendations, and a decision not to support eight recommendations. Initial funding of $25 million per annum for three years was allocated to the TTT-funded initiatives, allocated to four managing departments, namely Human Services, Education, Justice, and Premier and Cabinet. In 1998 the Government extended the strategy by a further year, bringing total funding to $100M over four years.

An integral part of the Turning the Tide Strategy has been evaluation, both of its component elements and in total, and funds were allocated specifically for this purpose. In May 1999, the Department of Premier and Cabinet commissioned a policy evaluation of TTT. The evaluation was undertaken by Health Outcomes International Pty Ltd. in association with Hoult Consulting, Siggins Miller Consultants and the National Drug and Alcohol Research Centre (NDARC). This report presents the findings of the evaluation.

The purpose of the evaluation was to assess the overall impact of TTT on the community; to determine whether the resources committed to the strategy had resulted in the intended outcomes; whether any such outcomes could yet be quantified and measured in any meaningful way; and to otherwise report on the process, outcomes and learnings from TTT so as to assist the Government in determining future policy directions.

Matters of particular interest to the Government included:

• Whether the suite of initiatives had been implemented in accordance with the goals and objectives of TTT;
  
  
• Whether the Government had received optimal value for money from the strategy;
  
  
• The extent to which participating managing departments and Government and non-Government agencies involved in program administration and service provision had coordinated their efforts and cooperated with each other;
  
  
• The appropriateness of the 'balance of investment' between different types of initiatives and whether there were any significant gaps in the strategy or barriers to implementation;
  
  
• Whether the TTT timeframes for implementation and achieving results were realistic; and
  
  
• Whether there were yet any meaningful indications of impacts in terms of reduction in use of illicit drugs, reduction in harm from illicit drugs, a strengthened service system, increased community awareness and understanding of harm minimisation principles, and increased appropriate community action.

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A variety of methods were employed in the evaluation of TTT. It was clear at the outset that a robust quantitative evaluation of the impact of TTT would be difficult, mainly because of limited or non-existent baseline and ongoing data in relation to key areas of the evaluation. These difficulties with quantitative data resulted in relatively greater emphasis on primary data collection using qualitative methods, together with an increased emphasis on the use of secondary data sources. Much of the primary data collection has been based on structured interviews with a large and diverse range of key stakeholders. The assistance and support provided by all those participating in the evaluation are gratefully acknowledged.

Contents

• Executive summary
  
  
• Background and context
  
  
• The turning the tide evaluation methodology
  
  
• Illicit drug usage – Victorian, National, and International experiences
  
  
• Policy responses to illicit drugs
  
  
• The implementation and impact of TTT
  
  
• Future directions
  
  
• Appendices
  
  
• Appendix A references
  
  
• Appendix B list of interviewees
  
  
• Appendix C ‘Principles to guide Government investment’, Siggins Miller Consultants

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