Monday, 13 August 2018
Social Services Legislation Amendment (Drug Testing Trial) Bill 2018; Second Reading
I rise today to oppose the Social Services Legislation Amendment (Drug Testing Trial) Bill 2018. This bill reintroduces a 2017-18 budget measure to establish a two-year trial of drug testing for 5,000 recipients of Newstart and youth allowance and now identifies the three trial locations: Canterbury Bankstown in New South Wales, Logan in Queensland and Mandurah in Western Australia. The government previously introduced this measure as part of the Social Services Legislation Amendment (Welfare Reform) Bill 2017. Labor opposed many of the measures in the welfare reform bill, including the drug testing trial. The drug testing trial measure was subsequently withdrawn from the welfare reform bill due to lack of support in the Senate, but this government seems determined to proceed with this measure, which the Australian Medical Association has described as 'mean and stigmatising'.
I spoke against this cruel and mean-spirited measure last year, and I speak against it again now. I speak from my firsthand experience of working with people with substance dependency over the last 20 years. Since my second year as a pharmacy student in the mid-nineties, I have worked with people living with addiction and dependency. Addiction and dependency is a health issue. Dependency doesn't discriminate between those who are working and those who are looking for work. The government's attempt to conflate drug misuse with unemployment is not just wrong; it's harmful. While I was training as a pharmacist, I worked in a community pharmacy—one of the first in New South Wales to provide an opioid treatment program. This program, underpinned by the principles of harm minimisation, has led to many people being able to rebuild their lives and their relationships and to gain employment, and it has been provided by community pharmacies since the late 1970s. I met teachers, chefs and executives all turning their lives around, with the support of GPs, pharmacists and addiction specialists.
More recently, I worked as a mental health pharmacist, providing clinical support to an OTP clinic and a withdrawal management clinic in Wyong Hospital. This in-patient unit provides withdrawal management from an evidence based, clinically-proven harm minimisation approach. It works. The problem is that there are just 15 beds at Wyong Hospital for the entire Central Coast. This unit is also part of the state-wide referral process receiving clients from all across New South Wales, particularly from areas where there are no local services. If the government is genuine in its claim to help those burdened by dependence, a good first step would be to properly fund units like this one and not attack welfare recipients. The current services are stretched and there are long waiting lists. Clients wait anxiously by their phone for a text message so that they can enter the unit as soon as there is a bed. If there is to be any likelihood of success, the government must work with the states to ensure that there are sufficient places for people entering treatment and that the necessary mental health and social services are available.
The government are still unable to provide any evidence to support the establishment of their drug testing trial, and they have still not revealed the cost. Clinicians in the drug and alcohol treatment sector have raised significant concerns about these measures, not only their impact on jobseekers but that they won't be effective in identifying those with a dependency or referring them to appropriate treatment. A former colleague, a drug and alcohol clinician whom I spoke to, described this proposal as 'technically flawed and socially irresponsible'. She fears it will punish people by taking away their only means of financial support and is concerned it will send them underground—in her words—'forcing vulnerable people into further disadvantage, homelessness and potentially crime'. As she sees it, this is the government using drug testing as a punitive measure. She is also concerned about technical aspects of the proposal. She asked: 'We know the drug testing will be contracted out to a third party, but will they have the right expertise? Will they be skilled drug and alcohol clinicians who can thoroughly assess the extent of substance use? Will people who are quite legitimately enrolled in opioid treatment programs be caught up in this trial?'
This legislation is yet another attempt by the government to demonise jobseekers and is likely to be at significant cost to the budget. Experts warn that these changes will not help people overcome dependency. This is not how dependency works. Instead, they will be pushed into crisis, poverty, homelessness and potentially crime. The government wants to trial drug testing of 5,000 recipients of Newstart and youth allowance in the Canterbury Bankstown, Logan and Mandurah regions. We are told that testing will be undertaken by a contracted private provider. The government have not announced the cost of this, nor do they know the detail of what types of tests will be conducted. Where is the evidence and where are the details? The National Drug and Alcohol Research Centre commented:
There is no evidence that any of these measures will directly achieve outcomes associated with reductions in alcohol or other drug use or harm, and indeed have the potential to create greater levels of harm, including increased stigma, marginalisation and poverty.
Let's look now to overseas examples. Drug testing of income support recipients has been trialled in several countries, and there is no evidence that it has been effective. In 2013, the New Zealand government instituted a drug-testing program amongst welfare recipients. In 2015, only 22 of 8,001 recipients tested returned a positive result for illicit drug use. This detection rate was much lower than the proportion of the general New Zealand population estimated to be using illicit drugs. Similar results were found in the United States. In Missouri's 2014 testing program, of the state's 38,970 welfare applicants, 446 were tested with 48 testing positive. In Utah, 838 of the state's 9,552 applicants were screened with 29 returning a positive result. These were costly initiatives—costly initiatives that drive people into poverty and potentially crime. We don't know the full cost of the government's measures yet, and we haven't seen evidence to support it.
The Department of Social Services' own figures show that very few jobseekers are likely to test positive. A recent Senate estimates hearing heard that overall the department expects only 100 to 120 people to test positive a second time across the three trial sites. That's $1 million committed for an evaluation of a trial that is likely to impact up to 120 people, before we know how much the contract to the private provider will cost. Concerns have been raised about these measures by health and welfare groups, including St Vincent's Health, the Royal Australasian College of Physicians, ACOSS and Uniting Care, amongst others. Not a single health or community organisation has come out publicly in support of this trial.
Addiction medicine specialists I've spoken to, and others who've been reported on, are concerned about the technical aspects of the trial. For example, the government is yet to confirm what sort of test will be used—urine, hair, saliva. With lower-cost tests there is a risk of false positives. Reliable tests can be extremely costly and likely unaffordable. For example, according to the Royal Australasian College of Physicians, a gold standard urine tests costs been $550 and $950 to administer. The testing could potentially encourage people to use less-traceable but more-harmful drugs or increase alcohol consumption, which is not being tested as part of the trial. Consultation with the treatment sector suggests that there are long waiting lists for treatment around the country.
I want to turn now to speak particularly about women and children who may be caught up in this trial. In New South Wales, there are only three residential treatment programs for women with children experiencing addiction—Kamira in my electorate, Jarrah House in Little Bay, which has a short 10-week program, and Kathleen York House in Glebe, which has only eight beds. I spoke to the CEO of Kamira, who also sits on the Network of Alcohol and Other Drugs Agencies' subcommittee for women, where this proposal has already been raised as a concern. In her view, this trial is set up for failure. She said to me that it will marginalise people already on the bottom rung of the ladder. Currently Kamira, like other treatment centres, is full, which would mean a two- to four-month wait for treatment. These are the questions she thought should be answered: What will happen if a woman tests positive? Will her children be removed by FACs? Will she lose housing after losing her children and become homeless? This is the harsh reality of this drug treatment trial. And, in New South Wales, all of these services are NGOs; there are no government funded residential rehabilitation services for women in New South Wales.
These trials will put increased pressure on the system, and, where treatment is unavailable, jobseekers identified as having a problem with drugs will have difficulty accessing the treatment prescribed. Further, health professionals warn that treatment is not successful unless a drug user is ready to seek treatment. Forcing people to turn up will not address their drug issues. It will put pressure on an already stretched sector and displace people genuinely seeking treatment. John Ryan, CEO of the Penington Institute, commented:
I strongly urge the Government to reconsider and reverse this retrograde approach to welfare before we see the increase in crime it is likely to create.
In Australia there is a real lack of funding for drug treatment services—including medically supported drug treatment. The Government would have been better off making stronger investments there rather than attacking the vulnerable.
If the government was genuine about trying to help people overcome addiction or seek treatment, it would do this differently. Labor is open to considering genuine attempts to help people into treatment, but these changes will impact people with serious illness, pushing them into financial hardship and, potentially, crime. The trial could put Centrelink staff at risk of aggression and violence as they attempt to enforce drug testing on participants.
Associate Professor Yvonne Bonomo, the director of St Vincent's Hospital Melbourne's Department of Addiction Medicine, has said exactly that:
International experience shows when you push people to the brink, like removing their welfare payments, things just get worse. There will be more crime, more family violence, more distress within society. We can expect at Centrelink offices there will be aggression and violence as people react to this. Had [the government] spoken to the various bodies who work in this area and know about this work, we would have been able to advise them this is not the right way. Pushing people to the brink won't make it better.
In conclusion, this bill is risky. As I mentioned at the outset, I've worked with people living with drug dependency and addiction for 20 years before entering this House. From my second year as a pharmacy student, I worked with people on the Opioid Treatment Program in community pharmacies. In the last 10 years before I came into this House, I worked as a mental health specialist pharmacist and also was a clinical support to an OTP clinic and an inpatient rehabilitation service. As I said at the outset, addiction and dependency are health issues. Dependency doesn't discriminate between those who are working and those who are looking for work. This government's attempt to link drug use or drug misuse with unemployment is wrong and it is harmful. I oppose this bill.