Policy Practice Projects

DPMP is conducting ‘policy practice projects’. These projects involve dealing with immediate issues confronting Australian policy-makers. Policy practice means engaging directly with policy-makers and providing policy support on specific issues with which they are grappling.

Over the five years of DPMP, we will complete at least one Policy Practice Project with each jurisdiction. The outputs of the policy practice projects will depend on the nature of the problem that the jurisdiction is grappling with, but may include written or verbal policy advice to the organisation in question, a model, literature reviews and so on. Policy practice projects will be publicly disseminated as appropriate.

The aims of the Policy Practice projects are:

To provide policy support
To apply policy research findings
To evaluate DPMP tools and methods as they are used in practice
To improve the Australian policy processes and quality of decisions

Across Jurisdictions

Project title: Using evidence to evaluate Australian drug trafficking thresholds: Proportionate, equitable and just?

Research team: Caitlin Hughes and Alison Ritter (NDARC) and Nicholas Cowdery AM QC (Faculty of Law - UNSW)

Rationale and aims

One of the key measures in Australia for distinguishing drug users from traffickers and for determining the seriousness of drug trafficking offences is the quantity of drug involved. Yet these tools have been subject to very limited academic scrutiny. Consequently there remains a lack of recognition of the potential risks that drug trafficking thresholds bring (to defendants, prosecutors, courts and the broader community), the importance of good design and the peculiarities of the Australian drug trafficking threshold system that increase the potential for unintended harm. Of equal concern has been the inattention to evaluating the design of these tools. New research by Hughes and Ritter (in press) demonstrates that, assessed against evidence of Australian drug markets, current ACT drug offence thresholds pose risks of unjustifiable or inequitable convictions. This provides troubling although partial evidence that current Australian drug trafficking thresholds may be contributing towards disproportionate sentencing of Australian drug offenders.

In this study we will extend the ACT study to evaluate, against research evidence, the trafficable threshold throughout all other Australian states and territories, taking into account inter-state differences in legal thresholds and drug markets. This will enable Australian policy makers and legislators to identify whether the problems identified are idiosyncratic to the ACT, or whether as hypothesised they represent a more systemic and wide-spread problem in the design of all or some Australian drug trafficking thresholds.

Methods

This project will utilise data concerning drug use, drug markets and the potential seriousness of a drug trafficking offence to evaluate the relevant trafficable threshold quantities (for heroin, methamphetamine, cocaine, MDMA and cannabis) that operate in each state and territory. Data will be derived from national datasets (including the Illicit Drug Reporting System and the Ecstasy and related Drug Reporting System) and independent research studies.

Expected completion date

December 2012

Funding

Criminology Research Council Grant

More information:

caitlin.hughes@unsw.edu.au

New South Wales Police

Project title: Identifying current and alternate police options for intervening with MDMA

Research team: Caitlin Hughes and Alison Ritter (NDARC)

NSW Police Collaborators: Fiona Christian and Pat Ward

Rationale and aims

In recent years there has been a significant rise in the number of police recorded MDMA use/possess incidents in NSW. For example, between 1999 and 2010 the number of incidents involving MDMA use/possession increased by an average of 22% per year. Yet, MDMA is a high harm, low risk drug, where policing responses may inadvertently contribute towards harms from use, such as the risk of overdose. NSW remains one of only two Australian states and territories that does not provide diversionary responses to MDMA use/possess offenders, a factor that may increase the risk of inadvertent harm. This project involves the first detailed investigation conducted in Australia into patterns of MDMA use/possess offending. It has been conducted in collaboration with NSW police with the goal of generating an evidence base to inform future decisions about current and alternate policing options for intervening with MDMA users.

Methods

A descriptive analysis of NSW police data was undertaken to examine the demographic profiles and circumstances of offending of all MDMA and cannabis use/possess offenders detected in NSW in 2006, the legal action taken towards them and their offending histories (both prior and subsequent) over the years 1998-2007. The data of interest thus included a reference year (2006), eight years of prior offending (1998-2006) and one year of subsequent offending (2007).

The sample comprised all individuals detected for an index offence in 2006, where an index offence was defined as an offence: Involving MDMA or cannabis that came to the attention of NSW police and resulted in a legal action; Involving one drug only (MDMA or cannabis); Having no other offence in same incident; and For offenders detected for multiple MDMA or cannabis offences in 2006, constituted their first offence in 2006.

The final sample comprised N=357 MDMA use/possess offenders and N=5847 cannabis use/possess offenders all of whom were detected in the reference year.

More information:

caitlin.hughes@unsw.edu.au

NSW Ministry of Health

Project title: The NSW Opioid Treatment Program: Exploring policy options using a system dynamics modelling approach (PPP)

Research team: Jenny Chalmers and Alison Ritter (NDARC), with NSW Health

Rationale and aims

NSW Health was developing a new Opioid Treatment Program (OTP) Strategic Plan. The DPMP undertook to inform this NSW Health project by modifying the national system dynamics model of the opioid pharmacotherapy treatment system to fit with the NSW system. The project explored the following four policy issues relevant to the NSW Plan:

What is the optimal size of the Opioid Treatment Program, in terms of patient places?
What are the repercussions of improving the quality of treatment?
What would happen if 50% of pharmacies stopped dispensing?
What would happen if the Government paid patient dispensing fees in pharmacies and private clinics?

Key findings

Optimal program size: If optimal size is defined as one that it is large enough to incorporate all those patients potentially seeking treatment, our model estimated a doubling of the OTP in NSW (16,000 more places). If optimal size is defined as: patients staying longer - a more than 45% increase in number in treatment; a 40% increase in NSW government costs (public clinics), and a close to 75% increase in the overall cost of patient dispensing fees. If optimal size is defined as patients re-entering treatment more quickly after drop-out – this produces an increase in patient numbers not dissimilar to above. If optimal size is defined as: people entering their first treatment episode more rapidly after instigation of dependence, this has the lowest modelled impact.
Improving quality of treatment: Underlying this policy change is the establishment of new clinics and a marked reduction in the staff to patient ratio as more attention is focused in meeting patient specific needs. We assume that the cost of prescribing in public clinics doubles, patients stay twice as long in treatment, are more likely to “recover” and encouraged to return to treatment after a break. The model shows a doubling in state government costs and a 24% increase in numbers in treatment.
Pharmacy dispensing: Given no more public clinic capacity for dispensing, the model predicts a 13% reduction in the overall patients dispensed. It is perhaps more interesting to determine how long it would take for these patients to find a dispensing place. The model suggests a waiting time of upwards of 6 months.
Dispensing fees: government costs?: Increased retention in treatment, consequent on the reduction in dispensing fees, results in a 15% increase in patient numbers, a further $349,500 increase in government dispensing costs and an 11% increase in NSW Government costs of running public clinics. If government subsidised dispensing fees attracted earlier entry to treatment there would be a further increase in patient numbers (24% more than at base-line) and the cost of running public clinics would expand to 21% more than at base-line.

Implications fo research

This project demonstrates the worth of a jurisdiction specific system dynamics model of service delivery. The model’s capability could be further improved with better data on excess demand for treatment and waiting lists. Specifically, who is it that has to wait and why?

Outputs

Publications
Chalmers, J., and Ritter, A. (2009). The NSW Opioid Treatment Program: exploring policy options using a system dynamics modelling approach. A report for NSW Health, Drug Policy Modelling Program, NDARC, UNSW.

More information:

jenny.chalmers@unsw.edu.au

NSW Ministry of Health

Project title: Pharmacy participation in the NSW Opioid Treatment Program: Development of an options paper for NSW Health (PPP)

Research team: Jenny Chalmers , Kari Lancaster, Trevor King and Alison Ritter (NDARC), with NSW Health

Rationale and aims

The Drug Policy Modelling Program (DPMP) at the University of NSW was engaged as a consultant by NSW Department of Health (NSW Health) to assist in their assessment of a series of policy options for the redevelopment of the Pharmacy Incentive Scheme (PIS). Established following the 1999 Drug Summit, the PIS was initially designed to increase the number of pharmacies participating in the NSW opioid treatment program (OTP) and the number of OTP clients being serviced by community pharmacies. In concert with NSW Health we firstly established a set of goals for the new model for pharmacy participation in the NSW OTP. We examined each of the policy options developed by NSW Health against three criteria:

Which of the goals is targeted by the policy option;
The possible unforeseen consequences of replacing the PIS with the policy option, in relation to the goals under threat of being compromised; and
Budgetary implications.

Key findings

Pharmacy dispensing is one of a ‘range of overlapping and interlinked systems of care’. In NSW, dispensing takes place in public clinics, private clinics and in prisons, as well as in pharmacies. Patients dispensed in pharmacies could be prescribed by medical practitioners working in the private sector or public sector. In our analyses of the potential implications of the policy options, it was challenging enough to hypothesise about implications for pharmacy involvement and pharmacy patients, given the short time-lines for the project, lack of evidence base and relevant data, let alone fully conceptualise implications for the wider system. A more robust analysis is required. As well as focusing attention on the machinations of public clinics including the processes by which public clinic patients transfer to pharmacy dispensing, attention needs to be paid to the relationship between pharmacies and prescribers and even the relationship between pharmacies and private clinics. More also needs to be understood about the needs and preferences of patients to more effectively provide for the diversity of this client group.

Implications fo research

Research that addresses one or more of the priority areas is likely to have high policy impact.

Outputs

Publications
Chalmers, J., Lancaster, K., King, T., & Ritter, A. (2011). Pharmacy participation in NSW Opioid Treatment Program: Options paper, A report prepared for NSW Health. Sydney: National Drug and Alcohol Research Centre.

More information:

jenny.chalmers@unsw.edu.au

NSW Ministry of Health

Project title:Treatment pathways from the client’s perspective: Informing a better match between service provision and service need

Research team: Jenny Chalmers and Alison Ritter (NDARC), with NSW Health

Rationale and aims

The NSW Ministry of Health is leading a project to develop a national population based model for drug and alcohol service planning, known as the National Drug and Alcohol Clinical Care and Prevention Modelling Project (DA-CCP). Central to the project is the establishment of a set of ideal treatment pathways, which represent the services that any one typical client may receive over the course of a typical year (categorized by age, severity of dependence and drug type).

The goal of this project is to generate empirical data showing the treatment pathways taken by people before they enter the Opioid Treatment Program (OTP) in NSW. The project aims to make service system development recommendations for policy makers based on the documented treatment pathways and an assessment of the implications of inaccessibility of treatment for the pathways taken.

Methods

The centrepiece of the project is a census of people who enter OTP in NSW during September and October 2012, using a self-complete instrument mailed to their dispensing point.

Progress to date

The survey is under way and the response rate is promising.

Outputs

A report will be provided to NSW Ministry of Health on completion of the project.

More information:

jenny.chalmers@unsw.edu.au

NSW Ministry of Health

Project title: Estimating unmet demand for pharmacotherapy maintenance treatment in NSW

Research team: Jenny Chalmers (NDARC) and Benjamin Phillips (formerly NDARC) with NSW Health

Rationale and aims

The purpose of this project was to summarise what is known internationally, nationally and in NSW about unmet need and unmet demand for opioid maintenance treatment (known as OTP in NSW) and provide some initial estimates for NSW. Unmet need is defined as the proportion of people who meet diagnostic criteria for dependence but who are not in receipt of treatment. This is therefore inclusive of people who may benefit from treatment but do not seek it or request it, those who simply do not want treatment and those who want help via means other than formal treatment. Unmet demand, on the other hand, is defined as the proportion of people who seek treatment but are unable to access it – that is they want treatment and seek it but do not receive treatment. Both unmet need and unmet demand are important estimates in planning for services.

Methods

Review of unmet need and unmet demand literature was undertaken. Estimates of unmet need and unmet demand from international studies was compared with the limited available Australian data. Analyses included the National Drug Strategy Household Survey and the National Survey of Mental Health and Wellbeing datasets.

Progress to date

This project is completed.

Outputs

A report has been provided to NSW Ministry of Health.

More information:

alison.ritter@unsw.edu.au

ACT Health

Project title: Consultation and modelling in relation to the ACT AOD treatment service system

Research team: Alison Ritter (NDARC), Pascal Perez (HEMA) and Jen Badham (Critical Connections)

ACT Health: Helene Delany

Rationale and aims

The ACT has been in an environment of change. A review of treatment services for alcohol and drug dependency has provided some guidance about treatment structures and functions for the ACT. In addition, a new prison opened in 2009 that provides drug treatment interventions and there is significant attention to ‘throughcare’ – which will mean ensuring effective links and pathways between the prison and community-based drug treatment services.

DPMP is working with the ACT to develop an ACT-specific drug services system model. With a finite set of treatment services, locations and a closed population, it is possible to model the movement of drug users /offenders /clients through the system over time. The model represents drug users/offenders/clients moving around the system according to simple rules driven by existing data. The costs of service provision can also be built into the model. Likewise, measures of harm such as overdose or infection rates can be built in if data exist that can be used as reasonable proxies.

Design/method

Extensive participatory consultation processes were conducted prior to building the model. These participatory processes mapped the current treatment system and explored the most important aspects for modelling. Stakeholders from across the ACT system participated in the workshops, including service providers (both government and non-government), consumers, police and corrections staff.
Arising out of the participatory workshops, a system dynamics model has been built from data provided by ACT Health and ACT Policing. The model will be validated against external parameters. Sample scenarios will be run examining the impact of changes in client flows or changes in service delivery.

The model itself along with a final report that describes the model, and a user manual will be delivered to ACT Health for their future use.

Progress to date

The model is completed. The manual is completed. The report is in final draft stages.

Expected completion date

mid-2012

More information:

alison.ritter@unsw.edu.au

ACT Department of Justice and Community Safety

Project title: Legal thresholds for serious drug offences: Expert advice to the ACT on the amounts for trafficable, commercial and large commercial drug offences

Research team: Caitlin Hughes and Alison Ritter (NDARC)

ACT Department of Justice and Community Safety: Victor Martin and Nikki Besch

Rationale and aims

In Australia one of the key measures for distinguishing drug users from traffickers and for determining the seriousness of drug trafficking offences is the quantity of drug involved. Legislative thresholds define the quantity of drug necessary for an offence of trafficking or an offence of minor, mid or high end trafficking, with three thresholds defined in most jurisdictions. To date there has been surprisingly little use of research to inform decisions on how threshold quantities should be set or what threshold quantities should be used. This is a noted absence since while with good design thresholds can increase the likelihood that sanctions will reflect the offence committed and increase the potential to deter current and would-be offenders, poorly designed quantitative thresholds may do the reverse. Most importantly they may inadvertently increase the risks of disproportionate sanctioning, such as erroneously convicting and imprisoning drug users as drug traffickers. DPMP was engaged as a consultant to provide expert advice on determining amounts for trafficable, commercial and large commercial drug offences. The aim of the project was twofold:

To evaluate current ACT drug trafficking thresholds for trafficable, commercial and large commercial offences; and
If necessary, to propose metrics to assist in the determination of appropriate threshold quantities.

Status: Completed

More information:

caitlin.hughes@unsw.edu.au

ACT Government

Evaluation of the Australian Capital Territory Drug Diversion Programs

Research team: Caitlin Hughes, Alison Ritter, Marian Shanahan, Florence Gray-Weale(NDARC) with David McDonald (Social Research and Evaluation P/L)

Rationale and aims

Diversion has become one of the most utilised policy interventions in Australian government responses to drug users (Hughes and Ritter, 2008; Ritter et al., 2011). The irony is that many key questions about optimal system design remain unknown: What ought ‘best practice’ diversion involve? And how can Governments improve the operation and outcomes of diversion programs?

Traditional means of evaluation have focused on programs themselves, rather than how programs intersect together, and factors outside individual programs that positively or negatively affect program inputs, outputs and outcomes. To overcome this deficit a systems approach will be adopted to examine drug diversion in the ACT. This project seeks to generate a thorough understanding of what is going on, to whom, at what costs, and the barriers and enablers to effective system provision.

Design/method

The project has four components overall:

Conceptual map of the ACT drug diversion system, detailing how the set of five alcohol and drug diversion programs work together and the broader context in which the programs operate
Resources analysis, for each program, taking into account both fixed and variable costs
Development of an evaluation roadmap to enable rigorous assessment of the implementation, outputs and outcomes
Identification of current barriers and enablers and avenues for system improvement

Key findings

This project ought enable the ACT to re-conceptualise what drug diversion actually entails in the ACT, to whom and at what costs. It will also enable the ACT to make informed policy decisions about what policy levers to pull (and which to avoid) so as to foster the improvement of the ACT drug diversion system.

Expected completion date

June 2012

Funding

ACT Government

Outputs

Report submitted to the ACT Health Directorate:
Hughes, C., Shanahan, M., Ritter, A., McDonald, D. and Gray-Weale, F. (in press). Evaluation of the ACT drug diversion programs. Sydney: Drug Policy Modelling Program.

More information

caitlin.hughes@unsw.edu.au

Victorian Pharmacotherapy Review

Research team: Alison Ritter (NDARC), Trevor King (Burnet) and Lynda Berends (Turning Point)

Rationale and aims

The Department of Health Victoria (DHV) recognised that the Opioid Replacement Therapy (ORT) program was no longer meeting the needs of clients. The Department invited DPMP in collaboration with Turning Point Alcohol and Drug Centre to review the adequacy of the service model , particularly in light of recent changes (including the availability of a wider range of ORT medications; the emergence of pharmaceutical opioid dependency as an issue; and the development of the Addiction Medicine Specialty). Specific focus was required on issues such as the difficulty recruiting and retaining GPs and community pharmacists; the impact of client dispensing fees; the capacity of the Specialist Pharmacotherapy Services to provide secondary support to primary care providers; and service gaps in rural and regional areas. DHV required a paper that identified short and long-term options and resource implications for service redevelopment.

Key findings

The review highlighted the strengths of the Victorian ORT system, but also aspects of the system that needed attention. The review recommended:

Improving GP training
Streamlining the permitting system
Redeveloping specialist services to better cater for clients with higher level needs
Developing the capacity of specialist services to address pain management and pharmaceutical opioid misuse issues
Investing in Addiction Medicine Specialist positions and training places
Developing specialist hub services in regional areas to improve access and quality of care
Developing a pilot mobile prescribing and dispensing service
Developing guidelines for unsupervised dosing
Extending the client categories that could be provided ORT fee relief
Extending the support provided for prisoners post-release
Developing a fund to support clients experiencing financial difficulty – leading to drop-out from community ORT services
Discussing the issue of client ORT fee relief with the Commonwealth.

Implications for policy

The project made clear, evidence-based policy recommendations. DHV has commenced funding new initiatives.

Implications for research

The project revealed numerous areas where further research is necessary. This project positions DPMP well to undertake further consultancy or other projects with DHV.

Outputs

Publications
King, T., Berends, L., & Ritter, A. (2011). Victorian Pharmacotherapy Review. Sydney: National Drug and Alcohol Research Centre.

More information

alison.ritter@unsw.edu.au

Victoria Police

Project title: The development of a Harm Index for use by Victoria Police

Research team: Alison Ritter (NDARC)

Victoria Police: Amelie Hunter

Overview:

The Victoria Police are in the process of developing a Drug Harm Index. The purpose of their Index is to inform strategic policing at a local command level. The Index will quantify the harm from illicit drug use and drug-related crime, and will identify (at a local command level) drug types and drug offences causing most harm. The goal is to provide an ongoing measurement tool to track changes over time. The DPMP is engaged as consultants on the project: providing advice on methods, data sources and reviewing documentation.

Status: Ongoing

More information:

alison.ritter@unsw.edu.au

WA Police

Project title: Modelling policies for licensed venues in Perth

Research team: Alison Ritter, Michael Lodge (NDARC), Pascal Perez, Anne Dray (HEMA) and Michael Livingston (Turning Point)

Overview:

The Western Australia Police (Alcohol and Drug Coordination Unit) and the Drug and Alcohol Office are jointly interested in exploring policy questions centred on licensed premises and related violence. The two institutions have been collecting venue-based data for some time now and it is felt that this provides a rich source from which to develop a comprehensive and sophisticated model. Having licensed premises as the unit of analysis is something of a departure from the core focus of DPMP work, however there are a number of policy issues around illicit drug use that can logically be explored. Following preliminary contacts established by Alison Ritter, a meeting was held, in May 2008, with WA Police and the Drug & Alcohol Office. After an overall presentation of DPMP, discussions focused on priority areas where modelling could support policy-making processes. The objective is to explore through simulated scenarios the consequences of contrasted policies for licensed venues.

More information:

alison.ritter@unsw.edu.au

Queensland Police and Queensland Health

Project title: Building a Queensland Cannabis Diversion Model

Research team: Caitlin Hughes and Michael Lodge (NDARC)

Queensland Health: Stephen Anstis and Carol Read

Queensland Police: Murray Ryan and Gabrielle Webb

Overview:

Queensland has adopted a comprehensive system of police and court diversion for cannabis users. This includes the police diversion program for minor cannabis offenders, illicit drugs court diversion program for other minor illicit drug offenders and Queensland Magistrate Early Referral into Treatment program. There are a number of questions that now arise about the future directions of the Queensland diversion system. In conjunction with Queensland Health and Police DPMP has built a Cannabis Diversion Model for the Queensland context. The model incorporated the costs and outcomes of the current system and the likely costs and outcomes if Queensland were to modify its existing system.

A report has been given to Queensland Health & Queensland Police on the diversion of drug offenders.

Status: Completed September 2010

More information:

caitlin.hughes@unsw.edu.au

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