Practice Guidelines for Clinical Treatment of Complex Trauma

In an open letter sent to the Hon Lia Finocchiaro, Chief Minster of the Northern Territory (NT) today, more than 200 community leaders and representatives from community, health, Aboriginal and research organisations have called on the NT Government to keep in place measures that work to reduce alcohol-related harm. This includes retaining evidence-based harm minimisation policies, such as the Minimum Unit Price for a standard drink (or floor price) on alcohol and reduced trading hours for take-away liquor outlets. Aboriginal Medical Services Alliance Northern Territory (AMSANT) Chief Executive, Dr John Paterson said, “Grog is something that hurts too many Territorians, and our government should be using every tool in the toolkit to keep people in our community safe and well. “Our message to the Chief Minister is clear: please listen to us and consult with communities who have experienced the damaging effects of alcohol firsthand. “We know all too well what happens when decisions are made without community engagement and consideration of the evidence. We can’t afford to take any backwards steps on alcohol.” Association of Alcohol and Other Drug Agencies Northern Territory (AADANT) Executive Officer Stephanie Holmes said, "We’re calling on the Government to put Territorians’ health first by maintaining alcohol policies that are proven to reduce harm and help make our communities safer. “Measures that prevent unfettered access to alcohol, including the Minimum Unit Price and shorter take-away hours, reduce harm and save lives.” From July 2022 to early 2023, restricted area legislative provisions were allowed to lapse across the NT despite warnings from community leaders of the increased harm that would result. There was, as predicted, a very significant increase¹ in violence and other harm, especially to women. Foundation for Alcohol Research and Education (FARE) CEO Caterina Giorgi said, “Just a few weeks ago following a National Cabinet meeting, every Chief Minister and Premier in Australia acknowledged the role that systems and industries play in exacerbating violence. “They also made a commitment to review their alcohol laws, and their impact on family and domestic violence victims in order to identify and share best practice and reforms. “Removing alcohol harm reduction measures will only increase harm. It will not make women and children in the Northern Territory safer.” Signatories to the open letter include: Dr John Paterson, Chief Executive, Aboriginal Medical Services Alliance Northern Territory Stephanie Holmes, Executive Officer, Association of Alcohol and Other Drug Agencies Northern Territory Dr Donna Ah Chee, Chief Executive Officer, Central Australian Aboriginal Congress Dr John Boffa, People's Alcohol Action Coalition Alice Springs NT Sally Sievers, Chief Executive Officer, Northern Territory Council of Social Service Michael Rotumah, Chief Executive Officer, Larrakia Nation Rob McPhee, Chief Executive Officer, Danila Dilba Health Service A/Professor Robert Parker, President, Australian Medical Association NT Council Darryl Coulstock, Chief Executive Officer, Ampilatwatja Health Centre Aboriginal Corporation Melissa Hinson, Chief Executive Officer, Urapuntja Health Service Caterina Giorgi, Chief Executive Officer, Foundation for Alcohol Research and Education. Open letter: https://fare.org.au/nt-open-letter/ Media contact: Joanna Le | media@fare.org.au | 0402 265 145 Media outlets are requested to promote help-seeking information when reporting on alcohol and other drugs, in line with the Mindframe National Guidelines. Suggested wording relating this this media story: If you or someone you know needs support, please call Lifeline 13 11 14, 13YARN 13 92 76, the National 24/7 Alcohol and Other Drugs Hotline 1800 250 015 or 1800RESPECT 1800 737 732. ¹Alcohol Policy and Alcohol related harm in Alice Springs - Central Australian Aboriginal Congress (caac.org.au)

Date: 28 November 2024 Where: 8/52 Marina Boulevard, Larrakeyah

30 September 2024 Media Release Urgent call to retain minimum unit pricing to protect the community As the new Finocchiaro Government considers major policy reform to protect the community, the Association of Alcohol and other Drug Agencies Northern Territory (AADANT) has called on the government to retain minimum unit pricing as a major evidence-based and cost effective policy to reduce alcohol related crime and harms. AADANT Executive Officer Stephanie Holmes said as alcohol-attributed death rates for Indigenous Territorians are ten times higher than the national average and two times higher for non-Indigenous Territorians, it was critical that the new government invest in effective alcohol policy reforms in the NT. “We welcome the new Finocchiaro Government and look forward to working collaboratively with them as they consider their approach to alcohol-related policy in the NT. “We note that the new government has been elected with a strong mandate to reduce alcohol-related social issues. “We urge the government to focus on alcohol policies with a strong evidence base and track record of making communities safer. “Minimum unit pricing is an example of a policy that has been highly successful in making the community safer, reducing alcohol-related harms and hospital admissions and saving taxpayers money. “Minimum unit pricing has resulted in a 14 per cent decline in alcohol-related assaults in Darwin. "Across the NT, minimum unit pricing has reduced alcohol-related emergency department presentations by 19 per cent.¹ "Minimum unit pricing protects the community from very cheap wine products pushed by the alcohol industry. Cask wine sales in Darwin halved after the minimum unit price was introduced."² Despite claims that minimum unit pricing had driven increases in the consumption of spirits, Ms Holmes said evidence does not support this claim. “There is no publicly available evidence that minimum unit pricing is linked to increased consumption of spirits. “The consumption of spirits was increasing before the introduction of minimum unit pricing, and spirit consumption increased in locations outside the NT where minimum unit pricing has not been introduced at all. “What minimum unit pricing has achieved is the reduction in consumption of low-cost high alcohol content products like cask wine. “And that has resulted in a reduction in alcohol-related assaults and alcohol-related hospital admissions. “We know that minimum unit pricing does not affect moderate drinkers but that the health impacts on heavy drinkers is significant. “Minimum unit pricing costs the government nothing to implement but saves taxpayers millions in reduced policing and health care costs. “Price policies are supported by strong evidence from all around the world. We understand that when alcohol prices drop, alcohol harms increase, and that’s why it's critical that we retain the minimum unit price." Ms Holmes said there was a direct relationship between cheap alcohol and increased alcohol-related harms and strongly cautioned the government against scrapping the policy. “We remain deeply concerned that if minimum unit pricing is scrapped, we’ll see significant increases in alcohol-related harms again. “Having been elected with a mandate to tackle law and order, the scrapping of minimum unit pricing leading to an increase in the availability of cheap cask wine, and the accompanying spike in alcohol-related harms would be contrary to both the government's and the community’s interests. “There is no doubt that scrapping minimum unit pricing in the NT will result in increased assaults, alcohol-related harms, and increased policing and hospital costs. “Instead of scrapping minimum unit pricing, the government should retain the policy and consider introducing indexation, as the legislation initially intended. “This would make an already successful policy even more effective than it currently is and would assist the Finocchiaro Government in delivering on its objectives of making the NT safer." Ms Holmes said she looked forward to working collaboratively with the government on these measures further. “We believe that the Finocchiaro Government and AADANT have the same objectives regarding alcohol policy. “We are both focused on keeping the community safe and reducing alcohol-related harms. “In pursuit of those important objectives, we encourage the government to focus on what works, what's keeping people safe, and what's reducing alcohol-related harms, based on the strong evidence we have on hand. “We strongly encourage the new government to keep minimum unit pricing in place.” Media contact: Darren Rodrigo 0414 783 405 The facts about minimum unit pricing in the Northern Territory Minimum unit pricing, alcohol-related assaults and hospital admissions. • The introduction of minimum unit pricing resulted in a 14 per cent decline in alcohol-related assaults in Darwin. • Across the NT, minimum unit pricing has reduced alcohol-related emergency department presentations by 19 per cent. • While Alice Springs only allows one cask wine to be purchased per person, no restrictions apply on purchasing cask wine in Darwin at all. This means it is likely that cask wine sales and associated harms will spike if minimum unit price is removed. • Based on evidence from other jurisdictions, retaining minimum unit pricing in the Northern Territory will reduce alcohol-related deaths.³ Minimum unit pricing and spirit consumption • There is no evidence that the minimum unit pricing has driven increased spirit use. Spirit consumption increased before the introduction of minimum unit pricing and increased in locations where minimum unit pricing had not been introduced. • International evidence globally demonstrates that the introduction of minimum unit pricing shifts alcohol consumption from high-strength to low-strength products. Scotland saw a shift of 3-8%, the Northern Territory 6-8%, and Wales 9%.⁴ 1 Evaluation of Minimum Unit Price of Alcohol in the Northern Territory – Frontier Economics - 2022 2 Taylor, N., Miller, P., Coomber, K., Livingston, M., Scott, D., Buykx, P., & Chikritzhs, T. (2021). The impact of a minimum unit price on wholesale alcohol supply trends in the Northern Territory, Australia. Australian and New Zealand Journal of Public Health, 45(1), 26-33. 3 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00497-X/fulltext 4 Menzies School of Health Research study in partnership with Peter Miller and team of Deakin University

The Association of Alcohol and other Drug Agencies NT (AADANT) has submitted a detailed response to the inquiry into Australia's youth justice and incarceration system. AADANT highlights that all Australians, including children and young people, deserve a safe environment and access to quality healthcare. The submission criticises the prevailing "tough on crime" approaches in the Northern Territory, stressing their failure to create safer communities and the disproportionate impact on Aboriginal Territorians. AADANT calls for a shift to evidence-based, public health responses that focus on harm reduction and human rights over punitive measures, advocating for policies that encourage access to support without fear of stigma. While focused on the Northern Territory, AADANT's recommendations have broader implications for youth justice policies across the country. Read our submission

Truth and Justice Commission Bill 2024 The Association of Alcohol and other Drug Agencies Northern Territory (AADANT) thanks the committee for the opportunity to provide a brief response to this Bill. AADANT is the peak body for Alcohol and Other Drugs treatment services in the Northern Territory (NT). As an independent, membership-driven, not-for-profit association, we work with our members to support and strengthen Alcohol and Other Drugs (AOD) service delivery for people who experience harmful substance use in the NT. AADANT supports the establishment of a Truth and Justice Commission, as prescribed in this Bill, to inquire into and make recommendations to Parliament about historic and ongoing injustices against Aboriginal and Torres Strait Islander Peoples in Australia. This is especially relevant to the NT with tenfold the proportion of Aboriginal and Torres Strait Islander residents, compared to the national population, who have suffered historical and continuing impacts of colonialisation and dispossession. These include drug laws, policies and practices that intentionally and disproportionately targeted and criminalised them, such as the NT Intervention. AADANT also acknowledges additional issues and concerns raised by other peak bodies in their responses to this Bill. These include the need for the Commission to: be established within the spirit of the Uluru Statement from the Heart, align with the Closing the Gap Priority Reforms, be representative of Aboriginal and Torres Strait Islander community diversity, and avoid a repeat of the harms caused by the failed Voice referendum process. We specifically endorse submissions to this inquiry by the Queensland Network of Alcohol and other Drugs (QNADA), and the National Aboriginal Community Controlled Health Organisation (NACCHO).

Towards a healthier future: Evidence-based solutions for AOD issues in Australia The ongoing conversation surrounding alcohol and other drug (AOD) issues in Australia highlights a pressing need for a transformative approach—one that moves beyond punitive measures and stigma to embrace an evidence-based public health framework grounded in human rights. AADANT's recent submission to the inquiry into the health impacts of AOD in Australia emphasises the importance of understanding these complex issues as intertwined with social, economic, and psychological factors. This submission outlines the urgent need for comprehensive policy reform and targeted interventions that prioritise accessible, culturally responsive treatment and support services. By shifting the focus from criminalisation to compassion, we can foster an environment where individuals feel safe to seek help without fear of judgment. AADANT advocates for a harm reduction strategy, underscoring the effectiveness of prevention and education in mitigating AOD-related harms. Read our full submission here

Naloxone must be made available to save lives The recent concern about fatal opioid overdose from nitazenes in the illicit drug supply has raised fears for many prison experts. People who are in prison are not afforded the same protections as people in the community while recent release from prison is also an extremely vulnerable time in which many people experience fatal overdose. We, a coalition of health practitioners, harm reduction advocates and experts, are today calling for expanded access to naloxone in prisons to protect against fatal overdoses from nitazenes and other synthetic opioids. In order to prevent avoidable deaths, we are calling on each state and territory government to immediately: Provide training to custodial officers to recognise overdose and administer naloxone Ensure naloxone is accessible to custodial officers to promptly and effectively respond to overdose Ensure that naloxone and naloxone training is routinely offered to all people exiting prison. Nitazenes are a synthetic opioid that can be hundreds of times stronger than heroin and can be fatal even in very small amounts.1 They have been linked to an increasing number of overdoses and deaths in Australia this year2 and have also been connected to at least 15 overdose deaths in prisons in the UK.3 With new national data released last week on wastewater analysis,4 and a NSW Drug Summit now scheduled for later this year, it is a reminder that we should be addressing harms of illicit drug use. “Nitazenes in prisons are a disaster waiting to happen,” says the CEO of the Australian Alcohol and Other Drugs Council, Ms Melanie Walker. “We know nitazenes are in the illicit drug supply in Australia and it is only a matter of time before they enter prisons. People in prison have a higher rate of injecting drug use than the general population and despite efforts to prevent drug supply in prison, the evidence shows that drug use is still common. Nitazenes and other synthetic novel drugs are significantly more difficult to detect than “traditional” opioid drugs such as heroin. Prisons are currently ill equipped to handle a potential influx of these lethal substances,” Ms Walker continued. A key tool in the fight against opioid overdose is naloxone, a life-saving medication which can temporarily reverse an opioid overdose, including from nitazenes. It is available in Australia as an easy-to-use nasal spray or injection. The Australian Government Department of Health and Aged Care recommends that naloxone be administered to anyone overdosing from opioids.5 However, naloxone is not readily available in prisons in Australia. Naloxone is generally only administered by healthcare staff. As noted by Ms Walker, this severely limits access for people who need it, when they need it: “Health staff are not always available or accessible to people in prison. If we are going to save lives, we must find ways to get naloxone to people in prison when they need it. One important step that all prisons could take right now is for custodial officers to have ready access to naloxone and be trained in how to recognise and respond to overdose. Many police officers across Australia now regularly carry and administer naloxone. Custodial officers should be trained in the same way.” The period following release from prison is an especially high-risk time for overdose, with opioid overdose deaths up to twenty times higher for people leaving prison than the general population.6 Ensuring that naloxone and training in how to use it is provided to people in prison before release is a key strategy in combatting overdose deaths.7 However, provision is currently patchy as not every state and territory provides training or access to naloxone for people exiting prison. “There are too few people getting naloxone at the time they leave prison,” says Ele Morrison, Deputy CEO of the Australian Injecting and Illicit Drug Users League (AIVL). “To save lives, training and access to naloxone must be expanded and improved within all prisons. As a first step we call on governments to implement these measures immediately. But we also encourage them to look for ways to implement harm reduction in prison.” -ENDS- Signatories to media statement Mary Harrod, CEO, NSW Users and Aids Association (NUAA) Geoff Davey, CEO, QuIHN Professor Alison Ritter AO, Director, Drug Policy Modelling Program (DPMP), UNSW Liz Barrett, Chair, Harm Reduction in Prisons Working Group Melanie Walker, CEO, Australian Alcohol and Other Drugs Council (AADC) Dr Lise Lafferty, Senior Research Fellow, Centre for Social Research in Health (CSRH), UNSW Sione Crawford, CEO, Harm Reduction Victoria Professor Kate Dolan, Harm Reduction Australia, UNSW John Didlick, Policy Analyst, Hepatitis Australia Paul Dessauer, CEO, Peer Based Harm Reduction WA Brent Bell, CEO, Hepatitis WA Steven Drew, CEO, Hepatitis NSW Ele Morrison, Deputy CEO, Australian Injecting and Illicit Drug Users League (AIVL) 1. Kozell et al, 2024, Pharmacologic characterization of substituted nitazenes at μ, κ, andΔ opioidreceptorssuggestshighpotentialfortoxicity, TheJournalofPharmacologyandExperimentalTherapeutics, https://doi.org/10.1124/jpet.123.002052 2. NSW Health , 29 May 2024 The Age, 4 July 2024: https://www.theage.com.au/national/victoria/synthetic-opioid-detected-in-four-found-dead-in-broadmeadows-20240704-p5jr1k.html 3. Super-strength synthetic opioids causing UK inmate deaths | Matrix Diagnostics 4. ACIC, 11 July 2024, https://www.acic.gov.au/sites/default/files/2024-07/National%20Wastewater%20Drug%20Monitoring%20Program%20%E2%80%93%20Report%2022_0.pdf 5. About opioid overdose and adverse reactions | Australian Government Department of Health and Aged Care 6. https://www.aihw.gov.au/reports/prisoners/the-health-of-people-in-australias-prisons-2022/contents/deaths/deaths-following-release-from-prison ; Borschmann, R. (2024) The Lancet Media Contacts Melanie Walker, CEO, AADC, 0438 430 963 Ele Morrison, Deputy CEO, AIVL, 0433 940 433

NUAA released a drug alert on Friday, 12 July 2024: Opioid overdoses following stimulant use https://www.instagram.com/p/C9UH_xzteG2/?img_index=1  CanTEST released a drug alert on Monday, 15 July 2024: High dose found in MDMA sample https://www.instagram.com/p/C9bK0TEBxbD/?img_index=1 The alerts will be posted on The Know Community online platform . Please contact PRN admin prn@nccrred.org.au if you require assistance with registration for The Know Community platform.

AADANT Policy Priorities for the 2024 Northern Territory (NT) Election