why we need to have the conversation about drug use

“It all comes back to human rights. People have the right to access health care without discrimination.”

With a few words Dr Stephen McNally sums up both the simplicity and the challenge of his work as executive officer of the Yarra Drug & Health Forum (YDHF).

McNally, who took on the role leading YDHF at the end of last year, has a long history of working at the intersection of public health, community advocacy and complex, sensitive health challenges.

The YDHF began almost 30 years ago, amidst community concern over street-based drug use and McNally says Drug and Health Forum has continued to be an important voice and leader in responses to the challenges of drug use, driven by listening to the community, enabling conversations and looking for solutions.

“A lot of eyes are on Yarra and looking at how Yarra is responding to these issues today. It’s highly relevant to other local areas”.

Dr McNally began his professional life as a researcher at Latrobe University, working in the areas of HIV and Hepatitis, before working for non-government organisations including the Australian Red Cross.

McNally’s time at Latrobe included working as a senior research fellow at the Australian Research Centre in Sex, Health and Society, focussing on HIV and Hepatitis C in Australia and Asia, working across Vietnam, Cambodia and Indonesia,

“This was 20 years ago, a time when the hepatitis C treatment success rate wasn’t great and access to treatment and to the broader health system for people who use drugs was pretty poor. I really started to understand and appreciate the importance of harm reduction.”

The impact of drug use on health and wellbeing, for individuals and communities, has been a strong theme in McNally’s work. One of his proudest achievements was the first Annual Overdose Report, completed while at the Penington Institute. The report is now an annual effort and has influenced policy at a national and state level.

McNally says his work at the Penington Institute taught him to appreciate the importance of communication, translating research evidence into public policy and programs that reflect and support communities.

“The importance and the challenge is to take evidence and actually  create change in the world.”

McNally says it’s positive to see how much public understanding and health policies around drug use have progressed in recent times, although there is still a long way to go and this forms a key part of the work of YDHF.

“Drug use is a hard area, there are moral and legal issues, stigma, and because in Australia a lot of the drug use is not legal, it makes it harder to have the conversations and for people to share their stories about how drugs have impacted on them. There is a lot of work to do around community understanding of drug issues and why people take drugs.”

The executive of the YDHF is currently developing a new five-year strategic plan and McNally has been meeting key stakeholders including local councils, communities and police. He says the response has been overwhelmingly positive.

“Everyone I have spoken with has noted the importance of the YDHF and the constructive role it has played in the past. Bringing people together is one of our strengths. ”

Key issues facing the YDHF include public drinking, public drunkenness, pill testing and the medically supervised safe injecting facilities. McNally says the relationship between mental health and alcohol and drug use is another important area.

He says the debate around medically supervised injecting rooms is far from over.

“There is a lot of evidence out there showing that the safe injecting room does save lives but what it’s also telling us is that there needs to be a lot more wrap around support and that additional services are needed, things like improving access to pharmacotherapy, and offering treatment for people that want treatment.”

The YDHF held a public forum on 27 April,  at which representatives from the Department of Health, VAADA and Harm Reduction Victoria discussed the recently released final review report into the Richmond medically supervised injecting facility.

The independent report made 10 recommendations, including making the MSIR permanent, expanding support for clients, and addressing safety and amenity through stronger collaboration between agencies.

The Government ruled out adopting Recommendation 2 – which proposes expanding MSIR access to include peer/partner injecting, access for people who are pregnant and people on court orders.

“The MSIR has been a success, but there have been learnings along the way. The report’s recommendations go to the heart of how we can make the service better and more responsive.”

McNally is clear that holding community discussion into the report is a core part of the forum’s responsibility.

“Our role is to have respectful conversation and to acknowledge and respect all voices. We don’t want to shut people down even though it might be hard to hear them. We need the emotional as well as the evidence base, we need to hear from those with lived experience.”