In October, the ACT announced that it had passed legislation decriminalising the possession of illicit drugs. It's the first jurisdiction in Australia to do so.
"The ACT has led the nation with a progressive approach to reducing the harm caused by illicit drugs with a focus on diversion, access to treatment and rehabilitation and reducing the stigma attached to drug use," state health minister Rachel Stephen-Smith said.
Under the changes, which come into effect in October 2023, the possession of "small amounts" of drugs like heroin, MDMA or cocaine in the ACT will be treated as a health issue, rather than a criminal matter, and will result in a caution, a fine or a health intervention.
"This sensible reform is based on the expert advice that a health-focused, harm reduction approach delivers the best outcome for people using drugs," Stephen-Smith said.
Drug-related arrests have soared in recent years. Figures from the Australian Institute of Health and Welfare found that there were a record 166,321 drug-related arrests nationally in 2019-2020. This represented an increase of 96 per cent in the last decade.
Yet at the same time, Australia has seen a significant increase in the number of fatal drug overdoses. Earlier this year, the not-for-profit drug and alcohol research centre, the Penington Institute, said that the number of deaths in 2020 could exceed 2,440 once all the data has been collected.
In 2014, that figure was 2,043.
Data from the institute also showed that 2020 was the tenth year in a row where there were more than 2,000 fatal overdoses in Australia.
So while advocates say decriminalisation will reduce harm to drug users, can it help to reduce the number of fatal overdoses? And is decriminalisation indeed the best outcome for drug users?
How will decriminalisation help?
In August, Professor Mark Stoové from Victoria's Burnet Institute said that reforming drug laws, including decriminalisation, would help to reduce fatal overdoses.
In a statement, he said: "The criminalisation of drug use generates and perpetuates the overdose crisis through stigma and fear. Evidence suggests that people who avoid a criminal record have improved social, educational and employment outcomes. People who fear arrest, incarceration, stigma and discrimination are also less likely to access health and harm reduction services."
Other advocates agree, saying decriminalisation will remove barriers for those who need help for drug-related health issues.
"The new laws will make a huge difference to people who use drugs in the ACT. It means that people who casually use drugs won't have criminal conviction as a possibility," Emma Maiden, the general manager of Advocacy and External Relations at Uniting, told ABC RN Breakfast.
"But hopefully what it will also mean is that people who use drugs and perhaps have more of a drug dependency issue, are more likely to be less isolated, have less stigma and are more likely to reach out for help and support."
The criminalisation of drug use, Maiden said, creates unintended harms for affected drug users, limiting their ability to maintain a normal life.
"It can impact on their ability to get employment to rent a property, and so it does have impacts on their life aspirations," she said.
She added that this impact is worse for those who are drug dependent.
"So for those people, the fact that it's criminal, it really isolates them. It means they don't have conversations with doctors, with their loved ones, with the people that are in their lives about their drug use."
This isolation could also be a factor in drug-related deaths. Research has suggested that the stigma related to drug use may increase overdose risk. A 2016 study found that one barrier to opioid overdose prevention programs was the stigma attached to drug use.
Maiden said that it took approximately "19 years" for someone who uses drugs to reach out for support.
"So what we see overseas and other jurisdictions is [when we] remove the criminal penalty, we create more connections and we make it more likely that people will reach out for help."
'No silver bullet'
However not everyone agrees that there is a link between decriminalisation and a reduction in fatal overdoses.
Dr John Ryan, the CEO of the Penington Institute is one of them. He said there's no single remedy.
"From the Penington Institute's perspective, there's no silver bullet solution to the overdose problem. That's why we want a national overdose prevention strategy … also known as bringing the various threads of activity that need to be taken [together]" he said.
"One of which is improving community understanding and education around overdose, the signs of overdose and how to respond in an emergency," he added.
He pointed to other measures such as greater access to naloxone, a medicine that reverses opioid overdoses, as well as the introduction of "safe supply", a harm reduction initiative that has developed momentum in places like Canada.
In recent years, academics have flagged that a safer supply of opioids could address the number of fatal overdoses in North America.
Dr Ryan put the rise of overdoses in Australia down to a lack of action in this area.
"I think the biggest factor is that we're not paying appropriate attention to it," he explained.
"In a nutshell, if you don't actually attend to the problem, it's only going to get worse. And I think what we're seeing is a failure to actually address the underlying issues in relation to overdose and therefore, the toll continues to rise."
Underlying causes
Other academics also doubt that decriminalisation would reduce fatal overdoses.
"I don't think we have enough evidence to comment on how good [decriminalisation] is, other than the big naturalistic studies that have happened in countries that have decriminalised [drugs] like Portugal," Dr Jonathan Brett, a specialist in clinical pharmacology, toxicology and addiction medicine at Sydney's St Vincent's Hospital, said.
Portugal introduced decriminalisation in 2001 and reportedly saw its fatal overdose rate drop from 369 in 1999 to 27 in 2016.
Like Dr Ryan, Dr Brett pointed to a more action-based approach as a means to reducing fatal overdoses, including a greater focus on naloxone availability and the consideration of poly-drug use or the use of more than one substance.
He added that the most effective measure to reduce overdoses would be to better understand the reasons why people are using drugs.
Research has pointed to a relationship between environment and drug use, as well as drug-related harms.
For example, University of Chicago economist Casey Mulligan published a working paper in December 2020 that suggested the isolation of the pandemic may have led to a rise in fatal overdoses. This echoed a similar claim made by the US Centre for Disease Control that same month.
And in 2018, The Lancet published a study that found those leaving prison with a mental illness and a substance use disorder were four times more likely to experience harm compared to those with neither.
"So I think addressing those big things is the elephant in the room, but [that's] not necessarily low-hanging fruit," Dr Brett said.
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