As Director of the Aboriginal Drug and Alcohol Council (South Australia), Deputy Chair of the National Indigenous Drug and Alcohol Committee and the Alcohol Education Rehabilitation Foundation and Adjunct Associate Professor of Sydney Medical School, Scott Wilson brings the insights and needs of Aboriginal Australians to the discussion about drugs. For more than 20 years, his personal and professional experience has made Scott a highly sought-after contributor and unique source of knowledge.
What’s your day gig, Scott, and how did you get there?
It’s a very long story – and an accident, really.
I was heavily involved in student politics at the University of Adelaide in the 1980s and at the time Dave, a friend of mine who was right into the black deaths in custody issue, had started writing all types of submissions.
They’d had a couple of meetings about the Royal Commission and the community collectively had said “Look we’re too busy dealing with the day-to-day stuff and worrying about alcohol policy procedures – lobbying and all of that – so we need to set up a body that can do this on behalf of the state”, so Dave was beavering away writing up funding submissions.
As part of that he got funding for what’s now called ADAC: the Aboriginal Drug & Alcohol Council (South Australia), based in Adelaide.
Once I became Director back in 1995, we started realising we were missing out on 90 per cent of our potential clients. Not everyone is going to just embrace sobriety overnight so I was able to get the mob to agree that we needed to move from sobriety to harm minimisation. That’s where we’re at now.
Then we got involved with the Clean Needle Program. The Grim Reaper and all those sorts of images were resonating at the time; there was a whole range of health concerns, including hepatitis C.
We’re a pioneer organisation – we produced the first full-colour hepatitis C poster in the world.
Is that right?
Yeah, there was a big event in Germany a couple of years ago of all the different hep C resources and they tracked us down for a copy of our poster to display at the conference.
Basically, we did the largest study of its kind at the time in Australia of people who were injecting drugs.
We (ADAC) were also the first group to start talking about FAS/FAE as it was called back then: foetal alcohol syndrome/foetal alcohol effect. That was before it became FASD: foetal alcohol spectrum disorder.
We were saying there was a problem and as a result I was getting people ringing me, attacking me, saying “Why are you stigmatising our women? There’s no such thing as FASD. Ra ra ra”. We were copping abuse left, right and centre, to the point where we got a t-shirt of a foetus and all around it there was a handful of pills, a smoke, a syringe – all that. We wore that at the ALP National Conference. We were standing out the front of the ALP National Conference at Wrest Point Casino in Hobart handing out things like that.
Are you a bit of an outlier in the Aboriginal health community in terms of embracing harm reduction?
There’s Craig Holloway and those guys at the Victorian Aboriginal Community Controlled Health Organisation, VACCHO, and Brad Freeman at the Aboriginal Medical Service Co-operative in Redfern, AMS. They were around for all that; they were there when their clients were dying from overdoses – actually, that’s still going on today.
But I remember at the NIDAC Conference – the National Indigenous Drug and Alcohol Conference – Brad talking about the new injectable buprenorphine…
Brad said it was quite weird, because when they first tried to get clients at AMS to go onto Buvidal these people were saying “You know, one minute you’re trying to get us off the needle and then all of a sudden you’re trying to get us back on”. And Brad said he told them “Well, the difference is if we have to shut our service you won’t be able to get your product, right, but if I know you haven’t had your injection, I can have you referred to a hospital and you can get it there”.
He reckoned that by the time he came to NIDAC, 65–70 per cent of AMS’s clients were on Buvidal.
Yeah, he said it was almost overnight that they sort of morphed into that.
And because a lot of them aren’t having to rock up every day for a dose now, or once a week or whatever, they’re getting on with life: getting jobs and moving on, and getting back with family and all.
You’re running an Aboriginal community-controlled organisation that has a long tradition in terms of service access. But in the space of people who inject drugs there aren’t many organisations like yours that do a Clean Needle Program, or NSP, and then there’s the problem of access into mainstream services and whether mainstream health NSPs can meet those clients where they’re at.
I know what you’re saying. Nunkawarrin Yunti’s a needle program; so are we.
But we’re what you call a “discreet program”, so we don’t advertise or anything like that. All we do is have the sticker out the front: the little circular one. If you’re someone who uses drugs you know straight away that we have syringes, but we don’t go out blowing our trumpet.
I’ve been trying to say to the day centre mob over at Ceduna (in remote regional South Australia) that we should be providing a Clean Needle Program there as well. The only issue for them is the worry that if one of the traditional folk was to be found dead from a drug overdose, and in particular if the needle was still sticking in their arm, then the community would automatically blame us and want payback. Someone would have to cough up. There might be a beating or a clubbing or whatever but it’d be over and done with then. The punishment with traditional folk is immediate and you move on and everyone loves everyone afterwards.
They all say they embrace harm minimisation but I think a lot of the old-school people still think “If we give them syringes, we’re supporting their behaviour”. They think we’re doing more harm because they’re going to be using and sharing. They’re not getting the point that this already happens and we’re working to minimise the risks that go with it.
One of our programs is mobile – again, it just has a sticker so when it’s out in community it’s that discreet that no one else will know. Through our program we can give out huge volumes of syringes to an individual. We’ve had quite a few come in and want 500 at a time. Someone said to me “What – and you give them 500?”, and I said, “Who are we to say ‘no’?”
We’ll say to them “Is this for you or are you sharing?” Most of them say they’re sharing, and they might be sharing with five or six other people. Who am I to say, “That’s a bit much, isn’t it mate?” We just say, “Okay, no worries. Have you got something to carry them in?”
It’s funny: I’ve started keeping throw-away plastic bags from the shops so that if people come in and get more than something that can easily be concealed, like a 10-pack, we can put it into a bag for them. At least there’s a bit of discretion for them when they leave.
We get a lot of non-Aboriginal folk as well. From our point of view it’s good because then they go and tell the other non-Aboriginal folk how good this Aboriginal service is, which is almost the reverse of what normally happens, right? So we have these guys saying “I was telling so-and-so that you guys are the best, and you’re an Aboriginal group” and we think, “Good on ya”.
We’re the only program on the western side of Adelaide so for people who use drugs here it does get a bit hard to find syringes.
We got an alert recently because for some reason there had been a big spike in heroin overdoses in Adelaide. An email alert came out from the Drug and Alcohol Services South Australia so that when any of our clients came in, we could say to them “Oh, by the way have you heard…?” They probably would have, but then we were able to push naloxone and say “Here’s a script. Have you thought about having some on your premises? You can get it for free”.
Are you part of the national take-home naloxone pilot trial that’s running in SA, Western Australia and New South Wales?
Yeah, we have the script here and we ask all our clients if they use opiates. Some of them have heard of the pilot, some of them haven’t. We just say to them “Just take this down to National Pharmacies and they’ll give you naloxone”. Pharmacies might sometimes say they don’t have any in stock so they’ll have to order it in, and some people are reluctant to give their name for that, but they can always say “When will you get it? I’ll come in tomorrow”.
Is it worth extending take-home naloxone to the rest of the country, in your opinion?
It should be freely available to everybody. It’s lifesaving. People should definitely have it.
Even non-users should have naloxone at home, because you never know what somebody’s doing in your toilet unless you’re in there with them.
Because there’s nasal spray now as well, we’re well past those old days of smashing through someone’s sternum like we see in the movies; you certainly don’t have to do that to administer it.
Naloxone products have a shelf life of a couple of years. I was talking to Carol Holly who used to manage SAVIVE, the drop-in service at the super-clinic in Noarlunga, and she said to me, “Put it this way, Scott: if its use-by date was last year and I’ve overdosed, I still want you to use it on me, because more than likely it will work.”