Researchers, health professionals, consumer groups and advocates in the field have repeatedly called for widespread availability of naloxone for people who inject drugs and potential overdose witnesses, to reduce the incidence of fatal overdose. This is just one example of where Australia has (in recent years) lagged behind other countries in implementing evidence-informed harm reduction programs. By documenting and analysing the successful establishment of a recently introduced policy to make naloxone available to potential overdose witnesses in the ACT (the “Expanding Naloxone Availability in the ACT (ENAACT) program”), we aim to illuminate the mechanisms and conditions for successful strategic advocacy processes which can be applied not only to naloxone provision in other jurisdictions, but also to other important IDU drug policy issues.
Members of the Expanding Naloxone Availability in the ACT Committee (ENAACT)
The aim of this project was to document and analyse advocacy processes using a case study of the recently introduced policy to make naloxone available to potential overdose witnesses in the ACT (the ENAACT program). This unique initiative is an example of successful policy advocacy by a circumscribed group (the Expanding Naloxone Availability in the ACT Committee) guided by the Canberra Alliance for Harm Minimisation and Advocacy (a consumer group), and therefore as a case study has the potential to provide a rich source of new knowledge about policy advocacy.
It is the process leading to the program’s establishment which has been the subject of the case study analysis. This case provides an example of how drug policy development occurs in a time of ‘non-emergency’ (that is, in the absence of an acute ‘crisis’ or heightened political and media concern, which is not to say that overdoses were not occurring). The case study analysis aimed to demonstrate the ways in which a collective process was used to achieve successful outcomes.
Within the holistic single case study design, qualitative data were collected using semi-structured interviews with key individuals associated with the initiative (primarily members of the ENAACT Committee). In total nine key informant interviews were conducted (via telephone or in person), sampling participants from across the different professional organisations who contributed their expertise to the initiative including researchers, clinicians, policy makers, consumer advocates and peak body representatives. Interviews ranged in length from 30 minutes to over 2 hours, and were audio-recorded and transcribed verbatim. Participants were given the opportunity to review their transcripts for the purposes of verifying accuracy, correcting errors and providing clarifications. Preliminary data analysis was undertaken by the authors using qualitative data analysis techniques to identify, analyse and report patterns within the data. More fulsome analysis was then undertaken collaboratively. All participants were invited to attend a face-to-face meeting to discuss the data, review the authors’ preliminary interpretation and generate new insights. All participants were also invited to comment on an initial draft of the final paper.
Data collection and collaborative analysis is complete.
This analysis of the process leading to the successful establishment of Australia’s first peer-administered naloxone program adds to the existing case study literature which has sought to describe and better understand the mechanisms and conditions which facilitate the implementation of new drug policy initiatives. Such analysis of how policy processes happen in real-world, contemporary settings is essential for generating new and timely learning which can be interpreted and applied to inform approaches across jurisdictions, and other drug policy issues.
We found that central to policy development in this case was the formation of a committee structure to provide expert guidance and support. It is the collective, collaborative and relational features of this group (who was involved, how they worked together, and what strategic actions were undertaken to successfully produce and enact the policy) which became the focus of the final paper arising from this project. The analysis demonstrates that the Committee served more than a merely consultative role. We posit that the Committee constituted the policy process of stakeholder engagement, communication strategy, program development, and implementation planning, which led to the enactment of the naloxone program.
In the paper we describe and analyse the roles of actors involved, the goodwill and volunteerism which characterised the group’s processes, the way the Committee was used as a strategic legitimising mechanism, the strategic framings used to garner support, emergent tensions and the evolving nature of the Committee. We conclude that this case demonstrates how policy change can occur in the absence of strong political imperatives or ideological contestation, and the ways in which a collective process was used to achieve successful outcomes. By drawing on the experiences of those most closely connected with the program’s establishment this analysis offers a unique insight into the internal mechanisms of this policy process, and illuminates the mechanisms and conditions which facilitate the implementation of new drug policy initiatives.
This case demonstrates how a possibly controversial harm reduction initiative can be developed in the absence of competing advocacy coalitions or politicised public debate. The change in this case occurred methodically, through the collaborative work of a group of dedicated individuals and organisations.
Lancaster, K., & Ritter, A. (2014). Making change happen: A case study of the successful establishment of a peer administered naloxone program in one Australian jurisdiction. International Journal of Drug Policy, 25(5), 985-991.
This project will make a valuable addition to the case study literature on advocacy processes, which will be of benefit to researchers, public health professionals, consumer groups and advocates alike. It will contribute to the academic literature, but the collaborative approach to analysis and dissemination will also ensure the results are translated and used in advocacy practice. In addition, we hope that the shared process of data analysis, interpretation and reporting will be a useful demonstration project regarding collaborative research. This research process will also support the Canberra Collaboration, which is seeking to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT.