Mattersof Substance. august 2013 Volume 24 Issue No.3 www.drugfoundation.org.nz

Where there is life, there is hope Harm reduction is about saving lives and treating people with respect. While we led the world with the first government sanctioned needle exchange 20 years ago, what is the current state of harm reduction services, and how can they be scaled up for greater impact? CONTENTS

FEATURE Where there 20 About is life, there a drug Psychoactive 24 eroin Substances is hope Act 101

Cover: Harm reduction is about saving lives COVER world and treating people STORY news with respect. While we led the world with 06 the first government 05 sanctioned needle exchange 20 years ago, what is the current state of harm reduction services, and how can they be scaled NZ news up for greater impact? 03

FEATURES HBecome 14 18 20 22 a member Needles and NIMBYs Turning tide on Psychoactive The Retreat “Not in my back yard!” compulsory treatment Substances Act 101 The Retreat is a recovery The New Zealand Drug Foundation has is the cry of communities Slave labour, torture and New Zealand has just haven in Ötähuhu. been at the heart of major alcohol and around New Zealand forced participation in passed a Bill to regulate Find out how it uses a other drug policy debates for over 20 years. when confronted with medical research: the ‘legal high’ industry. ground-breaking residential During that time, we have demonstrated the prospect of a needle compulsory treatment Get the skinny on this treatment model to a strong commitment to advocating exchange opening. But centres in Southeast Asia world-leading law. deliver its programme. policies and practices based on the what’s all the fuss about? are pretty rough, but is the best evidence available. tide turning? You can help us. A key strength of the Drug REGULARS Foundation lies in its diverse membership base. As a member of the Drug Foundation, you will receive information about major The Director’s Cut 01 alcohol and other drug policy challenges. You can also get involved in our work to Events 01 26 28 32 find solutions to those challenges. Guest editorial: Opinion: Q&A: News 02 Our membership includes health promoters, A small triumph Hurt people hurt Kathryn Leafe About a Drug 24 The Fix Editor-in-Chief people CareNZ’s new CEO and primary health and community organisations, Viewpoints 30 Will Godfrey reflects New Zealand’s drug laws world-leading proponent researchers, students, schools and boards on his time publishing have a disproportionally of harm reduction talks Q&A 32 of trustees, policy makers, and addiction treatment agencies and workers. about addiction, policy negative effect on our to Matters of Substance Mythbusters 33 and drugs. young people. JustSpeak about her new role, Membership and subscription enquiries challenges the system that prisons and running [email protected] causes harm to help our the Soweto Marathon. or visit our website. young people instead of hurting them. www.drugfoundation.org.nz

matters of substance is published matters of substance invites Brand development/ New Zealand Drug Foundation by the New Zealand Drug feedback and contributions. graphic design 3rd Floor, 111 Dixon Street Foundation. All rights reserved. If you’re interested in Insight +64 4 801 6644 PO Box 3082, Wellington, Neither this publication nor any contributing a guest editorial [email protected] New Zealand part of it may be reproduced or article, please contact us: www.designedbyinsight.com p +64 4 801 6303 matters of substance without prior permission of the [email protected] August 2013 Drug Foundation. p +64 4 801 6303 Vol 24 No 3 ISSN 1177-200X the director’s cut Social

@publicaddress Quinoa: it’s not worth it. 2 august

@aliikram Saying NZ has a “drinking culture” is a bit misleading we had a “smoking culture” a few years ago but made a decision to change. 23 June

@chrisiswhoiam Was going to tweet a joke about drug testing but I’d just be taking the piss. 17 June

@boobsradley Talk to your kids about drugs. Talk to your stepdads about jazz. Like, just generally be f you want to go fast, go alone. If you want to go far, go together.” polite and ask people about their interests. 24 June “ So says the African proverb underpinning the major shift in strategic direction we launch this month. @jamesdunnenz oh my stars who thought slapping We’re very proud of our achievements so far the skycity bill in ahead of the #legalhigh bill but, we’re now turning the dial to 11 with was a good look #nzpol. 11 July I a strong focus on leading change in how New Zealand deals with ‘the drug problem’. Ross Bell We have built a strong, sustainable and Executive Director successful organisation through effective KEY EVENTS & DATES advocacy on critical issues, expansion of our drug information services and increased investment by government and others. Cutting Edge 2013: Crossing the Border We’ve remained innovative with our communications, including (into community care) greater use of social media, and we’ve broadened our relationships Rotorua, New Zealand with the AOD sector and beyond. DAPAANZ is hosting Cutting Edge again this year with the theme As we head into our 25th year, we can now use this strong foundation Crossing the Border ‘into community care’. There will be workshops to lead and influence greater change and make a powerful impact. 12–14 S e p tember on the days before and after for those interested. Our vision of an ‘Aotearoa New Zealand free from drug harm’ doesn’t www.cuttingedge.org.nz change, but our mission – being a catalyst for broad action on drug harm reduction – and our way of working will. Reform Conference Being a catalyst means inspiring others to do better and recognising we can’t do things alone. So we’re informed by the concept of ‘collective Denver, Colorado, USA impact’, which demands commitment from across different sectors to Join your colleagues in the drug policy reform movement to learn, a common agenda. network and strategise. 23–26 O ctober It means being a critical friend, especially to government, to help improve www.reformconference.org its drug harm prevention responses. We are committed to building enduring consensus for new health-focused drug policy and legislation. Issues of Substance It also means we will invest effort into engaging with stakeholders. Ottawa, Canada We understand the increasing importance of social media, not only CCSA welcomes you to their biannual Issues of Substance as an engagement tool, but also because it means organisations can conference with the theme From Knowledge to Know-how: stop talking at people and start two-way conversations.

4–6 november Learn Inspire Change. We have identified key stakeholders to work with, but we want to www.issusesofsubstance.ca make special mention of certain groups: those most affected by drugs and drug policy including people who use drugs, especially young people, consumers of services, Mäori and Pasifika people. Through the Maze: Cannabis and Health We also want solutions based on people’s and communities’ strengths. Auckland, New Zealand We want to lead efforts that reduce the stigma faced by people most The New Zealand Drug Foundation is hosting a conference about affected by drug policy. cannabis. Essential to attend for all AOD people.

Good communication will be vital. We reckon our style can be 27–29 N ovember www.drugfoundation.org.nz described as communicating ‘evidence with attitude’. We use the best public health science in a way that provokes positive change. 20th International AIDS Conference Five core outcomes underpin our new plan: Melbourne, Australia 1. Law and public policy will encourage more positive drug Work together to strengthen efforts across all regions and around harm prevention. the world and build on the momentum of recent scientific advances 2. The AOD sector’s impact on prevention and treatment will be 20–25 Ju l y 2014 www.aids2014.org more effective. 3. Attitudes and behaviours around drug use will change positively. 4. Effective responses will be found for new and emerging drug harm challenges. Follow us 5. Young New Zealanders will stay engaged in education. Join us online We hope you will share this sense of purpose and help support our work. drugfoundation.org.nz/connect Contact me for a copy of our new statement of strategic direction: [email protected] matters of substance August 13 01 Check that the NEWS background colour is set to C=0 M=0 Y=1 K=3 NZ. before sending to 02 Ibogaine death Press Director Ross Bell said there had been concerns over offering the treatment It is sometimes in New Zealand. “It’s promoted as a miracle cure for entrenched adjusted for the methamphetamine and A woman undergoing heroin addiction, without ibogaine drug detox there being a good clinical Splash printer treatment has died at the base to support those Te Whare Rongoa treatment claims.” centre in Kaitaia. Only two treatment The Director of Te Whare centres in New Zealand Rongoa, Dr Cornelius van offer ibogaine as a detox Dorp, has said that, since treatment. February 2011, over 50 The New Zealand Drug people had used the Foundation has lodged ibogaine treatment but a complaint with the refused to comment on the Health and Disabilities death until an investigation Commissioner, and the was complete. death has been referred New Zealand Drug to the Coroner. Foundation Executive 01

Associate Minister of Health Todd McClay and MP John Hayes say goodbye to harmful highs. Photo credit: Christine McKay Dannevirke News 03 Thinking of “The book is a powerful Psychoactive Substances Act new tool that can be used the kids to shift clinical practice in In a world first, the New Zealand adult addiction services, A new resource for family services and Government has regulated the sale children dealing with services working with their parent’s addiction children so that the impact of psychoactive substances. has been launched by the of addiction on children Health Promotion Agency is reduced,” said HPA The Psychoactive Substances Bill, which creates a legal market for low-risk synthetic and the Skylight Trust. Principal Advisor drugs, was passed in early July and came into effect the day it was signed into law. Ruby’s Dad, written by Addiction Sue Paton. Associate Minister of Health Todd McClay said that the Bill is squarely about Frances Rabone, is a Copies of Ruby’s Dad public safety and will ensure that the onus will be on anyone wanting to produce children’s book that can be ordered at a psychoactive product to show it poses no more than a low risk of harm. can be used to start www.alcohol.org.nz or “The suppliers and distributors of these products have told us they want to be conversations with by phoning the Health responsible. They’ve told us they want to make low-risk products and market parents and young people Promotion Agency on them responsibly. This is their chance to prove it,” Mr McClay said. about addiction. 0508 258 258. New Zealand Drug Foundation Executive Director Ross Bell said the law is a world first. “This is a cutting-edge and pragmatic approach to new psychoactive substances which will reduce the harm they cause in our communities,” Mr Bell said. For a full overview of the Psychoactive Substances Bill, from inception to legislation, check page 20.

RESOURCES

For a synopsis of the Bill, visit nzdrug.org/YwYAso For the Drug Foundation’s submission and latest news, visit nzdrug.org/PSBsubmission the full Bill and progress through Parliament can be seen here: nzdrug.org/psychoactivesubs

02 matters of substance August 13 04 Contaminated 07 Pūtāruru bans 08 Begging ban houses legal highs –Auckland

As the government regulates the ‘legal high’ industry, the Waikato 04 town of Pütäruru has 08 united to stop the sale 02 of the products. 2,000 The community-led 07 initiative has Police Auckland Council has There are growing and local health workers’ moved to pass a bylaw concerns that the number backing as well as full that would make begging of houses contaminated support from the retailers illegal in the city. from the manufacture who had been selling A group of inner-city of methamphetamine ‘legal highs’. businesses including might lead to a nationwide Smith & Caughey, the problem. Pütäruru Police Sergeant Jason Shailer said there Heart of the City business Recently announced was a mistaken belief group and the Onehunga figures show that over that the products were Business Association have 2,000 labs have been 03 safe and that once the pushed for the ban, saying closed down by Police in 01 facts were put in front that people who beg New Zealand, with many of dairy owners, they intimidate shoppers. more going undetected. took the products off But Auckland Councillor their shelves. Dr Cathy Casey said Co-owner of the K Beez making begging an Pütäruru dairy Sid Patel offence will serve only 06 said that the lure of big to criminalise beggars money – about $100,000 a and give the Police year – made them selfish. powers that they neither want, need nor have the “Profit wise, legal highs manpower to enforce. are crazy, but selling them was the wrong thing to “Begging is a social do. I should have stopped issue, not a crime. 05 selling them a long time People who beg are ago,” Mr Patel said. among society’s most vulnerable, often trapped in poverty, addiction and deprivation,” Dr Casey said.

05 Statistics New Zealand 2012 Yearbook 06 Submissions

Number of cannabis-related charges in 2012 4,060 1,750 number of submissions to the Christchurch City Council on its Number of draft local alcohol policy (LAP). methamphetamine-related charges in 2012 Councils around New Zealand have been calling for submissions on LAPs after the passing of the Alcohol Reform Bill last year. 750 LAPs allow communities to set restrictions on the number of licences allowed and density of liquor outlets. Number of drug offence apprehensions of people under 30 made by for more information on laps New Zealand police in 2012 5,750 nzdrug.org/alcoholpolicies

www.drugfoundation.org.nz 03 Check that the NEWS background colour is set to

C=0 M=0 Y=1 K=3 01 World. 09 before sending to 01 03 Press It is sometimes 06 adjusted for the 02 UK bans khat May has stated the main reason for the ban centres Splash printer around fears khat is re-exported from the UK to countries that have banned the plant and involvement of terrorist organisations in its production. Ignoring expert advice, UK-based drug policy Harm reduction beats war on drugs Britain’s Home Secretary foundation Transform A 15-year study of Vancouver’s HIV in Vancouver so the city took a public Theresa May has banned said that, due to khat’s and overdose epidemic has shown that health approach to the crisis. the herbal stimulant khat. short lifespan, there isn’t time for it to be transited harm reduction methods have reduced “This is probably the city with the most Khat, a plant with mild through multiple drug use and improved public safety. aggressive harm reduction approach, yet stimulant properties, is destinations. The study, which ran from 1996 to 2011, we’re seeing declining rates of drug use widely used in the UK showed a decline in drug use, decrease within this community,” Dr Kerr said. by the Somali and East “It is clear therefore that African population. the Home Secretary is in prevalence in injecting, a dramatic Despite this, Canada’s government not only responding to decrease in sharing injecting equipment, continues to fight harm reduction Earlier in the year, the a problem her expert an increase in those accessing addiction programmes despite the evidence showing Advisory Council on the advisors say does not treatment and a small decline in violence. the benefits of harm reduction strategies. Misuse of Drugs (ACMD) exist but is also set to Co-author of the report and co-director recommended that the create the very problem of the Urban Health Research Initiative plant remain legal in the To read the full report she is claiming to be Dr Rhomas Kerr said that a public UK, with specific harm responding to – exactly health emergency had been declared Visit nzdrug.org/vancouverstudy reduction policies rolled out in communities where as her advisors have its use is prevalent. explained will happen,” Transform wrote. 03 Mexico/US border To read the ACMD’s report on khat

Visit nzdrug.org/khatreport

kg CANNABIS 04 Russia to drug The law means test children children may be asked 877,450 to “voluntarily” sit a written psychological kg kg test followed by medical 3,384 COCAINE 773 METHAMPHETAMINE checks. Children younger than 15 will require kg kg consent from their parents 149 HEROIN 91 OTHER DRUGS to undergo the testing. If a student comes back According to figures from the United States of America’s border patrol with Mexico, Russia has passed a with a non-negative test cannabis is the number one seized drug in 2011. federal law that will result, they will be sent allow school children to to a treatment centre. for Investigative Reporting to find out more be drug tested if they are The law is set to come into Visit nzdrug.org/drugseizures suspected of using drugs. effect from December 2013.

04 matters of substance August 13 08 04

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06 Coca growers 07 Australia bans 08 Champagne 09 No such thing as protest legal highs surgery ‘crack babies’ 05 11,000

Moves in Colombia to Nineteen brands of An NHS-funded hospital A 25-year-old study eradicate coca plantations synthetic cannabis were in Hampshire has applied of babies born in in the Catatumbo region banned in New South for a licence to sell alcohol Philadelphia has have sparked protests, Wales (NSW) in early to patients staying in a found poverty is a with four people dead June in a move by the private ward. bigger influencer of and dozens injured. state to force the federal Basingstoke Hospital developmental outcomes Since June, thousands government to take spokesperson Donna than having a mother who Number of Israelis who of villagers have been responsibility for Green said that it was smoked cracked cocaine have prescriptions for blockading roads in a regulating ‘legal highs’. usual for private patients while pregnant. medicinal cannabis. show of civil disobedience With support from to have the option of “Poverty is a more powerful Recently, Israeli orthodox rabbi against the destruction Queensland, Victoria, alcohol with their meals. influence on the outcome Efraim Zalmanovich ruled that of their only source South Australia and the Local authority member of inner-city children than medical cannabis is kosher. of income. ACT, NSW Fair Trading Jack Cousens said he gestational exposure to While cannabis can be prescribed The farmers are Minister Anthony Roberts would be opposing the cocaine,” lead researcher for over 30 chronic conditions, demanding subsidies called for the government to application. Hallam Hurt said. it remains illegal under Israeli until legal crops can be stop “hiding” over the issue. “It’s a hospital, not a The research followed law for recreational use. phased in, but Colombia’s In response, Home Affairs hotel. The NHS spends 224 babies, half of whom President Santos has Minister Jason Clare a huge amount of money had mothers who used refused to meet with them announced legislation encouraging people to cocaine during pregnancy. stating it is “unjust and would be developed to cut down on alcohol and The study found no illogical” for them to ban ‘legal highs’, and an on treating people with significant difference strike any more. expert panel is being alcohol-related illnesses, between the two groups commissioned to consider and we don’t need but did find that all the options like the system in hospitals sending this subjects had lower IQs New Zealand and Ireland. kind of mixed message.” than national averages.

www.drugfoundation.org.nz 05 cover story Where there is life, there is hope Harm reduction is about saving lives and treating people with respect. While we led the world with the first government sanctioned needle exchange 20 years ago, what is the current state of harm reduction services, and how can they be scaled up for greater impact?

cover story

Just some of the equipment available at the needle exchange. The exchange

t’s brisk business at Wellington’s needle exchange. About every five minutes this Monday afternoon, the bell rings as I someone enters from rain-soaked upper Willis Street into a brightly lit, functional interior. The walls of a small waiting area are lined with health pamphlets about preventing HIV, preventing hepatitis C and safe sex. Two large square holes are set into the bare counter with bright yellow bins beneath – one for loose used syringes and needles and one for the same equipment housed in specially created plastic containers. Debby, friendly and matter of fact, chats with the people who come in about the awful weather as they drop used equipment into the bins. She then issues them with fresh kits, encased in an anonymous plastic bag. They’re in and out in seconds. In 1987, New Zealand became what is thought to be the first country in the world to introduce a national needle exchange programme (NEP) in response to the HIV/AIDS pandemic. Dr Michael Baker, now Professor of Public Health at the University of Otago, was a medical advisor in then Minister of Health Michael Bassett’s office. He became an advocate and chief architect for the NEP.

The traditional response was to be tough on drugs, but there was a pervading air of reform about the Lange government, and they were willing to consider a different approach.

“There was uncertainty about how to respond to the emerging HIV/AIDS epidemic, which was starting to cause explosive outbreaks in injecting drug user populations in the UK and USA,” Dr Baker said. “The traditional response was to be tough on drugs, but there was a pervading Penny air of reform about the Lange government, Mackay

08 matters of substance August 13 and they were willing to consider a different approach. An insight “Even at that time, there were individual pharmacists who sold needles and syringes into Insite so users could inject more safely, so there possibly the finest example of harm reduction in were precedents for the programme. the world, Insite in Vancouver, opened its doors in “It was not plain sailing. The 2003 to intravenous drug users as a place where government’s AIDS Advisory Committee they could inject safely and connect to services like addiction counselling and treatment and to was very wary. They were worried about social services such as housing. unintended consequences such as an Insite was the result of at least 10 years of increase in the supply of needles and unceasing agitation by its prime movers, who syringes fuelling the HIV epidemic. never missed a chance to talk publicly about the Liz Evans offers an insight into the fight for good harm reduction practices. There was also concern because a national absolute need to prevent overdose deaths and the NEP had not been tried elsewhere. But spread of blood-borne viruses and HIV/AIDS. They everyone was well briefed on what we handed out pamphlets to motorists, appeared in One floor above Insite is Onsite, where clients wanted to do, including opposition MPs. the media, presented at conferences and worked wanting to withdraw from drug use can be accommodated and looked after. Once clean, “In the end, the legislation went with anyone they thought could help: journalists, educators, researchers, drug users’ families. they get all-around support to plan their through smoothly. I think there was by then post-addiction lives. a fairly pragmatic approach in New Zealand They were energised by the soaring rate of Surveys indicate public support for Insite is about towards preventing HIV/AIDS.” overdose deaths in Vancouver’s East Side community, which, in 1997, reached 400. 70 percent, and the facility’s funder, Vancouver There are now 21 needle exchange HIV was also endemic, with about one in four Coastal Health, says it does “outstanding” work, outlets, which have adopted a peer service having the virus. has made a positive impact on thousands of model, meaning former injecting drug clients, saved lives and provided vital health “It was such a sad and painful time for us,” says services to a vulnerable population. users are encouraged to join the staff. There Liz Evans, a nurse and one of Insite’s creators. are about 180 pharmacies involved and “We lived in the community, and we knew and Insite has been the subject of about 50 reports dozens of sexual health centres, Prostitutes were really fond of the people who were dying. and peer-reviewed papers in prestigious scientific Collective offices and base hospital and Then one day, and I remember this really well, journals. They indicate that people who inject community clinics. In 2004, the scheme Bud (poet, singer and champion of the homeless drugs who visit the facility are more likely to enter treatment and counselling, that it reduces was enhanced by the 1-4-1 programme Bud Osborn) came back from yet another funeral, and he was so angry and he said to the spread of HIV and hep C, reduces injection- me and Mark (Liz Evans’s colleague and partner related infections and improves public order. Mark Townsend) and our colleague Kirsten, Its annual budget of $3m is also worthwhile A 2002 international “We’ve got to do something about this”. economically. For every $1 it spends, Insite’s benefits are calculated to be worth up to $4.02.* review indicated that, for “And we said, ‘Okay, we gotta do something’ We didn’t really know what – just something”. Despite the positive findings and widespread every dollar spent on the public support, in 2006, the federal government In 1993, Liz Evans had founded the non-profit programme, it saved taxpayers eliminated harm reduction as a pillar of Canada’s Portland Hotel Society to run one of Vancouver’s anti-drug policy (the other three being prevention, more than $20 in downstream ‘single room occupancy’ hotels: budget treatment and enforcement) and began to accommodation for otherwise homeless people. health costs. threaten Insite with suspension of its precious drug “We realised many also had serious illnesses and law exemption. The battle went all the way to the complex social problems, and we found, in that Supreme Court, which, in 2011, ruled unanimously providing new 3ml barrels with any first year, about 88 percent of people we were in favour of Insite’s continued operation. needle free to customers who brought housing were injecting drugs.” But in June, the federal government introduced in used syringes and needles. Today, Support services were also desperately needed tough new regulations over Insite’s annual the programme provides in excess of two for the 6,000 drug injectors in the East Side. application for its exemption, the Health Minister million sterile needles and syringes each “There really wasn’t anyone around who was saying, “sanctioned use of drugs obtained from year to people who inject drugs (PWID). watching what was going on.” illicit sources has potential for great harm in the The success of the programme is So the fight for something better began. “There community”. Insite’s lawyers are now looking at highlighted by the fact that among people certainly wasn’t much appetite back then for the implications. who inject drugs and who use needle a big change from traditional drug treatment Liz Evans says much of the opposition to Insite is and enforcement. But after about a decade, exchanges, the HIV rate is just 0.3 percent. based on ideology, fear and ignorance. “It flies in the health authorities were on board, there was (In the American capital, Washington DC, the face of voluminous evidence that it saves lives enough political leadership to make the funding and limits the spread of disease. It’s frustrating where there is no formal needle exchange thing happen, the Police were onside, and it was because, when something has been so robustly programme, the rate is 50 percent.) kind of miraculous really.” researched, it seems like these things should not A 2002 international review indicated Today, Insite operates through an exemption be in question any more. I don’t want people to that, for every dollar spent on the from Canada’s Controlled Drugs and Substances use harmful drugs either, but they are a reality. programme, it saved taxpayers more Act. Clients inject pre-obtained illicit drugs Research shows Insite does not motivate drug than $20 in downstream health costs. under the supervision of healthcare staff who taking, but it does save lives, misery and money.” At Wellington’s needle exchange supply clean equipment and know what to do if an overdose occurs. (There hasn’t been – officially The Drugs, Health and References a single death at Insite, despite more than Development Project (DHDP) – Debby 1,400 overdoses.) Wounds and infections are * Insite for Community Safety explains why the NEP is so successful. treated, immunisations given. www.communityinsite.ca/numbers.html “Our job is to issue equipment that will

www.drugfoundation.org.nz 09 cover story

Needle Exchange New Zealand’s Charles Henderson.

keep clients safe while they inject. It’s not While the programme has been The money spent would to get them to detox, go on methadone or spectacularly successful in keeping anything else. HIV out of the PWID community, hep C, be more than justified when “I don’t ask questions, judge or advise,” as the programme’s General Manager you think what will need she says. Charles Henderson explains, is an to be spent down the track, Sometimes clients ask for contacts entirely different story. especially on health. of a doctor, dentist or counsellor. Once a month, a nurse specialising in hepatitis C – the scourge of the drug injecting The stigma of being a person community – visits. In Wellington, a GP used to hold a Wednesday afternoon clinic, who injects drugs means they but funding ran out. try to be invisible, and that Rachel, another staff member, tells prevents us getting health me the DHDP would make a great hub information to them, which for health and social services. “We have a rapport with our clients. stops them engaging with They trust us, and through us, they could services they really need. engage with the support they need.” Rachel runs through a wish-list: Work Carl Greenwood and Income, budget advisors, housing, an onsite nurse and/or doctor, career advisors. “Hep C was already established in “The money spent would be more than the injecting community by 1987. It’s justified when you think what will need to be much harder to eradicate a virus from spent down the track, especially on health.” a population than it is to prevent it But such services look likely to only becoming established in the first place. remain on a list of wishes for now. Seroprevalence studies of HIV, hep B DHDP General Manager Carl Greenwood and hep C in needle exchange attendees says one of the biggest problems he in 2009 indicated one in two had been encounters is the shame pervading the exposed to hep C, but that was down from drug-using community. “The stigma of 70 percent in 2004.” being a person who injects drugs means Carl Greenwood hopes Wellington’s they try to be invisible, and that prevents DHDP will become a focal point for the us getting health information to them, prevention of liver-destroying hepatitis C . which stops them engaging with services “So we’re not just a centre for education, they really need.” but also for rapid testing – with results Rachel says a national awareness in minutes not days – counselling and campaign highlighting drug injection as on-referrals. We have our clients’ trust; a health issue, while de-emphasising it as it makes sense to use that.” a criminal activity, would help reduce that But the Ministry of Health, which stigma. The Ministry of Health’s Director funds the needle exchange programme of Mental Health John Crawshaw says the at $4.3 million a year, will only say idea has possibilities. “We are willing to non-committedly that it is “keen to discuss the evidence for this issue and continue to work with providers about actions to address it,” he says. how the programme can be improved”.

10 matters of substance August 13 Charles Henderson says the programme Clarissa Broderick says there are about 20 the face-to-face costs of the GP practice could achieve much more. people currently waiting about six months and help cover the cost of the visit for “Whether New Zealand needs facilities for treatment. “While that’s down from the patient. But ironically, since Care Plus like Vancouver’s Insite (see sidebar page 9) about 100 people waiting up to two years is available only to patients with at least is a moot point,” he says. “We do not have back about 2005, we do still lose them, two conditions, our healthiest clients do as much street use of drugs, and the types they move, they go to jail.” not qualify. They are sometimes the most of drugs involved are different. One of the other major reasons reluctant to move to GP care because of “But we do need similar services: for waiting lists is the lack of general the cost of seeing the doctor and the nurse-led health clinics, better links to practitioners willing to prescribe opioid monthly prescription.” mental health services, nutrition and substitutes, usually methadone, to patients Andrew Miller says cost for his patients housing. We could have vaccination out in the community. has been removed by subsidies from programmes and an outreach co-ordinator These patients have already been Northland District Health Board. in every centre to support hard-to-reach with a specialist opioid treatment service One way of managing the waiting people who inject drugs: those in rural areas, for a while, have stabilised on the right lists is interim prescribing of methadone, youth, new initiates, same sex-oriented dose for them, got other aspects of their enabling a specialist service to prescribe individuals, steroid users and Mäori.” lives back on track and are now ready to a small dose of methadone for people Charles Henderson sees the growing transfer to GP care. who have not yet begun formal opioid toll of doing nothing about this. “That normalises their condition substitution treatment. But many services “Liver clinic extrapolations show as chronic and treatable, no different have not taken it up, regarding it as 50,000 New Zealanders have been exposed from type 2 diabetes,” says Clarissa “sub-optimal” treatment and its use likely to the hep C virus – the large majority Broderick. “Also, a GP can treat their to hide the problem of excess demand. via injecting drug use. Research indicates health as a whole.” that people who inject drugs are very But at many services, stabilised ‘health services intensive’. We cannot clients are log jammed at the exit. This I’ve formed very satisfying afford to do nothing and hope the problem can happen in areas like the Kapiti Coast, relationships with my patients, will go away.” where there aren’t enough GPs, but also because many doctors are reluctant to take and I’ve seen many come right Opioid treatment on methadone patients. off methadone. A Wellingtonian who decides they Alistair Dunn, a GP and addiction have had enough of life dependent on medicine specialist in Northland, surveyed illicit opioid drugs can make their way fellow doctors about joining up to the OTS. National Addiction Centre research to the Opioid Treatment Service (OTS) Of those not already prescribing an opioid in 2008 found an estimated 10,000 people on the northern fringe of the city’s CBD. substitute, 75 percent didn’t want to. They in New Zealand had a daily opioid Here, they can put their lives into the were worried about their lack of knowledge dependence and about 4,600 were hands of the specialist team there, one of and experience, about work overload, receiving treatment. It looked at why 18 around the country. It’s where I met time constraints, pressure from patients more did not seek help. Peter, who’s been on the opioid substitute to increase doses, about the effect of their One of the other major bones of methadone for four years. presence in the waiting room and the contention for client-patients is that of “When I got here, I reckon I had about perceived complex and challenging nature ‘takeaways’: doses of opioid replacement six months left in me,” the 56-year-old of the patients given to clients by pharmacists to tide father of three grown sons says. But Dr Dunn’s colleague Andrew them over a few days. Normally, clients Peter injected opioids from the age of Miller, who has prescribed methadone for swallow the dose in front of a regular 17, with a 15-year gap when he was raising about 15 years, says he’s never experienced pharmacist, and that means possibly his family. He is here to prepare for a move stress or risk with his patients. daily trips to the pharmacist – before to general practice care in the community. “They are motivated for me to prescribe work, if people are holding down jobs. He’s been coming to the service each because they don’t want contact with Clients complain it ties them to a certain month for 48 months to pick up a ex-associates still under specialist care, pharmacist and a certain area. They want methadone prescription and going four and they’re keen to have methadone seen more flexibility with takeaway doses but, days in seven to a local pharmacist to get as a normal medication. I’ve formed very as Raine Berry of the National Association his dose. satisfying relationships with my patients, of Opioid Treatment Providers (NAOTP) A new client to the OTS undergoes and I’ve seen many come right off explains, it is not a simple issue. rigorous assessments for physical and methadone,” Miller says. “Opioid Treatment Services have to mental health. Then their first real test Blair Bishop, liaison between balance the needs for client autonomy and begins – the wait for treatment. Wellington’s Opioid Treatment Service the mitigation of potential harms caused by “The waiting is terrible,” says Peter. and local GPs, says the region could do the inappropriate use of takeaway doses. “You make this really big decision you with double its current 60 prescribing There is a market for ‘diverted’ methadone, don’t want to do this any more and you doctors. He says many find the paperwork so prescribers have to be constantly aware want to be well. So you come here, you around controlled drugs tedious and of the safety of the community. But the have to have all these tests, and your head time consuming. lack of flexibility can be frustrating for is getting ready to make the big change, but “There is no monetary compensation. clients who want to engage in spontaneous then you have to wait. So you keep using.” If Care Plus, for instance, was available to or unplanned activities such as going to the Team leader at Wellington’s service a patient, then that would largely cover beach for the day or spending the night

www.drugfoundation.org.nz 11 cover story

That is despite the World Health Organization declaring in 2004 that “every dollar invested in opioid dependence treatment programmes yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs and theft alone. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12:1.” NAOTP Chair Eileen Varley says the welfare sector can also benefit through reduced family stressors and may help divert children from CYFS involvement in their lives, as well as individuals having the potential to move from benefits to employment. somewhere other than at home. There is Methadone helps them get their children “These savings have both financial and no easy way to manage this, unfortunately.” back from care, hold down jobs, find social benefits, and it leads to the question A second barrier to a number of homes. They have vastly improved of whether the justice and social welfare would-be OTS clients is the attitude physical health and re-engage with life sectors could contribute to a service that towards them of staff. Although national and their community. The programme has such direct benefit for them.” guidelines for opioid treatment providers reduces criminal activity and the risk of Charles Henderson questions why the state that staff with “higher punitive and transmitting blood-borne viruses to other government continues to pursue illicit drug abstinence orientation (are) associated with New Zealanders. What is so awful about use as a largely criminal justice issue when lower retention of clients in programmes”, all that?” research and overseas experience points to the country’s 18 services do vary in their Dr Daryle Deering says what is needed fewer taxpayer dollars being spent if it is approach to the people they are treating. are positive recovery stories, aimed at treated largely as a health issue. NAC researcher Dr Daryle Deering says people who inject drugs and the wider “It would be a pragmatic response that’s because they depend very much on community, highlighting that opioid to illicit drug use and its related harms, the philosophy of the clinical leaders at treatment is effective. just as setting up the world’s first each centre. And it certainly is. A 2004 study national needle exchange programme “Some are more paternalistic and investigated the costs and benefits was a pragmatic response to the take an approach counter to the literature of methadone treatment amongst a HIV/AIDS epidemic.” on effective treatment,” she says. “For Christchurch client sample and found Clarissa Broderick agrees, saying example, they insist other drug use – other treatment saved $25,000 per life year. the irony of imprisoning someone who than nicotine or perhaps cannabis – has Those on the frontline of providing is waiting to access opioid substitution to stop before a client starts receiving opioid treatment would like some more treatment is that methadone is inexpensive. opioid substitution treatment, and that of those savings returned to them. In “Packing someone who injects drugs off is reinforced later by regular urine tests. addition to treating opioid dependence, to jail makes no economic sense.” If other drugs consistently show up in they are expected to support and improve So maybe the easiest method of those tests, rather than taking a clinical their clients’ psychosocial wellbeing and reducing stigma and shortening those individualised approach, a contractual that of their families. They say they could queues to access help lies with the GPs. protocolised approach is taken, leading do that a lot better if they had adjunct Whangarei GP Geoff Cunningham, to a loss of privileges should the client services to provide a more holistic who has prescribed methadone for not meet service ‘rules’. approach: employment advisors with 15 years, says he would encourage his The danger of such an approach is that concrete options for job training, housing fellow doctors to climb on board. those people with the most complex issues advisors, parenting skills workshops, “Our patients have been selected are excluded from treatment. In some budgeting advice and counselling. very carefully to transfer from specialist cases, those services who do not demand Wellington methadone client to GP care. They are stable and well strict compliance with rules will be able to Peter believes housing is a top priority. managed, and I’ve had nothing but good take people faster than those whose criteria “To get away from people hassling you experiences with them. They are colourful, for entry includes stopping other drugs.” for your methadone, somewhere that’s delightful characters, and it is easy to build A third major barrier is the stigma yours and secure and warm, that’s rapport with them. In some ways, it is the associated with being a person who injects essential to recovery. I’ve seen people most rewarding aspect of my practice. drugs – perhaps reflected by the fact here transform from really jittery to really These guys are successfully rebuilding that GPs are allowed to refuse to treat calm in weeks, just because they’ve got their lives and health, and you get to be a patient requiring an opioid substitute, stable and safe accommodation.” a big part of it. Who wouldn’t enjoy an but no other. But such services cost money, and opportunity like that?” “Even we feel the disapproval of other Clarissa Broderick, for one, says her team health workers,” says Clarissa Broderick. is just trying to work smarter with the Penny Mackay is a Wellington-based radio and “And the stereotypes of an opioid resources they have because they know print journalist. treatment client makes my blood boil. no more money is coming.

12 matters of substance August 13 The wait

Opioid Treatment Services (OTS) are regionally operated around New Zealand. In some areas, people are waiting up to six months to get onto a service. For people in other cities, it is a matter of days.

x20 6 months Wellington Auckland – 0 people – No waiting list Christchurch – 0 people – No waiting list

OTS Team Leader Clarissa Broderick: We Tries to take clients from first presentation Clinical Director Speciality and Addiction have been two full-time case managers down to first dose within days. Auckland OTS Services, Canterbury DHB Specialist Mental for about six months. It is hard to recruit the Manager Toni Bowley: We are a large service Health Services Dr Alfred Dell’Ario: We right people and then hold on to them when with a large staff and can operate economies haven’t had much difficulty recruiting or they face heavy workloads of sometimes of scale. This means we can have admissions retaining staff so don’t have any specific complex and challenging cases. Premature based on clinical capacity rather than being difficulties around waiting times. The service burnout is not rare. We expect applicants to restricted to a funded number of opioid is closely aligned with primary care, allowing have specialist qualifications and a particular substitution therapy places. The criteria for the majority of clients to be treated in the skill set. I’m uncompromising on that because entry to our service is also lower than for community. We have 164 GPs willing to we value the standard of care we provide. some other services. This does not come prescribe, and 77 of them are engaged with without its problems, as staff caseloads swell clients currently. and can become a challenge to manage. x2 6 months Dunedin – 0 people – Currently no waiting list, but that is about to change Whanganui x2 2 months Medical Director CADS Dr Gavin Cape: Mental Health Clinical Director Frank West Coast We are simply not funded for everyone who Rawlinson: We have a capped number of needs our service. Two or three years ago, we places that are based on general population. Programme Co-ordinator Paul Eathorne: had a waiting list and addressed that using This means no one can enter the programme We have a problem recruiting people to the interim methadone prescribing. until someone else is stabilised enough West Coast and keeping them here, especially to move on. We could do with more GPs prescribing GPs. We are funded for 51 people out in the community willing to prescribe but currently have 75 on the books, and just Rural Otago – 0 people – No waiting list opioid substitute. five are out on GP authority. This service is at capacity but with no waiting list at present. There are more people being Gisborne – 0 people – No waiting list Nelson-Marlborough – 0 people transferred in, especially from Christchurch. – No waiting list Medical Director CADS Dr Gavin Cape: Medical Officer for Opioid Treatment The OTS service in Otago has underestimated Programme Dr Patrick McHugh: Our Addiction Services Manager Eileen Varley: the number of people in Otago with serious managers have smaller caseloads than the NMDHB Addiction Service has developed a drug problems and CADS has an OTS case larger busier centres so they can perhaps spend twice-weekly drop-in clinic for stable clients load far greater than it is funded for, which more time with each client addressing their to be seen by clinicians. It enables clinicians has stretched our service provision to the psychosocial needs. That means we can move to focus their time on other clients with higher limit. I believe CADS is attempting to respond them through the service quite quickly. We needs or circumstances requiring greater time to the community need but lacks full resource don’t seem to have a problem recruiting staff, input. The clinic means a more effective use of support to continue to do so. and I know all the local GPs so don’t really clinician time, which helps ensure waiting lists have a problem recruiting them either. can be managed proactively.

www.drugfoundation.org.nz 13 FEATURE Needles and NIMBYs Challenges to setting up a needle exchange

The cry “Not in my back yard!” is often heard when communities are confronted by a social solution they don’t fully understand. But when implemented with persistence and care, harm reduction initiatives like needle exchanges can win out over fear and misplaced loathing. Rob Zorn examines two communities where needle exchanges now work quietly and effectively. Rob Zorn

ost right-thinking or Palmerston North for equipment was people would becoming a barrier to sterile needle use What do Needle exchange agree that needle in the Wairarapa. But it wasn’t popular programmes do? exchanges are a with everyone. in line with New Zealand’s National Drug good idea. Few of “It was a difficult project,” says Policy, needle exchange programmes seek us would want to Needle Exchange National Manager to minimise drug harm by providing injecting equipment, education and information have to use one, but Charles Henderson. M on reducing drug use. They provide early they help stop the “There were lots of stakeholders intervention where appropriate as well as spread of infectious blood-borne diseases involved, and many had little understanding referrals to treatment, medical care, legal like HIV and hepatitis C, and we all benefit of how blood-borne viruses target hidden and social services. Staff also provide from that. populations involved in covert behaviours condoms and safe-sex education. But how would you feel if one like injecting drugs and how easily those Equipment supplied includes needles and opened across the road from your home? diseases can spread into the general syringes, swabs, butterflies, filters and vials of What would it say about you or your population. sterile water along with sharps containers for neighbourhood if the view outside your “There were the usual fears the the safe disposal of used injecting equipment. window included an injecting equipment exchange would be dealing drugs or dispensing machine and a mounted sharps become a hangout for unsavoury people. disposal bin? What would happen to your Others were worried kids might get into house price, and how often would you have the disposal containers and start playing to shield your kids from dodgy druggies with discarded needles. Business owners doing dastardly deals on your doorstep? on either side of the premises – one a car The setting up of two needle exchanges dealer and the other a tattooist – were quite in recent years has illustrated that NIMBY vocal and tried to rally the community (not in my back yard) syndrome is alive against the exchange.” and well in New Zealand. In Masterton The Rotorua outlet was more directly (2008) and Rotorua (2010), objections from a New Zealand Needle Exchange initiative fearful community members were among based on distribution information – and the obstacles that had to be overcome. because the one pharmacy dispensing The Masterton clinic came about as needles there was under pressure to meet a result of requests from the community. demand. There were a few objectors, A local alcohol and drug unit and an active but the community’s initial reception was group of local consumers were concerned more muted than in Masterton. A potential that having to travel as far as Wellington landlord was identified who visited the

14 matters of substance August 13 and their effect on the community and a single incident with either the car paints a picture that is far from the truth. dealer or the tattoo parlour owner once “The reality in New Zealand is that the exchange went ahead and that relations most intravenous drug users using needle quickly became neighbourly. exchanges are living stable and productive “The car dealer guy was just a bit lives. They’ve often got families and want old school, but he changed his tune and to use clean equipment because they are seemed to accept us once we were there.” motivated to keep themselves and others Detective Sergeant Rick Joblin, who in their lives safe. They have no desire to was Area Intel Manager in Masterton make trouble and would seriously prefer in 2008, said he remembers some initial Hamilton exchange and came away not to be noticed at all. community concerns that unpleasant satisfied, and the Council was quite “In fact, communities need to be aware characters might start loitering outside of the fantastic service needle exchanges supportive – until the exchange applied their new “resort”, but he said that hasn’t offer them by helping to keep their for resource consent to provide an transpired at all. intravenous drug users safe, informed electronic dispensing machine and “I can’t remember a single complaint and disease free.” sharps disposal bin for after-hours use. or any time we’ve been called there to The Council turned the application So are most local residents aware deal with trouble. Quite frankly, for us down, saying the exchange had not of the great service being run in their the needle exchange just isn’t an issue.” demonstrated that the 24-hour electronic neighbourhoods? Probably not, but most Denise Gemmell says law enforcement dispensing machine and disposal facility would not even be aware the exchange in Rotorua has been a little more guarded wouldn’t have an adverse effect on the was there in the first place. with its support, but that she is also character of the surrounding area. They also Needle exchanges tend to keep a said there was a potential for disturbance low profile. Signage is very limited unaware of any complaints or Police from clients arriving by car at night and and often little more than small blue involvement with the Rotorua exchange. from the activation of security lights. universal needle exchange arrows and “On the whole, New Zealanders are Ironically, two other 24-hour window stickers. You probably wouldn’t generally a pragmatic and egalitarian lot. businesses were already operating in the recognise them if you weren’t already Once you explain the benefits to them, they neighbourhood, one a noisy trucking firm. in the know. Dispensing machines and tend to take a live and let live attitude and This convinced Hamilton Needle Exchange disposal containers are easy to get to but just get on with things. There will always Manager Denise Gemmell, who was not visible from the road. The dispensing be discomfort with drug use, but once they in charge of establishing the Rotorua machines are protected by a security code see nothing nefarious is going to happen exchange, that the refusal was both only given out to clients, and it would be in their back yard, many actually become unreasonable and discriminatory. She impossible even for the most resourceful quite supportive.” visited 20 homes in the neighbourhood of children to break into a sharps disposal And if there’s a needle exchange on and managed to get written support for the bin. Short-term parking is readily available, your street and you’re worried about your exchange from 19 of them. and clients come and go quickly, quietly house price when you’re selling, just don’t A lawyer was also engaged to argue and with a minimum of fuss. tell the new buyers. Chances are they will that the refusal was groundless in that As a result, neighbours seem either never know. the exchange had minimised all potential quickly to forget about the exchange or to harms and was in full compliance with the see it as of no concern. Masterton Exchange Rob Zorn is a Wellington-based writer. law. The Council eventually relented, and Manager Brendon Olsen said there was not the dispensing machine and sharps bin were installed. There’s actually little a community THE NUMBERS can do to stop a well organised needle exchange from being established, and dollars in health expenditure both Masterton and Rotorua exchanges for every dollar spent on needle the amount of times the average went ahead without further incident. 20 exchange 7–10 needle and syringe are reused Nevertheless, the New Zealand Needle Exchange and the Ministry of Health will do what they can to ensure neighbours less than 1 percent: the rate of percent of those imprisoned in the last and those affected are aware of what’s HIV among injecting drugs users in 12 months used a needle exchange happening, that their fears are allayed and 1% New Zealand is the lowest in the world 25 and injected while incarcerated their questions answered. In Masterton, a series of public meetings was held, and in Rotorua, Denise Gemmell visited all neighbours in the vicinity personally. In both towns, Police were informed 50,000 10–30,000 so that co-operative relationships could New Zealanders carry the hepatitis C virus, injecting drug users in New Zealand be established. many of them unaware (injected in the last 12 months) Ms Gemmell says the media sensationalises people who inject drugs

www.drugfoundation.org.nz 15 HELP CLEAR THE CLOUDED CONVERSATION AROUND CANNABIS

27–29 Join us for three days of insightful dissertations, November 2013 debate and discussion on all things cannabis. Auckland New Zealand registrations now open nzdrug.org/cannabissymposium Why Speakers why should you come? Nadia Solowij • World-class experts answering your Nadia is a genius on the effects of cannabis on the questions on the health effects of cannabis. brain and currently is an Associate Professor in the School of Psychology at the University of Wollongong. • International symposium in our backyard. • Build consensus about the way in which we Professor Wayne Hall should be dealing with New Zealand’s most Professor Hall is a fountain of knowledge on the widely used illicit drug. health effects of cannabis. He spoke at our first cannabis and health conference in 1993. Currently, To find out more reasons to come he is at the University of Queensland specialising visit nzdrug.org/cannabiswhy in addiction, mental health and public health. Richie Poulton % % Y Richie is the director of the Dunedin longitudinal 46 20 17 study that operates out of Otago University. He’s one OF NEW ZEALANDERS of people who have Average age people of New Zealand’s ‘go to’ experts on the long-term effects HAVE USED CANNABIS used cannabis try cannabis for have experienced the first time of cannabis. harmful effects To find out who else is speaking Topics visit nzdrug.org/cannabisspeakers prevention — What works to stop early use? Details where Rendezvous Hotel treatment Auckland, New Zealand — What is working? when 27–29 November 2013 cannabis and crime — How does the justice system cost Earlybird special $650 (Now ends 20 September) deal with cannabis? Full rate $800 medicinal cannabis Student $420 — Are the medical benefits real? contact [email protected] synthetic cannabis 04 801 6303 — Is it cannabis at all? register drugfoundation.org.nz global perspectives — What is happening around the world?

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Turning tide on compulsory Russell Brown treatment he line between support and punishment for Slave labour. Torture. Forced participation in medical drug users has been blurred in many research. It reads like an account of some bleak, distant countries, but the chapter of human history – but it’s the contemporary situation in East T and Southeast reality for around 300,000 people detained in more than Asia is particularly dire. Drug users suffer 1,000 compulsory, government-operated drug treatment human rights abuses not even inmates convicted of serious crimes have to face. centres in East and Southeast Asia. Russell Brown reports. And compulsory treatment fails not only ethically, but practically as well. It’s not just cruel; it doesn’t work. A 2009 World Health Organization review of practices in Cambodia, China, Malaysia and Vietnam (with a particular focus on injecting drug use and HIV) found some recent improvement in China but made a series of urgent recommendations as a short-term means to improve practices in the treatment centres, starting with making them non-compulsory. First, said the authors, a distinction needs to be made between people who use drugs occasionally and drug-dependent people. Those dependent should have the choice to attend a drug treatment facility or not, since the right to health also includes the right to be free from non-consensual treatment. Further, treatment centres should be age- and gender-appropriate, offer evidence-based medical care, including methadone treatment (evidence shows opioid substitution therapy is the most efficient way to treat heroin dependence) and anti-retroviral therapy. They should offer HIV-prevention advice and be free of charge. Mandatory re-education labour is to be discouraged. Last year, a dozen United Nations agencies, including the UN Office on Drugs and Crime (UNODC), UNESCO and UNICEF, made a similar call, but much more forcefully. In a joint statement, they called on “states that operate compulsory drug detention and rehabilitation centres to close them without delay and to release the individuals detained”. A prisoner in a Thai drug jail having his head shaved.

18 matters of substance August 13 As well as threatening the health of countries that currently practise worse for alternative approaches and a move detainees, the agencies said, compulsory regimes. It’s important to note that we beyond the ‘control and contain’ approach treatment centres posed a broad threat still have compulsory centres that have that has been common to many countries, to human rights. Detention frequently not been phased out. People are still there would be thousands more detainees.” takes place without due process or being sentenced.” Both Wolfe and Rahman agree the legal safeguards. Daniel Wolfe, Director of the Open motivation for change is driven more by “Furthermore, detention in these Society Foundations’ International Harm the recognition that the old approach was centres has been reported to involve Reduction Development Programme, agrees simply ineffective than any ethical qualms. physical and sexual violence, forced that Malaysia is providing a useful model “I’m not sure if you’ve had many labour, sub-standard conditions, denial for other countries, both through direct candid conversations with Malaysians,” of health care and other measures that visits like that by the Vietnamese says Rahman, “but if you ever did, you violate human rights.” delegation and via regional conferences. would realise that ethics is not The agencies’ statement capped a more “But Malaysia may also be a model predominant within their education.” important and practical move that began in in another, less desirable way, since most Efficacy is a much easier sell. 2010 when international agencies began to countries in Southeast and East Asia that “At the recent International Harm withdraw funding from detention centres. practise drug detention seem to want to at Reduction Conference in Vilnius,” says In his recent article for the least keep compulsory centres operational.” Wolfe, “a representative from the World International Journal of Drug Policy, Rahman says Cure & Care clinics, Bank presented a slide showing sharply ‘Compulsory drug detention in East and “have methadone provision and basic improved success from the Cure & Care Southeast Asia: Evolving government, healthcare services. Vocational training centres compared to the compulsory UN and donor responses’, Joe Amon notes and job placement occurs upon referral centres run by the same agency.” that UNICEF and other donors have in the to a separate facility. They are trying Amon writes, “Despite rhetoric past offered donor support to detention to integrate services beneath one roof, that drug users are ‘patients’, not ‘criminals’, centres in Cambodia, Laos and Vietnam as in a similar way to Switzerland. the approach in most countries is still driven a kind of lesser evil, in an attempt to build “But due to the conservative more by an imperative of maintaining social the capacity of the existing centres to Muslim sensitivities the government cohesion, which is seen as paramount over provide drug dependency treatment and subscribes to and stigma arising therefrom, as part of a policy of strategic engagement sexual reproductive services are nowhere individual rights.” with government officials. near what they should be. Cure & Care Inevitably, progress in the region The force and nature of the UN clinics also do not allow for needle and remains uneven, says Wolfe. “And China, agencies’ landmark statement might have syringe programmes. Clinics frequently which has proven indifferent to many given the impression that no progress was have quotas and waiting lists, and that external human rights commentaries being made at all. Happily, the news is a impedes treatment. There are some and is too big an economic force to be bit brighter than that. Indeed, it may be Cure & Care clinics, however, that intimidated by threats by outside labour that the tide has begun to turn on the operate above capacity.” advocates, may be particularly hard to culture of compulsory treatment. Rahman credits the Director-General move on the drug detention issue. Other Six months after the joint statement, of Malaysia’s National Anti Drug Agency countries, like Cambodia and Laos, are a UNODC publication hailed Malaysia’s Puan Sri Dato’ Zuraidah Haji Mohamed more off the international radar and also two-year-old network of open-access for the positive change. Government should not be forgotten.” Cure & Care 1 Malaysia Clinics. It said, officials, she says, have far less to say UNODC, which has taken the strongest “Malaysia has made considerable progress and “the media is pretty quiet about stance amongst the agencies, might be in the provision of drug treatment.” the transition to voluntary treatment”. accused of wishing change into being when UNODC noted research visits to the Wolfe says the local leadership of it hails progress on reform. Nonetheless, clinics by delegations from Vietnam, officials like Mohamed remains the key there is a new, cautious optimism that Cambodia and Myanmar, countries that factor in progress. lasting change is now in motion towards all plan to make changes in the way they “Statements by the UN, criticisms a goal that will, says Amon, require treat drug dependence. Has Malaysia of forced labour by American apparel “much more work” to reach. become the regional exemplar? manufacturers and human rights reports “That is a fair conclusion,” says Fifa have all likely played a role, but country Russell Brown blogs at publicaddress.net and Rahman, Policy Manager at the Malaysian buy-in has been the single definitive factor. hosts Media3. AIDS Council, “but only in regard to Without local leadership willing to push

www.drugfoundation.org.nz 19 FEATURE Psychoactive Substances

Act 101 Catherine McCullough A world-leading piece of legislation has been passed in New Zealand to regulate new psychoactive substances. What is it all about, how does it work, and where do we go from here? Jackson Wood and Catherine McCullough Jackson examine the Psychoactive Substances Bill. Wood

ere at the Drug Jim Anderton noted that New Zealand’s Foundation, we are drug law, a relic from the 70s, simply It is encouraging to just a little bit proud could not handle the rapid development of New Zealand. and marketing of new drugs. think that drug policy Our Parliament In 2007, the Labour-led government can be worked out, and recently passed asked the Law Commission to conduct even improved, in this H the Psychoactive an independent review of New Zealand’s non-partisan fashion. Substances Bill by Misuse of Drugs Act (1975) (MODA). 119 votes to one. This almost unanimous The detailed report the Law Commission support for a Bill that regulates the released in 2011 supported Anderton’s they sat in a legal grey area. ‘legal high’ industry represents a big step conclusions and outlined a legislative The Psychoactive Substances Act is forward for New Zealand’s drug policy. response to the growing problem of an attempt to remove that grey and reverse The law is a pragmatic and evidence- emerging psychoactive substances. the situation where substances can be sold based approach to recreational drug use, Under a National-led government, without consideration to health and safety. and health and harm reduction are clearly Associate Minister of Health Peter Dunne Put simply, the law sets up a legal its main purpose. brought the Psychoactive Substances Bill framework for the testing, manufacture, before Parliament where it was passed into The history sale and regulation of psychoactive law in early July 2013. products. It reverses the onus of proof so New Zealand is often considered the One reason we are so proud is that, the people who want to sell the substances birth place of ‘legal highs’. As in many from conception to enactment, this piece have to prove that they are ‘low risk’ before other western countries, our drug laws of law has had (for the most part) support only banned specific substances. In the late they can be sold. from all the parties in Parliament, and very This means each product has to go 90s, some people cottoned on to the idea little political game playing has taken that a substance with effects similar to an through a clinical testing process that will place. It is encouraging to think that drug cost the manufacturer around $2 million. illicit drug could be legally sold as long as policy can be worked out, and even The clinical testing process will answer it had not been specifically banned. improved, in this non-partisan fashion. The substances that first came out, basic questions about each substance. like benzylpiperazine (BZP), mimicked What does it do? Is it poisonous or addictive? Is it likely to the effects of banned substances. People As we moved through the 2000s, it cause cancer? Will it cause kidneys to shut purchased them. Other people started became obvious that, as one substance down or cause psychosis? If the answer is to get worried about their effects. Media was banned, another one would pop up to yes to any of those questions, it is highly started doing stories about the drugs. take its place. Meanwhile, the ‘legal high’ unlikely the product will make it to market. It was only a matter of time until industry was making millions of dollars This is because the purpose of the law government took notice, and in 2004, from products that had no regulation is to “protect the health of, and minimise then Associate Minister of Health around their manufacture, sale or safety – the harm to, individuals who use

20 matters of substance August 13 psychoactive substances”. An Authority is currently being set up that will produce Animal testing guidelines around what constitutes ‘low risk’ and also administer the law and The testing of psychoactive substances on animals was a controversial aspect of the legislation. provide recommendations to government. Because of this, the final rules around animal testing are much more robust in protecting The results of clinical tests will be animal welfare. publicly available regardless of whether Under the legislation, animal testing is a last resort. An alternative testing technique must be the substances pass the ‘low risk’ threshold. used if it exists. If alternatives to animal testing are not used, the Authority will disregard results. This means the public, health professionals In circumstances where alternatives do not exist, animal testing can only go ahead if it meets and other countries looking on will have the following criteria: much better information on what’s in these products and what their effects 1. the trial is based on the relevant International Conference on Harmonisation Guidelines. might be. 2. If the trial is undertaken in New Zealand it complies with the restrictions placed on the use There are specific restrictions in the of animals in research under the Animal Welfare Act 1999. law that mean licences will need to be 3. If a trial is undertaken overseas, it complies with the restrictions on the use of animals obtained by any company wishing to import, in research, testing or teaching that are equivalent to or exceed those in the Animal export, manufacture or sell psychoactive Welfare Act 1999. substances. Dairies are specifically excluded from being able to sell, and communities will be able to have a say over if, and where, products can be tested, and the Authority stores that sell psychoactive substances are has produced guidelines. allowed to open. Built into the legislation is a requirement The Law The law will apply some of the best that it be reviewed by Parliament within five At a glance harm reduction tools from tobacco and years. This means that, if certain aspects of alcohol control to these products. Products the law are not working, they can be fixed, • The Act sets up a legal framework will need to come with health warnings, and the focus remains on protecting health for the testing, manufacture, sale and lists of ingredients, contact information for and minimising harm. regulation of psychoactive products. the National Poisons Centre. Advertising But the most exciting thing about the • Health and harm minimisation are or marketing of the products will not be passing of this cutting-edge legislation is included in the Act’s purpose. allowed, and importantly, the age of what it means for all of New Zealand’s • Products will no longer be sold in dairies, purchase is pegged at 18 alongside alcohol drug law. grocery stores etc. People and businesses and tobacco. MODA – at almost 40 years old – will need a licence to sell these products. One key health measure in the law is focused on punishing people who use • There will be restrictions on advertising, is the provision allowing the Authority drugs. By comparison, this new legislation marketing and the purchase age (18+). to recall products that turn out to cause is evidence-based and has health and harm • As with alcohol, councils will have harm not detected in clinical trials. The reduction at its heart. Authority will be able to do this without the option of developing local policies The Law Commission’s report provided any need for legislation – it will simply around where stores can be located. a blueprint for this legislation but also revoke the licence. for the reform of our drug laws as a whole. • Products will undergo rigorous clinical While there are a number of offences We reckon it’s time to roll up our sleeves testing to determine whether they are contained in this Bill, people who commit ‘low risk’. and, with the same spirit in which this law minor offences will not be criminalised. was made, bring New Zealand’s drug law • Clear rules around use of animal Those caught with unapproved into the 21st century so it becomes sound, testing. Animal testing can only substances, or buying approved products be used if there is no alternative. while underage, will be subject to an health-focused and modern. • If a product is proven ‘low risk’, infringement notice and fined. Unlike But for now, the world is watching as long as a person meets certain those caught with drugs scheduled New Zealand to see how well this new criteria (e.g. person of good repute, under the MODA, they will not run the model works. We are confident it will. New Zealand citizen), a three-year risk of having a criminal conviction on licence to sell that product can their record and cannot be jailed. The Jackson Wood and Catherine McCullough be granted. worst possible outcome is they don’t pay are Senior Advisers at the New Zealand their fine and it gets bigger. Drug Foundation. • Products that appear to cause more harm than clinical testing showed Where to from here? Find out more can be pulled from the market. A transitional period is now under • A register of all approved and • Psychoactive Substances Act (2013) way where products for sale in the three unapproved products will be publicly months prior to the Act coming into nzdrug.org/parliamentpsychoactive • Ministry of Health information about the available. effect may be granted an interim licence Psychoactive Substances Regulatory Authority • A code of practice for manufacturing for sale that will last until regulations come nzdrug.org/mohpsychoactive and retailers will be in place within into effect. The producers of any • New Zealand Drug Foundation page about six months. of these products can apply for interim Psychoactive Substances licences to continue selling until their nzdrug.org/PSBsubmission

www.drugfoundation.org.nz 21 FEATURE

The Retreat

On a leafy O¯ ta¯huhu street just off Auckland’s Southern Motorway is a new recovery centre called The Retreat. Utilising a ground-breaking residential treatment model developed in the United States, The Retreat harnesses Keri Welham the will and experience of volunteers from the recovery community to deliver its programme. Keri Welham reports.

t the end of an opened in April, and by early June, it had otherwise plain five graduates and two clients in residence. little street, a gap Each client checks in for 30 days at a cost in the trees offers of $5,850 plus GST. The substantial saving, a view of the compared with many other residential Tämaki Estuary treatment options, comes courtesy of A and the factories The Retreat’s major point of difference of East Tämaki. – its programme is delivered wholly by This is Avenue Road East in Ötähuhu, volunteers from the recovery community. and Craig LaSeur thinks it’s the perfect The volunteers are hand-picked for location for his suburban sanctuary. their message of hope, their own solid The American clinician has relocated recovery and their ability to connect Down Under to run the New Zealand with guests. While clinicians oversee the version of The Retreat. The 10-bed facility programme and control induction, the

22 matters of substance August 13 volunteers run workshops, chapel, music ready to change. He spent 28 days in jail, LaSeur says the volunteer-led model nights and onsite fellowship meetings. his wife left him, and he exited the Marine of treatment on offer at The Retreat is not This model saves money, making treatment Corps before he could be kicked out. for everyone. He believes it would never more accessible for those with limited Six years later, he was 28, working as work for teenage males with chemical financial means, and allows guests to see a cook in Chicago and addicted to crack addictions as they need much more what long-term sobriety looks like up close. and alcohol. He had been sleeping in a structure and discipline. It wouldn’t have In the women’s wing is a guest who is park with his rottweiler Magnum. One worked for him, LaSeur says, as his crack in her 30s. Her bed is made, a book from night, he called his mother and she said, addiction necessitated a complex detox the vast body of 12-step literature lies on “I love you” and hung up. On a Wednesday and clinical expertise. her quilt, and two gorgeous girls beam out afternoon soon after that phone call, he And so, every week, LaSeur refers some of a photograph propped up on a wall. woke up on a cocktail waitress’s couch, potential guests to other facilities. The bathrooms here look every bit like saw the paraphernalia of another night “There are those individuals who they belong in the rest home this once was. of drugs and drink, realised it was 2pm, need that clinical environment, and there The doorways are wide, the fixtures are called his stepfather and said he was ready. are also those who don’t. We are not a reminiscent of a 1980s school ablution hardcore programme.” block, and there’s an excess of beige. But The Retreat is run as a charitable trust. the bedrooms have particularly plush- There are those individuals If there is ever a surplus of funds, it will looking single beds – a comfort factor the that need that clinical be used on scholarships to further discount trustees refused to scrimp on – and are the fee. decorated in modern, welcoming tones. environment, and there are LaSeur says recent independent There are 10 guest beds, with the also those that don’t. We are outcome studies of guests at The Retreat in capacity to add another 16 eventually. not a hardcore programme. Minnesota have shown long-term sobriety In the reception area is a photograph results as good as – and sometimes of the 1958 Junior All Blacks. Next to Sir better than – those seen in much more Colin Meads, in the row behind captain His parents had been waiting for that expensive programmes. Sir Wilson Whineray, is Roger Green. phone call a long time. They had a bed LaSeur used to volunteer at The Retreat The well known and respected addiction waiting for him, a phone assessment practitioner has worked tirelessly over many booked with the famed Hazelden in Minnesota, which is situated in the years to make this centre a reality, and addiction treatment centre, and he was cathedral-like Wayzata Big Woods just despite being in his 70s, he joins LaSeur as on a plane to Minnesota 48 hours later. west of Minneapolis. And so, the suburban the other clinician on The Retreat’s team. Today, LaSeur is 43, married to Patricia setting for New Zealand’s version of The The kitchen is a simple set-up where and they have two sons. Once sober, LaSeur Retreat concerned him when he first looked guests prepare their own breakfast. The gained a sociology degree and studied at up the address on Google’s Street View. chef, himself in recovery, makes lunch the Hazelden Graduate School of Addiction What if the neighbours had regular parties and dinner, and the guests, staff, volunteers Studies. He worked in detox, then at and the sounds echoing over the fence and occasionally trustees eat together. Hazelden as a clinician, then at a sanctuary upset the sanctuary-like atmosphere of The LaSeur says guests are nervous on in the Washington State rainforest where Retreat? What if passers-by were forever their first day. The 12-step culture comes he ran a programme for 16- to 24-year-olds trying to get a gawk at the latest arrivals? wrapped in a new language of terms with chemical addictions. The challenge As it happens, Avenue Road East is and ideas. Often, the only sounds are feet of building a recovery centre from scratch quiet, and the neighbours are a non-event. padding down a hallway or pans clanging was enough to lure him to New Zealand. The beige and brown blocks of the former in the distant kitchen. The television is LaSeur follows the Blues rugby team, rest home and children’s hospital nestle only turned on one night a week. The goal is an enthusiastic new recruit to Facebook in between modest homes and a plant is a quiet, meditative atmosphere. and walks around with a colleague’s tiny nursery. There is no Betty Ford-style glitz, In the men’s wing is a guest in his 50s. mutt Froggy tucked under his arm. He has no high hedge, no exclusive address or Laid out on his bed are neat piles of the height of a basketballer, a youthful face, sense of isolation from the world – and reading material. a strong handshake and a deep enthusiasm to LaSeur’s mind, that’s part of the magic. At one stage, he passes LaSeur’s office, for catering to those who can’t afford With its unexceptional appearance, and the two bounce off each other. expensive treatment. geography and atmosphere, The Retreat “What are you up to,” LaSeur says, “Having something that’s affordable, offers a picture of everyday suburban with a warm, exuberant smile. there’s something about that that plucks sobriety. “Trying to get better,” the man calls my spirit.” “Here’s this little gem in South out, as he strides on by. LaSeur says The Retreat doesn’t offer Auckland,” LaSeur says. Froggy scuttles LaSeur has been sober 15 years. He counselling. around his feet. Wheelie bins line the curb went to his first 12-step meeting, on a beach “We are not an expert-driven model. for rubbish day. Autumn leaves create in Hawaii, when he returned from serving “It’s a practical programme of action perfect circles of colour at the feet of in Desert Storm with the US Marines. rather than reflection and self-pity.” smooth grey trunks. And for two people “You’re not allowed to do crack in He makes sure the guests are safe, well sitting down to lunch within the safety the Marine Corps,” he says, deadpan. fed and having a good time (by which he of these walls, a rebirth is under way. He was facing drug charges in a military means, getting sober). court, the collapse of his marriage and the “I kind of think of myself as a bed and Keri Welham is a Tauranga-based writer. crumbling of his career, but he wasn’t breakfast manager.”

www.drugfoundation.org.nz 23 ABOUT A DRUG

Heroin is always referred to as diamorphine when used in medicine, and it is almost always indicated to treat chronic pain. It is supplied in either tablet or injectable form, often in preference to morphine because it has less severe side effects. While non-medicinal use is almost universally illegal, a number of countries have been experimenting with diamorphine maintenance programmes to treat users who have failed at other withdrawal programmes. In 1994, Switzerland began such a trial in which it proved superior to other forms of treatment in improving the social and health situation for illicit heroin users. It was also found to save money, despite high treatment expenses, Heroin was first synthesised in 1874 by significantly reducing costs incurred by HHeroin is probably the most eby English chemist C R Alder Wright, trials, incarceration, health interventions but it did not become popular until it and crime. infamous member of the was independently re-synthesised 23 years The success of the Swiss trials later by German chemist Felix Hoffmann. opioid family. Opioids are led Germany, Holland, Denmark and Hoffmann was trying to produce what Canada to try out similar programmes. depressants, not because we now know as codeine – a substance Some Australian cities (such as Sydney) similar to morphine but less potent and they make you sad, but now have legal, supervised injecting addictive. Instead, he produced a form centres, in line with other wider harm because they slow down of morphine that was almost twice the activity of the central as potent. minimisation initiatives. Bayer was quick to market the new nervous system and ‘diamorphine’ as a cough suppressant messages sent between and cure for morphine addiction under the trade name heroin. The discovery that the brain and the body. it was, in essence, a quicker-acting form Alcohol, benzodiazepines, of morphine was embarrassing for Bayer and has gone down in history as one of the GHB and cannabis are also company’s biggest blunders. depressant drugs. In 1914, the US passed the Harrison Narcotics Tax Act to control the sale and distribution of heroin and other opioids, restricting its use to medicinal purposes Heroin is also known as only. It is now a Schedule 1 substance, ‘smack’, ‘skag’, ‘dope’, ‘horse’, which makes it illegal for non-medicinal ‘H’, ‘junk’, ‘hammer’, ‘slow’, use in signatory nations to the Single ‘gear’, ‘harry’, ‘big harry’, Convention on Narcotic Drugs treaty. ‘black tar’, ‘china white’, Today, Afghanistan remains the world’s ‘Chinese H’, ‘white dynamite’, largest producer of heroin. In 2004, it was In non-medicinal settings, heroin is ‘dragon’, ‘elephant’, ‘homebake’ producing 87 percent of the world’s supply. used as a recreational drug for the rapid or ‘poison’. (5α,6α)-7,8- However, production in Mexico rose 600 onset of transcendent relaxation and didehydro-4,5-epoxy-17- intense euphoria it induces. In the 1996 methylmorphinan-3,6-diol percent between 2007 and 2011, changing r diacetate. that percentage and making Mexico the filmTrainspotting , lead character Mark second-largest producer in the world. Renton describes its effects as follows: In New Zealand, heroin is classified “Take the best orgasm you’ve ever had... as a Class A drug under the Misuse of multiply it by a thousand, and you’re still Drugs Act 1975, attracting a maximum nowhere near it.” term of life imprisonment for importing, The onset of heroin’s effects manufacturing and/or supplying. depends upon how it is administered. Possession carries a six-month Intravenous injection is the fastest route imprisonment term and/or $1,000 fine. of administration, causing blood

24 matters of substance August 13 concentrations to rise the most quickly, reflex becomes suppressed, resulting in followed by smoking, suppository insertion depletion of blood-oxygen levels (anoxia). (anal or vaginal), snorting and ingestion. However, because heroin can cause severe Effects can last from five to eight hours, nausea, a significant number of deaths typically peaking at around two or three attributed to heroin overdose are actually hours after administration. Heroin’s caused by the unconscious victim choking relatively low half-life means dependent on their own vomit. users may need to take the drug two or Intravenous use of heroin with more times per day. non-sterile needles and syringes may As with most opioids, unadulterated lead to contracting blood-borne diseases heroin does not cause many long-term (e.g. HIV and hepatitis) poisoning from complications other than dependence contaminants used to ‘cut’ the heroin and and constipation. It can suppress the decreased kidney function, though this may immune system, and this may lead to be caused by contaminants or infectious opportunistic infections, which carry disease rather than by heroin itself. their own lasting effects. A range of treatments including However, heroin is usually far from behavioural therapies and medications unadulterated by the time it reaches the can help addicted people stop using heroin It is difficult to think about heroin use end user. Figures from the UK, for example, and return to stable lives. in New Zealand without associating it with indicate the average purity of street heroin nthe Mr Asia Syndicate, which began with varies between 30 and 50 percent. Heroin Marty Johnstone (Mr Asia) importing seized at the border has purity levels of 450,000 ‘Buddha sticks’ (cannabis) into between 40 and 60 percent. Choose your New Zealand in 1975. The Buddha sticks This variation can increase the future. Choose life... had been purchased for 10 cents each in likelihood of overdoses. Each set of But why would I want Thailand and made Johnstone (Mr Asia) hands the drug passes through would to do a thing like and his associate Terry Clarke (Mr Big) normally add further adulterants, reducing that? I chose not to around NZ$3 million. They used the money the strength of the drug. If steps in the choose life. I chose to expand into importing heroin into distribution process are missed, the purity something else. And New Zealand and Australia via Singapore. of the drug reaching the end user may be the reasons? There In 1978, the import bill for heroin into higher than they are used to, and they may are no reasons. Who Auckland alone was around NZ$34 million, not be able to tolerate the increase. which the syndicate onsold at 400 percent Also, tolerance typically decreases needs reasons when you’ve got heroin? profit. The syndicate fell apart in 1979, after a period of abstinence. If this occurs however, when Clarke was convicted for and the user takes a dose comparable to Mark ‘Rent-boy’ Renton, arranging Johnstone’s murder and sentenced their previous use, they may experience Trainspotting to life in prison. effects that are much greater than expected, Since the 1970s, heroin use in resulting in an overdose. New Zealand has declined steadily, and Death from overdose can take anywhere nowadays it is not commonplace. There are from several minutes to several hours. It Medications include buprenorphine a number of reasons for this. The main one usually happens because the breathing iand methadone, both of which work is that demand for heroin is low because by binding to the same cell receptors as New Zealand’s injecting drug community heroin but more weakly, helping a person is well enough served by pharmaceutical wean off the drug by reducing cravings. diversion – prescription medications Users can also be prescribed naltrexone, and methadone sold illegally on the which blocks opioid receptors and black market. Other reasons include effective border prevents the drug from having an effect. controls and the fact that New Zealand does A more recent, longer-lasting version of not really have cities big enough to allow for naltrexone, administered by injection the large but clandestine networks needed to in a doctor’s surgery, can be used with make its distribution profitable. patients who have trouble complying Exact figures for how many with naltrexone treatment in tablet form. New Zealanders use heroin are hard to come Heroin overdose is usually treated by, but according to the 2007/08 Alcohol and with an opioid antagonist, such as Drug Use Survey, around 3.6 percent of naloxone, which acts on the brain’s New Zealanders aged 16–64 years had used opioid receptors to reverse the effects. an opiate (including heroin) for recreational However, it may also precipitate immediate purposes at some point in their lifetime. withdrawal symptoms. This equates to about 94,000 people. o www.drugfoundation.org.nz 25 guest editorial A small triumph

Getting your fix of thought-provoking ideas about addiction recovery and drug policy is hard in a media that saturates us with stigma-laden messages. Will Godfrey reflects on the triumph of publications talking about sensible solutions to addiction. Will Godfrey

first ran a understand why he’d received a lengthy to me. That’s changed fast. Many of our publication about sentence for dealing ecstasy: “Just selling readers, contributors and staffers are drugs without quite a few little things to my friends that they members of AA, NA and the rest, and realising. It was wanted!” I didn’t have an answer for him. much of our content is about 12-step life. inside Pentonville, Other men would come to prison, get Passions run high about interpretations a large Victorian- released, and then return, often several times of this form of recovery – and why built prison in inner in a year, without receiving any treatment wouldn’t they, about something that you I for their palpable substance problems. And credit with saving your life? Opinion London. Inspired by a prisoner’s suggestion, one of my as you’d expect, hardly any of them were pieces that we have published that criticise education department colleagues and from a middle class background like me – tenets of ‘the programme’ – such as total I founded a small newsletter, written although many people I’d known at school abstinence or anonymity at a media level entirely by prisoners and read by prisoners or university used or sometimes sold illegal – have seen the comments fields erupt and their families. Pentonville’s governors, drugs, no one was ever locked up. with arguments against or in favour of wary of inciting either the volatile prison I brought along these memories as I the writers’ opinions. We’ve also run population or the British tabloid press, moved to New York and joined the editorial numerous pieces affirming the values ruthlessly censored the content of each team at TheFix.com, which launched in of a traditional 12-step approach, and issue, including most drug references. March 2011. As a journalistic enterprise, the same applies; while 12-step fellowships But of course drugs were everywhere. covering everything related to addiction are by far the largest single element of the I’d smell cannabis as I walked through the and recovery, drug policy and treatment, we US ‘recovery community’, other groups and wings every day. Swathes of the population were occupying a niche that we considered individuals attack this model – some even were using heroin. (In a futile prevention was growing in importance. As an online call AA an abusive ‘cult’. effort, staff were banned from bringing in magazine, we had the power to reach I certainly don’t believe that. Neither lunchtime sandwiches wrapped in foil.) unlimited numbers of people – and to allow do I share the core beliefs of AA. But it’s And in late Autumn, when the heating them to reach us in privacy. Happily for us, been a privilege for me to get to know pipes were turned on, the pungent aroma the traffic numbers have since shown just many within this community, to attend of hooch – brewed from bread, sugar and how much people care about this field. some meetings and to hear about how orange juice left in a warm place – would While I was already familiar with people have transformed lives that once be added to the mix. various kinds of substance use, I knew far seemed hopeless because of addiction. And as you’d expect, substances (alcohol less about ‘recovery’. One big difference I have nothing but respect for that. very much included) were a big factor in between the US and the rest of the world is What’s sometimes frustrating is the people being there in the first place. Battered the extent of the dominance here of AA and insistence of some AA members – and faces, cracked voices, tales of desperation, 12-step, abstinence-based recovery. People only some – that the 12 steps and total suicides and violence were facts of life I’d known back in the UK who were using abstinence are the only road to recovery. inside. So was a persistent sense, throughout substances would sometimes talk about The evidence doesn’t support that. There my four years there, that I was witnessing cutting down or quitting. Sometimes they’d are many people for whom AA doesn’t the perpetration of a mass injustice. do it. In the US, that very specific idea of work or who choose other paths. One I vividly remember one distraught being ‘in recovery’ was just one of many survey last year indicated that 23.5 million 22-year-old first-timer who couldn’t phrases and concepts that were unfamiliar Americans would answer ‘yes’ to the

26 matters of substance August 13 question, “Did you once have a problem that it would ‘encourage’ more opioid use. the greatest harm reduction of all. with drugs or alcohol, but no longer But the US still has a very long Political reality might be slow to do?” AA’s estimated US membership is way to go. The Obama administration change, but happily, the process has 1.3 million (the other 12-step fellowships passed legislation in 2009 to overturn a begun in the US. Historically, Washington are much smaller), so it’s interesting to longstanding ban on federal funding for and Colorado voted to legalise cannabis consider what everyone else is doing. needle exchange programmes; Congress last November, and with majority support Many find ways to deal with substance reinstated the ban in 2011, and it still stands. for cannabis legalisation now regularly problems on their own. But another And supervised injection sites remain illegal showing up in national opinion polls, important answer is harm reduction here – despite the success of North more states should soon follow. programmes, which we also cover widely America’s only legal supervised injection The hope should be that we achieve on The Fix. ‘Harm reduction’ makes site in Vancouver, recently confirmed by a – at the very least – a drug policy model many people think immediately of needle long-term study demonstrating its benefits. resembling that of Portugal, which, in exchange – a vital element, and I was A bigger scar on America’s conscience is 2001, stopped applying criminal sanctions recently pleased to publish an on-the- the appalling inhumanity of its incarceration for any drug possession for personal use. ground report on one programme – but of policies. The US has the highest Overall drug use in that country has course, there’s much more to it. incarceration rate on Earth, with about not significantly increased since then, An uplifting story here in the US 2.2 million people currently behind bars, but HIV and hep C infections have fallen, has been the advance of so-called ‘Good about half of whom are there for non-violent and more people with addiction problems Samaritan’ laws, which grant immunity drug offences. Savage mandatory minimum are now receiving treatment; the harms of from prosecution for drug offences to those sentencing laws see many languish for both drug use and drug prohibition have who call 911 to report an overdose. Fear of decades. One of our regular contributors at been mitigated. Police involvement is the most commonly The Fix is a writer who is in federal prison. With attitudes changing fast, there has cited reason that overdose witnesses fail He has been there for 20 years, having never been a more exciting time to run a to call for help. This summer, thanks to received a 25-year mandatory minimum publication in this field. The complexities, tireless campaigning from various groups, sentence for his first-time offence: selling entrenched prejudices and personal Vermont and Delaware became the drugs at the age of 22. passions that you encounter mean there are 13th and 14th US states to enact Good A growing clamour of opinion in plenty of pitfalls and stresses. Still, given Samaritan laws since New Mexico got the US and around the world – notably the amount of stigma that has surrounded the ball rolling in 2007. including some Latin American leaders – this subject, it’s a small triumph that such These laws save lives. They also show agrees that the War on Drugs has failed, publications exist at all. that attitudes to drugs are changing. The that the human rights violations must wider distribution of naloxone, the life- end and that legalising or decriminalising Will Godfrey is the now-former Editor-in-Chief saving drug that reverses opioid overdoses drugs is the way to make this happen. of TheFix.com. He was right to appreciate his publication while it lasted; just before – fatal overdose deaths attributed to As someone who believes that government Matters of Substance went to print, costs prescription opioids quadrupled here has no business penalising us for what we and complications arising from a board-level between 1999 and 2010 to over 16,000 put into our own bodies and having seen lawsuit forced The Fix to fold. 2013 was its – is another case in point. Some initially the damage prison does, I’m with those best traffic year, and it remains online for now. opposed naloxone distribution, on the basis who see the end of drug prohibition as

www.drugfoundation.org.nz 27 opinion Hurt people hurt people

Young people are often on the fringe of policy discourse, but JustSpeak, a youth-led organisation, has forged a strong voice on justice and corrections issues. Here, JustSpeak explains their youthful perspective on New Zealand’s justice system and asks whether positive progress is possible.

urt people hurt experience-based public discourse on addressing the underlying causes and people. It’s an criminal justice. JustSpeak volunteers are motivations of offending than community- unfortunate but working actively within our communities, based interventions. unavoidable truth at our policy tables and everywhere in Justice Minister Judith Collins recently within our criminal between with the belief that New Zealand’s stated that “a key to reducing crime is to justice system, and justice system has a lot of strengths, but it stop young people entering the court and it is no secret that is time that we engage with its challenges. justice system in the first place”. So how is H those who offend New Zealand is an exceptionally this currently done? When a young person are often society’s most vulnerable and punitive country and has one of the is apprehended for an offence, Police have damaged. It is particularly hard-hitting highest rates of per capita imprisonment a number of resolutions available to them, when a young person caught in the including official warnings, Youth Aid, criminal justice system speaks about Family Group Conferences or prosecution. being broken beyond repair. It forces us I don’t know if there is Prosecution is intended for only the most to engage with the two major challenges severe cases. However, statistics recently facing New Zealand’s legal and correctional anything you can do to help released by the New Zealand Police systems: how do we prevent youth from us; we are broken, all of the indicate a slightly different reality about becoming ‘broken’, and if we fail in this, stuff we have seen and has the way in which Police discretion how do we help them put the pieces back been done to us when we are is being used. together? These are discussions that attract In 2012, youth apprehensions for illicit a range of opinions, some more informed little means we are just broken, drug offences made up 4 percent of total than others. However, very seldom do we and you can’t fix that. youth apprehensions. Two-thirds of these hear from the individuals who are affected apprehensions were attributable to drug the most by our decisions – the young possession and/or use; a majority of the people of New Zealand. in the OECD; 194 prisoners per 100,000 time, the illicit drug in question was JustSpeak is an organisation people, compared to Australia’s 130 cannabis. While total apprehensions have committed to redressing this imbalance and Canada’s 114. While this statistic decreased over time, prosecution rates by contributing a young, informed and may be greeted with joy by the average have not. Close to twice the proportion of passionate voice to the discussion. radio talk-back caller, our obscenely young people are being prosecuted for drug JustSpeak is a non-partisan network high incarceration levels should be a possession and/or use when compared to of young people speaking to and speaking source of national shame. Why? Because 18 years ago, while the number of warnings up for a new generation of thinkers who sending people to prison is a very crude being given has dropped by 30 percent. want change in our criminal justice system. tool for reforming behaviour. A wealth of That amounts to an additional 55 young In order to achieve a more just Aotearoa, research shows that imprisonment has people each year who are faced with a JustSpeak believes that we need to little or no deterrent effect on would-be response that is meant to be reserved only cultivate a transparent, evidence and offenders and is no more successful at for the most serious offences. This action

28 matters of substance August 13 What’s changed? Location, Police discretion location, location

This is the proportion of drugs possession apprehensions of Prosecution decisions of young people 10- to 16-year-olds leading to prosecution for resolved crimes are highly variable across Police districts. The rate has almost doubled since 1994, while warnings have decreased

12 11.4% 35 10.5% 10 9.5% 30 National Rate 25 8 6.7% 20 6 5.5% 4.9% 15 4 Proportion (%) 10 Resolved apprehensions apprehensions Resolved

2 (%) leading to prosecution 5

Mäori Total Mäori Total asman astern WaikatoT Central E Caucasian Caucasian AucklandSouthern Wellington WaitematäNorthland Canterbury 1994 2011 Bay of Plenty Counties Manukau Police district (region)

Source: stats.govt.nz, JustSpeak.org.nz Source: stats.govt.nz, JustSpeak.org.nz violates one of the basic principles that cloud. A number of progressive initiatives needs of young offenders. Based on underpins New Zealand’s correctional are being incorporated into the youth the YDC, the IMG provides therapeutic rehabilitation system: interventions justice sector in New Zealand and are intervention to young people with should correlate with risk level. Not only attracting international praise. The moderate to severe mental health needs do more intensive interventions allow diversionary approach that is the main who are also at a high risk of re-offending. young people to associate with higher-risk focus of our youth justice system is also Unbroken, continuous involvement offenders (one of the main correlates of one of its biggest successes. While it with judges and social workers, as well criminal behaviour), but they can also raises concerns of potential differential as intensive monitoring of the youth, severely impact on protective factors such treatment (see the infographic on regional is utilised in the hope of improving as education and family connections. prosecution rates released by JustSpeak), the outcomes. Potential substance abuse issues only any progress made towards reducing the While positive progress is being made, further compound these problems. number of youth appearing before the the way in which we approach and discuss This pattern of increasing reliance on formal court system is progress worth justice issues in New Zealand needs to prosecution as a response to youth crime celebrating. change. Change for the good does not is alarming and directly contradictory In this vein, a number of novel necessarily need to be radical. JustSpeak to what we know is best for our young approaches to the court system have recently advocated in a submission on people. Studies tell us that many young been trialled in New Zealand, largely the Psychoactive Substances Bill for the people going to court or receiving custodial to successful outcomes. For example, sentences fail to get the help that they need the Christchurch Youth Drug Court exclusive use of a diversion system in to continue their education and deal with (YDC) is an initiative aimed at reducing response to youth substance possession mental health or substance abuse problems. offending related to alcohol and/or offences. Expanding what is the main Of the 3,500 young people under the age drug dependency amongst young people. strength of our current youth justice system of 17 who came before the courts in 2011, Becoming operational in 2002, the YDC is one step we can make towards a more 80 percent had substance abuse issues. aims to facilitate early identification of just New Zealand. Our current justice system However, between October 2010 and young offenders with substance abuse most certainly has its challenges, but April 2012, judges made only 18 orders problems and targets their needs it’s just as certain that the system can be for treatment programmes. Harsh accordingly. Diversion into this programme changed in a positive and progressive way. penalties do not fix broken people. The is initiated once a potential substance Some of our young people may be broken, appropriateness and efficacy of punitive abuse problem is identified in Youth Court, but they most definitely can be fixed. punishment as a response to youth crime, and young people are monitored closely particularly in relation to possession and throughout their involvement with the JustSpeak is a non-partisan network of young use offences, is something that needs to be YDC, being released only once they have people speaking to and speaking up for a new very closely examined. reached sobriety. The Intensive Monitoring generation of thinkers who want change in our But there are certainly some silver Group (IMG) Court is another specialised criminal justice system. linings on this rather dark metaphorical court system being developed to target the

www.drugfoundation.org.nz 29 VIEWPOINTS

Addiction is an equal opportunity disease Viewpoints presents the arguments on both sides.

the case No ONE is immune from drug dependency. But that is not to say addiction is an equal opportunity illness. There are certain types of people who are more likely to form an addiction due their genetics, personalities or their position in society. AGAINST Genetic make-up can make a person more likely to become addicted if they carry certain genes. The National Institute on Drug Abuse estimates that 40–60 percent of addiction can be put down to genetic predisposition, so those who have a family history of dependence start off with a bigger opportunity to develop an addiction. An example of this in action happens here in New Zealand. Mäori are far more likely to experience addiction than other ethnicities. A Ministry of Health survey found that over 26 percent of Mäori had had a substance use disorder. This is twice the national average of just over 12 percent. Even if it’s not nature, nurture certainly means that addiction is not equal opportunity. Within our society there are certain divisions based on income. It has been shown that people who live in poverty, or close to it, are more likely to develop addictions. Mäori also make up a disproportionate percentage of people in New Zealand’s prisons and are at the bottom of most socioeconomic indicators. A major reason for taking drugs is to self-medicate, to compensate for pain and fear, to provide relief from the misery and burdens of daily life. The truth is those who worry about their next meal, those in low-paying unfulfilling jobs and those who face discrimination because their colour or sexual orientation are more likely to ‘self-medicate’. Early and heavy use of drugs by young people increases the chance they will have addiction-related problems in adulthood. Teens’ brains are still developing and are very susceptible to the effects of drugs, and teens love to take risks. They may also lack the maturity and foresight to see the danger in what they are doing. You are more likely to become addicted if certain environmental factors exist for you, such as an abusive home, parents with a dependence or associations with criminals – and the reasons why are obvious. You are more likely to become addicted if you suffer from psychological disorders such as anxiety, depression, ADHD or even just low self-esteem. Some take drugs to help them deal with their disorder. Others take them because their disorder affects their judgement or impulse control. The factors that predispose people to addiction goes on. So no matter what Mr Lawford says, there are certain people who will always be more likely than others to form an addiction, and these factors tend to cluster, meaning that, in reality, addiction is not an equal opportunity illness.

30 matters of substance August 13 Christopher Kennedy-Lawford was a man born to have it all. The son of an actor and a politician, he was a member of a powerful political family with all the privileges money and fame can buy. Yet alcohol and other drugs nearly cost him his life several times. He is now a treatment campaigner and advocate.

Kennedy-Lawford is fond of saying addiction is an equal opportunity disease that can happen to anyone, but is it? It’s an important question because how we answer it may also shape how we approach treatment.

THE against side has argued that certain types of people, namely those in poverty or the case some other form of hardship, are more likely to develop a dependence problem than the well-off and privileged. This is not so. Addiction is no respecter of persons. Everyone would agree alcohol and other drugs are frequently used to relieve FOR fear, anguish, worry, low self-esteem and other forms of mental pain. But who would argue these anxieties are strictly the realms of the poor? Things that lead to mental trauma – sexual abuse, parental bullying, family violence, personal tragedies and so on – happen just as much in rich families as they do in poor ones. Two of Kennedy-Lawford’s uncles were murdered, for example, and one of them happened to be the President. But the fact is, there is little evidential base to suggest poverty itself means a person is more likely to develop an addiction. High Price, a new book by Dr Carl Hart, shows that up to 90 percent of people who use drugs can manage their drug use – we just don’t hear from them at a criminal, policy or health level. We all know money doesn’t by happiness. Rich people may not have the same worries as poor people, but they have anxieties of their own. The well-off also have the money to afford to buy greater amounts of substances and take them more often, making addiction even more likely. Rich people are also not immune to genetic predisposition towards dependence or to being young and making unwise decisions. Addiction is an equal opportunity disease that can affect doctors, lawyers, teachers and managers just as often as truck drivers, cleaners and beneficiaries. Kennedy-Lawford himself estimates 10 percent of Hollywood and 10 percent of YOUR VOICE Washington has it, and those are places of power and wealth. So while there are societal and genetic predispositions to addiction, the picture is still fuzzy. Are we just seeing the worst cases and ignoring the ones we don’t see? The real issue here is that addiction can affect anyone regardless of colour, class YOU or position. DECIDE

What do you think? Have your say www.drugfoundation.org.nz/viewpoints

www.drugfoundation.org.nz 31 Q&A

Q What is the difference between the UK drug Q You’ve done work in a lot of dangerous treatment sector and New Zealand’s? places. What is the craziest situation you’ve ever been in? a There are lots of similarities between the trends and issues within the sectors. a I was doing some work in Central Some of the things happening now around Europe, and we went into one of their the development of drug strategy here prisons, which was actually one of the in New Zealand and also some of the high security prisons, and the governor challenges that come through growth had put on this lovely meal for us as part and upscaling service provision are very of the day there. The service was excellent familiar. Also, the successes seem to be and the food was great, and we were coming from similar strategies as well. complimenting him about the service. He was explaining that the prisoners did A key difference is working in a bicultural this as part of their role and that these context with Mäori. Whilst I have worked jobs were privileged positions. The internationally in many different contexts, conversation went on, and we said this is my first time working in this region that they mustn’t get to do it very often, – I have really welcomed the huge learning and he said “No, no, no. It happens Kathryn curve of the last four years. every weekend.” “What do you mean?”, we asked Leafe Q What have you been doing since leaving the UK? “Every Saturday, we open the restaurant downstairs and the local villagers come to Chief Executive CareNZ a I might have an English accent, but the the restaurant, and the prison band comes West Coast is home. In 2008, I did a little out and plays, and all the villagers dance A lawyer who became a probation bit of work on the family farm but decided in the square!” officer, CareNZ’s new boss has that sheep farming wasn’t a good second worked in harm reduction across career option. We’re looking at him, and the Governor is like, “You don’t do that in England?” the globe. From running treatment I got involved in doing various projects in the West Coast region, including the centres in prisons to running the Q What is harm reduction to you? social services agency where my Soweto marathon, Kathryn Leafe grandmother was a founding member. a Harm reduction services are one of is committed to reducing the harm Then Pike River happened, and I ended a number of ‘entry points’ in a recovery drugs cause. up working with the families of the 29 journey. It helps keep people safer men. I also got involved in Christchurch, and alive. post-earthquake. It also builds a foundation for further work – a good experience and positive Q You were a lawyer who became a probation Being involved in two of the biggest relationship with services can make it officer? disasters in the South Island has been easier to access help and support later on. a I went to law school. My tutor at one of the biggest challenges in my university said to me, “You’re the most professional career, but it has also been one We’re all always doing harm reduction. disinterested lawyer I’ve ever met, of the greatest privileges. It’s not a position Kathryn. Go and be a probation officer.” you ever expect to find yourself Q A couple of years back, you ran the Soweto Marathon. Done any more since? So I worked in one of London’s big law in or something you train for. firms for about 18 months and ended up a No, but that was one of the best doing what my tutor said. Q You’ve also worked for the United Nations? experiences of my life. I ran a couple of London Marathons, then two in Soweto. a The A and D provider I was working for Q What are your top priorities for CareNZ? The first time I ran it – 2,000 metres above was selected as one of the 20 international sea level, 32 degree heat – I was involved a I am spending time getting to know staff best-practice centres to be part of a UNODC in an HIV project in Johannesburg. We and services – spending a lot of time out in programme called Treatnet. I led one of took young people in Soweto, Alex and the field meeting with services users and those centres and was involved in UNODC Tembisa and used theatre to do HIV key stakeholders. I’m also meeting key programmes to build capacity and improve people within the sector, particularly given education. They were all in this Kombi the quality of drug treatment internationally. that I don’t come from a New Zealand van following me around this marathon drug treatment background, it feels really One of the pieces of work I led was the hanging out the windows and shouting important to do that. writing of the good practice guide for their support for this white woman with working in prisons. This was when I first For me, it’s about building on the good this vest that said, “We’re all HIV positive had contact with CareNZ, and their work foundations and good work that CareNZ until proven negative”, which was a really does. We’ve got a solid reputation for our in Arohata is referred to in that guide. important message in South Africa. services, interventions, and treatment – with I’ve also worked across Eastern Europe The next year, I ran it with two of the some creative and innovative approaches and Central Asia providing consultancy young people from the project as training – so really wanting to maintain that and and training in relation to the development partners. I was in London, they were build on the commitment of the staff. of drug strategy and work in prisons. in Johannesburg.

32 matters of substance August 13 Mythbusters

Substance and Substantiation New Zealand has the highest drug use in the world

International reports often portray New Zealand as having one of the highest rates of drug use in the world. So is it all Kiwis and Kronic in the land of the long white cloud, or are other factors at play here? Mythbusters investigates.

annabis is the with a pretty obvious bias. UNODC report puts the usage of most widely used The UNODC even acknowledges methamphetamine in Oceania, making illicit substance shortcomings in its data collection. In specific mention of New Zealand, at in the world. The 2009, they held an expert group meeting 2.1 percent of our population using United Nations on global drug data collection, analysis methamphetamine. Office on Drugs and reporting, which suggested over 30 Mythbusters wonders whether there and Crime’s World recommendations about how to improve might be another factor muddying the C Drug Report 2012 reporting of drug statistics from member statistical waters. New Zealand has long estimated that, while in 2010 2.6–5 percent countries. Most of the recommendations been known for its general tolerance of all adults globally had used cannabis, focused on improving data collection towards soft drugs, at least in comparison Oceania’s average – and that’s essentially systems and substantial changes to process to the US and even Australia. As a result, Australia and New Zealand – was between in order to improve the quantity and Kiwis may feel more relaxed about 9.1 and 14.6 percent, nearly three times the quality of data collected in the Annual reporting their drug use. Perhaps that’s global average. Reports Questionnaire. why we tend to rank highly on the While the report itself specifically The International Drug Policy world scale. says the information it presents is based Consortium review of the 2012 World Drug So the myth that New Zealand has the on estimates, the estimates are based Report reinforces the issues around data highest drug use in the world rests on the on the submissions of only two out of and says that “faced with such a dilemma, reliability of data. New Zealand collects 14 countries. Professor Louisa Degenhardt UNODC is forced to adopt methods of some decent data on drug use rates in from the National Drug and Alcohol extrapolation that may be misleading”. the world while other countries maintain Research Centre at the University of No matter, because the World Drug a lacklustre approach to keeping tabs. New South Wales says that country-level Report 2013, released in May this year, Not only that, the data that we and other estimates are used for the report to make no longer puts New Zealand at the top, countries do get can be pretty patchy, regional-level estimates. and the estimated cannabis usage of with many different methodologies and “Oceania looks high, even though our Oceania is at 10.9 percent, not much circumstances in its creation. rates are similar to many other countries higher than North America at 10.7 percent. Mythbusters is prepared to concede and lower than others, as there are other So even if we are estimated to have a very that, per capita, New Zealand is up there countries with high reported levels,” slightly higher usage rate of cannabis, it’s with the best of them when it comes to Professor Degenhardt says. not really by that much. cannabis consumption. But are we the An example of both bad estimates Also, perhaps the World Drug Report biggest consumers in the world? We think and a high number bringing up the Oceania is out of date. The New Zealand the jury’s still out on that or at least only average is that of Palau, the small Pacific Government recently announced that the half way through the door. Island nation to the east of the Philippines. use of methamphetamine has halved since The 2012 World Drug report said 25 2009, something that was not reflected in REFERENCES percent of the population uses cannabis. the UNODC’s latest World Drug Report. • Visit the Mythbusters page on our This estimate was not based on survey data Government data now shows that only website for the references for adults but a survey of the one state high 0.9 percent of New Zealand’s population used in this column at school on the island. A small sample size are using methamphetamine, whereas the drugfoundation.org.nz/mythbusters

www.drugfoundation.org.nz 33 REGISTRATIONS NOW OPEN

27–29 Join us for three days of insightful dissertations, November 2013 debate and discussion on all things cannabis. Auckland New Zealand registrations now open nzdrug.org/cannabissymposium