Underdosing Naloxone Overdose Rates from Opioids May Not Seem Much of an Issue in New Zealand, but They’Re Important Enough to Warrant Intervention

Mattersof Substance. february 2015 Volume 26 Issue No.1 www.drugfoundation.org.nz

Underdosing naloxone Overdose rates from opioids may not seem much of an issue in New Zealand, but they’re important enough to warrant intervention. Prevention starts with making naloxone more freely available. CONTENTS

FEATURE: GOOD Underdosing BOOZE NEWS GUEST naloxone 14 EDITORIAL COVER: Naloxone is a drug COVER that can stop an opioid STORY 06 34 overdose, so why isn’t it more widely available? Cover photo by Matt Slaby for the Harm Reduction Coalition. ABOUT NZ A DRUG NEWS 20 02

FEATURES Become 14 18 22 24 a member Good booze news Secondary school On the road Voting for change was from across the ditch student drug use stats to reducing the easy part The New Zealand Drug Foundation has Why have half of Aussie Despite media hysteria, drug-driving harm Public policy conundrums been at the heart of major alcohol and drinkers reduced the drug use amongst young Experts from around the can be found aplenty after other drug policy debates for over 20 years. amount they drink? people is actually falling. world came to Wellington the ballot cast on cannabis During that time, we have demonstrated to talk drugs and driving. law reform in four US a strong commitment to advocating states. policies and practices based on the best evidence available.

You can help us. A key strength of the Drug Foundation lies in its diverse membership REGULARS 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 30 34 35 Events 01 ﬁnd solutions to those challenges. OPINION GUEST EDITORIAL Q&A News 02 Our membership includes health promoters, Time to be honest Hello Friday Norman Baker MP About a Drug 20 primary health and community organisations, about the pleasure Afternoon? The former minister Viewpoints 32 researchers, students, schools and boards Drugs give humans the Chris Raine on how responsible for drugs of trustees, policy makers, and addiction Q&A 35 pleasure we naturally seek, to reclaim your in the UK explains treatment agencies and workers. argues Adam Winstock. entire weekend. why he resigned. Mythbusters 37 Membership and subscription enquiries [email protected] or visit our website.

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matters of substance is published matters of substance invites Brand development/ NZ Drug Foundation by the New Zealand Drug feedback and contributions. graphic design 4th Floor, 265 Wakeﬁeld 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] February 2015 Drug Foundation. p +64 4 801 6303 Vol 26 No. 1 ISSN 1177-200X THE DIRECTOR’S CUT SOCIAL

@paulkidd “It has a ring to it.” 1985 letter from Donald Abrams suggesting the name ‘#HIV’ for what was then called HTLVIII/LAV. DECEMBER 01

@AustDrug We agree with @smh; if we want to reduce drug harm, sniffer dogs are waaaay down the list of effective ways to do it. DECEMBER 01

@minhealthnz Fewer smokers: 15- to 19-year-olds smoking rates dropped from 20 to 13% in 7 years. Quitting rates rose from 8 to 11%. DECEMBER 05

@TRI_Solutions “We cannot solve our problems have some sympathy for the how the Misuse with the same thinking we used when we of Drugs Act must feel as it turns 40 this year, created them” - Albert Einstein. DECEMBER 07 having myself experienced that milestone in the recent past. @TheNewImpostor Hungarian prime minister says But while I’m still in my prime [Wishful journalists and politicians should undergo thinking – editor.], New Zealand’s drug law mandatory drug tests. DECEMBER 16 I has long shown serious signs of aging and is now well past its use-by date. @nzherald The ‘Not Beersies’ ad fooled a viewer ROSS BELL Like many 40 year olds, the law has got who complained it was being shown too early. Executive Director sluggish. Despite being amended 18 times DECEMBER 10 in the past eight years it has failed to keep pace with a rapidly changing drug market, including the inﬂux of new psychoactive substances effortlessly @smh ‘What use will executing us be?’: Bali Nine traded over the internet. member speaks out after bid for clemency And then there’s the big question about the law’s fundamental rejected. JANUARY 08 effectiveness. Has it succeeded in doing what it was designed for? Over its lifetime drug use in New Zealand has not been supressed. @guywilliamsguy “Popular Irish bar Molly Malones, We remain among the world’s highest users of cannabis, and until in Courtenay Place, has closed.” - Check that... recently were up there with methamphetamine. While wider social “Unpopular Irish Bar Molly Malones”. JANUARY 22 factors will be the main determinant of drug use patterns, it is our drug law that determines how we respond. It has performed poorly. In the ﬁve years since the Law Commission’s review of the law there’s been an almost seismic shift in global drug law reform. New drug control models are being tried in Uruguay and the Czech Republic, KEY EVENTS & DATES and great momentum is building in the US. And let’s not forget New Zealand’s experience with regulations, which itself contributes 7th Australasian Drug and Alcohol Strategy Conference, Brisbane to the global knowledge base of innovative approaches. Convention and Exhibition Centre http://event.icebergevents.com.au/adasc-2015/

We must now turn our attention to modernising our drug law, a project 17-20 MAR 2015 that should go hand-in-glove with the government’s refreshed National Drug Policy. It’s here that we must grapple with the devilish detail and Alcohol and Cancer Conference, Te Papa, Wellington move beyond the proclamations of ‘decriminalisation’ or ‘legalisation’ http://www.alcoholaction.co.nz/?p=433 or ‘tough on drugs’. 17 JUN 2015 As the wonderful Mark Kleiman says elsewhere in this magazine, “Debating whether to legalise pot is increasingly pointless…the 20th Cutting Edge Conference – Its all about Whanau, dapaanz, important debate now is how to legalise it.” Nelson http://www.cuttingedge.org.nz/ This demands from us all a much better informed level of discussion 2-5 SEP 2015 on specific models for law reform. Fortunately, we’ve just been here with the recent development of the regulatory approach over new 4TH APAC FORUM 2015 - Leading Healthcare Transformation, psychoactive substances. You’ll recall the very specific details about Auckland matters we were required to consider, such as where can products http://apacforum.com/ be sold and who can sell them; can we test products on rats only, 23-25 SEP 2015 or rabbits or none at all; what are safe dosage limits; should the containers be child-proof, and so on. Int’l Harm Reduction Conference, Kuala Lumpur, #IHRC2015 The Law Commission has already presented a possible model, http://www.ihra.net/ proposing a cautioning and health referral system which could be 18-21 OCT 2015 fast-tracked for substances with greater harm profiles. I reckon that’s Follow us a pretty good starting point for our current law’s retirement plan. Join us online drugfoundation.org.nz/connect NEWS NZ. 03 Booze main 04 Methadone factor in funding cut family violence at the Mount TOO 5:00 LATE! AM

THE GLENN Inquiry PATIENTS WHO accessed released its final report a publicly funded 06 Capital’s council recommending sweeping methadone treatment caught out over alcohol reforms in order programme at a Mount closing time to tackle the epidemic Maunganui medical of domestic abuse in practice now have to pay New Zealand. The inquiry, for their visits or go to the instigated and funded DHB. The Bay of Plenty 01 One law for all? by Sir Owen Glenn, says District Health Board has Parliament should been paying for Mount Recidivist drink drivers are up reconsider the findings Medical Centre’s stand- of Sir Geoffrey Palmer’s alone methadone service to 12 times more likely to be sent 2010 Law Commission for people dependent THE WELLINGTON City to jail in one New Zealand region, report into alcohol and on opioids but cut the Council’s plan for late ought to adopt them in funding in November night drinking hours is in but the Ombudsman is refusing to full. “Alcohol can never 2014. Mount Medical tatters after the Alcohol release the information needed be an excuse for family has been receiving $2,000 Regulatory and Licensing to identify where that is. violence, but it can feed per patient each year for Authority accepted and accelerate family the service and has 65 appeals against plans to Research done at Victoria University, published last violence and make it patients. One patient, allow bars in the capital’s year, highlighted considerable differences in sentencing worse,” Inquiry Chair who didn’t want to be CBD to stay open till 5am. from region to region for similar offenders and might Bill Wilson said. identified, said they The proposed council also show where a drink driver is less likely to be jailed. were concerned about rules outlining when and Lawyers have expressed concern at the disparities in RESOURCES the move as they felt more where people could buy comfortable going to their alcohol had no legal the way the law is applied, saying it undermined the glenninquiry.org.nz/ local GP to get treatment. standing, said the judge. principle of the rule of law. the-peoples-blueprint Liquor laws implemented in 2012 set a national 02 Methamphetamine use up closing time of 4am. after legal highs banned 05 Victory LAP However, communities are able to set their own rules around drinking through FORMER high ban came into effect. across the country unless they are altered by a Local Local Alcohol Policies. METHAMPHETAMINE Mental health service The Police advocate for users have returned to Clinical Director Dr Syed Alcohol Policy (LAP). Tasman’s 2am closure a 3am proposal, but the drug after a ban was Ahmer said staff had seen hospitality associations placed on synthetic highs, an increase in use of came into effect with its policy in December say that would hurt the MidCentral District Health methamphetamine. vibrancy of the central Board’s alcohol and other last year. Hospitality “People who have used THE TASMAN District city. It is unclear whether drug service said. Staff at New Zealand appealed, methamphetamine in the Council has won a the council will appeal the Manawatu addiction saying the plan would past are now going back landmark legal ruling the Authority’s decision service say it is their have an adverse impact to using it after the legal allowing it to enforce in the High Court or revise “clinical impression” on patronage of bars highs came off the a 2am closing time for its plan. that more patients are and restaurants, but the market,” he said. on-licence venues. Under relapsing since the legal Alcohol Regulatory and alcohol reforms in 2012, Licensing Authority ruled maximum trading hours in favour of the Tasman of 8am to 4am apply District Council.

02 matters of substance February 15 07 Busted over 09 Survey shows Buddha in evolution of Burma Kiwi drinking attitudes

THE MINISTRY of Health released its Alcohol Use % 03 2012/13: New Zealand Health Survey on February, 79 with Associate Health OF ADULTS AGED 15+ YEARS 04 Minister Peter Dunne HAD CONSUMED ALCOHOL IN THE PAST 12 MONTHS. PHILIP BLACKWOOD, calling the results a 32-year-old bar manager encouraging. Of note from Wellington, is facing are the comparisons up to two years in a between similar data Burmese prison for collected in 2007/08, 1/3 posting a picture of which shows progress OF DRINKERS DRANK ALCOHOL Buddha with headphones around consumption REGULARLY, AT LEAST THREE TO on Facebook. The image behaviour, said Mr Dunne. FOUR TIMES A WEEK. was posted to attract 02 “It is particularly pleasing customers to his bar in to see risky behaviours Yangon, the nation’s such as drinking to largest city. However, 05 01 intoxication and working 1/2 the nation’s military 06 under the influence of OF DRINKERS HAD government places harsh 07 08 09 alcohol declining and DRUNK TO INTOXICATION restrictions on insulting fewer reporting first AT LEAST ONCE IN THE religion. Blackwood’s drinking before 15 years PAST 12 MONTHS. family are appealing of age.” The government to the New Zealand was concerned with other Government for assistance. findings, such as one in % five pregnant women 8 drinking during pregnancy. REPORTED DRINKING TO INTOXICATION 1 IN 5 AT LEAST WEEKLY. PREGNANT WOMEN DRINK DURING PREGNANCY. 1 IN 6 DRINKERS WHO DROVE IN THE PAST YEAR HAD DRIVEN WHILE FEELING UNDER THE INFLUENCE OF ALCOHOL. 08 Ministerial television advertising of “enough to justify forum: sport beer, wine and spirits further restrictions on and alcohol during matches. The alcohol advertising and % don’t mix recommendations come sponsorship”. In its from a ministerial forum report, released the week 6.8 set up in 2012 by former before Christmas, the OF DRINKERS WHO HAD Justice Minister Judith forum recognised an WORKED DID SO AT LEAST Collins to investigate association between ONCE WHILE UNDER THE alcohol law reform. Chaired exposure to alcohol INFLUENCE OF ALCOHOL IN THE PAST YEAR. THIS EQUATES by former rugby league promotions, an earlier age TO ABOUT 165,000 DRINKERS. coach and businessman of initiation to drinking Graham Lowe, the forum alcohol and increased THE GOVERNMENT has concluded after a two-year consumption. RESOURCES been told to end alcohol inquiry that the total cost sponsorship of sports of alcohol-related harm nzdrug.org/AlcoholUse_ NZsurvey clubs and ban any in this country was

www.drugfoundation.org.nz 03

NEWS

World. 06 07

03 ‘VAPE’ Not just a bunch of hot air ‘VAPE’ was named 2014’s Word of the Year by the Oxford English Dictionary. The term’s ofﬁcial deﬁnition is ‘to inhale and exhale the vapour produced by an electronic cigarette or similar device’. Increasing use as a cessation tool by smokers resulted in vape gathering some serious linguistic steam last year – its usage doubled, according to the dictionary’s editorial board. Vape beat out contenders including slacktivism (lazy internet activism), bae (a term of endearment similar to babe) and indyref (shorthand for Scotland’s independence referendum) to take the title.

05 Malta makes 06 US halts war on 02 Would you like 03 Venture- 04 Alcohol prices way for medical medical beer with that? capitalise it? headed north cannabis cannabis

THE UNITED STATES Congress has passed a law that effectively blocks the Department of Justice from arresting or prosecuting anyone who sells or uses medical cannabis in the FAST-FOOD CHAIN KFC THE FAMILY of the late IN AN attempt to combat SPECIALISED DOCTORS 32 states that currently has applied for a liquor reggae superstar Bob alcohol abuse, Northern will be able to prescribe have some type of medical licence for a new ‘concept’ Marley has announced a Ireland is set to introduce the extracts of cannabis in pot law on the books. store it plans to open in partnership with private minimum pricing on medicinal form to patients Originally intended as Sydney so it can sell beer equity firm Privateer alcohol. Minister of Health if they believe no viable a spending Bill designed and cider alongside its Holdings to develop Jim Wells said, “The level alternative exists, says to prevent a government fried chicken. A ‘Marley Natural’-branded of harm caused by Malta’s Justice Minister shutdown, the law spokesperson confirmed weed. The cannabis will excessive alcohol Owen Bonnici. A Bill included an amendment the move but refused to be Jamaican in origin but consumption in Northern before Parliament would from two California give further details. It is will be grown in the US Ireland is staggering.” allow pharmacies to sell Congressmen, Democrat thought KFC is attempting state of Washington. Many The total cost of drinking the medicinal cannabis. Sam Farr and Republican to keep up with the fans were outraged to hear is estimated to be just In rare cases, doctors Dana Rohrabacher, that growing popularity of of the collaboration with under a billion pounds. will be able to prescribe would forbid the casual dining restaurants, a corporation. Marley’s Minimum pricing would cannabis leaf in its natural Department of Justice which often feature daughter, who owns the reduce alcohol form, but the Health and the Drug Enforcement alcohol on their menus. rights to Marley’s name consumption by Superintendent will Administration from The move has been met along with other family disincentivising price- set certain conditions using taxpayer money with condemnation from members, disagreed. “My sensitive customers as about its sale. to interfere with state health advocates and dad would be so happy to well as ensuring that the medical cannabis laws. family groups alike. see people understanding cost of a drink directly the healing power of the reflected its strength, herb,” she said. Mr Wells said.

04 matters of substance February 15

04 01 08

THERE138 ARE 138 PEOPLE ON DEATH ROW IN INDONESIA. 09 64 DRUG CONVICTS ON DEATH ROW HAVE BEEN DENIED CLEMENCY BY 02 PRESIDENT WIDODO.

ROUGHLY 1/3 07 Study: smoking, 09 Firing squad OF THEM ARE FOREIGNERS. obesity both causes costlier than 08 UK tackles diplomatic IN war drug driving firestorm 2013 Indonesia executed five What we do EXECUTIONS RESUMED foreigners and an Indonesian is merely aimed IN INDONESIA AFTER A woman convicted on FOUR-YEAR MORATORIUM drug-trafficking charges at protecting ON THE DEATH PENALTY. by firing squad in the early our nation from hours of 18 January, setting the danger of off a diplomatic storm. Brazil drugs. A MCKINSEY Global POLICE IN the UK will be and the Netherlands both 15,000 Institute study has found able to test drivers for recalled their ambassadors to INDONESIA’S ECSTASY PILLS WERE BEING that smoking is a bigger drugs on the roadside for Indonesia after the execution, ATTORNEY-GENERAL PRODUCED PER DAY BY ONE MUHAMMAD PRASETYO burden on the world the first time as a result with Brazilian President Dilma OF THE PEOPLE EXECUTED, economy than armed of the Home Office Rouseff saying the incident ANG KIEM SOE. violence, war and approving a mobile had “severely affected” A cruel and terrorism, and obesity isn’t drug-testing device. relations with Indonesia. inhumane far behind. The analysis The Drugwipe device The Indonesian Government is a measure of the social can test for cocaine and has defiantly vowed to punishment ... 40–50 cost of each activity and cannabis from a saliva continue to execute those an unacceptable PEOPLE DIE FROM DRUGS IN INDONESIA EACH DAY. accounts for both public sample within as little found guilty of serious drug denial of human and private efforts to as three minutes. Traffic offending despite the mitigate these different officers will now be able diplomatic pressure. Rights dignity and social burdens as well as to test drivers on the groups have condemned integrity. the economic productivity roadside rather than execution for drug offences 45% lost due to disabilities and taking them into a Police in Indonesia, with Amnesty DUTCH FOREIGN MINISTER OF THE SOUTHEAST BURT KOENDERS ASIAN DRUG MARKET early deaths. According station, meaning the International calling the IS CIRCULATED IN latest round “a retrograde to the study, smoking and number of tests and INDONESIA ALONE. obesity on their own cost convictions is likely step” for human rights. more than drug use and to soar as the device car accidents combined. is adopted by forces.

www.drugfoundation.org.nz 05 COVER STORY

Underdosing naloxone Globally, an estimated 69,000 people die each year from opioid overdose. The drug naloxone can quickly block opioid receptors in the brain and is used in some cases to bring people back from the brink of overdose death. Amberleigh Jack looks at why naloxone is not being used more widely.

06 matters of substance February 15

COVER STORY

ark Kinzly almost The recent attempts by government to died from opioid prevent overdoses is a good start, according overdose. Twice. to Kinzly, but there’s still much more than He survived thanks can be done. And largely, it comes down to a life-saving drug to that vital drug. known as naloxone. “I have a 16-year-old son,” he tells M Others he knew me, referring back to his own near-fatal weren’t so lucky. experiences. AMBERLEIGH “I’ve watched my community die,” he “I bet if you talked to him he’d be JACK tells me. “The community is dying – either pretty happy that naloxone was available.” from AIDs or drug overdose – and the But for too many others, the potential community has been dying for decades.” lifesaver has not been at hand. Now, These days, he’s off the drugs, lives overdose prevention advocates, often with in Texas and is an overdose prevention the backing of government officials around advocate. Unsurprisingly, he thinks the the world, are increasing efforts to actively medication that saved his life should be prevent overdoses and make naloxone an over-the-counter drug. more readily available, saying hundreds Naloxone works by instantly blocking of lives are being unnecessarily lost. As opioids from receptors in the body, yet, nothing is happening in New Zealand, stopping them having any effect. It works and perhaps it’s time to ask why. in minutes and has the ability to bring In the US in October 2014, the Office people back from the brink of death. of National Drug Control Policy’s Acting Its availability is a major part of overdose Director Michael Botticelli (otherwise prevention programmes, particularly known as the White House Drug Czar – in the US. the first person to hold the title who is in

08 matters of substance February 15 injectible naloxone to be prescribed. By But Kinzly says the best way to deal Recent statistics suggest 2010, this decision had resulted in more with the problem is to catch it before it that more than 400 people than 15,000 naloxone prescriptions being becomes a massive problem. “Why would filled to potential overdose witnesses, you wait until you’re in a situation like died of a drug overdose with more than 1,500 reported overdose the US? in the four years between reversals. In 2011, 15 states had introduced “It’s always nice when you get the 2009 and 2013. more than 180 programmes that had doctors opportunity to deal with something that available to prescribe naloxone. By this could potentially become an issue and put time, more than 10,000 overdoses had been something in place early enough so that it recorded and more than 53,000 people doesn’t. It just makes sense, it’s really good recovery himself) told the Harm Reduction trained in naloxone administration. public health,” he says emphatically. Conference in Baltimore a disturbing fact. “It’s going to happen. Why would In 2010, there were 38,000 overdose deaths New Zealand be any different? Why would in the US – a figure that superseded the you wait until you’re in a situation like In New Zealand, users can obtain road toll deaths in the same year (35,000). the US is where it’s an epidemic? One of naloxone in an emergency situation when The number of road deaths has been the great things about New Zealand, you paramedics are called or by being presented steadily declining for the past two decades, guys have been really progressive around to a hospital emergency department while while the drug overdose death rate has areas of public health. Why would this be more than tripled. overdosing (as long as the hospital carries any different?” In 2012, 41,502 drug overdose deaths naloxone – most do, but a few don’t). were recorded in the US – almost 80 percent When asked why the drug is so difficult of which were accidental, and almost to obtain in New Zealand, Susanna Galea 7 percent were of unknown intent. And the – a consultant psychiatrist and Clinical One of the great things drugs? More than half were pharmaceuticals, Director for the Alcohol and Drug Service about New Zealand, you and more than 70 percent of these were within the Waitemata District Health Board guys have been really – says she doesn’t believe we have a need opioid analgesics. The non-pharmaceutical progressive around areas deaths? Heroin, mostly, either on its own for it. She’s worked previously in the UK. or combined with alcohol, pharmaceuticals Compared to there, she tells me, our issue of public health. or cocaine. Looking further into the stats is minor. makes for some depressing reading. In “We don’t have a massive overdose MARK KINZLY 2011, there were about 2.5 million visits problem. Yes, people are dying,” she to US emergency departments due to drug admits, “but it’s not a big problem. I’d say misuse and abuse. Around 71,000 of those in terms of people dying, it’s more around So what exactly does New Zealand do were by people under 18 years of age. medical complications from overuse by way of overdose prevention? It’s hard And it’s not just the US. Globally, an (such as cardiac arrest due to excessive to say. The needle exchange centres (there estimated 69,000 people die each year methamphetamine). That’s not to say we are 21 across New Zealand) include from opioid overdose (both pharmaceutical don’t do any overdose prevention at all. information and education on overdose drugs like Oxycontin and morphine as well It’s integrated within the harm reduction prevention for clients. It seems that for as illegal drugs like heroin and ‘homebake’ philosophy and within the patient’s care most, though, it’s not a huge priority. This opioids). In the US, it’s hit epidemic status, plan. So, no, there’s no need to start is probably due to the theory that heroin, and the rest of the world is seeing dishing out naloxone.” in the last couple of decades, hasn’t been increases, especially as prescription Yes, comparatively, the figures are a major issue in New Zealand. We have medicine misuse is on the rise. It’s also small in New Zealand. They’re also users, but they’re relatively confined and no longer limited to the streets. With the incredibly difficult to find. Recent statistics pretty rare. Heroin’s hard to get here and rise in prescription opioids, middle-aged suggest that more than 400 people died expensive. Charles Henderson, the head women are one of the rising demographics of a drug overdose in the four years of the Needle Exchange Programme, is for overdose rates. between 2009 and 2013. Of these, it’s quick to point out, though, that when the And the world is starting to take notice estimated that an average of about 30 figures are looked at on a per capita basis, as it struggles to get the rates under control. people per year die of opioid overdose. injection drug use is very much alive in While the ultimate goal is to reduce use Sure, it’s nothing compared to the figures New Zealand. For many, it’s a case of and abuse, as Allan Clear of the Drug Harm in the US, but compared to our road toll “out of sight, out of mind”. Coalition in New York says, “You can only figures, it’s a decent chunk. To borrow Peter Kennerley of the Ministry of help people get off drugs if they’re alive.” a term commonly used by the Police Health’s Addiction Treatment Services Enter naloxone. It’s a major component concerning road fatalities, “One death is admits New Zealand has a problem with of overdose prevention programmes and one death too many.” drugs but says the problem is more alcohol methods. A lifesaving drug that, if injected There’s also another factor to consider. and amphetamine related. Our people are quickly enough, reverses opioid overdose Oxycontin has been available since the dying, but they tend to die of medical and does so safely. It’s been around for 90s in the US, whereas it was introduced complications brought on by other drugs decades, yet in a number of states, it’s been in New Zealand in 2005. In that time, rather than overdose, he says. Government difficult to obtain until recently. It was in prescription numbers have increased by funding tends to be focused on harm 2001 that the Chicago Recovery Alliance more than 700,000. And we have 10 years reduction and education around drug first established a US programme to allow of catching up to do. and alcohol abuse.

www.drugfoundation.org.nz 09 COVER STORY

It takes about one to three hours. If I call you up and say, ‘I’m getting ready to use, check on me in an hour or so’ …

MARK KINZLY

Photo credit: ﬂickr.com/photos/intropin

Kennerley explains that New Zealand In New Zealand, paramedic and bystanders, and while traditionally only a has a multifaceted approach to harm hospital staff don’t tend to call the Police doctor can prescribe directly, states such as reduction, and the idea of overdose unless necessary, but Henderson suggests New York and California have loosened the prevention is integrated within that, that the Police often tend to turn up in an rules to allow doctors to prescribe for harm focused mostly on education and stricter overdose situation. reduction and syringe exchange prescription monitoring. “We recommend that the first point of programmes without having to be present “It’s a part of the overall service,” he says. call is to dial 111,” he tells me. to distribute the prescriptions. As well as “There’s no one approach, but it’s “One problem we’ve got is that, if drugs this, with the backing of the Federal partly around giving consumers choices are mentioned, it can be likely that the Government, the Police forces and armed and different sources of information. My Police will arrive. There’s plenty of defence forces have been trained and concern would be when opioids are anecdotal evidence that the Police then do supplied with naloxone over the past year. prescribed for pain management. People think about arrests.” The big rise in the use of prescription may end up with an addiction and start The Needle Exchange’s advice to rectify opioids, and the resulting increase in using them inappropriately. It’s something this isn’t without its flaws, though. addiction and overdose, have brought the that needs to be looked at.” “We’re in a bit of a no-win situation, problem to the forefront of the public He’s right, too. In New Zealand, deaths because our advice to clients would be that mind, says Allan Clear, and so have the are occurring. Similarly with the US, the they should possibly avoid the naming of high-profile deaths of celebrities including headlines are happening in the provinces. the drug used, because that immediately actor Philip Seymour Hoffman. And it’s been happening for a few years. can result in charges. But it’s my “The focus on opioids is a strategy we Vito Vari was 40 when he was found dead understanding that St John’s only carry adopted a few years ago,” he tells me about in his Nelson home in August 2011. The naloxone with advanced paramedics.” the Harm Reduction Coalition’s approach New Zealand Herald reported the coroner So the risk is that, by avoiding arrest, a to education and overdose prevention. finding to be death by accidental overdose. paramedic may arrive who simply doesn’t “There’s a ban on using any federal The drug? Oxycontin. have the lifesaving drug on hand. money to supply syringes to anyone else. Following suit with US immunity laws, So our focus [for funding and support] Henderson suggests, would help a lot. became much more on opioid overdose In the US at the end of 2014, 20 states [and pushing for access to naloxone and It was the surging rates of accidental had introduced Good Samaritan laws education tools]. Even when you talk to overdose death in the US that led to recent providing immunity from prosecution or Democrats around syringe exchange, if law changes, of which there are two main civil action if someone used a prescription they come from places like Minnesota, they arms. The first is wider access to naloxone, that wasn’t theirs or was found to be basically say, ‘This is a big city problem. the second is an increase in states that have intoxicated or to have gear on them at the It’s not our problem. We don’t have it’.” passed Good Samaritan laws, providing overdose scene. It’s a different story with prescription immunity for people who seek help when Since then, availability has increased medication though. someone has overdosed without fear of further. Now, 22 states have increased “But when you talk about prescription civil liability or prosecution. naloxone availability for users and drug use – people [in government] from

10 matters of substance February 15 places like Minnesota or Wisconsin – they FACTS all get it. And very often they say things like, ‘My brother-in-law had a problem,’ or ‘My cousin has been in rehab’.” That stigma and discrimination around Naloxone drug use is an issue in Australia as well – one that isn’t necessarily stopping strong overdose prevention measures but one that can definitely make them more difficult to implement without support from the top down. In Australia, Tony Trimingham knows more than he’d ever want to about drug overdose – and the stigma around use and abuse. In 1997, his son Damien, aged 23, was found dead in a disused hospital corridor in Sydney after overdosing on heroin. He was a regular user but had recently had a period of abstinence. The Naloxone (also known by its trade name Dosage lowered opioid tolerance contributed to Narcan) is a full opioid antagonist, which has been used globally for more than 40 years. Since the duration of action of some his fatal mistake. Shortly after, Trimingham narcotics may exceed that of naloxone, found himself struggling to find support It is generally distributed as an intramuscular injection, and it is most commonly injected the patient should be kept under continued and information and ultimately created into the upper arm to avoid any potential surveillance and repeated doses of naloxone Family Drug Support – a non-profit nerve damage. In the US, it is also available should be administered as necessary. organisation that helps families find in a nasal spray, eliminating any concerns For the reversal of known or suspected support, information and help when it over risk associated with needle injection. opioid overdoses in adults, an initial dose comes to loved ones’ drug use. When he It reverses the effects of opioids such as of 0.4–2.0mg is recommended, repeated talks about his son and the stigma around respiratory depression, sedation and every few minutes if needed. If there is no his untimely death, Trimingham has the hypotension. When injected, naloxone response it is likely the condition is not an same tone of voice I’m now all too familiar works within three to seven minutes and opioid overdose. with. The quiet conviction – something is said to be 97 percent efficient. that conveys both deep pain and regret Naloxone is also safe for use with children and newborns, with a suggested dose of as well as a fierce determination – Global availability especially when it comes to that 0.01mg per kg of weight. Most developed or developing countries all-too-common stigma. Side effects/risks “It’s still as strong as ever,” he insists. have naloxone available in emergency “I’ve known lots of families that lost departments, and more than a dozen Naloxone has no psychoactive effect and people and have never stated the fact it countries have introduced naloxone is non-addictive. distribution at a community level. These was a drug overdose. There’s a lot of As naloxone only temporarily reverses the include Afghanistan, Australia, Canada, pressure on families not to talk about it. effects of opioids, it is essential that the China, India, Italy, Kazakhstan, Kyrgyzstan, “I don’t think it applies in any other overdose victim be monitored following the Tajikistan, Thailand, the United Kingdom area. People with mental illness are now injection to ensure that overdose does not of Great Britain and Northern Ireland, reoccur once the naloxone wears off (usually speaking out, and the stigma is reducing as the United States, Ukraine and Vietnam. they do that. But not for drugs. It’s still the about 60–90 minutes). It is also imperative In New Zealand, naloxone is administered leprosy of the modern age. It affects the that opioids are not retaken, despite the user by ambulance officers and in hospitals. It is experiencing likely withdrawal symptoms. drug users more than anybody, but next not available for community distribution. to that, it’s the families.” It is recommended that emergency It’s an attitude that’s not just confined services ensure full monitoring following Cost to Australia. an overdose reversal. Back in Texas, Kinzly believes that The cost of a naloxone kit in the US The only known risk associated with stigma is one of the biggest hurdles to is about $20, although naloxone prices naloxone is the onset of opioid withdrawal making appropriate services available are increasing. symptoms due to the blocking of any opioids – whether that’s harm reduction, overdose in the system. These include body aches, prevention or even housing. And it can diarrhoea, tachycardia, fever, sweating, make overdose more likely simply nausea or vomiting, nervousness, restlessness or irritability, shivering or because of the shame attached to using. trembling, abdominal cramps, weakness “That stigma means we don’t tell and increased blood pressure. people we’re using,” he says. $ “We need to encourage people to be Naloxone is ineffective against non-opioid more open. Find someone you trust, even overdose or other non-opioid-related 20 medical conditions. if they’re not with you. Most of us don’t die immediately. It takes about one to three

www.drugfoundation.org.nz 11 COVER STORY

So the afﬂuent, inﬂuential mothers and fathers, sisters and brothers are now making noise. It’s like, well now our kids are dying, so we have to do something.

MARK KINZLY

Photo credit: ﬂickr.com/photos/mannaz

hours. If I call you up and say, ‘I’m getting “What’s happening in regards to “I’ve done Police trainings [in the past], ready to use, check on me in an hour or overdose is that, because of prescription and they’re usually incredibly hostile. so’ – do you know how many lives we drugs and how it’s affecting suburban I recall back in the 90s, I once said, ‘You could save just by teaching people not areas, white middle and upper class kids can’t get HIV from heroin,’ and one of the to use alone or to have somebody check are being affected,” says Kinzly. cops said, ‘Well that’s a shame isn’t it’.” on them?” “So the affluent, influential mothers But now? It’s something I understand. My own and fathers, sisters and brothers are now “It was astonishing [recently] to hear brother Barnaby died of a heroin and making noise. It’s like, well now our kids [a Police trainer] talk about how it’s the cocaine drug overdose in his San Francisco are dying, so we have to do something.” duty of the Police to revive someone from apartment. While intervention measures Allan Clear has found a similar shift in an overdose. Back when we started, the such as naloxone would likely have been attitude with the Police he’s worked with Police notion was that we’re better off able to save him (the drug doesn’t affect the through naloxone distribution and training. without them. When you see Police non-opioid cocaine in the system, but often In the US, 21 states currently have reversing overdoses and taking an active with combination overdoses, removing the trained Police departments carrying role in preserving the lives of drug users [by organising treatment rather than making opioids is enough), there wasn’t an naloxone. New York has more than 150 arrests], it’s astonishing they’re taking that opportunity as he was alone. He wasn’t departments involved in the programme. on, because a few years ago, they wouldn’t found until it was too late. He also hadn’t Already in January, one department – have seen it as part of their job.” told anybody he was using. He was highly Buffalo PD – recorded three overdose The reason? Clear thinks the rise in intelligent, a world-class computer security reversals. In Massachusetts, known to have prescription overdoses is a big part of it. expert who travelled the world speaking at a major heroin problem, one department – “A place like Staten Island is conferences and to government officials. Quincy PD – had recorded 300 overdose considered predominantly white, blue Friends have suggested he never told us reversals as of September 2014. Most collar working class – it’s a Republican of any drug use because he feared we’d be departments list at least one recorded save part of New York – and it’s been hard hit disappointed. By the time we found out, or reversal since beginning the programme. by overdose. Cops and firemen are seeing it was too late. And even then, the word Perhaps that’s what has helped make the problem in their own communities. ‘overdose’ is just beginning to be spoken the work with the police and other People they know are dying of overdose. within our family. My mother is only now frontline staff more open to being involved. That may affect the attitudes.” willing to let people know how he died. It’s no longer just a problem for typically Not that the stigma doesn’t exist The stigma is real, and everyone seems homeless black addicts, suggests Clear, but though or that there aren’t problems with to agree it needs to change for any real for neighbours and friends of the fairly introducing prevention programmes that overdose prevention intervention. affluent working class. He highlights this people get on board with. In some ways, though, attitudes are with his recent experience training Police “I guess it’s all relative. It’s still highly changing. And the reasons seem to be officers in the administering of naloxone. stigmatised. We do amazing work in New related to the rise in prescription opioid “I was taken aback to watch a cop do York, for example, but then you go down pain medications. the trainings with other cops,” he says. south, and it’s incomprehensible to me.

12 matters of substance February 15 teach them about tolerance. We also have People from any walk of life can be affected by overdose, says Allan Clear, Drug Harm Coalition what we call post-detox groups for vulnerable periods.” So what needs to happen? Some say a lot. Henderson is a firm supporter of naloxone being made available in New Zealand, And he’s quick to point out, if the estimated figure of 30 deaths per year is correct, that’s not an insignificant number. His hope? That the drug will be rolled out, and that the easiest way to implement it would be through the Needle Exchange Programme. “Through needle exchanges, we certainly hear enough anecdotes of overdoses occurring ... We need to be able to have the training measures in place to roll out something like naloxone.” Kinzly believes at some point naloxone will be available as an over-the-counter drug. But there’s a way to go yet. “It’s rare that we have the opportunity in our lifetime, with an epidemic going on, to dramatically curb it just by making a couple of simple things accessible. We can make a dramatic decrease in overdoses just by making the medication available. For Australia resulting in 242 deaths compared whatever reason, we don’t do that. I recall back in the 90s, with 374 overdose deaths (including “How do you give somebody something I once said, ‘You can’t get intentional). 310 of these involved that’s potentially fatal and not give them a prescription medications. medication that could potentially save HIV from heroin,’ and one Belinda McNair of the Penington them from that fatality? It’s just unethical.” of the cops said, ‘Well that’s Institute – which works on improving Similarly, Australia needs improvement, a shame isn’t it’. overdose prevention across Victoria – says according to Trimingham, and it’s she struggles to understand why naloxone something that needs to start from the top. isn’t widely available. “I’d like to see a more willing attitude ALLAN CLEAR “I’ve been trying to find ways where the from the people that have the power to drug could be misused in some way,” she exact legislation. People don’t want to go It seems the efforts of local government tells me. anywhere near anything that might have down south deprive people of healthcare. “If you give it to someone who isn’t anything to do with drugs or be seen to be You won’t find sympathy for drug users suffering an opioid overdose – nothing condoning use,” he says. in virtually any of the southern states. happens. If, God forbid, a child finds it “It’s not though,” he continues.“It’s You have great disparities in services and and injects its brother – the brother will accepting reality.” enormous disparities in health outcomes.” cry because he just got a needle in his arm And for New Zealand? Kinzly has a Closer to home, Australian heroin use – that’s it.” word of advice. Our overdose rates may not has been a growing issue for decades, with One thing everyone agrees on is that be large, but they’re important enough to 1,100 heroin overdose deaths being reported a major aspect of overdose prevention is warrant intervention. And prevention starts during the country’s “heroin glut” in 1999. education. The US, again, has multiple with making naloxone more freely available. While heroin deaths have decreased since community groups and programmes He refers back to my own situation and then, opioid overdoses are on the rise. designed to educate users and families to his near fatal overdoses. Naloxone is available through syringe on how to prevent overdose, ranging from “That’s it right there,” he says. exchange centres and programmes such as simply not using to full video tutorials “Whether it’s 30 deaths or one death, Victoria’s COPE (Community Overdose online about how to administer naloxone. it doesn’t matter. To that one person’s Prevention Education). While the drug is Back here, Galea says that education family, it’s a big fucking deal.” available, there are still major restrictions. is a large part of overdose prevention in Naloxone in Australia can only be New Zealand – that it’s incorporated into Amberleigh Jack is a writer based in Auckland prescribed to the user, not to a potential programmes, particularly in regard to witness. This, of course, relies on users Photos on the cover and pages 6 and 8 were taken by lowered tolerance due to abstinence Matt Slaby (www.luceoimages.com) for the Harm specifically seeking out a doctor and rules following hospital or rehab stays. Reduction Coalition. out concerned family or friends from being “We do have an inpatient unit. Once prepared with the antidote. As with the US, they’ve been detoxified, if they go back to overdose rates were higher than road toll their pre-treatment dose, there is a risk of deaths in 2013, with road accidents in overdose. We do teach them that, and we

www.drugfoundation.org.nz 13 FEATURE Good booze news from across the ditch

In late November 2014, the Australian Government’s Institute of Health and Welfare released its full report on the 2013 Australian National Drug Strategy Household Survey. The survey has been conducted every two or three years since 1985, and 2013’s iteration collected information from almost 24,000 people, asking them about their use, attitudes and opinions on alcohol, tobacco, illicit drugs and what they think about alcohol and drug policies. As Rob Zorn reports, the results are pretty encouraging.

ROB ZORN

14 matters of substance February 15 In fact, 40–49-year-olds have now replaced young people as the group most likely to drink at risky levels.

JULIE RAE

he 2013 Australian Drug Foundation (ADF) Head of Information National Drug and Research Julie Rae. Strategy Household “The later a young person first tries Survey has revealed alcohol, the less likely they are to have a some pretty good problem with alcohol as an adult,” she is things are happening quick to remind. T in Australia in terms The three big guns in combating alcohol of drugs and alcohol. misuse have long been accepted as Methamphetamine use has remained stable, marketing, pricing and availability – all three and the proportion of young people who largely legislative. But Australia has not have never smoked has risen from 58 percent made any major moves in these areas in Photo credit: Australian Drug Foundation to 77 percent. Risky drinking has declined recent years and could hardly call itself a overall, and about half of all drinkers have world leader in terms of alcohol law reform. reduced the amount they drink because of It’s the only country in the world where health concerns.1 alcohol is available 24 hours a day, and it This last finding is good news because it still has alcohol advertising on free-to-air indicates a fair proportion of drinkers now television. While this is usually only allowed are well aware of the health benefits of after 8.30pm, it can feature at any time reducing alcohol consumption. But what’s during the broadcast of live sporting events, particularly encouraging is what’s happened which are often watched by children. with the stats around youth. Young people “So Aussie kids are seeing these ads,” are now waiting longer before trying their says Rae, “and we know this sort of first drink (15.7 years of age, up more than marketing has an enormous effect. a year from 14.4 years of age), and the proportion of 18–24-year-olds engaging in British research by the Joseph Rowntree risky drinking behaviours has fallen from Foundation, for example, reveals kids around 30 percent to around as young as four can identify alcohol 20 percent. In fact, 40–49-year-olds have now by its bottling.” replaced young people as the group most In the absence of significant legislative likely to drink at risky levels. The proportion changes, there’s been a lot of discussion at of young people aged 12–17 years of age who the ADF about what the positive changes in are choosing not to drink at all has risen from the 2013 survey could be attributed to. And 64 percent to 72 percent. the answers are probably community While this doesn’t indicate that awareness and culture change – often two everything’s rosy with alcohol and drug use sides of the same coin. across the ditch, that the majority of young “We can only speculate,” says Rae, “but people are not drinking and taking drugs is we know there’s more talk going on in the news so exciting we should be shouting it news about risky drinking and young from the rooftops, according to Australian people drinking.

www.drugfoundation.org.nz 15 FEATURE

A seminar in June 2014 looked at best-practice approaches to prevention that communities can use. Photo credit: Australian Drug Foundation

Unfortunately, Big Alcohol will respond to these positive ﬁgures by trying to reverse them and have people drinking more, rather than less.

ADF GROGWATCH “We know there are a lot of programmes out there looking at the risks Underage drinking could and protective factors for young people, and we’ve got messages out there to be greatly reduced if all states parents that they need to set behavioural and territories introduced expectations for their kids.” secondary supply legislation The ADF isn’t the only organisation to prevent unauthorised working towards that culture change, but some of its programmes serve as supply of alcohol to children. excellent examples. Its Good Sports programme has been rolled out across the nation to help ensure JULIE RAE young people drink more responsibly. Sporting clubs go through a three-stage accreditation system that steps them the inﬂuence of a drug at work. It’s just through responsible alcohol management. basic awareness raising really.” It includes things like not having alcohol While it seems fairly certain initiatives present at junior competitions and like these have helped cause cultural offering alternatives to full-strength change, Rae is quick to point out that there |alcohol at events. remains a long way to go in the Lucky The ADF’s Other Talk programme Country. Alcohol still causes around encourages parents to have conversations 5,500 deaths and 150,000 preventable with their kids about alcohol. It uses hospitalisations and costs the country forums and parental advisory groups A$15 billion each year. to have those discussions. She says legislative changes are a must “We’re also working in workplaces if further progress is to be made. towards responsible event management “Alcohol needs to be properly labelled around alcohol,” says Rae. to warn people of the dangers of excessive “We just knock on the doors of these businesses and offer policy tips if they are drinking and trading hours need to be starting to think about alcohol use in the reduced in the interests of people’s health. workplace. We use an occupational health Underage drinking could be greatly and safety approach and talk about reduced if all states and territories absenteeism due to hangovers and the introduced secondary supply legislation harms that could be done to both safety to prevent unauthorised supply of and proﬁtability when someone is under alcohol to children.

16 matters of substance February 15 Photo credit: Australian Drug Foundation

British research by the Joseph Rowntree Foundation, for example, reveals kids as young as four can identify alcohol by its bottling. JULIE RAE ? The New Zealand situation

New Zealand does not have a regular government-sponsored equivalent to the Australian National Drug Strategy Household Survey. We did once have the national Alcohol and Drug Use survey, but this was last conducted in 2007/08. The survey has now been discontinued “We’ve made seatbelts compulsory to reverse them and have people drinking with questions incorporated into the even though the hospitalisations and more, rather than less,” says a 22 July 2014 New Zealand Health Survey. deaths from road accidents are much less issue of ADF’s Grogwatch.3 “Australia is than those from alcohol, so we need to still very much in the grip of a dangerous The 2013/14 New Zealand Health Survey have that preventative legislation in place.” love affair with booze.” Update reveals there has been a very And it seems such legislative changes And of course, as a multi-billion dollar moderate decline in overall hazardous drinking in New Zealand’s population over would meet with the approval of the industry, Big Alcohol wields significant the past seven years (from 18 percent average Aussie. The survey reveals most political influence. down to 16 percent). want to stop alcohol marketing to young “There’s a huge push and pull between people. Most support a ban on alcohol agencies like ourselves and government The rate of hazardous drinking amongst sponsorship of sporting events. As many policy,” says Rae. “The alcohol industry is men has dropped minimally from 26 to as 73 percent want alcohol advertising on a powerful lobbyist – and its arguments 22 percent, but the rate remains the same television restricted to late-night viewing are all around the free market, creating in women at (11 percent). Encouragingly, after 9.30pm. jobs and supplying goods. Great, but our the rate has decreased in 15–17-year-olds So if there’s now a national palate for response is, ‘With what harm and at (19 percent down to 14 percent). However, mirroring circumstances in alcohol law reform, why is the Australian what cost?’. Australia, the rate amongst 45–54-year- Government reluctant to act? It may be “We’re finally getting somewhere, olds has increased from 12 to 16 percent that it doesn’t think reform will be all but the real fear now is that government – meaning our young middle-agers are that popular (unlikely by now). It may inaction may see the foot coming off also the group now drinking most riskily. be that it isn’t convinced by the research the pedal.” and findings of its own body (it’s been A two-point percentage drop in hazardous convinced by much less), or the answer Rob Zorn is a Wellington-based writer drinking can’t be bad news in and of itself may be the same as it is just about – but is it really something to crow about everywhere else – the alcohol industry. if we’ve just been through a couple of The industry wields its might to oppose years of major alcohol law reform? reform on whatever front it can. For 1 The full report is available online at nzdrug.org/2013- One wonders how much greater that drop andshs. example, Brewers Association CEO Denita might have been if more attention had Warn was quick to use the survey’s 2 Media release: New data highlights ongoing trend in been paid to the Law Commission’s decline of risky drinking. Brewers Association of Australia findings around the decline in risky & New Zealand Inc. 17 July 2014. Retrieved 18 January recommendations around pricing, drinking to soothe public concerns around 2015 from http://www.brewers.org.au/wp-content/ marketing and availability. alcohol harm by saying they “dispel the uploads/2014/07/Brewers-Association-Media-Release- myth of a growing alcohol crisis”2 despite New-data-highlights-ongoing-trend-in-decline-of-risky- drinking-17-July-2014.pdf. RESOURCES the fact that Australia’s alcohol harm 3 Less under 18s drinking alcohol but more to be done. statistics are still a gruesome read. See the latest New Zealand Health Survey Grogwatch, 22 July 2014. Retrieved 18 January 2015 from results at nzdrug.org/nzhealthsurvey13-14 “Unfortunately, Big Alcohol will http://grogwatch.adf.org.au/2014/07/less-under-18s- respond to these positive figures by trying drinking-but-job-far-from-done/

www.drugfoundation.org.nz 17 FEATURE

CURRENTLY Secondary USE ALCOHOL

school student 39 % % % 45 27 55 23 %

drug use stats %

NO YES The third Youth2000 STUDENTS WHO HAVE EVER SMOKED A CIGARETTE 60 survey shows drug use by AMONG STUDENTS WHO secondary school students 50 53 CURRENTLY DRINK ALCOHOL % continues to drop. 40 DRINKING FREQUENCY

30 32

Findings presented in the Problem substance % use among New Zealand secondary school 20 23 students report, released in November 2014, % show declines in the numbers smoking 10 cigarettes, binge drinking and using cannabis. Nevertheless, 11 percent of students met the 0 2001 2007 2012 criteria for very high substance use, with binge drinking the most common problem use. BINGE DRINKING BY STUDENTS APPROXIMATELY 7 OUT OF 10 The Youth’12 survey was completed IN THE LAST FOUR WEEKS CURRENT ALCOHOL DRINKERS HAD by 8,500 students from 91 schools 50 HAD A DRINK IN THE LAST FOUR WEEKS (3 percent of the national school roll).

40 40 Key ﬁndings are presented here. The full report % 34 is online: nzdrug.org/youth12_drug_use 30 %

20 23 %

0 APPROXIMATELY 2 OUT OF 10 CURRENT 2001 2007 2012 ALCOHOL DRINKERS HAD HAD A DRINK WEEKLY OR MORE OFTEN

STUDENTS WHO HAVE EVER USED MARIJUANA 50 BINGE DRINKING*

40 39 % 30

REFERENCE 27 23 20 %

Fleming, T. Lee, A.C., Moselen, E., Clark, T.C., Dixon, % 24% R. & The Adolescent Health Research Group. * UNDER 16 YEARS DRANK FIVE OR MORE (2014). Problem substance use among New 10 ALCOHOLIC DRINKS IN ONE SESSION Zealand secondary school students: Findings from TWO OR MORE TIMES IN THE PAST the Youth’12 national youth health and wellbeing 0 FOUR WEEKS survey. Auckland, New Zealand: The University 2001 2007 2012 OVER 16 YEARS DRANK FIVE OR MORE of Auckland. ALCOHOLIC DRINKS IN ONE SESSION EVERY WEEK OR MORE

18 matters of substance February 15 CANNABIS OF THE 11% OF STUDENTS WITH OF THE 11% OF STUDENTS WITH USE VERY HIGH LEVELS OF DRUG USE VERY HIGH LEVELS OF DRUG USE

MORE LIKELY TO

% 92

3 100 % 30% 18% 39 WORRIED ABOUT HAD TRIED TO CUT DOWN HOW MUCH THEY OR GIVE UP DRINKING % 80 63 ARE DRINKING

% % % 13 27 23 23 % 60 %

26 40 25 37% 36% WORRIED ABOUT HAD TRIED TO CUT 15.4 % % HOW MUCH DOWN OR GIVE UP MARIJUANA THEY USED MARIJUANA TRIED CANNABIS 20 % 2.0 0.4 1.9 CURRENTLY USE % % WEEKLY USE % 0 CIGARETTES SMOK DRINK DRINK BING WEEKL SMOKE WEEK E E LY Y AL

CANNABIS ALMOST HAD EXPERIENCED

OTHER DRUG USES COHOL ARE UNCOMMON PROBLEMS BECAUSE OF 2/3rds THEIR ALCOHOL USE

HIGH LEVELS OF DRUG USE 31% had done things that could have USED LOW LEVELS OF DRUG USE PARTY PILLS got them in serious trouble, 33% were injured, 25.5% had unsafe sex and WHAT IS PROBLEM (VERY HIGH) SUBSTANCE USE? 24% had friends or family members 4% tell them to cut down The Adolescent Health Research Group (AHRG) deﬁnition is based on the following MOST YOUNG PEOPLE WITH USED factors: alcohol frequency, binge drinking, SUBSTANCE USE PROBLEMS ARE ECSTASY cannabis and other substance use. There are NOT WORRIED ABOUT THEIR USE, criteria for students aged under 16 years and NOR ARE THEY SEEKING OUT HELP 3% those aged 16 years or over.

STUDENTS WITH VERY HIGH USE CONCLUSIONS USED P HAD POORER HEALTH AND Efforts must be made to reduce the < WELLBEING ACROSS ALMOST EVERY AREA EXAMINED level of substance use (and related harm) by school students. 1% Holistic or systemic approaches THEY WERE MORE LIKELY TO: will be more effective at meeting the needs of students than those • report negative family experiences that focus on single issues, i.e. they LEVELS • have witnessed or experienced need to also address such things OF DRUG USE violence or abuse as problems in a student’s family and school life, experiences of • report negative experiences violence, risky driving, poor of schooling mental health etc. % 11 • have had an injury that Social norms, such as high rates 39 needed treatment of use among peers and family, and % • be overweight or obese the availability of alcohol and other

27 substances in communities must be 23 % % • gamble tackled in efforts to reduce high 89 % • have been in trouble with the levels of substance use among Police in the last year young people. (39% compared to 7%) Enhancing young people’s HIGH LEVELS protective factors, such as family LOWER LEVELS • have had sex and school connections, is equally as (68% compared to 18%) important as access to counselling or other social services.

www.drugfoundation.org.nz 19 ABOUT A DRUG

7% OF 16–64-YEAR-OLDS HAVE USED LSD 1kg OF ERGOTAMINE TARTRATE CAN PRODUCE AROUND 240G OF LSD – ENOUGH FOR 4 MILLION DOSES 6-14 A TYPICAL LSD TRIP LASTS FOR 6 TO 14 HOURS

20 matters of substance February 15 Lysergic acid diethylamide (or LSD) has many street names including yellow sunshine, window pane and Microdot but it is most commonly known as acid.

It is mainly used recreationally, as an phenomenon. No definitive root of the therapeutic value of the entheogen (a fancy word for a explanation is currently available LSD experience is its potential for chemical that brings you closer to the for these. producing self-acceptance and divine) and – in the 60s and 70s and The United Nations Convention on self-surrender.” again more recently – in psychedelic Psychotropic Substances requires its In the 1950s, Central Intelligence therapy for alcohol dependence parties to prohibit LSD for recreational Agency (CIA) officials thought LSD and anxiety. use. Hence, it is illegal in most might be useful for mind control In its pure form LSD has no colour, countries, including New Zealand, and chemical warfare and began a odour or taste. It is usually taken the United States, Australia and most research programme codenamed orally via absorbent blotting paper, in of Europe. However, medical and Project MKULTRA. Experiments a sugar cube or in gelatine. It can also scientific research with LSD in included administering LSD to CIA be administered by injection when in humans is permitted under the employees, military personnel, liquid form. It is generally accepted Convention. doctors, other government agents, to be non-addictive and is relatively In New Zealand, LSD is classified prostitutes, mentally ill patients and non-toxic. as a Class A drug under the Misuse of members of the general public in order LSD’s effects include altered Drugs Act 1975. This means it attracts to study their reactions, usually thinking processes, visual the highest penalties possible for without the subject’s knowledge. LSD hallucinations and an altered sense of manufacture and sale, including life was eventually dismissed by CIA time. However, an LSD trip can vary in jail. Possession can attract up to six researchers as too unpredictable in its greatly from person to person. One months imprisonment, a $1,000 fine results, and Project MKULTRA was trip can also be very different to or both. scrapped in 1973. another for the same person, and trips According to the Drug Use in New LSD became very popular as a can have long-term psycho-emotional Zealand Survey 2007/2008 published recreational drug among 1960s effects. Some users say LSD has in 2009, 7.3 percent of 16–64-year-olds counterculture enthusiasts, the most caused significant changes in their have used LSD, and 1.3 percent of prominent of whom was probably personality and life perspective. 16–64-year-olds used it in the American psychologist Timothy Leary Adverse psychiatric reactions such previous 12 months. (famous for the catchphrase “tune in, as anxiety, paranoia and delusions are LSD was first developed in 1938 by turn on and drop out) and whom possible, and LSD may temporarily Dr Albert Hofmann at the Sandoz President Richard Nixon once impair the ability to make sensible pharmaceutical company in Basel, judgements and understand common Switzerland. It was synthesised from described as “the most dangerous man dangers, so users can become more ergotamine, a chemical derived from in America” for his pro-psychedelics susceptible to accidents and injury. It ergot, a grain fungus that typically stance. LSD became a prohibited may cause temporary confusion, grows on rye. But he didn’t discover substance in the US with the adoption difficulty with abstract thinking and its psychedelic properties until 1943. of the UN Convention in 1971. impaired memory or attention span. Sandoz introduced it commercially The psychiatric use of LSD is The January 2013 edition of the in 1947 under the trade name Delysid enjoying a small renaissance with Journal of Addiction Medicine, for as a drug with various psychiatric organisations such as the Beckley example, reports a case where a man uses, and it quickly became a Foundation, the Multidisciplinary with no diagnosed mental illness therapeutic agent that appeared to Association for Psychedelic Studies manually removed his own testicles show great promise in the treatment (MAPS), the Heffter Research Institute during his first LSD trip. Fortunately, of alcohol dependence syndrome and and the Albert Hofmann Foundation that sort of thing doesn’t seem to pain relief. co-ordinating research into the happen very often. Some psychiatrists believed LSD medicinal and spiritual uses of LSD Flashbacks, in which an individual helped patients unblock repressed and related psychedelics. New clinical experiences an episode of some of subconscious material. A 1959 study LSD experiments in humans started LSD’s subjective effects long after the published in the Quarterly Journal of at MAPS in 2009 for the first time in drug has worn off, are also a reported Studies on Alcohol concluded: “The 35 years.

www.drugfoundation.org.nz 21 FEATURE

New Zealand researchers and policy makers, it was acknowledgement of the paucity of local data on which to base sound policy. Helen Poulsen, Forensic On the road Toxicologist, Institute of Environmental Science and Research, bemoaned the small number of samples available for the ESR lab to test. National Road Policing Manager with to reducing the New Zealand Police, Carey Griffith, said that, between 1 November 2009 and 31 August 2014, only 1,309 compulsory impairment tests were recorded. With around 400 trips by vehicle drivers each, drug-driving it’s an astonishingly low ratio of drives to tests. The contrast with Australian states is marked. In Queensland alone, there have been more than 129,000 tests since 2007. harm Several Kiwi presenters hinted at the need for better data. Unless this is collected, it will be hard to make a case for any policy and enforcement changes. The presenters dived into the technical complexities associated with detecting drug presence, instrument reliability, the hen researchers, validity of research methodologies, The Drug Foundation was Police officers, statistical analysis of changes in driver delighted to bring together community road behaviour and other bottomless wells. safety campaigners, Keynote speaker Professor Mark AR a wide mix of people to drug treatment Kleiman, UCLA Luskin School of Public deliberate on the intricacies professionals, Policy, dragged discussion into the policy W academics and realm. He challenged the fairness of per se of drug-driving policy at policy makers laws for drugs and cautioned against taking gathered at the Second International attention away from alcohol. He argued for Te Wharewaka o Poneke, Symposium on Drugs and Driving, you three principles to govern any drug-driving 12–13 November. would have a thought a few sparks would legislation: any law must be consistent fly – so many different perspectives under with public safety, administrable and just. Stephen Blyth compiled one roof. But the good-natured debate and “Copying over our alcohol laws and this short report on the disagreement about the many complexities filling in the names of various other around both policy and implementation recreational drugs is a terrible idea,” key themes covered. didn’t lead to a conflagration. Kleiman warned. Overseas speakers were amazed at Citing the example of residual THC in the frankness of Minister of Police Hon blood samples, he explained this does Michael Woodhouse and wished they nothing to prove how recently cannabis was could see a similar level of engagement imbibed nor if a driver is actually impaired. in their own jurisdictions. To penalise someone for THC presence is “It’s right that we treat this as a road something he describes as both unjust and a safety issue, otherwise messages get a failure in terms of reducing risk. STEPHEN BLYTH bit mixed. I don’t think that approach Instead, Kleiman argues for testing that necessarily undermines the general shows whether cannabis was recently used prohibition issue around drugs,” (which mouth swab testing may eventually he explained. be able to show) and creating a driving Minister Woodhouse signalled that the offence that penalises anyone caught with government wants effective approaches to a positive test. Stiffer penalties should drug-driving enforcement but only when apply to anyone caught with both cannabis based on good evidence. Establishing how and alcohol present because of the higher a drug being present correlates with the public safety risks. Taking this approach level of impairment was noted as a meets the principles of good law. particular sticking point. Our neighbours across the Tasman have If there was any commonality across been pursuing a vigorous roadside testing the diverse presentations made by approach, which began in Victoria in 2004.

22 matters of substance February 15 Minister of Police Michael Woodhouse during his opening remarks.

With tens of thousands of drivers subjected The New Zealand Safe Journeys strategy, to random roadside drug testing each year, referred to by many Kiwi presenters, does It’s right that we treat researchers found a reduction in the see a place for random roadside testing, It incidence of drug driving and fatalities this as a road safety issue, will take policy makers some time to settle otherwise messages get caused by drivers with drugs present. on an approach. Background research and Not only is the deterrence effect paying off, policy analysis is under way, with a period a bit mixed. I don’t think but the data is mightily useful in keeping of consultation being planned. We can that approach necessarily resources flowing into enforcement. expect to be engaging in debate about new The advice to New Zealand from Jeremy undermines the general policy later in 2015. Davey, then Deputy Director of the Centre prohibition issue The final session was a fast and furious for Accident Research and Road Safety at around drugs. Queensland University of Technology, was exercise in collaborative authoring: to get started with a testing regime. Small or participants were invited to have their say HON MICHAEL WOODHOUSE big, it doesn’t matter, just do something! on a framework to support countries seeking Davey cautioned participants that to introduce drug-driving law, policies and Australians don’t take kindly to people practice. Rita Notarandrea, Chief Executive trying to change the way they imbibe but Officer (Interim) of the Canadian Centre on will listen to reasonable road safety messages. Substance Abuse, chaired this session, “We’ve not fiddled with people’s which concluded with broad agreement drinking behaviours, we’ve fiddled with on a draft comprehensive framework for their driving behaviour whilst they use addressing drugs and driving. When alcohol,” he explained. Contrasting this finalised early in 2015, the framework will experience with that in other countries, be shared by symposium partners with Davey believes people will accept an anyone willing to listen. imposition such as random testing for the There was always a danger that we could wider good. Changing drivers’ behaviour is tie ourselves in knots letting debate about something where clever initiatives from the complexity of the issue get in the way of New Zealand raised a chuckle and gained making decisions. And while the debate is not yet over, it would seem that there is the some credit. Simon Hager-Ford provided RESOURCES an overview of the participatory approach will to create good policy and enforcement taken to develop the Drug Foundation’s approaches in New Zealand. Recordings from ALL sessions and Steer Clear campaign. As CCSA succinctly copies of ALL presentations are freely tweeted, “Kudos @SteerClearNZ, great Stephen Blyth is the Drug Foundation’s Senior available via the Drug Foundation website. simulator/resource for changing young Communications Adviser nzdrug.org/drugdrivingnz drivers’ attitudes”.

www.drugfoundation.org.nz 23 FEATURE

Voting for change was the easy part

As state regulation of cannabis moves forward in several US states, it’s too early to say how the legalisative experiments will turn out. Professor Mark AR Kleiman, who visited New Zealand as a guest of the Drug Foundation last November, brings a blindingly clear angle to the public policy conundrums that arise. Cameron Price delves into what happens after the votes are counted. CAMERON PRICE

he global trend towards a more liberal approach to cannabis is accelerating. In America, in particular, the T landscape is changing rapidly. Four states and the District of Columbia have legalised, and another 14 states have decriminalised. The US territory of Guam has decriminalised medical cannabis, and President Obama recently announced that he would no longer enforce federal cannabis law on Indian Reservation land. More states are in line for changes to their drug laws, with ballot measures due to be voted on in 2016. Early indications are that reform has diminished the burden of drug harm in liberalising jurisdictions. More people are seeking treatment, governments are receiving millions in tax dollars and saving money that was previously spent on enforcement and gangs have lost a major revenue stream. And popular feeling towards cannabis is softening. Polling has shown a generational shift in attitudes surrounding cannabis law – 52 percent of Americans now believe pot should be legal compared to just 16 percent in 1990. When broken down by age, 70 percent of those born after 1980 support legalisation.

24 matters of substance February 15 All of this adds to the impression that a wave of cannabis liberalisation is inevitable. The question, then, is what we do when it hits our shores.

Right now, Americans spend about $35 billion a year on illegal cannabis. That money goes untaxed.

MARK KLEIMAN

All of this adds to the impression “Despite the simple-minded sloganeering not be more damaging than the use of the that a wave of cannabis liberalisation is on both sides, the question of creating a drug itself”. He doesn’t believe in the inevitable. The question, then, is what legal cannabis market is about as technical libertarian argument that people should be we do when it hits our shores. as they come, with equally valid public free to ingest any substance that they want. goals in sharp conflict, many unknowns, Instead, he focuses on the context of the The end or the beginning? a variety of tricky design issues and some drug in question. The view that legalisation is the end of big risks,” Kleiman says. According to Kleiman, practical decades of debate is alluring but false. considerations should outweigh As the biggest change in drug policy since The accidental drug tsar principled ones. the end of alcohol prohibition, it’s the Mark Kleiman is Professor of Public Policy “Can we pick alternative policies for beginning of a new one. As Mark Kleiman at UCLA but is better known in the United some or all of the currently banned drugs puts it, “Debating whether to legalise pot States as the Washington State Hemperor. that would get us better social outcomes? is increasingly pointless. Unless there’s an The consulting firm he heads advised the I don’t think there’s a principled answer to unexpected shock to public opinion, it’s state government on the implementation that question, and I don’t think the answer going to happen, and sooner rather than of its legal pot regime. He was chosen as a will be the same in all countries,” he says. later. The important debate now is how to result of his extensive experience in drug A good example of this style is his legalise it.” policy, which includes co-editing The stance on cocaine. He believes it could be There is a dangerous tendency among Encyclopaedia of Drug Policy and writing made legal in the US, as there is a high the uninitiated (read: general populace) Drugs and Drug Policy: What Everyone prevalence of use and heavy enforcement to think of cannabis law as a simple Needs to Know. harms people dependent on cocaine. dichotomy: it’s either legal or illegal. This Kleiman didn’t start out with a passion However, because New Zealand doesn’t is in part because discourse about pot is for drugs. He had his start in the public have a high prevalence of cocaine, he dominated by two diametrically opposed corruption team in the criminal division of thinks it should remain illegal here. camps. Ardent legalisers want a free-for-all the US Department of Justice but was asked “You want a cocaine problem? Go ahead system while puritanical prohibitionists to join the narcotics section by a professor and legalise it,” he says. “Why import want the drug eliminated. who he had admired while studying at a problem?” However, the reality is that neither Harvard. As a result of being an ‘accidental’ side’s ideal system will be implemented. drugs expert, Kleiman says he approaches The least bad option Instead, the regimes that will be put in the drug policy debate without the baggage So, when should drugs be legalised place are likely to be nuanced, of preconceived notions about drugs and according to Kleiman? incorporating features of both sides. instead approaches it as you would any “Where the costs of maintaining While the talk is focused on the two other policy question. illegality are simply too high,” he says, “or extremes, the policy will encompass Pragmatic is Kleiman’s style. He feels where the potential benefits in controlled everything in the middle. that “the penalty for using a drug should use are high enough such that current laws

www.drugfoundation.org.nz 25 FEATURE

Bad reform will leave us in a worse place than we are in now, so failure to actively prepare for the eventuality of drug reform now is reckless.

cost us a lot in foregone benefit.” you sell is going to be to people who smoke Importantly, Kleiman acknowledges Continued prohibition too much. It’s true of alcohol today – there will be drug harm in any scenario, is probably the worst thing responsible drinkers don’t build breweries, regardless of legality. The key to good alcoholics do.” policy, in his view, is to minimise we could do about cannabis Instead, Kleiman supports a ‘temperate’ that harm. right now. Alcohol-style cannabis policy. To do that, costs and benefits must be legalisation, which is where “That would give us the benefits of traded off against each other. On the right legalisation without an upsurge in heavy side of the ledger, Kleiman says, “The we are headed, is probably use and use by juveniles,” he says. This undeniable gains from legalisation consist the second worst. sounds like the perfect compromise, but mostly of getting rid of the damage done by what exactly would temperance entail? prohibition. Right now, Americans spend Novel problems, novel solutions about $35 billion a year on illegal cannabis. On balance then, Kleiman is in the That money goes untaxed. The people ‘legalise’ camp, with reservations. Mind-altering substances do not have the same properties as other goods that are working in the industry aren’t gaining Commercial sale, low taxes and loose legal to buy and sell. What works in the legitimate job experience, and some of regulation are cited by Kleiman as reasons market for food, say, or clothing will not them spend time behind bars and wind to be wary of free-market-style legalisation up with felony criminal records. About work in the market for a potentially of cannabis. 650,000 users a year get arrested for dependence-forming substance such as “Continued prohibition is probably the possession, something much more likely to cannabis. The aim of the game shouldn’t worst thing we could do about cannabis happen to a black user than a white one.” be to maximise the sales or profit of the right now. Alcohol-style legalisation, However, Kleiman also agrees with supplier, it should be to maximise the which is where we are headed, is probably anti-pot campaigners that ending the war wellbeing of the consumer. There will the second worst.” on drugs will lead to higher prevalence and be times where the public health interest problem use, particularly among teenagers. Kleiman is wary of giving free rein to is at odds with the financial incentive “The losses from legalisation would corporations, partly because it will likely of companies. This clash should be mainly accrue to the minority of consumers result in a commercial lobby not unlike Big confronted head on by a regulatory who lose control of their cannabis use,” Tobacco. But his greater concern is that the regime that follows a mantra of harm he says. logic of the free market creates a financial minimisation. “While a bad cannabis habit usually incentive on companies to promote Production will have to be monitored. isn’t nearly as destructive as a bad alcohol problem use. Kleiman says a free market could be habit, it’s plenty bad enough if it happens “It’s not just that the problem users replaced by “such interesting ideas as just to you or to your child or your sibling are profitable; it’s that nobody else is letting consumers grow their own or or your spouse or your parent.” profitable. More than 80 percent of what requiring that growers and retailers be

26 matters of substance February 15 RESOURCES

TO VIEW THE FULL INTERVIEW with Mark Kleiman, where he talks about his views on cannabis law reform, head to the New Zealand Drug Foundation’s YouTube page: nzdrug.org/nzdrugtube

imposing an excise tax such that legal of the nation will legalised pot result in? What works in the cannabis costs only slightly less than its These are all obstacles that will have market for food, say, or street equivalent. to be navigated on the way to good “My belief is that, if you can keep the cannabis policy. clothing will not work legal prices close to the illicit prices, you in the market for a won’t get a big upsurge in heavy users.” Lessons to be learned potentially dependence- Other possible policy options discussed Public support can evaporate in an instant. forming substance such by Kleiman include a requirement that It may be that there is a coming backlash to retail clerks at dispensaries have training the reforms currently taking place. Voters as cannabis. in pharmacology and substance use might lose their appetite for change. As it disorder to discourage dangerous stands though, reform does seem likely. consumption. Another is for buyers to set But not all reform is good. Bad reform not-for-profit co-ops or public-benefit a self-imposed weekly or monthly quota. will leave us in a worse place than we are That way, they will be confronted by their corporations, as well as the alternative in now, so failure to actively prepare for actual use and may change their habits as a of state-monopoly retailing”. the eventuality of drug reform now is result. Banning the use of brand names and Another of his ideas is to give the reckless. Discussions need to happen now advertising and instead presenting the drug regulators explicit authority to restrict to decide what a law change will look like. in a plain package labelled with the dosage the amount of cannabis that can legally We have the benefit of learning from the and scientific name of the particular strain be grown. being sold may produce a psychological experiments currently taking place in On the demand side, Kleiman believes effect in people that curbs their use. America and the rest of the world. Not the key to mitigating the potential for The half-opened can of worms that is everything that works there will work here increased uptake lies in the price that cannabis law reform seems to produce though, so it is also important to think people have to pay for pot. more questions than answers. Will the law about what legal or decriminalised weed “The basic fact about a legal cannabis allow smoking in public? Will it treat would look like in Aotearoa. Neither of the market is that the product will be cannabis leaf differently to hash oil? Will extreme sides will ever see eye to eye, but remarkably cheap to grow. Once it focus on potency or weight? Will it ban perhaps both could agree with Mark competition and industrial-style smoking the leaf and instead insist on Kleiman when he says that we should production have taken effect, a legal joint vapourising? What amount of cannabis, “recognise preventing adult substance use would cost about what a tea-bag costs, if any, will a user be allowed to ingest disorder among the goals of the law”. rather than the illegal price, which is before they drive? What will become of 100 times as high.” drug testing in the workplace? What will Cameron Price works at the New Zealand Drug In implementing the legal regime in happen to patterns of alcohol and other Foundation as a Communications Adviser Washington State, Kleiman focused on drug use? What changes in the social fibre

www.drugfoundation.org.nz 27 FEATURE

State of USA CLASSIFIES CANNABIS AS A disunion: AMERICA SCHEDULE I DRUG different 1970 Under federal law, it is illegal to possess, use, tokes for buy, sell or cultivate cannabis, since the Controlled Substances Act of 1970 classifies cannabis as a Schedule I drug, claiming it has a different high potential for abuse and has no acceptable medical use. However, although cannabis remains illegal under federal law, the Obama folks Administration said it will allow state-level rules 50 to stand without much federal interference. Around the world and across the United States, 27 states and the District of Columbia have authorities are trialling passed state laws either legalising or decriminalising cannabis. Four states have different versions voted to legalise it, and Native American tribes can grow and sell marijuana, even of legalisation. Each in states where it’s illegal. jurisdiction has a 27 NATIVE AMERICAN different set of rules TRIBES CAN GROW AND around the growth, SELL MARIJUANA sale and use of pot. These early adopters STATES act as social laboratories of cannabis policy. Countries looking to reform their drug laws THE should take note of the DIFFERENT COLORADO MODEL successes and failures of the various MODELS COLORADO VOTERS APPROVED approaches. AMENDMENT 64 IN NOVEMBER 2012

• Regulated retail sales 4 • Possession of up to one ounce legal for THE FOUR STATES THAT HAVE adults 21 years and over LEGALISED POT HAVE ALL FOLLOWED • Driving rules similar to those of alcohol DIFFERENT MODELS, MEANING • Households may grow up to six plants THAT RULES AND REGULATIONS • 15 percent excise tax on the average market rate in addition to a FOR CANNABIS ARE DIFFERENT 10–15 percent sales tax IN EACH STATE. • Tax directed to the public school capital construction assistance fund

28 matters of substance February 15 WA THE ME MT ND VT OR MN NH ID MA CANNABIS SD WI NY RI LAWS IN THE WY MI CT UNITED STATES PA NJ NE IA NV OH DE UT IL IN MD CA CO WV VA DC KS MO KY TN NC Cannabis is now legal in some form or OK decriminalised50 in 27 states and the AZ NM AR SC District of Columbia. MS AL GA LA KEY TX

FL LEGAL

MEDICINAL USE ONLY AND DECRIMINALISED AK DECRIMINALISED

MEDICINAL USE ONLY HI ILLEGAL

NOTE: Federal law prohibits the possession, selling or harvesting of cannabis. Decriminalisation laws reduce the penalties associated with the use or possession of small amounts of cannabis. Sources: National Conference of State Legislature; National Organization for the Reform of Marijuana Laws, Pew Research Center.

THE THE THE WASHINGTON OREGON ALASKA MODEL MODEL MODEL

WASHINGTON VOTERS APPROVED WASHINGTON OREGON VOTERS APPROVED ALASKA VOTERS APPROVED INITIATIVE 502 IN NOVEMBER 2012 MEASURE 91 IN NOVEMBER 2014 MEASURE 2 IN NOVEMBER 2014

• State licences required to grow and sell • Possession of up to eight ounces legal for • Possession of up to one ounce legal for • Possession of up to one ounce legal for adults adults 21 years and over adults 21 years and over 21 years and over • Households may grow up to four plants • Households may grow up to six plants, three of which may be flowering • Driving allowed with up to five nanograms of • Retail sales outlets will be set up by the Oregon THC per millilitre of blood Liquor Control Commission • The Alcoholic Beverage Control Board will regulate and license cannabis producers • Households are prohibited from home growing • $35 tax per plant, $10 tax per ounce of leaf except for medical use • Products must be tested for mould, mildew, • Adults are not allowed to consume cannabis pesticides and potency before sale in public • 25 percent excise tax on all wholesale and • $50 per ounce tax on all cannabis sold retail transactions • Tax revenue is split between local schools, law enforcement, and mental health and addiction |by cultivation facilities at wholesale • Tax revenue is directed to a dedicated • Tax revenue not earmarked to any cannabis fund and split between health-care, specific funds addiction services and research • Driving under the influence prohibited

www.drugfoundation.org.nz 29 OPINION

To reduce drug-related harm, it’s time to be honest about the pleasure

Acknowledging the reasons most people actually use alcohol and other drugs could help them use them more safely, argues Global Drug Survey founder

Adam Winstock. ADAM WINSTOCK

espite the language And as the world creaks towards a field for 30 years. From supervised we use about drugs, closer examination of whether current drug injecting facilities to giving methadone or many people don’t laws are the best way to minimise the naloxone to people who use heroin and see themselves as negative health impact of alcohol and drug nicotine patches to try and help people “drug users” but as use – both on an individual and societal smoke less, these harm-reduction rational adults who level – it’s worth giving a moment’s initiatives have saved millions of lives aren’t on a mission thought to what advice we could give to worldwide. It saddens me that some people D people who use these substances to assist to seek moral have a problem with the concept of harm them in minimising harm. disintegration and cause themselves harm. reduction and, in the face of overwhelming People who use drugs are just people who There is always risk research suggesting the opposite, still think these kinds of help promote drug use. happen to use drugs (they might also do Even if drugs were regulated, rather than I have never had a problem with yoga, go the cinema, get degrees, litter the being illegal, they would not be without promoting measures that reduce harm and streets or be into base-jumping) – normal the risk of harm. And to date, the world thought I would be on safe ground with people who care about their loved ones, has a poor track record in providing harm this attitude until I started running the their health and wellbeing and want to reduction information on the world’s most GDS. But after we began receiving emails make the most of that wonderful thing that popular drug: alcohol. And conversations from people who used alcohol and drugs we all share: life. about reducing risks and harm are just not asking why we didn’t provide any I’m not daft enough to think that any that sexy. As our Global Health Survey questions about pleasure, we decided to. set of guidelines or precautions can make (GDS) showed last year, almost half of the We came up with the Net Pleasure the use of alcohol and drugs completely 65,000 drinkers who responded said they Index, which was based on tens of safe. I spend my working day with people were unaware of their country’s drinking thousands of responses weighing up the whose lives have been ruined by drugs; guidelines, and of those who did, only one in five paid any attention to them. good, the bad and the ugly things about from acute toxicity and risks associated different drugs. The index rated MDMA, with intoxication-related behaviours that It’s not clear why this is, but a possibility is that guidelines fail to LSD and magic mushrooms as the nicest everyone who uses alcohol and drugs is at acknowledge that the main priority of drugs on balance and alcohol and tobacco risk of, to longer-term physical those who drink or use drugs is short-term as the worst. complications and dependence that are pleasure, not the avoidance of harm. This Pleasure and drugs went together issues for only a minority of users leaves us with a challenge. How do you naturally, and it seemed many people had (depending on the drug). engage people who use alcohol and drugs given lots of thought to how to get pleasure And predictors for problem use are for pleasure in a conversation about the from alcohol and drugs. In fact, compared myriad. While some are constitutional, for harm associated with their use? to harm, pleasure was a rather engaging the vast majority of people, the major risks topic for people who used these associated with alcohol and drug use can The pleasure index substances. So we wondered what the be significantly curtailed by adopting The term ‘harm reduction’ has been a relationship was between harm reduction certain strategies to minimise risk. watchword, nay a mantra, for many in the and pleasure. And as part of GDS 2014, we

30 matters of substance February 15 Photo: ﬂickr.com/photos/goodnight_london

QUOTES OF SUBSTANCE

Suppose the Russians did something now. President John F Kennedy, supposedly after smoking cannabis for medical relief in the White House in 1963.

The biggest cause of alcohol consumption in kids is hand sanitiser by far. They [parents] should keep it out of reach of kiddies. asked people from around the world to almost any other drug, with many people National Poisons Centre toxicologist vote on the harm-reduction approaches dependent and not just for pleasure. Leo Schep. they usually adopted when they used the But I think we should treat illegal following drugs: alcohol, cannabis, MDMA, drugs more like alcohol – where the risks stimulants, ketamine, psychedelics, GHB of harm and dependence vary hugely and new psychoactive substances for the between people, where the risks of harm I guarantee that there will be first time. can be significantly reduced by adopting no clemency for convicts who These strategies include testing a dose safer use strategies and where rates of committed narcotics-related from a new batch, using a trusted supplier, addiction are relatively low and where, for crimes. the majority, (as for alcohol) use is a avoiding combining drugs or not drinking Indonesian President President Joko source of pleasure not harm. while on ketamine. Widodo in response to calls for clemency For each strategy, we asked people if ‘Highway codes’ for drug traffickers sentenced to death. they usually (more than 50 percent of the While I’m not sure whether talking about time) used this strategy, what they would pleasure will be an effective way to help score it out of 10 for the importance of reduce the risks of using substances, our reducing the risk of harm and whether I don’t believe that executing GDS ‘highway codes’ – our safety dos and using the strategy increased the pleasure don’ts for different drugs – have been people is the answer to solving they got from that drug, decreased it or had downloaded 30,000 times. the drug problem and certainly no effect. So what did we find? Well, put The highway code is just a start of a the trafficking of drugs in and simply, the vast majority of the strategies more objective, independent and informed out of Indonesia. adopted by people to reduce harm had approach that the GDS is taking, bringing Australian Foreign Minister Julie Bishop. either a neutral or positive effect on their together leading experts to ask you the drug experience. In other words, safer drug right questions about drugs and alcohol use is more enjoyable drug use. use and to make a difference to the way Taking a new approach we talk and think about drugs and use One in three said they found it them – safely. very effective to relieve their pain, These results pose the question: what sort that’s a score of 10 out of 10. of guidelines should we have? When it Adam Winstock is founder of the comes to guidelines, most governments Louisa Degenhardt, leader of an Global Drug Survey and Senior Lecturer tend to treat all illegal drugs like tobacco. Australian study that found that chronic at King’s College London For example, there is no safe limit or level pain sufferers get more relief from of use that is associated with no risk of cannabis than conventional medicines. harm: tobacco kills you, it’s highly Results from the 2015 survey are due later addictive, so don’t smoke. this year from globaldrugsurvey.com This is not bad advice because the risk Article reprinted with permission from of addiction with tobacco is higher than for The Conversation (theconversation.com)

www.drugfoundation.org.nz 31

Together, three the drug control control the drug three Together, the legal provide conventions drug a global system of for structure measures control deﬁning by control and prescribing to be maintained the parties by to be obeyed rules with each other. in their relations champion The most prominent has long been the conventions of so it came as a the United States, William when October last surprise (US ambassador to Brownﬁeld countries American South various

cultivation for personal use fits comfortably within the text of the conventions. Brownfield acknowledges that position. We may have to take this path in the end anyway. We may have to take this path in the end reform of If we discover in three or four years that have to the conventions is not possible, we’ll only this recreate Brownfield. So why not embrace interim measure and keep moving forward? This is a meaningful signal to other countries within contemplating the scope of reform possible the conventions. The US could simply have continued to please itself, but making flexibility a number explicit will strengthen the positions of hesitated. of countries that would otherwise have out’ the By the same token, a strategy of ‘calling US on Brownfield’s shortcomings would probably create domestic obstacles to reform in those same countries. Governments need to be aware of how this may appear to the public, and if reform within the conventions exposes them to the accusation that they’re international lawbreakers, that’s a bad, bad look. The loosening up embodied in Brownfield cannot be compared with weakening the likes of the UN Convention Against Torture, if only because it has the opposite effect. In this case, flexibility enhances human rights, security and public health, rather than harming them. The idea of flexibility within the conventions isn’t actually new. Reformers have long argued that decriminalisation of possession, purchase and – are we really to take the position that these two – are we really to take the position that these for countries and others should be condemned until actions that breach the letter of the treaties, a the treaties change? If so, we might be waiting for a while. Worse, we might provide a rationale in US federal backlash, reversing the law changes Colorado and Washington State and blocking reforms in California and elsewhere.

• • • •

For more than half a century, the half a century, than more For nation every nearly policies of drug shaped by been in the world have to the three their commitment – conventions drug United Nations having despite those conventions as outdated and come under fire But a US counterproductive. even a new ambassador is now proposing conventions. the of interpretation closely looks more Russell Brown at these and the implications have. may they This is a constitutional system without a court. The International Narcotics Control Board and the UN Office on Drugs and Crime may express disagreement with the positions of the US and Uruguay, but they cannot enforce their opinions and they certainly are not constitutional courts. Nation states are free to adapt and evolve within such frameworks. Whatever happens, treaty breaches are unavoidable in the short term. The US and Uruguay are both in breach of the conventions Brownfield fails because reform is being assailed Brownfield fails because reform is being from all sides, it’s an own goal for reformers. all the It’s the best the US can realistically do. For and attention on cannabis legalisation in Colorado successful Washington State, the votes behind the propositions represent a little over 1 percent of the country’s voting-age population. It’s far from demonstrated that there is a mandate for national legalisation or reform of the treaties – the latter isn’t even on the radar. A similar political reality applies in the international community: the leaders of Colombia, Guatemala and Mexico, the three countries that got the UNGASS scheduled, aren’t exactly clamouring to offer leadership now. incremental change. And incremental change is incremental change. And incremental change Don’t let probably the only real change possible. change ‘perfect’ be the enemy of ‘good’. Political that’s will, and must, precede legal change, and tensions what we’re seeing here. Only when legal be increase to an intolerable point will there enough pressure to engage in the huge challenge of treaty reform. And we’re not there yet. real It’s the only game in town. However necessary currently reform of the conventions might be, it is the not feasible. There is no real route to reforming – conventions at the UN or in the US legislature be a and pursuing reform in the short term would If waste of energy and even counterproductive. It’s a tipping point – a significant step in It’s a tipping point – a significant step in

• • • • • February 15 February

matters of substanceof matters VIEWPOINTS

EMBRACE IT

Doctrine

Brownﬁeld Brownﬁeld The The 32 33

.org.nz

YOUR VOICE YOUR REJECT IT YOU DECIDE What do you think? Have your say drugfoundation.org. nz/viewpoints drugfoundation www.

SO WHAT SO WHAT THE ARE ARGUMENTS? It’s only about demand, not supply. The more flexible interpretation proposed by the US on the demand side is not offered for the more critical area of supply – which is where much of the harm happens. Moreover, the US clearly intends for its new doctrine of flexibility to apply only to cannabis. What are the broader implications of redefining What are the broader implications of redefining major United Nations conventions as merely optional? Do we want the same “tolerance” and extended to key UN positions on torture human rights? Remember that the Bush that Administration did actually attempt to argue waterboarding was not a breach of the UN Convention Against Torture and that detainees Terror taken and held in the name of the War on were not covered by the Geneva conventions. Should we really open the door for this? The US may be comfortable with a loose interpretation of the conventions, but countries like Germany and the Netherlands take international treaty obligations more seriously. They will be constrained from serious reform until the treaties themselves are reformed. The conventions are intrinsically prohibitionist and always have been. It’s wrong to pretend that a shift in interpretation – to the point of interpreting the conventions to say the exact opposite of what they actually say – will change that. The 1961 convention clearly and undoubtedly prohibits regulated markets in cannabis. We would not assume that New Zealand could make significant reforms without touching the Misuse of Drugs Act 1975 – why pretend otherwise at the international level? So the pillars are morally irreconcilable. Can the the Can irreconcilable. morally are pillars the So “We declare, really community reduction harm to Uruguay like countries of efforts the support simultaneously and – prohibition of harms the curb to continue will regimes other that acknowledge and laws anti-drug damaging and severe apply other and punishment capital out carry even human rights violations in enforcing them”?

• • • • • could undermine the unity of of could undermine the unity any necessary to effect purpose at the 2016 United Nations change Special Session Assembly General policy. (UNGASS ) on drugs Fourth: combat and resist criminal criminal combat and resist Fourth: than punish rather organisations use drugs. individuals who became quickly to what Responses Doctrine Brownﬁeld known as the to A failure been polarised. have on this fundamental issue agree

policies, to accept the fact that some countries will have very strict drug approaches”. regimes like Russia be able to regress even further? Indeed, Brownfield made this explicit in the third pillar’s promise to “tolerate different national drug embraces – general decriminalisation, harm harm decriminalisation, general – embraces reduction, the legal status of coca. Flexibility cuts both ways. If the conventions’ guiding principles are deemed meaningless, won’t the same way it is breaking the rules. Brownfield has has Brownfield rules. the breaking is it way same the where areas other the for sympathy little relatively now it flexibility the opposed strongly had US the Brownfield is just the damage control. doctrine new its tying In self-serving. and limited It’s really is US the legalisation, cannabis state-level to in rules the break only can nations other that saying Holder memo confirming that the US Federal Government would not intervene in state legalisation. That was the real signal for flexibility. arguably what his ‘doctrine’ is designed to do. That horse has bolted. The moral rationale for the US bullying neighbours like Jamaica on cannabis reform is already gone. It went along with the of countries to negotiate new treaties, but actually actually but treaties, new negotiate to countries of be would agenda the off reform treaty real taking is and – does Brownfield what That’s disastrous. And with 2016’s UNGASS offering a once-in-a- of issue the address genuinely to chance generation isglobal drug law, that’s a bad move. No one meeting a be will UNGASS 2016 the that pretending US is essentially offering other countries a bribe to to bribe a countries other offering essentially is US maintain its own contradictory position. discussion. reform law the shelves unquestionably It begin the path to reform but to find a way for the US US the for way a find to but reform to path the begin the without level state at reforms permit to breach. treaty a of accused being of cost reputational the cannabis, around reform for space signalling In legalisation in Colorado and elsewhere, while while elsewhere, and Colorado in legalisation it afford to continues that system a preserving to not is here aim The power. foreign considerable It’s just theatre. This is simply a way for the US to to US the for way a simply is This theatre. just It’s to bowing of way a It’s circle. own its square cannabis overruling not by reality political domestic

• • • • • national drug policies, from the from policies, national drug to the liberal. and punitive strict “ﬂexible interpretation” of the of “ﬂexible interpretation” different tolerate Third: conventions. conventions. The second: accept accept The second: conventions. Pillar one is to respect the integrity the integrity Pillar one is to respect control the existing UN drug of the ambassador outlined four outlined four the ambassador US position. the revised of “pillars” In a statement in New York, York, in New In a statement there might be some wrigglethere room treaties. in the existing at different times) proposed that times) proposed at different GUEST EDITORIAL Hello Friday Afternoon?

Finding ways to address problem drinking one day after another takes a lot of creativity and ingenuity. Hello Sunday Morning founder Chris Raine brings these qualities in spades. He shares his thoughts on what day is next. CHRIS RAINE

n 2009, I committed People who blog on Hello Sunday If we want to create a healthier to taking a break Morning often do so when they have had a drinking culture, solving this problem of from drinking for a challenging experience or a ‘slip up’. While the 30 minutes between the desk and the year to experience we each are challenged in different ways fridge is crucial. Here is what I believe life without a and different times, the one time that is society should be doing to change it. hangover for 365 quite consistent with participants is the Employers, government and I days. As part of that transition period between work and home individuals should co-invest in a concept process, I wrote a – especially Friday afternoon. I am going to call ‘decompression’ time. blog called Hello Sunday Morning (HSM) This is because alcohol is the perfect Take all the money we spend on campaigns to share what I learned with the world. drug to help us get three specific things – trying to scare people away from alcohol, I wrote about everything – from dating reward, relief and reconnection. At the end combine that with all the funds from the to parties to dancing – it was a year of of a hard week of working, we like to give drinks tray that comes round the cubicles experiments. Each Sunday, I would spend ourselves a reward for the hard day or at 4.30pm plus all those Friday afternoon a few hours in a café in the morning week we put in, and alcohol is a relatively bar tabs and put all that capital into free writing about what I learned and the inexpensive luxury that we can purchase massages, yoga classes, crossfit classes, challenges I faced. At the end of the year, and consume quickly to give us that sense spa baths or massive Friday afternoon that blog then became a platform for others of accomplishment. Secondly, it is a group sports competitions. In this way, to also take a break from drinking and depressant, so it helps us relieve our we incentivise people to take 30 minutes share their stories online. We had five overactive working brain and think at the end of the week to blow off some people do their three-month HSM in 2010, about less stressful things. Thirdly, after steam, to relax and to reconnect with and today, our community has grown to staring at a screen all day or being in people WITHOUT alcohol. Following this, more than 36,000 people worldwide. ‘work mode’, meeting new people, or people can go to the pub or home or To date, more than 100,000 blogs have even people we know, can be slightly wherever and, in my thinking, would been written around the experience of discombobulating – this is where alcohol’s change that we can mine to gain a deeper ability to disinhibit our mind is ultimately be drinking for very different understanding of the psychology of why extraordinarily valuable. reasons to those they would have normally we drink and also how we change the The problem is that often our choice on when they finish work. culture we have. While Hello Sunday Friday afternoon is the lynchpin for the The point of all this is that, as health Morning does work – showing an average rest of the weekend and that then bleeds promoters, we only have so much time and reduction in World Health Organization into the next week. Your decision to go so many resources that we need to make AUDIT scores of over 40 percent, I’m not straight from work to the pub often means hard calls on the right time and place to naive enough to think that HSM is for you are using alcohol for this combination invest them. If we want to influence the everyone. So, if I could do one thing to of psychosocial reasons and are likely to culture, then is it not wiser to go all out change the drinking culture beyond getting drink more, which means you might wake on the points in which people would be everyone to take three months off drinking, up with a hangover on Saturday and then most influenced rather than spread our what would it be? feel the need to drink to feel better on campaigns over the whole week? Why I would change the way we do Saturday night. This then leads to feeling not target the 30 minutes that matter? Friday afternoon. even worse on Sunday morning. Friday afternoon.

34 matters of substance February 15 Q & A

So I think that we have moved on to a different place, and the politicians at the top of the Labour and Tory Parties are increasingly out of touch with reality.

NORMAN BAILER

There was a poll in The Sun, for example, which demonstrated a high level of support for reform. So I think that we have moved on to a different place, and the politicians at the top of the Labour and Tory Parties are increasingly out of touch with reality.

Q The British tabloids, though, which are Photo credit: www.ﬂickr.com/photos/policyexchange very powerful, don’t share your views on drug reform. A Well The Sun was quite supportive, and The Mirror was neutral on it, so that’s a big A UK Liberal Democrat step forward from where we were.

Q What were the key points that you talks drug policy took away from the international comparators study? Just after his resignation as Minister of State for the Home Ofﬁce A Pushing up penalties and putting people in prison does not reduce drug use. On the responsible for the drugs portfolio in November 2014, British MP other hand, it’s quite clear, from Portugal, Norman Baker talked to David Young about drug policy in the UK for example, that dealing with these issues and the widespread mood for reform. as a health issue in terms of the users is actually quite successful in weaning people off drugs.

One reason cited for the Brisish MP and Q When the international comparators study The question is how do you minimise Liberal Democrat Party member Norman came out, you said that the “genie was out damage to society? The evidence is that Baker’s resignation was a row over drugs of the bottle” on drug reform. Shortly after fines and prison sentences don’t in fact that, you resigned as Minister of State for minimise drug use, they perpetuate it. policy with Home Secretary Theresa May. the Home Office. Are you still optimistic Baker is quoted as saying there was little At the moment, when people [in the that the United Kingdom is moving towards United Kingdom] are arrested, they are support for “rational, evidence-based drug reform? policy” in the Home Office. given a fine, sent on their way out of the A Yes I am because, first of all, there is It was revealed earlier in 2014 that the Police station and carry on doing whatever movement towards reform all across the UK Government had done nothing about they are doing. In other countries, where world. an official report showing that tougher drug people are forced to go through a health laws do not result in decreased drug use. Secondly, I think the first evidence-based regime and address their behaviour, that Baker likened being the only Lib Dem in report can’t be simply swept under the reduces the drug use. a Home Office full of Conservative Party carpet. It’s there now, it’s public and it Q When the international comparators study members to “being the only hippie at an can’t be unwritten. came out, the Conservatives who were Thirdly, the debate in the House of Iron Maiden concert”. opposed to reform just pointed out that drug The Liberal Democrats have strong Commons demonstrated support for reform use in the United Kingdom is on a long-term views on drug policy in the UK – earlier right across the house from all parties. It’s downward decline, so the status quo must this year, leader and Deputy Prime only the official Opposition [the Labour be working. Isn’t it difficult to make the case Minister Nick Clegg called reform “idiotic”. Party] being difficult about it. for reform so long as that’s the case? Baker has voiced his strong opinion more Fourthly, the public response to both the A Well there’s also a long-term downward than once. medicinal cannabis stuff I did and the decline in countries that have seen reform. Here’s what he told Matters of wider international comparative study was I mean, Portugal is way down from where Substance. pretty positive. Including even the press. it was.

www.drugfoundation.org.nz 35 What we discovered from the international legalise drugs, it just decriminalises them comparators study was that the level of in a different context. We are in a position now penalty and the approach actually doesn’t And the interesting thing about the review bear much relation to the level of drug use. where those that started using panel was they recommended a ban on drugs in the 1960s are now So the issue is really what you do with sales and marketing of so-called legal people who have been using drugs, highs. They’re unhelpfully called legal in positions of power and whether you are seeking to penalise or highs [a term that covers some illegal actually have carried on whether you’re trying to help them. substances in the United Kingdom], but quite well. they are certainly not safe and people are Q You have mentioned Portugal. Does it offer consuming them. a policy framework that you would like to There is an issue about where the threshold So I will spend the next few months by and see the United Kingdom follow? kicks in, and I would insert a caveat in large in the constituency, up until the A I think Portugal is a very interesting terms of damage. But it doesn’t criminalise general election. experiment, and it’s been going now for 10 possession of them. I think that’s an I will intervene [in debate], particularly over years or so, so it’s actually got a reasonable important principle that I’ve been trying to medicinal cannabis I think, because that’s amount of experience to draw from. espouse generally, which is that we go after something we should be doing. I think it’s dealers, we don’t go after the users. inhumane and lacking in compassion to Q What was your experience working with the have the approach we have got. Conservatives and particularly Home Q The New Zealand approach to legal highs Secretary Theresa May on drug policy? But I will be less high profile than has been to regulate the market. I have been because I need to have A It was very immovable. Theresa May and A But New Zealand backed off that a bit a break, genuinely. her SPADS [government special advisors] though. I think the fact that New Zealand were stuck in this 1971 rhetoric that must did back off that somewhat has made it Q And what happens next in terms of drug present drugs as the downfall of society difficult for anyone who wants to policy? and were deeply harmful. They had the recommend that to do so. A The next thing will be the party attitude of ‘we must countenance nothing’. manifestos coming out ahead of the next That’s the public position, and of course, Q Are there other lessons from New Zealand? election. Our manifesto will be pretty under the radar, they are more rational. A I’m certainly interested in the reformist. I suspect the other two won’t be. Theresa May, for example, authorised the psychotropic substances issue, and I have The Labour Party in particular is hopeless handing out of foil to heroin users, which met the minister from New Zealand who on these issues. is a very humane and a sensible policy, was rather good. A liberal. He was And after the election, I think we will see getting them to move from injecting to interesting and good value. what we get [in terms of a coalition or single- smoking. But it’s the state handing out party government] and what comes out in paraphernalia, and she was nervous We’ll clearly watch what happens in New any coalition agreement if there is one. about the impact of that, so I did it. Zealand. It’s obviously an interesting test I fronted it, and I was very happy to case, and that’s what it’s about: it’s always But increasingly, I hope that politicians front a sensible policy. interesting to see other people’s test cases have taken the temperature, because the without having to commit yourself, so you temperature out there is for reform. It’s So she sometimes did the right thing, but started off down that track and we will see very clear that the papers even think there I get the feeling with the Tories that the where it goes. should be reform, and the public certainly politics will always trump the science if think so. it’s a contest. Q As a minister, yours was the loudest voice The fact of the matter is that, rightly or for drug reform in the UK Government. wrongly, you’ve got a large number of Your resignation takes that voice away. Pushing up penalties and people in high, key positions in public life, putting people in prison does A I mean Nick Clegg is very strong on drug whether they are in banks or in politics or reform. I have no doubt that Lynne anywhere else, who use recreational drugs not reduce drug use. Featherstone, my successor, will be strong and have used them and carry on with on drug reform too. That’s where the Lib their lives and their work. And that’s just Dems are as a party. The party is united on the reality of it. that view. Q So what role does coalition politics play in So when a nucleus of the population in the likelihood of drug reform? high positions looks at the papers and says, Q What is next for you? A Of course it makes it more likely. Put it “Actually, it’s not the end of civilisation this way, drug reform will not happen for A We’ve got six months until the election, because I’ve been using this substance for a long time in this country unless we have so as I have said, I shall have a bit of a so long,” I think that loses credibility. break. Nobody believes me of course, Lib Dems in government. So we are in a position now where those but I just want a break. that started using drugs in the 1960s are Q You oppose prohibition but you would Four and a half years in office when you’re now in positions of power and actually prohibit legal highs – can you explain that the only Lib Dem in the Department have carried on quite well. approach? against people who want to stop you doing A I didn’t say I was opposed to prohibition. things is a huge challenge and a huge David Young is London-based writer I mean the Portuguese model doesn’t burden to bear.

36 matters of substance February 15 MYTHBUSTERS

All heavy drinkers are alcoholics Photo credit: ﬂickr.com/photos/cjdjkobe

hat guy who is Alcohol is our most commonly used compulsive and can be termed an notorious for recreational drug, and it’s a leading addiction, he says. getting legless at contributor to crime, disease and injury “The more ingrained the addictive every social that is estimated to cause 800 deaths habit becomes, the more challenging it is gathering might be annually. Latest Ministry of Health figures for a person to recover from the disorder.” called an alkie or an (2011/2012) show one in five drinkers It might be more helpful and more alcoholic behind (19 percent) have “hazardous” drinking T his back. But the productive to reframe the debate over patterns – posing a risk to the drinker’s alcohol away from definitions of label is unlikely to be on the mark, at least mental or physical health. This equates to not from a diagnostic point of view. New about 532,000 New Zealanders. Men are alcoholism. The word is freighted with research from the United States has found much more likely to have risky drinking misunderstanding and stigma, and it can that nine out of 10 heavy and binge drinkers habits, at 26 percent, than women, at put people off seeking treatment or taking are not dependent on alcohol and could 12 percent. steps to cut back their drinking because potentially curb their drinking with a The New Zealand Law Commission’s they’re reluctant to associate themselves combination of effort and support. 2010 report Alcohol in our Lives: Curbing with such a negative term. Lotta Dann, The study, by the US Government’s the Harm says national drinking surveys manager of the support website Living Centers for Disease Control and Prevention, have consistently shown around 25 percent Sober, says the label ‘alcoholic’ can be a investigated the prevalence of alcohol of drinkers – the equivalent of 700,000 barrier, and for that reason, it doesn’t dependence among 138,100 adult drinkers Kiwis – typically consume large quantities between 2009 and 2011 and found a feature in any welcome messages on the of alcohol when they drink. Among young relatively low level of addiction even for site. Dann shot to prominence last year drinkers aged 15 to 24, the rate is much the biggest drinkers. Alcohol dependence following the release of Mrs D is Going higher, with about half binge drinking in was 10.2 percent among excessive drinkers Without, which recounts her journey to this way. and 10.5 percent among binge drinkers. quit drinking. Professor Doug Sellman, Director The results counter the stereotype that of the National Addiction Centre at the She says the website, launched six everyone who regularly drinks to get Christchurch School of Medicine, is not months ago, has gained 1,500 registered drunk is an alcoholic. at all surprised by the American research members and provides a safe forum for The authors say their findings have showing fairly low rates of alcohol people to share their experiences and offer important implications for public health advice as they try to live without alcohol. measures to tackle problem drinking, dependency even for high-risk drinkers, since even the most excessive drinkers but he says it comes down to definitions. “The word ‘alcoholic’ is rarely are unlikely to need drug dependency The term ‘alcohol dependence’ has meant mentioned at Living Sober. It is irrelevant treatment. Strategies such as increasing different things over time according to the to many of our members. We don’t spend a tax on alcohol, regulating alcohol outlet diagnostic criteria being applied. In the lot of time debating how to label ourselves. density and increasing host liability could latest handbook for psychiatric disorders, We all accept the truth that we struggle to help reduce dangerous alcohol use. the new term is the much broader ‘alcohol control and moderate the drug of alcohol, use disorder’, but whatever the label, For this study, ‘heavy drinking’ was but we don’t get hung up on semantics. Professor Sellman says the underlying defined as eight or more alcoholic drinks We just cut to the chase of trying to not problem of excessive drinking remains per week for women and 15 or more drinks drink day in, day out.” per week for men. ‘Binge drinking’ for the same. So, yes it’s a myth that all heavy women was having four or more drinks in “I think we have a similar profile to the drinkers are addicts or alcoholics, but that one sitting, and for men, five or more drinks United States. The issue is the extent of in one sitting. Regardless of whether they heavy drinking in both countries and doesn’t mean they don’t have a problem meet the threshold for alcohol dependence, virtually all other Western countries.” with booze. The right question to ask, it’s clear many New Zealanders would A pattern of hazardous drinking is perhaps, is not “Am I an alcoholic?” but recognise their own drinking habits fall hard to break regardless of whether it has “Why am I drinking so much so often, and into these undesirable categories. reached the point where drinking becomes what can I do to stop?”

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