Mattersof Substance. august 2012 Volume 22 Issue No.3 www.drugfoundation.org.nz

Storm in a pee cup Drug-related impairment in the workplace is undoubtedly a serious issue and a legitimate concern for employers. But do our current testing procedures sufficiently balance the need for accuracy, the rights of employees and the principles of natural justice? Or does New Zealand currently have a drug testing problem? CONTENTS

ABOUT A DRUG Storm in 16 COVER STORY FEATURE a pee cup STORY Cover: More than a passing problem 06 32 You’ve passed your urine, but will you pass your workplace drug test? What will the results say about your drug use and level of impairment? Feature ARTICLE OPINION

NZ 22 28 NEWS 02

FEATURES Become 14 22 26 30 a member Bizarre behaviour Recovery ruffling Don’t hesitate A slug of the drug Sensible, balanced feathers across the Just how much trouble can What’s to be done about The NZ Drug Foundation has been at reporting and police work Tasman you get into if you’ve been caffeine and alcohol mixed the heart of major alcohol and other reveal bath salts are Agencies around the world taking drugs, someone beverages, the popular drug policy debates for over 20 years. turning citizens into crazy, are newly abuzz about overdoses and you call poly-drug choice of the During that time, we have demonstrated violent zombies! recovery. But do we all 111? recently post-pubescent? a strong commitment to advocating mean the same thing, and policies and practices based on the best does it matter? evidence available.

You can help us. A key strength of the NZ REGULARS Drug Foundation lies in its diverse membership base. As a member of the NZ 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 find Events 01 32 20 28 solutions to those challenges. Fit to start? Guest editorial: Opinion: News 02 Our membership includes health promoters, Interlocks will help Electorally toxic Drugs and About a Drug 16 decrease drunk driving Rodney Hide explains why development primary health and community organisations, Viewpoints 34 harm, but we argue they’d politicians should be kept Ann Fordham argues the researchers, students, schools and boards achieve more if they as far away as possible UN may be its own worst Q&A 36 of trustees, policy makers, and addiction treatment agencies and workers. weren’t made user pays. from drug policy enemy in addressing global Mythbusters 37 formulation. drug and crime links. 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 NZ Drug Foundation. feedback and contributions. If graphic design 3rd Floor, 111 Dixon Street All rights reserved. Neither this you’re interested in contributing Insight +64 4 801 6644 PO Box 3082, Wellington, publication nor any part of it a guest editorial or article, please [email protected] New Zealand may be reproduced without contact us: www.designedbyinsight.com p +64 4 801 6303 matters of substance prior permission of the [email protected] August 2012 NZ Drug Foundation. p +64 4 801 6303 Vol 22 No 3 ISSN 1177-200X the director’s cut Social

@gnat The Health Promotion Board needs a “range of views”. Would be bias if all were in favour of promoting health. 28 June

@vaughndavis Accidently poured a @CokeZero into a glass that I’d spilt some espresso into. OMFG, as the young people say. I can see the music. 2 July

@peterdunnemp If Labour’s minimum alcohol price amendment depends on my vote, it is doomed. 4 July

have to admit I feel absolute despair every @kevinhague Extraordinary behaviour from time a young New Zealander dies trying to @winstonpeters in select committee on get high on solvents and gases. tobacco excise bill. Appears to believe no New Zealand has a tragic history of volatile adverse health impacts! 17 July substance abuse (VSA) deaths – 60 in the past decade. It’s one of the most difficult nz herald online “Mr Bell, it is simple to divert areas of drug harm reduction work. I people from the real issue by focussing on a The people using these products are often minor point. Can you please direct us to the Ross Bell very young and simply experimenting, yet empirical and irrefutable evidence which Executive Director they can die with their first high. It’s almost impossible to control supply of the products proves that raising the price of alcohol will as most are common and have legitimate household uses. We have reduce binge drinking?” NZ Herald reader few tools up our sleeve to try to prevent or reduce use and harm. comment nzdrug.org/NHdABT There is no easy answer but, frustratingly, every time there’s a high-profile case, people who should know better go looking for one. 12-year-old Darius Claxton died in a Christchurch car park in May KEY EVENTS & DATES using butane. Jamie Jury (18) and Brendon McLeod (17) remain in hospital with serious burns after an explosion when they were From Genetics to Practice: National Cannabis Conference using LPG last month. Brisbane, Australia Prompted by these cases, the Chief Coroner has announced he’ll A fresh look at the evidence base on cannabis and mental health, and conduct an urgent inquiry into ‘huffing’. His won’t be the first. treatment interventions. 19–21 S e p tember I have a word of caution for the Chief Coroner: The inquiry itself www.ncpic.org.au isn’t a silly idea but, from past experience, all these reviews First International Conference on Law Enforcement and accomplish is to remind us what a bloody difficult issue VSA is and Public Health that intuitions about solutions aren’t always grounded in evidence. Melbourne, Australia This was starkly illustrated by a 2005 inquiry by the Wellington Investigating the partnership between law enforcement and public Coroner who examined six VSA deaths. Ignoring advice received health in addressing complex social problems. 11–14 No vember from the Ministries of Health and Youth Development, he www.policing-and-public-health.com recommended a public awareness campaign. Child Youth Mortality Review Committee Chairman Dr Nick Baker recently reminded us NZ Drug Foundation Annual General Meeting the evidence says that’s exactly the last thing we should pursue. Wellington But evidence also shows we shouldn’t wring our hands. Sellers Stick this in your calendar now. Chocolate cake will be served as usual. of these products can be shown better ways to manage sales, and 27 No vember www.drugfoundation.org.nz we’ve had some successes recently with retailers. Services that work with young people can be better informed. 2013 International Harm Reduction Conference Vilnius, Lithuania The media have an important role – they can also get it very This 23rd conference is a must-attend for harm reduction wrong. Coverage of recent cases has been clumsy and dangerous, practitioners from around the world. showing specific brands, where to buy them and even how to 9-12 J une 2013 www.ihra.net/conference inhale. Guidelines for reporting on VSA are clearly needed. The Chief Coroner will undoubtedly look again at ways to control supply and availability, and we should keep an open mind about that. After all, the R18 restriction placed on spray paint as part of Follow us an anti-graffiti law has gone some way to reduce illicit use of those Join us online products. But considering we’re still left with a supermarket full of drugfoundation.org.nz/connect alternatives, our attention should switch to renewing efforts on health promotion and harm reduction. matters of substance August 12 01 NEWS NZ.

02 World drug 03 $300 for 04 Corrections report a smoke? changes

The 2012 United Nations Corrections Chief 33,100 people in prison World Drug Report Executive Ray Smith is are set to receive an released in late June heralding the smokefree expanded drug and alcohol showed New Zealand has prisons policy as the single treatment programme 01 the fifth highest prevalence most important health because of changes in the of reported cannabis use in initiative the Department government’s budget. the world. The report could have done. The changes reprioritise dunne slays party pill hydra $65 million of the estimated 14.6 percent of “There has been a drop in Corrections Department New Zealanders had used asthma and other New regulations for synthetic budget with the aim of cannabis in 2010. respiratory symptoms and reducing reoffending drugs announced in early July The report also estimated smoking-related illnesses 25 percent by 2017. that ecstasy use had fallen in prisoners since the ban.” by Associate Minister of Health Corrections Minister Anne but ecstasy substitutes had From 1 November 2011 to Tolley said it was time to Peter Dunne will help move increased and seizures of 22 May 2012, of the 5,661 get serious about breaking cocaine had increased by newly received prisoners New Zealand’s obsolete drug the cycle of reoffending. 0.6 percent. It focused on who identified as tobacco law into the 21st century. the good work smokers, 4,177 elected to “We know that two-thirds New Zealand had done take NRT using either of prisoners have addiction The new regulations will ensure the synthetic drug preventing the spread of patches and/or lozenges. problems and that up to HIV through drug abuse. 90 percent can’t read or industry will have to prove a substance is safe before it Smith said there had also write well,” said Tolley. can be sold in New Zealand. Many mainstream media been 72 percent fewer fires “The new law means the game of ‘catch up’ with the outlets reporting on the and a 57 percent “By seriously addressing legal highs industry will be over once and for all,” said UN World Drug Report got improvement in air quality. these major contributors to mildly confused because crime, alongside increased Mr Dunne. However, tobacco is still the Oceania region employment opportunities, Distributors and producers will have to pay for the cost in our prisons and the contained four out of the we can reduce the of proving that a product is safe through clinical trials price has skyrocketed. top five countries for likelihood of reoffending.” and submitting the reports to an expert advisory According to some annual prevalence. committee. prisoners Matters of Associate Corrections Minister Dr Pita Sharples Ross Bell, New Zealand Drug Foundation’s Executive Substance talked to, the said the increase in funding Director, said the new regulations are long overdue and price of tobacco can reach represents a significant are very welcome. up to $300 for one pouch, which retails for $50 shift towards rehabilitation “We have seen time and time again that, when one outside the fence. and restoration of substance gets banned, another similar substance (or prisoners to their whänau substances) pops up in its place. This will help stop and communities. that,” said Mr Bell. 05 sober drivers are “This is a more humane Any substance already on the market for at least six killed every year by response to offending, and months could stay on the market as long as there is an 23 drunk/drugged drivers it is cheaper and more application pending for it with the new regulator. effective,” said Dr Sharples. However, the regulator would have the power to recall repeat drink driving offenders are at an eight year high. While The funding will also any product of concern within the transition period. drink driving figures for 2011 were the lowest for four years, people with eight or more drink driving convictions rose 22 percent. The address rehabilitation Ministry of Justice estimates that, for every 100 drunk/drugged services for community RESOURCES drivers, 54 passengers are killed and 23 sober road users are killed. offenders, increase One News reported that the person with the worst drink driving education and employment Read the government’s policy advice: record was convicted for the 19th time last year. A person One training and put prisoners nzdrug.org/MxvN2j News spoke to has been convicted five times for drink driving into post-prison community and has never been referred to treatment by the Court. reintegration programmes.

02 matters of substance August 12 08 Alcohol- 09 Synthetic 42 related harm drugs DAYS “When you’re 06 dealing with two auckland bars lost their synthetic drugs, liquor licences in early June 08 after they hid dangerously 06 no one really intoxicated women in a back 04 09 knows what the room to avoid police. One of Auckland emergency composition of the women was unconscious. 02 rooms are being inundated The karaoke bars were with people suffering from that particular snapped when a police officer alcohol-related harm. Of tablet or pill is.” saw the woman being carried the 292,000 presentations into a back room during the to emergency rooms in The seizure of drugs by Rugby World Cup in October Auckland during 2010–2011, Customs has been clouded by 2011. The Liquor Licensing 3,600 were alcohol the increasing popularity of Authority report says the related. Auckland Council synthetic compounds that are police officer followed them has endorsed an alcohol not fully covered by existing into the back room and said harm reduction strategy law, Customs Manager Mark they were “too drunk to 03 but it has not been Day said. answer questions”. 01 10 properly implemented yet He said much of what The licenses were only due to the slow passage of Customs were intercepting suspended for 42 days despite the government’s Alcohol was fake ecstasy where the the Licensing Authority Reform Bill. ingredients were cheap but saying the actions were unknown, which leads to “reprehensible” and placed complications when people “the young women at even overdose. greater risk of danger”. 07 10 Tobacco excise

Treasury may have underestimated the impact the $1.3B government’s latest tobacco excise tax increase would have on the number of smokers choosing to quit or 05 smoke less. Dr Murray Laugesen predicted tobacco excise would only increase by $139 million over four years, not the $528 million calculated by the Treasury. This claim comes after Treasury reported that the revenue gathered from tobacco excise is more than the health-related costs of smoking. Tobacco excise will raise an estimated $1.3 billion this year.

07 UPDATE FUNDING FOR ADDICTION 50% $90 $120M TREATMENT $P IN CHCH METH USE the tackling methamphetamine: treatment had increased from HALVED SINCE 07/08 Indicators and Progress Report, $90 million to $120 million. $750 which comes out of the Prime The report also says the IN 2010 the latest results from a Minister’s Methamphetamine price of P in Christchurch has P use Ministry of Health survey Action Plan, shows that, last significantly increased due to show methamphetamine use year, use decreased from the earthquake disruptions, in New Zealand has halved 2.1 percent to 1 percent, going from $750 per gram in $967 down IN 2011 since 2007–2008. while funding for addiction 2010 to $967 in 2011.

www.drugfoundation.org.nz 03 NEWS World. 03

$25m $ AVAILABLE THROUGH A REPLACEMENT GOVERNMENT FUND

01 Sports clubs ban However, the three biggest sporting codes alcohol sponsorship in Australia – AFL, NRL, and Cricket Australia – have so far refused to sign on Leading Australian sports for funding. organisations have agreed to end all Co-chair of the National Alliance for existing and future sponsorship from Action on Alcohol Professor Mike Daube alcohol companies. said these codes should start discussions $25 million has been made available with the government so “they, too, can to soccer, basketball, netball, swimming, move away from their present role in cycling, hockey and other sports exposing children to alcohol promotion”. 08 organisations through a replacement The ‘Be the Influence’ fund is government fund. supported by revenue from Australia’s new alcopop tax.

02 Human rights + drug enforcement 03 Highless 04 Singapore to (almost) “There are no safeguards – when cannabis end drug death penalty the UN acts as a conduit for Israeli medicinal cannabis grower Tikun these funds, a further layer of Olam has developed a bureaucracy separates the money strain of cannabis from the abuses.” containing less than 1 percent THC and more International aid money for drug enforcement may be than 15 percent funding human rights abuses, says a new report. cannabidiol. Researchers Deputy Director of Harm Reduction International and claim it is a “highless” co-author of the Partners in Crime report Damon Barrett alternative for medicinal said that, in some cases, donor states effectively paid for marijuana. Singapore is proposing must co-operate with the capture and killing of their own citizens. “The cannabis plant, changes to its mandatory authorities. “There are no safeguards – when the UN acts as a enriched with CBD, can be death penalty for some However, the mandatory conduit for these funds, a further layer of bureaucracy used for treating diseases drug offences. death penalty will separates the money from the abuses,” said Mr Barrett. like rheumatoid arthritis, Courts will have discre- continue to apply in most “Instead of the UN being a guardian of human rights, it colitis, liver inflammation, tion to either sentence cases, particularly for becomes more like a laundry mechanism, washing the heart disease and offenders to death or life those who manufacture or funds of any form of accountability.” diabetes,” said Professor imprisonment with traffic in drugs and those One of the examples cited in Partners in Crime shows Ruth Gallily of the Hebrew caning, when two who fund, organise or abet that $US3.4 million for a UNODC border control project University. conditions are met. The drug trafficking. There are in Iran led to a dramatic increase in drug-related arrests Clinical trials of the low offender must only currently 35 prisoners and more than three times as many executions. THC strain, known as be a courier and not awaiting execution – 28 Avidekel, are due to start involved in the supply or for drug offences and Read the report: www.nzdrug.org/NxCaVO by the end of the year. distribution of drugs and seven for murder.

04 matters of substance August 12 09 06 05 02

03 07

1 IN 4 adult Palauans using cannabis 10

04 10 Palau and pot smoking

05 07 consumption rooms iran sentences The Danish Parliament has death for alcohol. 01 Two Iranian citizens were passed a law that will make The tiny pacific nation consumption rooms legal. sentenced to execution for of Palau was named the The law allows for “safe continuing to drink alcohol. world’s cannabis capital drug consumption rooms” The pair, who have been in the recent United where users can inject, snort convicted twice before Nations 2012 World Drug or smoke small quantities and were given 160 lashes of drugs. It also explicitly the second time, were Report. says police cannot search, sentenced to death by the However, the figure of seize and prosecute users in Iranian Supreme Court in 24.2 percent of adult possession of personal use late June. Under Sharia law, Palauans using cannabis quantities. Denmark joins consuming alcohol is a crime, comes from a survey taken Australia, Canada, Germany, and sentencing is not at the at the one state-run high the Netherlands, Spain and discretion of a judge. school in the small Switzerland in allowing archipelago. injection sites as a harm The UN extrapolated the reduction measure. 08 figures to estimate what uruguay to usage would be for the 06 legalise cannabis entire country. alcohol ban for A report by the Uruguay mps staff, not for mps Government suggested it Palau’s director for the The UK Parliament is might legalise and control the Ministry of Education revamping its alcohol policies sale of cannabis in the South 09 Russia’s top drug official blames Emery Wenty said he did after incidents involving American country. About The Beatles for kicking off not believe the UN figures. intoxicated Members of 5.6 percent of Uruguayans Russia’s drug problem “You sort of know just Parliament assaulting their between 15–64 smoke about everybody. It’s colleagues. However, the cannabis, and the industry “After The Beatles went to expand their consciousness inconceivable that a policy, which will stop is estimated to be worth in India’s ashrams, they introduced that idea – the quarter of the population people from drinking on US$35–75 million. This move changing of one’s psychic state of mind using drugs – to uses cannabis.” parliamentary grounds, will comes after Guatemala, Costa the population.” not cover the MPs or their Rica and Colombia have The UN statistician who Russia’s top narcotics official Yevgeny Bryun recently staff, only parliamentary called for a debate about worked on the drug report blamed The Beatles for the global drug problem, saying employees. Speaker of the legalising cocaine and Brazil accepted some of the that businesses are now capitalising on the image of House of Commons John and Argentina have referenda criticism but insisted there Bercow said a growing number coming up on whether to pleasure. is a relatively high of MPs and staff were seeking decriminalise personal use of Mr Bryun said tough measures were needed to combat prevalence of drug use help for problem drinking. all drugs. mass culture and advertising that promoted drug use. across the Pacific.

www.drugfoundation.org.nz 05 cover story

Storm in a pee cup

Standing next to a row of toilet cubicles in a Wellington drug testing agency, Sarah’s nervousness gave way to panic. The shy 20-something office worker did her best to contain herself in front of the agency’s manager and his assistant, but she was fraught with worry.

A few minutes earlier, the assistant had studiously patted her down before sending her into the toilet. To ensure someone else’s urine wasn’t being substituted, the assistant stood with her ear by the cubicle door while Sarah awkwardly pissed in the cup.

It only took a quick shake of the urine canister and a short moment for the assistant to tell her she’d failed her workplace drug test. By Sean Gillespie

06 mattersmatters of of substance substance August August 12 12 www.drugfoundation.org.nz 07 Since Air New Zealand won the right to test workers in the Employment Court in 2004, workplace testing has become a boom industry.

he agency’s have used three or more illegal drugs in manager came in the last year. With statistics like that, and confirmed. impairment of staff is a valid concern in With her mind safety-sensitive industries like aviation spinning and the and forestry. sense that she was And since Air New Zealand won the being eyed right in the Employment Court in 2004 to T suspiciously, Sarah test workers, workplace testing has become Sean didn’t initially understand how this could Gillespie a boom industry. One private testing have happened. Having come out of company boasts a 400 percent increase in hospital only a few days earlier, she was the number of tests it conducted between feeling drowsy and was worried they 2009 and 2011, with about one in 10 tests would just see an addled junkie. returning positive results. Eventually it occurred to her that her course of codeine painkillers could have been the cause. Substances as innocuous as The manager sent her on her way poppy seeds and painkillers saying he needed to see the prescription. She raced home and desperately searched containing codeine have been for the script. Fortunately, she hadn’t known to cause positive tests thrown it out. for opium. The agency gave her a tentative reprieve but said the lab would take a few days to do further tests and confirm. So it would seem we also have a drug In the end, she passed but was left with a testing problem. How do we balance civil negative feeling towards her employer liberties, such as right to privacy, with the and resented what she saw as a pointless need for workplace safety? Are drug tests exercise in bureaucratic box ticking. the best answer for this societal problem? Sarah, not her real name, is one of the And do tests actually address the issue? many people who’ve been innocently Not so much, according to Victoria caught up in the burgeoning drug testing University’s Julian Buchanan. The Associate net. But not everyone is innocent – there’s Professor and Programme Director for the no doubt New Zealand has a drug problem. university’s Criminology School has According to ACC, more than half of worked in substance abuse management for New Zealanders are binge drinkers, one in three decades, and he doubts the benefits seven smokes cannabis and eight percent of workplace drug testing.

08 matters of substance August 12 “Whenever you’ve got any testing in a being used arbitrarily with some quite While Cullen says case law and laboratory, you end up with false positives worrying consequences.” legislation strike a balance between and false negatives,” he says. “It’s always individual rights and workplace safety, The law a contested result.” there can still be issues around consultation. Aside from human error, results can No single law addresses workplace drug “If a workplace is not sure it’s a be skewed in other ways. Substances as testing. Instead, it is regulated by a safety-sensitive area and they bring in a innocuous as poppy seeds and painkillers combination of case law and five Acts. drug testing policy, employees may not be containing codeine have been known to These include the Crimes Act, which aware it’s not something the employer can cause positive tests for opium. addresses whether forced drug tests could actually do,” he says. “That’s potentially But Buchanan says concerns about the amount to assault, while the Employment an area of dispute.” validity of drug tests are much broader, as Relations Act requires good faith Employers aren’t legally required to current techniques only indicate a drug’s consultation in the development of a offer support, but some large companies presence – not whether the person tested workplace drug testing policy. The have chosen to write it into their drug is actually impaired. umbrella Bill of Rights Act outlines the testing policy. Air New Zealand is one of “Someone might have used cannabis on rights to refuse medical treatment, be those companies. a Saturday and test positive on Wednesday, secure from unreasonable search and “It’s always had an element in its but they’re not intoxicated,” he says. seizure and not suffer arbitrary arrest or policy of giving people who have infringed “It’s a bit like me being tested for detention. the opportunity to engage in a recovery alcohol. I had a glass of red wine last night. Employment law specialist Peter Cullen, process,” Cullen explains. If I test positive for alcohol today but I’m a partner at Cullen – The Employment Law “It’s not a black and white policy with not intoxicated, should I lose my job? It Firm in Wellington, says this combination them. If people want to change, they’ll doesn’t make sense; it’s a breach of civil ensures a fair balance between workplace often give them another chance. They’ll be liberties.” safety and personal right to privacy. He strict about it and make sure they do what But those concerns haven’t stopped the says the 2004 Employment Court case they said they’ll do.” rapid growth of the drug testing industry, between six unions and Air New Zealand Education and rehabilitation and Buchanan is troubled by the set the scene for workplace drug testing in programmes are both part of Air transparency of some of the companies New Zealand. New Zealand’s testing policy. Although within it. “It’s an obvious area where you’d testing positive could result in “There’s lots of glossy brochures and expect a line to be drawn because of the “disciplinary action”, it is more likely to promotion, but we’re only getting a need to protect the public in terms of safety lead to a referral to one of the available one-sided argument on drug testing,” on the one hand and to see the reach of the assistance and rehabilitation programmes. he says. law doesn’t go beyond what’s reasonably It’s a strategy that academic studies “The question is: knowing the severe necessary on the other,” he explains. have found effective. One published in the limitations of drug testing, who, if Air New Zealand won the case, with United States by Health Sciences Research anybody, should it be applicable to? It has the court allowing drug testing in safety- found lower levels of worker drug use in been rolled out across the board and is sensitive areas. companies with drug education and

www.drugfoundation.org.nz 09 It’s an obvious area where you’d expect a line to be drawn because of the need to protect the public in terms of safety on the one hand and to see the reach of the law doesn’t go beyond what’s reasonably necessary on the other. Peter Cullen

employees assistance programmes. New Zealand Drug Foundation Executive We’ve got a bit of a Nobody from Air New Zealand was Director Ross Bell says, even with staff challenging environment available to discuss drug testing policy for consultation, companies’ good intentions this story, but a lawyer for the Engineering, don’t always carry through. Even if where employers want to put Printing and Manufacturing Union organisations develop good policies offering something good in place but (EPMU), Greg Lloyd, says it’s a step in the support, he says, echoing Lloyd, a failed drug because it’s drugs, they’re right direction. test can quickly trump agreed processes. scared. It kind of freaks “They have a comprehensive policy “We’ve got a bit of a challenging and on paper it looks great, but like environment where employers want to them out. anything, something’s only as good as its put something good in place, but because Ross Bell application,” he adds. it’s drugs, they’re scared. It kind of freaks He says to help ensure good workplace them out.” culture, company drug policies should also exclude random testing, have a greater emphasis on rehabilitation over It seems to us that, because punishment and provide for consultation it’s drugs, all kinds of natural and representation. But even so, these justice principles can be policies don’t necessarily protect employees. thrown out the window. “There’s certainly examples of employers who implement these policies,” Ross Bell he says. “They have provision for rehabilitation, but whether it’s a local manager or HR “And then,” Bell adds, “there are these manager, they take the view that ‘you snake oil salesmen that come to them with tested positive, we have the right to sack the perfect solution saying: ‘Here’s this you, so we’re going to do it’.” complex issue of alcohol and drugs in the Even with a supportive policy in place, workplace, and you have to manage your drug testing can contribute to negative hazards, and the best way to do it is to get company culture. A study by Professor your employees to pee in a cup’.” Debra Comer for Pittsburgh State Bell says many employers mistakenly University’s Journal of Managerial Issues see drug testing as the perfect deterrent, showed that, while employees found drug despite the tests being expensive and too testing non-invasive, it created negative often inaccurate. attitudes towards employers from staff “Not only is the science still a bit ‘iffy’, because they felt the tests failed to detect but asking staff to pee in a cup is a impairment and enhance safety. degrading approach. Fundamentally, it

10 matters of substance August 12 11 people died in a hot-air balloon accident in Carterton. The pilot had tested positive for cannabis – the cause of the crash has yet to be determined.

strikes me as an awful way to develop workplace culture.” Cannabis Like Buchanan and Lloyd, Bell is concerned about the tests’ failure to impairment measure actual impairment. He says, although the mandate is to ensure Cannabis is New Zealand’s favourite illegal drug. Almost half the population aged between 16 and 64 admit to having tried it, and each year, more than one in 10 adults workplace safety, drug testing companies say they use it. ignore that their tests don’t pick up There is no data on rates of cannabis use in New Zealand workplaces, but it whether someone is hung-over or impaired accounts for more than two out of three positive results from workplace drug tests. from fatigue but will test positive to As an indication of how many Kiwis might be stoned on the job, statistics from someone who has drugs in their system across the Tasman show 2.5 percent of Australians turn up to work under the but is in no way impaired. influence of an illicit drug. The unnecessary and negative fallout Impairment from cannabis in safety-sensitive work environments is a risk that from a ‘positive’ drug test result is perhaps needs to be taken seriously, especially if the job requires a person to operate heavy best illustrated by the aftermath from a machinery or drive a vehicle. hot-air balloon crash in Carterton earlier Getting high can cause: this year that resulted in the deaths of all • impaired thinking and memory 11 occupants. • problems with balance and co-ordination After the accident, a government • poor concentration agency investigating the crash informed • distorted sensory perception – visual, auditory and tactile media that cannabis was found in the • reduced ability to perform complex tasks pilot’s system. The bold newspaper • decreased alertness headlines and court of public opinion • slowed reaction times. weren’t going to wait to hear that the ambiguous reference to drugs simply These effects last from two to six hours depending on the user, how much they meant he had consumed cannabis used, how the drug was taken and the environment in which they were using it. sometime in the last month. Cannabis impairment in the workplace therefore threatens the safety of the user Bell says, despite there being no and the people working around them. evidence the pilot was impaired at the time In New Zealand, it is not clear what percentage of workplace injuries can be attributed to cannabis or other drug impairment. However, up to a quarter of of the crash, his name was besmirched, the workplace injuries and 20 percent of workplace fatalities in Australia have been families of the victims caused further grief linked to alcohol and other drug use. and New Zealand’s international reputation If the rates of impairment-related workplace deaths are similar in New Zealand, as a safe tourist destination damaged. then around 17 people were killed in workplace accidents in the past year where “It’s irresponsible and sadly consistent drug impairment was a factor. with a lot of public coverage you get of any drug topic, whether the drugs are a cause

www.drugfoundation.org.nz 11 Impairment of staff is a valid concern in safety-sensitive industries like forestry. SNPA / Pam Johnson

or not,” Bell says. But what are the alternatives in the A good workplace “It seems to us that, because it’s drugs, New Zealand context? culture that invites trust all kinds of natural justice principles can Back at Victoria University, Associate be thrown out the window.” Professor Buchanan thinks drug testing has and openness between staff Moreover, Bell says more harm can be the potential to be developed into and management would caused by drugs that are less detectable. something workable, but it’d be a difficult be more valuable. When blood testing is used, such as after and lengthy process. the balloon crash, traces of cannabis can be He says the current legal levels for Julian Buchanan found a month after use. With urine tests driver alcohol breath testing took a lot of – the usual method for workplace drug testing and time to develop, and it would testing in New Zealand – it’s a week after be significantly more difficult to define use. However, methamphetamine can clear impairment test levels for multiple drugs. a person’s system in about 24 hours. He argues it would make more sense for “You could get workers switching from workplaces to design behavioural cognitive a relatively less harmful drug like cannabis tests indicating impairment relative to to a more harmful drug like meth. It’s an tasks performed by staff members. These absolutely bizarre unintended consequence sorts of tests would also capture people that the drug testing industry seems to who were fatigued or hung-over to the ignore,” Bell says. point of being a risk to safety. Other answers Buchanan also says a good workplace A United Kingdom inquiry between culture that invites trust and openness 2002–2004 by the Joseph Rowntree between staff and management would be Foundation into workplace drug testing more valuable. concludes that there is “no justification for “If we’re worried about people who are drug testing in the workplace as a means impaired or have got drug and alcohol of policing the private behaviour of problems, the best way is to talk to them employees or of improving performance rather than police them. and productivity”. “If you have a child and they have The foundation, a social policy and problems or issues, the best way to deal research development charity founded in with those issues is to have a relationship 1904, found drug testing has a role to play, with open communication. particularly where safety is a concern, but “If you start drug testing your children, investing in management training and once you go down that route of distrust systems is likely to have a more positive and policing, you might improve your impact and would be less costly, divisive stats, but you’re not necessarily improving and invasive. the situation. Because all you have is a

12 matters of substance August 12 standard drugs tested for urine test times (nz workplaces’ usual test method) Cannabinoids (marijuana, hashish, hash oil) Occasional users: 3–4 days Heavy users: 10 days Chronic users/high body fat: 30+ days Opiates (heroin, morphine, codeine) 1–2 days Cocaine 2–5 days Amphetamines 1–7 days Ecstasy 20–24 hours Speed 1–3 days Methamphetamine (P) 1–3 days Benzodiazepines (tranquillisers, sedatives, Up to 7 days antidepressants) Chronic users: 4–6 weeks *There are many variables affecting drug detection times, including body weight, metabolism, form of drug intake, strength of drug and frequency of drug use. hiding culture, a deceitful culture.” positive workplace culture. And there are other alternatives that “Employers have to put a bit of have proved successful in the workplace. effort into their workplace culture About six years ago, the EPMU developed rather than taking an enforcement or a peer intervention and support programme punitive approach. called ‘Not on the Job Mate’, where workers “Bosses have two choices: they can looked out for workmates. It was based on either build a workplace culture that has a similar workers’ support initiative high trust and collaboration between created by the Australian Builders Union, workers and bosses or they can create a culture that creates an ‘us and them’ which gained official recognition from the barrier, which can’t be good for United Nations International Labour workplace productivity.” Organization as being the ideal form of drug management programme. Sean Gillespie is a Wellington-based writer. Although it fell off the radar with the growing prevalence of drug testing in New Zealand, the EPMU is looking at Do you need a policy for managing reimplementing it. alcohol and drugs in your workplace? At the Drug Foundation, Bell agrees nzdrug.org/Ms3SSu with the need to focus on developing

www.drugfoundation.org.nz 13 FEATURE

Bizarre behaviour Bath salts. Police and media keep blaming them for bizarre behaviour. But, as Russell Brown writes, perhaps they need also

to have a look at their own bizarre actions. Russell Brown

14 matters of substance August 12 e live in an age of novel psychoactive substances. They’re hard to escape – because even if they’re not in our W bodies, they’re in our heads, thanks to the news media. And nowhere has that been better demonstrated than in the case of bath salts. Methylenedioxypyrovalerone (MDPV) is a psychoactive stimulant related to – but considerably stronger than – Ritalin. It was first synthesised in 1969 and has been in recreational use since around 2004. In recent years, it has been marketed in the from methamphetamine abuse to mental But which came first? Widespread use US as ‘bath salts’ in the same way that illness must be down to the panic drug of the drug and consequent problems? smoking products sprayed with novel du jour was disastrous. Or the reflexive attribution of any bizarre cannabinoids are sometimes sold as Someone should perhaps have told that behaviour to bath salts? We really do ‘incense’ – as a cute, fooling-no-one means to the New Zealand police, who recently not know. to suggest it is not being purchased and announced – via an unnamed “police But here’s one thing you can say: MDPV is a very poor candidate for a ingested for recreational purposes. source” speaking to a New Zealand Herald legal high. It raises blood pressure and But in 2010, something else began to reporter – that a disturbed man apprehended in Greenhithe recently had heart rate and can trigger severe anxiety happen. ‘Bath salts’ became a meme. A been on ‘bath salts’. attacks. Compulsive re-dosing seems stream of news stories attributing bizarre The Herald’s reporter rose to the bait, to be a common issue. The MDPV behaviour to ingestion of bath salts began reporting injuries suffered by two Toronto ‘experience vault’ at erowid.org contains – and continued after the US Drug policemen apprehending a “raging” man far more than the usual proportion of Enforcement Agency instituted an suspected to have taken bath salts. But the bad experiences – and some of them are emergency one-year ban on MDPV on original report, in Canada’s National Post, very bad. One is titled ‘I Went to Hell November 2011. People were trashing also noted that no toxicology tests had and I Saw the Abyss’. Another, headed hotel rooms, screaming, attacking priests been conducted and the police ‘Terrible Stuff’, recounts “the worst and policemen. And then things got spokesperson could only offer that the withdrawal that I’ve ever experienced really weird. man’s behaviour “was consistent with from any stimulant”. Bath salts got tied up with a light- someone who could be [on drugs]” – or So why would anyone take this stuff? hearted popular culture meme around possibly, the spokesperson acknowledged, The same reason people usually take zombies. When Rudy Eugene was partially just mentally ill. psychoactive substances: they want to captured on video in a mystifying attack on get high. Also, for years, MDPV was a poor homeless man – chewing off most of legal. Even where it wasn’t, it was the victim’s face – the place of bath salts in Simply assuming that easier to obtain (usually from places the pantheon of horror was confirmed. bizarre behaviour that could where it remains legal) or synthesise Three languishing Senate bills were swiftly be a consequence of anything than better-known but more thoroughly mashed together into one aimed at banning prohibited recreational drugs. Toss in the bath salts plague permanently. from methamphetamine uncertain provenance and potency and There were a couple of problems here. abuse to mental illness must potential impurities, and it’s pretty Firstly, no one really knows exactly what’s be down to the panic drug much a poster child for the flaws in the in a packet labelled ‘bath salts’. It might be du jour was disastrous. progressive-prohibition model of drug MDPV or the related (and more widely enforcement. You ban one drug and a used) drug mephedrone – or it might be nastier one comes along. You have no one of the 2C class of psychoactives or The Herald’s story also reported the control over the situation at all. methylone, which have wholly different case of another man who “skinned himself Perhaps the new regulatory regime effects. Hell, it might be actual bath salts. alive while on the drug”, for which I can for psychoactive substances will break Secondly, and more seriously, a find no original report other than an New Zealand out of this vicious cycle. toxicology report eventually found Eugene unsourced line in a feature in the July issue But for that to happen, everyone will had nothing stronger in his blood than of Spin magazine. The line has since been need to keep their heads. And by that I marijuana at the time he was shot by a recycled, often verbatim, by news services don’t just mean the drug users. policeman. Compiling actual incidences all over the internet. of MDPV psychosis into a convenient “In 2010,” Spin reported, “304 calls Russell Brown blogs at publicaddress.net narrative would be misleading enough. were made to poison control centers and hosts Media3. Simply assuming that bizarre behaviour nationwide regarding bath salts. A year that could be a consequence of anything later, the calls skyrocketed to 6,138.”

www.drugfoundation.org.nz 15 ABOUT A DRUG

M D M 3 A Total number of deaths related to MDMA in New Zealand 4–6 Number of hours MDMA remains active in a human body 14 Maximum number of years in prison for importing, manufacturing or supplying ecstasy in New Zealand

In 1914, a clever scientist working for the $ German pharmaceutical company Merck 43 created and patented the MDMA molecule. Median price for one ecstasy pill in NZ during 2010. Auckland $41, He obviously had no idea what he had created Wellington $56 and Christchurch $54 because the first recorded human ingestion of MDMA wasn’t until the 1970s when it 180,800 was rediscovered by Dr Alexander Shulgin. Number of New Zealanders aged 16–64 who have used ecstasy

3,4-methylenedioxymethamphetamine

16 matters of substance August 12 I remove the 3D glasses, lay back and close my eyes. Psychiatrists heralded MDMA as Everyone else is a few contain a cocktail of other MDMA is not risk free. It can make “penicillin for the soul” and a “low substances such as mephedrone, you confused, raise your body calorie martini”. They sought to feet away, licking BZP, ketamine and DXM. temperature to dangerously high use it to reduce the psychological grape and lime levels and cause depression and defences of patients, making them popsicles off each According to the New Zealand sleep problems. Chronic use can lead to memory loss and affect easier to treat. What these other. I remember National Household Drug Survey, pioneering psychiatrists didn’t tell people who regularly took ecstasy the body’s ability to regulate their patients was that it hadn’t thinking about how felt the presence of MDMA had serotonin production. actually been clinically tested or fun that looked, but been trending downward, possibly approved for human use. Whoops. I knew I had even due to a shrinking supply and But MDMA is currently being increased demand. There have only tested as a treatment option for Michael Clegg, a Catholic priest, better in store for been one or two examples of many afflictions. One group at the coined the term “ecstasy” for myself. laboratories producing MDMA in University of Western Australia MDMA because he felt it put him New Zealand, although police has been trying to find a in touch with God. Clegg created a A person describing their believe a number of pill presses compound of MDMA that will flood of ecstasy of biblical experience on MDMA. are currently in operation. help treat Parkinson’s disease. proportions in Texas by Post-traumatic stress disorder is distributing around about 500,000 There has also been a shortage where MDMA is showing the most pills in a single month in Dallas. and New Zealand followed suit in of MDMA over the past few promise of being approved for Incidentally, he became a 1987. Evidence shows MDMA is years due to the Cambodian widespread use as a treatment. millionaire in the process. By the only mildly addictive and well government cracking down on mid-80s, MDMA had become below drugs like alcohol and illegal plantations of mreah prew known as ecstasy and had cocaine on the harm scale, and to phnom. The critically endangered entrenched itself as the drug of date, there have been only three plant, commonly known as selsian choice for people going to MDMA-related deaths in wood, is a source of sassafras oil MDMA got you nightclubs and listening to New Zealand. – a key ingredient in MDMA. feelin’ like a S’Express. In 2009, the Australian police champion. The city After cannabis, MDMA is the worked with Cambodia to track Despite little evidence of second most used illegal drug in down and destroy more than never sleeps, better MDMA-related harm, the New Zealand and Australia. Of 33 tonnes of sassafras oil, enough slip you an Ambien. substance was banned by the US cause for concern is that pills sold to manufacture 2.45 million Drug Enforcement Agency in 1985, as MDMA in New Zealand can ecstasy pills. Jay Z, Empire State of Mind

www.drugfoundation.org.nz 17 HISTORY

Alcohol milestones in New Zealand

1893 1863 Alcoholic Liquors Sale First temperance Control Act is passed, 1917 movement meeting making licensing areas A law forces pubs to is held in the Bay of consistent with close at 6pm as a 1770 Islands. electorates and 1958 temporary wartime Captain Cook brews allowed for licensing Arnold Nordmeyer’s measure. This beer, flavoured with polls to be held every ‘Black Budget’ increases remains for the rimu leaves and bark, election. tax on beer. while harboured at Ship next 50 years. Cove in Queen 1873 Charlotte Sound. Licensing Act is passed, prohibiting the sale of liquor if two-thirds of residents petitioned 1909 1918 1835 against sale. Masterton declares 240,000 signature First commercial itself a dry zone and petition calling for brewery is all pubs close. None prohibition is established in reopen until 1946. presented to Kororäreka/Russell. Parliament.

1947 1839 1911 Workers in Greymouth First alcohol tax by Nationwide boycott local pubs for British Colonial referendum is held four and a half months Secretary Lord on prohibition of after they raise the Normandy. alcohol. 56 percent price of beer. It excludes beer. vote in favour of prohibition, shy of the 60 percent needed for it to 1884 become law. King Country Te Rohe Pötae is declared a special Mäori ‘no licence’ district. Locals 1919 voted to restore Votes of 32,0000 licences in 1954. New Zealand soldiers returning from WWI stop the passage of prohibition.

18 matters of substance August 12 2007 Labour government asks the Law Commission to review liquor law.

1969 1992 Drink drive blood BSA allows alcohol ads limit of 100mg per after 9pm in exchange 100ml introduced for free airtime for (lowered to 80mg alcohol health 2010 in 1978). promotion. Law Commission tables 153 recommendations for Parliament to change alcohol law.

1961 Alcohol can be served with food in restaurants. 1989 A new Sale of Liquor Act liberalises liquor 1995 law. Supermarkets can Number of off-licences 2012? sell wine. 24/7 trading has almost doubled Government passes the allowed. from 1989 levels. Alcohol Reform Bill?

2003 ‘Sherry tax’ is introduced by Economic Development Minister Jim Anderton, almost 1989 doubling the price of Broadcasting Standards cheap drinks with high Authority established, alcohol content. with one role to review alcohol advertising. 2011 1967 Justice Minister Simon Six o’clock swill ends 1999 Power writes the with pubs opening Alcohol purchase Alcohol Reform Bill. until 10pm. age lowered to 18 years. Supermarkets can sell beer.

www.drugfoundation.org.nz 19 guest editorial Electorally toxic

In a parliamentary democracy, are we able to have rational, evidence-based drug law? Former ACT Party leader Rodney Hide discusses Don Brash, Nándor Tánczos and the political conundrum that is drug policy.

have next to no little concern to the authorities. knowledge about Nonetheless, Don Brash and Nándor drugs, drug use and Tánczos both proved that even discussing drug policy, and I liberalisation is electorally toxic. The point think that’s typical is all the more dramatic because they come of the average from opposite ends of the political parliamentarian. spectrum and demographic. I That might Methamphetamine is demonized and Rodney explain why present drug policy is a Hide no expense is spared trying to stamp it chaotic failure, but I don’t think it does. The out. Politicians can trumpet a hard line problem runs a little deeper than that. After to their electoral advantage but can’t all, few MPs know much about monetary policy, but New Zealand’s monetary policy discuss the policy rationally or question is robust and working well. whether it’s working. We clearly – and fortunately – don’t need policy whizzes as parliamentarians It’s the nature of drug to ensure good policy. What we do need is a good policy policy that people’s views on dynamic so politicians have every drugs vary widely, are incentive to seek out policy that works and invariably hypocritical and to follow good advice. And that’s where cross the usual political our drug policy falls down. Politicians find it impossible to engage in any sensible boundaries. debate about drugs and drug policy, which leaves us stuck with the occasional tweak of the status quo without regard for overall The policy interventions for each efficacy. drug bear no relationship to the problem The political tweaks with alcohol are each drug presents or the efficacy of those the purchase age and hours of purchase. interventions. Instead, they have With tobacco, it’s packaging and where you everything to do with the drug’s history can indulge. Cannabis is illegal, but its and the preservation of the historical widespread availability and use appears of status quo.

20 matters of substance August 12 Nándor and Don see eye to eye on drug policy but not much else.

It’s the nature of drug policy that I suggest there needs to be a broad and acceptance of the large gaps in people’s views on drugs vary widely, are grouping of organisations and individuals knowledge. That builds the credibility of invariably hypocritical and cross the usual to develop good drug policy. what researchers and those with practical political boundaries. Nándor and Don There need to be developed clear experience do know. would not agree on much – but they did principles to underpin policy for all drugs. I don’t think building such a policy agree on cannabis. These principles have to be general enough framework is difficult. The hard part may The problem is that any policy move on to capture diverse political views. I suspect be getting agreement on the framework and any drug sparks instant and polarised the goal of harm minimisation is the place the way of thinking about drug policy political opinion. Politicians have no room to start, and few could disagree. amongst the array of organisations and to discuss or debate the issues. Minds are individuals involved. There’s no need to made up already and votes are instantly rush to the media and to the public. The lost. The point is all the more critical first step is the solid framework to This is why politicians don’t want to dramatic because they come guide policy, the facts and the evidence. talk drug policy. To succeed in an election, That’s what’s powerful. That’s what will political parties must win party votes from from opposite ends of the deliver. And that’s what will dampen the a wide collection of individuals, and the political spectrum and hysteria and the kneejerk political same goes for electorate MPs. Debate on demographic. responses. drug policy divides the vote. Constituents Wider public debate can only begin will have diametrically opposed views, once the framework is established amongst and many will hold those views so strongly There needs to be developed a the experts, the organisations involved, the that drug policy becomes a vote changer. framework within which all drugs and the practitioners and interested individuals. I The political wisdom is that drug policy for them can be consistently and think that will take years, and Parliament policy doesn’t win votes but it sure can coherently viewed. and politicians will be the last to the party. lose them. Facts and evidence are paramount; But without a solid framework, I am Does that mean what we have now is as what are the real facts about the risk, the afraid New Zealand will be left muddling good as it gets for drug policy? Not at all. harms, the extent of use and the potential through with incoherent drug policy What it means is that any rational for use? Within the framework, there imposing a huge cost on our people and discussion on drug policy has to occur well would need to be the full array of possible our resources. away from politicians, who will be the last policy interventions and, most critically, ones to get on board with any proposed the available evidence here and overseas Rodney Hide is a former Member of Parliament change. They are followers on drug policy, for their success. for Epsom and the Act Party. not leaders. There needs to be acknowledgement

www.drugfoundation.org.nz 21 FEATURE

Recovery ruffling feathers across the Tasman

‘Recovery-oriented systems of care’ is a recently born US concept that is shaping drug treatment policy in the United Kingdom and is now gaining ground in Australia. But not everyone agrees on just what this ‘new recovery’ means, and that, warns Patrick Griffiths, could have serious implications for developing systems, including those here in New Zealand.

Patrick Griffiths

22 matters of substance August 12 he concept of “Unravelling the genealogy of ‘recovery’ Professor McLellan said recovery- ‘recovery’ within was not an easy feat when we decided to oriented systems include “the full alcohol and other unpack its meaning in order to at least continuum of care; everything from drug treatment is shape what we felt was its inevitable prevention, through early intervention, far from new, and arrival upon our shores,” he said. expansion of standard treatments of all many programmes This resulted in the release of the types, but also expansion of recovery T have claimed discussion paper Australian Drug Policy: services, such as drug-free housing, recovery as their ‘New recovery’ and harm reduction. parenting assistance and legal help to try aim since as far back as the 19th century. A prolific and influential advocate and reverse some of these problems”. The emergent ‘new recovery’ philosophy is associated with the emergent recovery In England, greater emphasis is being more contemporary, however. It rose in the agenda is US writer William White, who placed on the narrow outcome of mid to late 1990s and now underpins drug was once of the view that methadone abstinence in drug treatment policy and and alcohol treatment approaches in clients were outside the definition of funding frameworks, which is not England and Scotland. recovery. He is now clear that new consistent with a holistic focus on The first Australian test of the new recovery paradigms can and should improving the overall quality of life. recovery paradigm, the Victorian include people on pharmacotherapy, This prompts Professor Allsop to caution Government’s Roadmap – New Directions saying that “denying medically and that there is a very real risk that the term for Alcohol and Drug Treatment Services, ‘recovery’ is open to being politically was released in June. captured with unintended adverse outcomes. The good news is that, in this document Because each individual “There are examples of that in some at least, the baby has not been thrown out of the discussion that has occurred, for with the bathwater as some feared it would must choose for themselves example, in England. Indeed, if you look be. Harm reduction remains firmly front the most appropriate path and at some of the writing, recovery has been and centre and is regarded as completely technique of recovery, there is used to narrowly focus on ‘getting people consistent with recovery. no justification for forms of off drugs’ with less attention given to the Director of the National Drug Research broad range of important outcomes. Institute (NIDRI) Professor Steve Allsop prescriptive public policy in “For me, a critical purpose of what we said the Victorian document was an this area. do is to aim to help people access a higher example of recovery being used quality of life. For many people, of course, John Ryan constructively. a key means to this goal is coming off “But you’ve got a good minister. What drugs, but it is not the only approach we we have to be mindful of is that [recovery] socially stabilised methadone patients should employ. And that’s where some of can be narrowly defined in a way that is not the status of recovery is a particularly the debate can end up getting quite heated helpful for the field but, more importantly, stigmatising consequence”. – it then becomes polarised, a clash of could contribute harm to consumers.” Professor Thomas McLellan was paradigms between ‘abstinence is best’ Anex is a leading public health voice President Obama’s number two drug policy versus a harm minimisation approach. in relation to drug issues. Its CEO, guru and was involved with promoting That simply isn’t helpful or necessary.” John Ryan, first became concerned after recovery while at the same time endorsing In February 2012, the Cameron hearing recovery discussed at the 2010 the benefits of needle exchange. He has lost Government announced that the treatment International Harm Reduction Conference a son to a drug overdose and has direct strategy in England involved greater in Liverpool. family members struggling with addictions. emphasis on individuals entering “full

www.drugfoundation.org.nz 23 What we have to be mindful of is that [recovery] can be narrowly defined in a way that is not helpful for the field but, more importantly, could contribute harm to consumers. Steve Allsop

recovery”. It recognised that entire systems involves fostering healthy supported public policy in this area.” transformations would be required but did connections, such as with self, family, CEO of Drugscope in the UK Martin not commit the extra funding needed to peers and community, and is premised Barnes says there are few additional achieve that. It announced that 20 percent upon fair access to prerequisites for resources being channelled into transitions of treatment funding would be tied to a wellbeing’. toward recovery-oriented systems. This is payment-by-results system in which “When you think about it, the despite evidence from the US that large services may receive payment for people Australasian view of recovery is a non- systems-level changes are required, who complete treatment and do not prescriptive form of harm reduction, including substantial investment in re-present for at least six months. training for drug treatment service staff. fostering improved health and wellbeing, Professor McLellan says the recovery “The biggest challenge facing the sector with cessation of alcohol or other drug use movement is definitely not a front for AA, [in England] is the transfer of responsibility a common aspiration and outcome. but that, in America, more people have [from April 2013] for drug and alcohol “I agree with Professor McLellan, who gotten sober and into recovery from AA treatment to local authorities as part of a than in just about any other way, and that new public health service. The National recovery is a state of being, not a method. Transformation toward Treatment Agency will also be abolished “Fine, don’t use AA. Get a priest, get and its functions transferred into a new a buddy, take a medication, go to a drug new recovery approaches agency called Public Health England,” court, find a good woman – whatever. would require large-scale he says. There are 50 ways to get into recovery.” investments and should not “A key issue is the risk of Professor Allsop says it is important be at the expense of already disinvestment. There will be a ring-fence for the Australians to be clear on what they around the new public health budget do and don’t mean by recovery to “stop underfunded harm reduction but no ring-fencing for drug and alcohol somebody else capturing the debate” and programming. treatment funding. Up to half the local the polarisation of the field that won’t public health service budget will represent Martin Barnes help anyone. current spending on drug and alcohol John Ryan has proposed a definition services. There is a plan to incentivise that he encourages New Zealanders to is one of the pioneers of US concepts of local authorities to continue to invest in consider. drug treatment – which is positive – but addiction as a chronic relapsing condition. “We’ve looked carefully at the various drug and alcohol services are one of 17 There are many sources and pathways of streams of thought and the definitions potential responsibilities for what will recovery. Recovery should be self- floating around. We certainly don’t agree be called Health and Wellbeing Boards determined rather than being imposed with the mainstream US definition of [including tackling obesity, smoking by others.” recovery because there’s just too much cessation, reducing winter-related deaths, of that underlying abstinence philosophy He said he was concerned by trends in etc].” in there. And they don’t tackle harm the UK and the distinct possibility that He warns against rushed wholesale minimisation or harm reduction at all,” similar approaches may be forced upon changes without sufficient funding. he says. health systems in Australia. “If new recovery was to become an “We reckon recovery can be defined “Because each individual must choose agreed strategy, it should only evolve over as ‘a voluntary self-determined process for themselves the most appropriate path many years at the frontline and be toward wellbeing through minimisation and technique of recovery, there is no preceded by substantial and cautious or cessation of drug-related harms. This justification for forms of prescriptive policy development arising from

24 matters of substance August 12 QUOTES OF SUBSTANCE

Fine, don’t use AA. Get a priest, get a buddy, take a The award is possibly the biggest travesty of justice medication, go to a drug court, even by the UN and the find a good woman – World Bank’s weak ethical whatever. There are 50 ways standards. to get into recovery. Pranay Lal of Union Southeast Asia, a lobby group fighting tuberculosis Tom McLellan and lung disease, expresses some discomfort that the World Business Council for Sustainable Development awarded the Indian widespread consultation. debate unfolded gradually in the UK and Tobacco Company its highest prize “Transformation toward new recovery then the sudden way that it has loomed for improving the environment and approaches would require large-scale large in Australia, colleagues in removing poverty. The prize was investments and should not be at the New Zealand should probably start presented by UNDP Administrator expense of already underfunded harm discussing it soon. Rt Hon Helen Clark. reduction programming.” “The recovery movement operates in an But Ryan remains open-minded and organised fashion, so I expect it will not be is hopeful that, amid the winds of change, long before it bubbles up in New Zealand. UNDP will not participate the better elements of recovery systems, We are very open-minded about it but in these awards in the future including strengthening recognition of the nevertheless starting out from a position of unless companies like this role of self-support groups, can be included healthy scepticism, because in the wrong are excluded. without undermining the successful hands politically, it could be negative – Helen Clark claims a serious mixed-methods approach that sets possibly in the area of methadone oversight in the award process and Australia’s long-standing policy frameworks. maintenance treatment. says UNDP is reviewing its rules “Appropriately adapted recovery “But there are many positive aspects to and regulations to ensure such an models and rhetoric should be considered, it – particularly recognising that treatment incident won’t happen again. but must not be used to either mask or systems need to be better integrated with justify erosion of the lifesaving and other social services and that, for people to cost-effective approach of harm reduction overcome serious problems, they may need throughout Australia. help with housing, jobs, mental health I’m not sure why they are “Given the weak evidence base, services and the like. tweeting that. I presume it’s an “New recovery principles, if adapted, wholesale shifts toward the new recovery attempt to be funny and I don’t could make a valuable contribution to drug paradigm, as it is currently framed, involve think it’s particularly funny. policy and practice, particularly when significant risks. In a contemporary context fostering community linkages to support We are not amused says ALAC of government budget pressures, this risk people.” spokesperson Lynne Walsh on a tweet is heightened. Adopting the ‘new recovery’ Drug Foundation Executive philosophy without serious localisation Director Ross Bell sent about ALAC Patrick Griffiths is a former journalist working for our culture and health systems is staff doing yardies at their farewell for Anex, an Australian non-profit organisation potentially quite dangerous.” function. working to increase understanding around Leading US recovery advocate Bill problems arising from the use of illicit drugs, White stresses that needle exchange and pharmaceuticals and alcohol. recovery are highly compatible – a position Might be a good idea to test endorsed by Professor McLellan. some of these MPs when they “Syringe and needle exchange, come to the house as well. naloxone distribution and other medications including opioid maintenance RESOURCES Mana Party Leader Hone Harawira in response to proposals to drug test medications are all part of a recovery- • Get a copy of Australian Drug Policy: beneficiaries. oriented system of care and can help ‘New recovery’ and harm reduction here: people move to a healthier, better way of nzdrug.org/MvH1K7 life,” he says. • Watch a recovery story: continued on page 33 Ryan says that, based on how the nzdrug.org/NCmrri

www.drugfoundation.org.nz 25 FEATURE Don’t hesitate

Elle Hunt

Why do some people hesitate to call for help in a life-and-death situation? Elle Hunt investigates emergency responses to overdoses in New Zealand.

esperate times individuals who witness a drug overdose response as wide reaching as New York’s call for desperate contact emergency services and even then Good Samaritan legislation. measures. Last year, only after their own attempts to revive the “We don’t treat [overdoses] as a the state of New victim have failed. potential crime; we treat them as a York – where more supposed poisoning,” explains Sue people die from Gullery, Clinical Manager at St John accidental drug New Zealand. “We would only involve D overdoses than in We would only involve police – and this is across the board – if car accidents – passed legislation designed police … if there was a there was a suggestion of a crime taking to reduce the number of such fatalities. suggestion of a crime taking place or that our safety or that of any Known as the ‘Good Samaritan 911’ law, place or that our safety or individual was at risk.” it offers protection from prosecution to that of any individual was Police, too, assess each reported people seeking help in the event of an overdose on a case-by-case basis. overdose. Governor Andrew Cuomo at risk. “Decisions around prosecutions will be expressed support for the measure, arguing judged on the merits of what’s happened,” that “the benefit to be gained by the bill – Sue Gullery says New Zealand Police Chief Media saving lives – must be paramount”. Advisor Grant Ogilvie. That similar immunity laws have been “Any prosecutions that we do take have passed in other states, including New According to findings submitted to the to meet the Crown Prosecution Guidelines, Mexico, Washington and Connecticut, is British Medical Journal, studies suggest which include a public interest test and an testament to the extent of the epidemic in witnesses to drug overdoses hesitate from evidential sufficiency test... and even if we America. There, the number of accidental calling for medical attention because they did decide to prosecute and it went through drug overdose deaths from both legal and fear police intervention. Many fear they the courts, particular circumstances could illegal drugs increased more than 400 will be held liable themselves under laws be taken into account in terms of sentencing. percent between 1980 and 1999. In 2007, against possession and use of illicit drugs. around 27,000 such fatalities were reported The limited shield from charge, “Our overarching priority would nationwide, compared to fewer than 17,000 prosecution and arrest offered under the always be the welfare of the individual, homicides. Good Samaritan legislation creates an and we would always encourage someone Drug overdose fatalities can be opportunity to save lives. to call 111.” prevented if emergency services are alerted Drug overdose deaths are nowhere near quickly enough, as death rarely occurs as frequent in New Zealand, but they do In reality, police are only immediately. But part of the reason the occur. Charles Henderson of the number of fatalities is so high, even though New Zealand Needle Exchange Programme interested in dealing with it most overdoses occur in the presence of estimates there are around 12 each year: on a criminal basis, and that’s others, is that most witnesses don’t call for “I’d say that, per capita, that reflects a lot their job. help. Findings published in Drug and of other places.” Alcohol Dependence in 2005 estimated Because drug overdoses in New Zealand Charles Henderson that between 10 and 56 percent of are infrequent, there is no need for a

26 matters of substance August 12 Working together to prevent overdose

the needle exchange programme (nep) has enjoyed a relatively good relationship with police and has formed part of a training video for pharmacists primarily to do with policy and operational edits promoting the health consequences and its concerns of blood-borne viruses and the added aspect of police safety concerns where injection equipment is well For these reasons, the fear of police hidden and not identified during police searches intervention in the act of reporting a drug You’re more likely to be (which was reported to occur before the NEP). overdose to emergency services is “not an prosecuted for not giving Effective intersectoral dialogue and common issue” in New Zealand, says Dr Paul assistance if you find someone understanding of what the issues are at the Quigley, Emergency Medicine Specialist at ground level, such as law enforcement practices the Capital & Coast District Health Board. in a collapsed or overdose that disrupt services, agreement on not arresting/ “Law enforcement is not interested in situation. targeting NEP workers, and treating NEP outlets an overdose unless it leads to death,” he (particularly dedicated needle exchanges) as safe says. “There are no real barriers to IV drug Dr Paul Quigley places for people who use drugs. users seeking help in emergency situations At a regional level, all the dedicated needle – in fact, you’re more likely to be exchanges (NEXs) actively maintain a local unconscious,” says Henderson. Then, prosecuted for not giving assistance if you connection and liaison. This can involve when ambulance staff reach the scene, they find someone in a collapsed or overdose presentations to whole squads (or even the can be informed that they are dealing with situation.” whole establishment at the station) to regular a drug overdose. Such a charge would likely come under phone contact and liaison at a managerial “We take that typical harm reduction level. The NEX workers themselves are very the crimes against the person outlined approach: we present the facts and the cognisant to ensure there is no compromising under the Crimes Act 1961, which detail mechanisms to keep people safe, legally of client anonymity to maintain these contacts. “duties tending to the preservation of life”. as well as physically. That’s all we can Police presence at the exchange site was and is But, as Henderson points out, this presents avoided at all costs for the obvious connotations do, frankly.” a Catch-22 situation. “Any admission of that the behaviour in question is illegal. use of drugs or administration of a drug Though drug overdoses are infrequent in New Zealand, Henderson warns fear of The Misuse of Drugs Act was amended in to another is likely to cause the police to 2005, and anecdotal reports from personal criminal sanctions can prevent people from get involved, and on that basis, they communications and operational directives can charge people under the Misuse seeking help in emergency situation. “What show it was clearly explained to the police of Drugs Act.” you end up with is people not wanting to frontline what this meant in legal terms Moreover, he adds, police have been know. They drop the victim in the street or On the basis of a review of the NZ NEP, it known to appear at the scene of an outside A&E. They won’t ring the was recommended that the NEP develop a overdose without having been notified – ambulances, and what good does that do? relationship with the Police College and engage “and we’re unsure as to why they come “Now some people may argue that they in providing a harm reduction curriculum to but they do,” adds Henderson. should get busted and go to prison, but we officers so there is a greater awareness of the “Frankly, in reality, police are only think there’s more harm in taking that implications of harm reduction in policing work. It is hoped this will be fruitful, resulting in a interested in dealing with it on a criminal approach than trying to encourage people greater understanding by police of the health to either get treatment or get off drugs basis, and that’s their job.” implications of injection behaviours and how The Needle Exchange Programme themselves. the adoption of an intersectoral approach as set cautions its clients to display discretion. “But it’s really this age-old problem out in the National Drug Policy can collectively “Our advice is don’t say anything during around treating illegal drugs as a criminal minimise these harms to benefit the individual the 111 call as to what drugs are used; issue instead of a health one. That’s always and the wider community. say the victim isn’t breathing and is going to come to the fore.”

www.drugfoundation.org.nz 27 opinion Drugs and the real development: t hreat

To coincide with the International Day against Drug Abuse and Illicit Trafficking on 26 June 2012, the United Nations (UN) General Assembly (GA) held an ‘informal’ debate in New York on the issue of drugs and crime as a

Ann threat to development. Ann Fordham suggests the real Fordham threat, however, remains the same old tired and failed thinking that is entrenching, rather than reducing, harms from the international illegal drug trade.

28 matters of substance August 12 UNODC Executive Director Yuri Fedotov he call for this debate reflects UN discussions about transnational organised crime and its link to the illicit drug trade. In T September of last year, UN Secretary General Mr Ban Ki Moon set up a UN taskforce, to be led jointly by the UN Department for Political Affairs and the UN Office on Drugs and Crime (UNODC), to mobilise the UN in a co-ordinated and coherent response. The challenge to the UN of developing a system-wide response on the issue of drugs and organised crime should not be taken lightly. For many years, civil society 26 June. While there is absolutely no Commission on Drug Policy. actors have been calling for UN agencies to doubt that the power and reach of These cracks in the consensus are ‘speak as one’ on an evidence and rights- transnational organised crime and the heartening. Yet, to really shift the debate based response to reducing drug-related activities in which such groups are engaged towards reform, there needs to be clear harm among people who use drugs. seriously undermine global development acceptance of a number of inconvenient HIV prevention in particular has been objectives enshrined in the Millennium truths – the greatest of which is that the at the top of this agenda. There has been Development Goals, presenting the issue in huge political and financial commitments some progress on this issue, with broad these terms reinforces the idea that people to eradicating the illicit drug market acceptance across UN bodies (after many who use drugs, farmers engaged in have failed. The global drug trade has not years of sustained civil society advocacy) producing drug-linked crops and the been contained and is estimated to be of life-saving harm reduction interventions ‘little fish’ in drug distribution networks worth some US$300 billion, most of such as needle and syringe programmes are also the ‘threat’. which is in the hands of organised crime. and opioid substitution therapy as key This conveniently ignores the fact these The second inconvenient truth is interventions for the HIV response. groups are often the most marginalised in that many of the security and law However, in recent months, we have society and their involvement in the drug enforcement-focused strategies employed witnessed a concerning roll-back by the trade is based on a complex combination to this end have only served to exacerbate UNODC on harm reduction and a of factors such as socio-economic status, the problems: the illegality of the market misrepresentation of the agreed best marginalisation, vulnerability and fuels the profits of organised crime and strategy for HIV prevention among people geography. The ‘drugs as a threat’ discourse drug market violence; the criminalisation who use drugs. This was well illustrated has justified punitive measures towards of people who inject drugs drives the HIV by my colleagues from the International consumers of drugs, crop eradication epidemic and leads to the overburdening Network of People who Use Drugs and schemes and resistance to pragmatic harm criminal justice and prison systems; and Harm Reduction International in their reduction measures on both the demand harsh supply reduction strategies lead to guest editorial in the May 2012 edition of and supply sides of the drug market. the destruction of the livelihoods of some this publication. There, they discussed the The actual GA debate was chaired by of the most marginalised communities for censorship of civil society voices at this Mr Yuri Fedotov, the Executive Director whom the only existing viable economic year’s 55th Session of the Commission on of the UNODC. As predicted, it was fairly option is the drug trade. Narcotic Drugs and moves by UNODC to uninspiring, which is typical of these large In understanding the multi-faceted reframe abstinence-based drug dependence diplomatic gatherings. There were the nexus between drugs and development treatment as effective HIV prevention. many routine and hollow statements from and how to respond effectively and The UNODC’s misguided leadership most member states echoing those we hear appropriately, there must be a on this issue is particularly worrying given each year at the CND. There were, coherent strategy in which drug it is the lead UN agency for responding however, a few progressive interventions control objectives do not adversely to HIV prevention among people who use that reflect the recognition by an increasing affect the same communities that drugs under its mandate as a co-sponsor number of governments that the drug development policies are designed to of UNAIDS. These recent developments control system is in need of modernisation support but that instead are integrated, highlight the ever-pernicious tendency to and reform. sophisticated and pragmatic. promote zero-tolerance approaches to drug The US, for so long the main proponent The real threat to development would use in an unfortunate recycling of the for prohibition, reiterated its statement that be to complacently recycle wasteful, failed powerful ‘drugs as a threat’ narrative, we need to prioritise treatment over and counterproductive strategies. despite the overwhelming evidence for punishment. Guatemala robustly defended both the failure and negative consequences its call for a review of current drug policies Ann Fordham is the Executive Director of this approach. and Luxembourg highlighted the need to of the International Drug Policy Consortium. It is this ‘drugs as a threat’ narrative take under serious consideration the www.idpc.net that was used to frame the GA debate on recommendations of the Global

www.drugfoundation.org.nz 29 FEATURE A slug of the drug

Recent research by the Canadian Centre on Substance Abuse has given substance to something we’ve long suspected. Combining alcohol and caffeine is not a good idea. Rob Zorn looks at why the researchers say these drinks increase harm and at some of their suggested solutions. Rob Zorn

affeinated consumption range from the innocuous – alcoholic beverages they taste good or give me energy – to the in Canada: downright troubling – I can stay awake to Prevalence of use, party longer, get a quicker buzz or drink risks and more without feeling drunk. Research in recommended Australia has found similar motivations. policy responses The report distinguishes between two C is a new report categories of CAB use: those that are examining evidence linking the combined pre-mixed and sold in liquor outlets and use of alcohol and caffeine to increases in those that are hand-mixed by consumers harms including severe intoxication, themselves. Hand-mixed CABs are the dreadful hangovers, drink driving and riskier option because they typically being on the giving or receiving end of involve more alcohol and caffeine. sexual assault. There are a couple of explanations for Caffeine and alcoholic beverages (or the increased harm from CAB CABs for short) are becoming more and more consumption. Firstly, caffeine interferes popular in Canada, as they seem to be here. with the consumer’s perception of their Though it has a myriad of lesser known own intoxication, so they feel less drunk competitors, Red Bull is considered the than they actually are. However, the standard energy drink for CAB concoctions caffeine doesn’t interfere with the alcohol’s just about anywhere. Red Bull and vodka effects on the body, including deficits in – or the Vod-Bomb as it’s otherwise known motor co-ordination and reaction time. In – is a “classic drink” according to the Red other words, the mind doesn’t realise it has Bull website and one of the most popularly to step in, as it normally might, to put the ordered drinks around the world. damper on activities like driving or other Red Bull’s aggressive marketing risky behaviour. campaign targets teenagers around the The second explanation is that caffeine world by sponsoring extreme sports events masks some of the depressant effects of and athletes as well as video games and alcohol upon the central nervous system musicians. Kiwis bought NZ$30.3 million leading to longer and more active drinking worth of Red Bull in 2010, a 7.5 percent sessions. Normally, the consumer would increase from 2009. In 2011, Red Bull realise they’re dangerously drunk and stop recorded an 11.4 percent increase in sales drinking or they’d pass out. However, the internationally, which was also reflected caffeine means the consumer often in New Zealand. continues to drink and be more active Reasons students gave the Canadian despite being physically and mentally researchers for their copious CAB impaired.

30 matters of substance August 12 EXPERIENCE Hannah

hannah is 21, works in retail but wants to be a police officer. She drinks caffeine- alcohol mixes because she enjoys the taste and finds them easy to drink. Her favourites are Pulse (vodka/guarana) and Jäger-bombs (Jägermeister and Red Bull). She’d drink about eight of these on a typical night out, and knows they’re about 8 percent alcohol. She sometimes mixes her own at home, but prefers the cheaper and more convenient pre-mixes. So what can be done to reduce this consume with alcohol” warning printed on Hannah doesn’t notice a lot of bad effects from drinking CABs other than feeling quite lethal cocktail of harm? The researchers some energy drink labels. dehydrated the next day and finding it harder suggest increasing price (through increased Sellman agrees, but says there are to sleep. She doesn’t think they lead to dodgy excise) and restricting hours of sale are the ethical reasons why warnings should still sexual behaviour any more than any other most effective measures for reducing CAB be mandatory. alcoholic drink. consumption. And to these, the National “Warnings probably aren’t all that “I’ve seen my friends go home with some Addiction Centre’s Prof Doug Sellman effective because we’re not rational beings blokes and thought they’re probably going would add getting rid of marketing. – we’re human beings. But consumers still to regret it – but I wouldn’t blame that on “Effectively what we have here is have the right to be fully informed about caffeine. That’s been happening since long multiple drug use – alcohol and caffeine the product they are being encouraged to before we had alcopops.” mixed with sugar making these drinks all purchase. It should be made very clear that She says the same is true for getting into cars the more dangerous. Of course they should there is caffeine present that will mask the with drivers who’ve been drinking, but that’s be highly taxed to reflect their danger, to effects of alcohol.” something she would never do. disincentivise their use and to fund society Unsurprisingly, our Canadian having to clean up their mess. And to researchers failed to isolate a silver bullet The one thing that allow these hazardous substances so be solution, and Prof Sellman admits he can’t might work is if you put so freely marketed just doesn’t make find one either. But based on evidence from a limit on how many any sense.” successful campaigns on health issues such The Canadian researchers warn, as drink driving and smoking, the report kids can buy. however, that increasing the cost of suggests a combination of policy, pre-mixed CABs could encourage regulatory and educational interventions “I want to become a cop and mixing consumers to shift to hand-mixed drinks, should be used to bring about a long-term alcohol and driving is bad for my career which involve more risk – but Prof shift in cultural norms. options so I always take a taxi or make sure my ride is safe.” Sellman doesn’t buy that that argument. Our government may be willing to “There are always some people who do tinker with minimum pricing, but unless it Hannah thinks overindulging on caffeine and alcohol drinks is mainly something the opposite of what you intend, but not starts to take the marketing and sponsorship teenagers do and that most people in their everybody will. The simple fact is, if you bull by the horns, any change is likely to be 20s start to drink less but with more variety. increase price and restrict availability and very long term indeed. She doesn’t think warnings about consuming marketing, consumption will go down.” energy drinks with alcohol would make any The researchers suggest that other Rob Zorn is a Wellington-based writer. difference and can’t ever recall having measures, including public education seen one. campaigns and warning labels, can “The one thing that might work is if you put a influence knowledge and awareness but are limit on how many kids can buy. If they could generally less effective than price. In fact, RESOURCES only get one four-pack instead of three, then I think they wouldn’t be able to drink so much.” 86 percent of students questioned said they • Download the CCSA report: were aware of but ignored the “Do not nzdrug.org/MjwAVk

www.drugfoundation.org.nz 31 FEATURE Fit to start? New Zealand’s interlock programme

In mid to late 2012, the Land Transport Act 1998 will provide New Zealand judges with the option of sentencing high-level drink drivers to use alcohol interlocks. But does the government’s insistence on users having to pay mean this promising harm reduction initiative is starting off on the wrong foot?

n alcohol interlock attempting to use balloons to fool the disqualification. Each time they get into is like a machine, but interlocks now measure their vehicle, they’re physically reminded breathalyser breath temperature. One fellow is said they must be sober in order to drive.” hardwired to a to have forced his breath through a pipe Evidence from overseas reveals 75 vehicle’s starting immersed in ice water (believing this percent of people will continue to drive system. The driver would remove the alcohol) and he then while disqualified, and MacIver thinks must give a breath had a blowtorch heating the pipe at the that’s also likely to be true here because we A test, and the vehicle other end to fool the temperature gauge. are so dependent on our cars. will not start if the result is over the These sorts of attempts, no matter how “In contrast, when alcohol interlocks pre-programmed blood alcohol elaborate, almost always fail, and in have been fitted, quite often there’s a 60, concentration (BAC) level, which, in New Zealand, various safeguards will be 70, up to 90 percent reduction in New Zealand, will effectively be zero. used, including blow/suck or blow/hum reoffending.” Judges will have discretion to sentence technology or the option of a camera to The Ministry of Transport website a repeat drink driver or a first-time drink ensure it’s a real person and the right estimates that, when the interlock driver with twice the legal BAC or more to person blowing into the device. programme reaches a 60 percent have an alcohol interlock installed in their Canada, Australia and Europe have participation rate, it could save two lives cars after a mandatory three-month interlock programmes, and they’ve been and prevent 25 injuries each year, disqualification. Release from the interlock used in the United States for 30 years. reducing the annual cost of road injuries programme will be based on meeting Ministry of Transport Senior Adviser by around $10 million. With further criteria such as having no violations for six Kathryn MacIver says that means we have compliance, those savings will be months or no violations for three months the benefit of starting with the very latest even more. plus completing an alcohol assessment. technology, but it also means there’s an One wonders, then, why it has been Interlock data will be downloaded to existing solid evidence base for their decided that the considerable costs NZTA on a monthly basis for monitoring effectiveness. involved with interlock systems will of both violations and circumvention “What makes interlocks often a better have to be met by the offender. Figures attempts, and there will be penalties for option is that offenders can drive again have not yet been finalised but, based on those who tamper with their interlock or after just three months, and international Victorian costs, are likely to be around try to get someone else to blow in it. evidence shows that’s much more powerful $150 per month to lease the device along There are anecdotal stories of people – in terms of behaviour change – than with a $200 application fee.

32 matters of substance August 12 QUOTES OF SUBSTANCE

If we could take alcohol out of young people’s hands we could take 80 percent of the violent offences out of the Youth Court. Principal Youth Court Judge Andrew Becroft on changes to New Zealand’s liquor law.

I believe all illegal drugs are bad. Top US Drug Enforcement Agency officialM ichele Leonhart was put on the spot by Democratic congressman. Jared Polis after she refused to admit that crack was worse for a person than cannabis.

I got so drunk by the time I went on at 2am I had forgotten the words to my For many on low incomes, these Offenders who enter the interlock own songs ... It was the worst expenses will be a barrier to applying or to programme won’t receive fines, and thing ever. ongoing participation, potentially leading financial assistance is planned for people to increased costs to the government in who can’t afford to pay. But that assistance Singer Adele comes clean about her enforcing compliance. Many offenders will be funded from the monthly leasing drinking problem in her biography. claiming hardship could request a fine and fees paid by those who can afford them. longer disqualification instead, potentially This means some people will receive a removing the benefits of the interlock greater financial penalty than others for the Are we witnessing a new system from a significant chunk of the same crime, so it’s not just those on low trend in product placement? drink driving demographic. incomes who may become disgruntled We get enough brand names Another worry is that these fees with the system. creating visual clutter around effectively amount to a disproportionately The Drug Foundation supports the use and on the pitch. Must we now hefty fine for the offender. The Ministry of interlocks but believes they should be endure audible product of Transport’s own Regulatory Impact funded by the government if they are to Statement admits fees are likely to amount placements by the commentators have maximum effect in reducing drink to around $2,000 in the first 12 months, during the game? drive-related harm. Keeping the current “far in excess of the average fine given MediaWatch listener Malcolm Hunt fine system in place (and using fines to through the Courts”. on the incessant use of the word MacIver acknowledges these costs are help fund the programme) would be more ‘pure’ by rugby commentator Ian a concern but reminds that the current just, ensure better levels of co-operation Smith during a test match between system puts financial pressures on offenders and compliance and result in fewer people New Zealand and Ireland sponsored that would reduce if their period without a driving drunk. by Steinlager, which happens to licence was just three months. It may be true that every other interlock have a brand called Steinlager Pure. “Remember that these are more serious system in the world is based on user pays, drink drive offenders, often with longer but New Zealand has often stood out disqualification periods. How much does internationally when it comes to looking it cost in time and money to rely on public after its wounded, and it won’t be the first transport for a year? And is an interlock time we’ve taken a stand in contrast to the more or less costly than losing your job?” rest of the world.

www.drugfoundation.org.nz 33 VIEWPOINTS

Should you give your teenagers alcohol? Viewpoints presents the arguments on both sides.

the case There’s a very good reason the legal drinking age is 18 and not younger. Alcohol is a drug, and minors shouldn’t be able to purchase and consume drugs. If we make it illegal for minors to purchase alcohol for their own good, then why on earth would AGAINST we sanction it being given to them by parents? Giving a teenager alcohol is unsafe for their physical growth and development. A teenager’s brain is still developing, a process that can be detrimentally affected by even the smallest amount of alcohol. Scientists don’t yet know the exact effects of alcohol on a developing brain, but they do know it impedes long-term thinking and memory. Research has shown that animals fed alcohol during developmental stages show permanent impairment as they age. And the brain isn’t the only organ affected. Elevated liver enzymes, an indication of liver damage, are found in adolescents who drink alcohol, and again, studies of animals experiencing puberty show alcohol has adverse effects on the maturation of organs and the reproductive system. But physical dangers are just the beginning; there are mental and emotional dangers as well. Parents who introduce their teens to alcohol run the risk of their child developing a casual attitude to the substance. They see their parents giving them alcohol as validation. After all, if it really was a dangerous substance, their parents wouldn’t give it to them, right? This can be dangerous for a teen. They’re at a stage of their lives where many view themselves as bulletproof new adults and can tend to be a little reckless. Combining this with alcohol can result in a number of unfortunate consequences such as violence, injury, unprotected sex and suicide. Research shows that children who first use alcohol before age 15 are five times more likely to abuse alcohol than those who first use alcohol at age 21 or older. That’s why Chief Medical Officers from the UK and Australia have recently said that the longer teenagers can abstain from alcohol, the better for their ongoing physical and mental wellbeing. Lastly, young people do not need to drink to learn how to use alcohol safely. The best way to teach your child about the safe use of alcohol is by being a good role model and being very careful about the example you set. In just about every country around the world, thousands of minors die annually as a consequence of alcohol-related incidents, and this is equally true in New Zealand. Alcohol is a serious and potentially harmful drug and not one we should treat casually when it comes to our young teenagers.

34 matters of substance August 12 As a parent, the responsibility for managing your teenager’s drinking lies solely on you – as both an authority figure and a role model. But at what age do you allow your teenagers alcohol? Should you try to keep them completely safe by enforcing absolute abstinence until they’re 18, or do you slowly ease them into drinking as they approach their late teens? ?

Drinking alcohol is part of our culture, and most people accept that it has a the case legitimate place. It’s a reasonably easy product to procure, which means your teen will probably have plenty of opportunities for experimental drinking – with or without your knowledge and probably despite your role-modelling and good intentions. FOR As a responsible parent, you want to have some influence over the way your children drink. An important part of making sure their experiences with alcohol are safe – both before and after they turn 18 – is guiding and familiarising them with it in a responsible way. Telling teenagers they can’t have something must always be done with care lest you create a case of forbidden fruit. Denying them alcohol could potentially create a certain mystique around drinking. You increase the risk of your teenager dangerously drinking unsupervised behind your back because your stance has been so hardline. Or if your teen is of the less adventurous variety, they could suddenly reach the legal purchasing age and have no experience or understanding of alcohol and the consequences of its consumption. Both situations are potentially very harmful. When they turn 18, your teen is free to buy alcohol without your knowledge or consent. By giving them the occasional drink, say a glass of wine with Sunday lunch or a beer at a family barbeque, and by role-modelling responsible drinking yourself, you’re more likely to remove ‘forbidden fruit syndrome’. Your teen will see alcohol as no big deal (in a good way) and may even wonder what all the fuss is about. Further, teenagers are very good at picking up on double standards, so parents who preach to their teenagers about the dangers of alcohol while continuing to drink themselves run the risk of undermining themselves as authority figures. Don’t tell them something’s bad for them but OK for you. Instead, show them how YOUR VOICE to drink responsibly, which is exactly what you want for them in the long run. By denying your teenager alcohol before they turn 18, you leave it to them to discover drinking for themselves, and they’ll probably learn most at parties and YOU unsupervised gatherings. And can you be sure about what attitudes towards DECIDE alcohol your teen’s mates’ parents have instilled?

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

www.drugfoundation.org.nz 35 Q&A

Q What was your role on the Commission? Q How are HIV and drug use connected? A I served as one of the 14 Commissioners. A The principal link between HIV and drug Eight of us were serving or former use is apparent in jurisdictions where the politicians with experience in dealing with epidemic is concentrated among IV drug laws that relate to HIV (I was a member users. The former Soviet-influenced and then the Chair of the New Zealand countries in Eastern Europe, Russia and AIDS Foundation in the early 1990s as well Central Asia have such epidemics. as a board member of the Public Health I chaired the Commission’s Regional Commission). The other Commissioners Dialogue in Chisinau, Moldova, last year were politicians, judges, academics or and was able to observe that the spread journalists with comparable experience. of HIV in those countries was entirely preventable. If adequate health promotion, Q How much work does New Zealand education and health protection measures Charles need to do to fulfil the Commission’s had been put in place following the fall recommendations? of the Berlin Wall in 1989 instead of the repressive measures that largely remain the A The Commission produced six key Chauvel response to the epidemic there, the situation recommendations: would be very different. Commissioner, • Remove discriminatory laws and Compulsory registers of HIV positive people, Global Commission on policies that stop effective HIV treatment. bans on their intermarriage or cohabitation HIV and the Law • Do not criminalise HIV transmission, with HIV negative people, an almost total exposure and non-disclosure. absence of information on how to keep • Protect key at-risk populations – IV drug oneself safe from infection, especially if The Global Commission on HIV users, sex workers, men who have sex one is in an ‘at risk’ group, and a ban on and the Law was established by with men, transgender people, prisoners harm reduction-based programmes are all the United Nations Development and migrants – from irrational laws and typical features of the bleak prevailing policies that put them at increased risk public policy in countries where IV drug Program under the leadership of of infection. use-based epidemics are rife and where, the Rt Hon Helen Clark. The • Empower women, especially women in tragically, the numbers of those infected Commission studied the impact developing countries, to be safe in their are still rising. of the law on people living with sexual relationships. HIV and recently made • Protect the sexual and reproductive Q This is not the first report to call for a recommendations on how the health of younger people. different approach. Do you think there is a growing momentum for a change law can better support universal • Revise international intellectual property rules to make treatments much in global drug laws? access to HIV prevention, more widely available. A Our report is merely one of a number of treatment, care and support. New Zealand has a generally good record recent international reports to have found in these areas, but there is room for that the evidence shows the prevailing It comprised a number of eminent people improvement, especially in some areas of approach to drug policy is failing. As the including Fernando Henrique Cardoso, immigration policy and in the adequacy of Law Commission reported last year, we former President of Brazil, Festus our drug laws. Sadly, in the Pacific – our need less of an emphasis on drug use as a Gontebanye Mogae, former President neighbourhood and the place where most criminal matter and more on it as a health of Botswana, and Dame Carol Kidu, of our aid dollars are spent – it’s a very matter. We need more focus on the the only women in Papua New Guinea’s different story. Repressive public policy organised crime interests that are often Parliament. – as in Samoa at the moment, with three behind dealing and less on the Labour MP Charles Chauvel was retrograde bills on the parliamentary order criminalisation of individual consumers. appointed to the Commission in June paper – hampers prevention messages and Expert opinion and views based on the 2010 and answers our questions about creates a fear of coming forward for testing evidence can reach no other conclusions. his work and the relationship between and treatment. I greatly fear the conditions So despite all the rhetoric and the vested drug use, HIV and the law. for a regional epidemic are in place. interests that line up against drug law reform, I am confident the tide will turn on drug policy – eventually. It has to.

RESOURCES • Read the Commission’s report: www.hivlawcommission.org

36 matters of substance August 12 Mythbusters

Substance and Substantiation Cannabis 20 times more carcinogenic than tobacco?

Recently, the British Lung Foundation claimed that, contrary to popular belief, smoking a cannabis cigarette is up to 20 times more likely to give you lung cancer than smoking a tobacco cigarette. This is a bold claim from an esteemed body, but is the evidence there to back them up? Mythbusters investigates.

he purpose of the The findings and methodology of this evidence connecting cannabis smoke and British Lung relatively small study have since been lung cancer is far from conclusive and that Foundation’s seriously questioned on more than one there is no scientific basis for the BLF’s (BLF’s) June media occasion, but the BLF chooses not to claim. release was to mention this at all. To the BLF’s credit, it did acknowledge announce its The second study gets only a small there was a need for more research to verify special report on mention, possibly because it found only a these findings. However, Mythbusters T the impact of 2.4-fold increase in the risk of lung cancer. thinks they’re guilty of mishandling the cannabis on the lungs. The report claims The third study gets no mention in the text evidence in the meantime. And while we cannabis is 20 times more carcinogenic at all even though it looked at more cannot doubt the BLF had the best of than tobacco despite also saying “studies people’s cannabis use over a longer time intentions to inform and protect, attention- on the subject have yielded conflicting than any of the other studies and so could grabbing reports such as these could have evidence: some suggest there is a link be argued to be the most valid. One the opposite effect. between smoking cannabis and lung cancer suspects the BLF largely ignored it because What we do know is that inhaling any while others don’t. Further research is it found zero correlation between cannabis smoke is bad for you. Smoke is a bunch of needed to confirm these findings and to smoking and lung cancer. particulates and gases released during explain why smoking a cannabis cigarette There is a fourth study the BLF could combustion, and both tobacco and might pose a greater risk than smoking a have included, but we’re not surprised it cannabis smoke will contain harmful tobacco cigarette.” didn’t. Donald Tashkin of the University substances such as sulphur dioxide and Mythbusters is starting to feel less of California has studied the effects of carbon monoxide. Putting these things into confident already, but, unfortunately, it cannabis on the lungs for three decades your body is not likely to be good for your gets worse for the BLF. and found that even smoking as many as The report references three studies on 20,000 cannabis joints does not increase health long term. the connection between cannabis and lung the risk of lung cancer. The BLF acknowledged more research cancer, but not one of these provides any To what must be the BLF’s horror, he on the subject needs to be done before any solid evidence to suggest the BLF’s claim goes on to speculate that cannabis could claims can be made then made a claim is true. even have a positive effect on the health anyway for which there was little The first study, conducted in 2008 of a smoker’s lungs. The active ingredient evidence. Mythbusters thinks that’s in New Zealand, claimed to have found tetrahydrocannabinol or THC may have disappointingly poor form. a link between cannabis and lung cancer. an “anti-tumoural effect” in which cells However, the ‘20 times worse’ statistic is, die before they age enough to develop REFERENCES according to Professor David Nutt, “the mutations that might lead to lung cancer. • Visit the Mythbusters page on our most alarming interpretation of the most Whether Tashkin’s findings will stand website for the references alarming evidence [in the research] the test of time remains to be seen, but it used in this column: possible” and a highly dubious one. seems we can say truthfully that the drugfoundation.org.nz/mythbusters

www.drugfoundation.org.nz 37 ДОСТОИНСТВОTOLERANCE SUPPORTCOMMUNICATION SAFETYRESPECT TRAININGEDUCATION CHANGEPARTICIPATION САМООПРЕДЕЛЕНИЕHUMAN RIGHTS EMPATHYЭМПАТИЯ KNOWLEDGEINCLUSION COMMUNITYSUPPORT INFORMATION BESTПРЕДСТАВИТЕЛЬСТВО TRUST PRACTICE РАСШИРЕНИЕ ВКЛЮЧЕНИЕПРАВ И ВОЗМОЖНОСТЕЙ DIGNITYМОБИЛИЗАЦИЯ REPRESENTATIONУЧАСТИЕ HEALTHCOMPASSION THE VALUES OF HARM REDUCTION JUNE 9 - 12, 2013 | VILNIUS, LITHUANIA

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