Mattersof Substance. august 2015 Volume 26 Issue No.3 www.drugfoundation.org.nz

Taking the pulse of Māori public health Restoring equality and addressing health outcomes for Ma¯ori comes with many challenges. Contents

FEATURE Taking the STORY pulse of 18 Māori public health

COVER: Health inequalities for Mäori remain, but much progress is being made getting the right sort of help COVER ABOUT STORY 06 28 A DRUG

WORLD NEWS FEATURE: 02 THE CRUEL C 14 $ $ $ $ ?

FEATURES Become 06 14 18 24 a member Taking the pulse of The cruel C The UNGASS A school’s Maori public health With hepatitis C rates 2016 primer core business The Drug Foundation has Health inequalities for growing, is there any A comprehensive Focusing on a positive school been at the heart of major alcohol and Mäori remain, but much relief in sight? introduction to the environment means alcohol other drug policy debates for over 20 years. progress is being made UN’s special session on and other drugs aren’t such During that time, we have demonstrated getting the right sort the world drug problem a big deal at Ötaki College a strong commitment to advocating of help policies and practices based on the best evidence available.

You can help us. A key strength of the Drug Foundation lies in its diverse membership REGULARS base. As a member of the Drug Foundation, you will receive information about major The Director’s Cut 01 alcohol and other drug policy challenges. You can also get involved in our work to 30 34 36 Events 01 find solutions to those challenges. GUEST EDITORIAL OPINION Q&A News 02 Our membership includes health promoters, Alcohol advertising: A brave new drug Toni-Marie Matich About a Drug 28 primary health and community organisations, what’s the problem? policy Bringing clarity and Viewpoints 32 researchers, students, schools and boards It’s time something is done The new National Drug compassion to the of trustees, policy makers, and addiction Q&A 36 about runaway alcohol Policy shows much promise medicinal debate treatment agencies and workers. advertising, says Professor but remains silent on the Mythbusters 37 Sandra Jones path to much needed drug Membership and subscription enquiries law reform [email protected] or visit our website.

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matters of substance is published matters of substance invites Brand development/ NZ Drug Foundation by the New Zealand Drug feedback and contributions. graphic design 4th Floor, 265 Wakefield Street Foundation. All rights reserved. If you’re interested in Insight +64 4 801 6644 PO Box 3082, , Neither this publication nor any contributing a guest editorial [email protected] New Zealand part of it may be reproduced or article, please contact us: www.designedbyinsight.com p +64 4 801 6303 matters of substance without prior permission of the [email protected] August 2015 Drug Foundation. p +64 4 801 6303 Vol 26 No. 3 ISSN 1177-200X

COVER PHOTO CREDIT: Rangi Kipa 2008, Staron(TM), marine resin. THE DIRECTOR’S CUT SOCIAL

@keith_ng So it turns out that, on asking conference speakers for their preferences for gifts, many don’t actually want alcohol. #fyi JUN 29

@LIVENewsDesk BREAKING: Kiwi Antony de Malmanche has been sentenced to 15yrs in prison for smuggling drugs into Bali JUN 30

@wimon_song Intermission at Sleeping Beauty on Ice and tbh, it probably would be better if it was about drugs. JUL 1

ould Kelly van Gaalen’s jail sentence be @GeorgeTakei Oregon legalizes recreational the start of the downfall of our obsolete marijuana. They will likely reap benefits drug law? Kaikohe mother of three, 38-year-old such as: higher tax revenue, less crime, van Gaalen was sentenced last month to and increased pizza sales. JUL 2 two years’ jail for possession of cannabis C for supply. She was charged with having @DomPost After Alex Renton’s death, 684g of cannabis, 24 times the personal @PeterDunneMP says treatment ROSS BELL use limit of 28g. was still worthwhile. http://bit.ly/1HvGJgv JUL 2 Executive Director The cannabis was found at her home by Police who were called by her husband @daihenwood Games like last night make me following a violent home invasion. He was originally charged for happy I don’t drink. I would have thrown the cannabis until Kelly admitted it was hers. the TV through the remote and been grumpy Kelly is a highly respected community member. She was this morning. JUL 9 on her community board, chair of the community arts council and promotions manager for the local business association – @SanhoTree #Naloxone could’ve prevented it easily. roles she resigned from following her arrest. Last year, she was RT @ClassicPixs: Philip Seymour Hoffman left one of 15 Northlanders to receive a Local Heroes medal. us 1 year ago today. R.I.P. JUL 12 There was no evidence of commercial dealing or that she was profiteering by supplying cannabis to minors. Yet Crown @Laiglo #US President commuted prison terms prosecutor Catherine Gisler asked for a three-year sentence, of 46 non-violent #drug offenders this week. arguing deterrence was important. Kelly’s lawyer Doug Blaikie JUL 17 sought community detention. Many more deserve this 2nd chance When handing down the jail term, Judge John McDonald said, @nzdrug With 1000 NZers infected with Hep C “To say this sentencing has troubled me is an understatement… It is not for this court to comment whether that is a just law or not.” yearly – a figure unchanged since 2000 – action Many mainstream media commentators have questioned critical say Needle Exchange NZ. JUL 27 the judge’s ruling. Jake Tame was curious why a discharge without conviction or community sentence wasn’t applied. KEY EVENTS & DATES The New Zealand Herald’s Brian Rudman highlighted similar 20th Cutting Edge Conference – It’s all about Whanau, Nelson , cases where lesser penalties were used. Others found much New Zealand more violent and nasty offences that received shorter terms. 2-5 SEP http://www.cuttingedge.org.nz/ Russell Brown slammed the judge’s claim that his hands were 3rd National Cannabis Conference, Melbourne, Australia tied as risible, untrue and cowardly. It is right to question the https://ncpic.org.au/2015conference/ proportionality of the judge’s decision. 7-9 OCT Recent analysis of arrest data by Salient has also uncovered Healing Our Spirit Worldwide, Hamilton, New Zealand a clear policy decision by Police to shift its focus away from http://hosw.com/ cannabis possession offences. And so it is also right to question 15-19 OCT Police actions in pursuing this case. 2015 Int’l Harm Reduction Conference, Kuala Lumpur But clearly our attention must turn to Parliament, whose http://www.ihra.net/ members remain ultimately responsible for their stubborn 18-21 OCT refusal to repeal our obsolete, 40-year-old Misuse of Drugs Act. Reform Conference, Washington DC, USA The just-released National Drug Policy has few signals in it to http://www.reformconference.org/ give us hope that this may be about to change. 18-21 NOV But the widespread public unease about this case could Follow us well generate the necessary community-driven demand for Join us online fundamental reform – silver lining unlikely to be of much drugfoundation.org.nz/connect consequence to Kelly van Gaalen’s 5, 7 and 16-year-old children. www.drugfoundation.org.nz 01 News NZ. 02 Tougher new 01 alcohol rules 03 Festival hangs in Rotorua on to BYO 11% 11% OF NEW ZEALAND ADULTS USED CANNABIS R&V (IN PAST YEAR) CONCERNED AT unruly festival goers spoiling A ONE-WAY door policy, the party, Rhythm and a ban on single RTD sales, Vines organisers have 1 IN 3 USE WEEKLY no new outlets within lowered the amount 1 kilometre of an existing people can drink. off-licence and a blanket Anyone camping % 10pm closing time for all in the official campsite liquor stores are some of 87 Helpline moving will only be allowed the new alcohol measures DID NOT REPORT ANY a maximum of 24 cans CONCERNS FROM OTHERS proposed in Rotorua. The government’s long talked about of BYO beer over the ABOUT THEIR USE Speaking to the Rotorua three days of the event. plans to merge telehealth freephone lines Lakes Council Local The move comes after will become a reality from 1 November. Alcohol Plan (LAP), fights broke at out at % In June, Homecare Medical was awarded Councillor Merepeka the neighbouring BW Raukawa-Tait said Summer Festival last 1.2 the contract to run Healthline, Quitline, the policy was geared year. It was reported RECEIVED HELP TO REDUCE the poisons helpline, the alcohol and OR QUIT towards addressing that around 90 people drug helpline and the helplines for the potentially harmful were injured and depression, gambling and public effects of alcohol. 63 arrested after immunisation advice. Homecare The proposed LAP alcohol-fuelled party % Medical is a partnership between was approved by the goers let loose. 42 two of New Zealand’s largest PHOs. councillors on 26 July. Alcohol legislation is REPORTED MEDICINAL USE Barring appeals, it could seen as the propelling Announcing the new arrangements, Health Minister come into force in early factor behind the more SOURCE Dr Jonathan Coleman said, “The public can still contact 2016. Any appeals could stringent BYO rules. services using current phone numbers. Behind the see implementation of Cannabis Use 2012/13, scenes, the new national service will be more seamless some form of delay for New Zealand Health Survey and ensure people access the right advice, at the right another year. (released May 2015) time, no matter where they live.” ADANZ CEO Paul Route, whose organisation has run the Alcohol Drug Helpline since about 1990, says the intent of the new service provider is that consumers will initially not notice a difference when the service 04 ‘Support. Don’t Punish.’ around Aotearoa switches over except that it will be available 24 hours a day. Ultimately, anyone calling will be able to access of the many activities Wellington, integrated assistance for a wide range of coexisting that took place on the and . Pictures problems whether addiction, mental health or other ‘Support. Don’t Punish.’ snapped here as part of health issues. global day of action. the worldwide photo Losing its core contract means ADANZ will no longer In New Zealand, people project joined those be viable as a stand-alone organisation and most staff working at the treatment taken in places as diverse will be made redundant. SMALL GATHERINGS frontline paused to as Macedonia, Tanzania “The Board is in discussion with another organisation of supporters, large acknowledge the vital and Thailand. regarding a possible merger which would allow our protests, music events, work they do providing ongoing services to have a sustainable future,” Rout said. dance displays, flash practical support to RESOURCES ADANZ is working closely with Homecare Medical to mobs, sport tournaments, people with drug ensure a smooth transition with opportunities for staff seminars, debates and problems. Informal events supportdontpunish.org/ to be employed in the new service. workshops were some were held in Auckland, photoproject

02 matters of substance August 15 05 Dry bar in 08 Problem Auckland with opioid short-lived 07 Just add water painkillers H20 249% 05 INCREASE IN OXYCODONE PRESCRIPTIONS AS IF THERE weren’t already enough ways to SCIENCE WRITER imbibe alcohol, along WHILE MUCH hope Roger Hanson says come sachets of dried greeted the opening 02 New Zealanders need booze. Some stores are of a booze-free bar in to be wary of the over- selling dried alcohol for Auckland’s Karangahape prescribing of opioid $1.50 a packet, with the Road, the public had drugs and related problems, 08 equivalent strength of little thirst for the which is at near epidemic half a standard drink. non-alcoholic nightlife. proportions in the USA. Both Alcohol Healthwatch Nightclub owner Grady Writing in the and the National Addiction Elliott opened Tap Daily News, Hanson Centre have raised concerns (The After Party) in reports on statistics about the providing of yet response to Auckland published by Best Practice another way for people to Council’s new alcohol Journal (BPJ) NZ that 01 02 03 drink. Alcohol Healthwatch rules on licensing show the dispensing director Rebecca Williams and bar closing times. 04 06 07 rate of oxycodone has said these products were Tap opened for five increased by 249 percent predominantly used by weeks from midnight between 2007 and 2011 young people trying to to 7am on Fridays and in New Zealand. Saturdays. Instead of beer smuggle alcohol into “The tragedy is that or wine, punters could restricted areas at sports bad decisions on the purchase a wide range and music events. dosage and applicability of non-alcoholic drinks. of powerful opioid “We gave it a shot, and drugs – decisions made Auckland drinking by pharmaceutical culture just didn’t tie in companies, governments with the dry bar. No one and doctors – have already showed up,” Elliott told led to many lives ruined the New Zealand Herald. by drug dependency,” Hanson writes.

06 Drug survey take-aways

“IT SEEMS having more who said they had used most did use drugs in the The findings could fill drugs available simply a legal high during the past month. Most drank pages, so jump onto the led to most existing users regulated period, almost alcohol (96.7 percent), Stuff website to explore adopting a broader range two-thirds carried on with cannabis the second the full results. of drugs,” says Global using other drugs as most commonly used Drug Survey founder they had before. substance (63.5 percent). RESOURCES Dr Adam Winstock. While just 13.5 percent of About half surveyed 25% http://nzdrug.org/gds15-nz OF THOSE SURVEYED USED Results from the 2015 the 3,400 New Zealanders used cannabis weekly ILLEGAL DRUGS IN THE LAST MONTH survey show that, of those surveyed used legal highs, or more often.

www.drugfoundation.org.nz 03

NNeEWwSs

World. 03 06

01

03 OECD weighs in on booze 08

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“THE COST to society and the economy of excessive alcohol consumption around the world is Malmanche sentenced to 15 years massive, especially in OECD countries,” said Whanganui man Antony de OECD Secretary-General Ángel Gurría, at the Malmanche was caught with launch of Tackling 1.7 kilograms of methamphetamine Harmful Alcohol Use: in his backpack in Penang. Avoiding Economics and Public Health Policy report. the death penalty, Malmanche will As well as analysis instead be imprisoned for 15 years. of where things stand, The lead lawyer for the defence, New Zealander the report contains Craig Tuck, told the New Zealand Herald, “There recommendations were ‘volumes of material’ we could have put before targeting both heavy the court, but the judges wanted to hear all the drinkers and wider evidence in one afternoon.” social practices. While individualist 04 Facing up to alcohol While a decision on an appeal has yet to be made, approaches are given and family violence Tim Lindsey, a law professor from Melbourne, priority, the OECD recommended against appealing because the original acknowledges broader and up to 47 percent of sentence could be replaced by the death penalty. approaches may also child abuse cases in the be needed. This includes lucky country. raising costs, for example, Launched on 17 June, through increased taxes, 02 Ecstasy on the streets of Amsterdam the National framework or by imposing minimum CANBERRA-BASED for action to prevent prices on cheaper alcohol. ecstasy would create less FOUNDATION for alcohol-related family criminality and safer pills, Across the whole OECD Alcohol Research and violence includes and keep the drug out average drinking has Education (FARE) is recommendations for of the hands of minors. dropped by two litres calling on all levels of policies and programmes of pure alcohol per capita With half a million Dutch Australian government that all Australian since 1980 to 9.2 litres. people having tried to urgently implement governments are urged Alcohol consumption ecstasy or some form measures that would to implement. by New Zealanders sits FOR a single day, ecstasy of MDMA at least once prevent and reduce Speaking at the launch at exactly the same level was allegedly sold from in their lives, change alcohol-fuelled violence. Australian of the Year as the OECD average a shop in downtown is seen as inevitable. Evidence presented Rosie Batty said, “The for 2013. Amsterdam. The store closed after by FARE shows alcohol involvement of alcohol The youth wing of the 24 hours with no-one is involved in up to and its impact on Dutch Liberal Democrats coming to harm, as RESOURCES 65 percent of family family violence must set up the shop to highlight sales were restricted nzdrug.org/oecd-harmful- violence incidents be acknowledged and how legal supply of to placebo pills. drinking reported to Police must be addressed.”

04 matters of substance August 15

05 02 09 07

01 09 UK ‘legal high’ ban considered ineffective

04

08 After 20 years, 07 New drugs glyphosate 05 Irish talk drugs spreading is out DRUG WARNINGS have been issued in Manchester, sanctions for possession Newcastle, Swansea and of certain amounts of many other UK cities and drugs for personal use”. towns. Police and health A delegation from the authorities are reacting same committee talked 541 to harmful side-effects of NEW SUBSTANCES with policy makers, people taking ‘legal highs’ health workers and NEW PSYCHOACTIVE and are issuing blanket politicians in Lisbon. warnings for people to THE IRISH public were substances keep being THE message that liberal In an official report, the avoid all substances. given just over a month manufactured, according spraying of glyphosate committee concluded the to have their say on the to the latest United Nations is not good for people Meanwhile, in the House country’s drug laws by Portuguese approach “has drug report. Up to last or the environment has of Lords, a Government the Oireachtas Justice not resulted in an increase December, UNDOC finally got through in bill to ban legal highs has Committee. As part of in drug taking nor has experts identified a total Colombia. The powerful been subject to intense a wider review of drug it resulted in Portugal of 541 newly synthesised herbicide has been challenge. With even policies, submissions becoming a destination drugs – 20 percent more sprayed from the air the Government’s own were invited “in relation for drug tourists”. than the previous year. in efforts to destroy drug policy advisers to arguments in favour of It is hoped the Irish Misuse The new drugs have been coca crops since 1994. calling the legislation unenforceable, hopes the and against altering the of Drugs Act will be updated found in 95 countries, The World Health political response will present approach to by the end of 2015. including this year for Organization warned meaningfully address the first time in Peru, in March that glyphosate, problems are at an 06 the Cayman Islands, known more widely as Delaware decriminalises dak Montenegro and the all-time low. Roundup, is ‘probably Seychelles. Ifor Glynn, CEO of Welsh publicly, Delaware’s carcinogenic’. In response, drugs charity Sands 900,000 citizens will Overall drug use remains President Juan Manuel stable around the world Cymru and Cais, told the face a $100 civil fine, and Santos said he would reports the United BBC, “The fact that it’s Police are still permitted ask the National Drug Nations, with about illegal doesn’t have any to seize the drug. The law Council to suspend $100 246 million people – impact on people using it. comes into effect in glyphosate spraying. Possession and private about 5 percent of the It doesn’t drive the problem December 2015. Described as Colombia’s use of up to an ounce of global adult population away. There are people Agent Orange, the chemical cannabis will no longer The move follows the – using drugs. out there who are buying attract criminal sanctions lead of nearly 20 states has been sprayed on and wanting these drugs. in Delaware, one of the that have already eased over 1.3 million acres We need to educate RESOURCES smallest states in the USA. penalties for personal of Colombian farm, range people about the risk If caught using . unodc.org/wdr2015 and forest land. of these drugs.”

www.drugfoundation.org.nz 05 Cover Story

Taking the pulse of Māori public health

Ma¯ori have been over-represented in drug, alcohol and smoking statistics in comparison to Pa¯keha¯ seemingly since records began. The situation is rooted deep within New Zealand’s colonial history. Are things improving for Ma¯ori? What approaches are working, and what else needs to be done to address inequities? Matt Calman talks with four figures from the sector about the state of the Ma¯ori nation in terms of treatment and harm reduction. MATT CALMAN

06 matters of substance August 15 www.drugfoundation .org.nz 07 Photo credit: Rangi Kipa 2008, Staron(TM), marine resin. Cover Story

You can concentrate on the person and their treatment, but there is a political and societal context to this as well, which to me is about human rights.

TUARI POTIKI

Photo credit: University of Otago Magazine

uari Potiki, who were full on into it” who enticed Some might say you like scores of Potiki to the job. can do it in the bush with New Zealanders, “It was sort of the beginnings of the grew up in a family Mäori alcohol and drug sector really, rongoä (traditional Mäori that liked to drink so it was quite pioneering in some ways,” medicine). Maybe, but if alcohol. He was Potiki says. “They were on the lookout you’re a chronic alcoholic, T drinking regularly for people to move into this kind of work. you can die from just giving with his mates by I got the bug.” the time he left school. By age 28, he was Potiki, who is of Ngäi Tahu, Ngäti it up straight away. in court-ordered residential treatment in Mämoe and Waitaha descent, has worked Hanmer Springs for intravenous drug use. in various parts of the sector – at the He was in and out of residential drug and coalface, in the office and in the boardroom. alcohol facilities over the next five years. For years, he counselled Mäori in prison. His treatment included counselling and For seven years, he worked at the Alcohol methadone. It was five months after leaving Advisory Council of New Zealand (his role his last residential placement in late 1989 involved engaging communities to take that he became drug free, and he has action around alcohol). For the last three maintained sobriety ever since. years, he has been Director of Mäori When asked about his struggle with drug Development at Otago University. use, he smiles and says wryly, “I didn’t He currently chairs the New Zealand really struggle. I just let it happen. When Drug Foundation Board. I was a junkie, I used to think naively that How are Mäori served today in terms all I had to do was stop putting needles in of treatment options compared to when my arm, and it would be okay, but there he started counselling in the early 90s? was a bit more to it than that.” “I think it’s changed a lot,” Potiki Potiki has seen treatment from both muses. “There are a lot more specific sides. After successfully giving up, he Mäori alcohol and drug services around studied for a couple of years and then the country, and many of them are attached began helping others as a drug and alcohol to iwi or Mäori health organisations.” counsellor in Christchurch. In the early While the vast majority of treatment Cover story image: 1990s, there weren’t many other Mäori centres remain mainstream, some Mäori Rangi Kipa 2008, Staron(TM), marine resin. The parata is a prow-figure usually found on traditional alcohol and drug counsellors. There were a programmes were flourishing, such as fishing canoes and references Kipa’s navigation of new handful of Mäori treatment centres, but the Te Utuhina Manaakitanga Trust in Rotorua pathways into the contemporary art world, this was part overwhelming majority were mainstream. and Ngäti Toa’s Rangataua Mauriora youth of a series exhibited in his solo show in NY in 2008. There were a couple of “old Mäori women programme in Porirua. Ngäi Tahu is one

08 matters of substance August 15 iwi that has begun providing some health and a commitment to value all Mäori support for its members, Potiki says. But it is important regardless of their circumstances. “The whole Mäori world has changed, Graham, a Cook Islands Mäori, came and Ngäi Tahu is a good example. Fifteen that approaches don’t put to Waipareira seven years ago inspired years ago, it was all new, and they were Mäori in one stereotypical by her own upbringing in alcohol and an just getting into their settlement. Now box of “this is what Mäori extended whänau that “dabbled in drugs”. that they’ve got a few runs on the board, do or that’s what Mäori She says some of her clients don’t grasp they’re moving into the health sector as the impact their substance use has had well. However, Ngäi Tahu has been look like”. on their families and others. reluctant to put tribal money – which has “We work with the client’s own taken 175 years to get – into things that resources to find an outcome that is should actually be being provided by the community-based results. She cites individual and meaningful for them,” government through our taxes.” smokefree-promotion YouTube videos Graham says. “We identify and enrich While access to Mäori services has by local waka ama clubs and the Otahuhu the facets of their life that encourage improved, the vast majority of Mäori Mangere Youth Group’s stand against liquor resilience in the face of outside pressures still go to mainstream treatment centres, stores opening near their community’s and distractions.” Potiki says. Some parts of the country have schools as examples of people taking Graham says one technique that is more options because of stronger Mäori action on an issue to improve health working well is narrative therapy, which population, such as in Auckland, but the and inspire others. encourages clients to talk about their own options are far more limited in other regions. “We’re bombarded with statistics that story in order to “separate the addiction “It still depends on where you go. are not pretty however. When you’ve got from the person”. If you went to the Dunedin CADS service, a story of young people getting together Another successful technique is I don’t think there’d be any brown faces and taking a stand on an issue to do with interactive drawing therapy, where the in there.” alcohol and drugs, it’s really inspiring, and clients express their inner thoughts and Potiki says there has been significant that motivates all Mäori to take action,” feelings by putting them to paper. improvement in academic qualifications Nahi says. “I really believe that strength- “It’s very successful, if they aren’t able for clinicians since he studied. Today, based approaches are the way to go.” to describe what’s really going on for them. there are postgraduate certificates and By “strength-based”, Nahi means framing It helps them get it out. The picture finally diplomas in drug and alcohol treatment, things in a way that empowers people, tells the story of what’s happening in and there is now a professional addiction allowing them to “have a sense of their their lives.” practitioners’ body, DAPAANZ. While own mana” and helping them consider Is it important to tailor programmes there is still a dearth of Mäori clinicians, action they can take in order to move for Mäori? And what does a Mäori inclusion of tikanga Mäori in current forward. It’s about buy-in and ownership. approach look like compared to a courses means Päkehä graduates will at Raukura Hauora O Tainui, one of Häpai mainstream approach? least have some grasp of Mäori culture Te Hauora’s owners/ sub-contractors, Potiki describes the fundamental when dealing with Mäori clients. has been working with sports clubs and difference is that the mainstream approach “Initially, there wasn’t really a community groups around the drug and will tend to focus solely on a client’s profession as such. It was sort of treated alcohol kaupapa. In response, the Redhill addiction. He likens it to how the frayed a bit like a poor relation of mental health. Rocketz Softball Club in Counties Manukau ends of a rope represent different parts of It’s become much more professional.” made banners and went smokefree, and a person: the physical wellbeing, mental Auckland-based Papa Nahi, General some of the members had gone without wellbeing, whänau and culture. Manager of Häpai Te Hauora Mäori Public alcohol, Nahi says. “When you go to a non-Mäori service, Health, agrees that services are still mainly Another of the three owners/ you hang those ones up, and you just clustered where Mäori populations are. subcontractors, Te Whänau O Waipareira, take [the addiction] in, and that’s what She says there remains a lack of investment based in West Auckland, offers an eight- they deal with. All of those other bits are in increasing the numbers of Mäori in the week-long alcohol and drug-counselling there too, but it’s as if they don’t connect. treatment sector. programme. Many of its clients are If you want the rope to get strong, however, “If we don’t have that [commitment], referred to Waipareira’s four-strong team they have to.” then it’s difficult to try and get any of counsellors by the probation service. While there is no one model that progress,” says Nahi, who is of Ngäpuhi- Waipareira AOD Addictions Counsellor encapsulates the Mäori approach, it is Nui-Tonu descent. Louise Graham says many of the clients generally much more about inclusion Häpai Te Hauora is a national Mäori come feeling whakamä (ashamed) and have and being part of the greater whole. public health organisation funded by been forced to attend by the criminal justice “Us versus I. [It’s about] connecting the Ministry of Health. Jointly owned system, and some don’t want to be there. to whakapapa, connecting to your sense by three Mäori public health providers, Others want to be good parents and role of belonging, identity, all of those things these organisations then undertake much models but lack the skills to do it. If clients that come with connecting.” of the organisations health promotions require drug and alcohol treatment, they Some will just want to get off whatever work, including for drugs and alcohol. are referred to an appropriate treatment they are using and have little interest in Its focus is very much on harm reduction facility. The values that underpin the the cultural side of things. rather than treatment. organisation are key to the success of the “If you need to detox, you need to Nahi says getting out to where Mäori counselling programme. They include detox. Some might say you can do it in are is key, and she is seeing some exciting upholding respect, dignity, equity, fairness the bush with rongoä (traditional Mäori

www.drugfoundation.org.nz 09 Cover Story

Associate Professor Marewa Glover, outside Massey University campus.

In my view, there are as many different ways to be Mäori than there are Mäori.

Photo credit: Peter Meecham

medicine). Maybe, but if you’re a chronic look like”, Potiki says. For example, while Massey University Research Centre for alcoholic, you can die from just giving many Mäori believe wairua (spirit) is an Mäori Health and Development Associate it up straight away without a proper intrinsic concept to being Mäori, it is less Professor Marewa Glover is more familiar medical detox.” important to others. than most with the desperately unfavourable Potiki says, when he counselled Mäori “In my view, there are as many Mäori health statistics when compared in prison, he would see them as Ngäpuhi different ways to be Mäori than there to Päkehä. Glover, of Ngäpuhi descent, or Te Arawa or whatever their tribal are Mäori. It has to be individualised. has been a leading researcher in affiliation was rather than prisoners, It has to be meaningful to the person, control for more than two decades, rapists, murderers or robbers. It is about otherwise it’s just religion in drag.” has helped design smoking-cessation seeing them as Mäori and also seeing the Graham says Waipareira offers a programmes and is an expert on smoking person sitting there, he says. holistic wrap-around service and can refer prevalence among Mäori. “It’s hard to explain, but if you can see clients to other arms of the organisation, What is clear to Glover is that measures that, then it helps them to see that too.” including to the marae-based tikanga such as smokefree legislation, increasing —— Mäori programmes. It incorporates the tobacco taxes, grim warnings, gruesome Starting and finishing the sessions with images of smoking-related diseases on Mäori view that taking alcohol and drugs karakia and waiata was an important part packaging and treatment approaches have harms a person’s wairua (spirit). The clients of “how we did everything”, aside from it reduced smoking rates, but things have are told the counselling is based on the being the obvious example of what Mäori now hit a brick wall. There is still a large kaupapa Mäori model and asked if they’re do differently to others. group of Mäori who have not been able happy to continue. Most are. It works the same way in the community. to quit and another group within that who “The majority of them actually want If someone comes to a session, they have never even tried to quit. to tap back into their culture, into their symbolically bring their whänau, their For Glover, it’s personal. She took up hapü and their iwi with them, Potiki roots,” Graham says. smoking at 13. Her sister also started in explains. Making that connection with Nahi says tailoring programmes to her teens. They grew up exposed to the them is usually a positive. have Mäori at the centre has to be a smoking of their parents “in the house, “They don’t feel alone. They feel “core component of everything we do” car, everywhere”. By her early 20s, Glover connected to something. If they’re going to if we’re serious about restoring equality had developed chronic bronchitis and give up the identity of being an alcoholic and addressing health outcomes for Mäori. needed a year of physiotherapy to recover. or a drug addict, it leaves a hole that needs She would also like to see Päkehä build She used willpower to quit and believes to be replaced with something. Often for more dialogue with Mäori and listen to she saved herself from chronic illness and Mäori, that’s where the journey begins. what Mäori want. “quite probably” lung cancer. They get into te reo and they go to wänanga “Drug abuse isn’t tikanga Mäori. It’s “I have been smokefree long enough (university), and they do all sorts of things.” been brought here. Back in the day, Mäori now that I can expect to live as long as But it is important that approaches have responded by saying ‘Look, this isn’t a never smoker would,” she says. don’t put Mäori in one stereotypical box of right. We want to do something about this.’ The Ministry of Health New Zealand “this is what Mäori do or that’s what Mäori We’re just continuing that on today.” Health Survey revealed 39 percent of

10 matters of substance August 15 Papa Nahi, General Manager of Ha¯pai Te Hauora Ma¯ori Public Health.

Photo credit: Peter Meecham

Mäori adults were current smokers in still smokes, despite trying everything 2012/13, down just 1 percent since from quit-smoking medication Champix 2006/07. A current smoker smokes to nicotine patches and gum. at least once a month and has smoked “It always keeps in mind for me how more than 100 cigarettes in their lifetime. the work we’re doing nationally for a The overall adult rate was 18 percent. lower socioeconomic solo mum on the Glover says, historically, Mäori benefit is in the wops! It’s not working smoking rates had long been stuck at for them. We’ve got to do something else. around 50 percent, and the rates had And not just for my sister, but for all the been even higher for Mäori women. other Mäori who are not touched by the In fact, Mäori women have had among mainstream smokefree activities.” the highest rates for smoking (and Glover says Mäori need extra resources smoking-related diseases) for women I have been smokefree to address the inequality, though there in the world, mirroring rates of other long enough now that I can is always a backlash when Mäori are seen indigenous groups of women such as to be given extra. Aboriginal Australians and Canada’s expect to live as long as a “People actually think we get extra, First Nations. never smoker would. but you really see it in the outcome. We’re Glover says, in explanation, smoking getting the same, and now we’re possibly was introduced to Mäori by sealers and getting less. It really comes down to that.” MAREWA GLOVER whalers in the late 1700s and early 1800s, —— and it became an item of trade. Mäori Potiki says just about every major women had been smoking for more than a health statistic, including for alcohol century by the time it become fashionable and drugs, sees Mäori suffering more than for women in Europe, England and America Päkehä, and it is easy to become “immune” during the 1920s and 1930s. Mäori children to seeing it reported all the time. had been exposed to both parents smoking “The problem is, though, that for generations, making it much more likely sometimes you have to make the problem for them to smoke. Since the first concerted explicit before people will do anything. quit-smoking campaigns in the 1980s, all I think there’s a fine line between being groups had come down at a similar rate, deficit focused and pointing out why but the Mäori rate started higher. However, something needs to change.” recent Otago University research suggests Potiki says that, for many Mäori the disparity gap for Mäori is starting to going through drug and alcohol treatment, widen again, Glover says. a self-awareness occurs that includes While she has long since quit – she cultural, historical and political awareness doesn’t even drink coffee now – her sister of why things are the way they are.

www.drugfoundation.org.nz 11 Cover Story

Marewa Glover asks if e-cigarettes will help curb entrenched smoking by Ma¯ori.

It’s the history of colonisation. You know, the gun and the Bible and alcohol are three of the primary tools that have been used to dispossess.

TUARI POTIKI

Photo credit: Peter Meecham

“With alcohol, it’s part of the history of a political and societal context to this as Nicotine Forum in Warsaw in late June, colonisation. You know, the gun and the well, which to me is about human rights.” she says the vaporiser (e-cigarettes) Bible and alcohol are three of the primary Nahi agrees inequality in the system industry has the potential to end the tools that have been used to dispossess,” needs to be addressed. “These issues are grip of the tobacco industry and save Potiki says. “When you look across complex, and usually, the presenting countless lives. You can buy e-cigarettes Australia or North America or anywhere health issues are the tip of the iceberg. here but have to import the nicotine where there is an indigenous population, What’s under the water is this huge complex e-liquid (which goes inside to produce you see exactly the same pattern and the social issue. We can’t focus on the top the vapour), as it is classed under our same results. There are socioeconomic presenting issue without addressing these current laws as an oral tobacco product. factors, absolutely, but there are historical other things.” This creates a barrier to the product for reasons why those socioeconomic Nahi is a member of the National lower socioeconomic groups who may not conditions exist.” Waipiro Harm Action Group, which was have access to a credit card or the internet, In his current role, Potiki has been formed at the end of 2013 to address the Glover says. The simple reason it has proved analysing the NZQF results of 2,800 Otago lack of progress for Mäori on drugs and popular among smokers trying to quit is it University entrants. They had achieved alcohol. The group aims to inform and carries nicotine in higher concentrations NCEA credits at the same rates as non- engage Mäori. than other products such as patches or Mäori, but it appeared they had been given “We saw there was a lack of a voice for gum, Glover says. poor advice regarding the right credits to Mäori in this area. It’s the start of a process She says one of the problems with take for their chosen careers. While this to help Mäori be involved in decision smoking-cessation products is that none, might not appear to be linked to drugs and making around drugs and alcohol.” until now, have measured up to the real alcohol, Potiki says it is very much linked. Glover has seen how “institutional thing. Her sister had texted recently to report Citing other examples, Potiki says Mäori racism” and inequities across the health vaporisers were “better than smoking”, today are more likely than non-Mäori to be system have held Mäori back over the which further steeled Glover’s support imprisoned rather than given a community- last two decades of her career. for the products. based sentence, are more likely to be “It’s always been there, and we still “We can’t keep doing what we’re convicted of a crime than given diversion grapple with it. Who’s making the decisions, doing. We have some smokers out there, and are accessing doctors at similar rates and how do they interpret the data? Päkehä and nothing impacts on them. Then along but are more likely to be told to exercise are still dominant, and they’re still making comes e-cigarettes and, I mean, my mind is rather than given medication and referrals the decisions for Mäori. They’re still not blown. We are on the edge of a revolutionary to specialists. listening to us or our analyses.” product that could set fire to everything, “There are absolutely systemic issues Glover, however, remains hopeful. and the traditional combustible market that contribute to the stats being the way She argues the smoking-cessation sector really is facing its end.” they are now. You can concentrate on the is on the cusp of a worldwide revolution. Glover says e-cigarettes are essentially person and their treatment, but there is Fresh from hearing speakers at the Global a clean syringe, with minimum harm, that

12 matters of substance August 15 Te Wha¯nau O Waipareira AOD Clinicians Auina Forsyth, John Winther and Louise Graham.

We work with the client’s own resources to find an outcome that is individual and meaningful for them.

LOUISE GRAHAM

Photo credit: Te Wha¯nau O Waipareira

could help the last group of smokers for Potiki says the drug courts, which whom nothing else had worked. She is were started in late 2012 in Auckland For some Mäori going calling for an amendment to the Smoke- with a focus on recovery rather than through drug and alcohol punishment, have been “incredibly free Environments Act to allow new treatment, a self-awareness non-combustible, non-therapeutic nicotine positive”, but he would also like to see the products to be able to be imported and sold Misuse of Drugs Act overhauled to become occurs. in New Zealand. They could then be added more health focused rather than punitive. as options to smoking-cessation programmes. He argues the people who import or deal However, New Zealand has never illegal drugs would still be identified and embraced a harm-reduction approach with punished, but it would mean the people smoking, Glover says. A harm-reduction who use drugs, or the easy-to-pick “low- clothes on, and they’ve really made an approach has always been interpreted as hanging fruit”, were not saddled with the irreversible stigma of criminal convictions. effort with themselves, [and] they’re “it’s okay to cut down”, but with smoking, “[The Act] needs to include in its talking more with their whänau.” the next cigarette could be the one that description of alcohol and drug-related While she employs specific counselling triggers a cancer, she explains. She also harm the harm that occurs through techniques at Waipareira, there is nothing says it seems nicotine has been application of the Act. Once you’ve got fancy about the values underpinning a “demonised” by the health sector even a criminal conviction, you’re stuffed to successful approach. What works has though it is the toxins in a cigarette’s do a lot of things for the rest of your life. always worked – making people feel smoke that kills rather than the nicotine. welcomed, loved, connected and accepted. For most people, it’s a time in their lives Yes, nicotine is addictive, but so is coffee, “We have a couple of lovely ladies on or it’s an occasional thing, and it doesn’t she argues. She is excited by the potential the desk who are the first people our cause any problems. For some, it does, and clients see. We offer them a cup of tea for e-cigarettes but also “very afraid” that they’re the ones who need a bit of help.” or coffee and say there’s kai available. some of her public health colleagues will Graham says there is enough help there [We tell them] ‘It’s a safe place. It’s succeed in having it shut down. for people in her community who need it confidential. We’re not here to judge “It’s almost like it’s just about power and for those she counsels and that it’s you, to tell you what to do. Basically, and control, and that’s not what it should hugely rewarding seeing them turn their our role is to support you, educate you be about. The ones especially against lives around. and give you some resources.’ Once they e-cigarettes have no skin in the game. “Some clients come in, and their head’s actually hear that, you see the barriers Yes, I’m Mäori, and I have skin in the down, and they’ve got their hoodie over drop from there.” game. Lots of Mäori do. We want to save their head, just real whakamä. But maybe all of our people. And these people who after the fourth or fifth session, we see a Matt Calman is a freelance journalist based are against it, I hope, in the end, they will dramatic change in them. They come in, in Christchurch. end up on the margins in this.” and they’ve washed, and they’ve got nice

www.drugfoundation.org.nz 13 feature

The cruel C Hope for hepatitis sufferers? 1992 was a bad year. The outlook for those suffering from hepatitis C is That was the year hepatitis C notifications in New Zealand jumped pretty bleak. It’s an unwelcome disease with unwelcome nearly fourfold over the previous year symptoms, both physically and psychologically, and to 89 cases. There were a number of reasons sometimes the cure is the most unwelcome of all. for the spike, including that awareness At least here in Godzone. Russell Brown looks at of the new liver disease had recently spread amongst doctors – the hepatitis C the New Zealand situation and some encouraging virus was only formally identified in treatment developments overseas. 1989, and it was still being notified as ‘non-A, non-B’ in this country – but it was the first real sign of what would come to be called the ‘silent epidemic’. This year, between 700 and 1,000 new cases of hepatitis C will be notified, adding to a population of at least 50,000

RUSSELL BROWN C14 matters of substance August 15 …at least 50,000 New Zealanders, many of whom have no symptoms and do not even know they have the disease.

Photo credit: flickr.com/photos/tray_edgun

New Zealanders, many of whom have the brain’s stock of serotonin, inducing School of Medicine, is still, as he no symptoms and do not even know they symptoms of clinical depression in modestly puts it, “in the right place have the disease. The numbers could be most patients. at the tight time”. higher. Unlike Australia, our system only “Let no-one say otherwise,” author Over the past four years, principally notifies acute infections and not patients and historian Redmer Yska has written through a partnership with the US drug with chronic disease who may have been of his own experience with interferon, company Gilead, Gane has overseen trials infected for 20 years but have only recently “it is inhumane treatment.” of a new generation of direct anti-viral sought help. And even though results have improved drugs that have shown a 98 percent cure Behind the numbers are the human considerably over the past 25 years, nearly rate for hepatitis C. Treatment – one tablet stories – people who have lived impaired half of those who undergo the ordeal of a day for 12 weeks – has no side effects. lives of constant fatigue and disability or interferon will find, as Yska did, that it Nearly 1,000 people have been cleared who have succumbed to hepatitis C’s twin has not cleared their virus. of the virus by participating in the trials end-game: liver cirrhosis and failure or What if there was a way to make all in Auckland, Christchurch, Hamilton, liver cancer. Some live with the knowledge that go away – to even eliminate hepatitis Tauranga, Wellington and Dunedin, and that they have infected loved ones or their C itself? There is, but in New Zealand, a smaller group of very sick patients with own new babies. the bargain has yet to be struck. liver failure has been treated in Auckland And then there is the stigma. Although —— and Christchurch under a compassionate medical ‘bad blood’ infection is among In 1992, Dr Ed Gane travelled from programme agreed with Gilead. Those the leading causes of death in people Auckland to Britain to find out about patients can be cleared of the virus before with haemophilia, and there has been hepatitis C. At the time, little was known receiving a transplant – meaning the new an increase in recent years of sexual about its long-term effects, and some liver won’t be infected. In some cases, transmission between men who have sex specialists had even declared that it was the eradication of the virus may enable with men, the overwhelming cause of not harmful. Gane found otherwise. the patient’s liver to recover to such a infection is injecting drug use. Even if “In 1992, I tested 500 samples from stage that they no longer need the it happened 30 or 40 years ago, it’s not people who’d been transplanted and found liver transplant. something you want your workmates to out that, yes, indeed, the most common Patients I spoke to for this story talked know. At times, past drug use has even cause for liver failure was hepatitis C, with emotion about regaining their lives. been cited to deny treatment. and that was really the first time that had Those who had been under Gane’s care Cruelly, the ‘cure’ is, for many, worse been demonstrated,” he says. “So I was all praised him personally. than the chronic disease. The established very lucky to be in the right place at the Although Gilead’s product, Harvoni, treatment for hepatitis C, interferon, right time.” has been approved for use in New Zealand involves weekly injections supplemented Gane, now Deputy Director and by Medsafe, it is not yet funded by Pharmac, with six daily tablets of ribavirin for Hepatologist at the New Zealand Liver and a 12-week course of treatment will cost 48 weeks. Interferon bolsters the body’s Transplant Unit at Auckland City around $80,000 or more. immune system in the hope that it can Hospital and Clinical Professor of Allison Beck, a peer health worker and overcome the virus, but it also depletes Medicine at the University of Auckland educator with the Hepatitis C Resource C www.drugfoundation.org.nz 15 feature

Let no-one say otherwise,” author and historian Redmer Yska has written of his own experience with interferon, “it is inhumane treatment.

Photo credit: flickr.com/photos/thirteenofclubs

Centre Otago Southland, says many of (Egypt’s is around 15 percent of the “In our clinic, instead of treating, say, her clients are aware of the new drugs population), for as little as 1–2 percent 10 people a year, we could easily treat 100 and ask about them. of the developed-world price. Both Gane people a year with no increase in numbers “But generally, my clients don’t and Beck acknowledge that New Zealand of people we need in the clinic. It’s so easy. have $100,000.” patients are looking at Indian-based online I truly believe that, once the prices come Beck’s client base is an ageing one, pharmacies but agree it’s hard to know down, treatment won’t be in the hospital mostly male, aged 50–60, “heading how legitimate the sites are. any more, it’ll be in the community.” towards liver disease”. Many have “I’m not trying to say don’t do it,” The benefits will be even greater vulnerabilities and are unwilling to says Gane. “I’m just not sure of how you outside Auckland. Beck notes that her embark on interferon treatment. access it legitimately, how you pay for region has no liver transplant unit, and “For them to put themselves at risk it and how you can be sure the drug is Invercargill has only one specialist nurse psychologically is something they’re not a fake.” able to administer interferon. quite scared about.” The number of new anti-virals is in There’s also a social problem: the stigma. Gane says many of those with the itself a hopeful sign. Gane notes that, “There’s a lot of stigma, a lot of virus are now holding off interferon when a second drug from AbbVie was discrimination against people with in the hope that Pharmac will fund approved in the US last year, the price of hepatitis C, purely because they’ve one or more of the new anti-virals. the first fell immediately. With Merck’s acquired it through practices like injecting The numbers are “steadily decreasing”, recent entry to the field, specialist drug use. What we would love to have and only 300–400 will be treated this publications are calling it a “race”. is more people, more patients being year through Pharmac-funded therapy. There is little doubt that funding even advocates for people with hepatitis C. A deadline is looming. Pharmac is an expensive anti-viral would represent We’re trying to work on that.” negotiating with Gilead and others on a long-term saving for the taxpayer. Caring Beck agrees her status as a former price, but with three new drugs trialled for a liver cancer patient is very costly – hepatitis C patient (she was cleared with already in New Zealand and another a liver transplant even more so. interferon) helps clients pluck up the two likely next year, trials could be Gane notes a study in Melbourne in courage to go to medical professionals. over within two years. which doctors are treating current injecting The bottom line, says Gane, is that The new anti-virals are available drug users, “and they’ve been able to turn the disease is completely curable. “Every through the public health systems in off all new infections in Victoria. What death from hepatitis C is a preventable France and Germany and via health that shows is that we don’t just treat the death. We have the means to not only cure maintenance organisations in the US sickest people on the waiting list, we individual patients but also to eliminate (who have complained publicly about have to treat everyone. And if you do [the hepatitis C virus] from New Zealand. the $1,000 a tablet price tag, in some that, including those people who are We just have to somehow get the cases threatening to ‘warehouse’ patients sill injecting, it’s what we call treatment government to pay for it.” in anticipation of cheaper drugs). They’re as prevention – and we will actually also available in India and Egypt, which eliminate hepatitis C without a vaccine Russell Brown blogs at publicaddress.net. both have epidemic infection rates within the next 15–20 years.

16 matters of substance August 15 feature

Very human stories

‘Jean’ – senior civil servant, infected ‘Maisie’ – council officer, infected through IV drug use, cured in an through IV drug use in the early 1980s, Auckland drug trial with sofosbuvir, cured in an Auckland drug trial. ribavirin and ledipasvir. “Within two weeks, I knew I was on the “One of the most memorable things was drugs not the placebo – the change was when they told me about my viral load – it very powerful. I had so much energy, had gone from over 3 million per millilitre I had to check with my nurse that I wasn’t of blood to undetectable in a period of two having some kind of manic episode … weeks … I think the psychological impact Things continued to get better, the fog was has been the most profound – it was like clearing. My terrible sleep patterns became having the sword of Damocles lifted. For seven hours of good solid sleep, aches and years, every time I had an ache or pain, pains lessened, feelings of anxiety and Photo credit: flickr.com/photos/mag3737 I would worry that something was wrong general malaise disappeared. – liver cancer had got me. I didn’t count “Four years on, I feel like one of the on a future old age or feel confident making luckiest people on the planet. I would those sorts of plans. It was quite subtle likely have died early after years of shit It’s so easy. I truly believe really, but once it was gone, I was able to health. I have a pretty damaged liver, but that, once the prices come see how much it had impacted on me.” it’s not struggling against a virus and is down, treatment won’t be doing fine. I have a beer or two now and in the hospital any more, Redmer Yska – author, infected then and sometimes wish that I hadn’t through IV drug use in the 1970s, virus made such bad choices back in the day it’ll be in the community. returned after interferon treatment, cured but, hey, who doesn’t?” last year via a three-month trial with DR ED GANE Sovaldi and interferon. ‘Reg’ – probably infected during surgery in Christchurch in the 1980s, cured with “After 40 years of living with this horrible interferon and an early anti-viral in 2007. virus, it is finally out of my system. I feel lighter, my brain feels like it is working “I think the worst thing about hep C was What are the drugs? better. Most of all, I’m chuffed that, along the reaction of the mainstream and some Trialled at various sites in New Zealand so far: the way, I played my part in looking after friends. I was so surprised at how many Gilead Sciences’ Harvoni – myself. And I did that by not drinking and of my friends owned up to having it, but making things worse.” talking about it had its risks. I had life a combination tablet of sofosbuvir (a polymerase insurance back then – the premium tripled inhibitor sold separately as Sovaldi) plus ledipasvir (NS5A inhibitor). Already approved and cut off at 50, so I abandoned that. ‘Jean’ – mental health worker, infected in New Zealand but not funded. Telling dentists or doctors got an instant through IV drug use in the 1970s. negative reaction and made you feel like AbbVie’s Viekira Pak – “A friend and I have just finished three a leper – often left alone while hushed, a combination of paratevir (protease inhibitor) months on the new Viekira Pak. We are scared voices worked out how they and ombatisvir (NS5A inhibitor) and dasabuvir both genotype 1A, the difficult one to treat. would approach it. I just stopped telling (polymerase inhibitor). Expected to be approved I’m clear a month after treatment. I was in as I realised I was limiting my options.” in New Zealand later this year but not funded. the first protease inhibitor trials years ago. Merck’s combination MK2 – We have been waiting years for this after ‘Barry’ – infected 20 years ago through a combination of grazoprevir (protease inhibitor) finding the old interferon/ribavirin IV drug use. and elbasvir (NS5A inhibitor). Expected to treatment too brutal to finish the course. be approved in New Zealand next year but I am very grateful to Ed for giving us “I was diagnosed by chance three or not funded. this treatment – there were only eight four years ago and didn’t think much compassionate doses available in Auckland. about it. I declined interferon because Some side-effects but not nearly as bad as of what I’d heard about it. Then last year, the old interferon regime.” I pretty much threw up and shit out all my blood for about a week. I figured I was dying. I had up to four blood George Henderson – musician, transfusions a week, and when I was infected through IV drug use in the somewhat stabilised this year, they got 1990s, cured last year via the Auckland me on a compassionate six-month -based ‘Vulcan’ trial with sofosbuvir course of Sovaldi. Still a couple of and GS-5816. months to go.” “Amazing. Pharma made something that worked, cured a disease that, as far as I’m concerned, had no cure before.”

www.drugfoundation.org.nz 17 feature The UNGASS 2016 primer

The next UNGASS on drugs has been brought forward from 2019 to 2016. That’s still a year away, but at a UN level, this amounts to blistering urgency. So are we poised for drug policy reform at the highest level? We’ll have to wait and see, but in the meantime, here is your guide to the impending session and all things UNGASS.

hy is this first time, sitting presidents – such as being held? Colombia’s Juan Manuel Santos and Guatemala’s Otto Pérez Molina – are The last United Nations General questioning the underlining premises Assembly Special of the international drug control Session (UNGASS) paradigm and calling for debate on W on drugs was held alternative approaches. in 1998, and its NGO/civil society representation focus was the total elimination of drugs from the world. Ten years later, member at UNGASS states met in Vienna to discuss progress If you haven’t already been accredited and agree on a new political declaration by the Economic and Social Council and plan of action. That was due to expire (ECOSOC), you won’t be able to take any in 2019, and an UNGASS on drugs was part in the official UNGASS proceedings. scheduled for that year. Registration as a non-governmental However, in September 2012, the organisation formally in consultative Presidents of Columbia, Costa Rica, status with the UN closed on 1 June. Guatemala and Mexico called on the Currently, there are 3,900 organisations UN to host an international conference on registered with ECOSOC. These include drug policy reform. Mexico subsequently a handful of organisations with drug policy sponsored a provision in a UN drug credentials, such as Association Diogenis, policy resolution bringing forward the Drug Policy Dialogue in South East Europe, UNGASS to 2016. It was co-sponsored by 95 other countries. Center for Alcohol and Drug Research The UNGASS on drugs comes at a time and Education, Drug Prevention Network when there have been growing calls for of Canada and International Drug Policy drug policy reform across Latin America. Consortium. Pre-registration for some These countries bear the brunt of the War events is also required, so even though the on Drugs, and there is a strong feeling that Drug Foundation is now accredited, there current policies are not working. For the may still be other hoops to dive through.

18 matters of substance August 15 Photo credit: flickr.com/photos/unicphoto

www.drugfoundation.org.nz 19 feature

Who to watch out for

Yuri Fedotov Ban Ki Moon Michael Botticelli UN Office of Drug and Crime (UNODC) Executive Director UN Secretary General White House Office of National Drug Control Policy Director

Former Russian Ambassador to the The most senior figure at the UN and Known as the ‘drug czar’ of America and United Kingdom Yuri Fedotov has progressive, Ban Ki Moon has previously a cautious reformer, Michael Botticelli is headed the UNODC for five years. called drug addiction “a disease, not a a former alcoholic who has said to people Due to his position, he is generally crime”. His predecessor, Kofi Annan, with drug problems, “You are my people.” conservative when it comes to calling is an outspoken advocate for the legal All of his predecessors came from military for reform. However, in his statement regulation of drugs, saying, “Drugs may or Police backgrounds, but he’s worked in on the International Day against Drug have killed people, but I maintain that drug policy all his life. Although he maintains Abuse and Illicit Trafficking, he focused wrong governmental policies have killed America’s hard line against drugs crossing heavily on “meeting the challenge of many more.” Ahead of UNGASS 2016, the Mexican border, he takes a harm- drugs with human rights-based responses” Ban Ki Moon has urged member states reduction approach at home. He’s called and called for a greater focus on treatment. “to conduct a wide-ranging and open for Police to be trained to use naloxone This stands in marked contrast with debate that considers all options”, which (an opioid overdose prevention medicine) his home country’s drug policies, as is a diplomatic way of saying that the and the distribution of clean syringes for Russia is currently dismantling the current system isn’t working, and we intravenous drug users. He’s in a unique treatment sector. need to change tack. While he won’t position – America has traditionally been lead the charge for reform, he will a big supporter of the War on Drugs, but certainly embrace it if it occurs. its liberalisation of drugs at home means it’s shifting its stance abroad.

Arthayudh Srisamoot Werner Sipp Commission on Narcotic Drugs (CND) Chair UN Development Programme (UNDP) Administrator International Narcotics Control Board President

The CND Chair is a rotating position, Helen Clark is the third most senior figure Werner Sipp previously worked as a held this year by Thailand’s Arthayudh at the UN and a reformer. Earlier this year, medical doctor in addiction treatment, Srisamoot. Thailand is very conservative her agency blasted the War on Drugs as a so he has seen the power of rehabilitation. on drugs – it has the death penalty and failure, saying that “policies and related At this year’s Commission on Narcotic has, up until recently, pledged to eradicate enforcement activities focused on reducing Drugs in Vienna, Sipp said, “A well drugs from the Southeast Asian region. supply and demand have had little effect balanced drug control system must Srisamoot is conservative – he calls drugs in eradicating production or problematic not rely solely on restriction and a “menace” – but he is more progressive drug use”. This is a change in position by law enforcement but must provide than the Thai Government. At the the agency and is likely a result of Clark’s sufficient access to prevention, treatment, Commission on Narcotic Drugs in Vienna leadership. In 2013, she said that “there’s medication, reduction of the adverse earlier this year, he said, “The important no doubt that the health position would be consequences of drug use, rehabilitation thing is to strike a balance between the to treat the issue of drugs as primarily a and social reintegration for individuals regulatory framework, which also relates health and social issue rather than a affected by drug use and addiction.” to addressing widespread drug abuse and criminalised issue”. Clark’s concern is This is significant, as the head of the criminal aspects, and taking care of the developing countries, which means the Narcotics Control agency is supporting human dimension.” UNDP is particularly focused on harm a policy of harm reduction. reduction to prevent HIV/AIDS.

20 matters of substance August 15 Leading up to New York 2015 2015 2015 2016 2016 The United Nations General Assembly 24 SEP 10-11 JAN MAR agreed to hold the UNGASS in 2016 SEP DEC and has tasked the CND to engage in the preparatory process. Vienna: CND final New York: 70th Session Vienna: CND reconvened Interactive civil Vienna: 59th Session intersessional of the General session and UNGASS society hearing of the CND Assembly special segment

NGO/civil society preparation Attendees will be given a country, and a number of intercessional meetings are scheduled. Much of what has been Although nation states will hold the then a mock special session will be held. discussed to date has been procedural, most sway at UNGASS (each state has Where is it being held? with the beginning of debates on real an equal vote), the non-governmental UN delegates meet in the recently substance just beginning in June. and civil society sectors will still be able refurbished General Assembly Hall. UN members are now invited to put to bring community voices to the United Among the many repairs necessary was forward ideas for inclusion into the Nations. In the lead-up to the special replacing the gold-leafed background zero (or first) draft. session, a number of events are being held behind the iconic UN emblem, which Over the three days allocated in to ensure the input of affected individuals had become caked with cigarette tar April 2016, country representatives and advocacy groups working in the and nicotine. Many environmental and a few others will speak to the drugs sector. improvements were introduced, so energy resolutions tabled. In 1998, each speaker CIVIL SOCIETY TASK FORCE: Formed in use is down by half. Each of the member was restricted to seven minutes, and March this year, the task force is comprised nations (193 at time of print) has six seats, 158 people spoke over nine UNGASS of 27 members – 18 regional representatives with the 600 remaining seats available for 20 plenary sessions, including 23 heads and nine representatives from affected guests, translators, UN secretariat staff and of state, eight prime ministers, one populations. There’s also a four-person members of the public. It is unclear what vice-president and seven observers. steering committee. The task force will access ECOSOC-accredited representatives Joining the discussions were several conduct regional civil society consultations. will be granted. United Nations agencies and programmes The Drug Foundation’s executive director Book in advance to get an apartment as well as some NGO representatives. Ross Bell is on the task force, representing via airbnb for under NZ$200. The closest Speaking on behalf of the New Zealand Australia, New Zealand and the Pacific. apartment currently listed is on 41 Street people was Tuariki John Delamere, His focus is on the effect global drug and 2nd Avenue, with a nightly fee of Minister of Customs and Associate policies have on indigenous populations. NZ$169. In a city with over 50 million Minister of Health, who was a CIVIL SOCIETY SURVEY: The task force visitors per annum, there is plenty of New Zealand First MP at the time. has also launched a global survey that is choice of hotels, whose prices have In 1998, there were many side events designed to provide an initial assessment dropped 13 percent in the last year. held alongside the UNGASS. These were on the civil society work in the field of Rates average NZ$202 per night. hosted by many august international drugs as well as to measure the awareness agencies, including the International and level of knowledge and interest in What is going to happen? Labour Organisation, World Health participating actively at the UNGASS 2016 At 4.20pm on 20 April, a Drug Peace Organisation , UNAIDS, Interpol and initiative at the regional and global levels. March is expected to take to the streets numerous NGOs. PRE-UNGASS MEETING: The task force of New York. The European Coalition for With just 50 member states, CND has committed to co-hosting a meeting for Just and Effective Drug Policies is already reflects only a quarter of the countries all NGO, government and other stakeholders talking with activists about how to make within the UN system. Hosting a drug prior to the UNGASS, whose conclusions this happen. Security restrictions mean policy debate at the General Assembly would be an officially recognised document any rallies are unlikely to get closer than is expected to bring some areas currently that will be presented to the UN. four blocks away from the entrance used off limits in Vienna into the limelight. REFORM CONFERENCE: In November by top-level diplomats. this year, the Drug Policy Alliance is Apart from this, little else is definite. hosting the Reform Conference in The formal agenda has yet to be set, but it Washington, DC. Hot topic: the best is likely to follow the format adopted at strategies for the non-governmental previous special sessions. A preliminary sector in the lead-up to UNGASS. paper and draft resolutions will be SSDP MODEL UNGASS: Students for prepared by the CND – something the Sensible Drug Policy will run a model Vienna-based UN body has begun. UNGASS at the Reform Conference. Although the CND only meets annually,

www.drugfoundation.org.nz 21 feature

Drugs are every nation’s problem, and every nation must act to fight them – on the streets, around the kitchen table and around the world.

PRESIDENT BILL CLINTON

Photo credit: flickr.com/photos/minexguatemala

Official declarations to curtail illicit manufacture, trafficking and consumption of synthetic drugs and ■■ 2014 CND (57th session) high-level a quest to eliminate or reduce the illicit review of 2009 Political Declaration manufacture, marketing and trafficking and Plan of Action implementation, of precursors. The need to eliminate drug Ministerial Statement. crops was also stressed. The declaration ■■ 2009 Political Declaration and Plan concluded with the pithy refrain: of Action. “Together we can meet this challenge.” Tuariki John Delamere, ■■ 1998 Political Declaration and Plan Here are quotes from the Associate Minister of Health, Minister of Customs – of Action. New Zealand representative General Assembly floor: ■■ 1990 Political Declaration and Our efforts to strike a balance between Programme of Action. supply control, demand reduction and the ■■ 1987 Declaration of the International management of drug problems have helped Conference on Drug Abuse and us reduce significantly the harm associated Illicit Trafficking. with illicit drugs in New Zealand. I note that there are those who How times have changed vehemently oppose methadone or needle – 20th UNGASS 1998 – Bill Clinton exchange programmes. For me, the answer, world drug problem President of the USA “Well, it works”, seems to be the best Enhanced action to tackle the world drug response to these critics, who I suspect problem lies at the heart of the political Drugs are every nation’s problem, and would have us blindly march down declaration from the 20th UNGASS every nation must act to fight them – on the road towards a “war on drugs”, a (A/S-20/4). Prefaced with recognition of the streets, around the kitchen table and philosophy that many would consider how widespread the drug problem is, the around the world. This is the commitment has not worked. declaration bares it motivation for action: of the United States. Year after year, our In many countries, the indigenous “Drugs are a grave threat to the health and Administration has provided the largest people are overrepresented in national well-being of all mankind, the anti-drug budgets in history. statistics on drug-use problems. This, independence of States, democracy, the Let us leave here determined to act unfortunately, is also true for Mäori, stability of nations, the structure of all together, in a spirit of trust and respect – New Zealand’s indigenous people, to societies, and the dignity and hope of at home and abroad, against demand and whom I belong. I think we need to do millions of people and their families.” supply, using all the tools at our disposal much better at empowering indigenous While supporting better access to – to win the global fight against drugs and people to understand how they can treatment and efforts to reduce demand, build a safe and healthy 21st century for control the factors that influence their particular attention is devoted to efforts our children. health, such as drug use.

22 matters of substance August 15 QUOTES OF SUBSTANCE

Feels like I got punished for synthetic cannabis products that weren’t mine. Entrepreneur Matt Bowden muses after the mortgagee sale of one of his properties.

Photo credit: flickr.com/photos/unicphoto Perhaps we need to be speaking easier to each other about why we have such a demand for drugs, legal and illegal. 1998 UNGASS declaration at 10 years Best-selling author Tommy ‘Kapai’ Wilson says ban has not diminished In 2009 Ross Bell, Drug Foundation Executive Director, said this about the demand in Tauranga. lack of progress after the 1998 UNGASS. I have no problem with aspirations – after all, wouldn’t we all love world peace? Police have been monitoring Kofi Annan, But 10 years on, meeting recently in your Facebook profile and UN Secretary-General Vienna to assess their progress towards established that you are their goals, I believe our political and It is my hope that they will record this engaged in a Facebook group diplomatic leaders have been hugely as the time when the international irresponsible. They’ve neglected any that actively sells and trades community found common ground in honest assessment of progress towards the in controlled drugs. the mission to create momentum towards objectives they themselves set. Instead a drug-free world in the 21st century. NZ Police resorted to licking stamps they’ve engaged in mutual back-slapping It is time for every nation to say “no” in an effort to warn off people suspected while ignoring the realities of human to drugs. It is time for all nations to say of online drug dealing. suffering around the world – much of “yes” to the challenge of working towards which is caused by their own policies. a drug-free world. One significant highlight did emerge from the Political Declaration. This was the We were not levelling cities RESOURCES recognition that global drug control efforts as we did in WWII with bombs, Report of the UN Drug Debate, April 2015 Drugreporter must be taken in full conformity with but with prosecution, prison – http://drogriporter.hu/en/cnd2015 international human rights law. For too and punishment. IDPC UNGASS 2016 pages – nzdrug.org/idpc-ungass16 long the world has seen systematic and Official UNGASS 2016 website unodc.org/ungass2016 egregious abuses of human rights in the Retired US federal judge Nancy Gertner name of drug control. reflects on drug sentences that destroyed lives. RESOURCES

Full analysis: nzdrug.org/1Phs0HM

www.drugfoundation.org.nz 23 feature Whole School Series N0.2 A school’s core business

This is the second in our series of articles looking into new approaches to protecting young people from drug-related harm being adopted by New Zealand schools. Rob Zorn visited O¯ taki College where a restorative practice approach is keeping young people caught with drugs engaged and in class – instead of out on the streets. ROB ZORN

taki College is a “When I started teaching here back It doesn’t take a rocket decile 4 school, in 2007, the standard approach to students averaging between caught with alcohol or drugs was just scientist to work out that 400–450 students, to stand them down or get rid of them,” there’s a back story to why nestled in he says. these young people are Horowhenua “Attendance rates were poor, and doing these things, and north of Wellington. our suspension rates were significantly More than half the you’ve got to get to that Ō above national and decile averages. students identify Things just weren’t flash.” back story. You can’t do as Mäori, and a large percentage come He tells me that, at the same time, that by excluding them. from poorer backgrounds. Sadly, both there was a lot of youth crime in the these demographics punch way above local community. their weight in terms of alcohol and drug “It was all angry stuff like smashing use, youth crime, violence and exclusions windows, breaking letterboxes and from school. that sort of mindless, wilful damage, I’m only there for a couple of and invariably, the young people who hours but sense a real calmness in the were doing these things were those who atmosphere. Principal Andy Fraser has had been disenfranchised from school. a warm smile, and he’s never far from “But as we started making changes a laugh. There’s an openness about him, to the way we looked at these young too. He admits the school’s had problems people and these problems and as (still has them) and that its journey our stand-downs fell away and our is far from complete. As he leads me exclusions approached zero, you around the school, I see a similar could just about map over that the openness reflecting from the students reduction of youth crime and all the he interacts with. destructive stuff. Unsurprisingly now, Ötaki College “It doesn’t take a rocket scientist is a demonstration site for the Ministry to work out that there’s a back story of Education’s Positive Behaviour for to why these young people are doing Learning (PB4L) initiative. This means these things, and you’ve got to get to other schools can visit the college to that back story. You can’t do that by learn how to build similarly positive excluding them.” environments. The Ötaki College Board of Trustees Things were not always this way. Chair agrees that community youth

24 matters of substance August 15 During the process, they come to see it’s not about tripping the young person up and kicking them out of school but about putting as much support as possible around them.

- Otaki College gate.

crime has declined dramatically and in problematic. That’s telling you something The contract close correlation to culture change at the right there, and we now listen to the “It was found to be more effective college. He should know. He’s Sergeant student voice a lot. if there was some sort of contractual Slade Sturmey, in charge of Ötaki Police. “I would have some teachers banging agreement at the end of these meetings “Even things like behavioural issues on my door saying they never wanted a that outlines decisions attributing at the community library have gone particular student in their class again and accountability,” Andy says. down a lot. We used to have to deal insisting we boot the kid out. It took about Through the contract, the student with 20 or more of these each year. Now, four years before we started seeing a shift agrees to undergo counselling, to address there’s maybe just one, but because we becoming embedded in the school-wide their wrongs and to submit to random have such a useful relationship with the culture, where teachers were feeling the drug testing. Whänau and teachers agree school, we just come in here and deal place was calmer and that they could to what they will do to support the student. with it together,” Slade says. engage much better with students. Students invariably sign, and the contract Andy says the students see Police In 2008, Ötaki College began developing has never once been questioned by a parent. units at the college all the time, and its Te Whakaruruhau initiative, which “During the process, they come to see they’re here for a lot more than to deal collaboratively involves staff, students, with offending. They provide educational it’s not about tripping the young person whänau, victims, professional counsellors programmes, support driver licensing up and kicking them out of school but and the Police. It’s a restorative practice and coach sports teams, so “it’s normal about putting as much support as possible approach targeted at students with drug for students to see the Police in a around them,” Andy says. and alcohol issues. It encourages them to positive way”. “And I think students understand take responsibility for their actions while that the drug testing is not a punitive So how and why have being supported by teachers and qualified thing so that, if they fail, they’re down the things changed? professionals. In line with Whole School road. It’s a way for them to see their own Andy says the journey commenced in objectives, a restorative school is one that progress, and many use it as a deterrent, about 2008 shortly after he became Deputy has a culture of care that is about a reason to give their mates as to why Principal. It was based on ‘student voice’, enhancing mana and is solution focused. they don’t want to use.” particularly from Mäori students who felt When a student is caught with or This is no soft option. Slade says the they weren’t getting the right deal from under the influence of drugs or alcohol, consequences of not fulfilling the contract some teachers. they may be stood down for one to three are also explained to the student at signing “They said that, where they had good days to allow for the college to prepare for – that the matter will be handed back to relationships with teachers, they would a restorative conference. Then the student the Police or to the courts. work hard for them, but where they didn’t, and their whänau meet with the Board “There may be further hours of they would be disruptive or not care, of Trustees to discuss a way forward that community work or even a criminal and student management became more will not result in exclusion. conviction, depending on their age.

www.drugfoundation.org.nz 25 feature

Andy Fraser by the school gate. Ma¯ori carvings either side depict Maia (representing the mana of women) and Manawanui (representing the mana of men).

No young person needs a drug conviction on their record.

“We see it as a health matter. If they’re at home. It’s hard work for teachers, Hopefully, when the using at this age, the main thing should be but they do see the benefits of getting supporting them to make better choices.” these young people into the school students come through So Te Whakaruruhau is working and socialising.” the gate, they understand then, I ask. Drix the richness, the importance “Hell, yeah, absolutely,” says Andy. of each other’s mana – “As a restorative school, we’re working An example is Drix, who became part of with people, rather than doing it to people. the school’s core business early this year. but also of working In an overall sense, the programme is very Drix was living in Hastings and spent collectively, regardless much about the whole community. Once 18 months on the streets when things of gender, to strengthen students understand that everyone cares, broke down with his whänau. Though not their community. it’s so much easier – when they come to even midway through his teens, he ended you with a problem and immediately see up with a massive youth justice record you stop and say, ‘Let’s deal with that.’ (Andy says it’s the size of a small novel). ANDY FRASER “In terms of drugs and alcohol, well, The offences were mostly assaults and they come at a huge cost to young people robberies. As part of the family group That can have devastating consequences and to families, so as a school, you’ve got conference process used to address his offending, he ended up coming to live for life, but fortunately it has never gotten to see dealing with that as part of your with his uncle in Ötaki. to this stage. No young person needs a core business.” Jo McInerney says the college has “So he was an interesting one, but in drug conviction on their record.” noticed a real difference between students the end, Ötaki College agreed to enrol Drug and alcohol counselling is who start in year 7 – and travel all the him and give him a chance,” Andy says. provided by Margaret Smith who works way through – and those who come in “He’s actually quite a personable fellow for Whaioro Trust, an iwi service covering from outside. now, though he was pretty wild and Horowhenua. Ötaki College is one of two “Some of these young people have woolly around the edges when he first schools she visits weekly. Assisted by been pretty challenging, but when arrived. There were soon some issues school Guidance Counsellor Jo McInerney, they’ve been here for a bit, they don’t involving theft and cannabis, so he has she assesses referred students and follows seem to feel they have to behave in the gone through the programme and is now up with weekly or fortnightly counselling same way as at their previous schools. back on track.” sessions. The number of students she’s Perhaps that’s because they don’t get Drix is just 15. He’s pretty tall for regularly seeing has fallen to 10 (her contract backed into as many corners by teachers his age and, reportedly, a very good actually provides for 15 per school). or other students. They understand they rugby player – like amazingly good – “The main focus is education,” can talk to people here and explain stuff and when I get to meet him, I find him Margaret says. and be honest about what’s happening open, approachable and calm. I like him

26 matters of substance August 15 From left to right: Hamish Wood (Deputy Principal), Andy Fraser (Principal), Margaret Smith (Whaioro Trust), Sgt Slade Sturmey (Board of Trustees Chair), Jo McInerney (Guidance Counsellor).

immediately and can’t imagine him school fitness programme run by Police) assaulting anyone. and still being able to do what I normally In terms of drugs and He’s been using cannabis for the last do here at school. That was important to alcohol, well, they come at three years. While in Hastings, he was me. I really like all the exercise stuff. I play stoned pretty much all the time, but he rugby and touch, but I’ll play any sport a huge cost to young people cut back using weed significantly when where you can run around and get hurt.” and to families, so as a he started at Ötaki College because of He tells me about how weed made school, you’ve got to see the way it affected his sport training. him tired all the time, which was no good dealing with that as part One day, he arrived pretty red eyed for his training, but he just laughs when I after smoking up on the way to school say he might be slipping on the black jersey of your core business. and was ‘snapped’ by Andy while in class. one day. He was stood down for a day and then Drix didn’t go to school while on the was asked to attend a meeting with Andy, streets in Hastings but says the education Slade and some of the Board to work out want people to think they have a drug he has had has been exclusively Mäori. a restorative process. problem,” Andy says. “I’m not good at English, and when “My uncle was there too, and he was “But every college in New Zealand I came here, I didn’t know how to write pretty disappointed. He gave me a real in English at all, but I can spell some and every community has a drug problem. growling about it, and that was pretty pretty big words now.” We don’t have the perfect model, but we hard,” Drix says. have one that is making a difference, and “They asked me to sign this contract So what does he think would have if it’s a model that could work for other giving them the right to drug test me happened had they expelled him? schools and communities, then we’re more whenever they want, but they didn’t kick “I think if they kicked me out, I probably me out. I think they actually gave me quite would have ended up just walking around than happy to talk about it.” a big chance, and I’m pretty thankful, eh. all day, smoking weed and being really I leave thinking I’d have been happy I don’t mind the drug tests. They mean I bored – just waiting for my mates to get to have my own children go here, and I’m have a reason not to do it – to say no to it.” out of school.” also making a mental note to watch out for Drix has been drug tested only once so He says he likes the teachers and thinks Drix in future All Blacks line-ups. Thanks far (it’s still early days). He doesn’t know they’ve been really good to him, and he to the Whole School restorative approach the result of the test yet, but he doesn’t tells me about one or two of his favourites. at Ötaki College, that may very well appear too worried. He says he’s not really “But actually,” he says, “I’ve got heaps become a reality. missing the cannabis at all and is enjoying of mean teachers around here” – and I’m sure he means that in a good way. having “heaps more spare money”. Rob Zorn is a freelance journalist based “They sort of did a deal with me, “Schools may be reluctant to talk in Wellington. talked about me staying on Cactus (a about these issues because they don’t

www.drugfoundation.org.nz 27 about a drug

28 matters of substance August 15 Alpha-pyrrolidinovalerophenone – also known as α-PVP, alpha-PVP, gravel, flakka or niff – is one of a number of recreational drugs in the ‘bath salts’ (or cathinones ) family, so called because they resemble bath salts and because they have sometimes been sold disguised as them.

Originally synthesised in the 1960s, We don’t seem to need the rats. Weird alpha-PVP usually comes in a crystal stories abound in the media. In April this It actually starts to form that can be smoked, snorted, injected year, the Associated Press reported that a or swallowed. The high can last for three man who had taken alpha-PVP ran naked rewire the brain chemistry. to five hours, but many users report it through a Florida neighbourhood, tried to They have no control over can be subtle at first and slow to come have sex with a tree and told Police he was their thoughts. They can’t on. This has caused some to ‘re-dose’ the mythical god Thor. Two others tried control their actions. early and use more than they intended separately to break into jail because they – with unpleasant results. thought people were chasing them. One Alpha-PVP is an analogue of wound up impaling himself through the methylenedioxypyrovalerone (MDPV), buttocks on a fence. a powerful stimulant with similar effects “It actually starts to rewire the brain to methamphetamine. It has been sold as chemistry. They have no control over a designer drug, originally in the US, since their thoughts. They can’t control their to sleep and plagued with “the worst the early 2000s. There has been very little actions. It seems to be universal that they thoughts”. Nevertheless, he felt a strong research done on it. Its toxicity – and even think someone is chasing them. It’s just compulsion to take it again. This (and exactly how it works – are not known with a dangerous, dangerous drug,” Don Maines, erotic feelings alongside reduced ability any certainty. The few studies that have a drug treatment counsellor in Fort to perform sexually) seem to be common been done, however, lend scientific weight Lauderdale, told Associated Press. side effects. to the frequent assertion alpha-PVP can In New South Wales, 44-year-old Alpha-PVP is around and used in really mess with your mind. Glenn Punch and his partner Rachael New Zealand but does not appear to be A 2014 study published in Hickel injected a legally purchased commonplace – with just one solitary Neuropharmacology, for example, alpha-PVP product known as ‘Smokin’ review on the New Zealand TripMe found alpha-PVP acted as a stimulant Slurries’. Punch died of a cardiac arrest website. Police and Customs have reported for rats and that their behaviour became while wrestling security guards after intercepting its importation since at least increasingly bizarre at higher doses. jumping a fence naked into a shipping 2012. As recently as April this year, four yard. Hickel fell off a truck, injuring Wellingtonians were caught importing herself badly, and ran off topless and more than three kilograms of alpha-PVP covered in blood yelling, “Help me, (it originates mostly from countries like THE EFFECTS LAST help me!” China and Pakistan). These are sensationalised stories that Detective Senior Sergeant Brent Murray make excellent media fodder and likely said in a media statement that alpha PVP reflect the bizarre behaviour associated is one of the emerging drug threats, which hrs with having taken high doses of alpha-PVP. is usually sold in capsule form here, for 3–5 Nevertheless, purely positive user experience around $40, and is snorted. reports are hard to come by, even with It is not explicitly scheduled under more moderate doses. Matters of Substance the Misuse of Drugs Act but is treated as could find only one on the drug education a Class C substance due to its significant FIRST SYNTHESISED IN THE and harm-reduction website Erowid, and structural similarities to other Class C drugs. that was by a user who insisted his drug In the US, it is only technically illegal use was extremely disciplined. in a handful of states, but it has been placed He reported euphoria and increased under a temporary nationwide ban effective 60s focus, but most other reports suggest from February 2014 – no doubt due mostly the elation (and the tinglings, warmth, to the naked and darkly amusing exploits erections and clarity) soon gave way of its users who made the news. to anxiety. Only one Australian state has made SOLD IN THE US SINCE THE One user described alpha-PVP as it specifically illegal. That is, of course, the devil in crystal form. He said his trip New South Wales, after the death of was terrifying and that, after a short period Glenn Punch and of another young of euphoria, he felt completely hopeless, man who jumped off a balcony while 00s unhappy and incoherent. He was unable high on a similar substance in Sydney.

www.drugfoundation.org.nz 29 Guest Editorial Alcohol advertising: what’s the problem?

While advertising of alcohol keeps spreading and spreading, the industry denies this leads to more harms. The evidence says otherwise, and something needs to be done about it, says Australian Catholic University’s

Professor Sandra Jones. PROFESSOR SANDRA JONES

espite what describes ‘marketing communications’ the industry as any material designed to promote the Australia and New Zealand may tell you, product. Secondly, the advertising (and systematic review media) landscape has fundamentally continue to allow the alcohol of longitudinal changed over the last decade. industry to self-regulate its studies on Countries such as Australia and own advertising, despite adolescent alcohol New Zealand continue to allow the alcohol decades of evidence that D use, published industry to self-regulate its own advertising, in Alcohol and Alcoholism in 2009, despite decades of evidence that self- self-regulation even of concluded that “alcohol advertising regulation even of traditional advertising is traditional advertising and promotion increases the likelihood ineffective and that young people perceive is ineffective. that adolescents will start to use alcohol, messages in alcohol advertisements that and to drink more if they are already directly contravene the industry’s own using alcohol”. codes. Further, the very nature of What is particularly disturbing about Australia’s self-regulation suggests it has that conclusion is that most of the included been developed to protect marketers rather studies only considered limited forms of than consumers. For example, alcohol alcohol advertising – typically print and/or advertisements are only allowed on TV broadcast – and collected data between during periods of M, MA or AV programmes 1985 and 2005. Firstly, advertising is far except during the live broadcast of sporting broader than traditional media channels events on weekends and public holidays. – in Australia, the advertising industry Similarly, the Outdoor Media Association

30 matters of substance August 15 has limited “the advertising of alcohol array of places one can purchase alcohol products on fixed signs that are located not only makes it more accessible, it Given the extensive within a 150 metre sight line of a primary further blurs the line between ‘place’ or secondary school” except “where the (distribution channels) and ‘promotion’ evidence that industry school is in the vicinity of a club, pub or (advertising). self-regulation of alcohol bottle shop or any other venue that sells It is now possible to purchase alcohol advertising is ineffective alcohol products”. online from anywhere at any time. (if the purpose is to protect Even traditional alcohol advertising Group buying sites (such as Our Deal and has changed since these earlier studies, as Catch of the Day) and retailers (such as the consumer rather than the marketers have become increasingly savvy Vinomofo) target consumers with offers marketer), there is a clear at developing products and advertising that for large quantities of alcohol delivered need for government or target vulnerable segments of consumers. to the door at prices substantially lower independent regulation. For example, we now see alcohol than bricks and mortar competitors. advertisements in ‘health’ magazines For those who can’t wait for the postman, promoting ‘low carb’ or ‘natural’ alcohol major alcohol retailers now offer online products and in women’s magazines or telephone orders that can be delivered associated with sporting events or that promoting alcohol that is ‘low calorie’ the same day for a small delivery fee. tie desirable ‘gifts’ to high-volume or presented as a fashion accessory. purchase (such as two four-packs) and Other aspects of alcohol advertising drive increased consumption. Such and promotion are poorly regulated (such regulations should also incorporate rules as online) or largely unregulated (such as Alcohol ‘advertising’ is on price-related promotions to prevent point of sale). For example, research no longer a passive one-way multi-pack pricing that makes it cheaper shows point-of-sale promotions are communication – something to buy a larger quantity and promotions abundant in packaged alcohol outlets and that enourage high-volume purchases that these promotions promote purchase we see on television or read (such as discounts on wine that are of large quantities of alcohol, link desirable in a magazine. available only when purchasing more products to volume alcohol purchases and, than three bottles). not surprisingly, increase the amount of alcohol people purchase. The elephant in the room Alcohol ‘advertising’ is no longer a Alcohol advertising: We know, based on several passive one-way communication – comprehensive reviews of the effectiveness what’s the solution? something we see on television or read and cost-effectiveness of interventions in a magazine. It is now a conversation Given the extensive evidence that to reduce alcohol-related harms, that between alcohol brands and potential industry self-regulation of alcohol some of the most effective strategies are consumers in which consumers become advertising is ineffective (if the purpose increasing price, reducing availability the co-creators and distributors of alcohol is to protect the consumer rather than and banning alcohol advertising. The advertising. A disturbing proportion the marketer), there is a clear need for changes recommended by New Zealand’s of young people own alcohol-branded government or independent regulation. Ministerial Forum on Alcohol Advertising merchandise, and there is an association Such a regulatory system should include and Sponsorship last year is exactly the between this ownership and drinking- a monitoring function (rather than being type of approach we need to follow. related attitudes and behaviours – let dependent on consumer complaints) Among other things, they called for the alone that it makes them walking alcohol and penalties for non-compliance. government to ban alcohol advertising advertisements that further influence To begin to address the nexus between during streamed and broadcast sporting their peers. alcohol and sport – and particularly events, ban alcohol advertising where The majority of alcohol brands have young people’s exposure to a barrage 10 percent or more of the audience is a web presence, which arguably promotes of alcohol advertising – there should be younger than 18, further restrict the hours their products to ‘adult’ consumers, a ban on alcohol sponsorship of sport for alcohol advertising on broadcast media while using questionable age-verification and on alcohol advertising during and introduce additional restrictions on methods that allow underage consumers sporting events. external advertising on licensed venues to evade entry rules. Most brands also have This monitoring and regulation should and outlets. multiple social media pages – including extend to online channels – including What we need now – in Australia, Facebook – which encourage consumers websites, apps, video games, social media in New Zealand and across the globe to like, comment, share, engage and build and video and photo-sharing services. – is governments that are brave enough a relationship with the alcohol brand Alcohol companies that use online to stop doing what doesn’t work (like and thus introduce their new ‘friend’ advertising should be required to allowing the industry to regulate itself) to their network. incorporate effective age restrictions and start doing what does work. As mentioned, the majority of the on entry pages, and these should be studies exploring the links between monitored and enforced. Professor Sandra Jones is Director of the alcohol marketing and consumption Point-of-sale marketing within Centre for Health and Social Research (CHaSR) were conducted over a decade ago, alcohol outlets should be recognised in Australian Catholic University’s Institute for when alcohol was a product we had to and regulated as alcohol advertising and Health, Melbourne. go to a store to purchase. The increasing should extend to promotions that are

www.drugfoundation.org.nz 31 Viewpoints

Performance and image-enhancing drugs under the Medicines Act. Offences are (PIEDs) are substances taken by people punishable by up to three months jail Rising who want to improve their sporting or a fine of up to $500. It is not strictly performance or their physical appearance illegal to possess or use them, but it is – in many cases, both. Generally, they aid illegal to sell or supply them. Penalties PIED use recuperation from exercise and help you for the latter are significantly higher than train harder and longer, increasing your for personal use. – should we fitness and musculature and (hopefully) your sex appeal. Is use becoming more frequent? be concerned? PIEDs include steroids (help grow PIEDs have been around in New Zealand and repair muscle tissue), peptides for decades, but there is mounting (stimulate the release of human growth evidence that their use is becoming hormones and are difficult to detect) more widespread. and varieties of pure hormones. Most of Former bodybuilding champion these substances have genuine medicinal Justin Rys (Mr Big), who was jailed for uses, such as for recovering from injury, importing fantasy with a street value of and many are classed as prescription $2.1 million, told The Press in September medicines, meaning it’s illegal to import last year that use has probably increased them for personal use in New Zealand 10-fold over the last five years.

YES While we don’t know the long-term effects of some of these selling them on. Detective Superintendent Ray van Beynen substances because they are so new, what we do know told The Press in September 2014 that what was actually about the overuse of steroids, for example, is alarming. contained in the products the supplier was peddling was They can lead to high blood pressure, liver damage, quite different from what the labels advertised. changes to the heart, breast growth in men and shrinking “In those cases, it is users who pay the price,” he said. of the testicles. Rys said something very similar before he died: And we could ask Justin Rys about the long-term “It’s not pure any more. It could be fucking anything.” effects of these substances – if he were still alive. Another problem – more to do with buying products Unfortunately, Rys, who had become a campaigner against locally from others who have imported them illegally – the use of PIEDs, died in June 2015. He was just 38. is that young buyers become exposed to unsavoury Doctors struggled to identify what was causing his illness, characters who may encourage them to buy other but Rys was in no doubt, describing himself as the author ‘products’ or lead them into dangerous situations. of his own misfortune and using his illness as part of his We’ve already seen the links between PIEDs and anti-PIEDs campaign. organised crime in Australia, but similar links are In short, PIEDs can kill you, but before they do, they evident in New Zealand. also bring with them all the additional risks associated with World Anti-Doping Agency Director General David other injecting drug use, including infection, transmission Howman says the availability of PIEDs in New Zealand and of disease through needle sharing and other problems other countries is a ‘‘major concern’’. Global intelligence caused by incorrect injecting and lack of hygiene. revealed organised criminal links to the trafficking of A particular problem with PIEDs is that they are often PIEDs, and there was ‘‘stack loads of money to be made’’. purchased over the internet without medical advice from Remember, these are people whose primary concern is not entirely unregulated markets. There is no control over the their customers’ health but to get people to buy more drugs. quantities people might take or what they might take, Lastly, and perhaps most tragically, there is the damage and there is no opportunity for supervision by a medical done to young people’s sporting careers through sanctions professional. Some PIEDs in common use are research when they are caught. On 5 June 2015, DFSNZ announced chemicals not yet approved for human use or not meant an under-19 representative and Lincoln University rugby for human use at all. player was banned from all sports for two years for And when buying in unregulated markets, there is importing the human growth hormone precursor GHRP-6. always the danger that substances are not what they claim “This young man has paid a high price for a poor decision, to be. In one recent investigation, Police found a supplier which has affected his immediate future in rugby,” Steel was ordering products in bulk and labelling them before said – and he was dead right.

32 matters of substance August 15 33 NO .org.nz drugfoundation www. PIEDs also gained huge media PIEDs also gained huge Given what is happening elsewhere, Should we be concerned? parcels by Customs more than tripled Customs more than parcels by and 2013. In 2013, between 2008 PIEDs around 340 parcels containing value of – with an estimated street intercepted about NZ$590,000 – were just 89 similar by authorities. In 2008, packages were seized. Tasman in attention across the February 2013, when an Australian Crime Commission report linked these organised crime to providing AFL and substances to professional league players. it should be no surprise that PIEDs use also seems to be on the rise in New Zealand. In the same article, Medsafe Group Manager Manager In the same article, Group Medsafe of the country’s also gyms leading Five were use PIEDs from in short, harms So, for the evidence for Sport and Recreation Murray McCully told Fairfax told McCully Murray for Sport and Recreation assessment no found Sport a recent Media that NZ-led in crime use or organised drug of widespread evidence sport. Associate Zealand Fairfax Media approached New about the potential office Dunne’s Minister Peter Health A spokesperson PIEDs. surrounding for tougher legislation about this issue this raised of concern at level ‘‘The said, action.’’ legislative warrant does not stage JessamineDr Stewart seen evidence said he had not in widespread was the use of PIEDs that suggested being not gyms, and numbers of people were large the drugs. of using a result as hospital admitted to have to found Fairfax and all were by approached illegal and said any drugs policies to zero-tolerance (and in a few authorities to be referred activity would cases, it had). justify up’. to all ‘het enough us getting robust is just not penalties, only certainly PIEDs will use, just for Increasing has already Zealand and New criminals, more produce with use or dealing drug jail for to people going too many got we’ve Until help. them seeking stops that the stigma seems little do anything there need to evidence, conclusive users with deal should just the PIEDs let we Maybe more. on their sporting impacts and any the side effects careers. punishment enough. probably That’s While the research found widespread While the research found that [young “It confirms our idea Ministry of Health figures also suggest study on seven of the country’s top first of the country’s a study on seven study in late 2014. The 15 rugby teams South Africa and was prompted by young caught doping. UK rugby players being only two use of nutritional supplements, had taken of the 142 players surveyed However, a prohibited substances. said they felt they significant 20 percent them. The researchers were at risk of taking a lot of pressure on also noted there was and that this may young men to look good in sport. impact on drug use people] are vulnerable. The dangers of supplement use don’t seem to be as clear to them as we would like,” Steel said. PIEDs use is on the rise, and seizures of Note, for example, that DFSNZ research found only only found research DFSNZ that example, for Note, health for evidence overwhelming isn’t And there links any show to evidence the strong just isn’t There “Some of the country’s leading gyms Amid growing concern about drug use The same article reporting this finding The same article reporting That same month, Fairfax Media made That same month, Fairfax “Now it’s anyone who ever wants anyone who ever wants “Now it’s It’s easy to get carried away imagining hordes of young of young hordes imagining away carried get to easy It’s substances in gym up unknown toilet people shooting room end of the picture. the extreme probably stalls, but that’s Zealand use in New PIEDs however, In the scale of things, other to in comparison problem a widespread is not and cannabis, methamphetamine alcohol, drugs like efforts our harm-reduction require where tobacco, attention. significant sportsmen illegal of 142 young two out had taken – a tiny less much than 1 percent substances. That’s use PIEDs Where drugs. other many to drop compared in place the systems is an issue, sporting bodies have support national it (or should do). from to police There’s Sport and the DFSNZ, NZ Police, including agencies many them and concentrate it up to leave Let’s Ministry. Health do most harm. that on the drugs In most cases, use. large PIEDs from resulting harms dosage, correct than the effect no greater doses have substances Unlike risk. significant is not a so overdose link PIEDs to it is very hard and tobacco, alcohol as such robust is hardly death and Justin Rys’s death, use with atypical a link. By such all accounts, he took for evidence amounts of these substances, and and excessive you. will kill amounts of anything excessive Minister Associate last year, Late crime. organised with recreational arena. were at the heart of the problem,” he said. among young people, DFSNZ undertook use of PIEDs is growing within the use of PIEDs is growing saying he receives regular reports that the saying he receives regular (DFSNZ) Chief Executive Graeme Steel as (DFSNZ) Chief Executive quotes Drug Free Sport New Zealand quotes Drug Free Sport recreational gym goers seeking a quick fix. recreational gym goers bodybuilding circles, with many just bodybuilding circles, was now more wide-reaching than use was now more wide-reaching like that.” found that PIEDs its own inquiries and bigger to get girls – it never used to be bigger to get girls – it look good, anyone who wants to get anyone who wants to look good, Opinion

Photo credit: flickr.com/photos/cjsmithphotography

A brave, new drug policy

The National Drug Policy 2015-2010 is finally out. How does it stack up? Drug Foundation Principal Policy Advisor Andrew Zielinski looks at the pros and cons and whether the policy will take us where we need to go. ANDREW ZIELINSKI

he curiously long social harms. Interestingly, tobacco as promised in the old policy, has not wait for a new has completely dropped out of the yet eventuated. national drug policy policy, focussing it on alcohol and The addition of specific actions had some of us psychoactive drugs. for completion by 2017/18, associated concerned about We’re particularly happy to see focus with priority areas, is also positive. the government not on a new objective: ‘A shift in attitudes We particularly welcome an action prioritising drug towards alcohol and other drugs’. Reducing supporting schools to keep students in T harm reduction. social stigma towards people with alcohol education, but we consider there should But the National Drug Policy 2015–2020 and other drug problems is vital to address have been an action on opioid overdose is now out and despite the delay, there are the issue of the 50,000 people a year who prevention work including naloxone use, aspects to applaud. Minister ’s want help to reduce their alcohol and other which will save lives. concepts of compassion, proportionality drug use but don’t get it. Finally, it’s especially promising to and innovation herald a promising Another important improvement is the note the addition of the ‘Getting the legal new direction. addition of indicators to assess progress balance right’ priority and associated The old policy’s harm-minimisation with objectives. While we would have action to “develop options for further goal, based on the familiar strategies of liked to see more illegal drug-related minimising harm in relation to the offence supply control, demand reduction and indicators, like a criminal justice indicator and penalty regime for personal possession problem limitation, remains a sound or two, the indicator on opioid poisonings within the ”. approach. However, a range of useful is very welcome. However, this brings us to our main objectives and priority areas have been We also welcome the priority areas concern with the policy – a lack of focus added to the policy’s framework. These added to the policy, particularly ‘Improving on more comprehensive drug law reform. give it more logic and flow and make it information flow’, ‘Getting the legal balance more self-contained. It’s unfortunate, right’ and ‘Shifting thinking and behaviour’. The case for drug law reform though, that the ‘Reducing alcohol and We’ve long been highlighting the need for The Misuse of Drugs Act (MoDA) is 40 other drug-related illness and injury’ better information to inform drug policy years old and should be comprehensively objective doesn’t extend to reducing and it’s frustrating that ‘Evidence online’, redesigned to reflect drug harm reduction

34 matters of substance August 15 best practice. MoDA was developed in But if we’re really serious about drug the 1970s when New Zealand’s cultural This brings us to our harm reduction, we need to start thinking context and drug scene were very different. about smarter control of more of our Back then, the average New Zealander not main concern with the currently illicit drugs. This means making part of the ‘’ counterculture had policy – a lack of focus on drugs available under strict regulation in little or no exposure to illegal drugs. more comprehensive drug much the same way we’ve been trying to Today, nearly half of New Zealanders law reform. deal with new psychoactive substances. have tried something illegal. The prevailing It doesn’t mean liberal availability and international approach was that drug promotion as is the case with alcohol. use was a criminal justice matter best Australia decriminalised minor cannabis MoDA’s prohibition model works controlled through legislated deterrence offences almost 30 years ago in 1987, against the harm minimisation principles and punishment. President Nixon started with the Australian Capital Territory of our national drug policy by leaving the ‘War on Drugs’ in 1971. and Northern Territory following suit non-pharmaceutical drug production New Zealand’s drug market is also in the 1990s. and sale in the unregulated hands of radically different from the 1970s when Our Psychoactive Substances Act is criminal elements. To best enable harm cannabis, heroin and psychedelics like potentially a globally innovative way to reduction, control of the whole drug LSD prevailed. While cannabis continues control newly emerging drugs by market should, carefully, begin to be to be our most popular illicit drug, new regulation, only allowing safe products. taken back by government and wider ‘designer drugs’ like ecstasy (MDMA) Unfortunately, amendments to that Act society. This concept is well expressed have arrived, and methamphetamine have meant continued prohibition, and by the Global Commission on Drug now features on the scene. problems with black market supply are Policy’s diagram below: The most fundamental change, though, emerging. Meanwhile, MoDA retains a has been the growth of new psychoactive strict prohibition approach for all our REGULATE DRUG MARKETS TO PUT substances not necessarily covered under established drugs, with harms persisting. GOVERNMENTS IN CONTROL MoDA. Many different and potentially Statistics NZ figures record that in 2014 The regulation of drugs should be pursued because they are risky, harmful new substances are available not because they are safe. Different models of regulation can there were 871 people aged 17 and over be applied for different drugs according to the risks they pose. – most recently, synthetic prosecuted for illicit drug use/possession In this way, regulation can reduce social and health harms and and drugs like ‘synthetic LSD’ in the risky as their most serious offence, with 661 of disempower organised crime.

NBOMe class. We had around 200–300 new those convicted and 26 of those imprisoned Unregulated criminal Unregulated psychoactive substances on the market – yet we still have some of the highest drug market legal market prior to the Psychoactive Substances Act use rates in the world, with one in 13 adults 2013. These substances are cheap to make over 15 years smoking cannabis at least and hard to detect, with little available once a month. Social and health harms Social and health safety information for consumers. And Drug policy spectrum they will keep coming. So, what type of reform do we need? Prohibition Decriminalisation Responsible Light Unrestricted The internet has also dramatically Our approach needs to shift from being & Harm Legal Regulation Access Reduction Regulation altered the drug market, with ‘dark-net’ sites predominantly criminal justice based like Silk Road (replaced by new sites like towards a health and social focus. We DIFFERENT DRUGS DIFFERENT DEGREES OF REGULATION Agora and Evolution) enabling people to buy must acknowledge that MoDA’s punitive drugs anonymously using digital currency. approach, heavily weighted towards Source: Global Commission on Drug Policy (2014). Taking Control: Pathways to Drug Policies That Work (Summary). So, our drug scene has changed supply control, is ineffective and harmful. markedly. But while MoDA has been As the UK Home Office recognises: amended 18 times in the past eight years, “The disparity in drug use trends and Right now New Zealand is, it’s failed to keep pace with changes criminal justice statistics between understandably, socially and politically and now exists as a patchwork of countries with similar approaches, uncomfortable with making currently illicit poorly considered amendments and and the lack of any clear correlation drugs legally available, even by strict outmoded assumptions. between the ‘toughness’ of an approach regulation. However, that we enacted the Internationally, recognising that strict and levels of drug use demonstrates the Psychoactive Substances Act shows some prohibition has failed to reduce illicit drug complexity of the issue.” level of willingness. Regulating to give demand or harms, there have been various We must align our law more with harm- control of the drug market back to the innovative reforms. Fifteen countries have reduction principles. This means addressing government is not radical policy. Actually, decriminalised the personal possession of the health and social problems underlying it’s the prohibition approach that’s radical, all drugs. Portugal decriminalised all drug demand for drugs and minimising the because it removes the levers governments use in 2000 and developed strong new problems arising from inevitable drug use. normally use to regulate markets. policies on prevention, treatment and harm A wealth of evidence since the 1970s tells Many of the drug harms we currently reduction. This approach is working, with us this is what works. A first step would see are there because profit-motivated drug use, offenders in prison, court cases, be not criminalising people for personal criminal drug suppliers are not concerned HIV infections and overdoses all decreasing. use/possession offences but using such with public health harm minimisation In the US, cannabis is decriminalised ‘infringements’ to caution, give information, principles or bound by product safety or legal in some form in 27 states and the make health assessments and offer treatment regulations. If we’re looking boldly towards District of Columbia. Four US states have (akin to the Law Commission’s recommended future drug harm reduction, we need to legalised recreational cannabis. South mandatory cautioning scheme). consider smarter drug regulation.

www.drugfoundation.org.nz 35 Q&A

Q Why is it so important to improve access considered ‘out of time’ should be granted to medicinal cannabis in New Zealand? access. With the only available medicine A Access to medicines that could improve priced out of reach – GW Pharmaceuticals’ diseases and illnesses where nothing else is Sativex derivative – something needs to be working, and in particular increase quality done about the cost. of life, is a human right. Around the globe, Another priority recommendation is we already see various medicinal regimes. permitting clinical trials so medicinal It’s currently used in 21 countries and 20 cannabis can be researched and studied in states of the USA. We know it is effective to order to be introduced as a new medicine. varying degrees in treating diseases/illnesses Both these recommendations would be via and reducing symptoms. This is particularly safe legal products that are manufactured to important for people with diseases and a pharmaceutical grade with strains/ratios illnesses where all reasonable medical consistent and matched as best possible to options and treatments have failed, with an individual’s needs. patients continuing to suffer. This often includes putting up with the intolerable Until this happens, we are likely to see side effects of those failed treatments. people sourcing products through the black market and risking being sold unsafe, laced Facilitating New Zealand-based cultivation products or ‘snake oil’. and research into the therapeutic benefits of medicinal cannabis is something we’d like Q What role does UIC have to play? to see. Creating an opportunity to reduce the stigma associated with cannabis for A This newly launched charitable trust is medicinal use will allow mature discussion set up to educate the public on medicinal Cannabis and policy frameworks to progress. cannabis and support New Zealand-based Somehow, we’ve got to separate cultivation and research into the therapeutic recreational use from medicinal. effects of -based medicines. medicines Our purposes are based on education, Q Based on your knowledge and research, compassion and logic. what are the most proven/promising areas The New Zealand chapter is an alliance with will help for prescribing medicinal cannabis? the Australian branch, and we are forming a A The list is quite long! The most common research and development team with them. would include HIV/Aids, glaucoma, We also continue to build our scientific and Toni-Marie Matich is cancer, chemotherapy, multiple sclerosis, medical advisory board, so we can provide epilepsy, chronic pain, autism, ADHD support and advocacy to New Zealanders who co-founder of the and Crohn’s disease. would like access to legal medicinal cannabis. However it is used, it’s important realistic New Zealand branch of cautions are understood. There are Q So far, what has UIC been doing in United in Compassion insufficient conclusions about safety New Zealand? What is next? and efficacy particularly when a patient A So far, we’ve been working hard on getting (UIC), set up to advocate is on other medications. Possible formally set up and establishing for the introduction of contraindications are largely unknown the frameworks to deliver on our purpose. and constantly evolving. We also need We’re here to help parents/caregivers and medicinal cannabis and to understand ratios and profiles of individuals from all walks of life and cannabinoids in relation to which illnesses/ circumstances, so we’ve been spending time as a community for diseases and symptoms they are best suited forming relationships and engaging people for. Medicinal cannabis isn’t a single strain patients and carers. all around the country. These individuals (as compared to one particular pill) that are what motivate and drive us. works for any one condition. Research is The mother of five began investigating vital in better understanding both the We are also working with decision makers the potential of medicinal cannabis positives and negatives. and influencers from the Police, medical professions and universities. after all other treatments for her I always make it very clear there is no way Later in the year, we aim to run a national teenage daughter, who has a rare of knowing whether an individual would or wouldn’t benefit from medicinal symposium on medicinal cannabis, so we form of epilepsy, did not alleviate cannabis. People need to be very realistic are very busy and excited too. severe, unrelenting seizures. – you see online and social media stories go viral without evidence to back them. Q What does a perfect/better future look like for you? Q What do you recommend as the most A A perfect and better future would be one appropriate way for people to access where there is access to safe, legal medicinal medicinal cannabis? cannabis products through a supported A I recommend the government allows for and moderated regime. This won’t happen the introduction of a compassionate access overnight, but I do believe it is possible! scheme. Any individual who has exhausted In the meantime, we need some sort of all reasonable medical treatments or is compassionate access scheme.

36 matters of substance August 15 mythbusters It sounds too much

Photo credit: flickr.com/photos/governmentofalberta

drugs bust on the per gram. Multiplied by 257.5 kilograms, price paid at the end of the line by Indian Ocean, this gave a total of US$165 million, or consumers. He suggests an alternative described as the NZ$235 million. way of calculating value would be to work biggest in New A New Zealand Police spokeswoman out the social harms prevented if a quantity Zealand’s naval says street value information for illegal of drugs was intercepted by Police or history, seized 260 drugs comes from a range of Police sources: Customs. These would include reduced kilograms of heroin “These include investigation, open source health costs, car accidents and loss of life. A worth a reported information, Police drug experts, drug The savings would be far greater than the NZ$235 million in June. The frigate notifications, intelligence and cases we simple retail value of the drug. HMNZS Te Kaha was taking part in a prosecute.” She says New Zealand retail Dr Wilkins says he would describe United States-led international maritime prices for methamphetamine remain high Police estimates in media headlines as operation targeting people trafficking and compared with other countries, and the accurate but “not necessarily highly smuggling drugs, which were, apparently, drug is generally sold at about $800–1,000 precise. It’s hard for them to take into part of a funding chain for terrorists. per gram. account what happens to these big kilo lots, Two months earlier, the UK’s Royal The approach used by Police and the where they are sold, how they get cut and Navy intercepted a tugboat carrying 3 tonnes navy – using recent information about the what quantity they are going to be sold in.” of cocaine off the coast of Aberdeen. The street value of a drug and then multiplying According to the 2015 Global Drug discovery was said to be the biggest Class A it by the number of kilograms seized – is Survey, which covers 50 countries, drug seizure on record in Britain and worth fairly standard. However, Chris Wilkins, Australia and New Zealand are some of £500 million (more than NZ$1.19 billion). a senior drugs researcher at Massey the most expensive countries in the world Estimated values of seized drugs can University’s College of Health, says this to buy ecstasy or cocaine. Australians be mind-bogglingly huge, and these recent, method can “greatly inflate” the value of report paying €207 for a gram of cocaine, record-breaking hauls must be seen as a the drugs. That’s because illegal drugs while New Zealanders say they pay €191 win for the authorities. Police and other intercepted in large quantities are usually (NZ$317) – about twice as much as enforcement agencies such as the Royal sold at a cheaper wholesale rate compared someone in Switzerland would pay for New Zealand Navy and New Zealand to the price paid for smaller quantities on the same amount. In Brazil, it can cost as Customs Service are understandably keen the street. little as €9 for a gram of cocaine, with the to publicise their efforts to curtail the The higher street prices are purer version costing €15. Even within supply of illegal drugs, but exactly how compensation for the bigger risks suppliers New Zealand, the price of methamphetamine are the values quoted in these stories are taking on, such as legal penalties and is generally higher in Christchurch than in calculated, and how accurate are they? violence from competitors, so the unit Auckland or Wellington. Mythbusters asked the New Zealand price for a drug increases considerably Geographic location, purity, availability Navy how it estimated the value of its as it gets closer to sale on the streets of and the risk of legal penalties are all factors recent drugs bust. Lieutenant Commander a first-world country. It makes sense that that influence the price paid for illegal Mike Peebles, the executive officer of a kilogram of cocaine bought in Colombia drugs, and these will fluctuate over time. HMNZS Te Kaha, says a United Nations can be obtained a lot more cheaply than It is difficult for authorities to get an Office on Drugs and Crime report provided a kilo of the same drug hitting the streets up-to-date fix on all of these when they heroin price information for the United of a city like New York. assess the value of drugs seized, so the States market from 2012. Using a price of The figures used in media coverage can estimates seen in media coverage should US$800 per gram for pure heroin, they give the public a misleading impression be seen as a rough guide only. Believe calculated the value of the 80 percent pure about the impact drugs seizures have on the headlines, but take them with a grain drugs they had seized would be US$640 suppliers, because they are based on the (or gram) of salt.

www.drugfoundation.org.nz 37

A global campaign calling for decriminalisation and harm reduction

Day of action 26 June 2015 www.supportdontpunish.org/action

Here are ome of the people who joined in the 2015 day of action in Aotearoa.

View 6420 photos on: supportdontpunish/photoproject