The pain and the poor Dealing with dealers Twenty candles Horsing around with Special K February 2009

Through the maze – healthy drug law reform The Misuse of Drugs Act was drafted in 1975 when the way we understood drugs was very different. With this year’s review, we can bring our drug law in line with modern knowledge and current public health policy objectives. Contents

matters of substance February 2009 Features Vol 19 No 1 ISSN 1177-200X 02 Cover story 21 Let’s talk about pot 14 Opinion matters of substance is published by the Through the maze – Beyond the cannabis Enforcing to reduce harm NZ Drug Foundation. All rights reserved. Neither this publication nor any part healthy drug law reform stalemate of it may be reproduced without prior A Global Cannabis permission of the NZ Drug Foundation. Commission report claims most harms matters of substance invites feedback and contributions. If you’re interested in around cannabis actually contributing a guest editorial or article, result from prohibition. please first contact us: [email protected] Will the United Nations p +64 4 801 6303 heed the call to consider David Blakey argues that some radical alternatives? The Law Commission’s intelligent and adaptable Brand development/graphic design law enforcement policy can Origin Design +64 4 801 6644 review of the Misuse of 24 Alternative development play a role in minimising [email protected] Drugs Act cannot come www.origindesign.co.nz in the Golden Triangle – drug-related harms. soon enough. The Drug reality or myth? Foundation has some ideas NZ Drug Foundation 33 Mythbusters 3rd Floor, 111 Dixon Street about how a new Act should Ketamine: not just for PO Box 3082, Wellington, New Zealand look, based on 30 years of horses, also for badgers p +64 4 801 6303 experience and evidence. The media’s delight in describing ketamine as a When you have finished with 12 Sentencing for drug crime this magazine, please recycle it. horse tranquiliser is doing nothing to help convey a clear understanding of Become a member Opium cultivation in relative drug harm. The NZ Drug Foundation has been Burma, Laos and Thailand at the heart of major alcohol and is reportedly in decline, News other drug policy debates for over but the Transnational 18 years. During that time, we have Institute argues 29 New Zealand News demonstrated a strong commitment What could be a worse mismanaged bans have to advocating policies and practices Sport, drugs and alcohol, based on the best evidence available. crime than dealing drugs? cost local farmers dearly. and getting tough on P – Not much, according to our these and other stories You can help us. A key strength of the criminal justice system. 27 Something for the pain feature in our round up NZ Drug Foundation lies in its diverse The western world spends of drug news on the membership base. As a member of the 16 Twenty years young NZ Drug Foundation, you will receive billions trying to prevent home front. information about major alcohol and We look back on some of illicit opioid use. Meanwhile, other drug policy challenges. You can also 31 World News the controversy at the time scant thought is given to get involved in our work to find solutions Drug courts work, but to those challenges. of the Drug Foundation’s the suffering left without institution and trace our pain relief in developing anti-drug ads fail. And guess what: meth, booze and Our membership includes health history in headlines and countries. promoters, primary health and quotes. ecstasy are bad for the body. community organisations, researchers, students, schools and boards of trustees, 01 Key Events and Dates policy makers, and addiction treatment 18 Down but not out – the Regulars agencies and workers. findings of Youth’07 We provide a list of coming alcohol and other drug 01 The Director’s Cut Membership and subscription enquiries happenings to help fill [email protected] Ross Bell argues that your new diary. or visit our website. progressive drug law reform is needed to reduce barriers Quotes of Substance www.drugfoundation.org.nz to people needing help. Some things said about drugs are insightful, 20 Guest Editorial some are insane, and New Zealand young people On the RISE for youth some are inexcusable. are happier. They’re using Caitlin Padgett introduces less cannabis and saying no Youth RISE – an advocacy to cigarettes, but not all the group for the rights of news is good. young drug users worldwide. matters of substance February 09 www.drugfoundation.org.nz The Director’s Cut Key Events and Dates

3rd International Conference Outside In: Community of the International Society for Responses to Complex and the Study of Drug Policy Diverse Needs 2–3 March, Vienna, Austria 6–8 May, Sydney This conference, hosted by the Today’s community service providers United Nations Office on Drugs acknowledge there are co-existing and Crime, should be of interest to problems for many people accessing a wide array of disciplines including services. This conference will help anthropology, economics, explore innovative and creative epidemiology, political science, community sector approaches that “This has never, ever worked, Our cover story argues that public health and sociology. will provide meaningful responses to people’s diverse needs. so let’s keep on doing it.” New Zealand’s obsolete drug www.issdp.org www.nada.org.au Why do we expect that law must be reformed so that School of Addiction 2009 one of the most complex it can complement the more 4–6 March, Auckland Working Together Conference social and health issues can balanced National Drug Policy. The biennial school, jointly hosted by 14–15 May, Wellington be solved through tough We argue that a health-based DAPAANZ and the Pacific Centre for Be part of the gathering momentum action by Police, the courts drug law would respect Motivation and Change, is offered to to reduce the harm of alcohol in our and prisons? The faith many human rights, including the experienced clinicians and practitioners communities. Come and share your in the field of addiction treatment. stories, highlight progress you’re have in the criminal justice right of people to equal access www.matuaraki.org.nz making and learn from others. ALAC system to fix social ills is to health services. It would is currently seeking presentation misplaced. Indeed, the system reduce the barriers that 3rd International Conference abstracts. itself can be the cause of some currently stop people seeking on Fetal Alcohol Spectrum www.alac.org.nz of those ills. help for drug-related Disorder 2009 Getting ‘tough on drugs’ problems and make it easier 11–14 March, Victoria, BC, Canada Youth Week 22–31 May or fighting the ‘war on drugs’ for them to access services This conference will be a catalyst doesn’t create communities for change around the globe by Start planning now to get involved. such as harm reduction Keep an eye on the website for free from drug harm. integrating research and policy into programmes or treatment. practice to assist governments, updates. We need to understand Do not be mistaken. This parents, services and caregivers www.youthweek.co.nz that the social and health is not a debate about ‘hard’ who strive to prevent FASD. harms from drugs can only www.interprofessional.ubc.ca versus ‘soft’ drug law. Recent be addressed through humane World Health Organisation social and health policies and 1st Conference of the research illustrated that “drug interventions. We do them a Connections Project use is not simply related to 25–27 March, Krakow, Poland disservice when we demand drug policy, since countries Joining the Dots: Criminal Justice, Customs, cops and courts to with more stringent policies Treatment and Harm Reduction will fix the problems created by towards illegal drug use did aim to facilitate the development social exclusion, poverty, of knowledge and an evidence base not have lower levels of such the human condition and for how different harm reduction drug use than countries with even genetics. They are and drug free interventions can be more liberal policies.” incorporated across criminal justice simply not equipped or processes. Instead, we hope that, World Smokefree Day qualified to do this – yet this www.connectionsproject.eu 31 May is where we invest our as New Zealand reviews its domestic drug law, and as www.worldsmokefreeday.org.nz energies and resources. International Harm Reduction In Australia (we don’t the international community Association Conference 2009 International Day against Illicit reviews global drug control, 20–23 April, Bangkok, Thailand have New Zealand data, but Drug Abuse and Illicit Trafficking we need to be open to new The conference theme is Harm confidently assume it will 26 June Reduction and Human Rights. be comparable), 57 percent approaches, informed by With this campaign, UNODC aims the best evidence, and be Asia has been consciously chosen to of expenditure on illicit host the conference based on many to raise awareness of the major drug policy goes to law prepared to challenge countries in that region failing to problem that illicit drugs represent to society. enforcement, with only 23 previously held tenets. provide vital health and harm www.unodc.org/unodc/en/ percent to prevention efforts, David Cameron, UK’s reduction services to which drug users are entitled. about-unodc/26-June.html 17 percent to treatment Conservative Party Leader, www.ihra.net services and 3 percent to has lamented, “If one takes a 2009 Cutting Edge: harm reduction initiatives. slightly progressive – or, as I Our place, our future Acknowledging there is still like to think of it, thoughtful 10–12 September, Wellington debate about the best mix – view [of drug control], one www.dapaanz.org.nz of investment, it’s safe to can sometimes be accused say we have a long way to of being soft. I reject that Publicise your own event online at go before we even reach a utterly.” So do we. www.drugfoundation.org.nz/events balance of approaches. Happy reading, Ross Bell. www.drugfoundation.org.nz matters of substance February 09 01 Cover Story

02 matters of substance February 09 www.drugfoundation.org.nz Through the maze – healthy drug law reform

Our Misuse of Drugs Act has been around for nearly The frontiers of human discovery advance at a remarkable pace. The way 34 years. It was first developed at a time when our we see the world changes as events and understanding of good drug policy was in its infancy knowledge alter our understanding of our environment and of each other. and patterns of drug use were very different from The challenge for policy makers is today. It is now being reviewed, providing a rare to ensure that legislation keeps pace. Sometimes, important laws are allowed opportunity for New Zealand to bring its drug law into to fall out of step with public attitudes the 21st century. In this essay, the Drug Foundation and scientific learning. That is the case with New Zealand’s now 34-year-old puts the case for reforming the Misuse of Drugs Act drug control law. from a criminal justice-focused law to one that Our world is radically different from that of 1975, when a Bill Rowling-led explicitly supports the health of people who use government drafted the Misuse of Drugs drugs and reduces drug harm across our communities. Act. Back then, many New Zealanders www.drugfoundation.org.nz matters of substance February 09 03 had little or no exposure to drug use. Fruitless attempts to prohibit alcohol Today, nearly half of New Zealanders last century demonstrated that trying under 65 acknowledge using cannabis to stamp out the supply of a product at least once. is a poor way of eliminating an entire Some things have not changed. market. Thai economist Pasuk We know, as we did in 1975, that the Phongpaichit noted in a recent paper misuse of drugs can hurt communities about his nation’s drug problem, “If you and individuals, but we have the benefit attack her supply but do little about of 34 more years of scientific research, demand, then the result is rising prices, leading to a much better understanding rising profitability, and hence increased of the best ways to reduce the harm entrepreneurship.” drugs can cause. When it comes to Entrepreneurship within the drug industry has thrived. Despite the fierce policy and legislation, we know what war on drugs waged by the United States works and what does not. and its allies over more than three Since 1975, New Zealand politicians decades, the global drug market has have made amendments to the Misuse expanded exponentially. of Drugs Act on several occasions. Today, policy reform advocates Unfortunately, many of these changes believe that viewing the issue of drug use were driven by short-term political through the prism of health and social considerations. Today, we are left with policy sharpens our understanding of a patchwork quilt of poorly considered the best ways to reduce the problems amendments and outmoded assumptions. Viewing the issue of drug use through the prism of that drugs can cause. This means that In 2008, the Government asked we look at both drug demand and the independent Law Commission to health and social policy supply, which offers a wider range of comprehensively review the Misuse of sharpens our understanding up-to-date policy tools. Drugs Act. This provides a long overdue of the best ways to reduce Social researchers also tell us that it opportunity to update the law, to ensure the problems that drugs is necessary to acknowledge the simple that it is ready for the future and can cause. fact that people will continue to use legal supports the drug harm minimisation and illegal drugs, no matter what legal goals of our drug and health policies. approach is taken. While we will always Ending the war on drugs want to reduce drug use, this fact means Experience has discredited the 1975 that we have an obligation to try to make approach, which saw drugs purely as a drug use as safe as possible for people who use drugs and for the communities matter for the criminal justice system around them and that people can access and the deterrence and punishment essential health services. of people who use drugs as the sole In New Zealand, it is important for us purpose of drug law. This is sometimes to learn from the emergence of ecstasy, known as the ‘war on drugs’ approach, party pills and other designer drugs, a term first used by President Richard and the phenomenon of diverted Nixon in 1971 and usually linked with pharmaceuticals such as the harsh drug control tactics used in the benzodiazepines and morphine United States that greatly inflated prison sulphate. Our drug law has proved populations. poorly prepared for such developments. It is an approach that has proven New substances or variations of existing ineffective both overseas and here. substances will continue to surface. In isolated examples, strong law The outdated approach underpinning enforcement initiatives have contained the Misuse of Drugs Act ensures that it the overall scope of a drug market, but has a heavily punitive focus on banning researchers have struggled to find solid illicit drugs and attempting to control evidence for a straightforward link supply. The law is not adaptable. When between efforts to clamp down on new drugs emerge, they need to be fitted supply and a sustained drop in the into a matrix of ‘harm’ and a political availability or use of illegal drugs. response planned.

04 matters of substance February 09 www.drugfoundation.org.nz I cannot envisage any user – a dependent drug user, that is – having any kind of thought as to whether it was a Class A, B or C drug they were consuming.

The 34-year-old law divides drugs As long ago as 1994, an advisory 2008) or penalties are strengthened into classes, ostensibly on their risk of group told the Ministry of Health that (as when methamphetamine was harm, and sets out the penalties for their “as a philosophical basis for drug policy, reclassified from Class B to Class A possession, manufacture and supply. It the justice perspective is very limited. in 2003), use of that drug should fall. gives power to the Police and Customs. Its underlying premise, that illegal drugs In practice, things do not appear so In keeping with attitudes when it was are ‘bad’ while legal drugs are generally clear cut. A 1999 report into United first drafted, there is no emphasis on ‘good’, is too black and white to be Kingdom drug laws by the Police attempting to dampen demand, or on credible.” Foundation found that “such evidence as we have assembled about the current attempting to reduce the dangers to Questioning the deterrence effect situation and the changes that have people who use drugs. The criminal justice approach relies taken place in the last 30 years all point The inevitable result of this narrow on faith in the law’s power as a to the conclusion that the deterrent approach is that far greater governmental deterrent, as well as the idea that people effect of the law has been very limited.” resources go to control and enforcement choose to use drugs because they expect Deterrence critically relies on than to programmes that focus on the rewards to be higher than the risks. individual perception. Everybody prevention or that deal with the harm In this context, criminal sanctions are has a different perception of risks and that drugs cause. intended to deter people from trying rewards, influenced by their social It also means that artificial drugs or shifting to more harmful ones. context, personal psychology and core distinctions are made between legal Looking at the world from this angle, values. This makes the provision of drugs – notably alcohol and tobacco we would expect the reduction of information a vital – and often neglected – and illegal drugs. In terms of economic punishments (including through – element of deterrence-based public impact and lives lost, tobacco is clearly decriminalisation or legalisation) to policy. People cannot be deterred from New Zealand’s most harmful and costly cause the use of drugs to rise, and when doing something if they do not drug, followed by alcohol. a drug becomes illegal (as BZP did in understand the risks involved. www.drugfoundation.org.nz matters of substance February 09 05 Health: the first principle of drug policy

It is often forgotten that health is the first change, like prevention and treatment drug illness and prevent the spread of principle of drug policy. Improving security (that can solve the problem). diseases that precede and accompany (against drug traffickers and dealers) and drug use, like HIV and hepatitis. It is also the result of the fact that the promoting development (to enable farmers challenge of reducing demand for drugs has But let us be more radical. Let us reach to find sustainable alternatives to growing been left to individual states, whereas out to people who need treatment, on a illicit crops) are necessary, but not sufficient, interdiction and reducing the world’s supply non-discriminatory basis. Drug therapy measures, because even if you eliminate the of illicit drugs are the focus of multi-lateral should be mainstreamed into high-quality world’s entire supply of cannabis, coca and agreements. There are Guiding Principles of and accessible public health and social opium, and even if you could seize all drugs Demand Reduction (1998), but they do not services – not ghettoised. There is also in circulation, you would still have 25 million carry the same weight as an international no point in throwing all drug users in jail. drug users looking for ways to satisfy their convention. The practice is even more remote We must promote alternative measures addiction. So the key to drug policy is from the statements of principle. to prison for drug addicts, offering them reducing demand for drugs and treating rehabilitation programmes. Furthermore, all addiction – and that is very much a It is time to redress the balance and bring forms of addiction should be treated: there is healthcare issue. health back to the mainstream of drug policy. no consolation for stabilising drug trends if That means putting more resources into Concern about the health effects of drug use people turn instead to other substances. prevention and treatment, as well as research was the chief motivating factor for the 1961 to better understand what makes people Finally, and most importantly, let us make UN Drug Control Convention. Yet, over time, vulnerable to addiction. drug control a society-wide issue. Drug public security has taken priority over public abuse is an illness. Let’s treat it that way. health. This is reflected in resource Then there is the question of reducing the imbalances (around 3:1 in favour of spending harm caused by drugs. It is not only a question on security) and policy priorities. I fear this is of handing out condoms, clean needles, Antonio Maria Costa, Executive Director political expediency: to focus on quick wins, disinfectants and bowls of soup. What is of the United Nations Office on Drugs like seizures and arrests (that reduce the needed is a comprehensive package of and Crime, www.unodc.org. problem), rather than on agents of slow measures to reduce vulnerability, treat the

For some people, the very fact that a Evidence shows that perception of drug is illegal will deter them from using health risks can be more important it. For similar reasons, people may than legal sanction. The UK Police choose not to jay-walk or to ride a bike Foundation report concluded that without a helmet. However, legal status “the public sees the health-related has clearly not proven a strong barrier to dangers of drugs as much more of a cannabis use in New Zealand, which is deterrent to use than their illegality.” The declining rate of smoking in among the world’s highest. New Zealand during the 1980s and According to sociologists and 1990s highlights the potential benefits psychologists, legal sanctions may be of a strong public information campaign less important than other factors in about health risks associated with a drug. discouraging drug use. Their research tells us that social sanctions may prove Sending messages through drug more important, such as public exposure classification A flawed belief in the principle of and shame if one is exposed as a person deterrence underpins the Misuse of who uses illicit drugs. People are also Drugs Act’s classification system, which affected by the fear of the effects of a was considered groundbreaking back drug, the fear of looking ‘uncool’ and in 1975. the fear of embarrassing their family In theory, the classification system is or community. designed to associate greater legal risks New Zealand research shows that with harder drugs that cause more damage non-cannabis users are much more likely for society and people who use drugs. to say they are simply “not interested” Of course, for a classification system in the substance than to cite the risk to be effective, people using or selling the of legal sanctions as their reason drug must be aware of the classification for abstaining. and its punishments. There is scarce

06 matters of substance February 09 www.drugfoundation.org.nz Drug law focused on reducing the harm around drugs would help those communities that are particularly vulnerable to drug misuse, rather than exacerbating social exclusion.

research in New Zealand or elsewhere drug like methamphetamine. five schedules, but different states that proves that this is the case. Although most New Zealanders who have their own legislation for scheduling The classification of drugs is have tried cannabis have not gone on to drugs and for punishments. This means intended to be evidence-based. harder drugs, there is a widespread that one drug like ecstasy has different The Expert Advisory Committee on notion that Class C drugs – cannabis in classifications and different punishments Drugs (EACD) makes recommendations particular – can serve as a ‘gateway’ to in different legal environments, which to the Minister of Health based on other drugs. must undermine the deterrent effect. factors including the likelihood of Indeed, this belief is consistent with In the United Kingdom in 2006, abuse, risk to public health, ability to American research that shows the use the House of Commons Science and create dependence and the classification of cannabis is roughly associated with a Technology Committee took a close decisions made by other countries. stronger likelihood to try cocaine or look at that country’s drug classification In 2003, on EACD advice, the psychedelics later. On the other hand, system and the workings of its equivalent government reclassified there is no evidence that the use of, say, to the EACD. The United Kingdom methamphetamine from Class B to ecstasy (a Class B drug in New Zealand) system is very similar to that of Class A. The Police Minister noted in is followed by greater likelihood of using New Zealand: it has a three-tier drug November 2008 that, since then, the heroin (Class A). Research published in ranking system of Class A, B and C. methamphetamine industry has grown. the Journal of Policy Analysis and Despite a legal system designed to deter Management concludes that the gateway The committee was troubled by the use, it would appear that industry concept remains controversial because a lack of research anywhere into such a participants perceive the rewards causal link between trying cannabis and system’s effectiveness. It cited evidence associated with methamphetamine trying harder drugs has not actually been from the Chair of the Association of creation and use as higher than the established. This supports New Zealand Chief Police Officers Drugs Committee risks of legal sanction. research showing such ‘pathways’ exist, that, “I cannot envisage any user – One apparent goal of pegging but that the ways they work are unclear. a dependent drug user, that is – classifications to penalties is to deter The classification approach has been having any kind of thought as to somebody who tries a Class C drug like adopted in many countries. In the whether it was a Class A, B or C drug cannabis from moving ‘up’ to a Class A United States, drugs are divided into they were consuming.” www.drugfoundation.org.nz matters of substance February 09 07 At the very least, this points to an determine the harm associated with any classifications. Because the longer-term information problem: if people who use drug: the physical harm that the drug effects of newer drugs like ecstasy are drugs are not informed of the legal risks causes the individual user, the tendency unknown, they can be difficult to associated with different drugs, the of the drug to induce dependence and classify. deterrence effect will be fuzzy. the effect of the drug’s use on families, Harm to society can be caused by There is even anecdotal evidence communities and society. many factors, including the damage to that some people might see a Class A In some cases, this is straightforward. family and social life, as well as the classification as an incentive to try a Drugs that can be taken intravenously – costs to the health, social and justice particular drug. such as heroin – carry a high risk of systems. It is interesting to note that a The committee was not sold on the causing sudden death from respiratory legal drug – alcohol – creates a lot of argument that a classification system depression and therefore score highly on accidental damage to users and to sends out ‘signals’ to drug users or any metric of harm. Methamphetamine property through drunken behaviour and potential drug users. Based on reported also carries the risk of heart failure and car crashes, while tobacco incurs higher ballooning drug use in the United seizures, and long-term chronic use can costs on the healthcare system than any Kingdom, the committee felt that using cause psychosis, aggression and violent other drug. the criminal justice system to send out behaviour. Cocaine induces very In 2007, a research paper published public health messages about drugs was, powerful dependence because higher in The Lancet used a group of at best, inefficient. doses are needed to obtain the same independent drug addiction experts to In the United Kingdom, the process effect over time and because they create attribute mean harm scores to illegal and by which drug classification decisions intense cravings and withdrawal legal drugs. One author of the paper was are made is often undisclosed and can reactions. the chairman of the committee that be ill-defined, opaque and seemingly On the other hand, so does nicotine, recommends drug classification arbitrary. While New Zealand’s EACD which is a legal drug, and hallucinogens decisions to the British government. goes to some lengths to promote do not encourage physical dependence “The results of this study do not transparency, the classification of drugs or carry a massive risk of causing sudden provide justification for the sharp A, remains more of an art than a science. death, yet rate highly on both the B or C divisions of the current In theory, three main factors United Kingdom and the New Zealand classifications,” the researchers

08 matters of substance February 09 www.drugfoundation.org.nz concluded. “Neither the rank ordering of told the select committee that the attention. The British system’s drugs nor their segregation into groups… classification system “is antiquated and credibility was undermined between is supported by the more complete reflects the prejudice and misconceptions 2000 and 2007 when five successive assessment of harm described here.” of an era in which drugs were placed in Home Secretaries all sought to readdress From a scientific perspective, the arbitrary categories with notable, often the classification of cannabis amid a researchers noted, the exclusion of illogical consequences.” Even the heated public debate. Eventually, alcohol and tobacco from the Misuse Association of Chief Police Officers the UK government ignored its scientific of Drugs Act was arbitrary. acknowledged that the classification advisors’ recommendations and The addiction professionals rated system was “pretty crude”. re-classified the drug. the drugs in the following order: heroin, The committee recommended that Under our similar system, the same cocaine, barbiturates, street methadone, the government decouple the harm thing could occur in New Zealand. alcohol, ketamine, benzodiazepines ranking of drugs from the penalties for While we have not been engaged in (e.g. Valium), amphetamine, tobacco, possession and trafficking. This would a heated and politicised debate on buprenorphine (e.g. the painkiller allow a more sophisticated and scientific cannabis recently, this is perhaps largely Temgesic), cannabis, solvents, approach to assessing harm and the because successive governments have 4-methylthioamphetamine, LSD, development of a scale that would be agreed in coalition deals not to revisit its methylphenidate (e.g. Ritalin), anabolic responsive to new research. steroids, GHB, MDMA (ecstasy), alkyl The committee pointed out that a legal status. This, in itself, has largely nitrates, khat. more scientifically based scale of harm cut off the potential for evidence-based The House of Commons Science and would have greater credibility than a scientific input to public discourse. Technology Committee concluded there system where the placing of drugs in a Another advantage of decoupling the are startling differences between this particular category is ultimately a scientific harm metric from penalties ranking and that of the United political choice. would be that tobacco and alcohol Kingdom’s Misuse of Drugs Act. The Relying on politicians to make could be included in a scientific scale same conclusion is reached when it is decisions about drug classifications to provide the public with a better sense compared with New Zealand’s ranking. can lead to science being overruled by of the relative harms involved with One of the research paper authors short-term concerns such as media different drugs, legal or otherwise.

It is not only a question of handing out condoms, clean needles, disinfectants and bowls of soup.

www.drugfoundation.org.nz matters of substance February 09 09 Reducing drug harm and promoting health avoiding drug-related harm, or setting Promoting such health messages is up needle exchange schemes and other part of the ‘harm minimisation’ harm reduction services. approach. This pragmatic approach The answer is not to throw out the accepts that drug use will continue to criminal justice approach altogether. be a part of society and that eradicating Nobody engaged in serious dialogue drugs by trying to stamp out supply is about the future of drug policy simply not feasible. Instead, the focus is advocates creating an unregulated drug on identifying the specific ways that market in which traffickers and sellers drug misuse can harm individuals and go unpunished. However, it is society and then responding with important to broaden the legislation’s strategies to reduce those dangers. ambit. Genuine, effective attempts to reduce supply should be viewed as one tool that can be used to reduce the cost of drugs to society. Drug users are vulnerable Drug use is different from drug people. They suffer from production and supply. Too often, we inadequate medical assistance. lump everything together. Drug use is They experience discrimination, primarily a health issue and should be invasion of privacy, Police addressed through health-based responses. Drug production and harassment and social trafficking, on the other hand, should marginalisation. They have usually remain the domain of a drug to endure the arbitrary control system. deprivation of rights. After years of viewing drug use through a criminal justice lens, it can seem jarring to consider the ‘rights’ of people who use drugs. However, New Zealand’s National Drug Policy international agreements like the is based on this concept. The National Universal Declaration of Human Rights Drug Policy is a regularly updated and the World Health Organization’s framework that was developed by the government in the 1990s to encourage Constitution make it clear that action plans and community everybody has a fundamental right to programmes to reduce the problems decent standards of health. In the midst that drugs cause. of a ‘war on drugs’ approach, this right The National Drug Policy’s stated is often denied to people who use aim is “to prevent or delay the uptake of drugs. drugs, reduce drug-related harm, make As Hungarian civil libertarian and families and communities safer and researcher Judit Fridli points out, reduce the cost of drug abuse to “Drug users are vulnerable people. individuals, society and government.” They suffer from inadequate medical Unfortunately, this dynamic assistance. They experience up-to-date policy framework exists discrimination, invasion of privacy, around a piece of legislation – the Police harassment and social Misuse of Drugs Act – that has become marginalisation. They have to endure dusty and irrelevant, with its limited the arbitrary deprivation of rights.” goal of reducing supply. In many ways, incarcerating The competing philosophies of non-violent minor drug offenders has the drug policy framework and the added to the damage harmful drug use legislation create tension and causes, both to people who use drugs confusion. The law’s strict focus on and to their families and communities. eradication of supply undermines Incarcerating users instead of health measures that would accept providing appropriate healthcare might continued drug use. These could temporarily shut away the problem involve providing basic information on from society, but it means that we do

10 matters of substance February 09 www.drugfoundation.org.nz not identify the underlying factors that There is an obvious analogy with cause somebody to use drugs in the efforts to reduce the incidence of first place or come up with a suitable sexually transmitted infections. Research long-term solution to an individual’s has shown that campaigns to promote drug use. Overlooking drug users’ chastity are usually ineffective, so a rights ends up costing society. better approach is for campaigns to focus Research into different health-based on encouraging safer behaviour. responses to drug use has identified a Drug law focused on reducing the number of initiatives that work harm around drugs would help those effectively. Well-designed prevention communities that are particularly programmes can support children to vulnerable to drug misuse, rather than make healthy choices. Comprehensive exacerbating social exclusion by relying harm reduction services can reduce the on incarceration to deal with people health, social and economic damage who use drugs. Law that is based on associated with using illegal public health analysis would aim to substances. reduce inequality. It would also These programmes work best in an recognise that, to reduce or stop drug environment of support and openness misuse, recovery must be supported by that is very difficult to foster when the provision of social services, such as drugs are seen purely as a criminal housing and employment. justice issue. The fear of legal sanctions A new Misuse of Drugs Act based strongly deters people who use drugs on the principle of harm minimisation from seeking help and stigmatises would make its top priority efforts to them. That means we miss out on reduce the damage caused by drug use. opportunities to help people to give It would recognise that many of the up drugs or to switch to safer forms of harms we currently experience from drug use. drugs are related to their legal status. New Zealand is not alone in trying A health-based law would respect to update the way it deals with drugs. human rights, including the right of Policy reformers have suggested people to equal access to health services. changes in the United Kingdom, It would reduce the barriers that Australia and Canada in an effort to currently stop people from seeking help introduce a harm minimisation for drug-related problems and make it approach to drug control law. easier for them to access services such In Canada, the Health Officers’ as needle exchanges and other harm Council of British Columbia believes reduction programmes, treatment or “The balance point for determining emergency care for overdoses. public health policies for currently Such laws would complement other illegal drugs would be that which national public health laws and minimises the prevalence of harmful use strategies, including the National Drug and negative health impacts, and also Policy framework. minimises any indirect or collateral Sociologists and researchers have harms to society from regulatory provided us with a wealth of information sanctions.” about what would work better than our And in the United Kingdom, Tom current law. The next step is to put these Feedback Wood, Scotland’s ‘Drug Tsar’, told a lessons to good use. newspaper in 2006, “I spent much of my We have spent 30 years trying You can provide feedback on this essay Police career fighting the drugs war and ineffectively to stamp out supply under on our Misuse of Drugs Act review pages there was no one keener than me to fight the mistaken belief that drugs should be on our website www.drugfoundation. it. But latterly I have become more and dealt with solely as a criminal justice org.nz/moda, where we will publish papers, videos, case studies and other more convinced that it was never a war matter. It is time to take heed of more resources to support broad community we could win. We can never as a nation than three decades of experience. engagement during the Law be drug-free. No nation can, so we must Our drug law must be adaptable for the Commission’s review. A full list of accept that. So the message has to be more future instead of rooted in the past and, references used in this essay is also sophisticated than ‘just say no’ because most importantly, supportive of drug on the website. that simple message doesn’t work.” and health policies. www.drugfoundation.org.nz matters of substance February 09 11 Sentencing for serious drug crime – how tough are we?

Is drug dealing a more serious crime than murder or rape or terrorism? You’d think so according to drug laws in many jurisdictions, and New Zealand is no exception. Graeme Edgeler outlines your likely time if you do the crime.

Serious drug crime attracts serious will likely receive lesser sentences. and as the quantity increases so to do the penalties. At its upper levels, maximum Different levels of involvement in sentences imposed. The Court of Appeal penalties are comparable to those for our dealing with drugs result in different has elucidated starting points for those most serious crimes. Dealing in Class A sentences too. The Court of Appeal has convicted of dealing with drugs (that is, importing or exporting, stated that: methamphetamine, beginning for producing or manufacturing, supplying “All other things being equal, a low-level supply at 2–4 years, with at or administering, selling, offering to sell manufacturer is more culpable than least 13 years anticipated for large-scale or supply or administer, or possessing an importer and an importer is more manufacturing (see table). The starting for any of the preceding purposes) culpable than a supplier.” point of a sentence is not the actual carries a maximum sentence of life Despite the technical availability of sentence imposed. It’s what is imprisonment. This is the same as the long prison terms, low-level Class A considered appropriate to given maximum penalties for murder and drug dealing does not result in sentences offending, before taking into account the manslaughter and more than you could as high as for rape. offender and any aggravating factors receive for being part of a terrorist group But serious drug crime does. (like prior criminal history or the fact (14 years) or for rape (20 years). Dealing with drugs – particularly offending occurred while on bail) and Of course, it’s not quite that simple. Class A drugs like methamphetamine mitigating factors (like a guilty plea, Many crimes with identical maximum and LSD – is treated very seriously by previous good character or a diminished penalties see markedly different the courts. Dealing with Class A drugs is intellectual capacity). Actual sentences sentences imposed. Although importing, in a category with very few other crimes can be higher or lower. Guilty pleas may manufacturing and possession for – murder and rape – where the law result in a reduction of up to a third. supply all count as ‘dealing’ drugs and requires (in all except the most limited In contrast, the starting point for a attract the same maximum penalty under of circumstances) that those convicted standard rape charge is usually around the same offence, the courts do treat receive prison terms. Not even all those 8 years. And although murder carries a them differently. The possession of 5 convicted of crimes like attempted life sentence, the non-parole periods grams of methamphetamine for supply murder or manslaughter will necessarily start at 10 years – or 17 years for is treated more leniently than the receive prison terms (perhaps getting particularly bad murders (such as those importation of a kilogram of the stuff. home detention or even community involving a home invasion, a child In reaching a sentence, a defendant’s service or fines). But Parliament has victim or multiple victims). culpability is taken into account, and decreed that dealing with Class A drugs Undoubtedly, the penalties for different offending, even involving the is in a different league – so serious that a dealing with Class A drugs could be same offence, is treated differently. special section of law insists that prison made harsher. The maximum life Guilty pleas and prior criminal is the only option. sentence can’t be increased, but other history are also considered. Two people And it’s not just some prison time. jurisdictions – notably the United States charged over the same aggravated Not only are maximum possible – impose mandatory minimum robbery might see the one who physically sentences high, the actual sentences sentences. In the US federal jurisdiction, carried the gun serve longer, and two imposed for dealing Class A drugs are trafficking of more than 50 grams of people involved in a similar aggravated also substantial. Even a low quantity of methamphetamine carries a minimum robbery that didn’t involve a gun at all drugs can result in lengthy prison terms, sentence of 10 years. (Other aspects of

12 matters of substance February 09 www.drugfoundation.org.nz Dealing with drugs – particularly Class A drugs like methamphetamine and LSD – is treated very seriously by the courts. It is in a category with murder and rape.

Sale/Supply Importing Manufacturing Low level (< 5g) 2–4 years 2½–4 years Not applicable Commercial quantities (5–250g) 3–9 years 3½–10 years 4–11 years Large commercial quantities (250–500g) 8–11 years 9–13 years 10–15 years Very large commercial quantities (500g +) 10 years – life imprisonment 12 years – life imprisonment 13 years – life imprisonment dealing with drugs – manufacture and not have mandatory sentences (although strategy behind such a move, of course, supply – are generally prosecuted by some prison time is highly likely). is to control a drug by empowering the states.) What about lesser drugs? The courts to punish its use more heavily. New Zealand has very few crimes penalties for Class B and Class C drugs that attract mandatory minimums (the are substantially lower at their maximums Graeme Edgeler LLB is a Wellington-based law life sentence for murder is one, the 6 and in practice. However, drug specialist and blogger. month loss of licence for drink driving classifications can change, as occurred another) – even crimes involving serious in 2003 when methamphetamine was violence like wounding with intent do moved from Class B to Class A. The www.drugfoundation.org.nz matters of substance February 09 13 Opinion

Enforcing to reduce harm

Drug markets are extremely resilient to supply-side enforcement efforts and will quickly adapt without any significant long-term effect on street-level availability. However, as David Blakey explains, drug control enforcement agencies do have a role to play in reducing drug harms.

An enforcement approach that aims to number of users and therefore a decline reduce drug harms is already widely in overall harm. As a result, enforcement accepted among the agencies responsible efforts are often judged by the amount of for tackling drug markets and trafficking drugs or dealers taken out of the market networks. For instance, the Serious and the extent to which they have Organised Crime Agency (SOCA) increased drug prices or reduced drug explicitly aims to reduce the harm from purity (as proxy measures for reduced the illegal drugs trade within the UK. availability). This is reflected in the UK The 2008 drug strategy Drugs: protecting strategy, which states: families and communities also has a “…there is evidence from other similar emphasis in the chapter on law countries of enforcement-driven price enforcement. effects. As part of the wider drug strategy However, despite the general the Government believes that taking consensus that enforcement should action to increase the price of drugs is focus on reducing harm, there is no worthwhile. We would expect higher shared understanding of what it means in practice or how success in this area should be measured. Traditionally, It is very difficult for ‘harm reduction’ is associated with enforcement agencies to schemes undertaken by health agencies demonstrate that even the such as needle exchanges that aim to largest drugs hauls have had reduce the spread of blood-borne viruses any significant impact on and drug-related deaths. But what could street-level availability, let ‘reducing drug harm’ mean for enforcement agencies? alone levels of use. It is possible to identify at least four potentially different approaches through prices to deter new users, encourage which enforcement agencies might those reaching the end of their drug-using reduce harms caused by drugs. career to stop and reduce to some degree 1. Reducing availability the consumption of current users.” A ‘traditional’ enforcement model The drug strategy also emphasises interprets reducing drug harm to mean that supply-side activity will focus on reducing availability, which, it is tackling the drugs that cause the greatest assumed, will lead to a decline in the harm: Class A drugs.

14 matters of substance February 09 www.drugfoundation.org.nz However, there are some serious 3. Adopting ‘traditional’ harm reduction undermine community confidence questions about this approach as a practices through open drug markets, and fear and means to reducing harm. As the review A third approach uses a more intimidation. Therefore, whilst reducing we published indicates, it is very traditional understanding of harm availability might be one approach difficult for enforcement agencies to reduction, as directly reducing the under this model, other approaches also demonstrate that even the largest drugs harm caused by drug use on drug users. become possible. hauls have had any significant impact This approach may mean enforcement For example, it may be that by on availability, let alone levels of use. agencies adopt traditional harm focusing on prosecuting the most violent Evidence suggests that both the drug reduction practices themselves, for drug dealers, you are not intending to market and the drug user adapt to instance, introducing needle exchange reduce availability (other drug dealers changing circumstances. Dealers will schemes within custody suites, or it may are likely to fill the void) but you are reduce purity to keep drugs at a price mean partnering with treatment and aiming to reduce gun crime and gang- that can be tolerated by the market, and harm reduction agencies. Evidence related deaths (if the replacement suggests such partnership approaches drug users may simply choose to use an dealers are less violent). Alternatively, are likely to be more effective at alternative drug, or commit more crimes focusing resources on open markets in reducing drug harms than traditional to cope with rising costs. Thus, reduced residential neighbourhoods that cause enforcement in isolation. The availability may have unintended considerable nuisance and fear, rather International Harm Reduction consequences that could actually than on dealers operating within closed Association explains: increase harm, such as increasing levels markets that have less impact on the of crime or damage to health through the community, aims to reduce community use of harmful cutting agents. harms rather than availability per se. The use of opportunities There are many examples like this 2. Reducing demand within the criminal justice where drug harms might be reduced An enforcement approach to system to encourage drug by enforcement agencies without reducing demand could take several using offenders to engage in necessarily affecting either supply or forms. For instance, a crackdown on treatment has been shown to demand. This, of course, could lead to drug use followed by stiff sanctions some uncomfortable and challenging might provide a ‘deterrent effect’ for lead to a reduction in their decision-making where certain less some existing or potential users, drug use and associated harms harmful drug markets and drug dealers although the evidence for this is thin. such as crime. are tolerated as the ‘lesser evil’ to more It might also mean involving Police and harmful drug markets. Yet these types other agencies in drug education of decisions are already being made, programmes but, again, evidence “Harm reduction approaches seek implicitly, within enforcement agencies. suggests this is not an effective way of collaboration with entire communities, Without unlimited resources, reducing demand (although it may be and law enforcement personnel are prioritisation of what to enforce and effective at delivering other outcomes, essential front-line workers when it how is always necessary. such as improving knowledge). comes to any interventions for drug users The benefit of an explicit focus on However, another approach widely (both as a result of acquisitive, drug- drug harms should be that it encourages used in the UK seeks to reduce demand related crimes and the criminalisation of the development and dissemination of by encouraging problem drug using drug use itself). Police officers are often new approaches to enforcement and offenders into treatment. An earlier in contact with drug users when they are focuses assessment on what matters report from the UK Drug Policy at their most vulnerable. As such, they most: the harms associated with drug Commission, Reducing Drug Use, have a key role to play in harm reduction markets, rather than more traditional Reducing Reoffending, concluded that best (and worst) practice.” indicators (price, purity, seizures etc) evidence does support criminal justice 4. Focusing on the most harmful that are easier to measure but undersell interventions, such as arrest referral markets and dealers. the good work already underway that is schemes and Drug Treatment and An approach that focuses explicitly focusing on reducing harm. Testing Orders (DTTOs), which link on the harms or ‘collateral damage’ enforcement and drug treatment. The caused by drug markets has the potential David Blakey CBE QPM is a Commissioner for the UKDPC and was formerly Chief Constable use of opportunities within the criminal to differ from one that focuses on of West Mercia, President of ACPO and HM justice system to encourage drug using reducing drug use and availability across Inspector of Constabulary, www.ukdpc.org.uk. offenders to engage in treatment has the board. Drug markets themselves are been shown to lead to a reduction in associated with a range of harms such This article first appeared inPolice their drug use and associated harms as gang violence, prostitution, people Professional, Issue 128, 11 September 2008. such as crime. trafficking and corruption, and can also www.drugfoundation.org.nz matters of substance February 09 15 The New Zealand Drug Foundation was University Professor of Medicine Sir launched on 19 December 1989 with a John Scott would chair the Foundation. Telethon grant of $500,000 and just a Past President of the Mäori Women’s Twenty little controversy. Welfare League Elizabeth Murchie and The Foundation’s initial objective Wellington School of Medicine Professor was to reduce the prevalence and Dr Eru Pomare were appointed as severity of drug-related problems by trustees. Together, they would appoint years co-ordinating the efforts of non- a further four trustees to the board. governmental organisations working in But this didn’t all happen without the drug area. It would provide existing some hullabaloo. National MP and agencies with accurate and credible Misuse of Drugs Spokesman Graeme Lee said the money should have gone to young information about drug and alcohol assist the drug fight instead of issues while representing their interests establishing a foundation, although he at government level. did admit that something needed to be The impetus to set up a foundation done to co-ordinate drug education came from a drug education conference services. in May 1989 when workers representing Mr Lee also criticised the 25 organisations unanimously supported appointments of Ms Murchie and Dr a call for one body to co-ordinate drug Pomare, who were already members of education. The then Health Minister, the Home and Neighbourhood Trust, The Drug Foundation Helen Clark, and Education Minister, pointing to a conflict of interest. He also turns 20 this year. Phil Goff, both said school boards had said the Foundation would likely adopt We thought we’d start been faced with the prospect of choosing a policy in favour of decriminalising between many competing programmes, marijuana if John Hannafin, Chair of our birthday celebrations with isolated schools often missing out. the Drug Advisory Committee, was with a look back on our Our first cash injection was provided appointed as the new Chief Executive. by the Home and Neighbourhood Trust, Mr Lee was not alone in his formation, which was not set up to distribute the $5.25 million criticisms of the new venture. without its complications. given to the 1988 Telethon. Auckland The National Society for Alcoholism

16 matters of substance February 09 www.drugfoundation.org.nz Quotes of Substance: a history and Drug Abuse (NSAD) and the “Alcohol advertising works on the basis that New Zealanders are basically Alcoholic Liquor Advisory Council well-informed, and they’re going to make well-informed decisions about (ALAC) said they had only heard about alcohol regardless of what they see in the media. But the fact is that the Foundation a week earlier. New Zealanders aren’t well-informed: we’re horrendously badly informed “There should have been a closer about alcohol health issues.” look at the priorities needed in fighting Ross Henderson, Executive Director, 10 March 1993 the drug war,” said NSAD Chief Executive Michael Lynch, adding that he did not object to the Foundation’s “This is a complex issue that requires carefully thought out solutions. establishment. However, NSAD was also annoyed Our first step is to see exactly what is going on – to stand back and take at having missed out on some funding. an overview, not blinkered by the fact that alcohol is legal and cannabis “We were bitterly disappointed, because is illegal.” we were relying on the money, but we Chris Spence, Executive Director, 14 April 1997 won’t be going out of existence.” ALAC Chief Executive Keith Evans said the Foundation’s real value would “Prime Minister Jenny Shipley was dreaming if she thought lowering the come when it could “weld together” drinking age wasn’t going to cause more harm to young people.” the voluntary groups. “Co-ordination of Sally Jackman, Executive Director, 1 June 1999 approach is not high in people’s minds.” How times change. While they had a crack at us 20 years ago, this month, “It’s time the Government, political parties, communities and parents all NSAD (now the New Zealand Society took alcohol policy and alcohol-related harm more seriously. Not only is it on Alcohol and Drug Dependence) is co-hosting, with the Drug Foundation, estimated to cost New Zealand a net $2.4 billion to $16.1 billion a year – one of the most significant drug policy choose your economist – but it’s putting our children at risk.” meetings ever to take place in Ross Bell, Executive Director, 11 June 2004. New Zealand. Happy birthday to us! www.drugfoundation.org.nz matters of substance February 09 17 Down but not out – the findings of Youth’07

New research suggests college students smoke less tobacco and cannabis, have better mental health and improved nutrition and exercise more than students in 2001. However, not all the news is good. Researchers expressed concern around the numbers of students who binge drink, experience physical or sexual abuse, or witness violence in their homes.

Youth’07, a New Zealand-wide they see their lives – from their secondary school health and wellbeing perspective.” survey, was conducted by Auckland Dr Denny says one of the concerning University’s Adolescent Health Research areas is the frequency and amount of Group. The researchers collected the alcohol young people are drinking. data from 9,107 randomly selected “We need to be getting the message out secondary students and compared them to the teens’ family and friends, as they to the 2001 results. need to be aware of the problems with Students’ cigarette and cannabis use alcohol use among young people.” has declined. Only 8 percent reported Drug Foundation Director Ross Bell smoking cigarettes weekly or more in says New Zealand’s long-running 2007 compared to 16 percent in 2001. anti-smoking campaign, focusing on how Fewer students had tried smoking smoking damages the lungs, may have cigarettes – 32 percent in 2007 down influenced teens’ perception of all forms from 52 percent in 2001. The decline in of smoking, including cannabis. “Young smoking is supported by the findings of people are transferring the view that the 2007 Action on Smoking and Health smoking is bad for you to anything they (ASH) study, which showed that the smoke, whether it’s pot or tobacco.” number of Year 10 smokers had dropped European drugs experts found a by 28.6 percent between 1999 and 2006. similar downward trend and say the The number of students who have used reason could be our changing attitudes cannabis has also decreased from 39 towards cigarette smoking. Ross Bell percent in 2001 to 27 percent in 2007. says New Zealand’s fall in tobacco use Dr Simon Denny, the study’s had been expected, but the cannabis principal investigator, says the survey drop was surprising. These findings is the largest and most comprehensive suggest that one of the most effective health and wellbeing survey of young ways to tackle illicit drug harm might people in New Zealand. “It’s about be to target alcohol and tobacco. young people themselves telling us how Alcohol Advisory Council Executive

18 matters of substance February 09 www.drugfoundation.org.nz Officer Gerard Vaughan says the binge around 7,000 teenagers every year. Its It is not about not supplying alcohol at drinking figures are going in the right Director, Dr Sue Bagshaw, says, while all, but doing it in a responsible way direction, but are still concerning. the results of Youth’07 are interesting, and leading by example.” “Young people’s drinking has to be she would like more research done on But Ms Fraser is very pleased to see seen in the wider context of the adult alternative education schools. “We want the overall reduction in smoking and drinking culture in New Zealand. Young to know what is happening with those cannabis use. “It is pleasing to see such people learn their drinking behaviours students as they are much more at risk.” comprehensive surveys done in from those around them; until we change Dr Bagshaw says binge drinking at New Zealand. The results certainly the adult drinking culture, we will not teen age is a “rite of passage” in confirm a lot of what we see.” change the behaviour of young people. New Zealand and that nothing will “We also have to look at the wider change unless the marketing of alcohol, The full report is available at environment, the cheap price of alcohol, and alcopops in particular, is restricted. www.youth2000.ac.nz. increased availability and new products “If they are less available, people will do that appeal to youth.” it less. Look what we have achieved with Vaughan says it can also be difficult nicotine.” to communicate with teens. “Young But the restriction of advertising will people are risk takers. It’s hard to tell not work on its own, says Deb Fraser, young people, who feel they are bullet Manager of Dunedin’s Mirror Youth proof, to think of the consequences of Trust. “Sometimes, the parents will their actions.” provide their child with a one-litre bottle ALAC have been working with of vodka, and not actually follow up people at events such as the Pacific where their child is going,” she says. Youth Symposium on ways ALAC might “At times, it is challenging to educate effectively communicate with youth. those parents because they drink and Christchurch’s 198 Youth Centre sees smoke in the same way as their kids. Youth’07 Results

Smoking ■■ Almost 8% of students reported smoking cigarettes weekly or more often. Smoking was more common among female students (10%) than male students (6%).

■■ Among students who smoke, 37% buy their own cigarettes. Of these, the majority (60%) are not routinely asked to show ID.

Alcohol ■■ 72% of students have tried alcohol, 61% currently drink, and 30% drink once a week or more.

■■ 34% have engaged in binge drinking (five or more drinks within four hours) in the last four weeks.

■■ Substantial numbers of students reported problems from drinking alcohol, such as unsafe sex (14%), unwanted sex (7%) or injuries (22%).

■■ 6% of current drinkers had been told by friends or family they needed to cut down their drinking.

■■ The most common sources of alcohol for students were their parents (54%) and friends (53%). 14% of students buy alcohol themselves, and 35% get someone else to buy alcohol for them.

Illicit drugs ■■ Nearly 5% of students use cannabis weekly or more often. Among students currently using cannabis, about one in four use it before or during school.

■■ Almost one-third of students using cannabis have tried to cut down or stop using it.

■■ Use of other drugs such as acid, heroin, methamphetamine, speed or ecstasy was uncommon among students. Only 1.2% of students reported using methamphetamine, and of these, most had used it only once or a couple of times.

■■ Party pills were the most common of the ‘other drugs’ used by students, with just over 11% of students having tried them.

Mäori youth health ■■ The figures for Mäori students in 2007 have also improved compared to 2001 but are still higher than the national and wellbeing average figures. improved ■■ Mäori students are less likely to drink alcohol or use cigarettes and cannabis. Fewer reported they had ever tried alcohol (84.5% compared to 89.5% in 2001).

■■ Fewer reported having ever smoked a cigarette (50.1% compared to 66.6% in 2001).

■■ Fewer reported having tried cannabis (47.8% compared to 57.7% in 2001).

www.drugfoundation.org.nz matters of substance February 09 19 Guest Editorial

limited research on drug use and sexual substance use and drug policies, and of behaviours, legal barriers in access and On the allies who believe harm reduction can be stigmatisation all contribute to the an effective approach for young people. further marginalisation of young people We now have more than 200 members RISE for who are affected by substance use. worldwide, representing 62 different Over the past three years, Youth RISE countries! has seen an increase in interest and Please check out our website if you’d youth engagement amongst young people and like to get involved and sign up as a youth allies within the harm reduction member, or you can just email us with and HIV movement, and a small number questions or for further information. Youth RISE (Resource. of international policy makers are The Youth RISE Team looks forward starting to take notice. to hearing from you! Information. Support. Youth RISE advocates for the rights Education.) is an of young people who use drugs because, Caitlin Padgett is the International when the resources and support for Co-ordinator of Youth RISE, www.youthrise.org. international youth young people needed to reduce drug- network for reducing related harms are unavailable and when Take Two to Thailand drug-related harm. sexual and reproductive health services do not address the link between Caitlin Padgett introduces substance use (including alcohol) and the movement. sexual health risks, our right to the highest attainable standard of health is being denied. Many young people live in a world When young people who use where illicit drugs are more readily injection drugs or are affected by drug accessible than the education, resources use are excluded from global and or treatment necessary to reduce drug- regional HIV/AIDS and drug policy related harms. Often, drugs are available design and implementation, our right to where social services are not. participation is being denied. And when education fails to honestly address Currently, there are an estimated 13.2 Youth RISE is asking organisations to million people who use injecting drugs drug-related harm and sexual and sponsor young leaders to attend the 20th in over 155 countries worldwide. Up to reproductive health, our rights to International Harm Reduction Conference 30 percent of all new HIV infections education and to freely access in Bangkok, Thailand, April 2009 (see back worldwide are attributed to injecting information are not being respected. page advertisement). drug use, and many are young people. In this fight towards equality and The Take Two to Thailand campaign In addition, estimates from the UN equal access, Youth RISE has sought to encourages organisations to sponsor a General Secretary state that 92 percent provide a voice for some of the most young person to attend the conference in of people who use injection drugs in marginalised youth worldwide. We have addition to (or instead of) their staff or low- and middle-income countries have participated in many conferences such representatives. A similar principle was no access to HIV prevention, and less as the international AIDS conferences in used for the 2006 International AIDS Conference where over 100 young people than 5 percent have access to treatment, both Toronto and Mexico, the first global attended courtesy of 31 organisations. care or support. methamphetamine conference, the Harm In many regions, the average age of Reduction Coalition conference and the Young people are disproportionately first injection is decreasing, and in some last two international conferences on affected by both substance use and drug policies worldwide. However, they are countries, it is as low as 15 and 16 years reducing drug related harms in Warsaw often excluded from global discussions and and Barcelona and the upcoming one in of age. Yet young people who use drugs decision making processes around harm are some of the most marginalised, Bangkok. We have also been involved in reduction – despite various international stigmatised and criminalised individuals the High Level Meeting on HIV/AIDS commitments that explicitly state young in society. They are systematically and the Beyond 2008 NGO Consultation people’s right to participate. By providing excluded from life-saving prevention on Drugs. We have done this to advocate young people with the opportunity to services and support, and proven harm for the greater inclusion of young people participate in events such as Harm reduction strategies are deemed too within harm reduction programming and Reduction 2009, you can help Youth RISE and future harm reduction pioneers gain controversial. Barriers such as the lack planning. invaluable experience, networking of disaggregated data, lack of youth- We are a network of young people opportunities and knowledge. friendly and peer-to-peer youth services, affected either directly or indirectly by

20 matters of substance February 09 www.drugfoundation.org.nz Despite cannabis being the most widely used illicit drug worldwide, it is rarely the focus of international drug policy control discussions. In light of this, The Beckley Foundation has released a report claiming prohibition is doing more harm than good and calling for urgent discussions on cannabis policy. If the ‘War on Drugs’ must continue, Rob Zorn asks, is it time we removed cannabis as one of its targets?

At the options for governments limited to United Nations General Should cannabis be legalised? Assembly Special Session held in little more than varying the severity New York in June 1998, the international of penalties for drug offences. YES community agreed on a 10-year Cannabis is the most widely used There is little evidence that cannabis use programme towards eliminating or drug in the world by far, with an would increase as a result of legalisation significantly reducing illicit estimated 160 million people using but, even if it did, the harm reduction manufacture, supply and demand for cannabis in 2005. Despite this, cannabis benefits gained would greatly outweigh drugs. The optimistic slogan under has received little direct attention in any negatives. which the programme was agreed was international drug policy discussions. Compared to the devastations wrought ‘A drug free world – we can do it!’ by alcohol and tobacco, which are legal, In March 2007, the UN Commission the harms associated with cannabis are relatively minor. on Narcotic Drugs met in Vienna to Policies introduced to decide on issues of global drug control, control cannabis have had Legalising cannabis would remove the and one can only guess at the levels of drug’s supply channels from the hands of subdued unease delegates must have little impact on its prevalence, criminal groups. felt. The 10-year deadline was and most of the harms The illicit cannabis industry generates approaching but, since 1998, drugs had associated with it result from tens of billions of dollars – money that only become cheaper, purer and more prohibition itself. governments could be collecting in taxes readily available. and spending on harm reduction. At that Vienna meeting, it was agreed that a high-level political gathering This, then, is the context in which NO would be held in the spring of 2009 to UK think tank The Beckley Foundation Legalising cannabis would lead to a review progress and to agree the way convened a team of international drug significant increase in its use, which might forward for the next 10 years. It is policy experts, the Global Cannabis encourage people to try harder drugs. difficult to think of an optimistic slogan Commission, to prepare an overview of Once cannabis is legal, it would only be a that could underpin this meeting given scientific evidence around cannabis and matter of time before other more serious there has been no significant progress in the policies that attempt to control it. drugs were made legal. controlling illicit drugs pretty much Its report, Cannabis Policy, Moving We need to send the strong message to anywhere. Beyond Stalemate, was published in society that drug use is harmful. Making Influenced largely by the United 2008, with the aim of bringing cannabis illicit drugs legal undermines that message. States’ ‘zero tolerance’ policies, the 10 issues to the attention of policy makers Some forms of cannabis, such as skunk, years of drug control efforts worldwide and informing discussion at the 2009 are very harmful and have been linked to have mostly amounted to a ‘War on United Nations Strategic Drug Policy the onset of mental health problems. Drugs’ approach, with drug policy Review meeting. www.drugfoundation.org.nz matters of substance February 09 21 The Global Any regime that makes cannabis legally Cannabis available should: Commission’s involve state licensing or state operation recommendations of entities producing, wholesaling and retailing the drug (as is true in many to countries jurisdictions for alcoholic beverages) contemplating legalisation of cannabis

either directly, or through regulation, control potency and quality, assure reasonably high prices and control access and availability in general and particularly to youth

While acknowledging that cannabis individual from certain jobs and Firstly, the UN drug control is not a safe substance, the main thrust activities, and arrest can impose conventions require cannabis use to be of the report is that policies introduced humiliation. Cannabis users can be an offence (although there is debate over to control cannabis have had little drawn into the criminal world and, the interpretation of this and the impact on its prevalence and that most in countries where data are available, flexibility allowed by the conventions). of the harms associated with it result arrest rates are sharply higher for minority States that have begun relaxing cannabis from prohibition itself – particularly the and socially disadvantaged groups. laws can therefore expect to be pressured social harms arising from arrest and The report makes several at the UN level. The Netherlands, for imprisonment. recommendations towards improved example, has been rebuked by the These findings will not be a surprise cannabis policy, ranging from the mild European Union, the United Nations to those who have long felt something is (police giving low priority to enforcing Office of Drugs and Crime, the USA seriously out of whack with cannabis cannabis laws) through to and other countries who say its relaxed laws worldwide. decriminalisation and legalisation. cannabis policies undermine As the report acknowledges, cannabis In a decriminalised system, offenders international collaborative efforts to can have a negative impact on both could be processed outside the justice reduce illicit drug use, production physical and mental health. In terms system, fines would be low and and trafficking. of relative harm, however, it is counselling and education could be A second problem will be in considerably less damaging than alcohol offered instead of imprisonment. generating sufficient political will to or tobacco, both of which are freely If cannabis was made legal, bring about legislative change. There available and legal. While there have governments could use a variety of are two reasons for this. Firstly, there is only ever been two deaths worldwide mechanisms to regulate it such as vocal opposition in most jurisdictions attributed to cannabis, alcohol and taxation, availability controls, minimum to relaxing drug laws by those who say tobacco cause literally millions of deaths legal age for use and purchase, labelling legalisation will encourage increased each year. More than half the arrests for drugs and potency limits. This would greatly cannabis use and lead to worldwide are for minor cannabis increase harm minimisation possibilities experimentation with harder drugs. offences and, suggests the Commission, such as delaying onset of use until early Secondly, popular opinion usually the damage done by criminalising these adulthood and encouraging users to supports retention of prohibition, and in minor offenders appears to far outweigh avoid driving after taking cannabis. most democratic countries, the majority the damage cannabis causes to However, as the report states: “That of politicians’ views will reflect the individuals or society. which is prohibited cannot be regulated.” majority of the population’s. In addition to the substantial The report favours a decriminalised, Therefore the report’s call for a government resources needed to enforce regulated market in cannabis as the re-think on policy so that it becomes prohibition, very large secondary costs best option, but it acknowledges that grounded on an evidence-based scale of and suffering result at a personal level. those working for decriminalisation, harm may largely be falling on deaf ears. For example, a criminal conviction for legalisation or any significant reform In the UK, for example, cannabis was cannabis possession can exclude an face an uphill battle. downgraded from Class B to Class C

22 matters of substance February 09 www.drugfoundation.org.nz Quotes of Substance

I’m like an alcoholic. When I see how much good ensure that appropriate information it’s doing, I can’t stop. is available and actively conveyed to Hollywood actress Salma Hayek admits users about the harms of cannabis use. Advertising and promotion ensure the possibility for prompt she is addicted to breast feeding, but should be banned or stringently and considered revision if the perhaps could have used a better analogy. limited to the extent possible policy increases harm.

I feel extremely strongly about this subject and desperately want to see a reduction in drug abuse monitor impacts of any and better paths to enable people changes, including any to get out of it. If one takes a unintended adverse effects slightly progressive – or, as I like to think of it, thoughtful – view, one can sometimes be accused of being soft. I reject that utterly. UK’s Conservative Party Leader when Tony Blair was Prime Minister, University, told the Edmonton Sun. David Cameron says he’s not afraid making police unlikely to arrest people “I will say to [Canadian Prime to talk about drug law reform. carrying small amounts and moving Minister] Mr Harper that, even from Britain closer to the ‘relaxed nation’ a conservative policy point of view, category. However, Home Secretary there are many, many good reasons to P coming on to the market Jacqui Smith has pledged to reclassify not be content with the status quo of has been great for business, the drug to Class B to avoid “risking the cannabis use control in this country. I must admit. future health of young people”. This is “It costs a lot of money, it’s very Paul Thomas, former Police dog handler, despite having read the Commission’s ineffective and it’s counterproductive.” who is now a managing director of Elite report and accepting most of its other We’re now more than 10 years on Dog Services – the first private company in recommendations. from the UN General Assembly’s New Zealand to use drug detector dogs in Nevertheless, the report outlines four declared intention to bring about a the workplace. possibilities for governments seeking to drug-free world, and they clearly haven’t make cannabis available in a regulated done it. When it meets again this year, market in the context of existing surely alternatives to prohibition will My disgust on this subject is not international conventions. have to be considered. But current directed at the vulnerable people The first option is to follow the Dutch conventions have kept cannabis illegal caught up in a spiral which leads model, which technically meets the in all countries, and these will not be them to crime. It is directed at letter of the law while allowing de facto reversed overnight. people who make money out of access to cannabis. Secondly, a nation The best we can probably hope for other people’s misery. may simply ignore the conventions, is that a process will be started to though any government following that change the international drug control Newly appointed Police Minister Judith route must be prepared to withstand conventions to allow a state to Collins says where she thinks drug control substantial international pressure, implement its own cannabis control efforts should be targeted. the report warns. strategies within its own borders. A third option would be to denounce It will be interesting to see what the 1961 and 1968 conventions and then happens, but somehow we’re unlikely What’s the difference re-accede with reservations respecting to see the assembled delegates accepting between a drug user and the cannabis. Finally, along with other the slogan: ‘A drug free world – we’re solution? Nothing. They’re both willing countries, a state could negotiate not even going to try’. no-brainers. a new cannabis convention on a supra- Sensible Sentencing Trust drug national basis. Rob Zorn is a Wellington-based writer. spokesperson demonstrates that “We wanted to facilitate an informed The Global Cannabis Commission report, organisation’s caring and sensitive side. debate and then… present some options Cannabis Policy: Moving Beyond Stalemate is on what individual countries could do,” available at The Beckley Foundation website, co-author Benedikt Fischer, a professor of www.beckleyfoundation.org. health sciences at Canada’s Simon Fraser continued on page 25 www.drugfoundation.org.nz matters of substance February 09 23 Alternative development in the Golden Triangle – reality or myth?

Drug control officials have hailed the declining opium cultivation in Burma, Laos and Thailand in the last decade as a great success, but Martin Jelsma and Tom Kramer, from the Transnational Institute, say indicators are that this is anything but the case.

The region, better known as the Golden and to eliminate opium production. Triangle, was once the world’s largest The problems are seen as very much opium producer. But, today, that position connected, and blame for both is put has been taken over by Afghanistan, squarely on small-scale farmers. which is responsible for over 90 percent The Lao government declared the of global opium production. country opium-free in February 2006. “The Golden Triangle is closing a Some small-scale opium cultivation dramatic period of opium reduction,” continues, mainly in small, hidden plots said United Nations Office on Drugs and in remote mountainous areas. Crime Director Antonio Maria Costa. There is, however, little reason for “A decade-long process of drug control optimism. First of all, the exact size of is clearly paying off.” the decline is debatable, as there are In both northern Burma and Laos, serious questions about the accuracy of opium cultivation declined due to policy the original Burmese production figures decisions by local authorities. Opium at the end of the 1980s and the early cultivation in Burma partly dropped 1990s. Some observers believe that as a result of a number of opium bans these figures were high and politically declared by cease-fire groups in northern motivated to claim credit later for a Shan State. In return, they hoped to gain decline that only existed on paper. international political recognition and Annual opium production in Burma support for the development of their may have never exceeded 1,000 metric impoverished regions. tonnes, still roughly double the amount The Lao government’s policy to reported for 2007. eradicate poverty by 2020 has two Furthermore, recent years have seen priorities: to end shifting cultivation a shift in cultivation patterns to new

24 matters of substance February 09 www.drugfoundation.org.nz Quotes of Substance areas in Burma, and the last two years hundred years. The fact that opium My immediate reaction is to have once again seen increases in opium poppy is highly valued and easily suggest it’s up to your client to production. The main increase has been cultivated in remote mountainous areas prove his or her suitability. in southern Shan State. Transnational with undeveloped infrastructure and That’s not going to be easy in the Institute (TNI) research carried out in transportation systems has made it a absence of your client. 2008 showed that opium cultivation crop with which it is difficult to Judge Unwin shows his displeasure at an was also up in townships in eastern and compete. Opium poppy cultivation is applicant’s failure to attend a Liquor northern Shan State. Additionally, strongly linked to poverty. Both Burma Licensing Authority hearing at the Porirua double cropping was reported in areas and Laos score lowest on the human District Court. More than 100 residents in southern Shan State. development index in the region, and marched outside the hearing protesting The decline of opium production in the traditional poppy growing regions against the application for yet another the Golden Triangle is not simply the in these countries are the worst off. liquor outlet in Cannons Creek. result of policy interventions by local Most of the cultivators are poor villagers authorities in Burma and Laos. It is from different ethnic minority groups. crystal clear that trends in the global Traditionally, they use opium as a market contributed significantly to the If you place a liquor store in medicine against malaria, respiratory Cannons Creek, then you might as shift of production from the Golden diseases and diarrhoea, and as a Triangle to Afghanistan. well place a bigger police station painkiller. Opium is also used at there as well. traditional festivals and ceremonies, including weddings and funerals. Youth worker Fa’amatuainu Wayne Opium seeds are used to produce Potoa joins more than 100 Cannons Creek cooking oil, and opium is also connected residents at a protest against the growing to spirit worship and sometimes used number of liquor outlets in their instead of money. community. Mr Potoa added that alcohol Most importantly, opium poppy is has serious consequences for the youth the key cash crop for these communities. he works with. They can often produce only enough rice Tom Kramer Tom to feed their families for four to six months Children in opium field, Wa region, Burma. a year, and according to a TNI researcher, Despite extensive funding, “Opium cultivation pays for the governmental agency support, household’s needs, including children’s the employment of professional This is not a new phenomenon. advertising and public relations Throughout history, there have been education, healthcare, food and household materials… People think that cultivation firms, and consultation with various remarkable shifts in the subject-matter experts, the international opium and heroin market. of opium poppy can help overcome the problems they face in their lives.” evidence from the evaluation These include the shift in cultivation suggests that the National Youth from Turkey to Iran and Pakistan in the In Burma, people are unhappy with the ban. “Everything is getting worse,” Anti-Drug Media Campaign had 1970s, and later to Afghanistan, and to no favourable effects on youths’ said a 60-year-old former poppy farmer in new cultivation in areas in Mexico and behaviour. Colombia. Heroin of Burmese origin has the Wa region. “People are desperate for Lloyd Johnston, principal investigator for been almost completely pushed out of food and clothes. They want to know why the European and North American there was an opium ban in the Wa area the Monitoring the Future study, gives a markets by heroin originating from when there was no ban in other places.” blunt assessment of the (in)effectiveness Afghanistan (in Europe) and Latin Farmers in northern Laos face similar of anti-drug campaigns in the US. America (in the US). Virtually all heroin challenges. “Opium in Laos is not the originating from Burma is currently big problem any more in the sense of consumed in Southeast Asia, China, drug production,” says a Western aid These are hard-hitting ads – India, Australia and Japan. worker in Laos. “It is a problem because that’s because we are dealing with What is more worrying is that the farmers can’t grow it anymore.” a group of people who think they opium decline has caused major Current levels of assistance to offset are bullet proof. suffering among former poppy-growing the impact of the opium bans are woefully The Australian government on a new ad communities in Burma and Laos. It is insufficient. International reactions to campaign targeting youth binge-drinking. therefore hard to claim this as a “success the post opium ban crisis in Burma and story”. Opium poppy has been cultivated Laos can best be described as ‘emergency in the mountains and hills of northern responses’. The main problem with the Burma, Laos and Thailand for over a bans is that the policy interventions have continued on page 26 www.drugfoundation.org.nz matters of substance February 09 25 Quotes of Substance

A New Zealand survey of 15 been wrongly sequenced. In Thailand, Interventions should comply with the and 16 years olds showed that the substantial time and resources were aims of human rights protection, conflict more often they went into stores invested in creating alternative resolution, poverty alleviation and that displayed tobacco products, livelihoods for poppy farmers before human security. They should also have the more likely they were to start the authorities introduced bans, and no a participatory approach and respect smoking. This should not come as deadlines were set for the elimination of traditional culture and values. a surprise. Clearly advertising opium poppy cultivation. In Burma and Interventions should be properly works, otherwise companies Laos, this has not been the case. sequenced. In particular, there should be would not pay for it. There are clearly serious questions no eradication or strict implementation of opium bans unless viable and Cancer Society Chief Executive about the sustainability of opium bans in sustainable livelihoods are in place. Dalton Kelly wants New Zealand to Burma and Laos. Early warning signs are Aid should not be made conditional follow New South Wales legislation to already apparent in Burma where opium on reductions in opium cultivation. remove retail cigarette displays. cultivation has spread to other areas in Shan State. There has been a marked Without such approaches, it is increase in production over the past two unlikely that the reduction in opium production will be sustainable. It is vital Pubs play a vital role in years, confirmed by UNODC figures, that the international community does communities up and down the which may be conservative. not abandon the Golden Triangle at this country and are an essential part In 1998, a declaration was signed to crucial time. of promoting a more responsible make the Association of Southeast Asian Nations (ASEAN) drug-free by 2020, drinking culture. It is hard to avoid Martin Jelsma and Tom Kramer work for the and two years later the deadline was the conclusion that a great British Drugs and Democracy Programme of the tradition is being abandoned. brought forward to 2015. Countries Transnational Institute (TNI). TNI’s study, elaborated national plans to comply, British Beer and Pub Association (BBPA) Withdrawal Symptoms in the Golden Triangle – putting huge pressure on farmers to Chief Executive Rob Hayward fears a Drugs Market in Disarray is available at abandon poppy cultivation. The 2008 www.tni.org/drugs. increased alcohol taxes will increase status report on progress acknowledges pressure on struggling pubs. BBPA says the “a target of zero drugs for production, taxes are the “death warrant” for pubs trafficking and consumption of illicit across the UK. drugs in the region by 2015 is obviously unattainable”. Over the last decade, there has been This is an idiotic waste of considerable progress in understanding money. People don’t pay their the impact and lessons learned through taxes for drunk women to get free rural development in opium poppy flip-flops, they want the police to growing areas, usually referred to as fight crime. The Police aren’t there ‘alternative development’. Experience to be an emergency supplier of has shown that alternative development flat shoes. KADAC can address the needs of targeted rural Matthew Elliott, Chief Executive of the Opium harvest in Pao region in Southern Shan communities and can contribute to a State, Burma. UK’s Tax Payers’ Alliance, is not impressed reduction in crops. with the Police’s latest weapon to tackle Among the important lessons learned BURMA binge drinking. Officers and safety officials is the need for an integrated approach. in Torbay, Devon, were handing out jandals All actors involved in rural INDIA to revellers spotted staggering home in development, including government, CHINA unstable high heels or bare feet. development agencies and civil society

organisations, should take into account BURMA the causes of opium cultivation in their development strategies and plans. It is BAY OF important that alternative development BENGAL THAILAND is not limited to a project approach, but guides national and local development

INDIAN programme design and implementation. OCEAN 0 200 miles The cultivation of opium poppy often 0 200 km GULF OF takes place in areas plagued by conflict, THAILAND continued on page 28 insecurity and vulnerability.

26 matters of substance February 09 www.drugfoundation.org.nz Something for the pain

Inappropriate restrictions on opioid painkillers are condemning millions of people to an agonising death, says Rachel Nowak.

Soon, Afghan farmers will start planting North America or Australia, you can cases globally each year. According to the poppy fields that are the main source expect a reasonably comfortable end, the World Health Organization (WHO), of the opiates that feed the world’s while in almost any low-income the majority will be in the developing illegal heroin trade. Billions of dollars country, you will die in great pain. world where fewer people are will be spent trying to destroy the crops The pain means you won’t sleep, your succumbing to infectious diseases while and stop the trafficking. personality will change, you will lose more adopt cancer-causing behaviours Drug addiction and the ramifications the capacity to care for your family and such as tobacco use. of the illegal drug trade need to be dealt you may commit suicide. If it is your AfrOx, based in Oxford, UK, which with. But there is another drug problem child who is dying, you will have to aims to tackle Africa’s looming cancer that arguably causes far more suffering watch helplessly. epidemic, is one of a number of but gets only a fraction of the attention: organisations arguing that pain control the chronic underuse of opiate-based should be an immediate medical and painkillers in poor countries. Misplaced fear of addiction humanitarian priority. This can be done Global consumption of these drugs means that even terminally relatively cheaply: a month’s supply of has more than doubled in the last two morphine costs just a few dollars. decades as the alleviation of pain has ill patients may not get So where are the hold-ups? come to be taken more seriously. Yet in morphine. A major one is the over-zealous the developing world, they are hardly regulation of painkilling drugs. ever used. According to the International Under the UN Single Convention on Narcotics Control Board (INCB), 80 Unless urgent action is taken, even Narcotic Drugs, which dates from 1961, percent of the world’s population more people will be condemned to a governments are obliged both to prevent consume just 6 percent of its morphine, similar fate. On top of the existing AIDS trafficking and abuse of opiates and to the most widely available opioid for crisis, the developing world is facing a ensure that people in pain have access treating moderate to severe pain. cancer epidemic. Extreme pain is a to medical opiates. Unfortunately, most If you are dying of cancer, for feature of both conditions. By 2020, countries concern themselves only with instance, in most of western Europe, there will be 16 million new cancer preventing abuse. www.drugfoundation.org.nz matters of substance February 09 27 Quotes of Substance

With many young Scots destroying their lives by shooting up heroin and other dangerous drugs, we owe it to their families and our communities to make sure our spending in tackling that is much more than a shot in the dark. Scotland’s Community Safety Minister Fergus Ewing highlights the importance of getting drug policy spending right.

It is scandalous that less than 10 percent of injecting drug users have access to evidence-based HIV prevention and care services… Many young people still lack accurate information about how As a result, patients are forced to In many places, the officials who to avoid exposure to the virus. travel hundreds of kilometres to the few organise a country’s supply of opiate- Let us empower the youth with doctors who can legally prescribe based painkillers are unaware of the information. opiates or the pharmacists permitted to unmet need. And such is the fear that United Nations Office of Drugs and Crime dispense them. Doctors risk arrest if they patients may become addicted that many Executive Director Antonio Costa marks provide pain relief to children or write doctors are reluctant to prescribe opiates the 20th anniversary of World AIDS Day prescriptions for more than a few days’ even to those who are terminally ill. with a new harm reduction resource for supply of pain medicine. The WHO This may stem from a mistaken estimates that, every year, tens of young people who inject drugs. association between medical use of millions of people with severe pain get opiates and the violence, poverty and ill no effective treatment, in part, because health that often accompany dependence We should remember that of restrictive drug laws. on illicit drugs. In fact, only a minuscule the human rights of vulnerable Some countries have changed their proportion of people treated with opiate groups, including drug users and laws to allow improved pain control. painkillers develop a compulsive need prisoners, are violated every day. Since 2004, Uganda has abolished laws Instead of showing compassion, dating from colonial times that to continue using the drugs, although we stigmatise drug users and prohibited anyone but doctors from they may develop symptoms such as cast them out as pariahs. prescribing narcotic painkillers and now anxiety if a drug is stopped too abruptly. The 2008 World Cancer Summit Top marks to Mr Costa again, who, allows trained nurses to prescribe them too. This makes sense, as 60 percent of in Geneva, Switzerland, endorsed a on the 60th anniversary of the Universal people in Africa will never see a doctor, declaration that makes tackling barriers Declaration of Human Rights, highlights according to the African Palliative Care to pain control a priority. This is an that the rights of people who use drugs are Association in Kampala, Uganda. important and commendable step, often violated by drug control measures. Meanwhile, many Indian states have but dealing with this level of suffering eased regulations that previously made it will require a concerted international difficult to transport morphine from the Heroin is consumed by people effort. Illicit trade in medical opiates is manufacturer to the hospital. on the margins of society, loitering extremely rare. Now the signatories to These measures show what can be in parks, near underground the international convention must done, yet pain control is still out of stations, or congregating around show that they can meet another key reach of the majority of people, even in grubby treatment centres. obligation: ensuring the adequate use Uganda and India. M R Rajagopal, a of medicinal opiates in pain control. Oh dear. ‘Grubby treatment centres’? palliative care expert at the SUT Mr Costa succeeds in insulting the many Academy of Medical Sciences at Rachel Nowak is New Scientist’s Australasian thousands of addiction treatment workers Thiruvananthapuram in the south Indian editor. across the world. state of Kerala, told the World Congress on Pain in Glasgow, UK, that morphine © New Scientist, issue 6 September 2008, reaches fewer than 1 percent of Indians www.newscientist.com. continued on page XX who need it.

28 matters of substance February 09 www.drugfoundation.org.nz New Zealand News

Surgeon’s story detention sentences. “People talk about “Squeaky clean” liquor doesn’t wash “We need to do more to sport and drinking as being store on school’s doorstep make the risks real to people intrinsically linked, only Two North Shore schools, who would embark on this because we’ve allowed them Rangitoto College and St John path. The importers, to be,” he said. School in Mairangi Bay, are manufacturers, dealers and opposing a liquor store that suppliers… These people are Students cry but binge could open within 100 metres targeting our children and we drink nevertheless of their front gates. But need to target these criminals business owner, Charlie Singh, instead.” said his planning and building The departed Labour certificates were issued by the Government had been North Shore District Licensing considering a centralised Agency, and he was told his computer system allowing shop would not breach any You may have followed the individuals’ purchases of city bylaws. story of surgeon Ian Denholm, pseudoephedrine products to St John School principal Head of Orthopaedic Surgery be tracked and monitored. With Bernard Fitzgibbon said the at Wairarapa Hospital, who 70 percent of methamphetamine liquor store’s opening would tried to get off a drink-drive precursors being sourced from provide young people easy charge by blaming alcoholic within the country, a similar access to alcohol, exacerbating handwash. The matter was programme could be existing problems. He believed resolved in November when beneficial to New Zealand, putting a liquor outlet on a Mr Denholm, 53, was Ms Collins said. spot thousands of children The Alcohol Drug Association convicted of drunk-driving, walked past daily would (ADA) ran a nationwide fined $500 and deprived of Sponsored athletes normalise the purchasing of survey that found a third of his licence for six months. drink more liquor for them. students had blacked out Denholm argued he had an North Shore Liquor New Zealand sports team during binge drinking, with extraordinary ability to absorb Licensing Inspector Peter members sponsored by 37 percent reporting binge alcohol from the gel because Richardson said Mr Singh had alcohol companies drink drinking at least once in the of eczema-damaged skin. His done everything to meet more as a result. A study of past week. arguments failed to wash with council requirements. “At the 1,279 athletes found close to ADA Chief Executive Cate the Wellington District Court moment, he’s squeaky clean.” half received sponsorship that Kearney said calls received judge. The judge agreed to He said because there had included free or discounted by the Alcohol Drug Helpline defer the disqualification been eight objections the alcoholic drinks. Study included a 19-year-old until 23 January, as Denholm matter would be referred to the co-author Dr Kypri found woman at a South Island was the on-call surgeon for Liquor Licensing Authority. that, when free alcohol was university. “I just can’t do this the Wairarapa area over provided, drinking rose to any more,” she said. “I can’t Christmas and New Year harmful levels – which, for recall what I’ve done or who SADD school period and needed to drive. most participants, was more I’ve done it with. I’m feeling party turns sour than six drinks in one sitting. sick with embarrassment and Drunken teenagers at a New Police Minister vows Even free uniforms were shame. You should see all the party funded by a high to fight P peddlers enough to encourage players bruises I’ve got.” school’s anti-drink-driving National has pledged to to drink. Many sponsors Ms Kearney said alcohol group have trashed a rural clamp down on peddlers of provided free alcohol regulation and misuse needed Southland hall. methamphetamine as part of a immediately after games and to be an important issue for Bottles were thrown at promised tough approach to free or discounted bar tabs at the new government. Calls to passing cars and into a drug crime. Methamphetamine their pubs, taverns and hotels. the helpline suggest that it’s children’s playground during was a “scourge” on society, Many athletes said they alcohol rather than the out-of-control party, which could not be allowed felt obliged to drink a methamphetamine that was organised by high school to grow, Judith Collins said in sponsor’s product after the scourge of New Zealand. pupils using money from her first speech as Police training and games. Dr Kypri The web-based survey the St Peter’s College SADD Minister. National planned to said governments should covered the drinking habits (Students Against Driving ban known methamphetamine withhold financial support to over a four-week period of Drunk) committee, last Friday. dealers from being eligible for teams receiving sponsorship 2,548 students from five Damage to the Waimumu electronic bail or home from the alcohol industry. universities. Hall near Gore has disgusted www.drugfoundation.org.nz matters of substance February 09 29 locals and prompted Police misses a test for some Cops save us mayoral 5drugs62013 summit2 of 100 to warn parents against innocent reason, like there’s a $300 million. Maybe. community leaders, which providing alcohol to young change to a training venue, called for zero tolerance of people going to parties. then technically it’s deemed drug supply. Brown is Waimumu-Te Tipua Hall to be a refusal. Therefore, they scheduled to meet Prime Society President Duncan could be branded a drug Minister John Key to discuss Falconer said the hirer had cheat, and that’s crazy. the issue. Key’s government given an assurance there Imagine what would happen if has promised to fund 300 more Police officers in would be parental supervision [Dan Carter or Richie McCaw] South Auckland, and Brown at the party. missed a test? It would make now wants them to target “Had we known that huge headlines throughout methamphetamine labs and would not eventuate, we the world, so naturally we’re ‘tinnie houses’. would have gone down (to the pretty concerned.” “If we don’t shut this hall) and turned people away.” About 400 Kiwi athletes drugs trade NZPA down,56632 we are in Sergeant Craig Sinclair, of will be chosen to join the Police estimate they have danger of condemning the Gore, said Police were also register, but it has not yet been saved the country over $300 next generation of people in investigating complaints of decided how many rugby our community to something million in socio-economic assault after fighting outside players would be included. worse than we presently have. harm in a bumper year the hall. We are looking at a designated of cannabis busts, based on Drink-drive iPod drugs line, an 0800 line, for the New Zealand Drug Harm New testing code a waste of breath people to pass on Index. They have destroyed information.” worries rugby officials Police are warning people over 124,000 cannabis plants He said police were not to rely on plug-in iPod and arrested 780 people in already starting to see drug breathalysers to monitor their drug raids in the past year. dealers using guns – notably drinking this festive season. They are crediting good in the murder of undercover An American company flying weather and targeted Police sergeant Don Wilkinson has been selling the ‘iBreath’ air surveillance for the outside a house with – a combined breathalyser success of the nationwide suspected drug trade and FM radio – which plugs cannabis crime effort, labelled connections last September. into the bottom of an iPod or New Zealand Rugby Operation Julia, which saw 25 iPhone and has a fold-out tube. Players’ Association boss percent more cannabis plants Dubbed as a Christmas Rob Nichol has voiced fears destroyed than last year. “must have”, the breathalyser, his sport’s clean drug-free Police also seized 147 which can be bought on the image may soon be tainted. firearms, recovered almost The new World Anti-Doping Internet for NZ$167.50, $440,000 worth of stolen Agency (WADA) code is not made by Apple but by property and found nine requires athletes to designate California company David methamphetamine labs in a daily reporting hour Steele Enterprises. over 640 raids. The operation including their exact Police say relying on the targeted those that grew, whereabouts. Testers can then breathalysers would be unwise, distributed and used cannabis turn up unannounced. It has and drinkers could be lulled as a gateway drug to other been heralded by WADA as into a false sense of security. criminal activities. a powerful tool in the war “These devices are not against drugs in sports, but it certified to the same standard has been decried as a breach as used by New Zealand Mayor urges of privacy and as over zealous Police devices,” a Police focus on drugs in other quarters. National Headquarters Manukau Mayor Len Brown Nichol believes the spokesperson said. wants Counties-Manukau principle behind the register “While Police welcome police to add drugs to their is sound but is nervous about anything to improve road priority list alongside rugby’s readiness to meet its safety, the safe option would domestic violence. Last stringency. “And if someone be not to drink and drive.” December, he chaired a

30 matters of substance February 09 www.drugfoundation.org.nz World News

Itemiser – the drug- but this is a huge study According to data compiled some respondents. Teens who testing machine that quantifies that. It’s not by Holland’s Trimbos recalled seeing 12 or more A portable machine, known surprising that alcohol would Institute for Mental Health anti-drug messages per month as the Itemiser, which can cause shrinkage of the brain. and Addiction, after 30 years were actually more likely to detect the presence of drugs That kind of thing has been of the Dutch tolerance policy, start using cannabis than such as cocaine, cannabis, observed in animal models usage rates in the country are those who had seen fewer heroin and ecstasy, has been and smaller studies.” somewhere in the middle of anti-drug messages per month. used outside nine different international norms. They pubs and nightclubs in Don’t turn a night out exceed those in Germany and Think AIDS before you 3606562 share Aberdeen city centre to test into a nightmare the Scandinavian countries, revellers for drugs. The device Last November, the but are below those of France, works by analysing swabs taken Australian government Britain and the United States. from people’s hands, with launched a series of ‘in your results produced in seconds. face’ advertisements aimed at Anti-drug ads

A green reading allowed tackling the binge drinking haven’t worked entry to the pub, while those epidemic among young A new harm reduction, health with an amber reading were Australians. Themed promotion resource aimed at given a drug information “Don’t turn a night out into young people who inject pack. Those returning a red a nightmare”, the campaign drugs was launched on the reading were searched. demonstrates the violence, 20th anniversary of World The test was voluntary, injury and humiliation that AIDS Day. but customers were refused can result from binge drinking. Among the estimated entry if they did not take part. The campaign will 16 million people injecting drugs worldwide, one in five Police revealed nobody had spearhead the government’s 6253052 refused to be tested. National Binge Drinking is likely to be HIV positive. Strategy and is targeted at Young people are at the Booze shrinks your brain teenagers aged 15–17 years, centre of the HIV epidemic young adults aged 18–25 years with an estimated quarter and their parents. It includes a of the 38.6 million people range of TV, print, radio and infected aged between 15 Internet ads, as well as ads in A new study has found a and 24. Half of all new HIV pubs, outside nightclubs and infections worldwide are 373788 US$1 billionTHIS ADVERTISEMENT PREPARED campaign BY DRAFTFCB APPROVAL to STAMP AD ID #: ONDP_YOUT_M2966 A Production: Leslie Nelson x3787 AD: K. Ross x3489 Signature / Initials Date Client Folder: ONDCP Colors: 4C AE: D. Fiore x2971 Traffi c ______Product: Above The Infl uence Size: Bleed: 8.75" x 11.375" Traffi c: T. Nallen x3687 Proofreader ______Art Director ______Job #: ONPD_YOUT_M2966 Trim: 7.875" x 10.5" VQC: M.Parrelli, L. Powell Copywriter ______File name: M2966_A_Burrito.indd Live: 7" x 9.75" Project Mgr: Creative Dir. ______also among this age group. on street furniture. The $20 Headline: Burrito Artist(s): pg/dr, tl-c, tp Fonts: Helvetica Neue LT Acct. Exec. ______curbCampaign: US McKinney Print teen drug use may Acct. Dir. ______Proof #: 10 9 8 7 6 5 4 3 Mgt. Dir. ______Date: 9/05/08 Production ______Studio ______million campaign will run Studio QC ______In some parts of the world, in factM2966 have 4C encouraged Version it. A

M2966_A_Burrito.indd 1 9/8/08 11:59:24 AM over two years. Drug use peaked in the and in some marginalised www.drinkingnightmare. mid-1990s, and since then, sub-groups, the most frequent gov.au. rates have fallen over 40 percent modes of HIV transmission among 8th graders, 30 percent for young people are unsafe injecting drug use and unsafe Amsterdam to close among 10th graders, and nearly 5870123 coffee shops near schools 20 percent among 12th graders. sexual activities. www.unodc.org/thinkaids Amsterdam, which has more But University of Pennsylvania than a quarter of Holland’s Professor Robert Hornik, The more alcohol you drink, tourist-attracting cannabis currently studying anti-drug Drug court a success the more your brain shrinks, a cafés, will close nearly campaign effectiveness, said the Addicts who commit a new study by the Texas A&M 20 percent of them to comply decline in cannabis use “could drug-related crime are less Health Science Centre College with a national ban on having be due to lots of influences, likely to reoffend if they are of Medicine has found. them located within 250 metres not just the campaign.” dealt with by the New South “The take-home message of schools. Forty-three shops Hornik was expecting the Wales Drug Court than if they is that, if you drink a lot, you’re will have to close by the end anti-drug campaign to have are sentenced through the going to hurt your brain,” said of 2011 if they cannot positive effects, but said they traditional judicial system, Rajesh Miranda, Associate successfully appeal. could not find any. In fact, research reveals. A new study Professor of Neuroscience Pot is technically illegal there was a small amount found that the Drug Court, and Experimental but can be sold in small of evidence to suggest the first launched in 1999, is Therapeutics at the College. amounts in designated cafés anti-drug campaign may have more cost effective than “This is something we knew, without fear of prosecution. had the opposite effect for sending offenders with a drug www.drugfoundation.org.nz matters of substance February 09 31 addiction to prison. evidence of brain problems, the UK government prison managers, prison Offenders who attend the particularly haemorrhaging. announced it will ban officers and prison health specialist court’s programme cigarette displays in shops. professionals. are 17 percent less likely to be High hopes for cannabis The toolkit provides reconvicted for any offence, information and guidance to Growing cannabis became Swiss back heroin 30 percent less likely to be legal in New South Wales, programme but reject people who work in and with reconvicted for a violent provided you are a licensed cannabis prisons and prisoners. It offers offence and 38 percent less farmer harvesting hemp for practical guidance on what likely to be reconvicted of a industrial use. The new measures countries need to drug offence, the research licensing system has been take in the short term to shows. It also shows that the developed to prevent prevent the spread of HIV Drug Court costs about industrial hemp being grown (and other infections) among $16 million a year, while the to camouflage illegal crops prisoners and how they can estimated cost of dealing with of cannabis, which looks provide them with treatment, the same offenders through almost identical. care and support. It also the traditional legal system Last November, Switzerland Properties growing discusses necessary medium- would be about $18 million. became the first country in industrial hemp will be and long-term reforms to the world to include audited and inspected facilitate such measures. prescription heroin in Methamphetamine linked regularly. Two hundred While the toolkit is written government policy. Final to heart disease people have contacted the primarily for use in low- and results from a national Department of Primary middle-income countries, referendum showed 68 Industries to express an it is also a useful resource for percent of voters supported interest in hemp growing. institutions in high-income making prescription heroin But the peak farming bodies countries. Its focus is on HIV, a permanent, nationwide of Australia and NSW said but it recognises that other health policy. they did not have policies on diseases – in particular Under the heroin scheme, the crop and were unaware of hepatitis and tuberculosis – started last decade, opiate a major interest in it. are linked to HIV and also addicts can receive the drug represent serious problems under medical supervision NSW puts tobacco in prisons. and accompanied by out of sight – will www.unodc.org/ New Zealand follow? counselling. Some 1,300 people are said to be part of documents/hiv-aids/HIV- New South Wales has the programme. Its opponents toolkit-Dec08.pdf passed ground-breaking new say it has failed to get the laws to protect children from majority of patients abstinent, “Awful” ecstasy research tobacco marketing, and the but supporters counter that UK Psychology Professor Autopsies on more than Cancer Society wants it has reduced drug-related Andy Parrott told the 200 Australians who died New Zealand to follow the crimes and deaths – a major Advisory Council for the from methamphetamine use Australians’ lead. Tobacco problem in the early 1990s. Misuse of Drugs that research show disturbingly high rates products will be out of sight A proposal to suggesting ecstasy was less of heart disease. Studying in most shops by the end of decriminalise cannabis, coroners’ reports between 2009, limited to a single point dangerous than alcohol and the most widely used illegal July 2000 and June 2005, of purchase in each retailer, tobacco was “awful from start drug in Switzerland, failed. Sydney researchers found that, and their sale partly licensed. to finish”. Mr Parrott spent Opponents said it would in 220 of the 371 cases of deaths “New South Wales children more than a decade studying increase cannabis tourism caused by methamphetamine will no longer have tobacco the harm caused by ecstasy. and turn the country into a use in which autopsy products placed strategically “It’s not a weak drug. It is one “Mecca for drugs”. information was available, in front of them in shops,” of the most powerful of the 54 percent had heart disease, said Cancer Society of recreational drugs,” he said. most commonly a narrowing New Zealand Chief Executive HIV/AIDS prevention The Advisory Council will of the arteries. Dalton Kelly. The new in prisons pass its verdict on the drug to Study co-author Sharlene government is expected to UNODC, WHO and UNAIDS the Home Office. It is thought Kaye, of the National Drug soon respond to a select have launched a toolkit on to favour a downgrading, but and Alcohol Research Centre, committee report on HIV/AIDS in places of Home Secretary Jacqui Smith said one in five also had ‘powerwalls’. Last December, detention, for policy makers, will make the final decision.

32 matters of substance February 09 www.drugfoundation.org.nz Mythbusters

Substance and substantiation

Ketamine: not just for horses, also for badgers Ketamine is a short-acting general anaesthetic used for both human medical and veterinary purposes. It is termed a ‘dissociative’, because it impedes the brain’s sensory connection to the body. On 26 February 2008, Associate Health Minister Jim Anderton announced Cabinet had approved the reclassification of ketamine to Class C under the Misuse of Drugs Act to take effect as soon as Parliament approves. In the meantime, however, media reports about the drug have left it ‘saddled’ with an inaccurate and unhelpful image.

The media’s inevitable power to shape Karenza Moor and Fiona Measham from tranquiliser’? Mythbusters suspects it’s society’s attitudes is a dangerous game, the University of Lancaster investigated because horses are quite large and the with stereotypes often hidden under the motivations behind ketamine use in term ‘horse tranquiliser’ provides a more poker-faced mask of balance and Britain. The following comments were powerful scary drug term for the headline objectivity. Journalists will pick up one made by the participants during the writers than, say, ‘guinea pig tranquiliser’. idea and blindly run with it until interviews: “It is embarrassing, cos Indeed, why does ketamine get the something blatantly unavoidable hits people that don’t understand it are like animal treatment at all given that them right in the face. Then they will ‘that is a horse tranquiliser’. It’s like many drugs, including morphine and run with the latest revelation until someone starting taking dog worming diazepam, for example, used medically something else hits them. Rarely does tablets, why would you do that? Some and non-medically on humans, are also there seem time or motivation for them people are just like ‘why?’” used on animals? None of these drugs to provide a more complete analysis of Moor and Measham also came across gets referred to in the context of their drug policy issues. a clear distinction made by clubbers animal use as does ketamine. The media This has been the case with ketamine between ketamine powder viewed as never seem to write about the ‘sheep drug aka ‘Special K’. Take, for example, this suitable for human consumption, and diazepam’ or the ‘dog drug morphine’. report from the tabloid The Daily Mirror: ketamine in injectable form for While it is hard to find any “Big Brother star Pete Bennett was a veterinary use, and therefore conclusive answers to these questions, regular user of the horse drug ketamine, ‘inappropriate for purpose’. “Injecting Mythbusters suspects the modern link to his friends revealed last night.” it would be in liquid form, and that’s ketamine probably stems from mid-90s Or this one by the BBC: “An for knocking out horses,” says Cassie, reports of the drug being stolen from vets anaesthetic used by vets as a horse a 22-year-old employed ketamine user. and misused. That the drug was a stolen tranquiliser, but becoming increasingly Mythbusters cannot help but wonder veterinary tranquiliser probably just common on Britain’s dance scene, why horses, and not guinea pigs, stuck with journalists. This is despite the is to be made illegal.” for example, have been receiving so fact that, subsequently, most of the drug Or this one by the news agency much mention. was supplied to Britain from larger-scale Reuters: “Scientists have unravelled how The substance is indeed used as an illicit or grey overseas markets. a horse tranquiliser and hallucinogenic anaesthetic for horses, but it is also Obviously, the name filtered through nightclub drug known as ‘Special K’ can widely used as a human anaesthetic. to the New Zealand media in the same ease depression.” It is used for the elderly, children way. It is a reflection on the inaccuracies It is not hard to spot a common theme and in emergencies because it does and laziness of drug reporting in the media galloping through all of these reports – not suppress the respiratory system, generally. This sort of misunderstanding horses. A recent Mixmag cover story on although the powerful hallucinogenic is not going to help rational policy ketamine actually pictured a ‘clubber’ effects – the reason it is used non- development or educating young people wearing a pantomime horse head on the medically – are an unwanted side effect. about harms or relative risks of drugs. dance floor. It is no wonder then that Ketamine is used on a whole range clubbers and policy makers think of of animals, including elephants, camels, Mythbusters acknowledges the Transform Drug ketamine as something used to sedate gorillas, pigs, sheep, goats, dogs, cats, Policy Foundation’s blog from which much information for this piece has been sourced. our big equine friends. rabbits, snakes, guinea pigs, birds, gerbils See http://transform-drugs.blogspot.com/ In a study called It is the most fun and mice. But why do we never read 2008/11/ketamine-badger-tranquilizer.html. you can have for twenty quid (2008), about the ‘gerbil tranquiliser’ or the ‘bird www.drugfoundation.org.nz matters of substance February 09 33