Drug law reform’s growing momentum Alcohol “as natural as water” What Kiwis know and think about drugs A drink a day keeps the doctor away? February 2010

Getting our Act together It’s been two years coming, but at last the Law Commission has launched its consultation paper on its review of the Misuse of Drugs Act. The stage may be set for massive drug law overhaul, but will the resulting new legislation strike a much needed balance between enforcement, harm minimisation and the health of New Zealanders addicted to drugs? Contents

matters of substance February 2010 Features Regulars Vol 20 No 1 ISSN 1177-200X 02 Cover story 21 Caffeine and alcohol 01 The Director’s Cut matters of substance is published by the Getting the MODA – a cocktail for disaster? Executive Director Ross Bell NZ Drug Foundation. All rights reserved. Neither this publication nor any part running introduces this issue by of it may be reproduced without prior commending the Law permission of the NZ Drug Foundation. Commission on a “considered, balanced and matters of substance invites feedback comprehensive review” and contributions. If you’re interested in contributing a guest editorial or article, of the Misuse of Drugs Act. please first contact us: [email protected] 33 Mythbusters p +64 4 801 6303 What happens when you Is drinking in moderation mix alcohol and caffeine good for my heart?? Brand development/graphic design The Law Commission’s first Origin Design +64 4 801 6644 discussion paper is out, and and put them in a colourful At the risk of making [email protected] its recommendations are can? Is their love affair with themselves unpopular, www.origindesign.co.nz our intrepid Mythbusters progressive and firmly caffeine-laden RTDs putting our youth in danger? question the evidence evidence-based. We’ve NZ Drug Foundation behind the widely accepted gone straight to the horse’s 3rd Floor, 111 Dixon Street 23 Talking with Doug after belief that a little alcohol PO Box 3082, Wellington, New Zealand mouth for some of the p +64 4 801 6303 the ‘Ten Things’ tour is good for you. thinking behind the review of the Misuse of Drugs Act. When you have finished with News this magazine, please recycle it. Drug law reform – A global snapshot 01 Key Events and Dates Become a member Here’s a rundown of what’s in store for the alcohol and The NZ Drug Foundation has been other drug sector during at the heart of major alcohol and other drug policy debates for over Doug Sellman reckons 2010. 20 years. During that time, we have there’s a lot the alcohol demonstrated a strong commitment industry doesn’t want 28 New Zealand News to advocating policies and practices you to know. He’s taken We give you the good oil based on the best evidence available. his ‘Ten Things’ lecture on on what drug news has been In light of the Law tour, and we ask him how making recent headlines Commission’s review, You can help us. A key strength of the that went. in New Zealand. NZ Drug Foundation lies in its diverse Sanji Gunasekara looks membership base. As a member of the at recent efforts in other NZ Drug Foundation, you will receive 25 Opinion 30 World News jurisdictions to reform information about major alcohol and How effective is the When drugs are involved, other drug policy challenges. You can also drug law. New Zealand Drug things can get interesting. get involved in our work to find solutions Diversion: Australia’s Harm Index? to those challenges. World News covers off alternative to drug what’s been happening Our membership includes health law reform internationally from the promoters, primary health and The Australian Illicit sublime to the ridiculous. community organisations, researchers, Drug Diversion Initiative students, schools and boards of trustees, demonstrates there are Quotes of Substance policy makers, and addiction treatment agencies and workers. alternatives to drug law Yet another selection of reform that potentially sane, sagacious and silly Membership and subscription enquiries address drug-related citations from people here [email protected] offending. New Zealand’s Drug Harm and around the world or visit our website. Research Update Index has been used to who have things to say Knowledge of and both measure and justify about drugs. www.drugfoundation.org.nz attitudes to illegal drugs a number of enforcement Last year, the Ministry of activities. Martin Woodbridge Health published a report questions whether the index on what Kiwis know and is really being used correctly. think about illegal drugs. Not all the findings were predictable, and some come as a surprise. matters of substance February 10 www.drugfoundation.org.nz The Director’s Cut Key Events and Dates

International Motivational Youth Week Interviewing Symposium 22–30 May, New Zealand wide 4–5 March, Christchurch The Youth Week 2010 campaign A unique opportunity for like minded is already being planned, so get people from the Pacific region and on board now. Visit the website for beyond to gather together to share more information on how you can experiences and ideas about reach a generation of young people motivational interviewing. by advertising during Youth Week www.pacificcmc.com and sponsoring the campaign. www.youthweek.co.nz It’s finally here, and it was In Chapter 11, the Commission Restoring the Balance worth the wait! identifies options to limit 8–11 March, Melbourne, Australia Two years of behind-the- the harms created by the The 5th Australasian Drug Strategy Club Health 2010 scenes work has resulted in law itself. Much of what Conference provides an important 7–9 June, Zurich, Switzerland a considered, balanced and the Commission outlines opportunity to hear and learn from The 6th International Conference on a full range of law enforcement, Nightlife, Substance Use and Related comprehensive review of encompasses regulatory justice, customs, health, academic Health Issues aims to promote better a complex bit of law. models used effectively in and community agencies. interagency understanding of issues That’s my humble other jurisdictions, including www.adsc2010.com that affect the health of young assessment of the Law from across the Tasman. people in nightlife settings. Commission’s Misuse of Drugs The Commission also outlines Addiction Treatment www.clubhealth.org.uk/ Act discussion document, a pathway to support and Leadership Day conference released for consultation treatment away from the 25 March, Christchurch this month. criminal justice system. These leadership forums bring together Inaugural National Indigenous addiction workforce leaders from Drug and Alcohol Conference The document opens with The review’s terms of different functions: policy, planning, 16–18 June, Adelaide, Australia this very blunt – yet accurate reference constrained the funding, training and education, – assessment of the Misuse Commission to working service management and delivery, The National Indigenous Drug and of Drugs Act: It “no longer within our obligations under consumers and cultural leaders. Alcohol Conference aims to help develop the capacity of those working provides a coherent and the three international drug www.matuaraki.org.nz to address indigenous alcohol issues effective legislative framework treaties. (That the international Evolving Communities and associated harms in meaningful for responding to the misuse treaties themselves need an Beyond Services and practical ways. The conference of psychoactive drugs… overhaul is obvious – but 14–16 April, Wellington will also showcase and celebrate the The Act is now outdated we should not expect the The 5th Building Bridges Conference quiet efforts and achievements of and does not reflect current Commission to be burdened aims to bring together the latest those striving to improve the health knowledge and understanding with that task!) Some will be thinking on community mental and wellbeing of Australia’s about drug use and related frustrated by this. The first health and addiction services for indigenous communities. providers and consumers of services. health, social and economic treaty celebrates its 50th www.nidaconference.com.au www.buildingbridges.co.nz harms.” Hear, hear! anniversary next year, and Drug and Alcohol Nurses of The Commission’s review if our 35-year-old law is Harm Reduction 2010: Australasia 2010 Conference covers a lot of ground obsolete, then that treaty is The Next Generation and Workshops including: how we should well and truly fossilised. In 25–29 April, Liverpool, England 14–16 July, Surfers Paradise, Australia measure and classify drug Over five days, this conference will spite of this, the Commission Drugs and Alcohol: Every Nurse’s be the main meeting point for all harm; controls over medicinal has rightly identified Business is the theme for 2010. cannabis; regulations over flexibilities within the bounds those interested in harm reduction. The conference theme, Harm Explore the role of nurses and their substances not covered by of these treaties that allow for Reduction: The Next Generation, will need to be aware of alcohol and international treaties; diversion many of the progressive reflect upon two and a half decades drug-related issues and how to start options for possession; and options outlined in its review. of harm reduction experience but tackling these appropriately. principles around compulsory Let’s not be scared by will also explore what is needed to www.danaconference.com.au move on in the next 20 years. admission for addiction the Commission’s proposals. www.ihra.net treatment. They are not radical, but they Cutting Edge In developing its proposals, are progressive, and they are 22–25 September, Auckland ALAC Working Together the Commission says the exactly what New Zealand 2010 will be the 15th Cutting Edge Conference 2010 Conference, New Zealand’s most primary justification for needs in order to find a better 6–7 May, Manukau City important alcohol and addiction regulation is to minimise the balance in the ways we seek This is a ‘must attend’ event for treatment meeting. anyone working on alcohol-related harm drugs cause to persons to reduce drug harm and help www.dapaanz.org.nz other than the drug user and those in need. issues. The focus will be on working together to create real and sustainable to society as a whole. I recommend you carefully change in the way New Zealanders Publicise your own event on our One of the most important read the Commission’s work think about and use alcohol. new-look website areas of the review relates and have your say. www.alac.org.nz www.drugfoundation.org.nz/events to the personal use of drugs. Happy reading, Ross Bell. www.drugfoundation.org.nz matters of substance February 10 01 Cover Story

Getting the MODA running

In March 2008, the Law Commission commenced a review of New Zealand’s Misuse of Drugs Act 1975. The aim of the review has been to produce a new legislative framework that would better balance the criminal justice focus of our current drug law with the need to support the health of people who use drugs and to reduce drug harm across our communities. In February 2010, just before the release of its first discussion paper,Matters of Substance spoke with Commissioners Warren Young and Val Sim about the progress of the review and the initial recommendations and options the paper puts forward.

02 matters of substance February 10 www.drugfoundation.org.nz MoS: Why is the Law Commissioner That means insufficient attention is paid minimising the overall harm resulting reviewing the Misuse of to the other aspects like treatment, from drug use. I think it’s very important Drugs Act? education and limiting drug harm. we don’t get sidetracked by semantics. Warren: The National Drug Policy is based Val: The immediate trigger was on the principle of harm minimisation, MoS: One of the issues your the Government’s concerns about new and we think it’s important that any new discussion paper covers is substances that emerged, such as the legislative framework also reflects that drug harm. Is the principle BZP in party pills, and whether their policy objective. Unfortunately, harm of harm to others a key aspect regime could deal with those substances. minimisation is seen by many people of the review? But there are a number of other concerns. as a proxy for a soft liberal approach to The Act is now 35 years old, badly aligned drugs or even an agenda for legalisation. Warren: We’ve taken the view that any with the newer National Drug Policy and That’s unfortunate because harm form of regulation of what people do in very heavily focused on supply control. minimisation just simply means their lives can usually only be justified www.drugfoundation.org.nz matters of substance February 10 03 when it is necessary to prevent harm of consequences, like drug tourism as substances regime. Other options would to others. Of course, when people are happened in the Netherlands when they be to create an entirely new body or to harming themselves, they’re also usually liberalised cannabis. graft that function onto the existing harming a range of other people. Warren: I think it’s important to be clear Expert Advisory Committee on Drugs. we have looked at policy options in the MoS: What are New Zealand’s light of our international obligations. MoS: Some argue that any regime obligations under the various So, for example, it’s really not even on should be aligned with international treaties? the table to legalise the commercial regulations around legal supply of cannabis because that would substances like alcohol and Val: There are three United Nations be contrary to those obligations. tobacco. Have you included drug conventions that broadly require I think it’s also worth adding that these in your considerations? countries to prohibit the importation, how we currently approach drugs is a exportation, production, manufacture, rather peculiar all or nothing approach. Val: No, our terms of reference possession and use of a number of Substances covered by the Misuse of expressly excluded alcohol and tobacco. substances, but within that framework, Drugs Act, and largely covered by the And rightly or wrongly, the different there’s considerable scope for less conventions, we prohibit all together, historical and cultural associations of restricted approaches, particularly but until we prohibit them, we largely alcohol and tobacco mean they have possession and use. The conventions have no controls over them at all. That traditionally been regulated quite also recognise demand reduction and means a whole bunch of substances differently. Obviously, including them problem limitation as legitimate drug can be happily supplied, sold and in this regime had the potential to policy goals. commercialised in a fairly unrestricted complicate the review, but separately, way, until we get round to saying, of course, the Law Commission has been MoS: Most of those conventions “This might be dangerous, and we need doing a review of the Sale of Liquor Act. are around prohibition. to prohibit it all together.” We think Warren: I think a lot of the issues, Has that limited the approach there is room for considering some actually, have had some commonality. you’ve taken? controls over a new substance before For example, the need to ensure that those who have alcohol or drug Val: Although there’s increasing we start having it supplied and sold at nightclubs. problems have adequate access to disquiet about prohibition as a drug treatment and that there are sufficient policy, still the international consensus One of the key issues with that is who any regulatory body would be. resources available to deal with people is to stay within that framework, and who have dependency has cropped up New Zealand agrees. If one country is An option could be to use the body that already exists under the hazardous in both reviews and really needs a very out of line with another, it risks all sorts similar approach.

04 matters of substance February 10 www.drugfoundation.org.nz Rightly or wrongly, the different historical and cultural associations of alcohol and tobacco mean they have traditionally been regulated quite differently.

Warren Young

MoS: What’s the Commission’s classifications could result in even more the most harm are the high-end preferred options around difficulty defining drug harm levels and dealers in large-scale drugs. classification? Is it a useful make sentencing even more of a problem Those causing less harm are tool to measure drug harm? the ones in possession of drugs for personal use. Why have you Val: A drug is classified as either MoS: So that brings us to the decided to split harm that way? Class A, B or C to determine the level of question of who should do control to impose over it and the the classifying. Warren: I think the social response to maximum penalties for misusing it. Warren: Currently, it’s the Expert drugs needs to be driven by where the Class A drugs are very high risk, Class B Advisory Committee on Drugs, which is most harm lies and how best to reduce are high risk and Class C drugs pose a made up of a range of experts and officials. that harm. People who are in the moderate risk. But I think it’s now most However, we think the disciplines business to make large amounts of experts agree some of the current represented on that committee are not money by preying on others require classifications are simply wrong. For broad enough and suggest there should a severe law enforcement response. example, ecstasy is Class B, but most be a list of expert areas in the statutes However, there is a very large pool experts now say it’s less harmful than a and that members must have expertise whose very small-scale sale, possession Class C drug like cannabis. So if the in one or more of those areas. and use is driven not by profit but system is retained, there needs to be a Perhaps more importantly, we think simply because they are supporting their systematic review. the officials on that committee, that own addiction, supplying to others in There are a number of other options. is, the representatives of Government their own drug circle or perhaps buying We could just not classify at all, have a departments such as Police, Customs, drugs in bulk. Sometimes, the most single maximum penalty and leave it to Justice and Health, should not actually effective way of reducing harm resulting the judges to determine what penalty be members. If you want to have an from that will be to have other forms of applies to what drug, but that does leave independent expert committee advising intervention, such as treatment, rather them with a very broad sentencing the Minister, then it ought to be genuinely than prosecution. discretion. independent. The problem with having Another option would be to reduce officials on it is that they’re subject to MoS: Can you explain each of your the classification to two: very risky ministerial direction. options for reducing the harm drugs and not so risky drugs. But this the law may cause such people is probably too blunt an instrument MoS: A lot of your recommendations and how it could be used to get as drug harms are more nuanced than or preferences are based again them help instead? that. It would be possible to create even on this concept of harm to further classifications, but too many Warren: Well, the first one is simply others. The people causing that, when people are caught with small

www.drugfoundation.org.nz matters of substance February 10 05 In terms of Class A drug dealing, there’s a maximum penalty of life imprisonment. So the approach taken currently is very stringent and tough, and we’re not suggesting any change to that.

Val Sim quantities of drugs for their own use or large-scale commercial suppliers will do Val: I think we’d say that our starting for small-scale supply, we give them a a lot more to minimise drug-related harm. point for each is exactly the same. We’re caution. If they accumulate two or three looking at what the evidence suggests is cautions, we start using criminal law. MoS: Some may accuse you of the best way of minimising harm. In our A variant of that is instead of a opening the door to legalisation view, that means some tighter regulation caution, we siphon them into a treatment with these proposals. Should around alcohol. In the context of drugs, or education programme after the second people be worried about that? because of our international obligations, or third time they’ve been caught. we’re saying we retain the prohibition Another option is to impose fines for Warren: There are a number of points framework but that there are things we people caught with small amounts. They to make here. First of all, people should can do to minimise harm. So I think the have to pay the fine, but we don’t have have no fear we are pursuing some sort two reviews are entirely consistent. all the costs and negative consequences of hidden legalisation agenda here or Warren: We should also note that of prosecution and conviction. even a soft liberal option. Our only focus alcohol causes massive harm in society. A third option would be diverting is what’s likely to be most effective, Clearly, it’s a drug that would have small-scale offenders into treatment or and we hope people will focus on the many more controls over it if it weren’t education programmes or community options with that in mind. for the history and culture around it. work instead of convicting them. The other point is that none The fact that we are proposing that other There are pros and cons of these of these options are at all radical. drugs ought to be dealt with in the same approaches. The problem with fines, All are either working or have been way as alcohol, in terms of treatment for example, doesn’t mean we’re being for example, is that many people simply tried in a large number of other western inconsistent. Far from it; we are being accumulate them. We then have all the jurisdictions including states in America, entirely consistent. costs and problems of trying to enforce Australia and a number of European them, and people end up getting the jurisdictions. sanctions they would have got in the Val: And I think we could add that MoS: Your review supports the first place. So, there are a number of the evidence from those jurisdictions is medical use of cannabis. Why? issues that really need to be seriously that taking a less punitive approach Warren: In the issues paper, we’ve thought about because, for small-scale hasn’t resulted in any significant devoted considerable time to how much offenders, there’s not a lot of evidence increase in drug use. room there is for a medicinal cannabis the current system is achieving much. scheme. It would currently be possible Val: We can also add that diverting MoS: So what do you say to those because, under the Medicines Act, you resources from prosecuting small-scale accusing you of being tough can seek approval for a controlled drug offenders to detecting and prosecuting on alcohol and soft on drugs? like cannabis to be used for medicinal

06 matters of substance February 10 www.drugfoundation.org.nz purposes. Even as an unapproved in a medicinal cannabis scheme is MoS: You’ve talked a bit about medicine, it can be supplied by individual who is the producer and supplier? changing the penalties around doctors under some circumstances. It Does the Government do it? Does it low-level and social supply for hasn’t been used like that in New Zealand, license other people to do it and under recreational use. What’s your but it certainly has elsewhere. what circumstances? view on large-scale supply? There is a lot of evidence that cannabis A second issue is how do people is effective in some circumstances, needing it for medicinal purposes access Warren: We need to ensure that the particularly for pain relief, so we think it? In some jurisdictions, people have to present severe response to big supply it ought to be seriously considered. go on a central government register before offences and things like the presumption However, if we went down that route, it can be supplied. In other jurisdictions, in favour of imprisonment for heavy it would be important to ensure the form it’s simply available by way of a doctor’s drug dealing do not change. and the way in which it’s supplied are prescription. We’ve canvassed the pros Val: I think it’s worth mentioning appropriately controlled. and cons of those various possibilities that, in terms of Class A drug dealing, in the report. there’s a maximum penalty of life MoS: In places like California, Val: I think one of the interesting imprisonment. So the approach taken the medicinal cannabis features about the Canadian situation currently is very stringent and tough, and regime is seen by some is its origins. The reason they set up a we’re not suggesting any change to that. as a back-door way into scheme was because their courts said legalisation. Is that what that there were human rights issues you’re trying to achieve here? involved. Because there was sufficient MoS: A lot of the proposals you have are about diverting people into Warren: Most certainly not, and that’s evidence to say cannabis was the only getting help. Should we be why we say we need to think about the effective treatment for certain options for proper controls. Obviously, conditions, the courts required the forcing people into treatment? government to establish the scheme. you can simply allow cannabis as a raw Warren: No. Forced treatment has been Warren: It’s important to note the product under certain circumstances, shown to be pretty ineffective generally. but that’s problematic. It would be Canadian courts could do that because However, we do have a whole chapter difficult to control its strength, its purity the Canadian Charter of Human Rights on whether or not we should retain the and to make sure that it’s not actually is supreme legislation, binding even causing harm. And that’s why the on the government. We don’t have an Alcoholism and Drug Addiction Act, Canadian government has decided equivalent legislation in New Zealand. or some replacement legislation, it will totally control the production Nevertheless, that the Canadian courts which allows for compulsory treatment. and supply of cannabis for medicinal have taken that view means it is something We’ve done that, firstly, because the purposes. So obviously, the first issue we ought to at least consider. Government’s recently announced www.drugfoundation.org.nz matters of substance February 10 07 The World in 1975

In New Zealand Methamphetamine Action Plan flagged Our population stands at a staggering 3,143,700. Robert Muldoon is Prime Minister, a review of the Act as a high priority, and Michael Fowler is the Mayor of Wellington. and it made sense for us to incorporate that within our review. 15 January: Publisher and writer A H Reed dies peacefully in his sleep. Secondly, we think it worth 1 April: The New Zealand Broadcasting Corporation is split into the competing channels considering whether any form of Television One and Television Two. Television Two holds our first Telethon. compulsory treatment should be part 12 May: Rugby legend Jonah Lomu is born. of the Misuse of Drugs regime so that treatment and supply controls sit side 13 October: The Mäori Land March reaches Parliament in Wellington, Whina Cooper presents by side rather than being fragmented a Memorial of Rights to Prime Minister Bill Rowling and Mäori Affairs Minister Matiu Rata. as they currently are. In music Our tentative view is there is some case for having short-term compulsory 2 March: Los Angeles police make a routine traffic stop of two people who turn out to intervention. Firstly, because people be Paul and Linda McCartney. Linda is arrested for having six to eight ounces of marijuana in her pocketbook. often are not able to make informed choices about treatment until they’ve The Goodies had five top 20 singles (in the UK) becoming, according to Bill Oddie, gone through detoxification. “The first, the only and the most successful comedy rockers.” Secondly, sometimes short-term compulsory treatment for detoxification In politics is necessary to prevent people from East Germany is ghettoised by the Berlin Wall, and the Cold War rages on. Star Wars harming themselves or others. is in full swing, with the Soviet’s Luna 1975A unmanned space mission.

The Vietnam War draws to a close with the fall of Saigon. The ‘Mayagüez Incident’ MoS: If we shift to a more balanced involving the Khmer Rouge in Cambodia on 12–15 May marks the last official US battle regime in New Zealand, in the Vietnam War. The Khmer Rouge goes on to murder millions of Cambodians in mass do we have the facilities and genocide campaigns termed ‘social engineering’. resources available to cope? Indonesia invades East Timor following the Carnation Revolution in Portugal, which led Val: A theme that has come through to Portugal’s withdrawal from East Timor as its colonial ruler. both in the consultations done for our Zimbabwe is known as Rhodesia, and South Africa rules under apartheid. alcohol report and for the Misuse of 20 November: General Franco dies, and Spain begins its transition from dictatorship Drugs Act is that there are significant to democracy. gaps in treatment services that need to be addressed.

08 matters of substance February 10 www.drugfoundation.org.nz A theme that has come through both in the consultations done for our alcohol report and for the Misuse of Drugs Act is that there are significant gaps in treatment services that need to be addressed.

What we suggest in the report is that We really have to see this as a sustained a rational set of policy recommendations a blueprint is needed for requirements strategy, and governments need to within that environment is not easy. over the next five years, and we’ve recognise it’s not something they can We are acutely aware in putting tentatively suggested a Mental Health deliver results on by the next election. forward policy options that there will Commission might be an appropriate We need to be thinking about five, 10, be people who read into them things agency to report on that. But I think it’s 15 year time horizons. That’s a very we don’t intend, that will see hidden important to say this is an area that has difficult challenge. agendas or will fear that what we’re doing been neglected. Treatment has really will produce some counter-productive been the poor cousin of supply control, MoS: What’s your message to the outcome. I think that’s inevitable in a and we need to do something to get a broader public around this process like this, and that’s why it’s very better balance between the various limbs review, and how can they important we emphasise that nothing of drug policy. And that means we need get involved? so far has been decided. to invest more resources. Warren: It’s important people understand Warren: We are inviting submissions to This Matters of Substance interview is available this is not something we can achieve our February paper until 30 April. We’ll on the Drug Foundation’s YouTube channel: overnight. That’s why we’ve suggested then carefully consider all the feedback www.youtube.com/nzdrugfoundation the blueprint; because even if we pool all with a view to producing a final report our resources into it at the next budget, we for Government around about the middle wouldn’t have the community organisations of the year. We’re also keen to meet Have your say available to use the funding or sufficient with interested individuals and groups. personnel with the needed skills. Anyone who works in the area or has The Law Commission’s consultation paper, strong views on these matters is welcome Regulating and Controlling Drugs, is to get in touch. available online at www.lawcom.govt.nz. MoS: Is there a danger that, because of the lack of resources, Register and have your say through the decision makers will be MoS: How have you found the Law Commission’s online consultation tempted to opt for the status process of the review? site: www.talklaw.co.nz. quo, the blind faith in the Warren: Drug policy is intensely For further information about the review, criminal justice approach? interesting but a very difficult and analysis of specific options outlined in the review and resources to support Warren: I think there is a danger of that. challenging area because drug policy you having your say, make regular visits This area has not been neglected because excites people’s emotions and therefore often produces strong emotional public to the Drug Foundation’s Misuse of nobody has recognised the gaps. But Drugs Act Review website: responses in both directions. There are a solutions have always been too long-term, www.drugfoundation.org.nz/moda. and they don’t fit within election cycles. lot of polarised views so trying to develop www.drugfoundation.org.nz matters of substance February 10 09 1:3 Getting the MODA running

The Obama administration’s new Drug law reform – drug czar, R. Gil Kerlikowske, says he wants to banish the idea that the US is fighting “a war a global snapshot on drugs”, a move that would underscore a shift favouring treatment over incarceration in trying to reduce illicit drug use.

USA feature page 13

The Law Commission’s current review of the Misuse of Drugs Act is a rare opportunity for New Zealand to drag its drug laws into the 21st century. Around the world, several other countries have also recently re-examined their drug laws. In this feature, Sanji

Gunasekara reviews the global state of drug law Latin America feature page 13 reform and finds that, while there is a trend towards more public health-focused legislation, sometimes it is a case of one step forward, two steps back.

The ‘war on drugs’ has dominated the that between 140 and 250 million people approach most countries have taken worldwide reported using illicit drugs at towards illicit drugs ever since the term least once in the past year. Even if some was first coined by President Nixon in kind of plateau might have been reached, 1969. Restrictive and punitive national over the past 40 years, there has been drug laws are partly a result of the global a “massive increase in the scale and framework for drug control, which is diversity of international markets for prohibitionist in nature. Yet in recent illegal drugs and increasing rates of drug Sanji years, several countries have sought to use in almost every country” according to Gunasekara adopt more humane, evidence-based and the International Drug Policy Consortium. public-health focused drug law. The consequences of a zero tolerance So what is behind the growing approach to drugs have often been more momentum towards drug law reform? harmful than the drug use itself, with The hard line approach has not led overly punitive drug laws contributing to a ‘drug-free world’ after all. While the to serious violations of human rights. United Nations Office on Drugs and According to Navanethem Pillay, UN Crime believes global prohibition has High Commissioner for Human Rights, contained drug use, its own figures show “Individuals who use drugs do not forfeit

10 matters of substance February 10 www.drugfoundation.org.nz The Bull Dog coffee shop – one of many coffee shops in Amsterdam where customers can buy cannabis for personal consumption. It was established in 1975.

Europe feature page 12

Indonesia feature page 14 Drug violence in Mexico is likely to continue without a major reduction in demand from across Portugal introduced a law that the US border. eliminates jail time for possession or use of small amounts of any illegal drug. Instead, users are sent to a panel of experts who provide assistance, leaving police to focus on large-scale trafficking. Here, the Policia Judiciaria seized almost three tons of cocaine with an estimated street value of more than €150 million (NZ$294 million).

their human rights. Too often, drug users that drug use should be viewed through Public debate is often reduced to suffer discrimination, are forced to accept a health and social policy lens instead prohibition versus legalisation. This treatment, marginalised and often harmed of a criminal justice one. oversimplification obscures what is by approaches which over-emphasise actually a continuum between the poles criminalisation and punishment while of harshly enforced punitive prohibition under-emphasising harm reduction and Shifting resources at one end and completely unregulated respect for human rights.” towards prevention, treatment commercial drug markets at the other. Shifting resources towards prevention, and harm reduction is more Legislative reform aims for a point treatment and harm reduction is more effective in reducing drug- somewhere in between these extremes. effective in reducing drug-related harms related harms than relying Until recently, Western Europe was than relying solely on the criminal solely on the criminal the centre of gravity for drug law reform. justice system. Such a rebalancing also Similar reform has also taken place in frees up law enforcement, courts and justice system. Canada and in certain states in Australia prisons to focus on more serious crime, and the US. Across Latin America, the including large-scale drug trafficking, most innovative legislative changes are while removing barriers for drug users Despite growing consensus about the taking place, while in some countries, to access treatment. Recent advances need for drug law reform, there is little legislative changes have been decidedly in addiction science support the notion agreement on the form this should take. retrograde.

www.drugfoundation.org.nz matters of substance February 10 11 Europe community service and fines. These or made Portugal a haven for drug tourism. changes did not legalise drug use in Overall, drug usage rates in Portugal Portugal. Possession remains prohibited, remain among the lowest in the EU, and criminal penalties still apply to drug and drug-related harms have decreased growers, dealers and traffickers. The law dramatically since the reforms. A major change stemmed from the desire to focus drawback has been the bureaucratic and police resources on those who profit resource-intensive nature of the system from the drugs trade while enabling a While drug laws still vary widely of commissions. public health approach to users and across the European Union (EU), many Contrary to widespread belief, drug occurred during a period of problematic states are moving towards a more use remains illegal in the Netherlands. drug use, primarily related to heroin. health-based approach. The European Rather, the Dutch government has After nine years, the impact of Monitoring Centre for Drugs and Drug adopted de facto decriminalisation. decriminalisation in Portugal remains Addiction describes a “trend to conceive Cannabis remains prohibited, but there controversial. This is largely because the illicit use of drugs (including its is a formal policy of not prosecuting drug use is influenced by many factors preparatory acts) as a relatively minor offences that involve a small amount in addition to the underlying legislative offence, to which it is not adequate to of cannabis for personal use. Retail sale framework, so attributing any change in apply sanctions involving deprivation of cannabis is tolerated, providing the patterns of drug use or harm to the of liberty”. outlets meet certain criteria such as no law change alone is difficult. In practice, this has meant that many advertising, no hard drugs, no underage Nevertheless, some observations EU states have adopted formal or de persons and no sale of large quantities. are worth noting. Since the law change, facto forms of depenalisation – drug Despite open sale at these ‘coffee cannabis use appears to have increased use remains a criminal offence but shops’, levels of cannabis consumption although levels are still lower than imprisonment is no longer imposed for are similar to those of neighbouring in most other European countries. possession or usage. With specific regards countries such as Germany and Belgium This may simply reflect an increased to cannabis, de facto decriminalisation and much lower than in the UK, France willingness to report use. Heroin use is virtually unanimous across the EU. or Spain. The Dutch approach also appears to have decreased, and there Only very few countries – Sweden, Latvia appears to have been particularly has been a marked drop in drug-related and Cyprus – still exercise the option to successful in separating the market disease and deaths. This has been impose prison sentences for possession for cannabis from those for other more accompanied by a large increase in of small amounts of cannabis. Legalisation harmful substances. But critics have the uptake of treatment. has not been adopted in any EU state. accused the Netherlands of undermining In 2001, Portugal formally global efforts against drug control, and decriminalised the use, possession in recent years, the Netherlands has and acquisition of all types of illicit Contrary to widespread progressively tightened its approach. substances for personal use, which was belief, drug use remains illegal New restrictions have been introduced, defined as being up to 10 days’ supply in the Netherlands. Rather, the and the number of ‘coffee shops’ had of that substance. The law change ended Dutch government has adopted declined from about 1,500 in 2000 to the use of criminal sanctions for drug de facto decriminalisation. 702 in 2007. possession and introduced a system of A major drawback to the Dutch referral to the Commissions for the approach relates to the ‘back-door Dissuasion of Drug Addiction, regional While the Portuguese experience problem’ – while the sale of cannabis to panels comprising social workers, has been described as ‘a resounding users is tolerated, supply to the retailer legal advisors and medical professionals success’ by the Cato Institute, the Beckley is subject to law enforcement, and that aim to dissuade new drug users Foundation concluded that the beneficial suppliers can still be prosecuted for and encourage dependent drug users impact of the Portuguese initiative has transporting cannabis to the shops. into treatment. not been as positive as expected. What Criminal organisations have taken The commissions are mandated is clear is that decriminalisation has not over a large part of the cannabis industry. to use targeted sanctions including heralded a rampant increase in drug use According to police, at least 80 percent

12 matters of substance February 10 www.drugfoundation.org.nz of what is grown in the Netherlands is the ban on federal funding of needle entire cities and corruption is undermining exported. Various initiatives to address exchange programmes has been lifted. governance. Despite billions of dollars this, such as allowing cannabis cultivation In a tacit admission that hard line spent in supply eradication, the region for ‘coffee shops’ within a closed system anti-drug policies in the broader region remains the world’s largest exporter of and hence decriminalising its production, have not worked, the US House of cocaine and marijuana, and domestic have so far failed. Representatives has voted to create an drug use is also growing. independent commission to review its Recognising the need for a new anti-drug policies related to Latin approach, the Latin American Commission United America. Since 1980, the US has spent on Drugs and Democracy, convened by States nearly $14 billion trying to stop drug- the former presidents of Brazil, Colombia smuggling from Latin America yet there and Mexico, has proposed a paradigm are still over 25 million users of shift away from a prohibitionist strategy marijuana, 5.3 million users of cocaine to one that embraces treatment and and nearly half a million users of heroin prevention at its core. In a report released in the US. in 2009, the commission calls for the Despite differences across counties While the US is the cradle of drug status of addicts to change from that of prohibition, there is a remarkable diversity and cities, the state of California comes drug buyers in the illegal market to that of drug law at state and county level. closest to the de facto legalisation of of patients cared for in the public health Currently, 13 states have decriminalised cannabis anywhere in the world. system. It also argues that it is essential the use or possession of cannabis and Cannabis is now available as a medicinal to differentiate between illicit substances 13 states have recognised its medicinal treatment in California to almost anyone according to the harms they inflict and use. Some states fall into both categories. who tells a willing physician they would Nevertheless, US law enforcement and feel less discomfort if they smoked it. emphasises the need for better strategies prison systems are overwhelmed by There are over 200,000 Californians with to reduce demand. prosecutions on drug-consumption charges. a medical letter from a doctor entitling them to purchase cannabis and hundreds of dispensaries selling it. Cannabis sold Not all drug reform across While the US is the cradle for medical purposes represents only a Latin America is progressing of drug prohibition, there is a small fraction of the total California in the same direction. cannabis market but diversion to this remarkable diversity of drug wider market clearly occurs. The law at state and county level. wholesale price of cannabis has fallen by Drug law reform across Latin America Currently, 13 states have half since the legalisation of medicinal was well underway even before the decriminalised the use or marijuana. commission’s clarion call for change. possession of cannabis and In August 2005, Argentina’s supreme 13 states have recognised its court ruled that it was unconstitutional medicinal use. Latin to impose criminal sanctions for the America personal possession of drugs, paving the way for new legislation to decriminalise In a sign that the federal position the possession of illicit drugs for is slowly changing, the Obama personal use. In Brazil, legislative administration has signalled its intent changes early last decade led to the to deal with drugs as a matter of public partial decriminalisation of possession health rather than criminal justice alone, No region has had greater incentive for personal use, with diversion into with treatment’s role growing relative to reform its drug laws than Latin America. treatment and community service instead. to incarceration. Federal authorities The continent has borne a heavy cost in Some of the most far-reaching have been instructed to end raids on the war on drugs. Thousands of lives legislative reform is occurring in Ecuador, medicinal-marijuana dispensaries, and have been lost, drug lords have taken over a country long known for having one www.drugfoundation.org.nz matters of substance February 10 13 Quotes of Substance

I can fly for miles and not of the toughest anti-drug regimes in the Mexico takes is unlikely to have a major see a sign of civilisation, only an region. In an attempt to address the issue impact on the violence without a major occasional smoke plume rising of proportionality and solve a prison reduction in demand from across the above the jungle. The smoke crisis, in 2008, Ecuador pardoned more border in the US. might be from a farmer clearing than 2,000 drug ‘mules’ who met three an area to grow licit crops, or it criteria – they were first-time offenders, might be a burning drug lab. had been caught with a maximum of Indonesia Dave, a 35-year-old crop-duster from two kilograms of any drug and had completed 10 percent of their prison Texas, one of 20 pilots who navigate sentence or a minimum of one year. Colombian jungles to spray herbicide New legislative proposals will have to on illicit crops while risking pot-shots consider the judicial precedent of this from cocaine traffickers. bold move. Not all drug reform across the continent Many drug users in Indonesia is progressing in the same direction. experience abuse and extortion at the hands If the snow has melted While Colombia’s Constitutional Court of police during regular ‘crackdowns’. from a neighbour’s house when declared in 1994 that the possession of In September 2009, Indonesia passed everywhere else still has a illegal drugs within fixed limits was not a new narcotics Bill. Contrary to covering, it could indicate that subject to prosecution, the hard-line what drug reform groups such as the the house is being used for government of President Uribe believes Indonesian Coalition for Drug Policy growing cannabis. this is inconsistent with efforts to curtail Reform were hoping, the new law Sergeant Mel Thomas on new drug trafficking and has been trying to maintains the death penalty for some surveillance methods used by undo that decision with a constitutional drug offences, continues to criminalise Leicestershire Police. amendment to recriminalise consumption. drug addiction and makes it a crime for parents to fail to report their addicted children to authorities. The law also The common use of the While there is no simple transfers responsibility for fighting term ‘junkie’ helps us to maintain one-size-fits-all solution, drug trafficking from the government the belief that users of substances to civil society. are in some way lesser beings. it is clear that overly punitive Nevertheless, the new Bill does Part of the reason we’ve approaches to drug use have introduce some positive measures. comfortably followed the failed elsewhere. For example, public health concerns are prohibition path for so long addressed through the requirement to has been mainstream culture’s provide medical and social rehabilitation view of drug users as subhuman Other apparently progressive drug for drug addicts. creatures who need redemption. law reform has been double-edged. What they really need is medical Conclusion In Mexico, new legislation was enacted support and laws that make in August 2009 that decriminalised Many countries have grappled with sense. possession of small quantities of all drug law reform. Today, we have a much Community worker Chris Middendorp drugs and mandated increased prevention better understanding of what works and writing in the Melbourne Age about the and treatment programmes. Despite many what does not. As New Zealand reviews recent publication of After the War on positive aspects, there are real concerns its 35-year-old drug law, there is much Drugs: Blueprint for Regulation by that the new law may end up sending to be learned from overseas. While there Britain’s Transform Drug Policy even more people to jail. It sets a very is no simple one-size-fits-all solution, Foundation. low threshold in differentiating between it is clear that overly punitive approaches a consumer and a seller and applies even to drug use have failed elsewhere. harsher penalties for small-scale dealing. Alternative approaches to drug law need While cocaine is sold by the gram on the to be guided by evidence, grounded in street, the maximum amount deemed for public health principles and must firmly personal use is half a gram. Possession of embrace human rights. more than this is punishable by three or A drug-free world might not be more years in prison. possible but a world free of the harms The new law is likely to create from the war on drugs ought to be. additional incentives for police corruption Sanji Gunasekara is a Senior Policy Analyst and the extortion of consumers and at the Drug Foundation. continued on page 16 small-time dealers. Whatever action

14 matters of substance February 10 www.drugfoundation.org.nz 2:3 Getting the MODA running

Diversion: Australia’s alternative to drug law reform

In the late 1990s, there was an increasing push within Australia to decriminalise cannabis and to provide legal access to heroin for those dependent on it. Political circumstances did not permit this, but Australia did adopt an Illicit Drug Diversion Initiative (IDDI), a national agreement to divert illicit drug users away from the police and courts. This has enabled a vast expansion of diversionary opportunities for illicit drug users in Australia. Caitlin Hughes looks at the nature of Australia’s diversion programme and its impacts to date.

Australia takes a multi-faceted (amounting to date to over $490 million). approach to drugs, involving reduction Somewhat contradictory is that the of both supply and demand, with the IDDI funding came through the Coalition overall aim being to minimise the harms Government’s recently adopted National of drug use to individuals and society. Illicit Drug Strategy ‘Tough on Drugs’. In One policy intervention that has essence, three factors were integral to the increased in prominence in recent years reform: an evidence base on diversion is the diversion of illicit drug users. programmes; law enforcement support; Caitlin Diversion involves providing alternate and overcoming the political perception Hughes responses to divert an offender out of the that drug diversion was a ‘soft’ reform. criminal justice system or into education The latter was achieved through rhetoric and treatment. that diversion was ‘tough on drugs’. While diversion had been mainstream For example, it did not alter the criminal police practice for many years, pre-1999 law and it remained tough on traffickers implementation largely rested on informal and offenders who failed to take up mechanisms such as police discretion to diversion. In spite of the rhetoric, the not charge an offender and/or ad hoc IDDI is essentially a pragmatic and formal programmes within Australia’s evidence-informed response, one that eight states and territories. A significant has received widespread acclaim. shift occurred following the adoption of Between 2000 and 2007, 35 new the Illicit Drug Diversion Initiative diversion programmes were adopted in (IDDI) on 9 April 1999. The IDDI was a Australia, 30 of which were funded by formal agreement by the Commonwealth, the IDDI. As a consequence, by late 2007, states and territories to divert minor there were 52 diversion programmes drug users via police and courts into operating for drug and drug-related education and/or treatment. Critical to offenders in Australia, with between enabling the expansion of treatment three and 12 programmes in each state places, it received federal funding or territory. www.drugfoundation.org.nz matters of substance February 10 15 Quotes of Substance

Marijuana leads to The diversion programmes provided three exceptions, these five programme homosexuality… and therefore across Australia can be categorised into types operate in all states and territories. to AIDS. five different types, the characteristics The provision of five types of A famous quote from White House Drug of which are summarised below. programme reflects best practice Czar Carlton Turner in 1986. Two years Police diversion for cannabis only: principles concerning diversion. Core aimed at offenders detected using or principles include the need for a broad later, the White House Office of National possessing 15–100 grams of cannabis. range of diversion programmes with Drug Control Policy (ONDCP) was A number of different responses are different levels of interventions, access established, a result of the Anti-Drug provided, including cannabis cautioning for all offenders regardless of age, gender, Abuse Act of 1988. and cannabis expiation. The former ethnicity or substance of use and careful involves a more one-off, therapeutic targeting using clear eligibility criteria. approach – a formal caution, provision The critical question is do the Animation is not only for of educational information and optional programmes work? There are a number children. It is also for adults who referral to an education session or of challenges to answering this question, are on drugs. telephone service. The latter provides Sir Paul McCartney at the Golden offenders with multiple opportunities Globe Awards 2010, speaking about his to avoid a criminal record through the Diversion programmes experience in animation with The Beatles’ payment of an expiation fee of $100–300. have reduced demands on the cartoon Yellow Submarine. Police diversion for other illicit drugs: criminal justice system. aimed at offenders using or in possession of between 0.5 grams and 2 grams of The reality is that we are all amphetamines, cocaine, ecstasy or heroin. the first of which is differing definitions paying the cost – even those of us Offenders are required to undertake an for ‘work’. Diversion programmes have a who drink responsibly or not at assessment of their drug use and attend variety of goals, for example, reducing all. At a time of financial pressure, education or counselling sessions. the harms from receiving a criminal it is essential we address this Police diversion for youth or other penalty, reducing offending and unacceptable drain on our public drug-related offenders: aimed increasing access to drug assessment and services and on business. predominantly at offenders aged 10–18. treatment. Diversion programmes differ This approach results in non-therapeutic Scottish Finance Secretary John Swinney in their ability to attain such goals, on the cost of alcohol abuse to Scotland. sanctions including a warning or the requirement to attend a family group largely due to their chosen mechanism conference. and target population. For example, the Court diversion for minor drug/ less intensive programmes appear better We have more sophisticated at reducing demands on police and more pain management techniques drug-related offenders: aimed at minor offenders with a recognisable drug intensive programmes appear better at available now than ever before reducing drug use and related problems. but many doctors turn patients (predominantly illicit) problem. Most programmes are pre-plea and require Programme outcomes, even among away because they’re very similar programmes, are also often not concerned about the problems that an offender undergo assessment and directly comparable due to population with prescription drug abuse. be deemed as having a treatable drug difference. Because of this, many people problem. Eligible offenders then receive That said, it has been shown that suffer needlessly with pain that tailored drug treatment (predominantly diversion programmes have had could be treated. counselling) for a period of 3–4 months while on bail. numerous benefits. American pharmacist Kathryn Hahn Court diversion for serious drug/ Firstly, they have reduced demands on the failure of pain management due drug-related offenders: aimed at drug- on the criminal justice system. For to inadequate training of physicians, dependent offenders whose offending example, the evaluators of the NSW personal biases and, increasingly, fears is directly related to their drug use. Cannabis Cautioning Programme of prescription analgesic drug abuse. Intensive case management, supervision, calculated that the scheme saved 6,000 urine testing and drug treatment for police hours in each year of operation. 6–24 months are required. Programmes This is because fewer offenders were generally operate pre-sentencing sent to court, and compared to a and offer offenders a final chance traditional criminal charge, cannabis to avoid imprisonment. cautioning produced a saving of 1.5 There is variability between the hours per officer at the point of arrest programme designs, which reflects the and seven hours in cases where an federal nature of Australia, but with offender would have had to go to court.

16 matters of substance February 10 www.drugfoundation.org.nz Quotes of Substance

Diversion programmes have also investigation, hospitalisations, criminal Nobody, as far as I’m aware, reduced offending and the likelihood activity and prison and probation has ever suspected that I’m a drug of imprisonment from reoffending. supervision costs. addict. Why would they? I don’t A national review of 12 police diversion Studies have also shown that diversion slur my speech and I’m one of programmes in Australia found the programmes can have counter-productive the most productive researchers impacts. A particular concern is the in the faculty. majority of offenders did not reoffend issue of net-widening, whereby the following diversion. Moreover, in spite Daniel Bouchard (pseudonym), a likelihood of receiving formal criminal 51-year-old mathematics lecturer at an of marked differences in offending justice contact is increased following the Australian university who takes an average between jurisdictions, the proportionate introduction of diversion programmes. of 50 Nurofen Plus tablets a day to feed a decrease in offending after diversion As shown in the South Australian codeine addiction that’s been an on-again, was relatively consistent across all Cannabis Expiation Notice Scheme, off-again problem throughout his life. jurisdictions, with 69–86 percent of net-widening can occur because diversion offenders without prior records and is faster for police to implement. It can 31–54 percent of offenders with prior also occur due to the belief that diversion Why is there not a greater records not reoffending within 18 months. will be beneficial for offenders. outcry, so that this sick man Even among offenders with prior records In recent years, there have been two receives psychiatric assessment – a proven predictor of reoffending – important learnings. First, the likelihood and treatment rather than a bullet of positive or negative impacts appears most committed either less or similar to the head? shaped by individual programme design, levels of offending. Marjorie Wallace, Chief Executive of for example, the choice of eligibility A third benefit has been reduced the mental health charity Sane, on the criteria. Second, the effectiveness of 29 December 2009 execution of Akmal drug use, frequency of drug use and/or diversion programmes is shaped by the Shaikh. Shaikh’s family claims a drugs harmful use. For example, the proportion broader diversionary and criminal gang exploited his mental illness to trick of offenders who self-reported as regular justice system design. Good design can him into smuggling 4kg of heroin into cannabis users decreased from 95 to 74 be facilitated by careful choice and early China where he was caught and convicted. percent before and after undertaking the evaluation of diversion programmes Queensland Police Drug Diversion and considering how the programmes Programme, and participants in the operate together. It also helps to identify There seems to be a belief Western Australian Pre-sentence potential linkages or referral points among residents that it is legal Opportunity Programme also reported between the programmes and reduce to drive a golf buggy after potential conflicts and gaps for specific significant reductions in self-reported consuming alcohol. types of offenders, for example, drug use. Gold Coast Police Inspector Steve Flori indigenous people. Fourthly, the programmes have reinforces the messages that drink driving The Australian Illicit Drug Diversion improved physical health, mental health rules are for all vehicles after a 19-year-old Initiative demonstrates there are woman was caught over the blood alcohol and relationships. For example, evaluators alternatives to drug law reform that have limit while driving a golf buggy on of the NSW MERIT programme found the potential to address drug-related New Year’s Eve. significant improvements in relation offending. The choice and design of to HIV risk-taking behaviour, poly-drug programmes needs to suit local use behaviour, psychological wellbeing circumstances and goals, but with It’s possible people won’t come and elements of physical health. They appropriate design, diversion programmes to hospital if they know they will also found improvements (though not can offer a very useful and politically have their blood tested. palatable way of increasing opportunities significant) in relation to social David Eddey, President of the Victorian to reduce drug use, drug offending and functioning. branch of the Australasian College for criminal justice costs. At the same time, Lastly, the programmes have Emergency Medicine, expresses his unease they provide more humane responses towards the new push for hospital staff increased the cost-effectiveness of to illicit drug offending. responses. For example, studies of the to drug test all people injured in road accidents. Victoria Police has been asking NSW Magistrates Early Referral Into Dr Caitlin Hughes is a researcher with the emergency departments to take blood Treatment court diversion programme Drug Policy Modelling Program at Australia’s from people involved in collisions so revealed that drug diversion offered National Drug and Alcohol Research Centre. they can test them for cannabis, savings equivalent to $2.98 for every For a full list of references, visit www.drugfoundation.org.nz/ methamphetamines, benzodiazepines $1 invested. This was attributed to matters-of-substance. and alcohol. reductions in the costs of police www.drugfoundation.org.nz matters of substance February 10 17 Research Update

3:3 Getting the MODA running

Knowledge of and attitudes to illegal drugs

P makes you kill people, that’s obvious. You read it in the paper all the time. I think P, you only have to take it once and you’re addicted, that’s what I’ve heard.

Last year, the Ministry of Health published a report on research into New Zealanders’ knowledge about and attitudes to illegal drugs. Sara McFall presents a brief summary of the report’s findings.

Findings of the quantitative telephone survey the Research report on knowledge of their associated harms, and it aims to and attitudes to illegal drugs reveals a improve public awareness of and access mixture of predictable, surprising and to sources of information and help. ■■ When you think about drugs encouraging findings: there were high causing harm in our The research reflects the views of levels of concern about methamphetamine, communities, which are the first those with experience of drug use (past or low awareness of the risks of drugged three drugs you think of? present) and those who had never used driving and a heartening belief that drug drugs. A telephone survey was conducted −− 94% said methamphetamine. problems are a community issue and not with 750 members of the general public, −− 58% said cannabis. the responsibility of individuals. and qualitative research, both in-depth −− 39% said alcohol. interviews and focus groups, was carried ■■ 79% were worried/concerned out with members of the general public about the level of drug use in People did not associate (who may or may not have used drugs) New Zealand. drug use with any particular as well as people recruited primarily ■■ 53% thought there was a lack through treatment services. Interviews of community focus to deal with class or ethnicity, and in were carried out with Mäori, Pacific and illegal drug use. the case of cannabis, many considered it to be an accepted Päkehä, youth (aged 13–17), people aged between 18 and 35 and parents in part of society. Christchurch, Napier/Hastings, Wellington and Auckland. The research sought to understand There was a general concern among how New Zealanders viewed illegal the public about drug use, about drugs, the reasons why people used increasing prevalence and problems drugs and perceptions about the risks including crime and violence. People and harms associated with their use. The did not associate drug use with any research was carried out by consultancy particular class or ethnicity, and in the firms Acqumen Ltd and UMR Research case of cannabis, many considered it to Ltd as part of the Ministry of Health-led be an accepted part of society. demand reduction programme for illegal There were a number of reasons drugs. The programme was created in given why people used illegal drugs, response to calls for accurate and including for perceived benefits such reliable information about drugs and as stress relief and relaxation, as part

18 matters of substance February 10 www.drugfoundation.org.nz It’s a norm when the bong is still on the table when you get up for school in the morning.

Don’t matter who you are, addiction has no boundaries. If you take P makes you kill people, that’s obvious. You read something for too long, you [will] become dependent on it. it in the paper all the time. I think P, you only have to take it once and you’re addicted, As far as I have seen, the side-effects of marijuana can be that’s what I’ve heard. relatively harmless. They get very, very hungry afterwards… My mum told me that like every time you do [methamphetamine] you lose heaps of brain cells and you can never get them back. If you put it into perspective, the drug that does by far and away the most harm in society is alcohol. And yet we allow it to be marketed and sold at the supermarket, it is readily No hangovers, you can drive, no mess, you don’t available, it is made glamorous… have bottles, you don’t have people lying all over the floor, spillage everywhere.

of social life, experimentation, peer When members of the general public Methamphetamine pressure, for creative reasons and to discussed the impacts and harms For the great majority of people, increase confidence. Past and present associated with drugs, these included methamphetamine was perceived as by drug users talked about trying drugs at a death, physical and psychological far and away the most harmful drug and young age, often because it was part of problems, failed potential in employment was associated with violence, gangs and the family environment. And for some, and education, and harm to personal serious physical and mental health drug production and supply was part of relationships. problems. There were several comments the local economy. At least half of those about brain damage and the interviewed had been introduced to addictiveness of methamphetamine drugs by a family member. For the great majority and a general fear of it from members “It’s a norm when the bong is still of people, methamphetamine of the public. on the table when you get up for school was perceived as by far “I think P, you only have to take in the morning.” and away the most harmful it once and you’re addicted, that’s what For older people with experience drug and was associated I’ve heard.” of drug use, the most common reason “P makes you kill people, that’s for starting was to cope with personal with violence, gangs and obvious. You read it in the paper all problems including past traumatic events. serious physical and mental the time.” People were aware of the illegal status health problems. “My mum told me that like every of drugs but did not consider this to be a time you do [methamphetamine] you deterrent or think that police would do lose heaps of brain cells and you can anything about possession offences. For A differentiation was made between never get them back.” those with experience of drug use, the occasional use and problematic use, and Others put the attention on illegal status was not seen as a deterrent some thought there were those with a methamphetamine into perspective. but some thought it was a potential predisposition to dependence. However, “It was interesting because I was deterrent for seeking help. the view of those with experience of thinking that, in the 60s, the scourge of Past and current drug users talked drug use was that addiction was a risk New Zealand was LSD, in the 70s the of the harms associated with drug use for all drug users. scourge of New Zealand was cannabis, in terms of physical and mental health “Don’t matter who you are, addiction in the 80s and early 90s, the scourge was problems, loss of self-esteem, loss of has no boundaries. If you take something ecstasy, now we’ve got methamphetamine. wairua, losing their children and long-term for too long, you [will] become dependent All these drugs have been around and impacts on employment opportunities. on it.” available for more than 50 years.”

www.drugfoundation.org.nz matters of substance February 10 19 “If you put it into perspective, the There was some discussion of cannabis Research with the general drug that does by far and away the most as a ‘gateway’ drug: public found the majority harm in society is alcohol. And yet we “Cannabis… trains your brain to considered drug problems allow it to be marketed and sold at the be addictive.” were community problems, supermarket, it is readily available, it is “Cannabis tends to make people which required a response made glamorous… ” stupid… I was never interested in it so Past and present drug users considered maybe it was my gateway… in that I from society as a whole. methamphetamine to be a high-risk drug went on to the next thing.” with serious effects on health. Some Help and support When past and present drug users found it gave them confidence but Most people thought there was a were asked whether they would have most talked of the harms to them and need to raise awareness of the harms of wanted help and treatment earlier, some their family. illegal drugs. This should be done in said they weren’t ready as they were still “I taught myself to make P at my ways that balance the reporting of having fun or needed the escape drugs house and the smell was so bad. I knew serious criminal activities in the news provided. Others called for better access it was really dangerous but kept at it. with the personal, social and particularly to treatment and practical interventions. I had my son living with me at the time family impacts of drug misuse. “I would have liked help earlier on and he was nearby. Unbelievable now.” “Society needs to be more real about and gave up [in my home town] and Cannabis drugs and acknowledge how common came [here] because I was told there was One of the interesting findings from they are. You can’t hide it as it just going to be less of a waiting list. I then interviews with the public was the makes people feel even worse.” spent close to a year waiting to get in the attitudes towards cannabis. Cannabis A further goal would be to reduce door. So after two years of trying to get was seen as very prevalent and easily stigma against people with drug into CADS, I was pretty sure that not available in the community including dependence and to promote supportive only would they have all the answers at schools. It was considered safer than environments that make it easier to seek [but that] there would be oompa-loompas other illegal drugs (and for some people, help and make changes. For those who and chocolate rivers once I got inside safer than alcohol), and there were a had experience of drug use, some that building.” number of comments about it being OK thought the media responsible for the “One thing CADS could do is have to smoke and drive. stigmatisation of drugs users. a team of people on the phone… saying “As far as I have seen, the side-effects “We don’t need to be judged as ‘Look, I know we can’t fit you in for an of marijuana can be relatively harmless. addicts. We already know we’ve interview for a couple of months but They get very, very hungry afterwards destroyed our lives and don’t need every couple of weeks, I’m going to give and the only negative side-effect of that, to hear it again.” you a call to see how you are going.’” I suppose, is they lighten their wallet on Interestingly, the quantitative and DrugHelp crispy chicken or something.” qualitative research with the general “No hangovers, you can drive, no public found that the majority considered A step towards addressing some mess, you don’t have bottles, you don’t drug problems were community of the calls for information about drugs have people lying all over the floor, problems, which required a response and where to get help is a new web spillage everywhere.” from society as a whole, rather than a resource funded by the Ministry of There was concern at what was personal responsibility. The qualitative Health and developed by a consortium perceived as the increasingly young age research found that most people of providers led by the New Zealand of cannabis users, and some discussed demonstrated care and support for those Drug Foundation. DrugHelp will the potential mental health problems with drug-related problems recognising provide reliable and objective information associated with cannabis. Interviews they were often caused by significant about drugs, share stories with people showed past or current drug users past events or other problems. affected by drugs and provide self-help considered most of the harms associated The general public wanted a public tools and access to further help and with cannabis were to the individual education campaign about drugs and the support. DrugHelp will be launched whereas alcohol and methamphetamine promotion of sources of help such as the in May. were associated with greater societal helpline. In particular, people called for Sara McFall is a Senior Policy Analyst – harms. Cannabis was not, however, more information for parents. Many also National Drug Policy, Ministry of Health. considered harmless and was linked thought it would be valuable for people The full report can be found on the National with memory loss, social isolation in recovery from drug problems to tell Drug Policy website – www.ndp.govt.nz. and depression. their stories.

20 matters of substance February 10 www.drugfoundation.org.nz Caffeine and alcohol – a cocktail for disaster?

The days of high-alcohol, caffeine and additive-filled ‘alcopops’ may be numbered. After a recent US FDA inquiry, global brewer Anheuser-Busch InBev and USA-based MillerCoors LCC have agreed to discontinue their lines of caffeinated alcoholic drinks. The two big Australasian liquor companies, Lion Nathan and Foster’s Group, announced they are to follow suit, limiting the alcohol content in their similar products to 7 percent. Martin Woodbridge looks at the reasons behind pressure on the liquor giants to pull a popular product.

Upon close investigation, it There are numerous alcoholic drinks A high dose of caffeine promotes is little wonder these products on the New Zealand market containing alertness and induces urine flow, which have been earmarked for high doses of caffeine. These products may decrease total body water and supplement the myriad ready-to-drink increase total blood-alcohol content. review or discontinuation. alcoholic beverages (RTDs) and mixers So are we being fooled, coaxed towards that flow from the shelves of bars and more potent and dangerous drinking bargain basement liquor outlets. habits, or is this concern unfounded? There’s plenty of research about the Senior physicians at Johns Hopkins risks and harms associated with alcohol University School of Medicine hold consumption, but the topic of caffeine- grave concerns at both the caffeine and alcohol content of these drinks. They say laced alcohol has not been so widely the caffeine content varies, with some canvassed. containing the equivalent of 14 cans of Upon close investigation, it is little Coca-Cola. They also note that alcohol wonder these products have been adds another level of danger because earmarked for review and regulation. caffeine in high doses can give users The vast range of drinks, supplements a false sense of alertness. and mixers available may contain – A 2006 study confirmed this concern along with very high doses of caffeine – when it found taking caffeine with numerous additives including guarana alcohol reduced participants’ perceptions extract, taurine, inositol, glucuronolactone, of alcohol intoxication compared with niacin, glucose-fructose syrup, B vitamins, those who took alcohol alone. A Brazilian flavours, food acids and antioxidants. study made similar conclusions but Of importance to this discussion is that also revealed, on impartial measures, most contain carbonated water, which, motor coordination, visual reaction time in league with the sugars (specifically and breath alcohol concentration to be fructose and sucrose), facilitates the at expected levels for that consumption absorption of alcohol and its metabolism. of alcohol. www.drugfoundation.org.nz matters of substance February 10 21 Are ultra-high caffeine drinks bad for children?

Another Brazilian study analysed Experts’ views on the safety of consuming 500 university students’ drinking habits very high amounts of caffeine. and found users of energy and alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and the possibility Dr Elaine Rush I am very concerned about the sale of caffeine Professor of Nutrition in large doses… Although caffeine does improve of developing alcohol dependence. at Auckland University of Technology physical performance, convincing evidence is accumulating that there are more problems than US researchers suggest benefits associated with consuming it. being wide awake and drunk at the same time increases the Dr Jim McVeagh I have had to deal with a number of teenagers risk of engaging in several Auckland GP and author having psychotic episodes following multiple cans of popular health blog forms of violent behaviour. MacDoctor of energy drinks. Caffeine is not a benign pick-me- up, nor is it a dietary supplement – it is a stimulant drug, pure and simple. So in reducing the individual perception of intoxication, do caffeinated alcoholic beverages put individuals at greater risk of harm? Do they promote Dr David Jardine From what I can see, caffeine is the most used a false sense of safety, thus fuelling Clinical Director of the drug in the world. It has been blamed for Canterbury District greater consumption? Health Board everything from cardiovascular disease to birth US researchers suggest being wide defects but the scientific evidence for chronic awake and drunk at the same time consumption being harmful is not there. increases the risk of engaging in several forms of violent behaviour. This is also evident from the findings of the British study that examined interpretation of Dr Peter Black Attempts to implicate caffeine as a cause of Professor of Clinical cancer and heart disease over many years have expressions by intoxicated and sober Pharmacology at the men and women. University of Auckland failed. There is however evidence linking a high Professor Doug Sellman of the intake of coffee to reduced fertility in women. National Addiction Centre says sober Excessive intake of caffeine can cause irritability, people are better able to accurately anxiety and insomnia – and that potentially might interpret facial expressions but that, in be an issue in some individuals. drinking situations, this ability becomes far more blurred – especially that of disgust being interpreted as anger. It is important to remember there are Dr John Birkbeck A product must be either a food, or a drug, Adjunct Professor and dealt with under the relevant legislation. a range of factors that influence the in Child Nutrition at absorption of alcohol. For example, Massey University These energy ‘shots’ would clearly be drugs variations between individuals will and put out of existence by lack of safety affect the rate and therefore the timing documentation. But the ‘dietary supplement’ and magnitude of the intoxicating industry in this country has been fighting this for effects. The faster alcohol is absorbed, decades as it is a very lucrative market… the greater the degree of inebriation, so it is not only the caffeine we should be concerned about, but also the carbonated Geoff Allen water and sugar content of these drinks. Restrictions on the sale of such products would New Zealand Food Safety prove very difficult to enforce. The only other food While some of the big liquor producers Authority Director are voluntarily limiting these products, that carries such an age restriction is alcohol – and it’s time New Zealand food and health this demands a highly complex system of special regulators took a closer look. legislation, licensing and policing effort – a system that is by no means watertight (as any 16 or 17 Martin Woodbridge is a Senior Policy Analyst year old will tell you). at the New Zealand Drug Foundation. For a full list of references, visit www.drugfoundation.org.nz/matters-of-substance. Source: www.sciencemediacentre.co.nz

22 matters of substance February 10 www.drugfoundation.org.nz Talking with Doug after the ‘Ten Things’ tour

Late in 2009, Professor Doug Sellman, Director of the National Addiction Centre, University of Otago, Christchurch, toured the country during a university sabbatical, delivering a lecture ‘Ten things the alcohol industry won’t tell you about alcohol’.

The primary intent was to publicise MoS: What were the key community Over the past 20 years, government an evidence-based ‘5+ Solution’ to issues you noted as you moved has allowed the alcohol industry immense New Zealand’s alcohol crisis, in parallel around the country? freedom to market and sell a Class B to the Law Commission’s current alcohol equivalent drug 24 hours a day and Doug: Three main concerns people law review. A second aim was to set advertise it on national television. At the seemed to have were: overt public up a network of alcohol action groups same time, the industry has absolved drunkenness and the sense of danger throughout the country. itself of all responsibility for the problems this brings to downtown New Zealand, caused by alcohol and blamed them on Doug will be elaborating on the particularly after dark; the number of a fantasy ‘irresponsible minority’. lecture and writing it into a book to liquor outlets and how communities often New effective regulation is now be released later this year. In the feel powerless to oppose their proliferation; needed to turn the tide of New Zealand’s meantime, Matters of Substance caught and marketing and advertising. I have harmful drinking culture. The 5+ Solution up with him to find out how the lecture the impression the lectures helped open is a set of policy directives that are series went. people’s eyes to the subtle but powerful supported by robust international influence of the alcohol industry – the evidence. It targets the excessively MoS: So how successful were excessive commercialisation of alcohol permissive environment in which alcohol the lectures? and, in particular, its ready availability. is marketed, supplied and sold as well as recommending increased treatment Doug: I think the lecture tour made Everywhere you go, there’s alcohol opportunities for heavy drinkers. some real headway on waking people up advertising. to the enormous, yet somewhat invisible, A lot of people out there are quite worried, but everywhere I went, people MoS: How has the community presence of the alcohol industry and responded to the lecture series? its unrelenting quest for profit at the were excited by the possibility that expense of the health, safety and change is going to occur. Doug: The public reaction has confirmed wellbeing of New Zealanders. my belief that there is a lot of public MoS: What makes you so sure alarm about New Zealand’s heavy drinking There’s still an extraordinary amount the 5+ Solution will solve culture and that conditions are right of apathy in New Zealand around alcohol. New Zealand’s alcohol crisis? for change. We now have a network A lot of people just don’t understand of enthusiastic and active local alcohol that alcohol is a neurotoxic drug that Doug: We will never solve the problem action groups throughout New Zealand directly causes aggression, and they of alcohol-related damage entirely. that have been working very hard to don’t appreciate the destructive effect Alcohol is here to stay. It’s almost as support the Law Commission’s report excessive drinking has on communities, natural as water. But education campaigns and whatever Government action families and individuals. have very little effectiveness, and the follows. Nearly 400 leading doctors and But after 42 meetings in 30 towns hope that individuals will spontaneously nurses have also sent the Government attended by nearly 5,000 people, there begin to act more responsibly is just an unprecedented sign in an historic are signs that’s starting to change. wishful thinking. statement supporting the 5+ Solution. www.drugfoundation.org.nz matters of substance February 10 23 MoS: And what do you expect the review process to be over so they can Government will do? carry on with business as usual. Doug: I think there are people in MoS: Speaking of the industry, did Government who understand the issues they give your lecture series and want to do something positive to any tangible opposition? reduce the damage from alcohol. At the same time, there will always be intense Doug: Actually, I was expecting lobbying from the alcohol and more organised reaction at the public advertising industries. meetings, but there were only sporadic Ten things the alcohol Those in Government know alcohol comments and challenges, generally 10 industry won’t tell you is a major eroding influence. We need to trotting out the well-worn arguments wait and see whether they have the guts around personal responsibility. But 1. Alcohol is a highly intoxicating and political nous to put up policies that I have no illusions the industry will drug with a relatively low safety index. will really make a difference. stand idly by. 2. Alcohol is a neurotoxin that MoS: Can you gaze into your MoS: What other tricks do you think can cause brain damage. crystal ball and describe the they may have up their sleeve? 3. Alcohol can directly cause legislation that will be written? aggression. Doug: Well, I think threatening to Doug: I fear the new legislation won’t withdraw election funds is a huge lever 4. Alcohol is fattening in moderate directly tackle the most important issue they will roll out at some point behind drinkers. – the excessive commercialisation of the scenes. The National-led Government 5. Alcohol can cause cancer. alcohol. If our parliamentarians really is big-business friendly, and it is very believe alcohol is ‘no ordinary 6. Alcohol cardio-protection has been hard to do something you know will commodity’ and that alcohol has the talked up. hurt your friends, even when it is public health risk equivalent of a Class 7. The alcohol industry actively for a greater cause involving your B1 drug, they will do something about markets alcohol to young people. fellow citizens. pricing and marketing. If those two 8. Low-risk drinking means drinking elements of the 5+ Solution do not appear low amounts of alcohol. MoS: So what can concerned in the new legislation, we are in trouble people do? 9. A lot of the alcohol industry’s – New Zealand’s heavy drinking culture profit comes from heavy drinking. will definitely continue. Doug: The Law Commission’s final A set of measures involving report will probably be made public 10. There is a solution to the national alcohol crisis: the 5+ Solution. accessibility (hours, venue density) in April, so we have a month or two and drink driving – with the possibility left for people still wanting to become of raising the purchase age, at least involved. If people go to our website for off-licence purchases of alcohol, (www.alcoholaction.co.nz), they can + Solution will have some benefit. But I will be join the email list, or contact us directly disappointed if that is all it comes to, so we can put them in touch with their 5 and I’m sure the sense of community local action group coordinator. anger that is beginning to appear will This phase is all about letting the The 5+ Solution, based directly on the become even more overt if a limp piece WHO sponsored publication Alcohol: Government know that New Zealanders of new legislation is put up in response No Ordinary Commodity, is as follows: really do want change. We’d like to see to the Law Commission’s final report. people teaming up and going to see their 1. Raise alcohol prices. If the new law doesn’t involve pricing MPs, particularly National MPs. 2. Raise the purchase age. and marketing, then New Zealand’s Writing letters to the editor is another heavy drinking culture could possibly 3. Reduce alcohol accessibility. good option and is reasonably easy. even intensify. Unless there are 4. Reduce marketing and advertising. Open the newspaper on virtually any new restrictions to marketing and 5. Increase drink-driving counter- advertising, we will very likely see day and there’ll be an alcohol-related measures. a cranking up of alcohol marketing in story to comment on. 2011, turbo-charged by the best excuse PLUS: Increase treatment opportunities Watch Doug’s public lecture on our YouTube available – the Rugby World Cup. for heavy drinkers. channel at www.youtube.com/ I’m sure the alcohol industry can’t nzdrugfoundation. wait for the current Law Commission

24 matters of substance February 10 www.drugfoundation.org.nz Opinion

from drug use in the year 2005/06; it is a benchmark by which to gauge year-by- How effective is the year progress. However, there remain problems even with this. New Zealand Drug Data credibility The ability to gauge yearly progress Harm Index? assumes the data is credible and can be compared accurately year by year. However, the two key data sources used to construct the NZDHI were the Health Behaviour Surveys and Illicit Drug Monitoring System (IDMS), and this poses problems. The IDMS sample sizes are small compared to the Health Behaviour Surveys, and the latter cannot be compared accurately year by year, as the methodology behind them has changed. In addition, there was considerable reliance on Australian data, which will not always translate well to New Zealand. Furthermore, drug use is not constant over time, nor can individual There have been numerous attempts made consumption be considered that way; to do so would also disregard the huge internationally to quantify drug harm. Martin gaps that exist in the data. The ability Woodbridge looks at New Zealand’s Drug Harm to reliably gauge year-by-year progress Index to see just how useful it is to measure with the NZDHI appears, therefore, to be practicably impossible. success in reducing social costs from drug use. Terminology The NZDHI assumes all illicit drug An illicit drug harm index has a number of consumption is ‘abusive’, imposing potential functions. It could, for example, a social cost. The World Health serve as a standard measure of drug- Organization describes abuse as related harm or as an index to measure the harmful or hazardous use of the performance of a drug policy or to psychoactive substances – including make comparisons between countries. alcohol and illicit drugs. However, The New Zealand Drug Harm Index not all drug consumption is harmful, (NZDHI) is intended as an in-house tool especially when we compare dependent Martin to direct drug enforcement resources and and non-dependent users. Woodbridge prioritise activities. Police and Customs, There are considerable differences in however, have used it in the media to the social costs attributable to dependent make claims about the social cost and non-dependent drug users; thus, savings of their drug control activities. the terminology used to capture costs Unfortunately, this is not a valid use is important. By describing all drug use of the NZDHI. as ‘abusive’, the NZDHI over-accounts Business and Economic Research Ltd attributable costs. It’s been estimated (BERL), an economic consultancy that 80 percent of identifiable social firm contracted to develop the NZDHI, costs are attributable to dependent users. explicitly states it cannot be used to A differential definition would better estimate the avoidable cost of drug detail the costs associated to different abuse, the cost-effectiveness of current users – dependent and non-dependent interventions or the social impact of – which would allow for better defined shrinking the illicit drug industry. policies and more realistic evaluations The NZDHI examines only the ‘harm’ of interventions. www.drugfoundation.org.nz matters of substance February 10 25 Examination of cost reduction in social cost if it truly reduces Furthermore, the NZDHI does not There is no doubt illicit drugs the amount of drugs consumed. However, address legal drugs such as tobacco continue to pose danger to society, if the drugs seized were simply replaced and alcohol, the relative costs of which especially with the black market for via the black market, purported cost are enormous. While the Ministerial drugs being so profuse throughout savings may well have been negated. Committee on Drug Policy (MCDP) had society. It is encouraging to see the Second, credible evidence suggests called for alcohol to be included in the New Zealand Police working hard that the ‘enforcement approach’ has had NZDHI, it was not. The lack of a suitable towards fixing drug problems. only marginal impact on use and benchmark across the whole spectrum There has been heated debate about availability worldwide. During our active of drug use makes it extremely difficult the way the NZDHI attributes cost to the enforcement era, the range, price, purity to be exact about social cost savings. and quality of illegal drugs improved, use and availability of drugs. Important which casts doubt on the validity of to this discussion is that the cost of those supply reduction initiatives. enforcement is included. Consequently, Alcohol use is integrally the more spending allocated to A call for suitable comparators linked to most other drug use, enforcement, the more the cost of drugs The original intention of the NZDHI with the total social cost of on society will increase according to the was to encourage agreement between concurrent use far greater NZDHI. This is an important concept agencies about the value of certain types than that of drug use alone. that requires contemplation. of interventions. The end product has far First, the NZDHI authors state that from hit that mark, however, with Police actual harm depends on consumption, using it to highlight the benefits of their Including alcohol would be not on how much is seized. This means supply interventions only, rather than in particularly useful because alcohol that a drug seizure only amounts to a improved cross-agency engagement. factors significantly in Police work

26 matters of substance February 10 www.drugfoundation.org.nz The total potential socio- economic harm to the community prevented by Police from the destroyed cannabis plants and dry plant material is estimated at more than $379 million. NZ Police, 2009 and because not all alcohol use results in the total costs of drugs on society. Of all Reducing the cost of enforcement social costs – but when abused, the costs Police activity related to drug offences, It is unfortunate the NZDHI rise markedly. Furthermore, alcohol use cannabis (55.8 percent) and stimulants doesn’t live up to its proposed potential. is integrally linked to most other drug (43 percent) contribute the greatest It could be a very valuable tool to use, with the total social cost of concurrent proportion. These drugs also contribute evaluate drug harm minimisation use far greater than that of drug use alone. the greatest Police-related (tangible) interventions, to help reduce the costs The report Costs of harmful alcohol costs of crime, at 39.5 percent and attributed to enforcement, for instance, and other drug use, released a year later 49.3 percent respectively – much greater assessing the effectiveness of Police by BERL, reveals the cost of alcohol, in than healthcare of victims (for cannabis, watch-house nurses, which are a comparison to other drugs, is substantial 6.8 percent, and for stimulants, valid attempt at reducing the cost and ($3.2 billion as opposed to $1.03 billion 16.2 percent) and preventative burden of drugs and alcohol on the in 2005/06), but the terminology used in expenditure (for cannabis, 15.3 percent, justice system. the two reports – ‘abuse’ vs ‘harmful use’ and for stimulants, 29.1 percent). Promoting good, proactive policing – is not the same, making it difficult to Although touted as savings, each (enforcement) and identifying areas for compare the stated social costs. drug-related activity conducted by improvement would be a more credible A focus on Police the Police, whether successful or not, use of the NZDHI, instead of short-term Police activity contributes actually translates to increased costs. public relations spin. significantly to the total tangible costs The call by Police for additional Martin Woodbridge is a Senior Policy Analyst associated with each drug. resources to combat drug availability at the New Zealand Drug Foundation. While drug offences make up therefore will reflect an increase in the For a full list of references, visit only 4 percent of Police activity, they social costs of drugs, according to the www.drugfoundation.org.nz/matters-of-substance. nonetheless contribute significantly to NZDHI, even further. www.drugfoundation.org.nz matters of substance February 10 27 New Zealand News

Tipsy teens’ sneaky 700,000 problem drinkers afterwards if the patient wants driver of late-night drunkenness and violence. trick backfires A “historic and to make a quit attempt. This is partly why the Christchurch Police Alcohol Two Tauranga teens tried to unprecedented” letter, signed Government in May introduced Strategy and Enforcement trick police into leaving the by more than 300 leading Team Leader Sergeant New Zealand doctors and the requirement that, by July area so they could drive home Al Lawn said that, in recent nurses, says at least 700,000 this year, 80 percent of after drinking. They called in checks of seven convenience New Zealanders need help hospitalised smokers be given a false report of a gang fight stores, 25 sales were made to with problem drinking. advice and help to quit. The taking place elsewhere. volunteers aged 10 to 17 and The letter comes as the Law required percentage will rise However, the two 18-year- that some convenience stores Commission considers the to 90 in 2011 and 95 in 2012. olds got only a few blocks tested for age vigilance were 3,000-plus submissions into And from next year, before being pulled over at “just horrendous”. its public discussion document, District Health Boards (DHBs) about 3.40am. The driver failed Alcohol in Our Lives. will be held accountable, not a breath test, and his mate Hard time for The letter accuses the only for their own hospitals’ was also arrested after Police prisoners’ kids liquor industry of using the performance on providing discovered he was the one same tactics as big tobacco better help for smokers, but who allegedly made the call to prevent effective regulation also for GP clinics. about the supposed gang fight. and maintain sales despite Performance in the first “enormous personal and league table for July to Smokefree learning social damage”. September 2009 was generally “Alcohol is a potentially dismal, mainly because it is dangerous and addictive a new target. Of the 21 DHBs, recreational substance. It causes only Wairarapa exceeded 80 Do the children of prisoners more than 1,000 deaths a year percent. Waikato came second follow in their parents’ – half due to chronic alcohol- on 39 percent. Waitemata, footsteps? Is crime somehow related diseases and half due which came 20th, blamed hereditary? Do children come to injuries,” the letter says. “technical issues around to see a criminal life as just “Of critical importance is accurately collecting the data”. normal? Or are the social, the fact that these injuries are economic and emotional disproportionately amongst effects such that these children The University of Auckland Buying alcohol now young people. are stuck in poverty with no became the country’s first less convenient smokefree university on “A visit to any Emergency apparent way out? Department on a Thursday, Hundreds of convenience 1 January by banning smoking These are some of the Friday or Saturday night, stores will lose their right to questions a three-year study on all its campuses and outdoor a stroll downtown in most sell alcohol after a landmark by community organisation spaces, including places cities in New Zealand after Liquor Licensing Authority PILLARS and research previously designated as dark during weekends or a decision to change its nine- company Network Research smoking areas. visit to a Women’s Refuge or year stance and reclassify into the status and outlook The new policy aims to addictions clinic will astound convenience stores as dairies of the children of prisoners eliminate the effects of passive many people.” rather than grocery stores. has sought to answer. smoking and create a healthier The authority found the They say there are about 20,000 children of prisoners and cleaner learning One out of 21 ain’t good Victoria Night ’n Day Foodstore, at the moment, and the number environment. opposite the Christchurch Health authorities want to is increasing. For the study, Staff and students were Casino was not a grocery end the bizarre spectacle of they interviewed prisoners, asked for their views, and 75 store, and it will probably have patients in gowns, some with caregivers of the children, percent of responses supported its liquor licence application medical tubes hanging off some children themselves and total prohibition. their bodies, smoking on declined when it comes up a wide range of stakeholders Reaction has been mixed, streets outside ‘smokefree’ for renewal in March. from community and however. Those on medical public hospitals. Police, councils and government organisations. campuses were largely in favour They want all hospitalised anti-alcohol campaigners According to the study, of the change, but student smokers to be offered nicotine have criticised the easy access children of prisoners suffer smokers were not happy at replacement therapy for the to around-the-clock alcohol from an alarming array of being forced out onto the street. duration of their stay and from convenience stores as a physical, emotional and

28 matters of substance February 10 www.drugfoundation.org.nz (in some cases) mental health Justice Minister Simon “Their issue is that they and the New Zealand Police, issues, and there is little Power said there was broad ‘don’t fund gang members’. and Barbara Docherty, the evidence their health needs agreement that the drivers I think they need to put their Director of Training and are being addressed of crime are complex, social heads around the table Development Services for effectively. Not surprisingly, and intergenerational and properly and decide they’re the Brief Interventions for the children tend not to do require early intervention. not funding gang members, Harmful Behaviours Unit at well at school. “Though responsibility for they’re funding the problem.” the University of Auckland. About two-thirds of Mäori reducing crime sits with justice prisoners and one third of sector agencies, many of the Driverless car New Zealanders’ Päkehä prisoners had lived tools to address the drivers of surprises Police fondness for drugs with a family member who crime are in other sectors, such Police working at an alcohol Nearly one in two adults had gone to prison when they as health, education, parenting checkpoint in Christchurch aged 16–64 years has ever used were a child. The differences support, housing, recreation, couldn’t believe their eyes ‘any drugs’ for recreational in these figures are wholly and economic, social and when a vehicle came towards purposes in their lifetime, them with no one in the explained by the eight-times community development,” equating to about 1,292,700 driver’s seat. higher rate of Mäori he said. people. The majority of these It turned out the driver imprisonment. people had used cannabis, had seen Police and jumped Organisers say the study Remote rehab a success with 46.4 percent of all into the rear seat, while his will continue this year to people aged 16–64 years The Salvation Army and front-seat passenger tried to continue building a full and having used cannabis in their the Mongrel Mob are hailing a get hold of the wheel. Once better informed picture as there lifetime, representing seven-week drug rehabilitation stopped, the driver blew a has been virtually no research 1,224,600 people. programme set up in the positive test and was charged, undertaken in this country These findings come from remote central North Island and his car was impounded that examines the effects of the 2007/08 New Zealand village of Kakahi as a success. for 28 days. imprisonment on the families Alcohol and Drug Use Survey The programme was the Police got a further and children of prisoners. and were published by the first of its kind because it shock when they opened the Ministry of Health last month allowed entire families to boot and found a friend of Government to tackle in the report Drug use in attend and work through the driver. “drivers of crime” New Zealand. addiction together. “Apparently, he’d just gone along for the ride. In the past year, one in Edge Te Whaiti, a Imagine if he’d been left in six (16.6 percent) adults member of the Mongrel Mob’s there for the 28 days,” had used ‘any drugs’ for Notorious chapter, says this Inspector Al Stewart said. recreational purposes, is something Corrections equating to 438,200 people. should introduce. New ALAC Council Cannabis (14.6 percent), “I’ve done a lot of drug BZP party pills (5.6 percent), Health Minister Tony Ryall and alcohol and parenting ecstasy (2.6 percent), has announced Rea Wikaira, The Government says it has programmes in the prisons amphetamines (2.1 percent) Chair of the Auckland Primary made addressing the drivers of and the biggest part you miss and LSD and other synthetic Health Organisation, as the crime a whole-of-government in there is not being able hallucinogens (1.3 percent) new Chair of the Alcohol priority. Reducing the harm to do it with your partner Advisory Council (ALAC). were the most common drugs caused by alcohol is one of or with your kids.” “He brings extensive used in the past year for four pillars to the approach The Ministry of Health management and governance recreational purposes. funded the programme, which Cabinet has agreed on. experience to ALAC, including One in three (34.5 percent) involved intensive The other three are: as a Director of Health Waikato past-year users of ‘any drugs’ antenatal, maternity and early counselling, and participants and the Waikato DHB and reported having driven a car parenting support; programmes had to have graduated from Chief Executive of the or another motor vehicle (such to address behavioural one of the Salvation Army’s Auckland Westpac Rescue as a motorcycle or a boat) while problems in children; and detox programmes to qualify. Helicopter Trust,” Mr Ryall said feeling under the influence of alternative approaches to Te Whaiti says it’s now Also joining the Board drugs in the past year. managing low-level offenders time for the Government to is Dr Ian Miller, a registered The full report is available and offering pathways out provide more money for psychologist who has worked on the National Drug Policy of offending. similar programmes. for both the Justice Department website – www.ndp.govt.nz. www.drugfoundation.org.nz matters of substance February 10 29 World News

This is why they call He has also given the green Brits amused by boozy Psychoactive drugs it ‘dope’ light to roll out a Healthy Music lemonade brouhaha classification system Investigators in Florida pilot – a project designed to A British lemonade brand off-beam – UK study say they lured a suspected work with licensed venues to boasting an old-style Victorian Drug users are well informed marijuana grower into turning create a respectful drinking brew has sparked a police about the harms associated himself in by leaving a ransom culture through live music inquiry in the US because with their drugs and perceive note in place of six seized performances and broadcasts. of its alcohol content. alcohol and tobacco as among seedlings. “We have the power to It began when a Maine the most dangerous substances, The sheriff’s office in create positive change and high school student consumed according to a survey by Monroe County says detectives healthier communities, and half a bottle of Fentimans London researchers. discovered the plants in a I believe we need to be lemonade before reading The findings, published wooded area and confiscated innovative in our approach to about the 0.5 percent alcohol in the Journal of them, leaving a phone number achieving that – where better content on the label. The Psychopharmacology, on a note that read: “Thanks than in licensed venues?” school administrators called suggest the current system for the grow! You want them he said. police who referred the matter back? Call for the price.” of classifying psychoactive Steven Alan Locasio to state officials. drugs in the UK may need called the number about Obama ecstasy pills US anti-drinking groups to be revisited. 10 minutes later and offered get popular vote got involved, warning The study surveyed 1,500 $US200 for the plants. parents and retailers about UK drug users who were asked Detectives agreed to meet the drink’s potential perils. to rate 20 psychoactive him for an exchange, To the Brits, the American substances on a ‘rational’ whereupon he was arrested reaction is puritanical and scale previously developed on drugs charges. somewhat batty. by Professor David Nutt of “We see it as slightly the Imperial College, London. Australian Drug Foundation absurd,” said Tiffany McKirdy, Heroin, crack and cocaine 50 years young Operations Director at topped the list in terms of President Barack Obama’s The Australian Drug Fentimans, a specialty harm, but alcohol was rated Foundation celebrated its approval rating may be brewer in northern England. fifth, solvents seventh and 50th birthday last November languishing, but that doesn’t “It looks to us like utter tobacco ninth. Ecstasy came by highlighting its “new mean America’s Commander- hysteria, the fact that the 13th in the harm rating, LSD approaches” towards in-Chief isn’t catching on principal contacted the police 16th and cannabis 18th. supporting young Australians. with new constituents. and the substance abuse The survey therefore The Foundation was set There is now a line of officials got involved.” found no relationship between up to help soldiers returning ecstasy pills made in the McKirdy said a person a drug’s legal status, based on from wars with serious alcohol president’s image, according would need to drink about the current classification problems, but CEO John to Texas police who snatched 28 bottles of the lemonade system, and its users’ ratings Rogerson says he is one of a batch off the streets last in order to consume the of harm. a long line of leaders willing December during a routine alcohol found in a typical In the UK, the Misuse of to try new methods of tackling traffic stop. pint of beer. Drugs Act (1971) currently alcohol and illicit drug use The drugs look like a However, it is no laughing classifies psychoactive drugs problems. “vitamin for kids”, police matter in Houlton, Maine, as A, B or C, though alcohol “Our view today is still spokesman Lenny Sanchez said. where Police Chief Butch and tobacco remain seen as controversial by some Police say that other ecstasy Asselin asked the state’s liquor unclassified. but no different to our founders pills they found were made licensing authorities to Dr Celia Morgan, of the 50 years ago – putting health to look like the cartoon first and treating drug users determine if the Victorian-style University College London’s as people,” he said. characters Homer Simpson lemonade could legally be Clinical Psychopharmacology Mr Rogerson has appointed and the Smurfs. sold to minors. Unit, said, “Given that the a new Youth Strategy Team The 22-year-old driver is He pointed out that Misuse of Drugs Act aims to of under-26-year-olds who expected to face felony drug non-alcoholic beers with signal to young people the provide a realistic youth possession counts. There similar residual alcohol content harmfulness of drugs, this view on policy and education has been no word on his cannot be dispensed to minors suggests a flaw with the current around alcohol and other drugs. political affiliation. under Maine law. classification of drugs.

30 matters of substance February 10 www.drugfoundation.org.nz “We found a high The new approach follows The High Court has upheld Cannabis café correlation between harm evidence that cocaine use an appeal by a Tasmanian opens in Oregon ratings by users and those is increasing among young publican against an earlier made previously by scientific people in the UK, partly driven Supreme Court ruling that experts across all substances, by lower prices. held him responsible for suggesting users are well the death of a 41-year-old informed about the harms Ecstasy collection motorcyclist by returning the of drugs.” could be fatal man’s keys and allowing him to ride home. A man who says he spent The High Court held that Cocaine users killing two decades collecting ecstasy dealing with alcohol and its At precisely 4:20pm on the planet pills of all colours and shapes dangers was “a matter of Friday 13 November 2009, the as a hobby has turned to Cannabis Café, the first coffee personal decision and police for help after they were house in Portland, Oregon, individual responsibility” for stolen – because he says some catering to licensed users of drinkers and that the publican of them are poisonous. medical marijuana, opened was not at fault because there Dutch police say the for business. was no duty of care. 46-year-old man decided to The new café went into The judges said that, with report the theft despite the operation just weeks after the the exception of exceptional illegal nature of the collection Justice Department announced Every time they snort a line, cases – which this case was because he was worried about that people who use marijuana part of the rainforest dies – not – publicans were bound the possible consequences if for medical purposes and those or so say UK police in a new by important statutory duties who distribute it to them will anybody swallowed one of campaign against drugs. but owed no general duty not face federal prosecution, the poisoned pills. They hope appealing to of care at common law to provided they act according It was not immediately young people’s environmental customers requiring them to state law. The time of day clear why about 40 red and concerns will prove more to monitor and minimise the for the opening was a pot- white pills out of the 2,400- effective than urging them service of alcohol or protect smokers’ in-joke: ‘420’ has pill collection would be to “just say no” to drugs. customers from the been used as code for the drug poisoned. Linking with Greenpeace, consequences of the alcohol or its use since the early 1970s. The man claims he is the police plan to spread they consumed. While there are medical not a drug dealer or user. the message that, for every “That conclusion is correct marijuana dispensaries in “I’ve tried it before but other states that serve coffee, gram of cocaine made, four because the opposite view didn’t like it. My passion for the National Organisation square metres of rainforest would create enormous collecting comes from the for the Reform of Marijuana are destroyed. difficulties relating to customer variety of colours, shapes Laws, or NORML, said that The move is backed autonomy and coherence and logos that are printed the northeast Portland café by the government. Schools with legal norms,” they said. on the pills.” is the first place in the nation Minister Vernon Coaker said, The Australian Hotels Police spokesperson where the drug is not sold to “Teaching young people Association said that, while Esther Naber said cater to patrons who want to about the devastating the case could not ease the investigators tended to make legal use of it in public. environmental consequences pain of the tragedy, the ruling believe the man’s story. of the drugs industry is one had helped to clarify the legal “Why would you make Booze blitz on parents way we can tackle usage, obligation publicans owed something like this up?” The Australian Drug though we need to balance people who had been drinking. she said. Foundation is calling for new this with giving young people But Australian Lawyers’ laws that will potentially hit clear information and advice Alliance President Mark adults with $6,000 on-the- on the other effects of drugs.” Aussie publicans Blumer said the ruling appeared not to blame spot fines if children drink Virgin rainforest is cleared to be in contrast to responsible alcohol at parties in their for illegal coca plantations Australian publicans are alcohol laws. homes. while toxic chemicals are used no longer legally responsible “It’s conservative in that Under the current state to process the leaves. Discarded for the behaviour of people who it harks back to a different era law, adults can supply as chemicals, which are dumped become intoxicated in their in a way, that is, the era if you much alcohol as they like in the forest and its rivers, bars or for any consequences want to drink you can drink,” at parties attended by minors, poison rare plants and animals. after they leave the premises. he said. but under proposed federal www.drugfoundation.org.nz matters of substance February 10 31 legislation, adults would be In the previous Global “We know that resentment synthetic alcohol on the brain required to gain permission Burden of Disease Study does exist in the workplace receptors, allowing drinkers from parents before they could (2002), alcohol was risk factor with other workers, with to drive soon afterwards. give under-aged visitors alcohol. number five for ill health taking breaks, but perhaps “Law enforcement could Adults would also be and premature death globally, if it was in such a way as to even have the antidote to use banned from providing an accounting for 3.2 percent assist people to quit, there on revellers who have used “excessive” amount of alcohol of deaths and 4 percent of would be less resentment.’’ the solution. However, they – considered to be anything the total burden measured in would need the backing of more than two standard disability-adjusted life years All the buzz and the government because, at drinks – at teenage parties. (DALYs). none of the ‘blah’ present, the substance would Queensland, New South In the present study, alcohol be classified as a drug and Wales and Tasmania have accounts for 3.8 percent of would fall foul of drug laws,” already adopted tougher mortality and 4.5 percent Professor Nutt said. measures to combat the supply of DALYs, ranking it as the That backing is unlikely of alcohol to youngsters, but third risk factor to ill health considering Professor Nutt Australian Drug Foundation and premature death after was recently sacked as a Chief Executive John Rogerson government advisor for said the remaining states have childhood underweight and the controversial comments gaping holes in legislation, unsafe sex. putting minors at risk. The full report is available We may not have personal he made about cannabis “As the law currently at www.who.int/healthinfo/ jetpacks or meals that come and ecstasy. stands, anybody could give global_burden_disease/ in a pill, but at least one He had criticised the your kid a drink or 10 and global_health_risks/en/ futuristic dream may soon decision to reclassify cannabis not be responsible for the index.html. become a reality. to Class B from C and said the consequences,” Mr Rogerson Researchers are developing process had become politicised. an alcohol substitute that gives said. Non-smokers call the pleasantness of feeling “If this legislation was for leave in lieu Anthrax-heroin scare in place years ago, lives could tipsy without the unpleasant British health authorities have been saved.” Many non-smokers believe hangover. The team, led by issued an alert to drug users The Australian Drug they deserve an extra week UK drug expert Professor after a drug-injecting heroin Foundation will send letters of annual leave to match the David Nutt, has developed the user in London tested positive to the parents of every amount of time their smoking drink using chemicals related for anthrax infection. secondary student warning colleagues spend on cigarette to the sedative valium. The anthrax case followed of a binge-drinking epidemic breaks, Australia’s Quit It works on the nerves the deaths of nine people in among adolescents and Victoria says. in a similar way to alcohol Scotland and another in calling for support for the “We’re constantly hearing causing feelings of wellbeing Germany during December tough new penalties. from non-smokers in the and relaxation. But no matter and January. workplace about this issue, how many drinks a person Nineteen cases of anthrax We could be living longer with smokers having more has, they should remain only mildly drunk. had been confirmed in Global life expectancy could free time or more breaks, The scientists from Scotland, and similarities be increased by nearly five more time off, and does that Imperial College, London, between those and the years by addressing five factors add up to an extra week’s London case pointed to the affecting health – childhood hope the colourless, tasteless leave a year?” Quit Executive heroin, or a contaminated underweight; unsafe sex; synthetic will eventually Director Fiona Sharkie said. cutting agent mixed with the alcohol use; lack of safe replace the alcohol content “We’d encourage heroin, as the likely source of water, sanitation and hygiene; in beer, wine and liquor. workplaces to tell smokers, infection. and high blood pressure – Professor Nutt claimed the look – instead of taking the according to a report substitute could slash Britain’s The European Center for time off to go and smoke, published by the World binge-drinking epidemic, Disease Prevention and Control we’d like to give you time Health Organization (WHO). which costs the NHS £3 billion said that investigations so Global Health Risks to ring the Quitline.” a year, and said it would also far “strongly” suggested that provides detailed global The routine of going outside reduce the number of deaths all the cases had been infected and regional estimates of for a cigarette could also be from alcohol poisoning. by a common source but premature mortality, disability replaced with changing a task The team is also working said the heroin was unlikely and loss of health attributable at work or having a piece of on an antidote pill that would to have been deliberately to 24 global risk factors. fruit, she said. mute the effects of the contaminated.

32 matters of substance February 10 www.drugfoundation.org.nz Mythbusters

Substance and Substantiation

Is drinking in moderation good for my heart?

We all know prolonged heavy drinking and regular bouts of binge drinking are bad for our health. But what about light or moderate drinking? Is a small amount of alcohol actually good for the heart? Mythbusters investigates…

Claims there were possible benefits for Another source of error is the as much as they reflect improvements the heart from drinking moderate amounts systematic misclassification of ex- in our knowledge about the biological of alcohol first emerged in the 1970s. drinkers and occasional drinkers as effects of alcohol. A recent review of Since then, a huge amount of research abstainers, which negatively biases the major studies investigating the alleged has focused on alcohol’s potential health status of abstainers. protective nature of alcohol on the heart cardio-protective effect. Most studies also failed to capture made a startling discovery. Studies There are several plausible biological drinking patterns that may be more reporting a positive protective effect had mechanisms for this idea – alcohol relevant to disease causation than all been funded by the liquor industry increases the profile of ‘good’ fats such as overall consumption. As a result of these whereas those that showed a negative or HDL cholesterol and has an anti-clotting shortcomings, many researchers now no effect had not received any industry effect on blood – but alcohol also has believe that the size of alcohol’s cardio- funding. This does not mean that many other effects that are harmful to protective effect has been exaggerated. industry-funded research is deliberately cardiovascular health, including raising When it comes to the link between biased, but it should encourage a more blood pressure and promoting electrical alcohol and cancer, there is little cautious approach when interpreting rhythm disturbances. ambiguity. Any level of alcohol is and reporting results. Despite the popular notion that a little harmful, and there is no level of Coronary heart disease affects 35 alcohol is good for the heart, the research consumption below which there is not percent of men and 28 percent of women is far from clear. For years, a J-shaped an increased risk of cancer. For breast in New Zealand during their lifetime. curve was used to describe this effect – cancer, each additional standard drink The idea that alcohol might somehow teetotallers were thought to fare worse per day increases the risk by 9 percent. prevent this may sound attractive but than moderate drinkers who in turn fared The risk of mouth, pharynx and larynx is not substantiated by the evidence. better than heavier drinkers. This view is cancer increases by 25 percent per The overall harms from alcohol now under serious challenge. Several early standard drink per day. overwhelmingly outweigh any potential studies that looked at the association Not surprisingly, the World Health cardiovascular benefit for most people. between alcohol and heart disease have Organization has classified alcohol as a Worldwide, at least 2.3 million people been faulted for their design and methods. Class 1 carcinogen, alongside asbestos died of alcohol-related causes in 2002, Non-randomised trials may have and formaldehyde. Yet public and in New Zealand, alcohol is associated overestimated the apparent benefits of understanding of the risks of moderate with an estimated net loss of 12,000 light to moderate alcohol consumption alcohol intake is low. In a recent US years of life annually. on the risk of coronary heart disease survey, almost one-third of all drinkers While there are many valid reasons to drink alcohol – sociability and because they were influenced by cited health benefits as part of their relaxation to name just two – uncontrolled confounders. For example, motivation for drinking. Just 10 percent Mythbusters thinks improving people who only consume light to correctly identified breast cancer as a cardiovascular health should no longer moderate amounts of alcohol also tend possible risk from moderate drinking. be among them. to have healthier lifestyles than heavy The underlying dynamics behind drinkers, while many abstainers do so much of the research into the potential For a full list of references, visit because they already have health health benefits of alcohol reflect the www.drugfoundation.org.nz/mythbusters. problems, not so they can avoid them. powerful commercial interests at play www.drugfoundation.org.nz matters of substance February 10 33