Mattersof Substance. february 2013 Volume 24 Issue No.1 www.drugfoundation.org.nz

Future drugs All around the world, things are rapidly changing. There are signs the War on Drugs may be running out of steam, new technologies promise new treatment possibilities, and scientific developments may be altering the very nature of drugs themselves. Here in , bold new policy initiatives mean the treatment landscape will soon look vastly different. BI BINGE?

26 FEATURE: BI INTO BINGE

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A key strength of the NZ of strength A key ou can help us. 22 .org.nz drugfoundation www. Become a member has been at Foundation The NZ Drug the heart major alcohol and other of 20 years. over policy debates for drug demonstrated have we that time, During commitment to advocating a strong based on the policies and practices available. best evidence Y membership diverse its in lies Foundation Drug Foundation, Drug NZ the of member a As base. about major information you will receive policy challenges. alcohol and other drug in our work to find involved can also get You solutions to those challenges. promoters, includes health Our membership organisations, and community health primary schools and boards students, researchers, and addiction policy makers, trustees, of and workers. agencies treatment enquiries and subscription Membership [email protected] or visit our website. FEATURE: RUSSIAN DRUG POLICY 01 01 02 16 34 36 37 Brand development/Brand design graphic Insight +64 4 801 6644 [email protected] www.designedbyinsight.com

30 How we see things from our front gate In 2011, Russell School became the centre for a battle against Big Alcohol. Where is it at now? The Director’s Cut Events News About a Drug Viewpoints Q&A Mythbusters 16 ABOUT A DRUG matters of substance of invites matters If and contributions. feedback in contributing interested you’re please or article, a guest editorial contact us: [email protected] p +64 4 801 6303

Russell Brand Recent reports about bisexual binge drinking are flawed and the reporting ridiculous. What’s actually going on? 36 Q&A: He’s a world famous comedian in recovery. asks Matters of Substance him about drugs, fame and pears. 26 Putting the ‘bi’ into binge

treatments drugs drug policy drug 06 COVER STORY Where now for of opponents law reform? matters of substanceof is published matters Foundation. the NZ Drug by Neither this reserved. All rights part it publication nor any of without be reproduced may the permission of prior Foundation. NZ Drug 28 Opinion: A majority in the US now support it. 22 punishment: and Crime the sorry state of Russian drug policy Russia treats its addicted citizens with cruelty. What’s going on behind the Iron Curtain? Future 

REGULARS FEATURES Slowly the world CONTENTS

02 matters of substanceof matters 2013 February 24 No 1 Vol ISSN 1177-200X

Why the UN needs civil society Executive Director of the UN office on Drugs and Crime, Yury Fedatov looks at the role NGOs play in combating drug harm internationally. 14 Guest editorial:

The Drug War in retreat? The UN has been forced to act on the War on Drugs. Where to from here? 20 NZ NEWS What does the future hold for What does the future hold for drug policy and recovery? Cover:

is starting to realise the is starting to realise the War on Drugs has failed.

Future drugs the director’s cut Social

@tim_burgess Can’t we give Lance Armstrong a break? I tried riding a bike once on drugs. If anything, it was a lot harder. I was in a hedge within seconds. 19 January

@reedfleming My parents are going away for the weekend. Dad: “How much wine have you packed?” Mum: “Heaps.” #ItsInOurDNA 23 November

@ghetsuhm Woo. Taking the whisky-soaking ’m not convinced cannabis deserves all the cake fruit out of the oven has cleared my attention it gets. sinuses. And possibly dealt to that pesky When it comes to drug policy reform, sobriety... 20 November shouldn’t we be looking at all substances, à la Portugal, rather than single out cannabis? That’s certainly the view of the @damianchristie New Zealand. So clean we even New Zealand Law Commission, which I call our beer and our drugs Pure. 27 November recommended our obsolete drug law be Ross Bell replaced with a cautioning and health Executive Director referral process for all substances, albeit @j20r I don’t have to be drunk to talk about my with a fast track referral for more harmful drugs like methamphetamine. feelings, it’s just coincidentally when I usually choose to do it. 29 November The Commission’s argument is that New Zealand’s ‘drug problem’ is fundamentally a health and social issue best addressed through health-focussed drug law which seeks to reduce harm from all substances, not just the common one. We strongly back this position. KEY EVENTS & DATES Yet much of the drug law debate in New Zealand, and globally, is dominated by cannabis. School of Addiction I understand why this is; cannabis is the world’s most popular , New Zealand illicit drug. 4 of the 5 percent of the world’s adult population that The theme for DAPAANZ’s School of Addiction is people with drug use problems who have cognitive impairment – clinically assessing uses illicit drugs use cannabis. 385,000 adult New Zealanders have 7–9 M arch them and how to adapt for them. used cannabis in the past year and about half of us have tried it; www.dapaanz.org.nz/school-of-addiction 9 percent of whom will be cannabis dependent. The total social cost of cannabis in New Zealand is $314 million, excluding the 2013 International Harm Reduction Conference cost of enforcing cannabis prohibition (which is $116 million). Vilnius, Lithuania So any talk about drug policy reform necessarily will focus on this This 23rd conference is a must-attend for harm reduction high prevalence. 9–12 J une practitioners from around the world. Daily, it seems, a growing evidence base is emerging on the health www.ihra.net/conference and social harms of cannabis. Last year New Zealand research received global attention when it found a link between early and Mental Health and Addiction Nursing Conference heavy use of cannabis and IQ loss. This month other research Auckland, New Zealand queried whether cannabis use increases stroke risk. A new For all nurses who want to get a better handle on mental health

Canadian study highlighted the road safety risks of cannabis 19–21 J une and addiction best practice. impaired driving. Rather than supporting the status quo criminal www.conference.co.nz/mhn13 justice response to cannabis, this evidence reinforces a challenge against it, and towards a new public health approach where we Through the Maze: Cannabis and Health prioritise prevention, harm reduction and treatment interventions. Auckland, New Zealand The New Zealand Drug Foundation is hosting a conference about You must excuse the serious cognitive dissonance displayed in cannabis. Essential to attend for all AOD people.

this editorial. I’ve argued that cannabis shouldn’t get special 27–29 N ovember www.drugfoundation.org.nz attention in drug policy debates, yet, based on shear prevalence alone the attention is deserved. I’m sure I’m not the only one confused and, to help, the Drug Foundation has decided to convene an international symposium starring cannabis. Follow us To our international friends, I extend a very warm invitation Join us online to visit us in late November this year to attend New Zealand’s drugfoundation.org.nz/connect second “Cannabis and Health” conference. Our website provides more detail. matters of substance February 13 01 NEWS NZ. 03 ‘Crack’ in dairies 04 Animal testing 05 “Alcohol and trampolines do not mix. That’s just asking for trouble.”

A new synthetic drug Animal rights activists marketed as Crack hit sparked fears over the shelves of Auckland whether Associate dairies in late 2012. Minister of Health ’s proposed regime Drug Foundation Executive Former trampoline for synthetic drugs will Director Ross Bell said and aerobics coach 01 include animal testing. even illicit drug users Stephanie McMillan were “gobsmacked” at the Mr Dunne was quick to commenting on statistics Prison smoking ban unlawful naming of the product. point out that, while released by ACC, which “The industry has crossed animal testing was show over 39,000 claims The High Court has ruled the line by branding a mentioned in scoping for trampoline-related the Department of Corrections’ product Crack and having documents, no final injuries over the past drug paraphernalia on it. practices had been settled four years. and that he had expressed ban on smoking in prisons It’s just one big piss-take Of those, 126 were aged a preference for no animal because they know they over 65. out of order. can get away with this,” testing. In late December, Justice Murray Gilbert ruled the ban said Mr Bell. Non animal-based testing “I can just was “unlawful, invalid and of no effect” because it falls Associate Minister of methods, such as those outside the scope of rule-making power under section Health Peter Dunne said put forward by Johns imagine it; a 33 of the Corrections Act. the packaging was alarming. Hopkins University, were family occasion, also in the document. Despite the ruling, Corrections is still enforcing the ban, “The issue with it seems a few drinks, with Corrections Minister Anne Tolley saying it had to relate as much to the Legislation for the a grandkid been successful and they would not back down. way in which it’s being synthetic drug testing “If we need to change the law to maintain this, then that presented as being an regime is likely to telling nana or is what we will do,” said Mrs Tolley. imitation of the real thing be introduced into granddad to Arthur Taylor, a prisoner at Paremoremo and the person rather than perhaps its Parliament early this year. ‘come on, come who took the case, is now seeking a High Court ruling to contents, but nonetheless, RESOURCES force Corrections to drop the ban. it’s pretty shabby. I think on, get on with As previously reported by Matters of Substance, the it’s nasty, I think it’s Learn more about alternatives me’.”stephanie mcmillan price for in prisons has skyrocketed to over pernicious and I think to animal testing at $300 for a 30 gram pouch. it’s unacceptable,” said nzdrug.org/animalalt Mr Dunne. 02 Minor drug offences

CANNABIS METHAMPHETAMINE POSSESSION UTENSIL POSSESSION UTENSIL Charges: 17,931 Charges: 11,057 Charges: 2,185 Charges: 3,899 Convicted: 13,131 Convicted: 7,563 Convicted: 1,523 Convicted: 2,765 Imprisoned: 890 Imprisoned: 737 Imprisoned: 341 Imprisoned: 548 REad more here

Ministry of Justice figures show Over the past six years, more Only one in three people are check out pages 18 and 19 than 17,000 people were being offered diversion, and for more details about how minor drug offences are taking up charged, with 13,000 nearly as many people are locking up people caught for court time and putting hundreds convicted and 890 imprisoned going through New Zealand’s minor drug offences is costing for cannabis possession. courts for possession as people New Zealand. of people in prison. are for dealing.

02 matters of substance February 13 07 More booze 08 New beginnings outlets may come = more violence to an end

03 08 07

04 A study published in Funding for Auckland’s the Australian and New Beginnings Court, 06 New Zealand Journal of which deals exclusively 05 Public Health has found with people who are there is a link between homeless, might come to alcohol availability and an end after dedicated “negative social funding ended in x8 outcomes” in Manukau, December 2012. number of dairies in Timaru South Auckland. that have pledged to stop The pilot programme, selling legal synthetic drugs. The study said increased which has cut the arrest 02 availability of alcohol rate of homeless people The Safer Communities Group 01 leads to greater by two-thirds, was a sent a letter to all dairies consumption, which in pilot scheme funded by across the district asking them turn leads to negative Auckland City Council to stop selling the products. social outcomes. and several other agencies. As of late December, only It has yet to secure funding two had refused to stop Areas with additional for 2013. selling them. off-licences were associated with 85.4 more Police The court has been events and 10.3 more achieving impressive goals, vehicle accidents per year. with arrest rates for those involved in the programme REad more here being reduced by 66 percent 06 and sustained for six Read the study at months following. nzdrug.org/manukaualcohol Also, bed nights in prison reduced by 78 percent during participation in the 09 court’s programmes and by 60 percent afterwards. Emergency department visits were reduced by more than 15 percent.

09 QUITLINE NUMBERS the increase on the price of tobacco excise as of 1 January 2013. JAN 2012 0800 11.1% 778 8,222 15,000 778 Number of people Number of people who 400Number of smokers who who signed up to used Quitline to stop contacted Quitline on Quitline in THE MONTH smoking in 2012 and who 1 January 2013. OF January 2013. have remained smokefree.

www.drugfoundation.org.nz 03

NEWS

World. 08 01 04 01 Colorado down to business

09 03 Portugal battles AMENDMENT 64 legal highs Colorado state officials are hammering out the details of legalising possession of small amounts of cannabis after citizens voted for the measure late last year. 04 US$13m more Governor John Hickenlooper has convened a task force to work out the regulations for drug courts needed to put Amendment 64 into practice. Some rules are already known, such as extensive background checks, almost $500,000 Synthetic drugs are in deposits, licensing and application fees, as well as 24-hour video surveillance and becoming popular in every plant must be tracked with extensive records kept. Portugal among people looking for legal highs. The Colorado Department of Revenue, which will have responsibility for regulating the sale of cannabis in the state, has said they expect it to be challenging. Portugal’s National Health Director Alvaro Carvalho One factor was that cannabis is still illegal under federal law. Because of this, banks, said consumption of these which are federally regulated, face legal risks for taking in funds from the sale of substances had increased narcotics. Also, the Drug Enforcement Agency has remained quiet about its stance US President Barack dramatically, and they were on the issue of legalisation in Colorado and Washington. Obama has requested seeing serious consequences. $13 million more for drug This did not stop the state’s first legal ‘pot clubs’ opening, one of which celebrated “Since January, four courts and treatment in on New Year’s Eve with a BYO cannabis party and a screening of The Big Lebowski. people have died and 2013 than in 2012. 170 others have needed The US now has 02 Fitzroy Crossing and FASD hospital treatment for approximately 2,700 drug psychotic episodes and courts, with an estimated The study by the Lililwan Project cardiac complications,” 120,000 people referred to 50 percent of also found there were 55 deaths in said Carvalho. treatment instead of jail. 2007 caused by alcohol in the small The regional government Spokesperson for the 8-year-old Aboriginal community – 13 of them suicide. in Madeira has closed White House Office of children in Fitzroy The study has implications for the shops selling the products, National Drug Control Northern Territory and Queensland and the national Policy Rafael Lemaitre Crossing, Western governments, which plan to government has plans said that, in the previous deregulate drinking in Aboriginal to follow with a Bill. fiscal year, the Obama Australia, suffer communities that had previously As has been seen in other administration had spent from foetal alcohol decided to be ‘dry’. jurisdictions, synthetic $10.4 billion on drug drug makers switch the prevention and treatment Read more here spectrum disorder chemical make-up of their programmes compared Read the full study at products as each new with $9.2 billion on (FASD). nzdrug.org/fitzroycrossing substance is outlawed. domestic drug enforcement.”

04 matters of substance February 13

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09 Bolivia wins on coca

07 Proximity to 02 alcohol matters

Bolivia has won its bid 2.5m to rejoin the 1961 Single 05 Convention on Narcotic 08 who estimates 2.5 million people die each year because of Cannabis Drugs after the United alcohol, and it accounts for 5.5 percent of total global burden dropped Nations’ anti-narcotics of disease and premature death. convention recognised the right of Bolivia’s The World Health Organization’s global burden of disease report, Research from the published in December 2012, shows that alcohol has become the indigenous people to Finnish Institute of third biggest contributor to the global burden of disease after chew raw coca leaf. Occupational Health high blood pressure and smoking. Bolivia’s president Evo showed having a bar Morales said it was a moral The data also showed that alcohol was becoming more of a within 1 km of your home victory for his people. factor in bad health in developing nations. increases the odds of you becoming a heavy drinker D.A.R.E. has announced “It’s not easy to change Read more here by 17 percent. it will no longer talk to international legislation, particularly when 25 years Information on the global burden of disease report was published The longitudinal study 10- and 11-year-olds ago they had decided to in the Lancet and can be found at nzdrug.org/globalburden followed more than 54,000 about cannabis, saying eliminate the coca leaf Finns for seven years. It it is inappropriate for and, with it, our culture,” 06 analysed how their patterns the age group. Morales said. of alcohol consumption In a one-page curriculum $1.9 BILLION Only a bloc of 15 changed when they moved document, the non-profit the amount HSBC paid in a financial settlement for laundering closer to a bar or when a said, “The two most countries, led by the billions and billions of dollars for Colombian and Mexican drug bar opened near them. common and dangerous US and UK, voted against cartels after the US Department of Justice (DoJ) decided not the exemption, with all Among people who were drugs with which to pursue criminal charges. Recently, HSBC has admitted it South American nations an average of 0.12 km elementary-aged students laundered money for drug cartels for over a decade. voting for it. from the nearest bar, over have knowledge or Rolling Stone’s Matt Taibbi recently decried the DoJ for not nine percent were heavy familiarity are alcohol Bolivia withdrew from the prosecuting HSBC executives and the company. Taibbi says the drinkers. Of those 2.4 km and tobacco,” and because treaty in 2011 after a change $1.9 billion is only a fraction of the total money laundered, and away, some 7.5 percent of that, it makes sense to their constitution to the DoJ’s reasoning is unsound when compared to the punitive were heavy drinkers. to remove cannabis from protect the traditional approach law enforcement takes against low-level drug offenders. its programme. rights of indigenous people. Read more here D.A.R.E. is yet to publicly Coca has been chewed for Read more here Read the full paper at comment further about the over 6,000 years in the Read the full Rolling Stone story at nzdrug.org/HSBCjoke nzdrug.org/UMCPJS reason for the change. region for its health benefits.

www.drugfoundation.org.nz 05 cover story

Future drugs All around the world, things are rapidly changing. There are signs the War on Drugs may be running out of steam, new technologies promise new treatment possibilities, and scientific developments may be altering the very nature of drugs themselves. Here in New Zealand, bold new policy initiatives mean the treatment landscape will soon look vastly different. Rob Zorn talks with a few experts about what we can expect to see over the next few years.

06 matters of substance February 13 www.drugfoundation.org.nz 07 Americans aren’t just thinking about it any more. They are ready to cross the threshold now and actually Future do something. drug policy Kasia Malinowska-Sempruch

egulated cannabis global prohibitionist mentality. This is a use is now legal in country where more than a million people two American states, (up to half the prison population) are and the signs are incarcerated for drug offences at any one other states will time. In fact, until recently, prohibition has follow. Does this been embedded so deeply in the American Rob amount to an psyche that openly supporting drug policy Zorn R undermining of reform has been a complete non-starter for America’s staunch prohibitionist stance? most politicians. And what implications might that have for Director of the Global Drug Policy future international drug control policy? Program at the Open Society Foundation It seems many of the hard lines in the Kasia Malinowska-Sempruch says it can’t War on Drugs are slowly turning into soft be emphasised enough that the changes and widening cracks. in the successful states were not pushed Holland’s regulated cannabis cafés have through the legislature; they came from been famous for years, but other countries the voting public. have gone much further. “Anyone who’s had a dinner table Portugal, for example, has become discussion about drug policy knows there the poster state for drug law reformers is significant support for reform in America, globally. In 2001, it decriminalised all drug and there’s a growing understanding that possession for personal use, resulting in the War on Drugs has failed. The numbers plunging HIV rates, more receiving show Americans aren’t just thinking about addiction treatment and an overall decline it any more. They are ready to cross the in drug use. threshold now and actually do something.” Uruguay has announced plans to And ironically, it’s been America’s legalise state-controlled cannabis. enthusiastic investment in the War on Dugs Colombia’s and Guatemala’s presidents that has hugely contributed to changing have called for a debate on legalisation to public opinion. help reduce drug-related crime. Costa Rica Malinowska-Sempruch believes people has decriminalised personal use, and are now starting to see that the epidemic Brazil and Argentina have referenda of arrests, debilitating stigma, mass coming up on whether to do the same. incarceration and disproportionate penalties Most shocking and perhaps most have not achieved any of prohibition’s promising of all, however, were the stated goals. And news stories about the referenda held in the November 2012 savage drug war butchery that happens American elections that legalised cannabis almost daily in places like Mexico are in Washington and Colorado. perhaps making many wonder whether What’s remarkable about this is that those espousing alternatives are worth America has long been the stronghold of another listen.

08 matters of substance February 13 prohibitionist influence has been slowly waning in the face of undeniable successes in places like Portugal. “But with public opinion changing and the Latin American countries saying they’ve had enough, America’s certainty has now become irreversibly fractured. It’s going to be difficult to continue pushing such a hard and simplistic line when your own people and neighbours are all saying something different.” Nevertheless, Trace doubts there America’s certainty has now become will be an immediate global rush towards irreversibly fractured. It’s going to be difficult something like the Portuguese model. to continue pushing such a hard and simplistic “There are plenty of states, such as Russia and some Asian countries, still line when your own people and neighbours are wanting to eradicate their way out of this all saying something different. social problem, so I think we’re yet a long way from finding the sort of consensus that Mike Trace will result in worldwide drug policy reform. “One thing we could get broader agreement on is moving away from arrests and harsh punishments for people who “They’ve also seen that the sky doesn’t start patrolling the streets of Denver and use drugs. We are seeing a growing necessarily fall when you introduce new Seattle? That all seems pretty unlikely.” consensus that the money used for drug policy models,” Malinowska- The Obama administration is indeed in incarcerating and punishing users is Sempruch says. a difficult position. On the one hand, it is not at all money well spent.” “The cafés in Holland did not provoke committed to prohibitionist UN drug And while hardliners remain, UN a massive spike in drug use. In fact, conventions, but it also has a responsibility leadership seems well aware there is a lifetime cannabis use there is lower than to uphold democratic change. If it does try new global mood for change. Trace says for many European countries, and among to counter the Washington and Colorado a General Assembly Special Session on 15 to 16-year-olds, it is much lower than in referenda, its most likely approach will be global drug control strategy, originally the US. Similarly, Portugal did not witness to hold state officials criminally scheduled for 2019, has been rescheduled an explosion of drug use when it accountable for administering legalisation for 2016. decriminalised.” and regulation, but the changes in public “At the UN, where everything happens And what’s happened in Washington opinion probably mean this will be an at a snail’s pace, bringing something and Colorado may just be the tip of the unpopular move. forward by three years amounts to great iceberg. Oregon also had a referendum to America is also facing international urgency.” legalise recreational cannabis use, which pressure to relax its hardline approach at So what happens during the years only narrowly failed. Rhode Island and home. Colombia, Mexico and Guatemala leading up to 2016 will be really important. Maine have signalled plans to introduce have all called on the US to consider other Organisations like the International Drug similar legislation, and California almost approaches such as decriminalisation. Policy Consortium will be doing what they crossed the legalisation line with These are producer or transit countries that can to influence UN leaders and Proposition 19 during the November 2010 have long been plagued by black market ambassadors towards a more enlightened mid-term elections. violence and crime as a result of illegal approach, but the future of global drug It is likely even more American states drugs largely destined for the US. policy may well depend significantly on will now be emboldened to pursue their How much this internal and external just what America does next. own policies, and perhaps most importantly, pressure will affect the international drug politicians will be less reticent about their control policy stage, where America has support for a public health approach. How such a strong and conservative voice, is Future quickly reform will spread across the US presently anybody’s guess. But at the very remains to be seen, but there’s little doubt least, Malinowska-Sempruch speculates it treatments there will be increased pressure on the should encourage the sort of debate that If there’s one thing we know about future federal government to relax domestic has been suppressed until now. addiction treatment in New Zealand, it’s War on Drugs policies at a national level. “It’s been bottled up for so long, and that things will be very different – and In fact, says Malinowska-Sempruch, perhaps now these initiatives will set off perhaps in unexpected ways. Resources the response to Colorado and Washington lots of calls for discussion at state, federal will be tight and demand will be high, but from the White House will be interesting and international levels. There isn’t a could new advances in computerised as cannabis use is still illegal under country on earth that hasn’t been affected treatment be the answer to all our problems? federal law. by bad drug policies,” she says. Co-chair of the National Committee for “Will the federal government sue? Mike Trace, Chair of the International Addiction Treatment Robert Steenhuisen Will the Drug Enforcement Administration Drug Policy Consortium, says America’s says government policy released during

www.drugfoundation.org.nz 09 Health Workforce NZ predicts a doubling in required treatment over the next decade. But this is all occurring against a background of increased demands for accountability and efficiencies, and there will only be a modest increase in funding. Robert Steenhuisen

2012 presents a pretty bold vision for providing enhanced outcomes and more computerised program called Positive New Zealand’s mental health and addiction efficient use of counsellor time. Choice, which has been trialled at five sectors that will require innovation in For example, computer-based training clinics in the San Francisco area. Clients how future treatment needs are met. for cognitive behavioural therapy log in to Positive Choice in a private area “The first thing that becomes (CBT4CBT) developed by Yale University’s of the clinic. If they report drug taking or abundantly clear is that we will need School of Medicine, uses videos, quizzes some other risky behaviour, such as to do much more with the same or fewer and games to help patients recognise and unprotected sex, the Video Doctor appears resources,” he says. avoid situations that put them at higher and makes a brief intervention by selecting “Increasing younger and older risk of using and to teach skills for refusing the most appropriate from a large store of populations, ethnically diverse groups drugs and coping with cravings. files and video clips. and the knowledge that alcohol and drug CBT4CBT trialled well, with 66 percent After their Video Doctor session, the problems have a significant impact on of participants returning drug-free urine client receives a printout out summarising other sectors like education, health, samples for longer, as opposed to 47 percent the main points covered along with some welfare and justice mean demand for who did not use CBT4CBT. In the trial, suggested next steps. Their physician services is only going to increase. it was used with patients before their receives a summary of their risky “In fact, Health Workforce NZ predicts twice-weekly sessions with counsellors, behaviours, suggested counselling a doubling in required treatment over the and its developers suggest it works so approaches and a list of appropriate next decade. But this is all occurring well because it helps patients focus on treatment centres. against a background of increased demands their most acute problems when they meet Video Doctor’s proponents say one of for accountability and efficiencies, and with clinicians. its strengths is that it overcomes factors there will only be a modest increase in The Community Reinforcement that may impede assessment and funding. We simply have to find ways to Approach Plus Vouchers programme counselling such as discomfort with be much more efficient.” (CRA+), developed by the National talking about sexual practices and drug Traditionally, addiction services have Development and Research Institute in the use and patients’ fear of stigma. understood their target as being the 3 US, also uses videos, quizzes and games to The Dartmouth Psychiatric Research percent of the population most impacted teach abstinence and life skills, such as self Center in New Hampshire has produced by mental health and addiction problems, and financial management. a range of internet and mobile phone but Steenhuisen says a new ‘whole of However, CRA+ can also interface technologies that also offer evidence-based population’ approach will mean a directly with a clinic’s urinalysis psychosocial interventions including goal reorientation towards earlier intervention equipment. It analyses samples and prints setting and monitoring, drug use analysis, and a much broader focus on the wider out motivational monetary vouchers where self-management, drug refusal skills, impact of substance abuse. they are negative. If samples are positive, problem solving and counselling. They are You’d have to wonder how the it identifies the drug traces present and currently developing a model especially New Zealand treatment sector is going goes through interactive exercises with for people with co-existing problems. to cope. the patient to assess the circumstances Along with cost savings, computerised One way might be by embracing new of their drug taking and develops a interventions promise to increase access developments in interactive computerised personalised plan to help the patient to treatment because counsellors who technology being used to augment avoid using in future. delegate some of their routine clinical conventional treatment overseas and The Video Doctor is part of a functions to computers will be able to

10 matters of substance February 13 Getting your anti-drug shot

An awful lot of treatment could be delivered using computers. In fact, there’s not a lot that can’t. Fraser Todd

their kids starting smoking is every parent’s nightmare. Most will dabble with cigarettes at schedule more patients. But how likely is overseas interventions any time soon. some stage, and many will become addicted. it this sort of technology will catch on in And there’s probably no need to. Wouldn’t it be great if we could just have our New Zealand and what sort of difference Todd believes we should simply buy kids vaccinated for nicotine (or any other drug could it make here? the software from overseas developers, most – like methamphetamine, for example) at the According to National Addiction of whom, he says, would be willing same time they get their shots for measles, Centre Deputy Director Fraser Todd, to supply modified versions that are mumps and rubella? these interventions can be as effective as culturally appropriate for New Zealand. Well, a study published in Science Translational one-to-one counselling for people with Medicine in June 2012 claims just such a thing mild to moderate problems, and the cost is not only possible, it already exists. savings and efficiencies they bring make ...I can see a real shifting According to Dr Ronald Crystal, Professor of their use here inevitable. Genetic Medicine at New York’s Weill Cornell “An awful lot of treatment could be of roles occurring in the Medical College, a vaccine can be created to delivered using computers. In fact, there’s future, especially towards prevent addiction to any substance, from not a lot that can’t,” he says. nicotine to methamphetamine, for the rest primary care, as computerised of one’s life. “I suspect they could even make interventions become more clinicians redundant for a wide range The vaccine works in exactly the same way as of problems.” mainstream. one used to prevent disease. A small amount What Todd means is that a person with of a specific type of drug is introduced to the mild to moderate needs may not need to see body, causing the immune system to create antibodies. Before the drug can pass through a clinician or may not need one right away, “The Dartmouth program, for example, the blood to the heart and brain, the antibodies because they could receive computer-based sell for about the cost of two clinicians’ destroy it, making it impossible for the user to annual salaries. And when you think about treatment supervised by someone differently feel the drug’s effects – a bit like what qualified. A nurse with general skills, for the efficiencies and cost savings involved, happens with varenicline tartrate (Champix). example, could work through a programme buying them just makes good sense on all The difficulty until now has been that with a drug-dependent person and rely on sorts of levels. molecules within addictive substances like the software for the in-depth knowledge “But the question this raises, of course, cocaine, methamphetamine and nicotine are about drugs and counselling required. is what are we going to do with all our so small, they tend to be ignored by the “It won’t work for everyone, and we’re surplus clinicians?” immune system. To combat that, scientists always going to need clinicians for more And yes, he’s serious. Computer-based created synthetic versions of the molecules serious cases, but I can see a real shifting of interventions could downsize the need for and attached them to larger proteins, which roles occurring in the future, especially clinicians so much that a lot could find makes them a little more noticeable. Finally, towards primary care, as computerised themselves out of work. they add what is known as an ‘adjuvant’, a interventions become more mainstream,” “Sure, this stuff is still in its infancy, chemical mix created specifically to attract he says. even in the States, but it’s the sort of thing the immune system. While there has been some work done that will take off very quickly. There’s a In Dr Crystal’s study, the process worked really in New Zealand’s addiction treatment real risk that some enthusiastic government well with mice. Scientists are now preparing sector around computer-based education is going to do the maths, see the potential to test the vaccine in rats and then primates programmes, it is unlikely we’ll be savings and try to put this in place before humans. developing anything of our own to rival here overnight.

www.drugfoundation.org.nz 11 “It’s really important we take the time to implement it properly, say over 3–5 years, and that the government works with the treatment sector to make sure risks like this are managed.” And, of course, computerised interventions will never be the answer to Considering its obvious all our problems. In fact, they are likely to benefits in reducing harm, introduce a few new ones, and New Zealand having to deal with having synthetic alcohol is bound too many treatment specialists will be a to happen in the future. very unique problem indeed. Professor David Nutt Future drugs Wouldn’t it be great if you could enjoy the pleasures of alcohol without all the negatives, such as hangovers, liver cirrhosis and drunk-driving convictions? Professor David Nutt thinks current scientific ability to target specific areas of the brain means such a drug may not be too alcohol as the worst drug overall. It is so memory impairment, sedation, relaxation far off and that ‘synthetic alcohol’ could toxic that, if introduced today, it would be and interrupted motor neuron control. also function as an effective treatment tool among the most controlled of substances. Professor David Nutt, former advisor to for alcoholism. And if we can make And it is a poison without an antidote. the UK Government on drug policy, thinks synthetic alcohol fly, what else might we Alcohol is metabolised into acetaldehyde, it is high time we used what we know be able to do? which literally pickles the liver (and other about neurons and how to target them to Medical problems associated with organs) over time, leading to acute illness develop safer, alternative intoxicants that alcohol are increasing alarmingly in the and death. deliver the same results as alcohol but developed world. Deaths from liver disease And alcohol has a number of more without the harms. are rising rapidly and may soon overtake immediate effects because it affects so many He suggests that, with current knowledge, heart disease as the biggest killer. different GABA neurotransmitters, of which it would be possible to develop a substance In fact, a recent assessment of drug- there are many subtypes, in the brain. that targeted the GABA neurotransmitter related health hazards in the UK scored These effects include loss of inhibition, subtypes that affect relaxation and

When given an opioid such as morphine, test glia, less pain is caused, more is prevented, Addiction-proof subjects displayed the usual characteristics of and negative effects such as addiction and addiction, including self-administering the drug. tolerance are severely reduced. painkillers However, when given a dose of (+)-naloxone Watkins isn’t yet ready to call the drug a with the opioid, the subjects exhibited no opioid painkillers have long been a two-edged success as positive results on humans are yet characteristics of addiction. sword, and the world is full of people who once to be conducted. But lots of things that work had chronic pain but now have addictions to Lead author Dr Linda Watkins of the University on rodents can be made to work with humans so she admits to being excited at the new their medication. For years, scientists have been of Colorado says she thinks that, when administered, the drug interacts with glia, possibilities this discovery holds for the future trying to separate the pain-relieving immune cells that make up 90 percent of the of both pain relief and opioid addiction. characteristics of opioids from the addictive high brain. When standard opioids or painkillers are they offer, and until now, most thought it administered, glia enhance the activity of the impossible. A recent study published in the neurons that respond to the drug. However, over Journal of Neuroscience has found a drug that not an extended use of painkillers, they become only reduces the addictiveness of prescription increasingly active, reducing the drug’s painkillers but also boosts their effectiveness. pain-relieving effect and increasing tolerance. The drug, (+)-naloxone, is a molecular mirror- Ironically, as glia become more active, they also image of the drug naloxone, which is used as an produce pain, effectively eliminating the overdose antidote. In the study, scientists found painkilling effects of the opioid. that, when rodents were given a combination of But when (+)-naloxone is introduced, it has an (+)-naloxone and opioids, the drug seemed to immediate calming effect on glia by blocking a prohibit the expected effects of the opioids. type of receptor they contain. By calming the

12 matters of substance February 13 I-Sniffbot intoxication in the brain in the same While ordinary members of the public way as alcohol but do not affect, for could conceivably choose to take synthetic example, the subtypes controlling alcohol to a party rather than their usual memory or steadiness. six-pack – sober drivers, for instance, or Furthermore, the benign effects of those with a big day at work tomorrow consumption could be reversed by – its most immediate benefits are for those antidotes. He points out that antidotes in treatment or needing to reduce the already exist for some of the effects of harms associated with their consumption. benzodiazepines, which stimulate GABA Being non-addictive and far less action in much the same way as alcohol. physiologically destructive, synthetic If adapted for alcohol, this would mean, alcohol could be used as replacement effectively, you could ‘take a pill’ after therapy in much the same way methadone indulging in a heavy drinking session and is used for those addicted to heroin and be perfectly safe driving home. other opiates. So, synthetic alcohol as an And of course, other benefits to approved medication could be a first step emergency and security services have synthetic alcohol would include that it towards mainstream acceptance, once always relied heavily on the sniffing abilities doesn’t target neurons associated with governmental red tape is overcome. of dogs. From searching for disaster addiction and that it would not break Eventually, those whose alcoholism survivors to following the trail of wanted down into toxic acetaldehyde and slowly is only in early stages could be encouraged criminals, dogs have always done it best. but surely kill your liver and you. towards a synthetic alternative, and some Their olfactory abilities have also done our “Considering its obvious benefits may avoid what might have been an canine servants proud in detecting illicit in reducing harm, synthetic alcohol is inevitable addiction by choosing it early on. drugs and other unwanted substances at our bound to happen in the future,” Professor Nutt first proposed the notion of borders, but Professor Ken Grattan of Nutt says. synthetic alcohol in 2004, and the idea is London’s City University believes we may “What’s probably making this catching on. A 2008 Sigma Scan (by the now have an even better option. He heads a unviable at the moment is the implicit UK Government Office for Science) team developing the world’s first robot sniffer. assumption by the public and legislators predicted the advent of just such a drug. Nicknamed the cargo-screening ferret, the alike that alcohol is a foodstuff rather than In fact, it went much further, suggesting robot will have an artificial sense of smell a drug. Current regulations mean that enhancement through lifestyle drugs may capable of sniffing out any number of replacing alcohol with a ‘real drug’ would well become the norm in the future as programmed odours. The sensors are made be challenging. It might have to pass the we get better at targeting certain receptors up of chemically coated optic fibres that same safety hurdles as medicines rather would glow when contact is made with a in the brain. than the much lower hurdles for foods. targeted aroma. ‘Cogniceuticals’ could improve memory, our ability to learn and even While many would argue you can’t beat a our decision-making abilities. dog’s natural sense of smell, Professor These futuristic drugs are Grattan says a robot can do things no dog ‘Emoticeuticals’ could enhance our can. For example, dogs tire, get hungry, make almost exciting as flying cars, responses in private life or in challenging mistakes and require the constant care of at jetpacks and meals in a pill, work situations, such as those that demand least one trained professional. They also tend but no doubt they will come high motivation. ‘Sensoceuticals’ might to slobber a bit and can be a bit pongy with a raft of challenges. enhance pleasure by restoring or themselves. Robots, on the other hand, accentuating the senses. Special sleep would be fully automated and capable of drugs could condense a refreshing night’s running for 24 hours a day without any need “But if governments signalled they sleep into a few hours or allow us to skip for reward or encouragement. wanted a safe alternative to alcohol, bed altogether with no ill effects. However, there are still drawbacks with the I am sure the combined skills of the These futuristic drugs are almost robot that would need to be overcome. exciting as flying cars, jetpacks and meals pharmaceutical industry and academia For one, the robot would only be capable of could rapidly produce viable candidates.” in a pill, but no doubt they will come with detecting odours it had been programmed to Nutt admits synthetic alcohol would a raft of challenges and ethical implications identify. Replicating specific odours and not quickly become a ready substitute that governments will need to sort through. programming robots to detect them is still for the average drinker. Those who “In the meantime, though,” says Nutt, tricky, and science is yet to match a canine’s enjoy going out to a wine bar or who “governments should be doing all they can natural sense of smell. like a few ‘brews with the bros’ are not to expedite production of substances like Further, robots aren’t yet able to detect the going to see a flavoured cocktail with synthetic alcohol. What’s at stake for them difference between a combination of smells, added artificial alcohol as an attractive here is a future with fewer substance- which means they would struggle to identify alternative. addicted citizens.” a programmed odour if one or more other But for those whose purpose in odours were detectable at the same time. drinking is primarily to get drunk rather Rob Zorn is a Wellington-based writer. And while it’s probably inevitable they’ll than to savour deep cherry undertones or one day replace their canine counterparts, the light refreshing bitterness of Pacifica RESOURCES the robots probably won’t be anywhere hops, it might be just what the doctor • For references to this article, please see the online near as cute. ordered. Quite literally. version at nzdrug.org/futuredrugref

www.drugfoundation.org.nz 13 guest editorial Why the UN needs civil society

Whether building bridges or breaking dams, civil society is crucial when dealing with drug, crime or terrorism, writes Yury Fedotov, Executive Director of the United Nations Office on Drugs and Crime (UNODC).

any civil society I should add that such activities available to alleviate their pain. The organisations also represent the wishes of Member States campaign led to a CND resolution aimed provide important who believe in the importance of at addressing this gap, and it shows research, do transferring knowledge, skills and how policy can be successfully allied valuable field work information across organisations in order to experience in the field. and make a sizeable to enrich their operations. Such activities I would also encourage civil contribution to are vital to ensure good policy is bound to organisations to continue to be the eyes M policy development sound operations. and the ears of society and to in the area of problem drug use. Therefore, The converse, however, is also true. constructively contribute to the CND. the UNODC sees civil society, as an equal For operations to succeed, they must also I participated in the first informal Civil partner. It needs to be listened to and be driven by prudent policy. This is why Society Hearing during the 2012 Session of respected for its expertise. the Commission on Narcotic Drugs (CND), the Commission CND and I am planning to Although the driving force behind and UNODC’s secretarial role for the drug UNODC’s work are the UN Conventions on conventions are so important. The annual do so again this year. drugs, crime and corruption, as well as the CND is also enhanced by civil society’s The meeting provides a welcome space international instruments on terrorism, our participation as observers. where civil society, UN Member States, ability to deliver on this mandate is often UNODC has also established effective and key international bodies can exchange reliant on civil society organisations. working partnerships with umbrella views and discuss best practices in the area For this reason, UNODC has developed organisations such as the Vienna NGO of drug policy. It is likely that this year the many years of engagement with them. The Committee on Drugs (VNGOC). They allow focus will be on civil society contributions importance of the relationship is heavily for coordinated and effective civil society to the 2009 Political Declaration and Plan emphasised in our Strategy for 2012–2015 participation in the CND, while bridging of Action. With this in mind, UNODC will and translates into close working the gap that often exists between continue to support the work of civil relationships in the field. Indeed, UNODC international policy-makers, national society and to take an active role in works with numerous organisations across authorities, and civil society. promoting the dialogue between civil the world on a wide range of activities. Civil society has also provided society and Members States. These activities include work on excellent contributions to the high level Whether building bridges between alleviating the suffering of people who use segment of the 2009 CND through the organisations, or breaking the dams that drugs and their families; we also work “Beyond 2008” project, undertaken jointly hinder their effective action, civil society together on empowering the victims and by UNODC and the VNGOC. The event organisations play a leading role in the area witnesses of crime. Elsewhere, we are gave a platform to 900 people representing of drugs, crime and terrorism. Over the strong partners with civil society in the thousands of organisations within their years, mutual suspicion has given way to fight against corruption and the need for networks and millions of members in effective criminal justice systems. around 145 countries. mutual respect to everyone’s mutual Just as importantly, this collaborative There are other situations where the benefit. Today, civil society is listened to work is regularly carried out in difficult voice of civil society has made a difference. and much admired wherever it works. environments. We are often in weak and Some civil society organisations, for My role, as head of UNODC, is to fragile nations, especially countries that example, have shown how the drug ensure that our enduring partnership have only just escaped from conflict and conventions have been overruled in some continues on this path and delivers which are slowly moving along the path countries producing greater suffering for assistance to the millions of people towards democracy. cancer patients due to shortage of opiates around the world who need us most.

14 matters of substance February 13 I encourage civil organisations to continue to be the eyes and the ears of society and to constructively contribute to the CND.

www.drugfoundation.org.nz 15 ABOUT A DRUG

If you got bad news, you wanna kick them blues; cocaine. When your day is done and you wanna run; cocaine. She don’t lie, she don’t lie, she don’t lie; cocaine.

JJ Cale, Cocaine

It comes from a plant grown deep in the jungles of South America. Planted, picked and processed by peasants, the shimmering white powder crosses borders and finds its way up noses and into the veins of people around the globe. Portrayed as one of the most glamorous drugs, cocaine has made a huge splash in pop culture and left a huge scar on South America.

16 matters of substance February 13 The thin oval leaves of a scrubby bush impotence, heart problems and, if the 2 known as the coca plant have long been user is snorting, disintegration of the KM important to the people of South America. nasal membrane. 1,700 The Moche and Incans knew chewing the Look at pop culture and you’ll see a the estimated area covered by coca leaves could help reduce fatigue and combat fine layer of cocaine dust. From Sherlock plantations globally in 2012. altitude sickness. It was a gift from the gods. Holmes using the tincture to inspire his This is about the same size as Coca first travelled across the Atlantic investigations to Tony Montana sitting New Zealand’s Stewart Island/Rakiura in the 1600s where it was often chewed like behind a snowy mountain, it has been tobacco. In the 1800s, it became a popular idolised as the drug of choice by the craze among the well to do of Europe, with rich and famous. Pope Leo XIII giving papal endorsement to Robert Louis Stevenson used cocaine 3.6% a coca-treated Bordeaux wine. to hurriedly rewrite the entire Dr Jekyll of New Zealanders In the 1850s, Paolo Mantegazza, an and Mr Hyde manuscript. Eric Clapton have tried Cocaine Italian neurologist, started chewing coca and Stevie Nicks sang about it and many leaves and was enamoured by its effects, movies depict cocaine use as a central writing, “I sneered at the poor mortals plot. After cannabis, cocaine is the most condemned to live in this valley of tears commonly shown drug in movies. while I, carried on the wings of two leaves There is a strong culture of movie stars $500 for one gram in New Zealand of coca, went flying through the spaces of themselves becoming addicted to it. 77,438 words, each more splendid than the Joking about his addiction, Robin one before.” Williams said, “Cocaine is God’s way In 1859, inspired by Mantegazza’s work, of saying that you’re making too much German chemist Albert Niemann isolated money.” Williams has a valid point. $200 FOR ONE GRAM in the USA the primary alkaloid from the leaves and Plantation prices are cheap. In the risky named the product cocaine. Also like process of reaching high demand markets Mantegazza, he couldn’t help but test the – the USA and Europe – the price substance out. Writing about the experience skyrockets. In 2010 across Europe the in his dissertation, he said it has a bitter average retail price of one gram was 15–60 taste, promotes the flow of saliva and leaves $NZ297, and in the USA it was $NZ201. number of minutes cocaine’s effects last a peculiar numbness, followed by a sense of Street prices in New Zealand can range (depending on route of administration) cold when applied to the tongue.” from $350–$800 a gram. Cocaine was heralded as a medical miracle, used in everything from lozenges to pep pills and, of course, Coca Cola. I suppose that its influence 9.6 kg Renowned Antarctic explorer Ernest is physically a bad one. I find the amount of cocaine seized by NZ customs in 2012 Shackleton took liquid cocaine to drip onto it, however, so transcendently the eye as a cure for snow blindness and Forced March pills, a blend of cocaine and stimulating and clarifying to caffeine. The pills’ directions suggested the mind that its secondary “one to be dissolved in the mouth every action is a matter of small 42 TONNES hour when undergoing continued mental the amount of cocaine seized by moment. Ecuadorian police in 2012 strain or physical exertion”. Today, cocaine is hardly used Sherlock Holmes in Arthur Conan Doyle’s medicinally. Use of cocaine and its synthetic The Sign of the Four derivative is confined to anoesthetic for nose and throat operations because of its vasoconstricting properties. Most medical Cocaine is not widely used in garner their workforce through slavery and research involving cocaine now is focused New Zealand. Many posts on tripme.co.nz, seek to protect their profits with intimidation, on understanding its addictive properties a New Zealand-based drug users’ online guns and violence. Corruption is also rife and the harm it causes. community, lament the lack of cocaine, because of the large amounts of cash the To quote Rick James, “Cocaine is one positing reasons for its scarcity such as our drug cartels can throw around. hell of a drug.” It is a serotonin- small market, good Customs Service and Indigenous rights of peoples across norepinephrine-dopamine reuptake the cheap price of methamphetamine. these countries have been trampled by the inhibitor, and its effects last for up to an New Zealand must, however, have UN Single Convention on Narcotic Drugs hour depending on how it is taken. some connection to the cocaine trade. signed in 1961. Coca played a big part in Commonly, the powder form is snorted In 2012 Algerian police found 165 kg of many spiritual and traditional practices of through the nose, but it can also be injected cocaine in a container of Fonterra milk many tribes throughout the South American and smoked. It gives an initial rush of powder shipped from New Zealand. It has continent, but to the international euphoria, alertness and numbness and never been made public where the cocaine community, use of the plant had to be increases blood pressure and heart rate. came from or how it got into the container. stopped. Bolivia has, after fighting for many The rush wears off fast and is followed For all its intrigue, there is a dark side years, been granted an exemption from the by discomfort, depression, paranoia and to the white powder. The War on Drugs convention that allows inhabitants to use a strong craving for more. has made coca growing very profitable for and chew coca. They have rejoined the Extended use has many negative many South American countries, namely Convention with the exemption despite consequences from hallucinations and Colombia, Bolivia and Peru. Cocaine many western – War on Drugs supporting paranoia (think American Psycho) to producers operating deep in jungles often nations – submitting against the move.

www.drugfoundation.org.nz 17 ANALYSIS The cost of our convictions

Every year there are two and a half thousand convictions of Unsurprisingly, young people aged 25 and under for possession and/or use of an illicit drug or drug utensil in New Zealand. New Zealanders are often the Between 2007 and 2011, there were 12,895 convictions in ones being caught up in the this age range. Over this period, New Zealand has spent more than $59 million imprisoning those who are convicted of minor drug criminal justice system. offences and have to serve custodial sentences. This money is This is a bad thing for many reasons. It severely narrows spent on imprisonment costs alone – it does not include costs to opportunities: it’s harder to get a job, harder to travel, harder to Police, the courts, treatment or probation. get credit and harder to do many things most of us take for granted. With an average cost of over $18,000 per person imprisoned It also exposes them to a negative environment, and it puts them for minor drug offences, we have to start asking, what is the cost in prison – a university of crime where drug use is rampant and of convicting young New Zealanders? joining a gang is often necessary for protection. All of this at a time when their brains and identities are forming. The reality is that lots of We are stacking the odds against our young people. Almost New Zealanders will use drugs half of all people convicted of possession and/or use of an illicit at some stage in their lives. drug or drug utensil are aged between 17 and 25.

According to a Ministry of Health survey, about half of all adult Number and percentage of 17–25-year-olds convicted of New Zealanders – or around 1.4 million people – have used illegal possession and/or use of an illicit drug or drug utensil. drugs. Around 485,500 had done so in the past year. year Most people will use drugs when they are young. The Ministry of Health found that over half of those aged 18–24 and almost 2007 2008 2009 2010 2011 two-thirds of those aged 25–34 admitted to using illegal drugs. 44% 45% 45% 44% 41% Data from the Christchurch Health and Development Study 2,456 2,662 3,020 2,702 2,055 found the rates of youth drug use to be even higher. By the age of 25, over 77 percent of the young people in their study admitted to using illegal drugs. Gender and ethnicity plays a role too. Significantly more Ever used any drugs for recreational purposes in lifetime, males are convicted every year than females. among total population aged 16–64 years, by age group and year gender (unadjusted prevalence). gender 2007 2008 2009 2010 2011 % Female 351 363 394 366 277 100 Male 2,103 2,297 2,623 2,336 1,778 Men Women Unknown 2 2 3 0 0 90 Total 2,456 2,662 3,020 2,702 2,055

80

70 Despite Mäori making up 15 percent of the population, Mäori aged 17–25 make up 37 percent of those convicted 60 of possession and/or use of an illicit drug or drug utensil.

50 year ethnicity 2007 2008 2009 2010 2011 40 Pa-keha- 1,259 1,391 1,605 1,501 1,112 Ma-ori 965 990 1,131 989 765 30 Other 80 73 94 69 68

20 Pacific 103 143 159 130 99 Unknown 49 65 31 13 11 10

0 16–17 18–24 25–34 35–44 45–54 55–64 Age group (years)

18 matters of substance February 13 Twelve percent of all people under 25 who are convicted are given a jail sentence. The costs

year sentence type 2007 2008 2009 2010 2011 Imprisonment 13% 11% 11% 12% 12% Community work 28% 28% 30% 30% 30% Monetary penalty 37% 33% 31% 27% 25% $250 The average sentence that comes with a conviction to imprison one person for one day. is short but just long enough to mean loss of job, loss of flat or failure of study courses.

age group mean sentence (days) Under 17 30 number of convictions for minor drug offences 17–25 64 12,895 between 2007 and 2011. Also, there are discrepancies between the sentences for various drugs.

drug type class mean sentence (days) BZP C 425 Cannabis C 49 Cocaine A 60 $59,000,000 Ecstasy B 131 spent between 2007 and 2011 imprisoning people Methamphetamine A 75 for minor drug offences. Heroin A 75

The mean sentence for possession of BZP is 425 days, while people who are in possession of heroin or methamphetamine get 75 days. This is obviously not a system based on relative harms. All this is costing us. Putting people in jail costs us. The Department of Corrections puts $20,470,500 the cost of imprisoning one person at around $250 per day. spent between 2007 and 2011 imprisoning people 25 and under for minor drug offences. number of mean people sentence cost per age group sentenced (days) person total cost Under 17 3 30 $7,500 $22,500 17–25 1,278 64 $16,000 $20,448,000 average number of days Per drug, the costs are even more astounding. These are the costs people are in prison for of those imprisoned between 2007–2011 for minor drug offences, possession of BZP. broken down by drug type and sentence. 425

number of mean people sentence cost per drug type sentenced (days) person total cost BZP 2 425 $106,250 $212,500 average number of days Cannabis 1,050 49 $12,250 $12,862,500 people are in prison for Cocaine 4 60 $15,000 $60,000 049 possession of cannabis. Ecstasy 21 131 $32,750 $687,750 Methamphetamine 387 75 $18,750 $7,256,250 Heroin 11 75 $18,675 $206,250 average number of days That means we spend over $4 million a year imprisoning young people are in prison for people for minor drug offences. This is just the cost of imprisoning. possession of It does not include Police costs, court costs, legal aid costs, 075 methamphetamine. probation costs or social costs.

www.drugfoundation.org.nz 19 FEATURE The Drug War in retreat?

Are we witnessing the beginning of the end for the global War on Drugs? Attacks on drug war ideology are coming from all quarters, argues Russell Brown, to the point where the United Nations has been forced to act. But how much regard the UN will give to the widening calls for reform remains to be seen – and not all the signs are good. Russell Brown

o one expected based Institute of Policy Studies Drug asked UN Secretary-General Ban Ki Moon outgoing Mexican Policy project for the past 14 years. for a review of the organisation’s drug President Felipe “They doctored it to make it sound as if policies. In November 2012, along with the Calderon to make he gave a rousing endorsement of the Drug leaders of Costa Rica, Belize and Honduras, the speech he made War – everyone needs to redouble their they won a UN vote to set a special session to the UN General efforts and so forth – and then the entire on global drug policy for 2016. Assembly in video disappeared, along with the summary. N September 2012. It’s unprecedented as far as I can tell. Calderon, the staunch A head of state giving a formal speech at The UN is very skilled drug warrior, called time on the Drug War. the opening of the UN General Assembly He begged member states – and in and having it expunged from the record.” at deflecting such initiatives. particular wealthy nations that account for Both summary and video are now back It’s the dark cul de sac down most illicit drug consumption – to examine on the UN website, if you know where to which drug reform proposals the “limits” of the war on drugs. look, but there is no transcript. Casual are lured and quietly “Well intentioned efforts” to try to keep readers will need to navigate half an hour drugs out of the hands of young people via into the clip to hear Calderon’s strongest strangled. criticisms. Such are the politics of global legal enforcement had led only to a black Sanho Tree, Institute of Policy Studies, market and enormous earnings that provided drug policy. Washington criminals with power and “an almost But there is no removing the fact that, unlimited ability to corrupt”. Wealthy on the same Wednesday that Calderon countries, he said, needed to explore made his speech, two other Latin American The South Americans are not alone in “regulatory or market-based alternatives” leaders told the Assembly the same thing. their desire for reform. Two years ago, for curbing the illicit drug trade. “The premise of our fight against drugs Germany, Britain and two dozen other In the official UN summary of has proven to have serious flaws,” said countries tried to have the phrase “harm Calderon’s speech, you will not find these President Otto Perez of Guatemala. reduction” adopted as a principle in the words – at least not in the context in which Once-inveterate drug warrior and 10-year political declaration, which they were uttered. His scathing criticism Colombian President Juan Manuel Santos embodies the UN stance on drugs. The of the Drug War is absent from the record. demanded “an objective and scientific” advocates of the longstanding zero-tolerance “The summary was scandalous in search for “better options to battle this philosophy – principally the US, Russia and itself,” says Sanho Tree, the former military scourge”. Japan – prevailed, but the rebels made it historian who has run the Washington- Collectively, the three leaders formally clear they would regard the declaration’s

20 matters of substance February 13 Wealthy countries need to explore regulatory or market-based alternatives for curbing the illicit drug trade. Mexican president Felipe Calderon

eventual compromise language as – and the people say ‘Screw you. We’re these policies down our throats?” equivalent to a harm-reduction stance. going to have a giant smoke-in in front of Tree is at pains to note that, while he Nonetheless, Tree is cautious. The UN the federal building’? Then you have a believes the US has reached a “tipping is “very skilled” at deflecting such legitimation crisis, which is not supposed point” on cannabis reform, dealing with initiatives, he says. “It’s the dark cul de sac to happen in advanced democracies. hard drugs is some way off yet. down which drug reform proposals are That’s a total breakdown of governance.” “Even the word ‘legalisation’ is a very lured and quietly strangled.” awkward term to use, because most people The key reform development may in I know who support ending prohibition fact be the state ballots in the US general What are you going to do? don’t regard it as the same as legalisation. election, where voters in Colorado and It’s not selling heroin to children in candy Washington State opted to legalise the Send in 10,000 DEA officers to machines – it means different types of recreational use and possession of arrest people for smoking a regulation, some of which would be stricter marijuana. In a statement that caused some joint? That would be a silly than others. It doesn’t mean we have to surprise, the re-elected President Obama waste of resources. legalise – but draconian penalties, if there’s said federal enforcement in those states high demand in a black market, are was “not a priority” for his administration. Sanho Tree, Institute of Policy Studies, counterproductive. Tree wasn’t as surprised as some. Washington “I don’t know what an ideal policy ”There’s not a whole lot Obama can do would look like for this country or for with any credibility. Technically, legally, other countries. However, we know what he can do any number of things – and he The wider implications, he says, lie in doesn’t work – the current system doesn’t could probably take it to the Supreme Court the way “the drug war in general is driven work. And we’re not allowed to find out and win. But it would be an absolutely by US domestic politics. By domestic what does work because we can’t pyrrhic victory. And one that’s not in the posturing. And you have two states in the experiment because the prohibitionists interest of the executive, legislative or US, including a major swing state, where have had a lock on policy for so long. So judicial branches of government. marijuana got more votes than Obama – the current policy is not only never going “What are you going to do? Send in or Romney. This gives international actors, to provide a solution – it is the obstacle to 10,000 DEA officers to arrest people for particularly Latin American countries, a lot us ever finding a sustainable solution.” smoking a joint? That would be a silly more political space. They can say, look, waste of resources. And what if they go all if the citizens of your own country are Russell Brown blogs at publicaddress.net the way to the Supreme Court and the starting to turn their back on the Drug War, and hosts Media3. highest court in the land says ‘No, no, no’ where is the legitimacy for you to force

www.drugfoundation.org.nz 21 FEATURE

Crime and punishment: the sorry state of Russian drug policy max daly

Russia’s treatment of its addicted citizens is characterised n Europe, America and Australasia, by cruelty, writes Max Daly. They are denied life-saving says Russia’s Chief medicine. They are beaten, fitted up by the cops, raped and Narcologist Evgeny Bruin, unfortunate tortured. They are, according to Russian state-sponsored addicts are fobbed propaganda, subhuman scum whose schizophrenic minds off with a cheap, I green poison, need correcting with anti-psychotic drugs. Yet according methadone, which turns them into to the country’s narcotics official, these are the luckiest homeless, dementia-ridden zombies with no livers in under five years. Some are drug addicts on the planet. even encouraged to take more drugs, with the provision of free, sterile injecting equipment. Luckily for Russian addicts, their motherland’s treatment system is, unlike in the West, a socially responsible one. In the mixed-up world that is Russian drug policy, scientific evidence and compassion are concepts that have become twisted hideously out of shape. Despite that the Russian government is overseeing a rapidly unfolding health and human rights disaster, its solutions remain couched in Soviet-era repressive psychiatry, propaganda and wilful ignorance of widely accepted scientific truths. At 1.8 million, Russia has one of the highest numbers of injecting drug users in the world. Most inject heroin, but more often now, drug users are injecting the even more damaging home-cooked synthetic opiate desomorphine, known as krokodil because of the scale-like effect it can create on the skin. Crucially, the country’s long-term opposition to internationally accepted methods of harm reduction has laid the foundations for one of the world’s fastest growing HIV epidemics. There were 100,000 people with the HIV virus in Russia a decade ago. Today, there are more than one million – three- quarters of whom are drug users. More than one in three injecting drug users in Russia has HIV, while the vast majority have hepatitis C. Estimates vary, but between 10,000 and 30,000 people suffer

22 matters of substance February 13 Problem drug users are expected to get drug free within three weeks at one of the country’s wide network of detox clinics. Methadone and buprenorphine are nowhere to be seen.

drug-related deaths each year in Russia. the deaths of its own people.” According to the Russian Federal Drug Yet amid the growing devastation, Russia’s heroin problem has Control Agency (FSKN), over 90 percent Russia’s rulers belligerently continue to snowballed since the end of the Cold War of drug treatment patients resume the use ignore what the rest of the world has found and collapse of the old Soviet Union. In the of illegal drugs within a year. to be the most useful weapon against 1990s, traffickers made inroads across the Once a patient has gone through detox, heroin epidemics: tried and tested harm- former Soviet states, particularly along the they may enter Russia’s vastly reduction measures such as methadone Silk Road from Afghanistan via Russia’s overcrowded rehab system. There are three and needle exchange. vast southern border with Kazakhstan. dedicated state rehab centres, assisted by According to Mikhail Golichenko, a At the same time, Russia was seeing a rise in more than 70 rehab wards, providing 2,231 former UN drugs official in Russia who is unemployment and poverty, and for some, beds for the treatment of alcoholism and now a senior policy analyst with the heroin became a way of dealing with life. drug addiction. But with two million Canadian HIV/AIDS Legal Network, their When she first started as an outreach registered alcoholics and 1.8 million attitude is: “We know that getting you off worker handing sterile injecting equipment injecting drugs users, getting a place in a drugs is painful, it’s cruel, but if you do it, to Moscow’s heroin-injecting population in state rehab is difficult. we will welcome you back to society. the late 1990s, Anya Sarang rarely saw a Unfortunately, the ineffectiveness of drug user with HIV. Now, in a city that has the government’s own drug treatment bizarrely claimed success in beating the system and the high demand for help has Russia is the world’s virus, a person gets HIV every three hours. led to a plethora of dubious private rehab cautionary tale on drugs and Today, Sarang’s campaigning organisation, centres, often situated in remote areas. HIV. No other government is the Andrey Rylkov Foundation for Health Charging at least $500 a month, this is so willing to deny the evidence and Social Justice, remains a lone voice in where many middle class Russian families calling for a humane drug policy and will send their drug-addicted sons and on harm reduction, silence proven methods of harm reduction as a daughters. open debate and witness the way of dealing with her country’s archaic But behind closed doors, for some deaths of its own people. treatment system. lurks a dark world of pain and punishment. Russia’s system relies on a two-pronged It’s a system riddled with what Dr Evgeny Damon Barrett, Deputy Director of attack on addiction: detox and rehab. Krupitsky of the Department of Addictions Harm Reduction International Problem drug users are expected to get at the Bekhterev Research drug free within three weeks at one of the Psychoneurological Institute in St If you are not ready, if you fail to kick the country’s wide network of detox clinics. Petersburg has dismissed as little more habit, then fuck you. You will be arrested Methadone and buprenorphine are than “science-decorated shamanism”. and you will get disease. You are doomed nowhere to be seen. The substances, used A report handed to, and later ignored to die.” in the treatment of most of the world’s by, the UN Committee on Torture in 2011 It’s the kind of tough, no-nonsense heroin addicts and deemed essential drugs by Anya Sarang and other campaigners, approach to drug addiction that is coveted by the World Health Organization (WHO), Atmospheric Pressure: Russian Drug Policy by right wing libertarian politicians and were banned until at least 2020 under the as a Driver for Violations of the UN authoritarian regimes the world over. But State Anti-Drug Policy Strategy of the Convention against Torture, gave an with the UN seemingly powerless to Russian Federation, adopted in 2010. account of hundreds of quack methods intervene and increasingly harsh policies Instead, detox is rooted in the kind used to treat addiction in state and private being adopted across the border in of behaviour-correcting methods used rehabs, many in the form of patents lodged Ukraine, it is a stance that is being viewed to suppress the will of Soviet political by the Russian Ministry of Health. It reads internationally with increasing unease. prisoners in the 1960s. Patients are given like a ‘how to’ manual for medieval As Damon Barrett, Deputy Director of a mixture of tranquillisers and anti- dungeon masters and mad scientists. Harm Reduction International, puts it, psychotics such as the neuroleptic Methods include punishment by “Russia is the world’s cautionary tale on haloperidol, a drug more commonly used starvation, long-term handcuffing to bed drugs and HIV. No other government is so to treat schizophrenia and delirium. Then frames, ‘coding’ (hypnotherapy aimed at willing to deny the evidence on harm follows a course of psychotherapy. But the persuading the patient that drug use leads reduction, silence open debate and witness success rates are not good post-detox. to death) and even the xeno-implantation

www.drugfoundation.org.nz 23 We are worried and afraid for every one of our activists, especially since Putin’s inauguration and the scale of political repression we have witnessed. Russian outreach worker Anya Sarang

of guinea pig brains. Out of 34 methods of from the widespread illegal practices ‘Yes, yes, I confess to everything,’ and off opioid-dependence treatment, 18 were employed by law enforcement officials,” you go to the prosecutor’s office.” deemed by analysts in the report as being says Atmospheric Pressure, which details There is even a word, ‘subbotnik’, to ‘life threatening’. how the concept of ‘bespredel’ (lack of any describe the forced provision of free-of- Yet casual violence and bullying has limits for Police) results in “routine law charge sexual services to Police officers been one of the more popular methods enforcement tactics” against drug users. by sex workers. used by private rehabs to try and get people “Detention without legal justification; If, during their journey through the off drugs. One 31-year-old man who planting clues to make an arrest or criminal justice system, in Police stations attended the City Without Drugs private detention; extortion of money or drugs; and in the country’s TB-ridden, Gulag-style rehab centre in Ekaterinburg – raided by or sexual violence targeting sex workers. prisons Russian drug users are beaten, Police last year after the death of an tortured or just left to rot, then they only inpatient – was interviewed for have themselves to blame. Russia’s Atmospheric Pressure. He recalled: Prison medical services Minister of Justice Alexander Konovalov “There is a couch... you lay down, get cannot cope with the flow summed up the prevailing attitude of the undressed... there were three people who of – if you allow me to use government to its most vulnerable citizens beat me up at the same time. It’d be even while discussing the inability of the prison worse if you tried to protect yourself. Then this word – ‘human material’ service to cope with the large number of they hit you on the hands with shovels, clubs. that ends up in the ill inmates. So are you going to inject drugs again? Will penitentiary facilities. Prison medical services, he said, you? – ‘No, I will not, I am not going to use “cannot cope with the flow of – if you drugs any more, stop, I swear, just stop Russian Minister of Justice allow me to use this word – ‘human flogging, don’t flog me any more please…’” Alexander Konovalov material’ that ends up in the penitentiary Professor Vladimir Mendelevich, a facilities”. harm-reduction advocate who has been These can also be much more extreme That drug addicts are treated with censored by the authorities for providing practices, such as physical violence used so little regard by Police in Russia is information on methadone treatment, sums to obtain a ‘confession’ or as torture-like no surprise. up the philosophy of dealing with drug punishment,” says the report. Zero tolerance for drug users is actively addiction in his country: “The Russian It details the experience of a 23-year- promoted by the state. The FSKN has gone drug treatment system has a definition of old drug user from Moscow: on record to clarify the government’s treatment as edification. You suffer, and “And I didn’t sign [the confession]. contempt for drug users. the next time you won’t do anything bad.” They didn’t hit me at first. I was even “An addict degenerates as an But the abuse doesn’t just occur in surprised. And they say: ‘Go, have a individual. His intellect decreases fast, private rehabs. Russian drug users, smoke.’ And led me to some gloomy room. his interests become primitive, his mind particularly those with physical signs of I smoke. And then the door opens. The weakens. He loses interest in life, his abuse such as track marks, can expect bright light hits my eye, I inhale, and friends and relatives abandon him. His similar or worse at the hands of the Police. straight into the [cigarette] coal they just appearance becomes repulsive, bum-like. “The daily life of drug users is hit me on the face. And then it starts: bang, Moral and ethical norms do not exist for characterised by a constant terror arising bang, bang, bang. And you just go: such persons.”

24 matters of substance February 13 Out of 34 methods of opioid-dependence treatment, 18 were deemed by analysts in the report as being ‘life threatening’.

In February 2011, NTV, a federal system. Among them, Ivan Anoshkin had including Russia’s poor, of what she calls channel, aired a TV programme called drugs planted on him and was the “shameless Russian justice”. How to beat the crap out of an addict. subsequently arrested and jailed, while “For heroin users, the state and the Meanwhile, the Russian clergy has adopted Evgeniy Konyshev had drugs planted on medical system are their enemies,” she says. a fairly unsympathetic ‘out of sight, out of him shortly after accusing the City Without “They are treated like scum, and people mind’ mindset in dealing with the Drugs rehab of practising torture under the are in a vicious circle where they cannot country’s problem drug users. The head of guise of drug treatment. get any treatment for their addiction and the Synodal Unit for Collaboration with the But as Mikhail Golichenko points out, end up slowly dying.” Armed Forces and Law Enforcement, Russian user-activists cannot be effective Now that much of the funding for harm- Arch-presbyter Dmitry Smirnov, said, for two reasons. reduction programmes in Russia has dried “An addict either undergoes treatment or “Firstly, they are too busy looking for up, partly due to the fact that Russia became should be isolated from society. I’m not illicit drugs while there is lack of access to a donor rather than a recipient of the Global talking about prison. We have many life-saving substitute treatment. Secondly, Fund to Fight Aids, Russia’s drug-fuelled islands in our country; in the north, in the they are too often in prison – because every public health disaster is set to become far east.” drug-dependent person is doomed to spend catastrophic. Apart from organisations Stigma is not the word. Russia’s drug his life in jail for nothing but an illness – such as the ARF, which are thin on the users, and the people who try and help addiction.” ground in Russia, what assistance can the them, are at the sharp end of what Anya Other citations against the authorities country’s problem drug users, HIV, TB and Sarang calls “an ideological war” that is on ARF’s caseload include inhumane hepatitis C sufferers hope to get from the being waged by the state against what it treatment through denial of TB treatment, international community? deems as anti-Russian forces in society. It inhumane treatment of a pregnant woman Sarang says, since the appointment of is the same war that saw last year’s jailing with drug dependency through coercion to her compatriot Yuri Fedotov as Executive of the feminist punk rock band Pussy Riot have an abortion and inhumane and Director of the UNODC in 2010, Russia has for singing an anti-government protest song degrading treatment of a drug-dependent merely become more efficient at snuffing against Russian president Vladimir Putin at woman through denial of cancer treatment out all semblances of UN influence on its an Orthodox cathedral in Moscow. in prison. domestic policy. The UN human rights Also last year, the Federal Drug Control “We are worried and afraid for every system has simply failed to respond. Service decided to close down the Anfrey one of our activists, especially since “The UN has offices here, but it should Rylkov Foundation (ARF)’s website. When Putin’s inauguration and the scale of withdraw them because they are powerless. asked why the site had been outlawed, the political repression we have witnessed,” It is a waste of time and money, and they minister responsible accused the ARF of says Sarang. should spend it somewhere else. Here, the promoting the use of methadone. And like “Now the repression of political UN has become a puppet. Like our citizens, Pussy Riot, several drug activists who have and human rights activists by the current the UN has become a hostage of Russia’s been vocal in criticising the government dictatorship has become mundane. drug policy.” have ended up in jail. More and more political activists are ARF lawyers are currently fighting thrown in prison.” Max Daly is a UK journalist and was previously eight legal cases involving activists or drug Sarang has expressed solidarity with the editor of Druglink. users who have suffered at the hands of the Pussy Riot and all the other victims,

www.drugfoundation.org.nz 25 FEATURE Putting the ‘bi’ into binge

Emma Hart suggests there’s a reason why bisexual people binge drink more than straight dudes and dudesses and that the biphobic media aren’t helping the situation at all. Emma Hart

ne of the whimsical A couple of questions came to mind. abuse and social isolation in both stereotypes about Didn’t the study size – 32 participants – heterosexual and gay-and-lesbian bisexuals is that we seem a bit small to be drawing these environments. They are stereotyped as drink like falling conclusions? And how was a ‘binge’ being confused about their sexuality or over in high heels defined? As a friend said, sometimes their going through a phase and as ‘greedy’. and short skirts is ‘binge’ is our ‘drinks with dinner’. To manage the stress and anxiety this O going out of fashion. Another thing the gaynz.com article caused, some were self-medicating with Unlike a lot of our managed, which most others didn’t, was alcohol. The quotes from the participants other tropes, there’s solid evidence to back to link to the research. When you dig a bit, throughout the research paper make this this one up. Population studies in you find that this wasn’t a quantitative very clear: New Zealand and the US show that study but a qualitative one. “I drink more when I’m under high more-than-one-gender attracted people stress, when I’m stressed out and binge drink at higher rates than exclusively maybe sometimes at parties when, after same-sex or opposite-sex attracted people. conversations with people, where they We really are irresponsible lushes. The thing is, it’s not how want to know, no one gets the bi thing. So when Stuff published an article on we’re drinking, it’s why we’re It’s really hard to explain. Quite a bit a recent University of Otago study with drinking. That’s the underlying because you get people who want to know the headline, “Binge drinking problem for issue with any alcohol abuse why you are not lesbian, why you are not young bisexuals”, you could be forgiven for straight, and I kind of feel that it’s slightly assuming the study had said the problem problem: why? easier to be one or the other.” was binge drinking. The Otago Daily Times And what do they mean by drink? led with “Study reveals binge-drinking The study used a standard definition of a bisexuals”, which seemed to indicate the Frank Pega, the lead researcher on the ‘binge’ as six or more standard drinks in same and also that there might be pictures. project, says, “The validity and strength of one session, but the participants were also Pictures you’d want to see. quantitative research is often judged on asked to think of occasions when they got The thing is, it’s not how we’re drinking, size and the representativeness of the study “really drunk”. That last means that the it’s why we’re drinking. That’s the sample... In qualitative research, issues of experiences they are describing are far underlying issue with any alcohol abuse sample size and representativeness are of more in line with what people generally problem: why? And surprisingly, that’s less relevance. What counts is rather imagine a binge to be. what the study was about. This is rather whether the study sample was diverse When it comes to mental and physical more obvious in the headline on gaynz.com: along important characteristics such as health issues, different groups within the “Exclusion leading some bi youth to binge ethnicity and socio-economic status.” lesbian-gay-bi-trans population are drink.” We’re not drinking because we’re What they found was that, among that normally lumped together. It’s nice to see happy-get-lucky good-time people. We’re diverse sample, many of the participants some research focusing on more-than-one- drinking because we’re miserable. reported similar experiences of biphobia, gender attracted people, which has moved

26 matters of substance February 13 stage of the process. researchers in the news-making process That more-than-one-gender attracted beyond using their media releases and That more-than-one-gender people experience discrimination that interviews. Therefore, researchers have attracted people experience hurts them to such a degree that they binge limited influence in the presentation of discrimination that hurts drink in order to cope seems an obviously their studies.” them to such a degree that serious problem. So why is it so difficult to The report on the study does end they binge drink in order to get it reported as such? Why wasn’t Stuff’s with some optimism. It contains a number headline something more like “Study of recommendations for easy, concrete cope seems an obviously recommends bisexual support groups”? things that could be done to improve the serious problem. So why is Craig Young of gaynz.com offers mental health of young more-than-one- it so difficult to get it reported some insight: “If we receive notification gender attracted people. It also notes the as such? of an article about this subject, we usually general resilience of the community and have the time to do greater and more its members’ ability to be “secure and diligent investigation because we’re a confident in their sexuality and their specialist publication and have archival right to be integrated members of past whether we exist or not. This has resources available on our website. We’re New Zealand society”. happened because there is actually also in contact with specific addiction One of the phrases Stuff removed specific funding. specialists to evaluate research when it from the study’s press release was the According to Mr Pega, “Little funding comes to hand.” assertion that one of the solutions needed is made available for research on the public For other media, this study could fall was “broad anti-stigma campaigns that health of sexual and gender minority at a nexus of sleaze. Both sexuality and increase society’s understanding of this populations in Aotearoa New Zealand. drug abuse are issues often both group of young people and how prejudices However, the former Alcohol Advisory sensationally headlined on websites like and bigotry negatively affect them”. Council of New Zealand (now the Stuff and also regularly turn up in the Accurate reporting of studies like government’s Health Promotion Agency) ‘most popular’ section. Recently, this one would have done exactly that. has funded a programme of research on ’s comprehensive youth sexuality Inaccurate and sensationalised reporting alcohol use in sexual minority populations strategy ran on Stuff under the headline actually increases the stigma and negative since 2009. The topic of the current study “Pill for kids on cards”. stereotyping that are causing the problem was identified as a priority in terms of a Mr Pega, who fronted the study in the in the first place. need for evidence and received funding media, says they did everything they could. For once, we’d quite like to not have through this research programme.” “We put out a media release, and I it both ways. The study was also conducted in accepted a large number of interviews to partnership with Rainbow Youth, which ensure that our study findings were Emma Hart is a Christchurch-based writer who was not just integral to participant disseminated as widely as possible... blogs at www.publicaddress.net/up-front recruitment but was involved at every Newsmakers generally do not include

www.drugfoundation.org.nz 27 opinion

Where now for opponents of cannabis law reform?

steve As a new high-profile group is established in the rolles US to fight legalisation,Steve Rolles, a long-time advocate for regulating drugs, considers how recent reform victories are reshaping the landscape of the oldest debate in drug policy.

28 matters of substance February 13 he debate around mandatory rehab are not supported by the to be conceding on decriminalisation but the legalisation and text on the site (referrals to treatment are drawing a line in the sand on legalisation/ regulation of specifically advocated only if needed). regulation. cannabis has been While the term ‘decriminalisation’ does The arguments against are familiar, with us since the not appear, it is precisely what is being with, perhaps unsurprisingly, “cannabis 60s, but recent advocated by most definitions used in drug use is harmful” front and centre, supported T years have seen it policy (closely mirroring the Portuguese by extensive detail and references. For move increasingly decriminalisation model, albeit only for Transform, debating the risks of cannabis is from the margins into the political cannabis). It is a significant shift for Sabet a distraction from the more salient point mainstream. In the US, support for who, as recently as April 2012, was writing that, however risky cannabis is, it is more legalising cannabis has crossed the 50 of decriminalisation that “such a policy risky when produced and supplied via an percent threshold; even in the spiritual may actually make us worse off” and flat unregulated criminal market (and this is home of the War on Drugs, and despite out that it “won’t work”. quite aside from the harms of that criminal bipartisan political hostility, a majority market). Cannabis needs to be legally now support an end to cannabis regulated because of its risks, not because prohibition. it is safe. Last November, the issue made the It would be gratifying More interestingly, SAM places great decisive move from theoretical debate to to think [Sabet’s] group has emphasis on the threat of the political reality as the states of Washington been convinced by reform commercialisation of a legal cannabis and Colorado passed ballot initiatives that arguments or evidence from market, dwelling on the spectre of Big not only legalised personal cannabis Tobacco. This, certainly, is a legitimate possession for adults but also set in motion 14 US states and 25 or so concern but, in fairness, hardly one that the first regulated markets for non- other countries around the has been ignored. medicinal cannabis anywhere in the world. world that have already Regulation is a blank slate; If, as seems likely, the laws are adopted decriminalisation governments can establish any legal and implemented (the federal government is policy framework they deem appropriate. still considering its response at time of models. As demonstrated by Uruguay’s proposals writing), this will represent the first real for a state monopoly on cannabis supply breach in the global prohibitionist regime. and the emerging non-profit cannabis While reform advocates have been It would be gratifying to think his cooperatives in Spain, a commercial model understandably jubilant, for opponents, group has been convinced by reform is far from a given, let alone one that “will a strategic rethink has become necessary, arguments or evidence from 14 US states act just as the tobacco industry acts” as perhaps best represented by a new group and 25 or so other countries around the SAM dramatically proclaims. called Smart Approaches to Marijuana world that have already adopted Indeed, the tobacco industry has seen (learnaboutsam.com). This initiative is led decriminalisation models. However, increasingly strict regulation of dosage, by Kevin Sabet, a US Office of National equally plausible is the dawning realisation price, packaging, public consumption, Drug Control veteran under three that decriminalisation, at least of cannabis, branding and marketing over past decades. administrations and probably the highest is now a political inevitability and In much of the West, even in the US, these profile opponent of cannabis legalisation Canute-like defiance is futile. Obama’s smarter approaches to tobacco (regulatory in the US with hundreds of print and recent statement that ‘we’ve got bigger fish tools are impossible under prohibition) broadcast credits to his name. Sabet is to fry’ (than arresting cannabis users) have helped dramatically reduce tobacco supported in the SAM leadership team suggests that SAM may also be echoing use in a matter of decades at the same time by former congressman Patrick Kennedy, (or informing) shifting priorities at federal as cannabis use has been rising. journalist David Frum and a group of level. There is certainly considerable It’s hard to escape the observation academics and medical professionals. convergence between the SAM proposals that SAM may be making a case against The SAM project appears to represent and the US Office of National Drug Control free-market legalisation while actually a clear strategic repositioning for Sabet Policy’s talk of a third way (between the supporting a strictly regulated market and, by inference, the wider coalition of extremes of legalisation and a War on model. Maybe having seen the light on cannabis law reform opponents. Most Drugs) and retreat from more hawkish decriminalisation, they will soon join striking is the recommendation that War on Drugs rhetoric. principled reformers in helping design the cannabis possession should become a civil Some hardline prohibitionist groups, optimal regulatory frameworks for legal offence and that criminal records for however, seem determined to dig in. cannabis that can deliver the shared goals possession be expunged. The additional The World Federation Against Drugs we all seek. requirement for a “mandatory health for example, describes advocates of screening and marijuana-education decriminalisation as “driven by greed, Steve Rolles is Senior Policy Analyst at program as appropriate” has met with disrespect of human rights and lack of Transform – www.tdpf.org.uk – and author of indignation amongst some US reformers, understanding of the harms of drugs and After the War on Drugs: Blueprint for Regulation. but suggestions that SAM advocates of addiction”. SAM by contrast, appears

www.drugfoundation.org.nz 29 FEATURE How we see things from our front gate

In 2011, Russell School became the centre for one small neighbourhood’s battle. Its success in reducing harm from a poorly managed local liquor store shows what can be achieved when communities engage and mobilise.

30 matters of substance February 13 QUOTES OF SUBSTANCE

Even during school hours, people would come onto the grounds intoxicated… I usually got arrested three One person even urinated to five times a year for the last in the playground while kids 17 years. In the last 12 months, were being taught physical I haven’t been arrested once education. and haven’t gone to jail. An amazing, positive change for Sose Annandale one gang member who recently graduated from the Salvation Army/ Mongrel Mob addiction treatment programme.

What we’re saying is there are drugs a great deal safer than alcohol and tobacco. he presence of plastered with colourful posters, and there Fantame Liquor would be sandwich boards all over the Baroness Meacher, chair of the almost right across footpath extolling the virtues of alcopops. All Party Group on Drugs, which the road from “Teachers walking kids to swimming recently recommended the UK Russell School in lessons would hear them talking about Government make fundamental Cannons Creek, how ‘yum’ the drinks looked and saying changes to UK’s drug policy to Porirua, has long which ones they’d tried. These are primary address harms from all drugs, T school kids!” legal or not. been a source of concern for parents and the board of When Fantame Liquor’s off-licence trustees. renewal was due in August 2011, the Principal Sose Annandale says the school community saw it as an ideal Frankly, I think we can stop store was open until midnight, and people opportunity. If they couldn’t have the store treating everyone as though would come from all over Wellington shut down, perhaps at least they could they’re fools and can’t make because it was the only place selling have its hours curtailed. decisions for themselves. alcohol that late. What they did It was a bit too much taking “They would hang around into the wee Matt and others formed a core stakeholder away people’s responsibility. small hours, and the school grounds became group and began upskilling themselves to About 80 percent of the obvious place to drink. In the morning, effectively oppose the licence renewal. New Zealanders drink there would be cans half full of alcohol in They attended some workshops by the extremely responsibly. the playground that kids could find, and It’s Our Turn To Shout campaign about Justice Minister says there would frequently be broken bottles, how to come across well in the media and protecting personal responsibility is smashed windows and other vandalism. how best to write a submission. one reason the Alcohol Reform Bill “But even during school hours, people The group decided to hold a public didn’t go further. would come onto the grounds intoxicated meeting for all those concerned to help or carrying boxes of alcohol they’d just bring about a collective ‘show of force’. purchased. One person even urinated in They knocked on doors throughout the the playground while kids were being The pressure that the neighbourhood inviting people to the industry has placed the taught physical education.” meeting and delivered flyers to about Damage at the school costs the taxpayer 1,000 households. minister under is absolutely about $60,000 a year, but it’s the dangers to “So many people I spoke to had stories not subtle. the pupils that are most alarming, and about the damage being done through the Intensive lobbying by Big Alcohol these include the normalising effects the store’s bad management. This showed we raised Green MP Kevin Hague’s shop’s marketing might have on them. were on the right course, that the wider hackles. Board of trustees Chair Matt Crawshaw community really was eager for an says Fantame Liquor’s advertising was very opportunity to speak up,” Matt says. aggressive, especially around RTDs. Sixty people attended the initial continued on page 33 “The shop front was completely meeting, which is a lot for such a small

www.drugfoundation.org.nz 31 Thirsty Liquor trading hours

community. At the meeting, real effort What happened? “The store was acting illegally, yet it went into educating people about how to What happened at the 30 November got to carry on while the community had to make a good submission to the District hearing came as a devastating blow. wait. The whole legal process felt hostile, Licensing Authority, and templates were Halfway through proceedings, it was and our little community just felt it had given to those who needed them. All in discovered the proprietor was illegally been slapped down and ignored yet again.” all, they managed to get 88 objections operating his liquor outlet and grocery The community also found the second launched against the renewal. store under the same licence, so the hearing in early May 2012 intimidating. Following advice from organisations hearing was adjourned before the They were not allowed to speak to their like the Drug Foundation, ALAC and community had a chance to have any say. submissions or address any new matters Regional Public Health, members of the It took more than five months to get a that had arisen, yet it seemed the group sat outside the store until midnight second hearing. In the meantime, the proprietor’s lawyers could speak all day. a few times so they would have personal They came away very despondent – eye-witness accounts of the sorts of things thinking no one was listening and that that happened. The whole legal process nothing was going to change. They studied the relevant legislation felt hostile, and our little But the result showed they had indeed and did some research to see whether the been heard and the community was elated. proprietor was of sufficient good character community just felt it had Its licence was renewed, but Fantame to hold a liquor licence. It turned out the been slapped down and Liquor’s closing times were restricted to store had twice been caught selling alcohol ignored yet again. 8 pm Monday–Friday, 9 pm on Saturday, to minors and had already been sanctioned and 6 pm on Sunday. It now also has to for excessive advertising. Matt Crawshaw shut 2.45–3.15 pm on weekdays to protect The school community also made pupils travelling home from school. submissions to both the Law Commission Presiding judge John Hole said there was store’s lawyers got the legal situation Review and the Justice and Electoral Select considerable evidence of bad management sorted, and Fantame Liquor began trading Committee. These focused mainly on the at the store leading to liquor abuse. again as normal. It did, however, remove harmful effects of having a liquor outlet Principal Sose Annandale says the its aggressive advertising and rebranded so close to a school and were themed, findings were a really important statement ‘How we see things from our front gate’. under the Thirsty Liquor franchise (which to the community. “We wanted to get our point across that Matt finds a powerfully unfortunate “It seems like things have been righted. this is not the sort of community we want statement – associating alcohol with thirst, Now, the bottle store has to shut in for our kids, where excessive drinking is right across the road from the school). deference to the school rather than the seen as normal and they have to wake up “The hearing result was really school having to defend itself against the every day with cans stacked on their bewildering, and we felt completely bottle store.” lawn,” Matt says. deflated,” Matt says. Matt, who lives near the school, says

32 matters of substance February 13 QUOTES OF SUBSTANCE Fantame Liquor

If you were waging any other war where you have 2,000 fatalities a year, your enemies are making billions in profits, constantly throwing new weapons at you and targeting young people – you’d have to say you are losing and it’s time to do something different. UK Deputy Prime Minister Nick Clegg’s clarion call for compassionate and evidence-based drug policies has been met with nods of agreement from many UK politicians. the vibe of the whole neighbourhood is become very aware. They realise now that I personally don’t support now much better. alcohol abuse is something that affects the a Royal Commission. In my “You can walk down the street at 8 pm whole community; not just the school or view, there’s always a danger, and not feel threatened. There’s this huge those involved with the violence. as someone said, that they sense of peacefulness now, like there “But, they’ve also seen that it is worth can take minutes and last should be, and people comment about it all standing up for what you believe in and for years. the time.” that things really can change when But not Prime Minister But the Fantame success was not the communities act with a united will.” David Cameron, who quickly backed first for the Porirua community. In 2008, an The Cluster is now working closely away from supporting an end to application was filed to open another bottle with Porirua City Council and will be Britain’s War on Drugs. store in Cannons Creek, directly opposite undertaking community consultation in 2013 around a new local alcohol policy for Porirua. We have the world’s most There’s this feeling now Matt Crawshaw agrees the initiatives renowned process to decide that, whatever comes our way, have resulted in some real community what is medicine and what we’re ready for it. building. He cites an example of where some families were forced from their should go in people’s bodies. Matt Crawshaw homes because of potential for earthquake And marijuana has never been damage. Members of the community were through that process. quick to get involved and already knew another primary school and just 500 metres Can it really be a medicine if we from another bottle store. The community how to work for change and support the haven’t tested it as such?, asks collected signatures and organised a well people affected. US Drug Czar Gil Kerlikowske. attended march on the day the application “It used to be the school holding was heard. gatherings and hoping people would come. Overwhelmed by the public opposition, Now, meetings are organised by the To be fair, they do look the judge denied the application and the community and are very widely attended. very similar. People are engaged and enthusiastic. store never opened. Blooming embarrassing moment for “There’s this feeling now that, whatever Jenny Lester, Chair of the Porirua Alberta police whose ‘historic’ bust of comes our way, we’re ready for it. Alcohol and Drug Cluster, which organised 1,624 cannabis plants are found to “We can’t wait for May when Thirsty the march, said these two instances have be common daisies. had a significant positive influence at a Liquor’s annual licence renewal comes up, local level. and we’re already talking about what sort “First of all, it’s like people have of shop should replace it.”

www.drugfoundation.org.nz 33 VIEWPOINTS

Should unregistered naltrexone implants be used to treat opioid dependence? Viewpoints presents the arguments on both sides.

the case Heroin addiction is not something you’d wish upon your worst enemy. It tends to come with a lifestyle of chaos, carnage and criminal justice involvement. It also tends to come with health complications, including high rates of FOR communicable disease and even death. The life of a heroin addict is not exactly safe. It’s also not an easy life to escape. So when a potential pathway out of that lifestyle is available, even if it’s risky, people should have the opportunity to take it. We’re talking about consenting adults here. Who are we to prevent sick people from taking something that could help them get better? Plus, it’s not like the current options are perfect. Right now, the gold standard for treating opioid dependence is methadone. Although it is well evidenced, methadone is not without its problems. It is highly addictive, has a longer withdrawal period than other opiates, can be fatal and doesn’t prevent people using other drugs, including heroin, while undergoing methadone maintenance. For some, the benefits of methadone undoubtedly outweigh the potential risks. For others, however, methadone either hasn’t been or is unlikely to be successful. People deserve to have options. Although naltrexone implants are less well evidenced than methadone, emerging evidence shows that naltrexone implants appear to compare favourably. Ngo et al. (2008) found mortality rates for patients with naltrexone implants were comparable to those of a methadone cohort. Furthermore, those with naltrexone implants presented to hospital less frequently for non-fatal opioid overdoses than those using methadone. Although there is less evidence available on the efficacy of naltrexone implants than there is for other pharmacotherapies for opioid addiction, they definitely show promise. Given the limitations of existing therapies and their unsuitability for certain people, naltrexone implants should continue to be available to those who are willing to try them for themselves.

34 matters of substance February 13 Thousands of Australians have been implanted with sustained-released naltrexone in an effort to help them overcome opiate addiction. Theoretically, it makes sense: block the body from experiencing the effects of opiates. But there are problems. Naltrexone is still being tested and is unregulated. It’s a controversial situation, but given the extreme circumstances so often faced by those with an opiate addiction, is the potential return worth the risk?

The reason that we have a process for regulating medicines and other the case therapeutic goods is that we only want people to be taking things that are proven to be safe and effective. At this stage, naltrexone implants simply do not fall into that category. AGAINST In terms of clinical data, there is not enough quality evidence available. The most systematic review conducted to date was carried out for Cochrane by Lobmaier in 2008. It failed to find any randomised controlled trials that assessed the efficacy of naltrexone implants for treating people with opioid dependence. There have been a number of studies conducted on naltrexone implants since the Cochrane review, but there are still significant issues with the quality of available evidence. For the most part, studies use the same base cohort, data is derived from small samples, and studies with larger sample sizes tend to be based on retrospective analysis. To put it simply, the data is unreliable. Better evidence is crucial given the reported adverse effects. These include wound opening and localised infection, allergic reactions, implant removal, headaches, nausea, vomiting and psychological issues. These also include death. Comparing a cohort taking methadone with one implanted with naltrexone, Ngo et al. (2008) found that the implant group was at greater short-term risk of non-opioid overdose. Furthermore, hospitalisations due to non-opioid drug use increased significantly. The authors note that changes were robust, long lasting and common across all genders and ages. Similar results were not found with methadone. The Australian experience adds even more weight to the notion that these implants are risky – particularly in an unregulated environment. There have been a number of highly publicised deaths – most recently three patients at a clinic run by someone who wasn’t even a medical doctor. Yet given that these implants are not regulated, there are no protections offered if something goes wrong. There also YOUR VOICE seems to be scant oversight on those who are providing these implants at significant cost to people who are desperate to change their lives. Yes, people who are trying to recover from heroin addiction deserve all the YOU help they can get, but they also deserve to be protected from further harm as they DECIDE strive to free themselves from their addiction. The current situation is simply not acceptable and could indeed be considered exploitative. While naltrexone implants definitely deserve further clinical trialling, they should not be available as a treatment option until they are proven to be safe and effective. What do you think? Have your say www.drugfoundation.org.nz/viewpoints

www.drugfoundation.org.nz 35 Q&A

...drug addiction is a disease, not a crime. A lot of it is the result from crime activity, not just the problem. I’m saying something they already know. Russell Brand

Q Everyone says it’s kind of a big deal. Q What is recovery? Russell A The 10 years and everything? I’m really A Don’t take drugs. Don’t drink. One day at happy about that. It’s a day for extra a time. Brand gratitude, I suppose. You really have to reflect on what it was like when you were Q Is that it? Comedian, actor, author – drinking and using. So 10 years of A Yeah. On a basic level, that’s it. Maybe and in recovery abstinence from drinking and drugs is get into a higher power if you want to. But good. I’m very happy. for me, my recovery is one day at a time On the 10th anniversary of his [Takes a bite of pear.] and don’t drink and don’t take drugs. recovery, comedian Russell Brand I still eat pears though. Like a maniac. Q One of the things you’ve done recently, you I can’t stop. If I had to give these up, God, invited Matters of Substance had a bit of a crack at politicians in the UK backstage to the final show of his I’d rather die. about the War on Drugs. What was your message to them? Australia and New Zealand tour. Q Being a celebrity and all, do you feel that A That drug addiction is a disease, not a extra burden of having to model the recovery? We talked about recovery, pears crime. A lot of it is the result from crime and his pro-recovery activism. A: No. I don’t. Being a celebrity, that’s activity, not just the problem. I’m saying Happy 10 years in recovery, abstract, innit? something they already know. Russell. Q You’re in the public eye, everyone knows Q Do you think people in the recovery you’ve used, that you’re in recovery. Is there community should get more engaged in a sense of obligation, then? the policy debates around drug policy? A No. I’ve got it the same. For me, I’ve got A I don’t mind what people do. I mean, the same disease as anyone else. It affects like for me what I think is that I’ll just do me the same way as everyone else. what I can do. Obviously I think it would be better if people who knew about Q But you’re in a different position than addiction were in charge of the treatment anyone else. of addiction, rather than people who don’t A That don’t make no difference to me. know anything about it. Just the same as with agriculture Q But it makes a difference to other people. A But that’s not my business. That’s what RESOURCES my programme is. What goes on with other • A full transcript of the interview is available at people – good or bad or indifferent – that’s www.nzdrug.org/RussellBrand up to them. What goes on in here... [points to head] that’s my programme. That works for me.

36 matters of substance February 13 Mythbusters

Substance and Substantiation

There is no such thing as cannabis withdrawal

Cannabis has a reputation for not being that harmful. It’s down the end of most harm scales, some jurisdictions are reassessing its legality, and proponents say it can heal the world.

owever, as we symptom percent of sample duration in days move towards normalisation of Trouble falling asleep 46.9% 756 cannabis as a Decrease in appetite 38.8% 62 recreational drug, Feeling aggressive 24.1% 52 the prospect of withdrawal from Feeling sad, depressed 45.1% 122 H Feeling irritable, jumpy 45% 113 its use needs to be considered. Do users experience Feeling anxious, nervous 50.1% 95 withdrawal from cannabis, or is it all just smoke? Mythbusters explores the issue. When a lot of people think about they did not undergo the messy and percent diarrhoea and 5.5 percent withdrawal, they get an image of the painful scenario often associated with the shakiness. All these symptoms occurred person addicted to heroin. As Renton process. Even the Diagnostic and Statistical within one and a half weeks of stopping describes it in Trainspotting: Manual of Mental Disorders (DSM)-IV does . “I don’t feel the sickness yet, but it’s in not recognise cannabis withdrawal. Psychological symptoms of withdrawal, the post. That’s for sure. I’m in the junkie However, as our knowledge of drugs however, were experienced by a greater limbo at the moment. Too ill to sleep. and their effects has evolved, we now number of the sample and for longer Too tired to stay awake, but the sickness understand that withdrawal has a wider periods. For example, craving for cannabis set of parameters than physical ones. is on its way. Sweat, chills, nausea. happened in 75.7 percent of the sample The DSM-V looks likely to include Pain and craving. A need like nothing else and lasted for 113 days. cannabis withdrawal when it is released I’ve ever known will soon take hold of me. So yes, there are very distinctive, if not It’s on its way.” later this year. tangible, symptoms of withdrawal from John Irving’s character eloquently So what does cannabis withdrawal cannabis, and as Levin pointed out, shows there are two sides to withdrawal: look like? In a study published in the withdrawal symptoms make it very likely physical and psychological. During American Journal of Addiction in 2004, people who try to quit will relapse. withdrawal, the dependent person will Levin et al. studied 469 cannabis smokers undergo certain changes, behaviours and and asked them if they had experienced Given that many countries are looking experiences in the course of their body withdrawal symptoms. to legalise cannabis and divert tax income readjusting to life without the drug. The study shows symptoms were to treatment, the fact cannabis does have For a long time, it was thought there mainly psychological, with only 23 percent negative withdrawal symptoms needs to was no withdrawal from cannabis because, reporting headaches, 10 percent physical be considered in determining policy and when dependent people stopped using, discomfort, 2.1 percent vomiting, 4.3 treatment options.

www.drugfoundation.org.nz 37 27 to 29th Join us for 3 days of insightful dissertations, November 2013 debate and discussion on all things cannabis. Auckland New Zealand register your interest www.drugfoundation.org.nz