Hard News by Russell Brown

4

New Drug Harm Index, new problems

The New Zealand Drug Harm Index 2020 just made it into 2021: it was quietly posted on the Ministry of Health website before Christmas. And it contains some startling claims. Not the least of them, that cannabis is New Zealand's most harmful drug – accounting for $626 million in "community harm" every year. Would you be surprised if I told you more than a third of that was lost GST?

Well, it is: the authors of the index estimate the public purse loses $224 million a year because tax can't be paid on revenue or personal income from producing or selling cannabis. It's nearly all of the foregone tax estimated for illicit drugs in general. If only there was something we could do about that!

The authors acknowledge what you're probably thinking right now, if a little snippily:

Overall, $240.2 million is lost to the tax base through the failure to pay appropriate taxes in relation to revenues and profit generated by illegal drug trafficking. This additional revenue could only be realised either by the legalisation of illegal drugs or by the diversion of this investment into legal forms of investment. Nevertheless, it remains a genuine social harm associated with illegal drug trafficking.

It's only fair to note that (subject to some assumptions about the profitability of selling drugs) this isn't actually wrong and that foregone tax revenue appeared as a harm in the last version of the Index in 2016. It just seems more on the nose after we had a chance to fix it in 2020.

But a similiar similar level of community harm from cannabis, $250 million worth of it, is new. That's the dollar value attributed to "Harm to family and friends". Now, it is laudable that the authors are acknowledging this kind of harm from drug use and seeking to quantify it. But the means of quantifying it is, to put it mildly, questionable.

A significant component of the friends-and-family harm has been calculated not by looking a New Zealand data, but by transposing the findings of this study, which asked people in Nordic countries how much they'd be willing to pay for treatment for someone close to them – a family member or someone they knew well enough to talk to – who had a drug addiction problem. The median responses across all respondents ranged from 500 euros for a friend to 13,000 euros for a child.

The Index authors have then, I think, taken the lower figure of 500 euros and sprayed it across all use of all categories of drugs in New Zealand and added it up in $NZ. Cannabis, because it is so widely used in New Zealand, is then deemed to account for as much harm to friends and family as methamphetamine.

Further, drug use patterns in the Nordic countries and New Zealand are quite different. Notably, mortality from opioid addiction is four or five times higher in those countries, especially in Sweden, where more than half the respondents in the cited study personally knew someone who had been "treated for addiction to illegal drugs". I'm assuming the large majority of them weren't there for cannabis. Indeed, the study's authors suggest it's not very helpful to look at cannabis prevalence in understanding their results.

The Nordic countries study is worthwhile in itself and its authors make some interesting observations, including that harms reported by friends and family are lower in Denmark, where drug use is traditionally "demystified" (in comparison, say, to neo-prohibitionist Sweden). They also say this:

This shows that it is dif´Čücult to use expected harm to assess the  actual  level of  harm. It  also  suggests that an important part of the harm of drugs is  related to  fear  and  that the  fear  itself is not well founded. Finally, since  fear  is reduced by experience and closeness, the results imply that one important element in the overall cost of drug use – social fear – may fall if drug use becomes more common in a society.

They seem very conscious of the complexity of what they're measuring. That consciousness has not carried over to the use of their data by the authors of the New Zealand Drug Harm Index, who assume the exact opposite in their report:

The current measure assumed the proportion of the adult population willing to pay for treatment for friend or family was the same in New Zealand as in Norway. This assumption is conservative, as New Zealand’s adult population has a higher proportion of current people who use drugs than Norway’s.

One problem with the Index may be that it has dispensed with the pretty limited form of expert input used in 2016 in assessing the harm posed by individual drugs: "In essence," the authors assure us, "both wastewater analysis and hospital admissions provide the necessary information on a range of illicit drugs."

This may be why they've come up with some plainly ridiculous figures. The serious "personal harm" suffered by heroin users (excluding death) is reported as zero. I guess we can just close all the needle exchanges then! Of course we can't. We know people in New Zealand are still being infected with blood-borne diseases and suffering serious injection injuries and poisonings.

A Drug Harm Index that can fail to detect real, reported, literally costly harm in this way has real problems. But this exercise has been defined by its problems from the beginning. The first attempt, undertaken by Police, counted the cost of enforcement in its dollar figure for harm – meaning, absurdly, that the more harm there was, the more needed to be spent on enforcement, which would duly increase the measured amount of harm. And so on.

Responsibility for the Index was subsequently transferred to the Ministry of Health, whose attempt was better, but committed the fundamental error of conflating harms from natural and synthetic cannabis. This new version still does that to an extent, where hospital admission codings refer only to "cannabinoids". Basically, there's a problem with nearly every measure relating to cannabis.

The authors are also obliged to perform something of a fudge on hospital admissions where, say, someone gets in a fight or injures themselves while blind drunk, but is also found to have cannabis or other illicit drugs on board. Such multiple-cause admissions "were distributed equally over known factors to avoid double-counting". But alcohol harm isn't counted even where it might be the primary cause, because alcohol and tobacco are excluded from the Drug Harm Index.

I'm honestly wondering whether these indexes are worth persisting with, at least in their current form, which were established, with those eye-popping dollar values, as essentially a Police PR exercise.

Let's not deny for a second that drug use can be harmful: that harm is the very thing that drug policy should seek to address. But the Index variously overstates, understates, misattributes or omits various harms through its methodology. Until we can find a way to go out and learn about harm, especially from – crazy, I know – people who use drugs, this is nothing like a policy tool.

Until then, I think there's probably a case for calling it the Prohibition Harm Index.

2

Medicinal cannabis: 2022 will be a better year

The year we are about to depart has been a frustrating one for the New Zealand medicinal cannabis community.

A cluster of companies established to produce and distrubute legal cannabis products ran up against a regulatory scheme that sometimes seemed unworkable and informal growers and green fairies struggled to see a place for themselves after the narrow failure of last year's cannabis legalisation referendum. Patients faced products disappearing from the shelves or seized at the border. A strengthened sense of common cause was probably the best thing to come out of the year.

Happily, a series of recent developments – most of them just this month – means it looks like 2022 will be a better story.

A week before Christmas, Rua Bioscience got the first New Zealand-produced medicinal cannabis product, a 100mg/ml CBD oil, past the extremely onerous "minimum quality standards" administered by Medsafe – nearly two years after the Medicinal Cannabis Scheme came into effect.

Three weeks before that, NUBU Pharmaceuticals cracked another barrier in the regs – the unrealistically low microbial count required for dried flower products – by gaining approval to import and distribute an Australian whole cannabis product to be used as a tea.

Notes on preparation of such a tea and a warning that the flower, "does not meet the minimum quality standard for product intended for use by inhalation" have since been added to the page listing products that meet the minimum quality standards. The product, ANTG Eve, grown by Australian Natural Therapeutics Group, meets Australian standards for use with a vapouriser , so patients will presumably make their own decisions there.

ANTG Eve itself is an interesting strain. It's 17% CBD with negligible THC content, but unlike most other high-CBD flower, it's an indica, rather than a sativa, strain (hemp is sativa). The terpenes in indica strains theoretically produce a more calming, sedative effect, especially in the absence of THC, and patient reviews here (free registration required) suggest success with anxiety, inflammation and chronic pain. It may turn out to be most useful for child epilepsy patients – if you recall the battle that Katy Thomas had this year to import a British CBD oil that seemed to work best for her epileptic son, that was an indica product.

ANTG is also talking up work by Australian cancer researcher Dr Matt Dun with the Eve strain. Dun tested Eve – in what form it isn't clear – in vitro on leukaemia and glioma cells and says he found the high-CBD strain more  effective in killing cancer cells than high-THC strains. The cytotoxic potential of various combinations of THC and CBD has previously been demonstrated in vitro and in mouse models, especially for glioma, where treatment options are scarce and clinical evidence is limited. (That may change with a new Phase II trial at the University of Birmingham, funded by GW Pharma, which owns Sativex.)

I gather NUBU plans to keep on working on the microbial count limits – presumably aiming to demonstrate that limits intended for products like pharmaceutical powder inhalers shouldn't apply to use in vapourisers, whose tiny ovens typically run at 200º C or more.

There have been some other local developments: Rua shareholders vote on January 22 on a proposal to acquire New Zealand-based Zalm Therapeutics. The deal looks to primarily be a means to establish a relationship with current Zalm shareholder Cann Group of Australia. Rua would be able to take over Zalm's existing supply contracts with Cann Group and send its own genetics across the Tasman to be grown in Cann's indoor facility.

Does it seem ridiculous that it's still difficult for Rua to grow in New Zealand – and outdoors? Yeah, it basically is. But they've just brought on board E3C – East Coast Cannabis Company – to manage an outdoor growing trial. E3C, a grassroots grower collective, have been operating on the wrong side of the line and they've been brave being so visible and so vocal thus far, so this is a really big deal for them.

Had last year's cannabis referendum gone the way, groups like E3C would have lined up to go legit – not many people in the cannabis community actually want to be criminals – and it's great that Rua continues to offer this kind of opportunity to skilled growers.

For now, while the politicians either take fright or try and co-opt cannabis into their culture war, New Zealand Police seem to be showing herculean levels of discretion. They shouldn't have to but it's a very good thing they do.

Another of the larger ventures, Cannasouth, had a particularly difficult year, but this month finally did the $10m deal to acquire all of its cultivation subsidiary.

Finally, Helius CEO Carmen Doran published this pretty upbeat column about the year ahead, which notes "a long and hard haul" to this point, but argues that "thankfully the industry has now moved into the most important phase – delivery." It also mentions Rua – one effect of the difficulty with regulations has been to make the local cannabis industry even more collegial – and points to Helius subsidiary Hale Therapeutics completion of a pilot study aimed at developing a CBD treatment for dogs.

The second Helius-sponsored MedCann summit is set – virus willing – to go ahead in February. It looks like there'll be a fair bit to talk about.

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Amid all this talk about industry, I think it's important to acknowledge the work of patient advocate Gareth Duff in getting his prescribed medications – from Tilray and Medleaf – fully funded for a year. Not by Pharmac, or even ACC (who seem to accept applications from clients, but never approve them) – but the Ministry of Social Development.

This isn't a particular beef with Pharmac: it's not constituted to fund unapproved medicines and it's possibly not worth trying to change that. But people like Gareth and Pearl Schomburg, who have found themselves far more able to manage their lives and severe, chronic conditions with a handful of cannabis products than with the punishing loads of pharmaceutical medicines they previously required, are actually saving the system a lot of money. There needs to be a much better way of supporting them.

Gareth has written about it in a long post here on Facebook.

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Meanwhile, hanging over all of this is the maddeningly opaque process of amending international drug control treaties in line with 2019 World Health Organisation recommendations on reclassifying cannabis to acknowledge its medical use.

I've written an explainer about what's happening for the New Zealand Drug Foundation. Done well, this could establish a global set of rules and practices for cannabis cultivation and production. Done poorly – and some of the signs are not promising – it will be a missed opportunity to treat cannabis in a more rational fashion and will be simply ignored by more progressive countries.

Parts of the process have been relatively transparent, but since it moved on at the beginning of the year  to the International Narcotics Control Board, a UN-aligned agency that doesn't even publish minutes of its meetings, it has fallen into a black hole. NGOs, who do most of of the thinking about drug regulation, have been entirely shut out.

Researching and writing the Drug Foundation piece reminded me, not for the first time, that the international system of drug control is a strange and self-sustaining business, in which the worst actors frequently have the most control. Change comes hard.

Happy New Year!

2

Public Address Word of the Year 2021: Covidiot

The Public Address Word of the Year for 2021 is "Covidiot" – a word which seems to sum up a particular kind of frustration in 2021,  but which, oddly enough, is a word coined in 2020 – as a Professor of Linguistics observed in January.

That narrowly edged out "casserole", a more recently-coined insult which has spread like Omicron and was the subject of a determined social media advocacy campaign for this vote.

Next was "Spread your legs," the immortal blurt by Covid minister Chris Hipkins, which has already won Quote of the Year over at The Project.

There came "vaxxed" with the double X, which is what we almost all got in 2021.

And rounding out the Top Five is "Eftpostle", a brilliant coinage which feels like it must have appeared in 2021, when the Apostle Brian Tamaki has been more annoying than ever before – but which actually dates back to 2019. The earliest that I can find is by Twitter user @rosalea_w on April 15 of that year. It was still about Brian Tamaki though.

Here's the full Top 10

1. Covidiot

 2. Casserole

 3. Spread your legs

 4. Vaxxed

 5. Eftpostle

 6. Antivax

 7. Freedumb

 8. Delta

 9. Shot Bro

 10. Mahi

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As ever, there are prizes!

One pair of the amazing NuraTrue wireless earbuds goes to Public Address reader Cushla Dillon who was the first to propose the word "freedumb". In fact, that was the first nomination altogether.

The other pair, drawn at random from everyone who voted, is Richard Kyle, who has won despite misspelling his own email address!

Thanks also to my favourite little craft brewery North End Brewing of Waikanae, who make beer with love, enterprise and and originality, some of which will be greatly enjoyed by me and our Chief Voting Form Officer Hadyn Green. Bravo!

Public Address Word of the Year 2021: The Vote!

Welcome to to the voting stage of the Public Address Word of the Year 2021. Over the past week's korero phase, readers have been discussing and proposing words and phrases to sum up the year. I've made up a long list of  nominations and you can vote for those by clicking ...

HERE to go to the voting form.

As ever, you're asked to rank your top three choices. Do be sure to scroll down all the way before making your choices – the list is quite long.

There are prizes for playing. One prize will go to someone drawn at random  from everyone who votes. The other will be drawn from the readers who proposed each of the top 10 words in the vote.

And they're pretty good prizes!

I'm pleased and grateful that the good people at Nura are back again with the niceness (it's us and the All Blacks, really). They've given me two pairs of this year's NuraTrue wireless earbuds, which I think are their best product yet. (Not just me, to be fair: here's the five-star review from TechRadar and the 9/10 from Tech Advisor.)

I'm also delighted to welcome aboard my favourite little craft brewery North End Brewing of Waikanae, who make beer with love, enterprise and and originality. The law these days prevents us giving away alcohol as prizes, but you can be assured that by making me and our Chief Voting Form Officer Hadyn Green just a little little happier, North End is very much helping this thing get to air.

106

Public Address Word of the Year 2021: Discussion and nomination

It's that time again! Time to find the word or phrase that conjures, captures or sums up 2021. What'll it be? Last year's Public Address Word of the Year winner, "doomscrolling", made it all the way to The Guardian but is hardly heard now.

This is how it works: you, the readers, nominate words in this discussion. After two or three days of the korero, I’ll cull the nominations into a long list for the public vote.

As ever, there will be one prize drawn at random from everyone who votes. The other prize is for the people who nominate words and phrases in in this discussion. I'll draw the nomination prize from the top 10 words in the final vote, so you’ll have a chance to win even if you’re not in in the first few minutes of nominating.

I'm keeping the changes I made last year to the korero phase of Word of the Year: you’ll only be able to nominate one word per post. And three in total.

I'm pleased and grateful that the good people at Nura are back again with the prize niceness (it's us and the All Blacks, really). They've given me two pairs of this year's NuraTrue wireless earbuds, which I think are their best product yet. (Not just me, to be fair: here's the five-star review from TechRadar and the 9/10 from Tech Advisor.)

I'm also delighted to welcome aboard my favourite little craft brewery North End Brewing of Waikanae, who make beer with love, enterprise and and originality. The law these days prevents us giving away alcohol as prizes, but you can be assured that by making me and our Chief Voting Form Officer Hadyn Green just a little little happier, North End is very much helping this thing get to air.