Hard News by Russell Brown

13

A complicated pathway to wellness

He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction was published last week and while it offers a substantial list of recommendations for the way such services should be conceived and delivered, I found what it has to say about drugs and public health particularly striking and significant.

From the recommendations section:

Take strong action on alcohol and other drugs

  1. Take a stricter regulatory approach to the sale and supply of alcohol, informed by the recommendations from the 2010 Law Commission review, the 2014 Ministerial Forum on Alcohol Advertising and Sponsorship and the 2014 Ministry of Justice report on alcohol pricing.
  2. Replace criminal sanctions for the possession for personal use of controlled drugs with civil responses (for example, a fine, a referral to a drug awareness session run by a public health body or a referral to a drug treatment programme).
  3. Support the replacement of criminal sanctions for the possession for personal use of controlled drugs with a full range of treatment and detox services.
  4. Establish clear cross-sector leadership and coordination within central government for policy in relation to alcohol and other drugs

There, in point 27 and 28, the expert panel responsible for the report has explicitly called for the decriminalisation of the personal use and possession of drugs. This, they explain, is the result of what they heard in the course of a national consultation process:

In relation to illicit drugs, we heard how their illegality poses a barrier to seeking help and how a criminal conviction for drug use has far-reaching impacts across a person’s life; for example, by negatively impacting on employment or eligibility for access to housing. We also heard very strongly about the impact of methamphetamine (or ‘P’) on users and on their families, whānau and communities. While only just over 1% of New Zealanders are estimated to use amphetamines (including methamphetamine),  the impacts of methamphetamine are substantial, and it is a signifcant problem for some communities.

Across the country there was a clear call to adopt an approach to drug use that minimised harm. Minimising harm from drug use requires viewing use as a health and social issue that can be solved, or at least managed, by providing support, compassion and access to treatment for users. It also requires us all to counter prejudices about people who use drugs.

A couple of pages on, there is this:

The criminalisation of drugs is widespread around the world, yet it has failed to decrease drug use or the harmful efects of drug use and has contributed to social issues such as gangs’ involvement in the supply of drugs, prison overcrowding, unemployment and family separations. Criminalisation downplays the health and social impacts of drug use that can best be managed by providing support to people early and throughout their lives. Having a conviction for a drug offence can afect an individual’s ability to gain employment, maintain relationships and travel, and the fear of these long-term consequences (in addition to potentially serving time in prison) creates a signifcant barrier to a drug user seeking support for recovery.

The fear of having children removed by Oranga Tamariki—Ministry for Children or being sent back to prison for alcohol or other drug use while on probation was highlighted to us as examples of other barriers to seeking treatment. We also heard that while great strides have been made
in reducing stigma associated with mental health, signifcant stigma is still associated with drug addiction, potentially compounding existing barriers to people seeking help.

These arguments – about stigma, barriers to care and social participation, the malign impact of organised crime – are not new in New Zealand. Reform advocates have been saying these things for a long time. Often, Portugal, whose introduction of sweeping decriminalisation 18 years ago has driven a dramatic drop in drug harm, is cited. It's cited in this new report too:

As was hoped, decriminalisation removed the most substantial barrier to drug users seeking treatment – their fear of being treated as criminals and entering the justice system. Now, more people than ever are receiving treatment for their drug use, and Portugal has experienced signifcantly decreased incidence of new HIV infection, decreased use of almost all drugs by people under 18, and a lower prevalence of drug use than the European Union average in schools and across the overall population.

Another beneft is that the quality and response capacity of healthcare networks for people with addictions improved dramatically across the country, so treatment is available to all people with addictions who seek treatment.

The report also observes that in theory, this is already New Zealand's official stance: we just don't do it in practice.

In summary, we note that New Zealand’s current official National Drug Policy is based on harm minimisation, but that this needs to be extended given it is still underpinned by the criminalisation of drug use. The criminalisation of drug use has failed to reduce harm around the world and a shift towards considering personal drug use as a health and social issue is required if we are to minimise the harm associated with drug use. This approach runs counter to the views of a minority of submitters who supported a ‘tougher’ approach to drug use. However, we believe the ‘war on drugs’ approach has been inefective and has done little to address the myriad of harms that drug use causes, including the increasing role of organised criminal organisations.

The passages I've quoted here are not the only ones along these lines. These points are made repeatedly It's one thing to bang on about  Portugal, but sometimes you might as well be talking about Mars: it's a distant place where they do things differently. To emerge with these ideas from our own place is another thing altogether.

Apart from anything else, this gives Jacinda Ardern's government substantial and unprecedented political cover to actually make good on its rhetoric about drugs being a health, not a criminal, issue. On one hand, it's an unprecedented moment. On the other, it could just be yet another review urging change only to be ignored.

The new report also has much to say about our most popular drug, alcohol. Effectively, it argues that we should haul back the way we treat this drug to something more like the way we treat all the others. In doing so, it cites the Ministerial Forum on Alcohol Advertising and Sponsorship, the 2014 Ministry of Justice review of the effectiveness of alcohol pricing policies and, most importantly, the Law Commission's 2010 report on the Regulatory Framework for the Sale and Supply of Liquor, which found our much-amended liquor law in almost as ramshackle a state as the no-longer-fit-for-purpose Misuse of DrugsAct 1975.

Some public health experts believe alcohol excise must be sharply increased – more than doubled – across the board. One risk there is relatively privileging the producers most able and ready to turn out cheap commodity alcohol, at the expense of your small craft beer producer. The Ministry of Justice review goes through the pros and cons of an excise increase versus a minimum price per unit (it's complicated), but does find that minimum pricing would have a relatively greater impact on consumption by young drinkers, whose risks are laid out in last week's mental health report.

The multiple dimensions of drug policy – law, science, medicine, culture – are what make it so fascinating to some of us. And when we remember that alcohol is a drug – one with no recognised safe dose – it reminds us to take all those things into account.

Ironically, one impediment to the report's recommendation that the age of purchase for alcohol be restored to 20 is the significant possibility that we will vote to legalise and regulate cannabis in the next two years. Canada, whose cannabis reform process has been deep and thoughtful, decided that setting an age of access older than 18 would exclude the very citizens it was trying to reach with regulation. You could make an argument for an age of 18 for cannabis and 20 for alcohol, but it would be a politically and socially difficult one.

But the Law Commission, I think, got it right here:

Many of the necessary changes must flow from the community itself, not the law. Many individuals, local government bodies, educational institutions and businesses can contribute to the goal of changing the drinking culture without any changes to the law. Strenuous efforts need to be made to change the pervasive binge-drinking culture that afflicts New Zealand. Social attitudes need to be shifted so it is not regarded as socially acceptable to get drunk. Some New Zealanders appear to have adopted what has been labelled elsewhere as “a new culture of intoxication”. Efforts should be made to demonstrate it is both possible and normal to socialise without drinking alcohol in a risky way.

Along with their deficits, drugs often have a cultural role. When the drinking age was lowered, it meant 18 year-olds had an ability that I never did to experience live music, whose major venues are generally licensed premises which rely on the sale of liquor to subsidise their cultural presentations. When licensing hours were restricted, the major casualty was a club culture in which alcohol was never the focus anyway. Sydney has, rather infamously, almost killed off its nightlife with a licensing crackdown.

Can we decouple those things from destructive alcohol consumption? Sure. But as with any other drug, that will mean an understanding of cultural context, and not only curbs on price and availability. It will require positive initiatives as well as deterrent ones.

One thing we won't do, of course, is make the personal use and possession of alcohol a criminal offence. And as we move forward and try and do the right thing, reducing the harms from all the other drugs by reducing the harm the system currently does starts to look paradoxically easier than dealing with the harms of the one we currently embrace.

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