An adviser on America’s opioid epidemic says New Zealand needs to treat all drug abuse as a health problem, not a criminal one.
Fresh from leading a committee advising US Federal officials on policies to address America’s runaway opioid problem Professor Richard Bonnie believes New Zealand must go beyond the legalisation of cannabis and decriminalise all drugs.
He says the New Zealand Drug Foundation is right in arguing for decriminalisation of all drugs, as drug law which criminalises users is obsolete and ineffective. Bonnie, a public health law expert here recently to speak at an AUT conference, supports their view. “You can’t arrest your way out of this problem.”
The opioid epidemic in the US is on such a trajectory now that it will get worse before it gets better, he says. As a result, health authorities there are starting to employ a number of pragmatic tactics such as making the overdose antidote naloxone more available to first responders.
The Drug Foundation’s executive director Ross Bell rejects criticism that such views – and resulting measures – amount to a surrender in the war against drug use.
“To me it doesn’t come down to is this soft or hard on drugs or whatever. Is this going to save lives? If the answer is yes then do it. That’s our basic approach.”
Drug overdoses are now the leading cause of death for Americans under 50. Last year 64,000 people fatally overdosed in the US, an increase of 22% on 2015. The grim tally significantly exceeds America’s 37,000 annual road toll and 32,000 gun deaths.
The epidemic is creating a tsunami of social consequences, from morgues hiring cold-storage trailers to cope with the influx of corpses, to huge spikes in the number of children in state care.
Six out of 10 overdoses are opioid-related, and many addictions begin with prescription pills. There is a kind of “opioid exceptionalism” in the US because of the abuse of synthetic forms of the drug such as the potent painkiller fentanyl, Bonnie says. His team’s task was to advise the Federal Drug Administration, and a key part of the job was updating the science around pain management and alternatives to prescribing opioids.
“It took 10 to 15 years to get to this point, and even if we can arrest the momentum of the epidemic it’s going to take years to unravel because you’ve got all these people who are now addicted to opioids,” he says.
The committee’s advice included making naloxone, also known as Narcan, more widely available so that emergency services and other officials can treat overdose victims on the spot. This requires funding and regulatory reform at a state and local level, and has been highly controversial in parts of the country.
Unsurprisingly a central plank of the team’s recommendations was to improve access to addiction treatment. “This then relates to our whole problem with our healthcare system. There are just so many impediments…. People don’t have (health) insurance, insurers don’t cover certain things.”
While supplying illegal drugs requires a criminal response, drug abuse needs to be understood as a public health problem and that means putting long term structures in place, he says.
“You have to have criminal sanctions and you have to enforce them, but that doesn’t mean that you enforce them against people who need addiction treatment instead of being put in jail.”
Drug abuse in New Zealand takes different forms and thankfully Kiwis have never had a great appetite for heroin, largely due to lack of availability. But opioids are an issue in Australia, and New Zealanders are among the highest drug users in the world, so the Drug Foundation believes we’re vulnerable. “It could change in an instant, just like we’ve seen a crisis around the synthetic cannabis problem,” Bell says.
The national drug policy says alcohol and other drug problems are first and foremost a health issue, but despite the fine words it’s not treated this way.
“Of all the government spending on illicit drugs, 80% goes to police, the courts and prisons, and only 20% goes to health. So New Zealand’s got a long way to put into practice what it says in the policy documents.
“Those people who don’t want to take a different approach, I think the onus actually is on them to prove to us why the status quo is the best thing. And I think very quickly their arguments will fall down. Under the status quo we have waiting lists for treatment, we are arresting people without providing them help,” Bell says.
As part of the negotiations to form the new coalition government the Green Party has won agreement for a referendum on personal cannabis use.
New Zealand Police Association president Chris Cahill says it’s probably time to have the conversation about decriminalisation or legalisation, but he believes it needs to involve a much wider cross-section of society, including police, educators and mental health, social and youth workers.
“Currently the debate is driven by either very much the pro-cannabis groups or academics. You need to talk to people out there in the community who are actually dealing with the effects of these things.”
He says a closer examination of overseas decriminalisation models shows they haven’t been as successful as people like to think. He points to the legalisation of marijuana for personal use in Colorado. The law change has pushed down the price of harder drugs to compete with freely available marijuana, he says, and hasn’t driven criminals out of the drug scene at all.
In the same manner as big liquor, there are also indications that marijuana suppliers are starting to have an influence on legislation because of the tax revenue the industry generates. “How can we keep it from becoming a cash cow? Two wrongs don’t make a right. I’m not sure if we knew how much harm alcohol did in society that it would necessarily be legal now.”
Any reform of the drug laws would need to go hand in hand with better access to addiction treatment, something that is a source of frustration for police who would rather refer people to the appropriate health services than charge them.
“There is a dearth of good drug counselling and rehabilitation centres available, especially around that serious stuff,” Cahill says.
“These people need help and it isn’t there in a timely manner, especially if you go out to the provincial centres of New Zealand.”
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