Today, the Drug Foundation and the Helen Clark Foundation released a new paper: Minimising the Harms from Methamphetamine. The Drug Foundation's Executive Director, Sarah Helm, breaks down the findings.
We jointly commissioned a report into methamphetamine in New Zealand with the Helen Clark Foundation because we were concerned that New Zealand’s approach is failing. We wanted to look around the world at the best and emerging evidence. We suspected we could do better.
Some of the results aren’t surprising to us.
Firstly, the need to extend the very successful, comprehensive Northland methamphetamine initiative, Te Ara Oranga, around the whole country. An evaluation has shown that Te Ara Oranga is extremely effective and returns between $3 - $7 for every dollar invested. As former Prime Minister Helen Clark says, expanding it is a no-brainer.
The report points to a need for more kaupapa Māori support and treatment options, and to making treatment more accessible. It also recommends a greater focus on harm reduction, and the removal of criminal penalties for methamphetamine use. We agree wholeheartedly with those findings.
Māori need to be equal partners in all methamphetamine interventions and policy. Māori are severely disproportionately affected by our current approach.
The report also contains a couple of important new proposals.
Firstly, the authors recommended a small, controlled research trial of a new Stimulant Substitution Therapy treatment model, particularly in the context of people who have been through treatment and haven’t been able to fully abstain.
Many people who go through treatment are able to reduce their use and improve their lives but don’t achieve full abstinence. It does seem ludicrous to return these people to the black market where they inevitably experience a range of harms, instead of pouring support into them. Housing and innovative projects like running for recovery group, Speed Freaks, seem pretty important interventions to helping these people succeed.
Substitution therapy isn’t new, nor is it controversial. It is about getting the formulation right and ensuring other support is also offered, not just medication alone.
Methadone and other opioid substitution therapy has been being used successfully in New Zealand for decades. It has been proven to save lives, reduce harm to people, reduce criminal behaviour, and is an extremely cost-effective intervention.
However, the application of this approach is newer to methamphetamine and stimulants. The most promising results have been with a longer-lasting ‘extended release’ stimulant formulation. Currently there is a nationwide trial in Canada and some research underway in Sydney. There are other recent results from Canada, and you may be surprised to learn that New Zealand was involved in a trial a decade ago.
This is clearly an emerging area that deserves more research. While we don’t have any plans to progress this at the moment, any research trial would have to be run by researchers, be tightly monitored and would be limited to people with prolonged regular use who have been through treatment at least twice.
Importantly, the report also looks into some of the complex reasons some people use methamphetamine, including those with unmet health needs.
One group is people with untreated ADHD, who may knowingly or unknowingly self-medicate on stimulants like methamphetamine. People with ADHD report that methamphetamine for them has a calming effect, similar to the medications they would be prescribed if they were properly treated. ADHD is unfortunately under-diagnosed in New Zealand.
We have heard some harrowing stories for people in this predicament, some reporting that they can’t leave the black market now because they admitted illicit use to their clinicians and have been labelled as ‘drug-seeking’.
Since hearing this I have been talking to ADHD NZ, who are working to improve access to diagnosis and medication. They tell me that for many people with ADHD, methamphetamine can actually be easier to access. This group clearly need a health intervention, not to be left to the black market and be criminalised and stigmatised.
About 40,000 people use methamphetamine each year, but less than a quarter of this group use methamphetamine monthly or more often. This means most people who use methamphetamine don’t experience addiction – despite the impression we get that if people have ‘one hit they are hooked’.
While this is untrue, methamphetamine harm is concentrated in some communities.
We need to stop pretending we are fixing this with drug busts – we need comprehensive approaches like Te Ara Oranga.
It is time to update our narrative, interventions, and policy settings around methamphetamine use, with new evidence, solutions, and a fuller understanding of who uses methamphetamine in New Zealand and why. We need to abandon the sensationalised story and stigma, and instead offer help to people who need it with open arms.
Lastly, I wish to thank the report’s authors: Philippa Yasbek, Kali Mercier, Dr Hinemoa Elder MNZM, Dr Rose Crossin, and Prof Michael Baker MNZM. Philippa undertook the bulk of the work as a volunteer, and we are hugely grateful to her for this. It is an excellent and comprehensive report. Have a read and make up your own mind (PDF, 7.3 MB).
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