9.2 What needs to happen

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9.2.1 Issues

We heard extensively across New Zealand that alcohol and other drugs are viewed as serious public health concerns and a blight on our communities. Alcohol, in particular its promotion, socialisation and ease of access, was a specific concern, and we heard from submitters concerned about the number of liquor outlets in their communities and their lack of power to influence this. Alcohol is the most common substance of addiction, and in any given year nearly 20% of New Zealanders’ drinking could be classified as hazardous.¹⁹¹

Harmful alcohol use has significant impacts on an individual’s health and society, including causing damage to developing brains (from in utero to adolescence),¹⁹² impairing self-control, and playing a role in at least half of youth suicides¹⁹³ and one-third of recorded offences.¹⁹⁴ Further, alcohol use can negatively affect personal relationships (causing harm to the wellbeing and health status of others),¹⁹⁵ decrease work productivity and increase absenteeism,¹⁹⁶ negatively affect educational outcomes,¹⁹⁷ and cause public nuisances such as litter, noise and property damage.¹⁹⁸

Despite alcohol’s harm, New Zealand has a normalised heavy drinking culture that, by and large, does not recognise current alcohol use as a crisis. Strong vested interest groups have incentives to resist change. We see parallels with tobacco control and smoking, and believe a similar approach will be needed to tackle the harmful use of alcohol.

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),¹⁹⁹ the impacts of methamphetamine are substantial, and it is a significant 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.²⁰⁰

New Zealand’s National Drug Policy 2015–2020, the Substance Addiction (Compulsory Assessment and Treatment) Act 2017 and the Psychoactive Substances Act 2013 are all intended to minimise harm and promote and protect wellbeing. They are also, however, fundamentally underpinned by an approach that criminalises personal drug use. These issues are playing out on the international stage also; for example, the 2018 Global Commission on Drug Policy report recommended responsible approaches to the regulation of drugs as the best way for governments to take control of illegal drug markets and weaken the hold of organised crime.²⁰¹

Demand for addiction services is already increasing, and current issues associated with the capacity and capability of addiction services to meet the needs of New Zealanders will continue to increase, yet very little has been invested into services such as residential treatment.

9.2.2 What needs to happen

Alcohol

Action on reducing the harmful use of alcohol has stalled. Current policy approaches are not having the required impacts, particularly for some groups who are disproportionately affected by harmful alcohol use such as Māori and people living in the most socioeconomically deprived areas. We believe the Government has already been presented with evidence-based options for reducing the impact of harmful alcohol use and that immediate action is needed to curb New Zealand’s problematic drinking culture.

In 2008, in an attempt to respond to the harms associated with alcohol, the Law Commission was tasked with examining and evaluating the laws and policies relating to the sale, supply and consumption of alcohol in New Zealand and formulating a policy framework covering the principles that should regulate the sale, supply and consumption of alcohol. While the Government adopted most of the Law Commission’s recommendations, the most substantial and potentially reformative recommendations were not implemented. These recommendations were to:

• increase the price of alcohol through excise tax increases
• regulate promotions that encourage increased consumption or purchase of alcohol
• move, over time, to regulate alcohol advertising and sponsorship
• increase the purchase age of alcohol to 20 years
• reduce the hours that licenced premises are open.

Further work on alcohol pricing that considered the potential impact and effectiveness of a minimum price regime²⁰² and on advertising and sponsorship has been undertaken. The Ministerial Forum on Alcohol Advertising and Sponsorship, for example, reported in 2014 and made several recommendations with a focus on reducing harm to young people arising from alcohol advertising and sponsorship.²⁰³ However, there has not yet been a comprehensive government response to recommendations about combating harmful alcohol consumption and to the work on pricing or on advertising and sponsorship.

In relation to alcohol reform, it has long been argued that most New Zealanders drink responsibly and should not be ‘punished’ for the actions of the small minority who do not drink responsibly. We do not believe one in five New Zealanders drinking hazardously each year is a small minority. We also know that alcohol’s reach across society is far greater than simply the sum of its impacts on individual drinkers; families, friends and communities are all touched through one person’s drinking.

Throughout the Inquiry process, we heard a strong appetite for strengthening alcohol reforms, particularly around decreasing the exposure of young people to alcohol advertising and promotions. We believe the case for change has been made and action on alcohol reform is required.

In our view, the main impediment to stronger alcohol reform is a lack of political will.

Other drugs

The criminalisation of drugs is widespread around the world, yet it has failed to decrease drug use or the harmful effects 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 affect 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 significant 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, significant stigma is still associated with drug addiction, potentially compounding existing barriers to people seeking help.

It is clear to us that New Zealand’s approach to drugs needs to change. While New Zealand was the first country to introduce a state-sponsored needle exchange programme, we seem to have lost our spirit and failed to put people’s health at the centre of our approach. In its review of the Misuse of Drugs Act 1975, the Law Commission made a range of recommendations for reforming our drug laws that focused on minimising harm and promoting health. Potentially transformative recommendations from the review that were not adopted include:

• repealing the Misuse of Drugs Act 1975 and replacing it with new legislation rooted in a health-based approach that the Ministry of Health would administer
• introducing a mandatory cautioning scheme for personal possession and use of drugs
• removing prison sentences for low-level drug dealing.

In addition to considering these recommendations, we had the opportunity to consider how other countries have adopted health-based approaches to drug use. Some of these approaches, such as from Portugal, appear to be generating great success, are widely advocated for across New Zealand, and show great promise for transforming our current approach.

 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 ineffective and has done little to address the myriad of harms that drug use causes, including the increasing role of organised criminal organisations.

Alcohol and other drug policy does not have a clear home within government

Central government appears to have lost traction on alcohol and other drug issues, although we note the recent formation of a cross-party group on drug harm reduction. Overall, leadership is weak and it is unclear where responsibility for coordinated strategy and policy lie.

Given the significant role that alcohol and other drugs play in people’s wellbeing across New Zealand, a unit with a strong cross-sectoral focus dedicated to advancing alcohol and other drug policy is critical. One option is for the proposed social wellbeing agency (discussed in chapter 7) to take on this role and provide strong, coordinated leadership. Whoever is tasked with leadership should be mandated to tackle alcohol use in the same way as New Zealand successfully tackled smoking. Although the approach to alcohol use will differ, the same kind of focus and commitment to reducing harmful alcohol use is needed.

Investment in addiction services

It is difficult to determine a desirable balance between spending on addiction treatment and mental health services. However, addiction services receive a relatively small proportion (about 11%)²⁰⁵ of the total public expenditure on mental health and addiction services, and the addictions sector has long been considered the ‘poor cousin’. An injection of investment into the addictions sector is required to increase the number of services available to people across the country and to promote better collaboration between the mental health and addiction sectors. There should be a comprehensive range of culturally responsive, evidence-informed options that give people choices.

Over time, additional investment in addiction services should lead to savings and enable resources to be shifted towards earlier intervention, for example, through a decrease in the prison population. In the short term, the investment we recommend for services in the ‘middle ground’ (chapter 4) should also increase access for people requiring support for alcohol and other drug challenges. This will include a range of services, from brief interventions in general practice and primary care settings through to social and detox options and follow-up community-based services.

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