Hard News by Russell Brown

6

Lately in cannabis

Anyone who keeps an eye on evidence around cannabis and public health will be familiar with the Christchurch Health and Development Study. It's one of two local longitudinal studies frequently cited with respect to cannabis and youth development. But in a new article in the New Zealand Medical Journal, it is used for something different: attitudinal research about cannabis reform ahead of this years referendum.

The sample size – 899 – is that of a respectable poll. But it differs from a conventional opinion poll in some key respects: the most obvious of these being that everyone "polled" is 40 years old and was born in Canterbury.

Timeliness is another one: the research was conducted between June 2017 and June 2019. So it was almost all done before the May 2019 Cabinet paper on this year's referendum was published and some of it well before the coalition agreement in which a referendum was first announced. So several questions relate to an anticipated legal age of use of 18, rather than the proposed 20.

But it does signal where reform campaigners need to try and win the argument with middle New Zealand, and how difficult that could be.

The study finds 49.8% of the cohort against legalisation, 26.8% in favour and the remainer "neutral" on the issue. But a near-majority (47.8%) is in favour of decriminalisation and a 42% plurality believes decriminalisation would not increase drug problems in New Zealand, versus only 32% who believe it would.

This is somewhat in line with conventional opinion polling in 2017-18 – people believing that decriminalisation is a lower-risk option than legalisation and regulation. And yet the evidence increasingly is that the reverse is true, that legalisation allows for important regulatory controls that simply removing criminal sanctions does not. In Canada and some US states, actual of de facto decriminalisation regimes saw increases in youth use that stopped or reversed under legalisation.

So legalisation campaigners are talking to an audience that's not necessarily wedded to prohibition, but will need to convince doubters that legalisation is the better, safer option.

But the study's legalisation question also warrants attention. Its proposition is that "Cannabis should be legalised and available for sale to people aged 18 or over, like alcohol and tobacco." Does the comparison with the two problematic legal drugs taint the question?

Legalisation campaigners will need to convince doubters that the regime proposed in the referendum bill is not "like alcohol and tobacco", but in fact considerably stricter. (Which is objectively true.)

The study also shows overwhelming support for medicinal cannabis. More than 83% agreed or strongly agreed that "Doctors should be able to prescribe cannabis based products for medicinal purposes (eg, to relieve chronic pain) without restriction" and nearly 88% agreed or strongly agreed that "Cannabis or cannabis-based products can be an effective form of relief for people experiencing chronic pain or physical health problems." Only 2% of the cohort firmly believed that doctors should not be able to prescribe cannabis products.

But now that we have regulations controlling the production and prescription of cannabis products by fitting them within the existing pharmaceutical regime, does it look like the kind of medicinal cannabis people were thinking of?

Legalisation campaigners will need to convince doubters that the kind of medicinal cannabis (perhaps "therapeutic" is a better word than "medicinal") access they support might not ever happen without a "Yes" vote for broader legalisation.

The two strongest predictors for support for legalisation were regular use of cannabis at some point and use of any other illicit drugs at some point. Māori, people with experience of depressive illness and people with higher educational attainment were also more likely than others to favour legalisation.

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Professor Joe Boden, who did the media duties on the study, is also one of the authors of another academic article on legalisation published this month.

Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, options and considerations is primarily a review of the evidence of legalisation in other jurisdiction – of which the authors clearly believe there is not enough.

They do, however state that "[l]egalisation offers some distinct advantages" over decriminalisation, "for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies."

The tone sometimes seems to be that of the lead author, Auckland University's Dr Benedikt Fischer, who is not a prohibitionist but has been vocally concerned about commercial creep in North American regimes. The discussion for the article says of any permission for commercial production or distribution of cannabis that:

Based on experiences from other psychoactive substance policy fields, it is most likely that, in both direct and indirect ways, this will contribute to a markedly increased cannabis‐related adverse health and social harm burden in New Zealand under legalisation.

But the only evidence cited relates to alcohol sales. One study cited essentially compares shop-bought booze to home brew, which is relevant in some territories but not in New Zealand, and another looked at ED attendances in the wake of the Sale and Supply of Liquor Act 2012 and found that while the number of visits to liquor outlets increased after the Act, characteristics of drinking sessions that led to ED visits, including the amount consumed, did not change.

I'm not at all convinced on this evidence that the mere presence of business would lead to "markedly increased" adverse health outcomes. Especially under the very tight regulations proposed on use and sale in New Zealand – which the authors note are so strict as to be "questionable" in comparison with the rules on alcohol and tobacco – and given the provisions in the referendum bill that aim to curb market dominance and provide for community enterprise. The authors do, after all, note an absence of "apparent major or ‘catastrophic’ consequences" in even the most commercialised cannabis regimes.

The "hybrid" system in Canada, from which Dr Fischer hails, perhaps had commercial creep baked in thanks to its medicinal regime, which allowed large cannabis companies to grow and push marketing boundaries well before the federal government introduced general legalisation. Indeed, legalisation in Canada can even be seen as a bid to belatedly tie down a burgeoning grey market as much as a liberalisation.

It also seems notable that Canada's model is very popular among Canadians, while Uruguay's wholly non-commercial state monopoly struggles with logistics issues and is unpopular there, even among cannabis users.

All that said, the paper is a thorough and challenging summary of not only the evidence but the arguments for cannabis reform. It's worth your time.

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Oddly, the "Big Cannabis" problem in the Canadian system is basically overlooked in a public discussion paper published recently by NZIER , which offers "some facts and recommendations" ahead of our referendum, but offers scant consideration to licensing. That may be because it was published before the market allocation and licensing provisions arrived in the final version of our referendum bill, but it feels like a big gap – the more so because is bears directly on one of the paper's big conclusions: that cannabis prices will fall under legalisation. That really depends.

Cannabis is cheap to produce at scale, but the collapse in US prices seems mostly related to a level of oversupply that's actually destabilising the young industry. In Washington State, growers are now not only keen on limiting the number of licences, but happy to see the quantity allowed at different licence tiers reduced. Last year in Oregon, where the oversupply is even more prodigious, the government passed legislation last year allowing it to limit the number of licences issued when supply exceeds demand.

And demand for cannabis is clearly not unlimited. In Canada, the very modest growth in demand has been among occasional users and older people, while youth use has declined. The heavy users who consume most of the weed are just doing what they've always done, but more legally. Even in places, like Colorado, where overall use increased a bit more steadily after legalisation, it seems to have hit a hard plateau.

It would be fair to say the designers of New Zealand's system do not anticipate a big increase in production. Indeed, one of the stated aims of our regime is to reduce not only cannabis harms but cannabis production over time. As the NZIER authors observe, this may be incompatible with even the small increase in overall use likely under legalisation.

The NZIER paper also largely ignores the so-called "social equity" features of some US jurisdictions, which are clearly reflected in our bill, which addresses the particular harm suffered by Māori under prohibition. But it offers some interesting insights – especially on the gulf in carbon emissions between indoor-grown cannabis and outdoor. Cannabis production in New Zealand has steadily moved indoors as a consequence of police activity since the 1980s. The difference is strong enough to say that legalisation would be good for the planet.

NZIER also puts a value on the tax windfall from cannabis legalisation: near enough to half a billion dollars.

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Finally, let me link you to something that's not an academic publication or  an economic analysis, but does deserve attention. It's a press release on behalf of Pearl Schomburg, the medicinal cannabis advocate I profiled recently in the Weekend Herald.

After the Herald story was published, Pearl had a lot of people contacting her for help. She was ready for this – we discussed it before I filed the story. As she says in the release:

"Since then my phone has not stopped ringing with patients needing help, most of them elderly. They feel like they have nowhere to turn and fear persecution. It really isn’t good enough. We need access to safe products now."

Yes, there is now a new medicinal cannabis regime: the regulations came into force halfway through the virus lockdown and they're pretty good. But the experience of other jurisdictions suggests that it will take at least three years to get up to speed, for locally-manufactured cannabis therapeutics to make their way through the process and for enough doctors to get comfortable with prescribing.

But some doctors are never going to prescribe, and most "green fairies" aren't going to be able to produce to GMP standard. Yet some of them are producing good, reliable cannabis products – I've seen the results of tests done on the quiet by ESR and I've seen enough patients, Pearl included, using those products as a substitute for bucketloads of pain medications that that were blighting their lives.

The problem is that there are also bad actors and bad – possibly even poisonous – products. And there's currently no way for patients to tell, or for producers to demonstrate their products are as advertised. Even if you believe that the therapeutic potential of cannabis is completely oversold, it's a harmful situation that needs fixing.

Pearl, a great-grandmother, doesn't see the need to draw a hard line between use for pleasure and use for relief, but this part of of the cannabis community really isn't about getting wasted. You're not going to get high off rubbing a balm on your sore bits – but as a cannabis preparation that balm comes with a harsher legal sanction than the $50 bag of buds you bought from your dealer. It doesn't make sense and I don't think it's line with what the public actually thinks.

But I think the right thing isn't going to happen here unless and until there is a "Yes" vote in the referendum. It's not just "vote yes so your grandmother doesn't get busted" – it's "vote yes so she doesn't get poisoned."

PS: If you want more like this, there's a Drug Foundation webinar on Thursday in which Pearl features. You can register here.

2

Speaking as equals: the rise of Know Your Stuff

Five years ago, Know Your Stuff didn't have a name. They were just a group of people from the festival community who began testing party drugs onsite because they'd seen the consequences of people taking substances they couldn't identify or didn't understand. They didn't want to see people in their own culture in distress, or needing medical attention, or dying.

Since then they've grown, taken on a name and a brand and become a key part of the frontline of harm reduction. Until this year, they've had to operate on a wink and a nod, because of the potential consequences for event organisers who allow them on site. This year, that changed: Splore's organisers decided they would talk to news media and be open about Know Your Stuff's presence and why they were there.

The result was this One News report, which features a quick bite of the Splore Listening Lounge conversation I had with Know Your Stuff's deputy manager, Dr Jez Weston. The edited transcript of that conversation is published below.

We don't know what next summer's festival scene looks like, or if there will be one. But if festivals go ahead, I think there's the potential for a return to dangerous substances being sold as MDMA in particular, given likely disruption to international supply chains. If that happens, you'll hear about it first from Know Your Stuff – and their role will be more important than ever. But maybe we'll get that law change ...

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Our first guest represents an organisation I've seen grow from a down-low testing service for mates to an organisation everyone else, including medics and journalists, relies on for accurate information on what's happening with party drugs. So please welcome Dr Jez Weston of Know Your Stuff. Jez, first, a quick explanation for people in the audience who who may not know: what is Know Your Stuff? What do you do?

Okay, we go to a lot of festivals, we set up a tent, people bring us their drugs. And then they can get them tested before they take them. They can find out what they've got and get good advice about what are the risks, what are the impacts, what's going to happen, how to stay safe, in a nonjudgemental, supportive environment. And one of the reasons that works is that we're all festival-goers, all of our volunteers, it's very much a peer-led grassroots organisation. This has grown out of the festival community. It's still very much part of the festival community.

And that applies to you too. You've got a 'doctor' in front of your name, but you came into this as a member of the community.

Yeah. This was set up by Wendy Allison. She was doing it, it must have been five years ago, pretty underground, and I was helping her with some shifts. And I realised, my background, I'm a scientist, and I actually really like doing the science. Someone comes to you with something, it's an experiment to find out what it actually is. And then it's also an experiment to go, here's some advice you can use, and really give people actionable advice.

So what's happened with Know Your Stuff over the past year? Because you've become increasingly prominent, especially for an organisation that does something that presents legal challanges.

We've got two big things at the moment. One is trying to get the legal position clarified, and I'll go into that in a bit more detail later. The other is just growing. Growing really fast – by 30-50% each year in terms of the number of tests, the number of events, the number of volunteers.

In my day job, I work on research commercialisation and investment, and I'm often helping start-up companies go, hey we've got a product, everyone wants it, how do we grow this company to something that can serve that?We're a social organisation but it's exactly the same pathway. How do you put in place management, how do you scale up, how do you deliver process? How you just cope when things are just growing rapidly?

And I guess it complicates it that you've also been part of the political conversation in the past year.

Yeah. I should explain. So nothing we do is illegal, okay? We're not handling the substances, we're not giving any of the substances back. The clients, whoever comes along, they have to do all the sample handling for themselves. Obviously, our clients are in possession, so that's illegal, but hey, they're trying to look after themselves.

The risk comes in a line in the Misuse of Drugs Act 1975:  Section 12 says it's a crime to provide a venue for people to take drugs. Now, does having testing on site mean that you're providing a venue? No one really knows. No one's been to court yet about this. But if someone was convicted for that, then, the festival owners, the people who put on all of this stuff for us, they potentially could get 10 years in jail. Which is crazy.

So that's where the risk is, it's for the people putting on the party. 

Yeah. It's a legal gray area and we've been working with a lot of festivals for quite a few years now. We still can't say what festivals we go to. We can't say up front that we'll be at particular festivals, we're always getting asked, will you be at X, and we kind of have to go, Well, kind of just come look for us, see if we're there. But thanks immensely to Splore, Splore's been a festival that's been the most open about having us on site and making sure that people can find us and know that this is a thing that they can do to keep themselves and their friends safe.

And if people do want to find you, you're up by Wellness.

We're in the Seaview camp site by the Wendy's Wellness Area and if you look for the Orchard Thieves bar, we're just to the right of that. Open from 10 until six o'clock. The quiet times are in the middle of the afternoon, when it's way too hot. If you come along at like five to six and go, "we're going out tonight, we've got shitloads of drugs, five different things we want to test", we'll be like, "it's 6pm, come on mate, seriously". Come before 6pm please.

And part of the reason it takes a little time is that there is counselling goes on here, isn't there? It's not just here's what you've got, off you go.

I wouldn't call it counselling. It's a discussion. Because we're very much speaking as equals. We're not going, well okay, we almost never say to someone, look, this is really dangerous, don't take it. That's not our role. We're going to find out the information about the substance itself, we're going to have a conversation with the people who've got that substance, get an understanding of their level of experience and familiarity and have a conversation about what's going to happen, how can you stay safe, how can you look after each other.

Now another conversation people might find themselves having is with the research team who are studying the impact of what you do, which is partly how you've been able, it was a nice compromise brokered by Chloe Swarbrick essentially, wasn't it? Because New Zealand First stood in the way of a law change.

If you see people walking around in pink hi-viz, that's the Victoria University team. They are doing some independent research into the attitudes to and effectiveness of drug testing. Know Your Stuff, we think it's a great thing, we think we're making a difference, we think we've got really solid evidence to show the impact of what we're doing, but we would say that, wouldn't we?  Having that independence adds weight to the political argument.

New Zealand First, they're an interesting organisation for a whole bunch of reasons. There are people within New Zealand First who are very supportive. There are people within New Zealand First who are taking a very moralistic, in honesty, okay, can anyone tell me the name of the law and order spokesperson for New Zealand First? [Silence from audience.]  Exactly. And yet this one particular guy is having a bit of an outsized impact. He turned up and said, taking drugs is bad, bad things should happen to people who take drugs, up to and including death. And I think that's pretty callous. If I had kids, it's not a situation I'd want them to be in.

But Young New Zealand First at their party conference raised up a request to reconsider their stance. I mean, I didn't even know there was a Young New Zealand First. But having met some of them, they're pretty good guys. And so New Zealand First is kind of going either way, and maybe in some sense is looking for a face-saving way of actually getting on with an effective piece of work that really does make a difference to people's lives. So hopefully that's where the independent research steps in.

We should get on to the News You Can Use. What have you been seeing this season that people should be wary of? What advice can you offer?

Okay, three things. First is, there's just a lot of MDMA in the world right now. But one pill is not necessarily one dose. We are seeing a hell of a lot of pills that are two, three, maybe even more doses than that. And our tech can give an indication of dosage, it's not great on the percentages but it can give an indication – certainly better than just chucking it down your neck. And so if people know, then they can take a half. Maybe not even that.

Other things: there have been a lot of cathinones around in previous years. Cathinones, your bath salts, eutylone,  methedrone, pentylone – we called that last summer's shitty drug, and we have seen some of that mixed in with MDMA. And the health risks from that, it will just make you very agitated, it will keep you awake, and you might want to take more. And if you do take more, then you might end up not sleeping for a very long time.

One of the theories we've got is that nobody wants to buy this stuff, okay, so what we're seeing, it's mixed in with MDMA and so if you do a reagent test – those are the little colour-changing chemicals you can buy from The Hemp Store or Cosmic – with MDMA those give a really black colour. And that indicates there's MDMA in there. That doesn't rule out anything else, and that black colour kind of covers up all of the cathinones, the bath salts. We've got a spectrometer, so we can actually detect those mixtures.

So if you have MDMA and it feels a bit odd, come to us. We can find out what it might actually be.

Third thing, caffeine. People are putting a lot of caffeine in some pills, which kind of surprises me, but then again it's cheap. And you've got these MDMA pills, they've got a lot of MDMA in them, people take them, and they're like, Oh, I don't want to dance, I just want to lie down. Cause you've taken way too much MDMA, okay? So people are putting caffeine in there so people will be able to get up and dance.

And the other mixture we keep seeing claimed, because of that, loads of people bring us pills that say, people have told them, it's MDMA and ketamine. It's not MDMA and ketamine, we've never seen that combination. It's just too much MDMA. You take it, you feel completely monged, you can't stand up. It's just too much. Take less.

Take less. Start low, go slow. You have been in the past year running testing sessions at the Drug Foundation offices in Wellington, outside the festival environment. I know that there are a lot of people in Auckland who would find that useful. Is there any prospect of that happening?

Most of the time we are not at festivals, much as we'd like to be. So we've been running monthly clinics in Wellington CBD, people can come along, test what they've got, what they're planning on taking. Part of Know Your Stuff growing is now we have Auckland teams, we have Christchurch, we have Dunedin.

We would like to have monthly testing at each of those venues, Auckland first. What we haven't got is a venue. And we would love to find somewhere that is relatively central, has a waiting area, and then a fairly private testing area, that's accessible evenings or maybe Saturday afternoons. So if you know of any venues, please come and find us and we'll have a conversation.

Hopes for the future. You want that law change, don't you?

We want the law change. Because then we can be entirely open, and if you come and find us and you look for our signs, they've got the happy-face-sad-face logo on them. It doesn't say, "Bring us your drugs." I would love to have a great big sign, a big flashing sign that says "Bring us your drugs," okay? We would like to be really open and be able to publicise in advance that we'll be at festivals.

The other thing we would like is funding. We run entirely off donations. And if you think about how much money we are saving the country and the health services, if we can avoid even just one helicopter trip, then that would pay for another spectrometer for us. But New Zealand's just pretty crap at funding preventative health care. And I think that's a broader problem than just Know Your Stuff.

Do you think the fact that you now seem to be a key part of the information environment is going to help? Because clearly the health services rely on you as an early warning. Newspapers treat you as a trusted source, and run stories off it, and increasingly seem to get them right. Which hasn't always been the case, has it?

We've had a lot of good coverage from the media. Some of it's been a bit sensationalised, but that's going to happen. At the end of each day, we will catch up with the [onsite] medics.  And we will say, Look, here's what's on site, here's what you might have to deal with at three o'clock in the morning. They're always super, super grateful to have that info.

We talk with our clients and say, Okay, how is this changing your behaviour? And a lot of people say, yeah, I'm going to take less, going to take it more sensibly, going to know what to expect if I'm taking this, won't be so worried if it's kind of weird. But then they say, outside of festivals, it's actually changed my behaviour. Because I grew up in New Zealand where you just kind of necked it and waited for whatever was going to happen. They've been saying that outside of festivals, they're taking a more cautious and respectful approach to drugs. And I think that's probably a bigger win.

9

Psychedelic science: Microdosing and more

At last year's Splore festival Listening Lounge sessions, one of the most popular discussions was the one on psychedelic therapy. So for this year's festival, I brought back two of the participants from that panel – Dr Will Evans and Amadeus Diamond – and was delighted to be able to bring in Dr Suresh Muthukumaraswamy of the University of Auckland School of Medicine.

Suresh carried out the neuroimaging for several key studies on the effects of LSD and other psychedelics on on the brain at Imperial College London – and he will soon launch a New Zealand-based study of a facet of the new science of psychedelics that is much more talked about than it is actually understood: microdosing.

The Auckland study, like most things in New Zealand, was disrupted by Covid-19, but Suresh and his team are hopeful of beginning it soon. So it seemed like a good time to publish this discussion. (Thanks, as ever, to Emma Hart for the transcribing.)

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Suresh, I'm going to start with you. What is microdosing and why is it interesting to you?

Suresh: I guess most people know what microdosing is, it's a kind of new movement that started about ten years ago, where people are taking very low doses of typically LSD or psilocybin, about a tenth of a trip. And it's kind of interesting because there's really no good scientific literature on it yet. 

The first time we talked about it, you basically said, "Who knows? Could be homeopathy."

S: It could be homeopathy, we don't know, right – from a scientific standpoint. Because there's just not the data out there. But it's kind of interesting because for a long time people have claimed that drugs like LSD and psilocybin create this long-term improvement in mood and all this wellbeing, etc, creativity, and that's kind of interesting. Microdosing is also kind of the same effect from these very low doses, but taken over a long period of time. 

You've done some of this research, the brain imaging for the key research, the studies at Imperial College and they were all full-blown psychedelic experiences – and they had therapeutic value, didn't they?

S: In those studies with LSD and psilocybin, we were giving people very large doses, trip doses of those drugs and then we were putting them into scanners, trying to work out how those drugs were changing their brain function, and then trying to relate that to the experiences that they were reporting.

To me, the scientifically interesting thing about microdosing is that it's long been claimed that those positive effects that people have when they take psychedelics are kind of related to that psychedelic experience that they experienced at the time of the trip. Now, the microdosing thing says, well actually, maybe they can get those same benefits without actually needing to have that psychedelic experience itself, and that to some extent turns the whole thing on its head. So it's just an interesting scientific question –what's going on there?

The really interesting part of your study is that people won't be sitting in a lab doing this. Initially they will, but they'll be out there, going to work, falling in love, driving cars.

S: Not driving cars.

Not driving cars. You couldn't get driving cars through. I've been telling people driving cars.

S: Not driving cars. Not doing surgery.

How is it going to work?

S: There have been previous studies where people were given single microdoses in a lab, and then people sit there for six hours, and that's it. To me, that's not a very good test of what a recreational microdoser might do, because what they do is they take a dose in the morning, and then they go out and they do their everyday activities, and it's about enhancing their current experience, with this microdose. So the  only way that you can satisfactorily test that is not by putting someone in a lab, cause our labs are so boring. These little white rooms full of clinical beeping equipment. So what we wanted to do here was basically have it so that people could take the drugs at home. So what we're going to do in the study is the first dose will be taken in the lab so we can monitor them, make sure everything's okay, and then for the next six weeks after that people will take the microdoses at home. 

So how do you verify that?

S: I could tell you that Russell, but it would kind of …

There are spoilers involved here.

S: When you're running any clinical drug trial, what you're asking is, how do we monitor adherence behaviour, that we want people to take this every third day, and what people are going to be doing? There'll be a kind of messaging system where we message them, and then they take the dose, and they film themselves taking the dose on their mobile phone, and they send that back in to the research team, and there's some codes on the drugs involved, so we know they're taking the dose, at the time – and noncompliant participants will be booted out of the study.

Now, the first question that people usually ask is, "How can I get on the study?" And the most interesting thing about eligibility is that for the time being at least, it's men only. Explain to me why.

S: Whenever we do a study we select a sub-population, right, and this caused a lot of grief about this. But you know, we limit 25-65, right, and people don't accuse me of being ageist. The reason we're only selecting men in this particular study is that we know some of the measurements that we're going to be taking, looking at brain plasticity, those vary over the menstrual cycle, and so that would, because our microdosing course is six weeks it would create a whole bunch of extra confounds that we can't control.

What you're trying to do in a study is, you've got this little signal you're trying to dig out, right, in the noise, and if you just add extra noise into your study you make it that much harder to actually find the signal you're looking for. So what we decided in this particular study is that it would be better and more optimal to just stick with men at this stage, so we can basically decrease that noise level to make us more sensitive to what we're trying to see. If we do a subsequent study, then we could move into the female population.

You're saying "at this stage". You're hoping, I gather that this is just the first stage of an ongoing study.

S: It could be. It depends on the results, right. If we don't see anything, it's just like, well, it might be time to shut up shop, it's all homeopathy, we can stop microdosing. Or you can stop microdosing.

You're imagining it ...

S: And go home and go back to the old way of doing things. But if we do find effects, then there would definitely be an avenue for future studies.

That would also require funding. Now you've had a couple of benefactors to get this far. Who have they been? You don't have to tell me their names.

S: We have one local person gave us a chunk of cash. We had someone from Silicon Valley reached out and has given us some funding as well, and I've got another person who's a very famous person who is looking at potentially giving us some more funding, so you might have noticed we did this kind of media blitz, right, and that was really done to draw in donors.

Will: We've got that Everyday Hero page as well. So if anyone wants to contribute five dollars, Everyday Hero, psychedelics. I think we've raised about four thousand.

Part of that media blitz is also something that we announced on stage here a year ago, which is a foundation devoted to psychedelic therapy, the Entheos Foundation. Does one of you want to talk about that?

S: I'll let you talk about that, Amadeus.

Amadeus: Sure, so the Entheos Foundation is essentially New Zealand's first psychedelic funding venue. We're just in the very final stages of getting all the approval from the charities services, so we've been working with a lawyer, getting a lot of the wording right, cause we've made the submission and obviously we expected a lot of push-back and clarifications and making sure that everything was legal and above-board and everything, so we've been working with that, and we've been just making sure we're dotting the ts and crossing the is getting that all across the board. So we basically have two prongs. One of them is funding research, things like Suresh's trial, and then also education. So coming to events like this, putting on our own events to promote good accurate information, as unbiased as we can, around psychedelics and therapy, but also a few other things.

W: Our mission is to fund and promote research and education in the use of psychedelics as medicine, and to provide the public with evidence-based socially-responsible information about the use of psychedelics in medicine, psychotherapy, and indigenous practice.

A: That's a point that we should probably be quite firm on as well, is indigenous practice is such an important part of at least the base of knowledge for all of this. Not necessarily something like a clinical trial, but in general, the use of psychedelics and the socially responsible way to look at them is you really need to have a look at that ancient wisdom and take that into account and have a look at what people have been doing for thousands of years before trying to reinvent the wheel. So that's something that we really need to keep in mind as we go forward as well.

See, this is an interesting thing for someone like you, Suresh, because you are scientist, you're a researcher. Will's a doctor. And yet I'm often quite fascinated at the cordial relationship between you guys and the psychedelic community. I went to a gathering at Will's place and on one hand there were researchers like you and Paul Glue from Otago University – and on the other there were people who run ayahuasca ceremonies. How do you navigate that, Suresh?

S: It's tricky.

Because you're not an evangelist, you're emphatically not an evangelist, are you?

S: No, I'm definitely not a psychedelic evangelist.

W: We do that part.

S: I'm just a boring laboratory scientist that is interested by these questions. But as a scientist, you're still a member of society. So yeah, you try as much as possible to be objective and study these things objectively so that there's accurate data out there that other people can interpret in a particular way. And so as much as possible you try to be objective. But at the same time, you are still a member of society and we do stuff for society. It is a tricky space to navigate.

Will, there is an active therapeutic community out there, isn't there? I met some very interesting people at your party who are doing different kinds of holistic therapy.

W: Yeah. And we're trying to bridge that and bring it above board. So we've just started as, I guess in affiliation with Entheos, but also as a precursor to a study that we've just submitted to ethics review, looking at the use of MDMA-assisted therapy in end of life anxiety and depression. We need a group of professional psychotherapists that can actually do this work above ground, that their boards are happy with. So we have a group of about 30 psychotherapists meeting on a monthly basis, working towards a policy change, working towards preparing the groundwork for when this does come on board, because we're a couple of years away from legalisation of MDMA in America. And similarly psilocybin.

For therapeutic use.

W: For therapeutic use, absolutely.

A: Well that depends, there have been all these decriminalisation campaigns have been pretty successful getting unanimous decisions on city councils in the US, Santa Cruz a few weeks ago, Oakland, Denver.

W: Yeah, legalising nature.

A: Yeah, decriminalise nature, exactly. So who knows what's going to happen with that, that might keep rolling on.

On the other hand, we've got Phase 2 trials at Douglas Pharmaceuticals in West Auckland of a slow-release ketamine product that they hope will treat treatment-resistant depression. Because I've talked to you about this, Suresh, you can give a rat ketamine and the rat gets un-depressed, same with people, but it doesn't last. I wonder whether we're actually at the stage of discovering some of the best therapeutic strategies.

W: Well, ketamine is one of those easy ways in to this kind of work. And we've started actually a subgroup that's looking at ketamine-assisted psychotherapy. I could write a script for ketamine now, and someone could have that legally in a clinic setting and have some psychotherapy around it, and probably get similar benefits to most of the other major psychedelics. It's paradoxical because these substances are illegal, so any conscientious professional is not going to do psychotherapy in a legal setting. But how do you get the training, how do you know how to do that safely? And so it's Catch 22. So ketamine might be a way in.

So what is the effect here? What is, in biomedical terms, what is the beneficial effect here, and is it better than SSRIs, with which we are currently flooded?

S: In terms of effect size, they're probably roughly equivalent. And that's nice for when we talk about populations and stuff like that, right. But that doesn't help individuals. Because what you see when you get patients coming in to your clinical trials like we do, we've done multiple depression trials, every patient's kind of a bit different

And SSRIs, they get a bad rap, often. But actually there's a huge silent majority out there that they go in to their GP, they get their first SSRI, they don't have much side effects and actually after a couple of weeks, it actually really helps them. And they have a really good clinical outcome from that, and they don't go on crusades against SSRIs. So for some people it's really effective, for others it's not.

So the way I think about it is, what the general population needs is a lot of options, of different therapeutic strategies that are evidence-based, that they could potentially use to help them, and of course that doesn't necessarily just mean drugs, that could also mean psychotherapeutic approaches and also electrical or magnetic stimulation approaches. 

Right, which is interesting.

W: I'd go a step further, though. I mean, there's no substance out there for mental healthy where it's a one hit for six months plus benefit. And in fact, the landmark study on the psychedelic effect, which we can generalise to most of the psychedelics, which is that essentially they reset the brain. They have this effect of decreasing the default mode network, which is this brain network responsible for a lot of our everyday thoughts but also our rumination and self-talk.

The default mode network is basically how we get up and go to work in the morning and not walk into traffic, isn't it?

W: Right, and that gets locked into kind of negative patterns and negative states. We don't know exactly the relevance of it, but the point is that psychedelics suppress that. And the landmark study out of Johns Hopkins and NYU back in 2016, they  published the effect of one dose of psilocybin, the active compound in magic mushrooms, having a six-month benefit. After one dose, and psychotherapy on either side, for depression and anxiety in end of life.

They've followed up that study now, four years down the line, and 70% of the participants, initially 80% of the participants had a significant decrease in their depression and anxiety scores, carried out to six months which is when they stopped following up. They followed up four years later, and 70% of them still have effect. So SSRIs are a daily thing, this is a one-hit kind of out-of-the-ballpark kind of deal. Which can't actually be commercialised. I think they will give SSRIs a run for their money. But to reiterate what Suresh is saying, SSRIs have a role, definitely.

Amadeus, if we were to go and bring out Netflix on our televisions or our phones at the moment, we would see there's a new series on called GOOP Lab, which is Gwyneth Paltrow's evidentially-dubious self-help program. And the first episode is a psychedelic therapy one. They go to Mexico. The episode itself is okay, but then subsequently there's an episode about energy healing. Is there a problem with psychedelic therapy being seen in the context of less well-evidenced approaches?

A: It's a double-edged sword. On one side of it, it's a completely new demographic, that's a target audience that we probably have not really reached before, although Suresh and I did do an interview with Next magazine late last year that will be published shortly. So there is some interest in that area, but you also don't want to mislead people too much, which is I assume what you're getting at. And there's also some sort of ethical problems around how they made that episode and how they sourced their teachers and the substance and all this sort of thing. But as with most things, you do need a hook. And I think if people see something like that, that's pretty superficial and pretty unhelpful overall, they're going to dig a little bit deeper and find good information, because most of the information out there is good. Most people in the psychedelic space are pretty conscientious and ethical people.

You know the people in that space internationally. You go to the conferences. What's happening research-wise at the moment?

A: Quite a bit. One of the things I was going to mention that was going to dovetail off what Will was saying in terms of psychedelics versus SSRIs is that they're so widely applicable. So you have basically two, to put it very simply, you have two groups, the tryptamines and phenethylamines and that covers most of the drugs that are used in psychedelic science. And you can have them used for depression and anxiety in palliative care. You can have them used for depression and anxiety in non-palliative patients. You can have them used as addiction therapy.

A study out of NYU and Johns Hopkins has used psilocybin to treat tobacco addiction, and they had about an 83% success rate at six-month followup there. LSD's also being used for alcohol dependence. Johns Hopkins is now running a trial using psilocybin for eating disorders. Alzheimer's research.

Obviously, the data aren't in for most of these things, but there's at least good reason to think that you can get benefit on so many different neurological issues through this one very specific group of drugs. So there is a lot of research being done out of Johns Hopkins and NYU and that's not even to mention the MDMA. Will, I'll let you go over the MDMA work that's being done.

W: Yeah, as mentioned, the FDA have deemed MDMA and psilocybin as breakthrough drugs, meaning that they have potential therapeutic use that is quite profound, so they've cut the red tape. So they're in Phase 3 trials of MDMA for treatment-resistant PTSD, and that I think is affiliated with the Pentagon, because they're veterans.  mean, the suicide rate of the veterans coming back ... We just got a message through Entheos today from a veteran asking for psychedelic therapy here. So they're anticipating MDMA will get through there and become prescribable.

And let's be clear, this is therapy, this isn't giving someone an E and letting them get on with it, is it? This is as an adjunct to therapy. 

W: It's arguable that just taking it without the support may have an effect, but we don't have a study that shows that, because it's unethical. And it does expose you to a certain degree of risk. I think you need to be in the right set and setting, set meaning your own state of mind, hence four hours of psychotherapy beforehand, and the mantra there with the psychotherapists is, if there's anything you don't want to talk about, let's talk about that. And get things out. And then you have the experience, and then you have another four hours of integration. So that's where the effect really is.

A: Integration is so important.

W: And it speaks to this initial question of, is it the substance, is it the mystical experience? It seems to point to the mystical experience having a profound association. But ultimately I think it's a false distinction, it's a false dichotomy. We have daily experiences, our lives are psychedelic whether we take the substance or not. And I think thinking about it in that as a whole will make more sense. But you won't be able to reduce it down to a meaningful outcome in a study.

And the microdosing thing also, just to link it back to that, it's a way for us to get it into the mainstream, and to get people thinking about it in a more acceptable way. When I speak to my medical colleagues and I talk about microdosing, they're much more open to the concept than if I talk about a macrodose. And just having that initial lead-in I think is really important. So I think Gwyneth Paltrow, good on her for bringing it to the mainstream. People can come to the Entheos website to get more information.

Suresh? Last word.

S: Does it have to be the last word? Because it's going to be a negative word. I was just going to say that there is an alternative view to those views as well, that actually from a scientific perspective the evidence for psychedelics as therapy at this point is actually pretty weak. And the studies are small, they're isolated.

One of the problems with clinical trials when you have outcome measures that aren't objective and they're subjective, is that there's deblinding effects, cause the patients know which trial arm they're in. That is, they know that they haven't taken the placebo, cause they've been tripping for 12 hours.

And the more media there is around these things, then the more likely they are from expectancy effects to have these kind of positive results. And I have done clinical trials before where we've seen really big placebo effects. So at this point, if you were someone who's sitting at NICE in the UK doing an evidence evaluation, at the moment your evaluation would have to be that it's pretty weak at this point, but that doesn't mean that we shouldn't be doing more research on it, and coming up with better designs to try to come up and to try to solve some of those issues. So I think it's still at a research stage.

12

Back on the road

It probably was too good to last. The blessed peace on the roads that I wrote about here began eroding even before we left Level 4 of the Covid-19 restrictions – and on day one of Level 3, with the tradies rushing to catch upon their work, the double-cab utes roared back.

The streets were dangerous again.

Nothing was ever going to really change, people sighed: the roads becoming safer for humans was always a mirage. But I think that maybe the window did shift a little during lockdown.

I had to make a quick trip over to Gilmours on Sunday because we were having friends over for lunch (how much it pleases me to write that sentence). It's a good trip, nearly all on off-road paths – and the paths were thronged, much as they were through lockdown, with families walking and riding the inappropriate bikes they'd fetched out of the garage six weeks before.

And on the roads themselves, amid the flurry of the return to economic activity, I feel like more drivers are aware of people on bikes, a little more willing to lift the the foot off the gas. Well, some of them anyway: the dreaded utes still seem to be as fecklessly-piloted as ever.

The controversial tactical responses and speed reductions intended to provide for physical disancing in Auckland have not been on my streets. Apparently there's a temporary 30km/hr speed restriction on Ponsonby Road, but it just seemed its usual clusterfuck yesterday. Barely a Covid-cone have I seen.

I actually asked the Auckland Transport Twitter account exactly where the promised temporary safe spaces were going two weeks ago. They weren't allowed to just tell me, apparently. I was assigned a case number and, four days ago, received an email response:

Kia ora Russell 

Thanks for contacting us to request information on where temporary emergency speed limits have been applied around Auckland.

Moving down the COVID-19 alert levels means more Kiwis are safely heading back to work and starting to move around Auckland. That means there are more cars on our roads across the city and more people on our footpaths and shared paths.

We have moved as fast as we can to temporarily change some roads. In some areas this meant using road cones and/or signs to create space for physical distancing, in others this meant temporarily reducing the speed limit.

Under the Land Transport Rule: Setting of Speed Limits 2017 (section 7.1(2)(a)), Auckland Transport must consider the setting of emergency speed limits if we believe there is a risk of danger to a person due to an emergency which affects the use of the road.

It’s important that we help keep pedestrians and cyclists safe and enable them to stay a safe physical distance away from those not in their bubble while they’re travelling to work, school, and local businesses. As such, we considered the setting of emergency speed limits as a way to protect those users.

The high-risk locations have been chosen based on where we expect to see more people needing to use the carriageway to keep their physical distance from others. For more information on this, and for a list of the roads with emergency speed limits, please see our New Zealand Gazette release.

We hope the above clarifies why emergency speed limits have been implemented in some areas. Thank you for taking the time to raise this with us.

Ngā mihi

Devin 

Customer Care Case Manager 

Which was all very nice, but it didn't answer my question. Indeed, it was clearly aimed at pacifying the kind of people who regard any gesture towards the safety of vulnerable road users as an unacceptable infringement on personal liberty, if not a de facto communist plot.

Indeed, when I shared this tweet on Saturday, with the observation that Queen Street would be a better place if there was this much space for people all the time, one correspondent was very keen to inform me that this was the future that "commies" want:

In truth, pedestrians and people two wheels vastly outnumber drivers in Auckland's central city. In normal times, about half a million pedestrian journeys are made every day. And yet 80% of the street is reserved for the driving and parking of motor vehicles. It is remarkable that the idea that the allocation of street space should reflect consumer demand is somehow creeping communism, but that's the place we're at.

But as much as the additional space for the area's principal users to moe around in is welcome, I'm not sure Auckland Transport is getting it right. Look at the images below and see if you see anywhere marked for people on bikes or scooters. I think this could have been done a lot better – and that AT dispensing with its walking and cycling team looks like a worse idea every day:

— Auckland Transport (@AklTransport)

May 18, 2020

Days into Level 3, I sat outside the West Lynn shops glumly watching traffic speed through the village, even as families were out on their bikes. The whole village should be under a 30km/hr speed limit all the time, yet there's not even a temporary speed limit. A planned set of bike lanes has been half-finished for two years, since Auckland Transport took fright at a group of protesters. The lanes just stop.

So I had all this in my head this morning when RNZ reported a cost-benefit analysis of proposed new rules which to regulate the use of footpaths by people on wheels. The new rules could lead to one death a year, but would deliver a net financial benefit of $10 million a year, according to the analysis. This is not only a weird way of looking at it, it sets up a false conflict.

The overwhelming death and injury threat to both pedestrians and cyclists is the same: it's cars. In 2017, the year that the number of New Zealand cyclists killed while riding more than tripled to 18, pedestrian deaths also spiked. None of the pedestrians died as a result of bike crashes.

This isn't to say that injury accidents between cyclists and pedestrians don't occur: between 2010 and 2014, there were 33 of them on foothpaths, which made up 13% of foothpath collisions. Pedestrians aged over 55 were the most at risk and the most common injury was fracture. But in the same period, there 3849 pedestrians injured in motor vehicle collisions.

The proposed rule changes aim to regulate the use of footpaths by cyclists and other wheeled users, so it's inevitable that the focus will fall on the potential for an increase in inuries involving riders. But it's also regulating something that happens every hour of every day in every city: cyclists taking to the footpath out of a well-founded fear of death or injury on the road. It's not immediately clear that setting rules around that use – a speed limit and an affirmation of pedestrian right of way – will really result in more of it.

What is going to raise the use of bikes in pedestrian areas is the overall increase in cyclist numbers – new riders especially. We got my partner an e-bike this summer, and it's been an absolute boon. She started riding to work and the difference in her wellbeing was soon apparent. We rode together nearly every day during lockdown and these days we do our weekend retail dates by bike. It's brilliant – good for us, good for the environment. But it honestly wouldn't have happened if she'd had to take her chances on the road from day one.

Now that lockdown has given us a glimpse of how it might be, it's time to get with the work that will actually make everyone safer. And that's fixing the roads.

13

The company of strangers

I didn't really debate whether I was going to fly last week. My mother was in Wellington Hospital after a traumatic health event, I am the only surviving direct family member and she needed me there. If Air New Zealand was going to sell me a ticket, I was going to buy one. And if they weren't, I would drive and make my case at any checkpoint I encountered.

It turned out I was able to buy a ticket in the usual fashion for the sole flight between Auckland and Wellington on Thursday. Booking a rental car and a hotel room were also fairly normal processes.

Auckland Airport's domestic terminal was, as you would expect, quiet on the day. Only passengers were admitted to the building and only through one entrance. Inside, counters were unmanned and the food court was shuttered. It was very, very empty. There was no queue for security and up in the flight lounge there was room for us to all sit very far away from each other.

Being on the plane was a different matter. I'd been assigned an aisle seat with no option to change it and I was surprised to discover that there was a passenger in the window seat, 80 centimetres away. This seating configuration was replicated for the length of the cabin. More unnerving was the way people finding their own seats, further back than mine, were so close that they inevitably brushed against me. The physical distance between us was zero.

It was the first time in at least six weeks that I'd been this close to people I didn't know and it felt alarming. I had been intending to just trust the air filtering in the cabin, but I reached into my bag, got my mask and put it on until everyone was seated. I knew there were few if any Covid-19 infections in the community, but I didn't know who these people were.

On arrival, everything in the city was mediated by Level 3. The listed entrance to my hotel was closed when I got there and no one came to clean my room or empty the waste bin. Parking was free everywhere and most of the restaurants and cafes in the area had some form of contactless sale going on. I installed the Regulr app but it was confusing and it turned out to be easier to just wander around and look for food and coffee. Going to the supermarket seemed comfortingly familiar.

The hospital seemed to be operating an array of visitor policies: I had been told one nominated family visitor would be allowed and the staff at the main entrance were kind and friendly about locating my name on the list each day, asking me a list of questions and letting me in. The hospital's brand of hand sanitiser was light and boozy-smelling and I rather liked it. But signs by the lifts still proclaimed a policy of no visitors except under exceptional circumstances. And when I arrived on Saturday morning, it took about 10 minutes to get in because there were two family groups ahead of me. I'm not about to complain about a hospital showing compassion.

I encountered my only checkpoint on the Friday morning. Just north of Plimmerton, the motorway was coned off and vehicles were directed to the truck weighing station where perhaps 50 police officers in hi-viz stood in rows. I explained the nature of my journey – I was heading to my mother's house in Paraparaumu to fetch important personal items that hadn't come with her in the ambulance – and the explanation was accepted without question. "Drive safe," said the police officer.

I returned on Sunday, and even though I'd been able to leave Wellington Airport via the baggage claim area, I was not able to enter that way. I'd done the self check-in Auckland quite alone, but in Wellington there were three staff hovering anxiously. Wellington, always a rather twitchy terminal for security, was overmanned and twitchier than ever. All checked luggage was going through the scanner and at security there were at least twice as many staff as they needed, which meant a lot of anxious hand-waving and chatter.

"Please try to maintain two metres distance from other passengers," said the boarding announcement. We were called in rows, five rows at a time, but it didn't really change the reality of distancing on the plane. I saw that one woman was carrying her boarding pass inside a passport and winced, even though I knew that she would be outbound from Auckland and not an arrival. I put on my mask again, until we were airborne. It was hot and annoying and my reading glasses fogged up.

About a third of the passengers were wearing masks and they were a slightly different bunch to Friday's southbound flight. Many of the people leaving Auckland seemed to be headed for work, some of them to essential service on farms. Many of the people leaving Wellington seemed to be on their way to leaving New Zealand.

I'm using this experience to try and think through what happens if and when we move to the revised Level 2 Covid-19 restrictions today. The rules attempt to lock in standards for distancing from strangers, notably at hospitality sites. Bars, cafes and restaurants will need to be able to seat every patron and tables will need to be distanced.

It will be difficult for most establishments and, on the face of it, almost impossible for music venues, where people typically stand – or dance – shoulder to shoulder. The government has banned dancing.

I feel this pretty keenly. The people who play music at bars and music venues, the people who come to hear them and the people who operate the venues, they're all my tribe. The Save Our Venues initiative has demonstrated the loyalty people feel to these places and enabled a remarkable flow of short-term financial support.

But that won't last forever, and I wonder if we'll find solutions that keep these cultures viable while safeguarding our ability to manage the virus in the community. For smaller places, like the Portland in Kingsland and my local, Cupid bar, I wonder if private parties, with a fixed group of known individuals on a contact list, might be an avenue. I'm going to feel more secure having a dance with friends who I know have been observing the rules than I am getting on a bus or a plane with strangers.

For larger venues – let alone concerts and music venues – the solutions will be different and perhaps more elusive. We may simply not have any festivals next summer. But if that happens, perhaps the communities who attend them could maintain those bonds and party with the people they know. Getting something that works and sustains the culture may require imaginative effort on all sides. I think the effort will be worthwhile.