Hard News by Russell Brown


Splore 2019 – Please Don't F*ck This Up, Part 1: Treatment and Health

This is the first excerpt from the panel looking at the next two years' pending drug policy reforms at the Splore Listening Lounge this year. Those reforms include a new amendment guiding police discretion in the case of drug possession (effectively requiring the police to justify prosecution), new medicinal cannabis regulations, the possibility of onsite drug checking getting some legal cover, a new focus (and funding) for addiction services and treatment and next year's referendum on legalising cannabis for adult use.

The panel was called, in recognition of the historic opportunity these reforms embody, Please Don't Fuck This Up.

Panelists were Chloe Swarbrick MP, Wendy Allison of the volunteer harm reduction service Know Your Stuff, Otago University researcher Geoff Noller and David Hornblow, who works for Waipareira Trust and independently as an addiction practitioner. Given the topic, David does most of the talking in this one. (That's me asking the questions in bold, obviously.)

Thanks again to Emma Hart for transcribing a panel in which a lot of ground was covered in an hour.

David, in the report of the Government Inquiry into Mental Health and Addiction, many of your peers said that criminalising their clients was not helping them. Is that the widespread view in the profession?

David:Yeah, absolutely. I think the main stumbling point in treatment is harm reduction over abstinence, actually. Listening to your panel beforehand, there's a lot of really good stuff coming through, treatment modalities, and treatment types that hit a wall of entrenched interests in the treatment industry that go, 'No, it's abstinence or nothing'. And harm reduction is still something that's only filtering through. I think it's very confusing for the public, because they get a lot of information about harm reduction, about using less, using less – they get into a lot of trouble, all of a sudden it's, 'No you give up completely now.'

There is the prospect of considerable extra money coming into treatment services, but is that going to work if we don't at least broaden the kinds of treatment, the kinds of assistance available? Because pretty much all there is, if you are clinically addicted to drugs or alcohol, is 12 Steps, is some flavour of an abstinence-based programme. Those programmes work for a lot of people, but why don't they work for everyone?

D: It's an all or nothing approach. You buy a new family of recovery people, and for some people that's really powerful and it totally works. For Pacific Island or Maori whanau, removing someone from their family – saying that their old life was the bad thing, and that they must change and have this new family now – becomes really problematic. And working at Te Whanau o Waipareira, I've seen that I'm not willing to make a moral judgement on why someone got addicted. I just want them to get better.

And if that means they stay in their house and they work harder there instead of going away into a residential place for six weeks, learning a whole new language of recovery, and then coming back to a bunch of people that don't know anything what happened, that's a recipe for failure for me. I think it is not working as well as it could be. Luckily, Northland has had Te Ara Oranga– that's a really good program.

Chloe: And that was funded by the Nats, to begin with.

National should own that program because it's been …

C: They don't want to.

D: Dr Hinemoa Elder has come up with a really good set of tools about how to actually embrace and keep Maori, PI, minority people in the healthcare industry – because it's still very white and very abolitionist, when it gets up to the high level. I think we need to mature, because there's a whole lot of people being taught about harm reduction at university level, then they get into the industry, and it's captured by 12 Steps. Absolutely captured.

How do you feel about the Alcohol and Other Drugs Court, which is still in trial after five years? It has clearly helped people, and yet it's predicated on criminalisation as the way in, and on abstinence as the way out.

D: Speaking as an individual, if you read the preamble to actually signing on to the program, if you don't agree to attend NA and live by all their precepts, they won't take you in. So that means that if you're not willing to have a spiritual awakening, then you're not getting in. And they might dance around the problem by saying, you can say that your spirituality is this pen or that chair or whatever.

To an atheist, that's just belittling. And not the way we should be doing it as a progressive society. 43% of us are atheists. It should be reflected in our treatment. The court is amazing, it is a little step towards a fairer judicial system, don't get me wrong, but there's a lot more it could be doing. I think it could go broader.

Where would you like to see more money go? There's been all kinds of hints that there will be new money.

D: Community, Whanau Ora, for a start. Give it more, thanks. Holistic, tapa wha based … I don't know  if anyone knows what tapa wha is, the four po, the four pillars of your health: your community health or spiritual health, your family health, your body health, and your mental health. If they're not acting in concert, it's going to be hard, that's a basic precept of it. And I think that can translate really well into Pakeha society. And that's a lot of what I do, is translating the precepts of it into Pakeha society, because we take all comers. So I think things like that. More in-home. More harm reduction, not just prohibitionist stuff, is where we need to send the money.

Geoff: One thing about the money too, that people sometimes don't understand, is that in New Zealand drug policy is budget-neutral, there's no money in drug policy. So any money that comes from somewhere, if it's going to go to health, it has to come from a Health budget line.

C: Which is a nightmare.

G: Often people will think, oh we're going to change drug laws, that means the cops are going to miss out on, you know, 10% of their budget. They're not, and that's actually good for the police to know. And obviously the higher-up guys do.

What that means is they've got $100 million – or probably more, actually – to put into other aspects of their work. And I think it's really important for that narrative to be out there, because it's all well and good for us to sit around here nodding heads and going, this is great, we all agree with this, but actually it's the people that don't agree that we need to be talking to, whether it's your work colleagues or whoever.

David, one thing we've started to hear, not always in entirely organised, rational ways, is concern about the health risks of cannabis – which are real. Do you see that at the addiction treatment coalface? How many people are developing problems with cannabis that need treatment?

D: Everything kind of goes hand in hand, when someone is at the critical end. Addiction is a spectrum, and as someone gets further and further into it, then they'll take anything to alleviate pain at the last end. If you're throwing synthetics into the mix, if you're throwing over-the-counter medications and a whole lot of alcohol, cannabis harm is not up there with the pharmaceutical types.

Who are most of your clients? Where are you seeing the harm? Is it synnies, is it meth, what?

D: No, it's still alcohol. It's still the most pervasive, damaging thing in our society.

G: Some stats from the AOD help line, looking at the proportion of clients, even at the peak when we had the so-called legal highs – that's a whole separate thing compared with the different legal highs we've got now, which are killing people – alcohol was 70-something percent. Cannabis was around 15%, and that was at its peak.

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