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Minimising meth’s harms – Expert Reaction

A new report recommends several actions to reduce the harms of methamphetamine use in Aotearoa New Zealand, saying the evidence is clear that reducing supply alone doesn’t work.

The report, commissioned by the Helen Clark Foundation and the New Zealand Drug Foundation, recommends steps such as rolling out treatment partnership programme Te Ara Oranga nationally. It also proposes a pilot to test whether a stimulant substitution treatment model could help people move away from the harmful impacts of being in contact with the illicit methamphetamine market.

The SMC asked experts to comment on this report.

Dr Marta Rychert, Senior Researcher, Shore & Whāriki Research Centre, Massey University, comments:

“New Zealand is among countries with the highest use of methamphetamine globally, with latest data showing 1.2% of adults have used methamphetamine in the past year.

“The report is timely, and offers some practical solutions that could be implemented in New Zealand, in keeping with harm reduction approach advocated by the authors.

“Proposed solutions range from expanding existing responses (e.g. expanding access to drug treatment) to implementing entirely new and innovative solutions. One of the innovative recommendations is to pilot a substitution programme where people with methamphetamine use disorder could legally access alternative substances. Scientific evidence for this solution is mixed, but the report usefully puts ideas forward for the public debate and policymakers’ consideration.

“In my view, one of the recommendations in the report deserves particular attention. That is to expand Te Ara Oranga programme which has been piloted in Northland, and recently evaluated. The programme is a holistic solution involving partnership between the police, social workers, addiction services, iwi providers and other agencies. The evaluation of the programme concluded it was a cost-effective and community-tailored response. The programme recognises that effective response needs to support both users and their whānau to quit, as well as strive to reduce methamphetamine supply operated by gangs.

“Methamphetamine use and problems are concentrated in neighbourhoods with higher deprivation levels. Ultimately, underlying issues in those communities – such as poverty, housing insecurity, limited employment and education opportunities – need to be addressed if we want to tackle the issue long term.”

No conflict of interest.

Associate Professor Chris Wilkins, Shore & Whāriki Research Centre, Massey University, comments:

“I think the report rightly brings meth back into the spotlight, following much debate about cannabis as a result of the Referendum. The wastewater sampling provides clear evidence of both the scale and geography distribution of use in New Zealand (this has been really valuable objective data on consumption, confirms what we found in our surveys and pilot wastewater testing, which were sometimes greeted with scepticism). There is good reason to believe NZ Health Survey underestimates use considerably.

“I would endorse the roll out of the Te Ara Oranga programme, particularly to Bay of Plenty and Hawkes Bay where there is high levels of use, but really throughout the country (there is also evidence of high levels of meth use on the West Coast and bottom of South Island). It was great to see the emphasis on the need for services to be local, including in small towns and rural areas (our research has long identified the expansion of meth use and manufacture into rural/regional areas and the lack of accessible treatment services, users often lack the resources to travel beyond their home location). Also, I agree there’s a need to provide a range intensity of treatment services also with Māori approaches, including supporting peer to peer support (e.g., Alcoholics anonymous). There is opportunity to be innovative and adaptable with services to attract more people into treatment and help seeking, and use limited resources wisely.

“Gangs appear to have played an important part in the spread of meth and have adopted direct selling and multi-level peer marketing. Competition over meth selling between gangs results in violence. There is also a largely unknown impact on levels of corruption. Gangs present themselves as economic/social role models in many communities. Enforcement should focus on gang organised crime meth trafficking.

“I would urge caution in adopting some kind of stimulant replacement programme – the evidence of effectiveness has been mixed and there are risks with stimulant maintenance including mental health and addiction, physical health of users, and impact on others (reasons to believe it has important differences from opioid substitution).”

No conflict of interest.