On The Nation: Lisa Owen interviews Matt Noffs, Ross Bell and Vanessa Caldwell

Youtube clips from the show are available here.

Headlines:
New Zealand and Australian drug experts have suggested this country set up meth inhalation rooms, similar to drug injection rooms already in place in many countries.

The Drug Foundation and the National Committee for Addiction Treatment say despite official stats, the number of meth users appears to be on the rise again.

Vanessa Caldwell says the money spent dealing with methamphetamine is split 80% on drug enforcement and 20% on treatment.

Ross Bell from the Drug Foundation says New Zealand could double the $100million spent every year on drug treatment.

This week police have shot two men — one fatally; one is critically injured. Both shootings have been linked to methamphetamine, or P. And gang leaders say the country is in the midst of a second P epidemic. We’ll talk to some New Zealand-based experts about that shortly, but first, Matt Noffs is the chief executive of the Australian youth drug treatment organisation the Noffs Foundation and author of a book on Australia’s meth crisis, and he joins me now from Sydney. Good morning. You have held New Zealand up as an example of how to deal with meth. Why? What’s good about what we’re doing?

Matt Noffs: I think this is hard for an Australian to say, but arguably, New Zealand has led human rights going all the way back to the vote for women in the late 1880s, and, of course, we followed soon after, and the rest of the world took a long time to catch on with that. So I think New Zealand has always pioneered in the field of human rights, and I don’t think it’s any different for drugs. Recently, very recently, you guys saw a significant drop of methamphetamine, and I think looking from our point of view, it’s clear to see you’ve done the right thing and we’ve certainly taken on some of those approaches.

What is the right thing?

Well, I think looking at treatment over law enforcement first and foremost. You know, every country around the world for decades has taken on the idea that the way to get through this is to arrest our way out of the problem. And what we’ve seen is it simply hasn’t worked. ‘Say no to drugs’ doesn’t work. It’s a fool’s ideology. So more and more we see that treatment does work, being compassionate works, but actually working with law enforcement and saying, ‘How can we shift this paradigm?’ And New Zealand did that a few years ago, and that’s why I believe, and I think Ross Bell and the New Zealand Drug Foundation would agree, that’s why you’ve seen a significant drop of 6% prevalence to at some stage last year below 1%. That prevalence can be maintained and further reduced by thinking forward, like you have done for over 100 years now.

There has been some suggestion this week that there’s reports of a second epidemic here, or a resurgence. If that is the case, could it be that the effectiveness of what we are doing is plateauing?

Look, I think there are many things that New Zealand has done to, I suppose, experiment in a field that desperately needs innovation. And certainly looking at laws that New Zealand has approached, say, synthetic drugs in a way that other countries have looked to and said, ‘How can we do that as well?’ Of course, that hit a few stumbling blocks, but at the same time, you have approached things in an innovative way, and I think doing that, continuing that, will yield great results. Doing things in a traditional way, in a way that the rest of the world has done, won’t do that, and I think to see that significant drop in the use of methamphetamine you have seen over the past years…

In terms of that drop — so we are about from 2.2% down to about 0.9% — what’s realistic to aim for? How much lower can you go?

Well, I think that is incredible. We have been at 2% for 10 years.

But could we go lower than that? If zero is not achievable, what is achievable?

No. I think… Honestly, I think you can have a vision to reduce it further than that. I agree with you, but I think it’s unrealistic to get to 0%, and I think what you should be doing is going back to the drawing board and saying, ‘What have we done that has been so successful to see that drop? How can we again have a great relationship between police and treatment and, of course, government and non-government organisations, like the New Zealand Drug Foundation, and continue that innovation?’

In terms of innovation, I really want to get to this with you — this idea of injection rooms or inhalation rooms. Inhalation rooms, that you’re talking about in Australia, where people can take meth under supervision. Can you tell us just briefly how they work and why you need them?

Yes. So we were one of the first countries in the world to have a safe injecting facility in the last ‘90s. Alex Wodak and others pioneered that, and our New South Wales government started the first medically supervised injecting centre for heroin. Since then, there are nearly 100 of these drug consumption centres around the world. They’ve seen a huge reduction in crime in the community. They’ve obviously helped people. They’ve reduced overdoses significantly. But they’ve made the communities safer. In Germany, for instance, they’ve said they look to us for inspiration. They’ve got nearly 30 of these, and they’ve added inhalation as part of that. Why would you want people inhaling in a room? Because when you have people inhaling, you’d rather them inject. When you have injecting drug use, it’s common in a community, you also have the risk of the spread of hepatitis and HIV. So the other things that these do, a very important aspect, is that they are a conduit into treatment. They capture populations that have so far been unreachable.

Do you think that we could benefit from those in New Zealand?

Absolutely. And I think the most important thing is to start a community conversation, to work with communities who are suffering in this methamphetamine crisis and to say, ‘What do you think about this idea?’ Of course it starts as a contentious argument, but it’s one that needs to be had. And, of course, after a while when people see the evidence and you visit places like Germany that also has a conservative government, you see these reductions, the community realises they make them safer, and, of course, you help people into treatment again. So going back to your last question, I think something like that continues your innovative approach, but also you could see a further reduction in methamphetamine use.

All right. Thank you so much for joining me this morning. From Sydney, Matt Noffs. Appreciate your time.

Now, in the studio with me this morning is Ross Bell from the Drug Foundation and Dr Vanessa Caldwell, the co-chair of the National Committee of Addiction Treatment. You heard what Matt Noffs had to say there — that we could benefit from a conversation about inhalation and injection rooms. Should we have them here, Ross?

Bell: I think we should do whatever we have to do to make the doors very widely open to people who are using methamphetamine to get them whatever help. I'm not sure that supervised inhalation rooms is quite what we need yet, but all options should be on the table. We talked about innovation — you know, what are the innovations we should be doing. One of the innovations that happened recently was a gang, the Mongrel Mob, partnering with the Salvation Army to provide residential treatment for gang members, and so there's lots of innovations New Zealand should be looking at.

Vanessa, what's your view on the inhalation rooms — taking meth in a controlled environment like that?

Caldwell: Look, I take Matt's point — you know, people are desperate, families are desperate. And we do know what works. We just need to do more of it, and opening the conversation to have other things on the table is always a good idea.

So you wouldn't rule that out?

Caldwell: No, not at all.

Okay, I want to just get an idea of what you think this situation is like here in New Zealand at the moment. Is P making a comeback, as has been suggested, Ross, this week?

Bell: We're hearing different things around the country. So, the official statistics, as Matt talked about, show a huge reduction in methamphetamine use. The latest stats, though, go to 2013, and we're hearing different noises now. Has something happened since then to now? Or is it that we are now left with a concentrated group of people who have been using methamphetamine for a long time who is getting that kind of chaos that you can see with methamphetamine use, and it's the problems are associated with that group, that 0.9%; and if that's the case what are we going to do with that 0.9%?

Because the thing is when you look at all the laws of economics — the supply is increasing, prices are down. People are telling you it's super easy to get. That doesn't seem to add up with these dropping figures. Do you think those figures stack up?

Caldwell: On one level, I think, as Ross mentioned, there is a bit of a gap in the statistics on a timeframe, but I also agree that we're probably seeing the more visible signs of those people who have developed problematic use, and so— you know, who were using much earlier in the piece and are captured within the—

So a slow climb in those users coming to your attention?

Caldwell: Correct, yes. So it's the addiction treatment stats that are actually increasing, and certainly the other statistics that are increasing are those people who are having difficulty accessing treatment, and that's the key issue that I think we need to address.

I want to talk about that a bit later, but who are these people? Are they functioning users? What's going on?

Caldwell: Look, they're every— from all walks of life. This occurs for many people, for those who you might not expect. Yeah, absolutely anybody.

Convictions are also rising, Ross. I think 28% jump between 2013-14 and 2014-15. And most of that increase is made up from people who have never been charged with a meth offense before. So what does that tell us?

Bell: I think that tells us a few things. I think one of the things it tells us is — are we approaching this from the, you know, right perspective? What we've had in New Zealand— Matt talked about successes, but we've had failures before we've had successes, and we've had significant increases in methamphetamine use throughout the late '90s and the early 2000s. And the response that government made there was we made it a class-A drug — which is why you're beginning to see people, you know, getting these kinds of convictions — resources went to police and ESR and Customs, and we got rid of cold and flu tablets from the chemists. So we did all of that supply-control stuff, and it's only been in the last few years that we looked at the demand for methamphetamine, so more— the new resources under the Prime Minister's plan went to treatment — they didn't go to cops; they went to treatment. So now if we've got, you know, these kinds of convictions — if we've got people who are getting into trouble, getting kicked out of home, relationship problems all ending up in front of the courts, what kind of support should we be providing those people?

Should we be convicting them in the first place? Should it be a class-A drug?

Bell: Well, I think it’s a class-A drug because it’s been deemed as a very high-risk drug, but that doesn’t necessarily mean that your approach always has to be a criminal approach. Could we be using the interventions that these individuals have with the criminal justice system not to ping them, not to put them through the courts, but to provide them help instead?

So you would want some people who have been charged as such not to get a criminal record? Do you think that would be helpful?

Bell: Well, what other health issue gets solved through a criminal justice approach? We could use the criminal justice system as the door through which people come, but we could avoid- Because criminal convictions we don’t think actually helps anyone. But you could use that opportunity to provide help to those people.

Caldwell: And I think the police would agree. I mean, they are just as interested as we are in getting people help earlier to potentially avoid situations that occurred this week, for example. Yeah, they’re certainly keen to support people into getting help where it’s needed.

So have we got that split right between the money we’re spending on enforcement and the money we’re spending on treatment?

Caldwell: Well, that’s the interesting issue. We’ve got a lot of rhetoric. We’ve got it in writing that the resources will be allocated according to the priority around people first and getting help and a health-focused approach, but actually, the money doesn’t follow that. The money is, you know, an 80-20 split between police and Corrections, with 80% spend and 20% treatment.

So how much-? If you could put a dollar figure on it-? You’ve got people basically queuing up for rehab spots. How much money do you need to fix that?

Caldwell: Look, I think just a rebalancing of that so that we actually start to talk more productively about what it’s actually going to take to solve the problem. We know-

So 50-50 split between where the money goes, between enforcement and treatment?

Bell: I think we could have a bolder vision around this. A balanced approach doesn’t necessarily need to mean an even division of money. One of the visions we could have is zero waiting lists. I think it’s appalling in this country that there are- When someone puts their hand up for help and then they’re told ‘we can’t see you for a few months’, well, that’s a ridiculous situation, so we should aim for zero waiting lists. And one of the other things I think we’re seeing with the current situation around meth is problems in the provinces, and those are parts of the country that don’t have adequate treatment availability.

Do we have the resources for zero waiting lists, the expertise, the professionals?

Bell: Well, what’s stopping-? We could. We spend more money right now on drug-law enforcement than we do on all alcohol and drug treatment combined. We spend about $100 million on drug treatment. Why can’t we aim for doubling of that? It’s not, in the scheme of things, a lot of money.

Caldwell: And we’re not talking about spending on bricks and mortar on buildings. This is about actually service delivery in many, many different forms. We know, for example, that a large majority of the people who have problematic methamphetamine use will actually get well by themselves without any professional intervention, and we’ve got resources to support that so that it’s actually successful.

When the Prime Minister launched this action plan, he said, ‘We’ll use every tool we have available,’ but it sounds like you’re not getting the money.

Bell: If you look at what happened under the life of the Prime Minister’s plan, that’s when use went from the 2.2 and it more than halved. I think that’s a great success. So what now? Let’s learn from that. If that success was largely through tackling the demand for drugs, then let’s keep doing that. If it means shifting resources away from law-enforcement and supply-control measures then to reducing demand, then we should do that.

All right. Thanks, both of you, for joining me this morning. Much appreciated.

Transcript provided by Able. www.able.co.nz

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