By the NZ Drug Foundation and the Helen Clark Foundation
Harmful methamphetamine use has become a serious and intractable health issue in Aotearoa New Zealand over the past 20 years, and it is the country’s most feared and stigmatised substance. While Aotearoa New Zealand has turned increasingly towards a health-based approach to drug use over the past several years, no comprehensive analysis has been undertaken about what that might look like in the context of methamphetamine use.
This paper begins by providing an overview of how methamphetamine is used, by whom and why, how big the market is, what the harms are that it causes, and how it is currently regulated. We then recommend how we can reduce those harms by better implementing what the evidence tells us about how to lower demand and support people better using a mix of psychosocial, cultural, and pharmacological approaches.
While only around 1.2% of New Zealanders use methamphetamine each year, according to the New Zealand Health Survey, the relatively low overall number of users hides the significant health, social, and economic impacts of dependent use. While methamphetamine is used in every community in Aotearoa New Zealand, the negative impacts are particularly severe in communities with high pre-existing levels of deprivation and where prevalence of use is significantly higher than the population average. Wastewater testing shows highest per capita methamphetamine use in rural towns in Northland, Bay of Plenty, and Hawkes Bay.
Māori use methamphetamine at a higher rate than non-Māori, and are criminalised for its use at a disproportionately higher rate. The flow-on impacts of colonisation and ongoing systemic racism lead to Māori being more likely to suffer from mental health and addiction issues, and generally from poorer health overall. That means that methamphetamine use takes a higher toll on Māori, who also face greater barriers to accessing appropriate healthcare. In addition, Māori face cultural impacts from high methamphetamine use that are not experienced by other groups. Community leaders have highlighted the negative impacts from high rates of methamphetamine use as one of the most significant issues facing Māori communities.
Methamphetamine is a strong and addictive stimulant. While the majority of people may use it occasionally over a long period without serious health effects, others can rapidly become dependent and find it extremely difficult to stop using it.
The social and economic impacts of methamphetamine in Aotearoa New Zealand are significant. Large profit margins have led to the development of highly sophisticated distribution networks. In some parts of the country, these networks market methamphetamine aggressively, using many of the same tactics as the alcohol industry, such as freebies, discounts, and targeted advertising. These networks aim to introduce new users to methamphetamine, and to increase use among those who already use.
Anecdotally, methamphetamine has in many places replaced, or partly replaced, cannabis as a key source of income for some gangs and other organised crime groups.
It is clear from local and international evidence that attempting to reduce harmful drug use by focusing on reducing supply alone does not work – where there is demand for a drug, someone will always step in to sell it for a profit. Arresting a dealer or intercepting a large amount at the border may dent supply temporarily, but never for long. It is also clear that aggressively marketing a drug can help to increase demand (alcohol is a good example of this phenomenon).
Historically, our approach to reducing harm from methamphetamine use in Aotearoa New Zealand has primarily been to focus on the supply side: coming down hard on dealers, and attempting to stamp out international trafficking and local manufacture. At the same time, we have punished people who use the drug and provided too little, if any, treatment and other support options. Support is often only available to those who are already severely dependent, or who enter the criminal justice system.
The public discourse is now starting to acknowledge that controlling use through enforcement alone has been largely unsuccessful and that drug use should be treated as a health and social issue. Prosecuting individuals for their use is neither effective, nor compassionate. A programme in Northland – Te Ara Oranga – has successfully piloted an approach where police, health staff, iwi, and local NGOs work together to address social issues, and help people access help, rather than prosecuting people for their use.
To get on top of problematic methamphetamine use in Aotearoa New Zealand we need to increase the focus on innovative, and proven, ways to reduce demand. We also need to help people who experience methamphetamine addiction to extricate themselves from a toxic illicit market. People who are addicted often become trapped by debt and turn to dealing or other crime to support their own use.
First, we propose a comprehensive approach to prevention, harm reduction, early intervention, and accessibility of treatment services. In this paper we examine some of the different interventions that could achieve that – such as rolling out the Te Ara Oranga approach nationally.
Second, we propose a pilot to test whether a stimulant substitution treatment model tailored to the Aotearoa New Zealand context could help individuals move away from the harmful impacts of contact and involvement with the illicit methamphetamine market, thus making it easier for them to access support and treatment, and get their lives back on track.
In our proposed pilot, a substitute stimulant – or where this is ineffective, methamphetamine itself – would be provided in tightly controlled circumstances to people who have become addicted and have struggled to achieve abstinence, despite having been through two rounds of treatment. Methamphetamine addiction treatment is often successful at helping people reduce their use but does not always help them achieve full abstinence, or maintain abstinence in the long term. This proposal could help both those who have found treatment to be unsuccessful and those who have found it to be partly successful. Prescribed stimulant substitution could help both groups to avoid interaction with the illicit market and the risks that entails.
Our proposal is modelled on highly effective and well-evidenced experiences in Aotearoa New Zealand with opioid substitution treatment, with heroin-assisted treatment in Switzerland and other places, as well as recent experiences in Canada, where drugs such as amphetamines and opioids have been provided on prescription to dependent users.
Much of this paper relies on international literature and data because there is relatively little data in Aotearoa New Zealand on this topic. There is obviously a need for caution in assuming international data will apply in Aotearoa New Zealand in the same way. We have preferentially sought out Australian literature where nothing is available from Aotearoa New Zealand because of the broad cultural similarities between the two countries.