Home » Posts tagged 'drug misuse'
Tag Archives: drug misuse
The most vulnerable need advocates to campaign on their behalf: The New Zealand experience of naloxone
No naloxone available? No excuse.
No excuse either for drug agencies failing to formally lend their support for naloxone distribution to users, families, and friends.
Getting naloxone into the community was recommended by the World Health Organisation, and some countries like the USA, Australia, Scotland, Wales have made excellent progress, but here in New Zealand it has been difficult to get naloxone on the drug policy agenda let alone into the community, despite the fact that Coroner data indicates that every week someone dies of an opioid overdose.
Why should this be so difficult when naloxone has no abuse potential, is relatively cheap, easy to administer and is so effective at reversing overdose? Unfortunately, the failure to deliver a humane and effective drug policy has little to do with a lack of evidence, understanding or science, but much more to do with a lack of interest, care or regard for people who use illicit drugs, and people who inject drugs (PWID) tend to be the most marginalized. Naloxone distribution is a vital life saving service for PWID.
Numerous opportunities have existed in New Zealand to ensure naloxone is available to users, families and friends. In August 2013 sixty-seven agencies were represented at an invitiaton-only National Think Tank Event led and coordinating by the New Zealand Drug Foundation. After two days debating priorities, values and strategy, to shape the future of drug policy in Aotearoa, the NZ Drug Foundation produced a 12,000 word vision statement, that became known as the Wellington Declaration – but surprisingly in this comprehensive document outlining drug policy priorities naloxone didn’t even get a mention.
A year later in August 2014 in it’s Matters of Substance Magazine, rather than present a robust case for naloxone distribution in New Zealand, the NZ Drug Foundation Magazine framed Naloxone take-home as a contestable issue, open to debate. They offered arguments for and against naloxone. This included some spurious arguments against naloxone distribution including “there could be an unintended consequence from widening availability of naloxone” and “people could become less cautious about their drug use because they know life-saving treatment is close at hand”.
In October 2014 after a new government was elected the NZ Drug Foundation prepared a twenty page Briefing Paper to Parliament which was designed to identify key drug policy priorities to enable ‘opportunities to make real reductions in drug related harm‘ (p.3). The document emphasised the need to secure New Zealand representation at the United Nations international meetings (see below), and specifically highlighted the need to tackle deaths caused by huffing solvents, but astonishingly made no reference or representation to the new government concerning fatal opioid overdoses nor did it mention the need to distribute naloxone to users, families and friends.
With this lack of formal commitment to naloxone distribution from the lead NGO organisation for drug users/drug agencies in New Zealand, it was hardly surprising that when the new government eventually rolled out its five year Drug Policy Strategy 2015-2020 on 28th August 2015, the policy document made no mention of naloxone whatsoever. Interestingly, the new drug policy did, as promoted in the NZ Drug Foundation Briefing Paper, prioritise a commitment to ensure New Zealand would be represented at international UNGASS meetings (p.22).
Belatedly, Matters of Substance published a better informed and considered magazine feature on Naloxone after the embarrassing ‘for or against’ debate, the Foundation produced a stand alone Naloxone Background Paper. However, while this discussion paper includes some excellent sources and appeared to offer a robust argument for reducing overdose, it also undermined the campaign with some odd statements and inclusions, such as “Due to the controversial nature of drug harm reduction and naloxone access”, and it confusingly recommends consideration for: “legal protection from arrest for drug possession and/or the act of injecting someone for people who administer naloxone in an emergency situation”, [my highlight in red], as well as recommending “reclassifying naloxone as restricted medication” rather than pharmacy only, largely it seems, to ensure that anyone who accesses naloxone must receive training. The briefing paper also aired some odd arguments against naloxone: “There may also be views that wider access is not necessary with naloxone already available in hospitals and with advanced paramedics” and it further “[naloxone] will lead to greater risk taking behaviour”.
There are other disconcerting aspects buried within what might otherwise give the impression of a solid report arguing for greater naloxone distribution, such as the omission of data concerning the high percentage of overdose deaths that occur before the medics arrive, for example, a London study by Hickman et al (2007:320) found that when an ambulance was called the person who overdosed was already dead before the arrival of the ambulance in 85% of cases. Had this information been understood and included in the NZ Drug Foundation background paper they would surely have given greater emphasis to ensuring naloxone is in the hands of People Who Inject Drugs (PWID), their friends and family, but the report seems to prioritise naloxone training over naloxone distribution. The recommendations in the paper also includes loop holes that seem to almost invite a piecemeal approach to distributing naloxone, by suggesting various components of naloxone distribution could be seen as possible ‘separate options’ for consideration.
a London study by Hickman et al (2007:320) found that when an ambulance was called the person who overdosed was already dead before the arrival of the ambulance in 85% of cases
While this paper was primarily about the role of naloxone to reduce overdose death, it was an ideal opportunity to mention closely related strategies known to reduce OD deaths in New Zealand, such as the benefit of allowing prescribing injectable drugs in New Zealand to people who continually inject rather than restrict them to oral methadone which is then invariably injected, or the effectiveness of Drug Consumption Rooms in reducing overdose. Here’s a link to the report that includes my highlighted concerns and critique.
Despite the absence of any clear formal commitment to wider naloxone distribution, the campaigning in Aotearoa NZ must continue for naloxone take-home, and indeed for other strategies to reduce overdose and drug policy harm, including: drug checking; prescribing injectable opioids to opioid injectors; a Good Samaritan Law to end arrests for possession and manslaughter when co-users call for emergency help; end the risk of criminalisation for possession of needles and utensils in New Zealand (unless proven to be obtained from the needle exchanges); and establishing Drug Consumption Rooms.
In view of this failure to put naloxone on the formal agenda, it was somewhat incongruous see the Director of the NZ Drug Foundation on International Overdose Day showcase a persuasively well-argued newspaper article (with no sense of irony or doublespeak), asserting that New Zealand must do more to tackle overdose and distribute naloxone. If the New Zealand Drug Foundation had proactively promoted the need for naloxone, it could have been quite different. It’s New Zealand Drug Foundation, in its pivotal drug policy advisory role, that needs to do more to tackle overdose and push for naloxone distribution.
It is hard to understand given the insights clearly displayed in their newspaper piece on International Overdose Day why the New Zealand Drug Foundation have omitted naloxone from important documents (the Wellington Declaration & subsequently the Harm Reduction Briefing to Parliament), and why they haven’t campaigned when and where it matters, for naloxone take-home from the outset. Staff from the NZ Drug Foundation did however, as promoted and prioritised in the harm reduction Briefing to Parliament, go to Vienna and New York (see here) and engage in the inertia of the UN drug control system that is committed to a ‘drug’ free world.
With an alternative emphasis on national drug policy reforms in New Zealand rather than international networking, important drug policy harms could be tackled. Key drug policy issues that need tackling here in New Zealand include:
2. There is no naloxone take home.
3. There is no injectable maintenance prescribing.
4. There is no heroin prescribing.
5. There is no Good Samaritan law.
6. There are no Drug Consumption Rooms / Supervised Injection Facilities.
7. Unemployed people on state benefits are drug tested and lose benefits if they repeatedly test positive for illegal drugs.
8. People with life limiting illnesses are criminalised if caught self medicating with cannabis.
9. The Police and Air Force scour the countryside every year digging up millions of dollars worth cannabis plants.
10. The Alcohol and Other Drug Treatment Courts adopted from the USA and based on an abstinence and disease model of addiction that uses scram bracelets and random alcohol and drug testing, have had their five year ‘pilot’ extended a further three years.
11. New legislation to enforce Compulsory Assessment & Compulsory Treatment of Addiction came in force in February 2018.
12. The Psychoactive Substances Act 2013 made possession and supply of all NPS an offence – unless approved by the state (none have been approved).
13. Housing NZ have fuelled a needless moral panic about methaphetamine contaminated houses and awarded over $50m to companies to decontaminate houses.
The 2016 and 2017 CND and UNGASS meetings predictably delivered no tangible positive outcomes or progress. It’s now International Overdose Awareness Day 2017 and New Zealand users, families and friends are still struggling to gain access to naloxone. Distribution has been agreed in principle, but procrastination concerning the cost and production of additional health education material to accompany the naloxone have stalled distribution.
Having failed to even mention naloxone in the weighty 2013 Wellington Drug Policy Declaration, and failed to mention it in the 2015 Briefing to Parliament, the urgent need for naloxone was finally acknowledged in the New Zealand Drug Foundation December 2017 Briefing to Parliament;
While nations like New Zealand, inexcusably fail to deliver easy to implement drug policy reforms at a national level, and instead invest considerable energy on high maintenance, but low outcome international drug policy reform gatherings, serious harms continue. A growing number of drug reformers are recognising the need for genuine policy transformation. It is time to stop talking the talk and start delivering outcomes, one in particular Low Threshold, Easy Access, Naloxone Take Home.
In the meantime, people who use illicit drugs in New Zealand are needlessly suffering, some are dying. No naloxone take home – no excuse.
It is literally a matter of life or death.
Dr Julian Buchanan, is a retired Associate Professor, Victoria University of Wellington, Institute of Criminology
31st August 2015 on International Overdose Day. (updated 5th January 2018)
by Julian Buchanan (updated Dec 2016)
While it can be argued that some groups have benefitted from drug prohibition, this divisive and ill-founded strategy has caused untold harm to many. Yet despite the unequivocal evidence of social damage, severe law enforcement measures to deter the use of certain substances have continued unabated for over five decades. In their eagerness to end the draconian drug war and replace it with a policy rooted in evidence, science and reason, should Drug Reformers accept and embrace any policy improvement as a step in the right direction? Before we consider the issue of drug reform in terms of incremental change versus abolition, we need to distinguish between individuals, and the organisations/leaders/spokespeople who have an interest in drug policy. With regard to individuals who may have shifted from once embracing the dominant discourse of prohibition to a more informed and enlightened view of drugs, any incremental move warrants encouragement and supportive discussion. In respect of organisations, leaders, and spokespeople with an interest in drug policy, however, I think we need to be more much more questioning and critical.
An incrementalist approach, which perceives any step away from the traditional drug war model as an inherently positive move, is at best naive. It mistakenly assumes that incremental changes to Prohibition should automatically be supported, as key steps towards ending the Drug War. Herein lies a major issue. So, for example – imagine that one ‘Reform’ organisation campaigns to get drugs ‘out of the hands of gangsters‘ and wants drugs to be regulated.
On the face of it, this sounds good – as if we are on the same page, heading in the same direction. If, however, the proposed changes promoted by this ‘Reform’ organisation mean that some drugs will be legalised, but will only be available via BigPharma or Big Business, and new laws will be rolled out to make possession of ‘unregulated’ drugs a criminal offence – then we are definitely not on the same page: I can’t support replacing prohibition with Prohibition 2.0.
For me, the wrongful policing, criminalisation, and incarceration of people for possession of banned drugs is the most important issue in the Drug War, and I think it is paramount, from a human rights perspective, that in the course of any reform, the State shouldn’t decide what a person can and can’t consume, and shouldn’t seek to prevent such consumption, or to punish people for personal possession of unapproved drugs. Such enforcement has always been selective, repeatedly and unfairly targeting disadvantaged people, indigenous people, Black people, women and ethnic and minority groups. So, what might appear to be a step in the right direction could end up being a lost opportunity for genuine reform. If reformers aren’t careful, they could wind up supporting the launch of a new regime of Prohibition.
The example above highlights the importance of clarity and transparency concerning what individuals and organisations who ‘sit around the table’ to tackle the drug war, are actually seeking to replace it with, and why. Inevitably, abolition will involve a process of change, but it is vital to support only those changes that are clearly part of the bigger process of abolition.
A further example would be a shared concern regarding the huge number of people going to prison for drug-defined crimes (such as possession, cultivation, and supply). An organisation comes along and says prison for drug-defined crime is wrong. Yes, this appears to be another incremental step in the right direction that we should support. On the surface it is; but this penal reform organisation seeking to keep offenders out of prison, later also disturbingly argues that we can stop drug users going to prison by setting up Drug Abstinence Courts, random drug testing, scran tags and 12-step rehabilitation programmes. In our shared efforts to produce incremental reform, we risk supporting new oppressive regimes rooted in prohibition and abstinence.
Should we support this ‘incremental improvement’ away from prison to Drug Abstinence Courts? I don’t think so. Drug Abstinence Courts are new prohibition, utilising quasi-compulsory methods to enforce abstinence and impose a blanket ban on drug use. In the USA, this apparent step in the right direction has spawned a huge rehab and drug-testing business that profits from these drug ‘offenders’. There are now around 3,000 Drug Courts, with more being rolled out in other Anglophile countries.
A third example would be a reform organisation promoting the view that drug use is not a crime problem, but a public health issue. In our gratitude at the prospect of drugs moving out of the law enforcement arena to which they should never have been consigned, it would be easy to lend support to this change. Further examination and discussion, however, reveals that while the ‘reform’ organisation supports decriminalisation of all drugs, it sees the use of all currently-banned drugs as a public health issue, and fails to distinguish between recreational use and problematic use, or between different drugs. The risk here is that the oppression for so long endured at the hands of law enforcement could be replaced by oppression at the hands of the medical and health professions coercively ‘treating’ people for their ‘public health’ problem.
A fourth example is that of campaigns to legalise particular drugs, such as the growing move to legalise cannabis. While this is laudable, and a move I wholeheartedly agree with in principle, selectively privileging particular drugs, based upon their popularity, to join the licit market in alcohol, caffeine and tobacco does not signal an end to Prohibition – on the contrary; it arguably bolsters prohibition. Granting pardons for particular drugs is a dangerous and uncertain pathway towards drug reform. Instead, we should challenge the very foundations of prohibition and push for the legal right to possess any substance for personal use, without threat, intimidation or punishment from the state.
The trouble with combating a major injustice such as the Drug War, and then settling for incremental adjustments, is that it compromises, complicates and confuses the reform movement and message, it dilutes and divides the drive for reform, and it establishes a new regime which then gains its own momentum, and poses its own problems, which are even harder to correct.
The Drug War will be remembered in history as one of the greatest social policy disasters in modern times, an ill-founded and ill-conceived approach, a serious breach of human rights which has devastated the lives of individuals, families, communities, and indeed whole countries. There is only one acceptable solution to Prohibition and that is Abolition.
*With thanks to Jerry Dorey for helpful edits and suggestions!
The so called ‘War on Drugs’ never existed. The idea that there is or has been a war against drugs is a lie, it’s classic prohibition propaganda. There has never been a campaign against drugs. Let me explain. Society and governments have always appreciated the wide ranging benefits and pleasures derived from drugs. Drugs have never been as popular as they are now. The availability, promotion and use of pharmaceutical and legally approved drugs such as caffeine, alcohol, tobacco and sugar, has never been greater. However, prohibition propaganda has conveniently resulted in these drugs escaping under the radar of the prohibitionist drug discourse, and these substances are incorrectly, not perceived as drugs.
Rather than a War on Drugs, what we have is a Drug War, a hostile war waged by the proponents of approved drugs against anyone using unapproved drugs. More accurately, a process better conceptualised as a politically driven Drug Apartheid; an arbitrary and illogical separation, not of people, but of drugs. This distinction between these two sets of drugs has no rational basis, it has no science or evidence to support it, neither is it based on the risk of harm. Under the strictly enforced Drug Apartheid alcohol, sugar, tobacco and caffeine enjoy privilege, power and promotion, while unapproved drugs are outlawed and anyone found involved in possession, production or supply risks stigma, criminalisation and punishment, including life imprisonment and the death penalty. This brutal, inhumane and damaging system that impacts negatively on individuals, families, communities and nations, is perpetuated because society has been successfully indoctrinated (at a personal, cultural and institutional level), to believe a social construction of ‘drugs’.
Anyone seeking to expose or challenge the drug apartheid, risks being ridiculed, and is vulnerable to public humiliation, as experienced by Professor David Nutt. The unwarranted and ill-founded attack on David Nutt was no isolated incident. Further, to deter any association with outlawed drugs, armed forces, customs officials, and police invest massive energy and resources, while magistrates and Judges impose some of the severest sentences available to the courts for drug violations. Such is the power of the drug apartheid, that a criminal conviction for using the ‘wrong drug’ results in life-long consequences for travel, employment, housing, relationship and opportunities. The ever increasing business opportunities and technologies, spawned from the drug apartheid, drug testing (urine, blood, hair, sweat, saliva, and waste water!), has enabled the oppressive regime to extend beyond law enforcement agencies, to the civil arena, so that surveillance, monitoring and sanctions to maintain the drug apartheid are now carried out by employers, benefit agencies, schools, colleges and even in homes by parents on their children.
This untenable and indefensible position, of outlawing some drugs and privileging others, was enshrined in the 1961 UN Single Convention, a law that is rooted in moral and politically ideology from the 1930s, 40s & 50s. The decision to isolate a group of substances was never based upon science, reason or evidence. Yet ironically, since it’s inception, drug reformers have tried to end this drug war by engaging ideologically driven politicians, governments and UN bodies with endless streams of evidence, inquiries, research, reports and debates.
This considerable drug reform effort, has for five decades (1960-2010), resulted in no significant drug law or policy change by any major advanced western capitalist country, – apart from some US state privileging cannabis for entirely different reasons. The vast array of campaigns, reports, research, presentations, inquiries, reviews, and publications have for decades been consigned to a vacuum, while the increasingly wealthy and all powerful multi-national companies with a vested interest in maintaining the drug apartheid, have worked closely alongside politicians and government agencies, to maintain drug policy inertia through propaganda, procrastination, misinformation and distortion. Indeed prohibition benefits many groups and organisations.
A recent US opinion poll (the General Social Survey), that explores support for cannabis legalisation, indicates that for almost 40 years (1970-2007) public interest in legalising cannabis changed little, fluctuating between 16% and 33% during that period. However, in the seven year period since 2007, support for legalisation has risen rapidly from 31% to 52%. How do we make sense of this dramatic shift?
One influential contributing factor over this period, has been the global and widespread increased access to the internet, and the mass engagement with social media such as Twitter, Facebook, Scoop.it, LinkenIn and YouTube. Social media provides an alternative source to information, evidence and peer exchange, and has I believe, played a significant part in enabling the wider public to gain access to independent, research based knowledge and reason, necessary to critically consider and question the basis of the Drug Policy Sham. In particular, the widespread dissemination of research evidence, facts and case stories (such as Charlotte Figi), about cannabis to the public, has resulted in long overdue, and much needed calls for decriminalisation and legalisation, to allow people suffering with life limiting illnesses, that fail to respond to medicine, to explore possible benefits from cannabis, and sensibly too, to allow recreational use of cannabis. Personal possession of cannabis should never have been outlawed, but neither should personal possession of any substance. Every person should in principle have totally rights over their own body and what they consume without threat of harassment, punishment or incarceration. The risks associated with personal consumption of any substance is a health and social care issue, not a law enforcement issue (if it’s an issue at all!).
The public acceptance of cannabis is a very significant shift, indeed, it could mark the ’tipping point’ – the start of the process that could see the end of the drug apartheid. But let’s be clear here, cannabis reform in the US is not occurring because fifty years of research, evidence and debate has finally persuaded politicians the drug war was a mistake, and the politicians are seeking legislative change. No, cannabis is being embraced, essentially because public insight and awareness has significantly increased since 2007, and there has been a shift in public opinion, that has resulted in serious electoral pressure upon politicians to enact cannabis law reform. The drive is coming from the grassroots, it’s not being led by politicians, instead governments are being forced to change by the public and ballot box.
In an era where the interests and activities of multi-national companies and politicians are becoming increasingly enmeshed. An era where democracy seems unresponsive to the needs of the vulnerable, and shows little interest in the protection of the common good, another four decades of inquiries, reports, reviews towards incremental change, would be a grave strategic mistake. The leverage for drug reform will be found, not in trying to persuade politicians or the INCB, UNODC, UNGASS, CND to lead the way on incremental changes which fail to address the underlying fallacies, but rather, by winning over mass public support, by utilising social media to distribute evidence, developing well-informed community movements, regularly disseminating accurate information, sharing influential case studies and rallying a huge social movement and public outcry that demands political change and transformation. The Drug War fallacies spawned by UN, have created a global system of propaganda and prohibition. This system needs exposing and ending, it is misguided to imagine it can provide foundations that can be adjusted and reformed incrementally to deliver drug legalisation.
Despite this encouraging drug law reform development, in respect of cannabis, the attempts towards genuine global drug reform could easily be thwarted. If, as drug reformers, we are not clear in our arguments and strategies for reform, which should be firmly rooted in protecting human rights and promoting harm reduction, cannabis will simply be invited to join the other privileged legal drugs in the drug apartheid. This could be a positive outcome for: big business, who can extend their repertoire and profit from the commercial sale of cannabis; for the state, who can profit from taxes, as well as continue to utilise drug laws as a key control mechanism for stopping, searching, arresting and punishing the poor, indigenous and minority ethnic groups; and the business enterprises spawned from the drug wars, (the industrial penal complex, the drug testing industry and the drug treatment industries). In this pivotal period for drug reform, simply privileging cannabis and failing to address the fundamentally flawed system of drug control would amount to colluding with a corrupt system.
Some drug reform entrepreneurs may attempt to hail privileging cannabis as an incremental step in the right direction, but the widespread and growing public support for decriminalisation, (and ultimately the regulation of all drugs), could be dissipated by this tokenistic gesture to invite cannabis to sit around the table of the powerful. While alcohol, tobacco, caffeine and maybe cannabis enjoy privileged status, the scourge, oppression and madness of a drug apartheid, remains an affront to human rights, a system of punishment and control that will continue to haunt this generation and future generations to come, one that will be remembered shamefully in history. The international system of drug control is deeply flawed and damaging to individuals, communities and countries. There is no ‘World Drugs Problem’ what we have is a UN led World Drug Policy Problem. It needs naming, exposing and dismantling. There can be no minor adjustments, or so-called incremental steps to accommodate the status quo, abolition is what is required not compromise.
This period of history will be recalled for the needless self-inflicted harm, imposed across the globe by a drug apartheid, in which drug laws and drug policy have caused considerably more harm than the drugs ever could.