National Drug Policy 2007-2012
Appendices

Table of contents:

Foreword

Part One: Introduction

Part Two: The Next Five Years

Appendices

Abbreviations

References and Bibliography

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In this section:

• Appendix 1: Drug Use in New Zealand
• Appendix 2: National Drug Policy Co-ordinating Structures
• Appendix 3: The National Drug Policy in Context

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Appendix 1: Drug Use in New Zealand

There has never been a time, place, or culture where some psychoactive drug has not been used, and it is highly unlikely there will ever be. (Ryder et al 2006)

Drug-related problems can have a significant impact on individuals, families and whānau, communities and society as a whole. The costs including treatment, education, service provision, enforcement and custodial care can be measured in financial terms, but the personal and emotional costs on the lives of individuals and the people around them are immeasurable. This is why the Government believes it is critical to continue to progress an agenda of prevention and reduction of drug-related harm affecting the wellbeing of all New Zealanders.

This section provides a background to the development of the National Drug Policy (NDP) by presenting an overview of tobacco, alcohol, illegal and other drug use in New Zealand and the harms caused by their misuse. It presents a rationale for continuing to develop the NDP. Note that the amount and quality of information differ considerably depending on the substance in question. In general, the data are more comprehensive for alcohol and tobacco than for illegal and other drugs, and there is more information about health harms than social and economic harms.

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1.1 Tobacco

Tobacco smoking is the single biggest cause of preventable death and ill health in New Zealand. It is estimated that smoking is currently responsible for nearly one in five (approximately 5000) deaths per year in this country. Health effects include cancers (mouth, lung, throat, pancreas and kidney), blindness, chronic respiratory disease, heart disease, stroke, and sudden infant death syndrome (SIDS). Tobacco use causes the highest mortality rate of all recreational drugs in New Zealand.

In addition, second-hand smoke is now recognised to be a substantial health hazard. Exposure to second-hand smoke is estimated to be responsible for about 300 deaths per year in New Zealand.

Smoking is strongly associated with socioeconomic status, with the highest prevalence among people with low incomes. The proportion of smokers in the most deprived areas is two to three times greater than the proportion of smokers in the least deprived areas (Crampton, Salmond, Woodward et al, 2000).

The prevalence of cigarette smoking has decreased over the last 10 years, from 27% in 1995 to 23.5% in 2005, (Ministry of Health, 2006). Other notable findings on tobacco use are as follows.

• Smoking rates among Māori and Pacific peoples are comparatively high: the age-adjusted prevalence of smoking among Māori is 46% and for Pacific people it is 36%. European/other ethnic groups have a prevalence of 20%.
• Mäori women (50%) have higher smoking rates than Mäori men (40%).
• The prevalence of smoking among Pacific males is 39%, while the prevalence among Pacific females is 33%.
• Higher smoking prevalence is seen among young and middle-aged groups (15 to 49 years) compared with people aged over 50 years. Smoking prevalence generally declines with age as more people quit after the age of 40.
• The prevalence of smoking among people aged 15-19 years is 27%. In this age group, males (25%) and females (29%) have similar smoking rates.
• The prevalence of smoking among Māori and Pacific youth (15-19 years) is 46% and 36% respectively.
• Among Māori youth, females have a higher smoking prevalence (60%) than males (32%). The reverse is true among Pacific youth, with 28% of females currently smoking compared with 46% of males.

According to the Year 10 Smoking Survey (Robert Scragg, 2006), the prevalence of smoking in year 10 students has decreased from 11.4% to 10.7% in girls and from 8.1% to 7.2% in boys over 2004 and 2005. This is consistent with a continuing downward trend since 2000, when the prevalence was 16.3% among girls and 14.0% among boys (see Figure 1).

Figure 1: Prevalence of daily smoking (year 10 students), by sex, 1999–2005

Source: National Year 10 Smoking Survey (Scragg, 2006)

The Year 10 Smoking Survey indicates a decreasing trend in the prevalence of daily smoking across all ethnic groups from 1999 to 2005. The decline over this period has occurred among European, Mäori, Pacific and Asian year 10 students, although large relative inequalities persist (Table 1).


Table 1: Prevalence of daily smoking (%), year 10 students, by sex and ethnicity, 1999–2005

Female	1999	2000	2001	2002	2003	2004	2005
Māori	36.2	37.1	34.3	34.3	34.2	29.1	26.5
Pacific	23.0	19.4	19.5	17.6	18.1	13.2	14.5
Asian	5.9	5.1	3.2	3.9	4.5	2.9	2.9
European/Other	13.1	12.2	11.4	10.8	9.8	7.2	7.3

Male	1999	2000	2001	2002	2003	2004	2005
Māori	23.6	24.2	19.1	16.8	19.4	16.2	14.0
Pacific	16.6	16.8	14.3	10.8	12.5	11.8	10.2
Asian	7.9	9.4	7.2	7.5	6.4	3.8	5.3
European/Other	12.6	12.1	10.0	8.6	7.6	5.9	5.4

Source: Year 10 Smoking Survey (Robert Scragg, 2006)

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1.2 Alcohol

Alcohol is the most commonly used recreational drug in New Zealand, with over 80% of New Zealanders reporting that they have drunk alcohol in the last year. While most people drink without harming themselves or others, the misuse of alcohol by some results in considerable health, social and economic costs. These costs are borne by individuals, families and the wider community. Alcohol-related harms include:

• Haemorrhagic stroke, cancers of the mouth, throat, breast and liver, and cirrhosis of the liver
• Mental health conditions, such as dependence and depression
• Birth defects, including foetal alcohol syndrome and other permanent disabilities
• Economic and social harms such as poverty, unemployment, low productivity, family breakdown and child neglect
• Non-fatal and fatal injuries, either intentional (eg, from violence or self-harm) or unintentional (eg, from road traffic crashes).

(Alcohol Advisory Council of New Zealand, 2005.)

1.2.1 Alcohol consumption

The results of the 2004 New Zealand Health Behaviours Survey – Alcohol Use show that 81.2% of New Zealanders had consumed alcohol at least once in the last 12 months (Ministry of Health forthcoming). However, further analysis shows markedly different drinking patterns for different age groups, in terms of both the frequency and amount of alcohol consumed. For example, although people aged 18–24 years did not consume alcohol as frequently as people aged 55–65 years, they were significantly more likely to consume large amounts of alcohol on a typical drinking occasion.

Among New Zealanders aged between 12 and 65 years who had consumed alcohol in the last 12 months, about 14.7% consumed more than the recommended upper limits for responsible drinking on at least a weekly basis. The Alcohol Advisory Council (ALAC) recommended upper limits are six standard drinks for men and four standard drinks for women on any one occasion.

Males (82.5%) were significantly more likely to have consumed alcohol than females (78.4%) in the last 12 months. Among past-year drinkers, males (53.9%) were significantly more likely than females (39.9%) to consume alcohol four or more times a week on average.

The heaviest 9.5% of drinkers reported consuming enough alcohol to feel drunk at least once a week, with males (14.3%) significantly more likely than females (6.4%) to drink enough to feel drunk at least weekly. Two in five drinkers reported that more than once in the last 12 months they had felt the effects of alcohol the day after drinking. About 15% of drinkers had felt the effects of alcohol from the night before while at work, study or doing housework.

1.2.2 Alcohol and Māori

Non-Māori (81.3%) were significantly more likely than Māori (74.2%) to have consumed alcohol in the last 12 months. However, Māori drinkers (50.3%) were significantly more likely than non-Māori drinkers (23.3%) to consume a large amount of alcohol on a typical drinking occasion. Māori drinkers (21%) were also more likely than non-Māori drinkers (14.7%) to consume a large amount of alcohol at least weekly.

1.2.3 Alcohol and Pacific peoples

Pacific adults (46%) are more likely to be non-drinkers than the total population (19%). They are also less likely to have started drinking early in life or to be regular drinkers, and have lower rates of alcohol dependence compared with the New Zealand population overall. However, Pacific adult males in particular appear to have higher than average rates of hazardous drinking patterns. Current Pacific drinkers (27%) are more likely than other New Zealanders (8%) to have consumed more than 10 glasses on their previous drinking occasion (Ministry of Health and Ministry of Pacific Island Affairs 2004).

Figure 2. Past-year alcohol use in adults, by ethnic group and sex (age-standardised), 2002/03

Source: Ministry of Health. 2004b. A Portrait of Health: Key results of the 2002/03 New Zealand Health Survey.

1.2.4 Alcohol and youth

Over half (55.7%) of youth aged 12-17 years had consumed alcohol in the last 12 months (‘youth drinkers’), and about one in eight of these, or 12.4% of all youth drinkers, said they had consumed large amounts of alcohol at least once a week. Over three-fifths (62.5%) of youth drinkers reported that someone else had purchased alcohol for them in the last 12 months.

1.2.5 Alcohol-related harms

The national alcohol use survey found that alcohol consumption causes a wide range of self-reported problems and harms for drinkers, including affecting work or study, and results in actions regretted later, such as having unprotected sex.

The survey found that people had also experienced problems as a result of someone else’s drinking, including physical assault, sexual harassment and impacts on their family life, social life and financial position. More than one in 20 New Zealanders aged 12-65 years had suffered physical assault (5.7%) and sexual harassment (5.3%) as a result of someone else’s drinking during the last 12 months.

A study of New Zealand data from 2000 found that 51% of alcohol-attributable deaths and 72% of years of life lost in 2000 were due to injuries. Young people were more likely to experience alcohol-related injuries than older drinkers. (Alcohol Advisory Council of NZ, 2005)

Among New Zealanders aged 12-65 years who had wanted to reduce their alcohol consumption during their lifetime, 2.2% had received help to reduce their alcohol consumption, and 1% had wanted help but had not received any.

1.2.6 Alcohol and pregnancy

Four out of five (82.4%) of pregnant female drinkers reported stopping drinking during their pregnancy, and 79.2% of female drinkers who were planning a pregnancy reported that they had stopped drinking alcohol.

1.2.7 Transport-related harm from alcohol

Alcohol consumption degrades driving performance, and the risk of a crash increases as the driver's alcohol level increases. For example, a 30+-year-old driver with an alcohol level of 50 mg/100 ml is six times more likely to be involved in a fatal crash than a 30+-year-old sober driver. The same driver with a level of 80 mg/100 ml is 16 times more likely to be involved in a fatal crash. The national alcohol use survey found that approximately one in five drinkers reported having done at least some of their driving under the influence of alcohol in the last 12 months.

In 2005 driver alcohol impairment was a contributing factor in 100 fatal traffic crashes, 390 serious injury crashes and 940 minor injury crashes (Ministry of Transport, June 2006). Between 2003 and 2005 driver alcohol impairment was a contributing factor in 30% of fatal crashes, 18% of serious crashes and 11% of minor injury crashes. For every 100 drunk drivers or riders killed in road crashes, 55 of their passengers and another 35 sober road users die with them. People with a high blood alcohol level are more likely to be injured or die as a result of a crash than those who are sober.

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1.3 Cannabis

Cannabis smoking has adverse effects on the respiratory and cardiovascular systems and increases the risk of major psychological problems. Cannabis is the most widely used illegal drug in New Zealand and the third most widely used recreational drug after alcohol and tobacco. The 2003 New Zealand Health Behaviours Survey – Drug Use showed that one in seven New Zealanders (13.7%) had used cannabis in the last year, and that 15.1% of past-year users smoked cannabis frequently (10 or more times per month on average) (Ministry of Health, forthcoming).

¹ Years of life lost are a measure of premature mortality. They measure deaths in units of time (life years) rather than by events (mortality).

Other findings from the 2003 New Zealand Health Behaviours Survey – Drug Use included:

• Among past-year users, males (21.3%) were significantly more likely than females (6.3%) to smoke cannabis frequently (10 or more times per month on average)
• People aged 18 to 24 years were most likely to have smoked cannabis in the last 12 months (40.8% of males and 27.1% of females)
• Similar proportions of males (19.6%) and females (21.3%) aged 13 to 17 years report cannabis use in the past 12 months
• Māori (20.8%) were significantly more likely than non-Mäori (14.0%) to have smoked cannabis in the last 12 months.

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1.4 Stimulants

Stimulants include amphetamine, methamphetamine, crystal methamphetamine, ecstasy (MDMA), cocaine and crack. Earlier surveys have shown a significant increase in illegal stimulant use between 1998 and 2001: in 2001 5.3% of those surveyed reported having used an illegal stimulant in the last year, compared with 3.2% in 1998. In the New Zealand Health Behaviours Survey – Drug Use 2003 report (Ministry of Health, forthcoming), amphetamines (including methamphetamine) were the second most commonly reported illegal drug ever used (6.8%) or used in the past 12 months (2.5%). Past-year ecstasy (MDMA) use was reported by 1.9% of New Zealanders, making ecstasy the second most commonly used stimulant.

Methamphetamine is a particularly problematic stimulant. It is the only illegal stimulant commonly manufactured in New Zealand, and its manufacture and sale are closely linked to organised criminal groups. Methamphetamine is also the stimulant most commonly identified with violence, anti-social behaviour and mental health problems in New Zealand.

A 2004 study found that amphetamine-type stimulant users are disproportionately male and aged 18–29 years, with the heaviest use among 20–24-year-olds (Wilkins, Reilly, Rose et al, 2004). Stimulant users are typically in full-time employment, come from a range of occupational (including professional) backgrounds, earn mid-level incomes, and have relatively high levels of educational achievement.

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1.5 Hallucinogens

Hallucinogens include LSD and ‘magic mushrooms’. In the New Zealand Health Behaviours Survey – Drug Use 2003 report, 1.2% and 1.1% of people reported past-year use of LSD and mushrooms.

² In most New Zealand and international studies ecstasy is classified as an amphetamine-type stimulant rather than a hallucinogen due to its chemical structure.

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1.6 Opiates

Opiates include morphine, codeine, opium, heroin and a wide range of pharmaceutical drugs such as methadone and buprenorphine. Due to New Zealand’s geographic isolation it is difficult to import heroin and raw opium in bulk, so the majority of opiates abused in New Zealand have been prescription medicines (eg, morphine sulphate tablets and methadone), poppies and ‘home bake’.

The prevalence of opiate use remained relatively stable throughout the 1990s, with 0.6% of those surveyed in 2001 being current opiate users compared with 0.5% in 1990. Prevalence of use reported in the New Zealand Health Behaviours Survey – Drug Use 2003 remained low: around 0.1% of people reported last-year use of poppies, homebake and/or morphine.

Although the prevalence of opiate use is relatively low, the associated social and health harms (eg, crime and the potential spread of blood-borne viruses) are serious. There is strong evidence from other Western countries that high rates of crime are associated with the injecting of illegal opiates. As a result of low rates of employment among injecting drug users (IDUs), combined with the high costs of illegal drugs, many IDUs turn to crime as a way of funding their drug use. Reduction in property crimes have been demonstrated among IDUs retained in opioid substitution treatment programmes in Europe, North America, Australia and more recently New Zealand.

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1.7 Inhalants and volatile substances

Solvents include petrol, glue, butane gas and liquefied petroleum gas (LPG). These substances are contained in readily available products such as adhesives, thinners, petrol, aerosol sprays, gas, paint and anti-freeze and are inhaled by recreational users. In 2003 0.1% of people surveyed had used solvents in the previous year.

Solvent use has been associated with a number of deaths. Over the three years from 1996 to 1998 there were 35 deaths specifically due to solvents. These deaths were related to drug dependence, abuse, accidental poisonings and suicide. During 2004 and 2005 the Wellington Coroner investigated six solvent-related deaths of young people that occurred from 2003 to 2004.

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1.8 Performance and image-enhancing drugs

Performance and image-enhancing drugs (PIEDs), in particular anabolic agents, can boost muscle growth and athletic performance. Anabolic agents are not psychoactive, but their use carries serious health risks, including heart disease, cancer (liver, prostate and kidney), jaundice, and blood-filled liver cysts.

So far PIEDs have not been included in national drug use surveys in New Zealand, so there is a lack of information about the prevalence of their use. However, the New Zealand Sports Drug Agency (NZSDA) carries out a drug-testing programme on athletes involved in competitive sports under the New Zealand Sports Drug Agency Act 1994. Between 1994 and 2003 the NZSDA carried out a total of 9350 tests, with 97 (or 1.04%) positive results or refusals to provide a sample. In 2002/03 there were seven doping infractions under the NZSDA drug-testing programme.

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1.9 Diverted pharmaceuticals

Currently there is no way to measure the volume of diverted pharmaceutical drugs on the illicit drug market. The only surveys conducted on the recreational use of pharmaceuticals have focused on tranquilliser use.

Other pharmaceuticals of particular concern include morphine, methadone and other opioid-based pharmaceuticals, amphetamine, benzodiazepines, codeine, methylphenidate (eg, Ritalin), sildenafil citrate (eg, Viagra) and ketamine. In addition, there is evidence of large-scale diversion of prescription and pharmacy-only ephedrine and pseudoephedrine products into the illegal manufacture of methamphetamine.

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1.10 Legal highs

Legal highs are substances such as ’party pills’ that have psychoactive effects and are sold for recreational use. There has been a dramatic increase in the availability of products containing benzylpiperazine (BZP) in the last five years, with an estimated 1.5 million capsules being manufactured for sale in 2003. One concern about legal highs is the lack of information provided to users about health risks in particular poly-drug interactions associated with their use.

BZP was made a ‘restricted substance’ by the Misuse of Drugs Amendment Act 2005. The sale of products containing BZP is confined to those over 18 years of age, and restrictions have been placed on the way in which products containing BZP may be advertised or distributed.

A recent survey (Wilkins et al 2006) of 2010 people aged between 13 and 45 years found that 20% of the sample had ever tried legal party pills and 15% had used them in the last year. The highest use was reported by people aged 20-24 years. The survey also found that Māori were more likely than non-Māori and males more likely than females to have used legal party pills in the last year.

In November 2006, the Expert Advisory Committee on Drugs (EACD) considered research into BZP and related substances. Based on the evidence considered, the EACD made recommendations to the Associate Minister of Health including that BZP, phenylpiperazine and related substances be classified as “class C1” controlled drugs under the Misuse of Drugs Act 1975.

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Appendix 2: National Drug Policy Co-ordinating Structures

Since the first National Drug Policy was released in 1998, structures for co-ordinating intersectoral decision-making and monitoring progress towards policy objectives have been established. These are the Ministerial Committee on Drug Policy and the Inter-Agency Committee on Drugs as well as the Expert Advisory Committee on Drugs.

Ministerial Committee on Drug Policy

The Ministerial Committee on Drug Policy (MCDP) is chaired by the Minister of Health, and includes the Ministers of Corrections, Customs, Justice, Police, Māori Affairs, Youth Affairs, Transport, Social Development and Education. The MCDP meets, on average, twice-yearly to review progress and decide which new policy initiatives should be recommended to the Government.

Inter-Agency Committee on Drugs

The Inter-Agency Committee on Drugs (IACD) is a monitoring group of officials chaired by the Ministry of Health, and includes the Ministries of Education, Justice, Transport, Social Development, Youth Development, and Pacific Island Affairs; Te Puni Kōkiri; Department of Corrections; Department of the Prime Minister and Cabinet; New Zealand Police; New Zealand Customs Service; Land Transport New Zealand; Accident Compensation Corporation; Local Government New Zealand; and the Alcohol Advisory Council of New Zealand.

Expert Advisory Committee on Drugs

In 2000 the Misuse of Drugs Act 1975 was amended to establish the Expert Advisory Committee on Drugs (EACD). The EACD provides the Minister of Health with expert advice on the risk of harm to individuals and society from any particular drug or substance and on drug classification issues. The Ministry of Health provides secretariat support for the Ministerial Committee on Drug Policy, the Inter-Agency Committee on Drugs and the Expert Advisory Committee on Drugs.

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Appendix 3: The National Drug Policy in Context

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