National Drug Policy 2007-2012: Part Two

National Drug Policy 2007-2012
Part Two: The Next Five Years

Table of contents:

Foreword

Part One: Introduction

Part Two: The Next Five Years

Appendices

Abbreviations

References and Bibliography

2. Policy and strategies

In this section:

2.1 Policy foundations
2.2 Moving forward
2.3 Strategies
2.4 Information collection, research, evaluation and monitoring
2.5 National Drug Policy Discretionary Fund

3. Issues relating to population groups

3.1 Maori
3.2 Young people
3.3 Pacific peoples

2.1 Policy foundations

As we have seen, this National Drug Policy builds on the first National Drug Policy. The principle of harm minimisation and the balance of supply control, demand reduction and problem limitation strategies will continue, as will the co-ordinating mechanisms, the Ministerial Committee on Drug Policy (MCDP) and the Inter-Agency Committee on Drugs (IACD). The Ministry of Health will continue its leadership role and the National Drug Policy will continue to be the umbrella document that guides agencies in their responses to drug-related harm.

2.2 Moving forwards

Drug policy in New Zealand has developed and matured since the first National Drug Policy was published in 1998. Objectives have been reviewed and updated to reflect new evidence and changes in the social and political environment. The Government will continue to address drug-related harm through approaches known to be effective. The Government will also seek new and innovative approaches to these issues.

2.2.1 Evidence online

An online information source will be developed and maintained. This will co-ordinate and collate up-to-date research and survey data, information on emerging issues, and annual position reports. It will also include detailed information on the prevalence and patterns of drug use and the related health, social and economic harms experienced by the population.

2.2.2 Action plans

Action plans will be developed under the Policy. These plans may be substance-based or related to a particular target group or setting, or may be generic. Action plans that have already been developed include: Clearing the Smoke: A five year plan for tobacco control in New Zealand 2004-2009 (Ministry of Health, 2004a), the National Alcohol Strategy 2000-2003 (Ministry of Health and the Alcohol Advisory Council, 2001), the Methamphetamine Action Plan (Ministerial Action Group on Drugs, 2003) and the Action Plan on Alcohol and Illicit Drugs (Ministry of Justice, 2003).

Agencies represented on the IACD will work together to develop action plans to achieve the objectives outlined in the National Drug Policy. These plans will:

Specify the types of activities to be undertaken
Contain specific outcome indicators and targets
Identify ways to resource the activities
Nominate which government agency will take the lead in each area.

In developing new action plans, the process followed will include:

A systematic review of the evidence
Involvement of topic experts
Consultation with stakeholders.

As these plans are generated, individual agency work programmes to advance the National Drug Policy’s objectives will be developed and built on.
The development of indicators will be a significant component of the action plans. In some cases indicators already exist, but in other cases it will be necessary to collect baseline data before meaningful indicators can be developed.

Progress on the National Drug Policy and implementation of action plans will be monitored and reviewed in the following ways.

The MCDP will meet at least twice-yearly to review progress and decide which new policy initiatives should be recommended to the Government.
The IACD will ensure that policies and programmes throughout government are consistent with this policy and are mutually supportive. It will receive reports from individual government agencies on progress made in implementing this policy, and will make recommendations to the MCDP on new policy initiatives. The IACD will also seek representations from other agencies, as appropriate.

2.2.3 A stronger intersectoral focus

The first National Drug Policy had a strong emphasis on health objectives and approaches to addressing the harms arising from tobacco, alcohol, illegal and other drug use. Over the next five years the Government will retain health-related objectives but will also develop a greater intersectoral focus, which will encompass both the social and the economic harms from drug use.

All government agencies will be held accountable by the MCDP for achieving the objectives of the National Drug Policy, delivering effective policies and programmes, and collaborating with other agencies to achieve a co-ordinated approach to reducing drug-related harm. This broadening of focus may require government agencies to refine their data sets and undertake research in new areas to ensure there is an adequate evidence base to work from.

2.2.4 Addressing emerging trends

The Government expects that in the next five years there will be changing patterns of drug use, and that new trends will emerge in the nature and extent of the drug problems faced in New Zealand. For this reason it is important that the National Drug Intelligence Bureau, ALAC, the Health Sponsorship Council, and government agencies maintain vigilance over legal and illegal drug trends. The National Drug Intelligence Bureau will be reviewed to ensure that it can provide a strong, proactive and prominent capability to forecast future trends in drug use.

2.2.5 Contribution to social wellbeing

The Government’s theme, families young and old, has five sub-themes:

Strong families
Healthy confident kids
Better health for all
Strong and safe communities
Positive ageing.

Drug abuse underlies many social issues and concerns, and tackling it will help to address issues such as family violence, crime, safety, educational under-achievement, unemployment, road safety and family cohesiveness. A strong and cohesive National Drug Policy and resulting action planning will contribute significantly to all of these sub-themes.

2.3 Strategies

Strategies will be developed, as necessary, to achieve the objectives of the National Drug Policy taking into account five interacting components:

The physical, economic, social and legal environment in which drugs are produced, marketed, distributed and used
The characteristics of individual drug users (eg, their age, gender and ethnicity)
The setting in which the drug use occurs and/or in which interventions can be implemented (eg, schools, workplaces, public places)
The characteristics and effects of the drug in question (eg, its psychoactive properties, dependence-producing effect and legal status)
The need to reduce health, economic and social inequalities.

There will be a focus on the following three strategic areas over the next five years: regulation and law enforcement; health promotion and education; and assessment, advice and treatment services.

2.3.1 Regulation and law enforcement

Regulatory intervention is a powerful tool for controlling the environment within which drug use occurs. However, the focus and goals of regulation necessarily differ for legal and illegal drugs.

Legal drugs
Legislation controlling legal drugs includes the Smoke-free Environments Act 1990, Sale of Liquor Act 1989, Customs and Excise Act 1996, and Part 3 of the Misuse of Drugs Amendment Act 2005.

Regulation of legal drugs can be applied to:

The purchaser or consumer (eg, setting a minimum purchase age, degree of acceptable intoxication and location of use)
The product (eg, restrictions on content, volume, packaging and labelling; requirements for warnings and product information; and controls over price, distribution and marketing)
Consumption facilities (eg, licensing regimes, controls over hours of operation, location and density of outlets, restrictions on marketing promotions, requirements for staff training and security systems).

The focus for the next five years will be to review the enforcement and adequacy of these regulations and to identify areas for more efficient and effective controls, especially for volatile substances and other restricted substances.

Illegal drugs
Where drugs are illegal, regulation generally involves measures aimed at preventing them from reaching users and deterring individuals from choosing to use them. This includes prohibiting importation, manufacturing, supply, possession and use. The enforcement of illegal drug regulations involves initiatives to prevent the establishment of extensive and enduring drug distribution networks and to disrupt the activities of existing organised criminal groups.

The focus of the next five years will include reducing the availability of illegal drugs in the community by reducing the levels of importation, manufacture, cultivation and distribution of both illegal drugs and precursor substances. It will also include working proactively to suppress the involvement of organised and trans-national criminal groups in existing drug markets, and to stymie their involvement in any new drug markets. This will involve the development and use of new and enhanced enforcement techniques and strategies. Enforcement agencies will continue to undertake joint/interagency responses to drug trafficking, both domestically and internationally. There will also be a strengthened capability within monitoring and enforcement agencies through effective workforce development initiatives.

Legislation controlling illegal drugs includes the Misuse of Drugs Act 1975, Medicines Act 1981 and Customs and Excise Act 1996.

2.3.2 Health promotion and education

The 1986 Ottawa Charter defined health promotion as the process of enabling people to increase control over and improve their health. It includes the impact of economic, social and cultural factors on health. Health promotion strategies include interventions designed to build healthy public policy, strengthen community action, re-orient health services, create supportive environments, and develop personal skills. Relevant drug health promotion intervention includes:

The use of the regulatory tools available for legal drugs, including pricing and tax policy
Working with industry on the nature of advertising and marketing of products
Community action and resiliency programmes
Social marketing.

Effective health promotion programmes often involve a comprehensive approach using a number of these strategies together.

Health education strategies involve providing information about drugs and their effects to inform people’s choices about drug use. The focus for the next five years will be to continue to fund Community Action on Youth and Drug (CAYAD) programmes, social marketing (including tobacco control and alcohol culture change), and other health promotion initiatives.

The Government will review the scope and funding of drug-related health promotion and education to ensure that the best and most effective mix is achieved.

2.3.3 Assessment, advice and treatment services

Over the next five years the Government will continue to improve the quality of, and access to, drug treatment services. Treatment interventions are vital to the limitation of problems arising from substance use.

In June 2005 the Minister of Health released Te Tāhuhu – Improving Mental Health 2005–2015: The Second New Zealand Mental Health and Addiction Plan. One of its 10 leading challenges focuses on addiction, and aims to improve the availability of, and access to, quality addiction services including maintenance treatment programmes and opioid substitution. Most of the other leading challenges, including service delivery for people with co-existing mental health and drug-related problems, are also relevant to alcohol and drugs, including the directions on promotion and prevention, primary health care, and Māori mental health. Te Kōkiri: The Mental Health and Addiction Action Plan 2006-2015 (Minister of Health, 2006) is the implementation plan for Te Tāhuhu – Improving Mental Health 2005–2015.

Access to, and the quality of, primary mental health services for people with or at risk of developing drug problems will be improved. The needle and syringe programme for injecting drug users at risk of contracting blood-borne viruses will be maintained and access will be improved. There will be a systematic review of the interface between addiction and mental health treatment and criminal justice systems, including implications for Māori and Pacific peoples, women offenders and youth offenders.

There will also be work on minimising alcohol and other drug-related crime, crashes and anti-social behaviour, as well as associated injuries and other types of victimisation.

2.4 Information collection, research, evaluation and monitoring

The successful implementation of drug harm minimisation strategies will involve:

Baseline and ongoing data collection, monitoring and research on the impact, risk factors, patterns of use and related harms
Evaluation of the effectiveness of policy interventions for tobacco, alcohol, illegal and other drug use.

Information gained through data collection, research and evaluation supports policy interventions and service development in a number of ways. First, it enables agencies to accurately identify the scope and nature of particular drug issues and to prioritise policy responses in a way that will prevent or reduce the harm most effectively. Second, it helps build the evidence base for determining which policy interventions will be most effective. Finally, it provides data to monitor and measure the results of specific local interventions. Data collection to support research into the size of the drug problem and emerging drug trends, and to create an evidence base for policy interventions and decision-making for service provision, will be refined and expanded.

Although the national and international knowledge base is growing, there are still substantial gaps in our knowledge. For example, there is little information available on the social and economic costs arising from alcohol use and some other types of drug use. The IACD will be specifically tasked with addressing these issues and ensuring that researchers from each agency (and independent researchers) undertake a stocktake of existing knowledge and identify what further information is needed.

Research into drug issues will continue to be funded, as appropriate, through the Health Research Council, Cross-Departmental Research Fund, National Drug Policy Discretionary Grant Fund and individual agency budgets.

2.5 National Drug Policy Discretionary Fund

The National Drug Policy Discretionary Grant Fund (NDPDGF), established in 2004, provides government ministers involved with drug policy with access to a pool of funding for new initiatives or projects that fill gaps in drug policy work. The NDPDGF will continue to fund:

High-quality cross-departmental projects that support the advancement of the National Drug Policy
Projects that fill a gap which would otherwise remain unfilled due to not meeting a particular agency’s funding criteria
Projects that allow for forward planning and fast response by government agencies to changes in current and emerging drug trends.

The fund is jointly managed by the IACD and MCDP.

The NDPDGF has funded research into benzylpiperazine (BZP), a substance for which there was little knowledge world wide. It is expected that the NDPDGF will continue to be a source of funding for cutting-edge research and interim support for innovative approaches to drug issues.

3. Issues relating to population groups

The relationship between drug use and social factors such as unemployment, low income, poor housing and low social cohesion is clear. However, individual risk and protective factors can mediate this relationship so that some individuals will do better than others. The groups most at risk vary, depending on the particular harm being addressed and whether or not this harm is related to single drug or poly-drug misuse.

At a population level, low socioeconomic status is associated with an increased risk of drug-related harm from tobacco, alcohol and illegal drugs. In addition, three specific population groups have been identified as being at greater risk of many drug-related harms than other New Zealanders: Māori, Pacific peoples and young people. These groups are an important target for initiatives to reduce drug-related harm because they have a higher need and require specific approaches to ensure that efforts to reduce harm are effective.

3.1 Māori

Māori suffer disproportionate harm from the use of drugs, especially tobacco, alcohol and cannabis. Strategies designed for the general population have been less successful in reducing harm among Māori. The Government recognises the importance of consolidating gains in Māori development and accelerating Māori participation.

He Korowai Oranga, the Māori Health Strategy (Minister of Health and Associate Minister of health 2002), is a government strategy developed to address health issues affecting Māori. The overall vision of He Korowai Oranga is whānau ora, which emphasises whānau health and wellbeing and places whānau at the centre of public policy. The strategy strongly supports Māori holistic models and wellness approaches to health and disability.

There is a clear association between high smoking prevalence, ethnicity and low socioeconomic position in New Zealand. Overall, Mäori smoking rates remain high (see section 1.1) and have declined at a slower rate than for non-Mäori. Smoking is a significant contributing factor to the health inequalities seen between Māori and non-Māori.

Data from large-scale New Zealand surveys show that while Māori are less likely to drink alcohol and drink less often, they drink more heavily on a typical drinking occasion when compared with non-Māori (Reference to A 2003 study for the Alcohol Burden of Disease and Disability Group). Thus Māori are more likely than non-Māori to have potentially ‘hazardous’ drinking patterns (see section 1.2.2).

The National Drug Policy recognises that drug problems in Māori communities may be addressed more effectively when targeted approaches are developed by and for Māori. This has implications for the way services are provided for Māori to minimise the drug-related harm they experience. Some ways in which services might be organised to better meet the needs of this group are outlined below.

3.1.1 Mainstream services for Māori

Access for Māori clients to the full range of mainstream drug treatment services  including rehabilitation, detoxification and drug education services  should not be limited by socioeconomic factors or geographical isolation. Programmes and interventions should be appropriate for Māori across the continuum of care from health promotion, early intervention and treatment.

3.1.2 Kaupapa Māori services

Kaupapa Māori services are predominantly provided and delivered by Māori within a framework of Māori concepts of health and wellbeing. Such services can be delivered either by Māori groups within mainstream services or by Māori community/hapū/iwi services.

3.1.3 Māori advocacy and peer support services

Māori advocacy and peer support workers who work in and with mainstream and kaupapa Māori services to meet the needs of Māori clients, their whānau and hapū will be encouraged.

3.1.4 Māori with co-existing disorders

Māori present for treatment with dual diagnosis more often than non-Māori. Anecdotal evidence suggests that Māori with both drug and other mental health problems present to drug and alcohol services rather than to mental health services because they do not want to be associated with the perceived stigma of mental health services. Drug and alcohol workers therefore need training in how to assess and manage people with dual diagnosis. Drug and alcohol services should ideally have access to Māori drug and alcohol counsellors, and be in consultation with whānau, hapū, iwi and liaison support from kaupapa Māori mental health services.

3.2 Young people

Young people, from primary-school age through to young adulthood, are a particular concern and warrant a strong focus for the prevention of drug-related harm. Information for young people about the effects of drugs and ways to prevent and reduce harm needs to be appropriate. For young people who are already using drugs, it is important to focus on effective interventions to help them to stop their use (eg, smoking cessation services) or minimise the risk of harmful effects (eg, reducing excess or binge drinking).

School-based health promotion initiatives work best when supported by consistent family and community-based approaches. A community focus will also be necessary to reach members of this target group who are at higher risk, including those who may not regularly attend school. Personal decision-making and other life skills need to be developed and fostered so that young people feel able to make healthy decisions about the use of tobacco, alcohol and other drugs.

3.3 Pacific peoples

The increasing prevalence of tobacco and alcohol consumption, combined with low rates of tobacco, alcohol and drug service utilisation, are growing concerns for Pacific communities (prevalence data for Pacific peoples are summarised in section 1). In addition, the largely youthful structure of the Pacific population points to the possibility that rates of drug use may continue to increase in future.

Tobacco smoking and hazardous drinking patterns are leading causes of preventable deaths for Pacific people. The prevalence of smoking for Pacific males is higher than the national average, while that for Pacific females (which was low in the past) is now similar to the national average. Pacific adult males have higher rates of hazardous drinking patterns than other ethnic groups (see section 1.2.3).

Receiving suitable and timely treatment is vital to reducing the harms linked to tobacco, alcohol and other drug use. It is therefore important to include a Pacific focus in efforts to improve the access and quality of services. There are two areas for development to further meet the needs of Pacific peoples: improved data collection and improved service utilisation.

3.3.1 Improved ethnicity data collection

Pacific communities in New Zealand are made up of a number of separate ethnic groups, so ethnic-specific data are required to ensure health services are targeted at areas of need. For example, Cook Island female adolescents have a smoking rate of 42%, compared to Samoan adolescents with a rate of 24% (Scragg 2005). Effective interventions may therefore require ethnic-specific programmes. Improved ethnicity data collection will enable agencies to accurately identify problems and target initiatives more effectively.

3.3.2 Improved treatment service utilisation

Research suggests that there is a relatively low level of treatment service utilisation by Pacific peoples. One approach to address this is to improve and formalise the linkages between primary health organisations and community organisations that provide alcohol and drug treatment services (Ministry of Health 2001), given that the enrolment rates at primary health organisations for Pacific people are high (Ministry of Health and Ministry of Pacific Island Affairs 2004). Improving the quality of Pacific and mainstream services through cultural competence frameworks and Pacific models of care are also emerging responses to managing disparities in service utilisation and health outcomes.

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