Advice on Canterbury District Health Board draft plan 2002
Research and Policy Analyst = Drug Law Reform Advocate
(and candidate for CDHB, 2001 "Smoke-Free Ecology)
Absent in NZ - Evidence Based Cannabis Related Health Promotion
This submisson identifies a priority area for enabling of health services: and urges the understanding and correction of a chronic SYSTEMIC PROBLEM - the wrongful administration in the NZ community of unworkable and inappropriate "substance prohibitions and criminalisation", particularly cannabis.
This submission singles out cannabis because it is used by an estimated half million New Zealanders, while 52% of survey respondents admit having tried marijuana at some time (National Drug Survey, Alcohol and Public Health Research Unit, Auckland University, 1999).
I do not seek to promote marijuana use or misuse. My concern is simply that prohibition is a severely flawed way to control this substance - while criminalisation is a grossly inequitable way to treat recreational drug users.
Cannabis represents a major health care anomaly in NZ. It appears to be the one area of Health care and community health promotion where intrusion of non-health sectors is wholly disproportionate, unreasonable and evidently counter-productive. The irrationality and hypocrisy of existing cannabis harm reduction is particularly notable when comparing the $2 billion black market in marijuana (and billion dollar++ criminalisation industry), with regulated and above-board control of the legal (and dangerous) drugs alcohol and tobacco.
Brief historical background of the Cannabis Issue:
In 1927, cannabis/hemp was prohibited under the Dangerous Drugs Act, amid concerns from MPs that there was no evidence of domestic cannabis abuse, and that the Police were being given extensive home invasion powers "to which they were not entitled".
In 1973 the NZ Board of Health reported on Drugs and Dependency in NZ, recommending in respect of cannabis, "continuation of the prohibition, so long as it may be shown to be largely effective". MPs debating the introduction of the Misuse of Drugs Act in 1975 promised robust implementation of their legislation, however no such accountablity eventuated, and while arrest rates have increase 24 fold since the mid seventies, cannabis has yet to be debated in Parliament some 27 years on (an indictment of the systemic failure NZ Parliament if ever there was one).
In late 1994, an extensive analysis of the possible philosophical basis for drug policy in New Zealand was prepared for the Ministry of Health, but received limited circulation. "Prescription and Permission" (J. Bushnell, H. Carter, P. Howden-Chapman) stated in its summary that "normalisation within the context of harm minimisation has been more sucessful than a justice approach in reducing drug related harm".
Subsequent submissions of the Issues Paper towards a National Drug and Alcohol
Policy identified "decriminalisation/legalisation" as the most recommended drug harm minimisation intervention (Oct 1995 MoH, Mental Health Services).
Around this time, speculative cost-benefit analysis endorsed by the Premier's Drugs Advisory Council (Victoria Australia, 1996) suggested that "the dollar spent on demand reduction acheives 7 times the dollar spent on enforcement".
Regrettably there has been suppression and obsfucation of such evidence, including a "legisative implication" vetoed by the Bolger/Shipley Cabinet in May 1996 - delaying the release of the National Drug Policy until July 1998 - by which time several references to to criminialisation related harm, and equitable evaluation of services had been strangely deleted...
Genuine best-practice "harm minimisation" - Not in the National Drug Policy,
then or now!
The Raurimu incident of 8 February 1997, brought cannabis and mental health into the spotlight - unfortunately the effect of prohibition deceit on Stephen Anderson's mental health received much less attention (search articles on alcp.org.nz for some inside information). However, the coroner did recommend following the Raurimu inquest, that "health professionals must find a way to overcome a patient's obsession with cannabis"...
An Inquiry into the Mental Health Effects of Cannabis by Parliament's Health
Select Committee in 1998 stated that the prohibition did not appear to be effective, pointing to a harm minimisation approach (with equitable cannabis, alcohol and tobacco health promotion). The Committee's report explicitly stated that "the double standards surrounding cannabis represent an impediment to effective anti drug education". There were concerns expressed too about the unhealthy stigmatisation of cannabis users, and the potential for worsened mental health in vulnerable individuals.
That committee recommended significantly that Government review the appropriateness of existing policy on cannabis, and reconsider the legal status of cannabis and its use.
This recommendation was repeated six months later in response to a petition seeking decriminalisation of recreational marijuana use. The recommendations were dismissed by the then National-led government.
Following election of the current Labour-Alliance government, Parliament has been conducting an Inquiry into "Cannabis Related Health Promotion" again before the Health Select Committee. There is considerable concern, however, that the expected adjudication against criminalisation is being stalled so as to not upset the present steadt course for re-election, 2002.
My own presentation to the Inquiry late last year, focused on the glaring absense of quantification of total drug related harm (specfically prohibition and riminalisation harms) from the full harm minimisation picture. If levels of use are barely affected by the legal status, then the public health burdon of illegal cannabis is theoretically greater than that of legal cannabis (where the community has credible drug education). While harm due to use is therefore mitigated, considerable harm and public cost due to criminalisation and alienation is totally eliminiated - THEREFORE HARM MINIMISATION REQUIRES REMOVAL OF CRIMINALITY.
By any standards, existing policy purporting to minimise harm "caused" by cannabis is fraudulent in terms of not minimising all harm "related" to cannabis. What appears to be an ongoing deliberate confusing of harm "caused by" and "harm related" to drug use is of grave concern to me and should ring alarm bells with any health professional or administrater who can add two or three numbers together. This is particularly so when it would appear that direct drug related harm is being eclipsed by criminalisation harm, evidenced by high levels of criminality in NZ, surprise, surprise, under criminalisation policy.
New Zealand is being conned on cannabis and existing policy purporting to minimise drug-related harm is a gross abuse of reason, and gross abuse of New Zealanders human and civil rights. An abuse held in place by unseen political forces and hidden agendas - and a silly, misguided international convention.
My concern as an observer and reformer, should be well evident from the above summary. Cannabis is a massive issue in NZ affecting the community wellbeing and safety, but is being sidelined because of the self interest, ignorance, and/or apparent cowardice of elected representatives.
Health Promotion - Disabled by systemic hypocrisy
In terms of the CHDBs goals and plans to improve, promote and protect community health, there are indicators that the systemic anomaly of prohibition is the major cause of failure in delivery of Health Promotion - particularly to young people, and marginalised groups such as Maori and unemployed.
While the degree of negative influence of the cannabis double standard cannot
be easily quantified, there is explicit logic in the conclusion of the Health Committee 1998 Cannabis report "Young people perceive a double standard in that alcohol barons receive knighthoods, while cannabis dealers go to jail, despite the obvious harms of alcohol and tobacco, and apparent innocuousness of marijuana" - (or words to this effect, p 39)
The significant sector of "alienation" in the community has repercussions in rejection of prohibitionist values and consequent degradation rule of law, mutual community disrespect and intolerance, and, by extrapolation, devaluation of health promotion generally.
According to this hypothesis, systemic hypocrisy and cannabis-alcohol-tobacco
double standards comfortably account for other areas of observable health promotion failure - eg, alcohol misuse, tobacco uptake, poor diet, problem gambling, sexual health, lack of exercise etc. Many at-risk people aren't respecting general health promotion messages, because there is a major problem with CREDIBILITY in the delivery of these messages. When drug education programs deliver double standards to school age children, the effect is the opposite to the intended "early intervention".
The huge black markets in recreational drugs in NZ represent approximately 20% of the population who are directly in defiance of authority and its simplisticly inadequate health advice ("just say no"). One needs to consider too that there is a peer-pressure attitude driven by the hundreds of thousands whoare day-to day outlaws, thanks to one particulary inapproapriate "health service.
If health promotion is thus disabled, District Health Boards should consider the downstream effects and costs of this failure - An $800 million burden in Canterbury alone including surgery and other mainstream health services in the DHB's domain.
Treatment providers have one set of clients who are implicity labelled "criminals", while an equivalent set are merely alcohohics (and of course many are poly-drug). How much harder must it be to help those who have the criminal stigma, self esteem, and attitude??
Repercussions in alienation may ultimately be seen in the NZ youth suicide rate - sadly some five times that of youth suicide in the Netherlands, an indicator which would tend to support the logic against prohibition (and ring more alarm bells please, Health Professionals!!)
Stopping inppropriate, cost-ineffective delivery of Non-Health-sector services
(and diversion of funding into programmes for success)
Significantly, the Ottawa Charter on Health Promotion, 1986 states that health promotors should identify and remove "barriers to health promotion" from non-health sectors.
I believe that the CDHB should identify and remove the Justice/Police/Courts/
Corrections intrusion into cannabis related health promotion, and do this as its absolute priority - a top of the cliff intervention and the re-enabling of health promotion. The logic points in one direction -> the good of the community depends on resolution of the cannabis debate.
While cannabis in particular is the key to the problem specification and resolution, as an advocate for reform I am eternally frustrated that the powers that be cannot even seem to carry out due process without stalling or claiming that some irrelevant research needs to be done before de-criminalisation can be considered.
Solving the problem - ie amending the Misuse of Drugs Act so that cannabis use
is no longer a crime - while so simple, is made extremely difficult while there is "no political will to resolve the debate" and issue the necessary Order in Council.
Systemic fraud is chronically aided and abetted by inability of public representatives to debate drug related health issues and fix what's broken systemically.
I am hopeful however that the introduction of District Health Boards, and a genuine desire for "best practice" to break through the lies and bring on evidence based drug harm minimisation.
I therefore implore that the CDHB engage this problem, perhaps in conjunction with other DHB's and Health Institutions around New Zealand.
Particularly it is recommended that the CDHB urge the Health Select Committee to deliver its adjudication on Cannabis Related Health Promotion as its single urgent priority.
Recommendation: That the CHDB prioritise cannabis related acheivable "best practice" and adopt drug related harm minimisation rationale and advocacy.
I would be more than happy to assist the CDHB with progressing these issues, and would appreciate the opportunity to speak to this submission.
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