First published in NZ Herald, 18 Jun, 2021
Yesterday marked the 50th anniversary of US President Richard Nixon declaring drugs "public enemy number one" and beginning a so-called war that was manifested around the world and still dictates our global approach to drugs today.
His legacy is enshrined in our own Misuse of Drugs Act (1975).
As a scientist and public health specialist, my focus is on evidence-based policy. My ongoing involvement in the Covid-19 response has been to elevate the voice of evidence, often in the face of uncertainty, misinformation, political dissension, and fear.
This month, I was invited to join the NZ Drug Foundation board and accepted because I feel the voice of evidence in drug policy has been ignored for too long at our collective peril.
We have a tussle going on between, on the one side, evidence and research, and on the other, fear, misinformation,and political disagreements.
Drug harm reduction is what led me from clinical medicine into a career in public health. I cut my teeth on creation of the NZ Needle Exchange Programme in the late 1980s, an initiative where we were world-leading. The supply of sterile injecting equipment for people who use drugs prevented an imminent epidemic of HIV transmission at the peak of the HIV/Aids pandemic.
After it was proven that the sharing of needles could transmit HIV/Aids, we decided it was morally right to ignore the illegal status of injected drug use in favour of preventing countless unnecessary deaths and disease.
I feel the voice of evidence in drug policy has been ignored for too long at our collective peril."
Today, 21 exchanges around NZ distribute more than 3 million needles each year along with harm reduction support and advice – reducing the transmission of diseases such as HIV and Hepatitis C.
This harm reduction approach was also used in the distribution of condoms to prevent HIV and other sexually transmitted infections (STI). At first controversial, this simple measure has become a normal and vital part of STI prevention.
The needle exchange and recent moves to legalise drug-checking are great examples of homegrown, evidence-based, drug harm reduction initiatives.
But the truth is our laws are still a decades-old memorial to Nixon and his kind that support a false moral presumption that by banning drugs we can solve drug use problems. This approach entrenches inequities in health outcomes, particularly for Māori, who are more likely to be arrested and convicted for drug offences than non-Māori with the same level of drug use.
The law prevents other harm reduction interventions such as supervised drug use spaces that could prevent synthetic cannabinoid deaths. Importantly, it gets in the way of users seeking help and information that might prevent unnecessary harm or addiction. People aren't able to be honest about their drug use when the behaviour is criminalised.
Our law also puts drugs into classes, supposedly based on the harm they cause. But the system is outdated and broken. Some drugs with little risk of addiction or risk to public health sit as Class A or B and can attract a life sentence for dealing.
Public and political opinion is shifting but we need to elevate the voice of science and evidence in our policy settings. A first step is needed – to decriminalise drug use.
This reform would allow users to have honest conversation, get help if they need it, and be provided with information and support.
Ultimately, we must shed Nixon's shadow and re-write our drug laws based on evidence and with public health principles at the core. The Law Commission wrote a blueprint over 10 years ago that would be a great place to start.
Together the Government, the public, and scientists have proven we can put science and evidence first in the way we have responded to Covid-19 – even when there are massive forces opposing us. We can and should do it again to address drug harm.
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