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A breath of fresh air to reduce vaping harm

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number of people who go to ED with alcohol related injuries

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number of people who go to ED with alcohol related injuries

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Plenty of New Zealanders turned to the bottle to get through the ups and downs of last year's Covid-19 rollercoaster, documents show.

New data provided to Checkpoint shows ambulance staff showed up at more than 16,000 alcohol-related incidents in 2019.

In 2020, it shot up 37 percent, with paramedics heading out to more than 22,000 alcohol-fueled episodes.

St Johns said it had enough with staff often finding themselves on the receiving end of alcohol-fueled bashings.

"Many of our ambulance officers have been assaulted because of this," Canterbury territory manager Ian Rex said.

"On a Friday and Saturday night, our crews actually know what they're going to be facing, and they prepare for that, and it's becoming the norm."

The data obtained by Checkpoint was originally compiled for the Helen Clark foundation's research into the cost of alcohol consumption.

It revealed the extent of New Zealand problem drinking in 2020, the year of the one national six-week lockdown, plus a couple more for Auckland.

The data for Counties Manukau showed a 51 percent increase in the number of intoxicated, poisoned, or injured patients ambulance staff took to the emergency room.

In 2019, 1602 patients were taken to hospital. For 2020, that jumped to 2427.

"And this can be from falls, it can be from fractures, it can even be some small lacerations, or even the real big stuff where they get knocked out and actually have to be resuscitated," Rex said.

Canterbury saw the highest number of patients being transported to hospital for alcohol-related incidents in consecutive years.

In 2019, the number was 2695, increasing to 2894 in 2020.

Rounding out the top three, along with Canterbury and Counties Manukau, is Auckland, where trips to hospital jumped 41 percent from 1844 in 2019 to 2616 in 2020.

Most St John call outs are to the home - something Rex said was becoming more common.

"The household has become so used to having alcohol that when situations do get out of control, it becomes sort of norm," he said.

"And I think society in itself is just accepting that along with this comes aggression and sometimes even harm."

Lawyer and Communities Against Alcohol Harm secretary Grant Hewison spends much of his time helping communities prevent alcohol-related harm.

He said the 51 percent rise in alcohol-related trips to hospital for Counties Manukau was concerning.

"This is an alarming trend," he said.

"A 50 percent increase in one year. That is alarming."

There was a liquor store in almost every neighbourhood in Counties Manukau, he said.

"The easy and simple solution is to have a Local Alcohol Policy that just puts a cap or a sinking lid on liquor stores in South Auckland," he said.

"Frankly, we do not need any more and we need far less."

Hewison could not say why alcohol-related ED trips had skyrocketed but believed there could be a link to online services popularised during Covid-19 lockdowns.

"And I think these statistics may be linked to that quite significant surge as we saw it of online sales, and they're almost unregulated," he said.

As for who is keeping St John busy with alcohol-related calls, males aged between 20 and 29 remained top in both 2019 and 2020.

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Alcohol-related emergency department visits increased in 2020 - data

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Plenty of New Zealanders turned to the bottle to get through the ups and downs of last year's Covid-19 rollercoaster, documents show. New data provided to Checkpoint shows ambulance staff showed up at more than 16,000 alcohol-related incidents in 2019. In 2020, it shot up 37 percent, with paramedics heading out to more than 22,000 alcohol-fueled episodes.

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E-Cigarette Use Costs U.S. $15B Per Year, Reports UCSF in First Study of Its Kind | UC San Francisco

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Health Care Costs are $2,000 Per Year Higher Among People Who Vape Compared to Non-Tobacco Users

By Elizabeth Fernandez

Use of electronic cigarettes costs the United States $15 billion annually in health care expenditures - more than $2,000 per person a year - according to a study by researchers at the UC San Francisco School of Nursing.

The study, published on May 23, 2022, in Tobacco Control, is the first to look at the health care costs of e-cigarette use among adults 18 and older.

"Our finding indicates that health care expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn't use any tobacco products," said lead author Yingning Wang, PhD, of the UCSF Institute for Health & Aging.

The researchers based their estimates of health care costs and utilization on data from the 2015-2018 National Health Interview Survey. Health care utilization included nights in the hospital, emergency room visits, doctor visits and home visits.

"Health care costs attributable to e-cigarette use are already greater than our estimates of health care costs attributable to cigar and smokeless tobacco use," said Wang. "This is a concerning finding, given that e-cigarettes are a relatively new product whose impact is likely to increase over time."

Principal investigator Wendy Max, PhD, director of the Institute for Health & Aging, noted that from 2013 to 2018, e-cigarette use among high school students soared from 4.5% to 20.8%.

"We weren't able to look at e-cigarette use among youth under 18 in this study," Max said. "However, if more young people continue to take up vaping and keep on using this product when they become adults, the negative impacts on health care costs are likely to increase over time."

The authors called for continuing efforts to control tobacco use among youth in order to reduce illness and health care costs associated with e-cigarette use.

"Even with the current relatively low use of e-cigarettes among adults - 3.7 percent - health care costs are already substantial, and likely to increase in the future if youth continue to use this product," said Max.

Authors: The senior author is Wendy Max, PhD, director of the UCSF Institute for Health & Aging. Co-authors are Yingning Wang, PhD; Hai-Yen Sung, PhD; and Tingting Yao, PhD, of the Institute for Health & Aging; and James Lightwood, PhD, of the UCSF School of Pharmacy.

Funding: National Heart, Lung, and Blood Institute (U54 HL147127) and FDA Center for Tobacco Products. The authors report no conflict of interest.

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E-Cigarette Use Costs U.S. $15B Per Year, Reports UCSF in First Study of Its Kind

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Health Care Costs are $2,000 Per Year Higher Among People Who Vape Compared to Non-Tobacco Users By Elizabeth Fernandez Use of electronic cigarettes costs the United States $15 billion annually in health care expenditures - more than $2,000 per person a year - according to a study by researchers at the UC San Francisco School of Nursing.

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From introducing appealing flavors to offering college scholarships, manufacturers and sellers of e-cigarettes aggressively target young people.

There are few federal restrictions on e-cigarette marketing, allowing companies to promote their products through traditional outlets - such as TV and radio - despite a ban in 1971 on cigarette advertising on both outlets to reduce cigarette marketing to children. E-cigarette companies also take advantage of other marketing outlets, including the internet, retail environments and recreational venues and events.

Youth and young adults are widely exposed to e-cigarette marketing and have high awareness of e-cigarettes, which are the most popular tobacco product among youth. By 2016, nearly 4 out of 5 middle and high school students, or more than 20 million youth, saw at least one e-cigarette advertisement.

Here are four ways e-cigarette companies market their products to target young people.

1. Offering scholarships

Several e-cigarette companies are offering scholarships, ranging from $250 to $5,000, that involve asking students to write essays on topics like whether vaping could have potential benefits, according to the Associated Press. For example, one company asks applicants to write about whether e-cigarettes minimize smoking's negative effects.

E-cigarette manufacturers often say that their products are intended for adults who want to quit smoking; however, the AP reports that, "although some of the scholarships are limited to students 18 and older - the nation's legal age to buy vaping products - many are open to younger teens or have no age limit."

"Most of these kids are not smokers," said Robin Koval, CEO and president of Truth Initiative®, in the AP story. "What [e-cigarette manufacturers are] saying and what they're doing don't seem to agree here. But that's not surprising."

2. Creating a buzz on social media

E-cigarettes make frequent appearances on social media newsfeeds and timelines. Most recently, emerging e-cigarette brands, like JUUL, have relied heavily on social media to market and promote their products.

For its launch in 2015, JUUL spent more than $1 million to market the product on the internet, according to one research study. The brand has paid for campaigns on Twitter, Instagram and YouTube to promote images and company-sponsored ads that associate JUUL with being cool, having fun, relaxation, freedom and sex appeal.

The study found that social media growth - especially the number of JUUL-related tweets - "highly correlated" with JUUL retail sales. The number of JUUL-related tweets skyrocketed from a monthly average of 765 in 2015 to a monthly average of 30,565 in 2017. By the end of 2017, JUUL captured more than half of the entire e-cigarette market share.

3. Sponsoring music festivals and events

In 2013, blu eCigs® sponsored the Sasquatch! Music Festival in Washington, which featured a vapor lounge with surprise guest appearances from top performers, device charging stations, an interactive social media photo booth and samples of blu eCigs. More recently, JUUL sponsored a "Music in Film Summit" at the 2018 Sundance Film Festival in Utah.

Both of these examples are marketing tactics that are banned for cigarette and smokeless tobacco companies (however, these companies skirt these restrictions with other types of experiential marketing). The 1998 Master Settlement Agreement and the 2009 Family Smoking Prevention and Tobacco Control Act prohibited cigarette and smokeless tobacco companies from sponsoring music, sports and other cultural events because of evidence that linked these types of marketing tactics with youth tobacco use. Other types of tobacco products, including e-cigarettes, are not bound by these restrictions.

4. Introducing appealing flavors

The 2009 Family Smoking Prevention and Tobacco Control Act banned flavors in cigarettes - except menthol - to curb youth appeal, but flavors are still allowed in other tobacco products. E-cigarette companies capitalize on this gap in regulation by offering kid-friendly flavors, such as cotton candy and gummi bear, and packaging e-liquids to look like common food items.

Youth e-cigarette users cite flavors as a main reason they begin using e-cigarettes. A study that included middle and high school students found that 43 percent of young people who ever used e-cigarettes tried them because of appealing flavors.

In May 2018, the FDA and the Federal Trade Commission took joint action against several e-liquid companies that marketed their products to look like candy or other kid-friendly food items, such as Reddi-wip, Nilla Wafers and Warheads candy. Truth Initiative has repeatedly called on the FDA to fully regulate e-cigarettes to reduce youth appeal, access and use.
Learn more about e-cigarettes with the Truth Initiative resource: E-cigarettes: facts, stats and regulations.

More in tobacco industry marketing

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4 marketing tactics e-cigarette companies use to target youth

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From offering candy-flavored tobacco products to college scholarships, manufacturers and sellers of e-cigarettes aggressively target young people.

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Coporate cigarette companies' development of the E cigarette

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Coporate cigarette companies' development of the E cigarette

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As the harms from conventional products have become better understood, and tobacco control measures have been put in place, the cigarette market - from which tobacco companies make most of their profits - has started to shrink. To secure the industry's longer-term future, transnational tobacco companies (TTCs) have invested in, developed and marketed various newer [...]

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By the IMARC Group, some of the top companies in the e-cigarette industry are Philip Morris International Inc., Altria Group Inc., British American Tobacco PLC, Japan Tobacco, Inc., Imperial Tobacco Group, International Vapor Group, Nicotek LLC, NJOY Inc., Reynolds American Inc., ITC Limited, J WELL…

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Background

In October 2017 the Ministry of Health - Manatū Hauora issued a position statement which said that vaping has the potential to contribute to the achievement of the Smokefree 2025 goal. The work of the Ministry of Health's and HPA's tobacco control programmes aims to improve the wellbeing of New Zealanders by supporting people to quit smoking, creating smokefree environments, and protecting children from the harm of smoking.

This site has information about vaping and smoking in New Zealand, and is for people who are looking to quit smoking and those who support them, as well as anyone interested in the role of vaping in New Zealand as a way to quit.

Under the Smokefree Environments and Regulated Products (Vaping) Amendment Act the existing prohibition on the advertisement of tobacco products is extended to vaping products. This means it is prohibited to encourage the use, promote the sale or notify the availability of vaping products.

This website is an exception to this and the Director-General of Health has issued Vaping Facts (this website) as a public health message under section 24(f) of the Smokefree Environments and Regulated Products Act 1990. See the Ministry of Health website for further information: https://www.health.govt.nz/news-media/news-items/public-health-message-issued-vaping-facts

Copyright

Any material on this website may be reproduced provided that:

the content is not changed

it is not sold

the material is not used to promote or endorse any product or service

it is not used in an inappropriate or misleading context

any disclaimers included on the published information are reproduced on the material

an acknowledgment of the source and of HPA is included.

Please note, this does not apply to any logos, emblems and trade marks on the website, the website's design elements, or any photography or imagery. If you wish to reproduce any of these, please contact us to discuss: communications@hpa.org.nz

Enquiries

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Privacy Policy

For you to get the most out of using our website, Te Hiringa Hauora|Health Promotion Agency, "we" or "us" need to collect some personal information about you. We will protect your personal information, and will only collect, use, store, and share it in accordance with the Privacy Act 2020, including (where applicable) the Health Information Privacy Code 2020.

This Privacy Policy sets out information about:

what information is collected by us through your use of our website;

how your information will be used, stored, and shared; and

how you can access and change your personal information;

In summary:

we collect personal information about you, including any information that is emailed through to us and use it to provide you with the services you have asked us for;

we collect personal information about you, including any information that is emailed through to us and use it to provide you with the services you have asked us for;

how you can access and change your personal information.

This Privacy Policy forms part of the terms of use of our website. Your use of this website means that you accept and agree to the terms of this Privacy Policy and any changes to it.

We may change this Privacy Policy from time to time, including if we want to collect more information about you or use or share your information in another way. This Privacy Policy was last updated in May 2021.

What information do we collect

Any information you share in the emails you send to our email address.

Aggregated, anonymous information about visitors to our website.

Anonymous and aggregated information about visitors to our website including website usage statistics.

How do we use your information

The personal information we collect from you via our website will be used to provide you with the services you have asked us for.

We may use anonymous and aggregated information that we collect about visitors to our website so that we can analyse, evaluate, and improve the website. For more information, see below under the heading Use of cookies and tracking technologies.

Will my information be shared with anyone else?

We may share the personal information that we collect about you as follows:

when we need to give some employees, contractors, agents and advisers access to the information you provide us to ensure that our website works properly. This includes our providers that host or maintain data centres where your information is processed or stored, or that operate service platforms and other infrastructure and systems on our behalf; and

as otherwise permitted by the Privacy Act 2020 and where applicable, the Health Information Privacy Code 2020.

We may share anonymous and aggregated information about visitors to our website with public sector health agencies and other organisations and individuals that have an interest in our organisation.

How is my information stored?

We take your privacy seriously and will take all reasonable steps to ensure that your personal information is stored in a secure environment and protected from unauthorised access, use, modification or disclosure.

We store our data (including your personal information) on a secure Microsoft Azure cloud platform and we use Microsoft Office 365 applications. We protect our data with all reasonable technical and process controls. We retain personal information in compliance with the requirements of the Public Records Act 2005.

We store our data, including your personal information, on a secure cloud platform using Microsoft Office 365 applications. We protect the data with all reasonable technical and process controls. We retain personal information in compliance with the requirements of the Public Records Act 2005.

How long is my information held?

We will only hold your personal information as long as it is required for the purposes for which the information may lawfully be used.

Where any information (which may include personal information) provided to us through our website constitutes a public record, it will be retained as required by the Public Records Act 2005.

Exercising your privacy rights and complaints

You can ask us to provide you with the information we hold about you and request corrections to it. If we have a good reason for refusing a request for correction, you are entitled to ask that a statement be attached to the information that the correction that was requested was not made.

If you have any complaints, questions about our privacy practices or procedures please contact us. We may be able to clarify the need for it or work with you to alter it. We will do our best to respond to all reasonable requests in a timely manner.

Contact us:

Privacy Officer
Te Hiringa Hauora
PO Box 2142
Wellington 6140
enquiries@hpa.org.nz

Contact the Privacy Commissioner

If you are not satisfied with our response to any privacy-related concern or you'd like more information on the privacy laws in New Zealand and contact details for the Office of the Privacy Commissioner, please visit the Privacy Commissioner's website.

Cookies and tracking technologies

This website uses cookies and a number of tracking technologies. For more information and instructions on how to switch off cookies click here.

Use of cookies and tracking technologies

This website collects statistical information which is used for making the site faster and easier to use. Information from your visit is combined with the data from all site visitors and presented as statistical information on overall site use. To do this, the website uses "cookies" and other tracking technologies.

A "cookie" is a file that our webserver may send to your computer when you access this website. This file is then stored on your computer. Vapingfacts.health.nz may use cookies and certain other passive information collection technologies to make your use of this website easier by allowing vapingfacts.health.nz to provide better service, customise websites based on consumer preferences, compile statistics, analyse trends, and otherwise administer and improve this website. Certain features of vapingfacts.health.nz may not work without use of passive information collection technologies.

The website uses "session" cookies. Session cookies are temporary bits of information that are erased once you exit your web browser window or otherwise turn your computer off. Session cookies are used, for example, to improve navigation on this site, and to collect aggregated statistical information.

The website may use "persistent" cookies: Persistent cookies are more permanent bits of information that are placed on the hard drive of your computer and stay there unless you delete the cookie. Persistent cookies store information on your computer for a number of purposes, such as helping to determine what areas of the website visitors find most valuable, and customising the website based on your preferences on an ongoing basis. The website server only knows that an unidentified visitor with your cookies has returned to the website and not any personally identifiable information.

The website may use "web beacons" (also known as internet tags, single-pixel GIFs, clear GIFs, anonymous identifiers and invisible GIFs): a web beacon is a tiny graphic on a web page or in an email message that is used to track pages viewed or messages opened. Web beacons tell the website server information such as the IP address and browser type related to the visitor's computer. Web beacons may be placed on online advertisements that bring people to hpa.org.nz and on different pages of the website. Web beacons provide us with information on how many times a page is opened and which information is consulted.

The website uses both First Party and Third Party web beacons and cookies. Third Party web beacons and cookies are used for the purpose of marketing this website to people that may find benefit from the services included on the website.

Choices you have about this website's use of cookies and other tracking technologies

You can choose to enable or disable the use of some cookies and other tracking technologies on this website. Cookies that are necessary to the operation of this website and for the provision of the services you have requested will continue to function regardless of whether you have provided consent. Other types of cookies and tracking technologies will be turned off until you provide explicit consent. As a result, the functionality of hpa.org.nz may be reduced until you choose to provide explicit consent.

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Other tracking technologies

The following Google Analytics Display Advertising Features are enabled for this website:

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This means that vapingfacts.health.nz is enabling Google Analytics to collect data about traffic to this site through cookies and anonymous identifiers in addition to data collected through standard Google Analytics implementations.

If you would like to learn about Google's use of personal data, please view their privacy policy here.

Use of HotJar

We use Hotjar in order to better understand our users' needs and to optimize this service and experience.

Hotjar is a technology service that helps us better understand our users experience (e.g. how much time they spend on which pages, which links they choose to click, what users do and don't like, etc) and this enables us to build and maintain our service with user feedback. Hotjar uses cookies and other technologies to collect data on our users' behaviour and their devices (in particular device's IP address (captured and stored only in anonymized form), device screen size, device type (unique device identifiers), browser information, geographic location (country only), preferred language used to display our website). Hotjar stores this information in a pseudonymized user profile. Neither Hotjar nor we will ever use this information to identify individual users or to match it with further data on an individual user. For further details, please see Hotjar's privacy policy by clicking on .

You can opt-out to the creation of a user profile, Hotjar's storing of data about your usage of our site and Hotjar's use of tracking cookies on other websites by following this opt-out link.

Use of Monsido

Monsido is a monitoring and automation tool used to help improve the website's user experience and functionality through Web Accessibility, Content Quality Assurance, Data Privacy and Performance among other utilities. We primarily use Monsido to help in the optimisation of our websites to provide users with a better experience.

Contact information and policy updates

Contacting vapingfacts.health.nz

If you have questions or complaints about our privacy practices or procedures, please email us at ask@vapingfacts.health.nz as we may be able to clarify the need for it or work with you to alter it. We will do our best to respond to all reasonable requests in a timely manner.

You can also contact the Privacy Officer in writing at:
The Privacy Officer
State Services Commission
PO Box 329 Wellington
Telephone (04) 495 6600
Facsimile (04) 495 6686

How will I know whether vapingfacts.health.nz has updated this policy?

Without prejudice to your rights under applicable law, vapingfacts.health.nz reserves the right to amend this Privacy Policy without prior notice to reflect technological advancements, legal and regulatory changes, and good business practices. vapingfacts.health.nz may modify this Privacy Policy at any time and such modifications will be effective immediately on posting on vapingfacts.health.nz.

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In October 2017 the Ministry of Health - Manatū Hauora issued a position statement which said that vaping has the potential to contribute to the achievement of the Smokefree 2025 goal. The work of the Ministry of Health's and HPA's tobacco control programmes aims to improve the wellbeing of New Zealanders by supporting people to quit smoking, creating smokefree environments, and protecting children from the harm of smoking.

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Marketers are targeting teens with cheap and addictive vapes: 9 ways to stem rising rates of youth vaping

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Vaping products are ubiquitous in New Zealand, sold through a growing number of stores. To reduce youth vaping rates, they need to be harder to access, less appealing and less addictive.

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My friends are taking ecstasy at raves and music festivals. Is it safe? - Anonymous

Key points

no drug use, including ecstasy, is 100% safe

festivals can present unique risks

look out for friends, know the risks and where to get help.

What is ecstasy or MDMA?

Ecstasy is a slang term for drugs meant to contain 3,4- methylenedioxymethamphetamine (MDMA), a stimulant that can also cause mild hallucinations at high doses. While ecstasy was traditionally sold as tablets, it's increasingly sold in crystal, capsule and powder forms.

According to the most recent data, only 1% of Australians aged 12-17 said they had tried ecstasy. However, studies suggest young Australians who attend music festivals are much more likely to have tried it.

So, is it 'safe'?

There seems to be a common perception ecstasy is "safe". But no drug use - legal or illegal - is completely safe. While drug experts rank ecstasy as less harmful than other drugs, such as "ice" and alcohol, there are still significant risks involved:

1. given ecstasy is illegal, the market is unregulated. As a result, drugs sold as "ecstasy" commonly do not contain MDMA and may contain something far more dangerous. This means the effects can be unpredictable

2. even if your drugs contain MDMA, the dose or potency can vary hugely. Recently, very high purity ecstasy has been detected in Australia. This can significantly increase the risk of overdosing or having serious side-effects

3. even pure MDMA at normal recreational doses can be risky in the wrong conditions (for instance, when it's very warm)

4. common short-term effects also include increased heart rate and body temperature, teeth grinding and anxiety. While evidence on the long-term effects of taking MDMA is still emerging, there may be lasting impacts on memory, mood, cognition and sleep.

What are the risks when taking it at festivals?

In recent years, there have been more reports of drug-related deaths at festivals. While the media typically describes deaths involving ecstasy as "overdoses", most ecstasy-related deaths are not the result of simply taking too much.

Drug experiences can be influenced by lots of different things and music festivals can sometimes result in a "perfect storm" of risk factors. For example, an experienced male taking an ecstasy pill at a quiet gathering at home is likely to have a very different experience to an inexperienced female taking her ecstasy pills at a crowded festival on a 35℃ day.

Females, those with lower body weight, and/or those who haven't used ecstasy before, and therefore haven't built up any physical tolerance, should use a smaller dose.

Some key risks at music festivals include:

hyperthermia aka heatstroke: MDMA affects the body's ability to regulate temperature (it can increase body temperature and also make it harder to cool down). Environmental factors at festivals such as warm weather, crowds and dancing can significantly increase the risk of overheating (see tips for staying cool)

hyponatremia aka water intoxication: MDMA can disrupt the body's water/electrolyte balance (can make your body retain water). While you need water to avoid dehydrating, drinking too much can also be dangerous. Read up on these guidelines on dehydration and overhydration for more information

dodgy on-site sellers: UK research found people buying drugs on-site (inside the festival grounds) were more than twice as likely to buy drugs that did not contain what they thought. There have been cases where festival goers thought they were buying MDMA but actually bought N-ethylpentylone (a riskier stimulant linked to psychosis and deaths)

policing or legal problems: festivals often have a heavy police presence with sniffer dogs and being caught with drugs can lead to possession or supply charges. However, it's very important not to panic and swallow your drugs if you see sniffer dogs. This has been linked to at least three festival deaths in Australia.

Worried about your friends?

If you're going to a rave or festival and suspect some of your friends might take illicit drugs, it's important to be aware of the risks, look out for your friends and know where to get help. Here are some tips:

1. make emergency plans with friends: download the festival map, have a meeting point, make sure mobiles are charged, stick together and know where on-site support services are

2. look out for red flag symptoms (for instance, feeling hot, unwell, confused or agitated) and never be scared to seek help from on-site medical or support services. They're there to help you, not judge or arrest you

3. be informed: Drugaware, Dancewize and Boomtick all have great information about drugs and how to keep safe.

I Need to Know is an ongoing series for teens in search of reliable, confidential advice about life's tricky questions. If you're a teenager and have a question you'd like answered by an expert, you can: Please tell us your name (you can use a fake name if you don't want to be identified), age and which city you live in. Send as many questions as you like! We won't be able to answer every question, but we will do our best.
Jodie Grigg, Research Associate at the National Drug Research Institute, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Feature image source: Pixabay

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'My friends are taking MDMA at raves and music festivals. Is it safe?'

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My friends are taking ecstasy at raves and music festivals. Is it safe? - Anonymous Key points no drug use, including ecstasy, is 100% safe festivals can present unique risks look out for friends, know the risks and where to get help. What is ecstasy or MDMA?

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MDMA soaring in popularity in New Zealand, making its way into high schools

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Last year more than one million pills were captured by police and Customs.

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Why should we be concerned about youth alcohol consumption

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Why should we be concerned about youth alcohol consumption

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By Sarah Catherall

Teen binge drinking is often brushed off as an experimental phase on the road to adulthood. But as Sarah Catherall reports, research shows early habits die hard - and are setting up young people for a raft of serious health problems later in life.

It's Saturday night and my living room is a sea of teens, the floor swaying as they dance to deafening music.

One of them holds a bowl of vomit and pretends it's his. My 18-year-old daughter is huddled in a group laughing.

About 60 kids have turned up to her house party, including a couple of gatecrashers who found out about it through social media, to celebrate the end of the school year.

As I walk around picking up cans and bottles and try to monitor their alcohol consumption, the party gets louder and louder.

I weave through swaying, rocking, drunk bodies to fill bowls with chips.

Ready to Drink (RTD) boxes and beer cans lie empty and girls walk around sipping or skulling cheap wine from gleaming green bottles. At midnight, when I call the party to a close as planned, the teens pile into Ubers and head for town.

This scene at my house is typical of a New Zealand party involving young drinkers: no one sticks to the Ministry of Health's recommendation of two standards drinks a day for females and three for males, everyone sips themselves into the "risky drinking'' category, by downing five-plus drinks.

A New Zealand Health Survey released last week found a quarter of females and 38 percent of males aged between 18 and 24 have drinking habits that can be categorised as "hazardous'', while 57 percent of 15 to 17-year-olds are drinkers.

It's tempting to shrug off such drinking as a phase of youth, but research shows alcohol habits formed early often continue into adulthood, and that drinking while young can be tied to serious mental and physical health problems, some that may only show up decades down the track.

***

Alcohol Healthwatch's Dr Nicki Jackson has three simple words for parents and young people: "Delay, delay, delay.'' She says a recent study showed that half of adults with a drinking problem had developed it by the age of 20, and more than two-thirds by 25.

And there are lot of adults with drinking problems - one in every five Kiwis is a hazardous drinker, according to the New Zealand Health Survey.

"The style or pattern of drinking among those that do drink warrants strong concern and action. This age group has the highest prevalence of hazardous drinking, with about 151,000 young adults being classified as a hazardous drinker," says Dr Jackson.

She says a cocktail of law changes in 1989 - supermarkets were cleared to sell alcohol, the drinking age dropped from 20 to 18, and bars and restaurants began selling alcohol long into the night - contributed to what she believes is a hazardous drinking culture.

That Saturday night scene at my house, in other words, is par for the course. "Young people are price sensitive, and that's why we see so much preloading which is totally driven by prices," she says.

Sitting in a cafe near her university hall, first-year student Amelia* puts it like this: "There's such a drinking culture. You don't drink for the taste. You drink to get drunk.''

The 18-year-old works part-time and is conscientious about her studies. She will typically have four ciders or White Rhinos (a pre-mixed gin drink) before she goes out.

Others Amelia knows buy the cheapest bottle of wine (under $10) they can find at the supermarket and down it before they go out. By the time they leave the hall, they're already stumbling around, and some are vomiting. Once in town, they might buy a couple more drinks but don't really need to splash the cash seeing as they've already "preloaded''.

Some of "the boys'' are competitive about how much they can drink, she says, jibing each other about "who can finish a box first''. "A box" is a 12-pack of RTDs, at 7 percent alcohol a can. "Drinking is so ingrained in the university culture,'' she says.

Indeed, a recent Otago University study found students who didn't drink were ostracised and called names such as "grandma'' and "weirdo''.

Those who drank heavily got kudos.

Co-author Dr Kirsten Robertson says abstinence is not an option in a culture of intoxication.

"Some students could not even understand why you would consider drinking in moderation. For them, alcohol is used as a tool to get drunk. You either drink to get drunk or you don't take part.

Drinking in moderation was seen as a waste of money and unnecessary calories."

***

About 11pm every Friday and Saturday night young drinkers take over Wellington's Courtenay Place. By 1am, the street is full, with queues snaking from the doors of clubs and bars along the one-kilometre strip.

You would expect Hoff Hospitality Group manager Matt McLaughlin to be delighted by the crowds near two of the company's bars and one of its clubs, but he says many of the young drinkers aren't out to buy drinks - they've already preloaded. They often arrive into town already drunk, and his bouncers and bar staff have to deal with them.

McLaughlin says each night, he would turf out out every tenth person from the company's bars. "Young people drink the cheap stuff at home or at their flats and then they come into town wasted. They can walk around the streets intoxicated, but if they come into one of my bars, I risk losing my licence.''

Over two decades in the hospitality industry, the biggest change he has seen is the slump in the relative cost of alcohol. A bottle of wine now costs about the equivalent of half the price it did in 1989. As a consequence, preloading has boomed, he says.

McLaughlin is also head of Hospitality New Zealand's Wellington branch, and he says bar owners are concerned about the huge gulf in the cost of alcohol between off-licences and on-licensed premises.

He knows people will say he has a vested interest in getting people to buy drinks in bars, but he says beyond business reasons, the persuading culture is a concern.

"The accessibility of cheap booze is the number one issue of our drinking culture. You can get a bottle of wine on a street corner and it's as cheap as chips. And young people just want to get wasted.''

He is calling for a public health campaign about drinking responsibly. "Maybe that getting hammered and spewing in the garden is not a good look.''

***

At weekends, hospitals put extra staff in accident and emergency departments to deal with alcohol-fuelled problems.

At Wellington Hospital, Dr Paul Quigley, an emergency medical specialist and clinical toxicologist, says that on average about 36 patients affected by alcohol need treatment over the weekend.

It's 18-year-olds who most commonly arrive in ED after overdoing it, he says.

"They learn their lesson, and for 90 percent of them, they never return.'' But, Dr Quigley says, he's noticed an increasing number of 16 and 17-year-olds, who have been given alcohol by a legal drinker, showing up.

"That's a huge problem. The age of initiation of drinking is a leading predictor of outcomes.''

Health researchers Jude Ball and Terry Fleming have studied 15 to 17-year-olds through the Youth 2000 survey and found secondary students are starting drinking later and not drinking as much as they used to.

But, Ball says, those that do drink are still drinking to excess.

"The style of drinking does not appear to have changed much - for a lot of young drinkers, and an increasing proportion of older adults, it's still about drinking to get drunk. That's definitely of concern."

A recent Health Promotions Agency study found that more than a third of underage drinkers said their parents bought their alcohol for them.

Dr Quigley says: "My personal opinion is that a 16 or 17-year-old shouldn't be drinking. If they do, it should only be with an adult over a meal - not at a party with lots of loose other 16-year-olds.''

It's not just emergency doctors worried about the impact of alcohol on young people. Doctors from across the specialities shake their heads at young New Zealanders' drinking habits.

Dr Erica Whineray Kelly, a breast cancer specialist at the Auckland Breast Centre, is concerned about young female drinkers. She says the riskiest time for binge drinking is the time when women often drink the most - between the onset of the first menstrual cycle and before the first pregnancy, when breast cells are not fully developed.

"Breast cells are not very good at dividing as they are immature so make mistakes or mutations when they do, and do not repair themselves.

"These abnormal cells can be the start of the cancers that turn up decades down the track.

"We need to look after those immature breast cells until they fully develop. Our young women need to move, eat more grains and veggies, abstain from alcohol, and keep weight in the healthy range. I think that we will see the consequences of that drinking in some decades to come."

"Alcohol has become so much more widely available,'' she says.

"I'd like the drinking age to go back to 20. Alcohol is a drug and young people often can't handle it. We need to show young women the unsexy side of drinking.''

It's brains that worry Professor Jennie Connor, chairperson in Preventive and Social Medicine at Otago University.

"Alcohol is a neurotoxin and there is reliable evidence that prolonged heavy drinking in young adults causes irreversible damage to their brains because the brain hasn't fully developed or matured until about age 25," she says.

"Heavy drinking in adolescence and young adulthood increases the risk of problematic drinking or dependence later in life, with all of the injury, chronic disease, mental health and social outcomes that are associated with that.''

Alcohol Healthwatch's Dr Nicki Jackson is also worried about the brains of young New Zealanders.

In 2015, she requested statistics from the Ministry of Justice and discovered 73 percent of 20-24 year olds had some alcohol in their system at the time of suicide.

With so many medical professionals worried by alcohol, perhaps it's not surprising the newly-formed Health Coalition Aotearoa argues alcohol is one of three public health issues, along with tobacco and unhealthy food, that require urgent action.

It's calling for a number of policy changes, including restricting alcohol sponsorship and marketing, and increasing taxes on booze.

Others, including Professor Connor, want to see the drinking age returned to 20. "Eighteen-year-olds should not be expected to make a healthy decision about drinking when the system they live in suggests it is fun and harmless to drink heavily as much as they feel like.

"The current purchase age of 18 means that a majority of 15 to 17-year-olds drink."

Talk to Alcohol Beverages Council's executive director Nick Leggatt and you'll have a different conversation.

The council, which represents liquor companies, points out that youth drinking is actually dropping - in 2006/07, 89.1 percent of 18-to-24 year-olds were drinkers, whereas in 2017/18 that had fallen to 83.6 percent, according to NZ Health Surveys.

Leggatt says youth drinking has dropped since the age was lowered to 18, evidence that the legal drinking age has no bearing on whether young people drink or not.

On price and the widespread availability of alcohol, he says New Zealand already has the sixth highest excise tax out of 27 countries and introducing a minimum price or a higher tax would only make moderate drinkers consume less.

"The vast majority of Kiwi drinkers are responsible and have a right to purchase alcohol. Supermarkets are a very important part of them being able to do that.''

Professor Jennie Connor isn't having it.

"There is no evidence that young people are 'more sensible', and I think that should be framed as a lay interpretation of these changes, or a 'view'."

She is concerned about talk that 18 to 24-year-olds are drinking less, when the rates have not changed over three successive health surveys.

"Heavy drinking in adolescence and young adulthood increases the risk of problematic drinking or dependence later in life, with all of the injury, chronic disease, mental health and social outcomes that are associated with that.''

***

Back at the cafe by her university hall, Amelia considers some of the disincentives proposed to slow teen drinking.

She mulls over whether higher taxes would put her contemporaries off drinking but decides price hikes - and in fact not much else - wouldn't deter them. "Drinking is so ingrained in university culture."

I know that only too well. A year has passed since that pack of 18-year-olds littered my house with bottles and vomit.

My daughter is at university now and she and her friends have moved onto attending parties in her university hall and at flats. They frequently join the throngs on Courtenay Place at the weekends. But the locations are all that's changed; the drinking continues.
*Not her real name Where to get help
Alcohol Drug Helpline - 0800 787 797, free text 8681, alcoholdrughelp.org.nz

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The lifelong health hangover of teen drinking

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By Sarah Catherall It's Saturday night and my living room is a sea of teens, the floor swaying as they dance to deafening music. One of them holds a bowl of vomit and pretends it's his. My 18-year-old daughter is huddled in a group laughing.

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Alcohol exposure in NZ supermarkets ‘like advertising candy’ to children, researcher says

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The way alcohol is sold in supermarkets could have a major impact on Kiwis’ drinking, according to Dr Karen McBride-Henry.

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effect of reducing alcohol age on emergency department.

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effect of reducing alcohol age on emergency department.

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Abstract

Aims: To quantify the effect of a recent national law change on the presentation of ethanol intoxicated patients to a central city Emergency Department (ED).

Methods: All records of ethanol intoxicated patients presenting to the ED for twelve months before and after the change to the minimum legal drinking age were studied. Each patient was classified as having laboratory confirmed intoxication, clinical suspicion only, or no record of intoxication. Three age groups were identified, 15-17 year olds, eighteen and nineteen year olds and over 20 year olds. Within each age group the proportion of presentations with ethanol intoxication was compared across the two time periods.

Results: The number of intoxicated 18 and 19 year olds increased in the twelve months after the national law change from 66 to 107 (52 to 80 for laboratory confirmed intoxication and fourteen to 27 for clinical suspicion only). This represented an increase in the proportion of presentations in this age group with intoxication (p=0.009) from 2.9% to 4.4%, a 50% increase (RR=1.51, 95%CI 1.11-2.03). There was no evidence of an increase in the proportion intoxicated for those over nineteen years (3.4% vs 3.3%, p=0.48, RR=0.97, 95%CI=0.89-1.06) although the numbers increased slightly (963 to 992). However there was a worrying trend for an increase in the 15-17 year olds, with numbers increasing from 72 to 95 and the proportion increasing from 5.0% to 6.7% (p=0.07, RR=1.35, 95%CI=0.98-1.88).

Conclusion: The recent lowering of the minimum legal drinking age from 20 to eighteen years has resulted in increased presentations to the ED of intoxicated eighteen and nineteen year olds. A similar trend was seen in the 15-17 year olds.

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alcohol drinking / legislation & jurisprudence*

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national center for biotechnology information

# data[].attributes.attachment_link.title
Changing the minimum legal drinking age--its effect on a central city emergency department - PubMed

# data[].attributes.attachment_link.description
Aims: To quantify the effect of a recent national law change on the presentation of ethanol intoxicated patients to a central city Emergency Department (ED). Methods: All records of ethanol intoxicated patients presenting to the ED for twelve months before and after the change to the minimum legal drinking age were studied.

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Alcohol is one of the most commonly used drugs in New Zealand. It is readily available and used in many settings for lots of different purposes and effects. However, there can be negative health and social consequences associated with its use.

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Health Minister Andrew Little says a highly-lauded programme to help people kick methamphetamine addiction will be rolled out nationwide - but he can't say when.

Methamphetamine is considered to be the illicit substance that causes the most harm in New Zealand, and Little's commitment is being welcomed by drug reform advocates who have been frustrated at the Government's refusal to replace the Misuse of Drugs Act, a law that is widely seen as no longer fit for purpose.

A nationwide rollout of the Northland's Te Ara Oranga programme is likely to take years, though, because it is developed with buy-in from the community as well as multiple agencies and Māori providers, and then continually improved.

Little revealed his commitment while discussing the low uptake for a police health referral, which was confirmed in a Ministry of Health review into a 2019 change to drug laws.

The change codified police discretion into the law, clarifying that police shouldn't prosecute for drug use if a therapeutic approach would be "more beneficial to the public interest".

Since then, police have been charging fewer people for drug use/possession and making greater use of referrals and warnings - though the review noted that such trends were in train well before the law change.

It also noted that police appeared to be applying the law change to non-Māori more than Māori.

The Herald has previously revealed that Māori are now even more likely than non-Māori to be prosecuted for drug use/possession as their most serious offence.

The review added that Māori and non-Māori tended to be treated the same once they were involved in police proceedings for drug use, but Māori were overrepresented in the number of people in those proceedings.

"There is still work to do. We know that police bias in prosecutorial discretion is an issue," Little told the Herald.
Related articles
"Any inequities in this system are simply unacceptable."

Police are working with Waikato University to research police bias, which will lead to a work programme to address it.

The review also agreed with a recent police report that said prior convictions were a major factor in whether someone gets charged for drug use.

But Little questioned whether they should be.

"If many drug offenders actually have underlying drug addiction problems, and we want to fix the problems, then we want to do that regardless of prior track record."

Far too few people engaging with health referral

The law change was expected to lead to a jump in people being referred to health services rather than down the criminal justice path, if their worst offence was drug use/possession.

But the review highlighted an extremely low rate of engagement with the referral pathway - called Whakarongorau Aotearoa - which police set up following the law change.

In the 22 months since the law change, police data shows 8586 people who faced the possibility of a drug use charge as their most serious offence, but only 959 health referrals were made.

The referrals are made via an app, and the user is then sent a text message by an alcohol and drug helpline. Only 147 of the 959 people who accepted a referral responded to the text message.

This 1.7 per cent engagement rate (147 out of 8586 people) is higher than it was for the first year following the law change, when a Herald analysis found it was below 1 per cent.

But it drops to lower than 1 per cent again if all drug use/possession police proceedings are considered, not just those where that is the most serious charge; police figures show more than 1000 such proceedings a month on average, including 497 prosecutions and 541 warnings or referrals a month.

Some police managers didn't even know about the health referral, the review said, while some officers were reluctant to offer it because they were unsure if such services were available in their region.

Little said increasing uptake was important, but it was hard to know what the level of engagement should be for several reasons, including the need for user buy-in and the fact some drug consumption isn't harmful.

But a text message and follow-up text messages were often not the best way to engage people with drug addiction issues, he said.

He pointed to Te Ara Oranga as a better way to encourage people, in this case methamphetamine users, to accept an offer of help.

The greatest difference police can make in the health space when encountering drug users is with methamphetamine, given that almost all (95 per cent) of the substances involved in drug use police proceedings are cannabis (58 per cent) and methamphetamine (37 per cent), and the latter is generally considered far more harmful than the former.

Labour's election manifesto promised to roll out Te Ara Oranga to the East Coast and the eastern Bay of Plenty, where methamphetamine makes up more than 90 per cent of the drugs found in some of the region's wastewater samples (which don't detect cannabis).

Little announced $2.8 million for the eastern Bay of Plenty - from Whakatāne to Rotorua - and he told the Herald he was committed to a nationwide rollout.

When that will happen though remained up in the air, given the attention demanded by the Covid response and overhauling the DHB system.

"Our commitment is to roll it out nationwide," Little said.

"The way we're sequencing it is slower than I and others would like, but that's the best we can do at this point."

Drug Foundation executive director Sarah Helm welcomed the commitment.

"The original programme in Northland would be much more effective with additional funding for the health services, so it needs to be both rolled out widely, and properly funded."

Green Party drug law reform spokeswoman Chlöe Swarbrick, who has been calling for it to be rolled out nationally, said it needed to be done "as quickly as possible".

The costs would end up being recouped and then some in the long run, she said.

"It ends up with people contributing more productively and participating more in society and in their communities. In a nutshell, we save money by preventing issues cropping up in the first place."

Te Ara Oranga: 'Extremely successful'

Inspector Chris McLellan, who leads the police component in Te Ara Oranga in Northland, said it had been a game-changer in many communities.

"It's many agencies - Māori providers, NGOs, DHB specialists, police, and everyone who has an invested interest in reducing methamphetamine harm in our communities. It's been extremely successful up north."

The programme, which started under a National-led Government, was built up with the community over a number of years to ensure it was fit for purpose.

"The key is actually people knowing the whānau, having contact with them, knowing the history, and then being able to affect change and support them through that change," he said.

"Coming off methamphetamine is a long-term journey, so appreciating that people may stumble and fall - it's about how we pick them up and keep them on the journey."

Since December 2017, there have been 911 referrals from police, 858 of which have been referred to the DHB for treatment.

"Fifty-three whānau groups have been supported, linking in multiple reports of concern for hundreds of children."

But the numbers didn't paint the whole picture, he said.

"The biggest thing is whānau. There are amazing stories. I met a lady the other day whose son went through the programme, and now she's reintegrated to help us with some of that whānau work - that's pretty special."

He has already had conversations with police counterparts in eastern Bay of Plenty, though it will take some time to set it up, bed it in - and there will always be more lessons.

Key question: How to improve health referral uptake

Little said improving access to police's Whakarongorau Aotearoa health referral was important, as was building up alcohol and drug treatment services generally.

"We know that in different areas, different DHBs, the availability of alcohol and drug addiction services is quite variable."

The Government has been working to address this through an increase in funding to the sector, as well as an overhaul of the DHB system.

"We do know that addiction services generally almost certainly need greater support, and the way they get access to people beyond the criminal justice system referral process, we've got to find better ways to do that," Little said.

He suggested police partnering with social services could see more engagement in the health referral, but such a change would be years away.

"Accessibility is critical, but actually that initial conversation is crucial as well rather than just, 'here's a leaflet, take it away and have a think about it'. Finding ways to do that in a less threatening environment is important," he said.

"The question is engaging the police on how we might better integrate social services so that the referral is more meaningful.

"As we start to reorient and rebuild mental health and addiction services, I think that there'll be opportunities for that further down the track - two, three years away."

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The P scourge: Health Minister Andrew Little commits to national rollout of rehab programme - NZ Herald

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Health Minister Andrew Little says a highly-lauded programme to help people kick methamphetamine addiction will be rolled out nationwide - but he can't say when.

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Click on the drug name to find in-depth, accurate information on that substance.

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Speights sponsorship on rugby jerseys

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An adverse advertising ruling would force the hand of a recalcitrant alcohol sponsor, as anger mounts at sports heroes modelling beer to kids.
The Advertising Standards Authority confirms it has received a formal complaint about the Highlanders and their players breaching rules against advertising alcohol to children.

The rugby franchise did not return calls on Monday and the international liquor company Lion, which owns the Otago-affiliated brand Speight's, refused to comment on the issue until it saw details of the complaint. Speight's was already a sponsor, but this year has agreed a new deal giving it naming rights, and emblazoning its brand across the middle of the playing jersey.

"We have not received a complaint," said Lion NZ external relations director Sara Tucker. "Once the complaint has been received and if a decision is made to put it in front of the Complaints Board, we will be notified in due course. We are happy to comment on the complaint once it has been through the process."

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On Monday night, former Prime Minister Helen Clark added her voice to the calls. "I have long been concerned about the association of sport with alcohol via sponsorship arrangements," she told Newsroom.

As a minister, Clark banned tobacco advertising in sports and created the Smokefree sponsorship brand instead - a strategy that has proved effective in ending cigarette abuse among children.

"The alcohol-associated imagery which can be seen on the Speight's Facebook page also includes images of children alongside the Speight's brand," she said. "This in my opinion amounts to advertising alcohol to children - which is both harmful and wrong."

Justice Minister Kris Faafoi had earlier told Newsroom that he believed it would be beneficial to review the Sale and Supply of Alcohol Act but first, he would be watching closely the effect of the new Alcohol Advertising and Promotion voluntary code, administered by the Advertising Standards Authority, which took effect in April. "I want to ensure alcohol regulation in New Zealand is fit for purpose and operates effectively."

Last month he expanded on that by telling MPs the review was necessary, and would take place later this Parliamentary term. "I am concerned about the impact of alcohol misuse on individuals and their family, whanau, and communities," he said in response to a Parliamentary question. "I am also concerned about the monetary cost of alcohol-related harm to New Zealand society."

Already, Green MP Chlöe Swarbrick has a private member's bill that would ban alcohol advertising in sports, that she is submitting to the Parliamentary ballot. She said players were faced with career-critical decisions about promoting alcohol in ways that make many uncomfortable.

In Otago, opinions are divided. A month ago, members of the team visited Green Island School to serve the children breakfast, as part of a deal with another local sponsor, Harraways rolled oats.

They wore their Speight's jerseys. The Highlanders show the jerseys on their Facebook page, but Harraways has cropped off the Speight's logo in imagery on its website advertising the school visit.

Principal Steve Hayward said: "They weren't serving up Speight's. It was porridge."

Schools were underfunded and needed support from wherever they could get it, Hayward said. It had become more difficult with bans on tobacco and alcohol advertising - though he could still accept gambling sponsorship.

A local pokies trust pays the $5000 cost of buses to and from school camps and swimming lessons, and still more for sun shades. "If I worried about stuff like that, then my kids would miss out on school camps, they would miss out on bikes, they would miss out on equipment for the rock band."

He had little time for the "do-gooders" complaining about the Speight's promotion.

He remembered the days when he and the other teachers would have a beer in the hot sun at school camp, while they supervised children on the climbing wall. Now that was frowned on. "This is just woke culture gone mad," he said.

The Advertising Standards Authority complaint has been laid by Alcohol Healthwatch executive director Dr Nicki Jackson. Her complaint says that under the new sponsorship deal, the Speight's name and logo are neither brief nor subordinate, as the code requires. She supplies 49 images and videos of the Highlanders giving the Speight's branding prominence, often in settings with children.

"Thousands of children will be exposed to the alcohol advertisements and alcohol sponsorship advertisements through televised broadcasts," her complaint argues.

"As for child-focused activities the Speight's Highlanders have engaged in (e.g. community training sessions, skills and drills, rip rugby roadshows, autograph signing sessions, pre-game Kidszones featuring 'giveaways, face painting and lots of fun activities', and school visits), we submit that children under 18 years of age are likely to comprise more than 25 per cent of the participants, or spectators."

The complaint concludes: "We submit that these Speight's alcohol advertisements are being directed at minors, and have strong and evident appeal to minors."

The Advertising Standards Authority upholds relatively few complaints against its members in the advertising industry. More often they are deemed "settled" after the offending advert is withdrawn, or reaches the end of its natural life and is removed.

Jackson told Newsroom that children looked up to the Highlanders players and their All Blacks as heroes, so their alcohol messaging was "incredibly harmful".

"We got rid of tobacco sponsorship and advertising. Based on the same quality of evidence, we need to do the same for alcohol," she said. "This advertising is pervasive and we've shown in these images that's it's going right through into chlidren's classrooms.

"We know that alcohol consumption has been declining in New Zealand, the industry has been trying to bring back customers to beer. So this is not surprising, but it's a clear breach of the code. This is clear evidence that the voluntary code isn't working.

"If it's found to be in breach, then the advertising on the jerseys will have to end."

Chlöe Swarbrick told Newsroom her member's bill would tighten up on local licensing controls, and end alcohol sponsorship and advertising around sports.

She said the liquor industry spent about $26 million on sports sponsorship, which could be covered by the Government, like the previous Smokefree sponsorship, potentially from a tax of a few cents per drink sold.

She said successive reviews - a Law Commission report in 2010, a Ministerial review by Sir Graham Lowe in 2014 and the He Ara Oranga Government Inquiry into Mental Health and Addiction in 2019 - has all warned of the harmful impact of alcohol sponsorship of sport.

"You see these sports heroes with this massive alcohol company emblazoned across their chest, and the kids racing out onto the field, and I just think that in most people's minds these athletes aren't wanting to promote alcohol.

"And we have an opportunity to showcase what healthy lifestyles look like, and that doesn't go hand-in-hand with excessive alcohol consumption.

"It would be phenomenal if we saw leadership from the players, but we also know that individuals - whilst they do have an enormous amount of influence - are still operating inside a system that is demonstrably flawed.

"And none of them would have to be making this decision - which feels to many like a life and death one for their career - if we did actually just fix these rules."

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Highlanders face having to remove booze branding from jersey after complaint

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An adverse advertising ruling would force the hand of a recalcitrant alcohol sponsor, as anger mounts at sports heroes modelling beer to kids. The Advertising Standards Authority confirms it has received a formal complaint about the Highlanders and their players breaching rules against advertising alcohol to children.

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Hospitals overwhelmed by alcohol and drugs patients

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Hospitals overwhelmed by alcohol and drugs patients

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Stretched and struggling to cope - that's the alarming message in a Waitematā DHB doctor's letter to the government.

Dr Adrian Kerner's letter to Justice Minister Kris Faafoi, obtained by Checkpoint, says Auckland's emergency rooms are overwhelmed by patients showing up with alcohol and drug problems.

It also warns of people in their 20s and 30s who are alcohol dependent and showing signs of organ damage.

Meanwhile, data provided under the Official Information Act shows the problem is costing the taxpayer hundreds of millions of dollars.

Dr Kerner, a senior doctor and emergency medicine consultant, was unavailable for this story, but excerpts of his letter to Faafoi bore out just how much of a strain alcohol and drug misuse was having on the health system.

"The emergency departments are already overwhelmed by volume of attending patients," he wrote.

"Our resources are stretched, and we are struggling with the volume of patients who present with alcohol and drug problems and associated mental health and other psychosocial problems."

Dr Natalie Anderson is a senior lecturer at the University of Auckland, but she has held onto her other day job as a practising emergency department nurse.

When it comes to out-of-control, alcohol-fuelled scenes in the emergency room, she has pretty much seen it all.

"Having people screaming and yelling and vomiting and urinating and being threatening makes for a really challenging workplace," she told Checkpoint.

"I'm sometimes spending so much time with people who are vomiting and drunk, and perhaps aggressive or shouty, when I know that there are other people who also really need my time and aren't getting it because I can only be in one place at a time".

Some patients were waking up so drunk, they had no idea how they were injured the night before and therefore unable to fill out ACC forms.

"Our departments are absolutely at the very limits of managing the kind of complexity and acuity - how sick our people are [and] how complex their needs are - and that alcohol abuse is just really tipping the scales often so that we just can't manage to cope," Dr Anderson said.

In his letter, Dr Kerner backed potential changes to the Sale and Supply of Alcohol Act, such as targeting irresponsible promotions.

"We are seeing many people in their 20s and 30s who are alcohol dependent with evidence of organ damage."

Data provided by all three Auckland DHBs under the Official Information Act showed that between early 2019 and late 2020, Counties Manukau DHB spent more than $16.5 million treating more than 5500 people who showed up to its emergency department with alcohol issues.

Waitematā DHB spent $18.1m treating 3807 people over the same nearly two-year period.

Neither come close to Auckland District Health Board, which spent more than $37.5m treating patients presenting with alcohol problems in 2019 alone. It did not yet have data for 2020.

Health Coalition Aotearoa board member Dr David Galler spent 31 years as an intensive care specialist at Middlemore Hospital.

"We've seen people who have been drunk and tripped and become quadriplegics," he said.

That's not to mention the thousands of alcohol-fuelled falls and car crashes and brawls that have left people in Middlemore's emergency department.

"That's a real problem in some areas where there is high density of liquor stores," he said.

"There certainly would be no place like South Auckland for the high density of liquor stores. There's nowhere at the moment in the country I would expect."

Dr Galler has written his own letter to the Justice Minister, pointing out New Zealand was not on track to achieve a World Health Organization target of a 10 percent relative reduction in the harmful use of alcohol.

He wanted alcohol taxes increased, marketing regulated on platforms like social media and sponsorship of public events banned altogether.

Faafoi's office told Checkpoint the Justice Ministry had been asked to assess its ability to review the Sale and Supply of Alcohol Act.

Cabinet would decide on the scope and timing of alcohol reforms.

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Hospital EDs overwhelmed by alcohol and other drug-related cases

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Stretched and struggling to cope. That's the alarming message in a Waitematā DHB doctor's letter to the government. It says Auckland's emergency rooms are overwhelmed by patients showing up with alcohol and drug problems. The letter to Justice Minister Kris Faafoi also warns of the number of people in their 20s and 30s who are alcohol dependent and showing signs of organ damage.

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The most famous (and successful) of the fourth-generation devices is the Silicon Valley start-up Juul, a monochromatic pen that looks like it has rolled straight off the Apple production line. That aesthetic is no coincidence: The Juul was created by two Stanford design graduates. The company's stated mission is to help "one billion adult smokers" and dominates more than three-quarters of the US e-cigarette market. In New Zealand, a Juul "starter kit" retails for around $100.

In 2018, cigarette giant Altria, the parent company of Philip Morris USA, purchased 35 per cent of Juul for US$12.8 billion, rocketing the company's value to $US38 billion and making founders Adam Bowen and James Monsees the first e-cigarette billionaires. But the acquisition also raised significant questions about their mission statement. That same year, research revealed that 3.6 million American high school and middle school students were using e-cigarettes. FDA commissioner Scott Gottlieb declared a vaping "epidemic" in the United States, saying that e-cigarettes had become an "almost ubiquitous - and dangerous - trend among teens."

Stepping into a specialist vape store today is an aesthetically flattering experience: all burnished chrome, soft lighting, and glass cabinets. From Big Tobacco-backed producers to local manufacturers, devices and e-liquids are promoted with soft pastels and tones of summer, paired alongside scenes of artists and DJs. Actor and George FM DJ Tammy Davis has served as an ambassador, posting ads for the Vype pen on his personal Instagram, as has Marc Moore, the creative director of fashion brand Stolen Girlfriends Club. (Outside the world of celebrity, there's still something for everyone - one New Zealand brand, "Get Hooked", is geared towards the vaping fisherman.)

In 2018, at the Rhythm & Alps festival outside Wanaka, Vype, the flagship vapour brand at that time for British American Tobacco New Zealand (BATNZ), ran its own selfie booth. Festival-goers could win tickets to an upcoming show by dance act Fatboy Slim by posting a photo with Vype branding and the requisite hashtags. Scrolling through Instagram, the hashtag leads to shots of predominately young partiers, smiling, laughing and - in at least one case - getting their breasts out, Duct-taped nipple shields and all. The ingenious thing about this approach is that vape companies don't need to pay creative agencies to find models, stage expensive photo shoots and plaster the images on billboards. Their own customers do their marketing for free - and their personal social networks reach further and deeper than any tobacco company could ever penetrate.

Vype also sponsored the 2019/2020 edition of Rhythm & Vines, the country's largest New Year's Eve festival. The company set up a branded on-site charging lounge and vape station. Rhythm and Vines is an R18 event, and Vype was acting within the law, but Kapitan says it is a long shot from being the target demographic for a product that is ostensibly meant to help smokers. Products marketed to people in their early 20s also look particularly fashionable to people a little bit younger, she adds. "It was clearly the playbook of everything we saw during the era of Big Tobacco. I had never seen that here before."

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The most famous (and successful) of the fourth-generation devices is the Silicon Valley start-up Juul, a monochromatic pen that looks like it has rolled straight off the Apple production line. That aesthetic is no coincidence: The Juul was created by two Stanford design graduates.

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Gandalf the green fairy on medicinal cannabis, jail and helping the sick - NZ Herald

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"We're very serious in what we're doing" - Gandalf on a growing passion.

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The 2019/20 New Zealand Health Survey showed that 57.5% of 15-17 year olds reported drinking in the last year.

This equates to 105,000 young people, which is 59,000 less than in 2006/07 (164,000)!

This is a fantastic change to see - but we still have a long way to go as over half of all young people in this age group are drinking. The New Zealand low-risk drinking guidelines recommend that for young people aged 15 to 17 years, the safest option is to delay drinking for as long as possible.

Hazardous drinking, among 15-17 year olds

We have witnessed significant declines in the prevalence of adolescents being classified as hazardous drinkers.

Note: 'Hazardous drinking' refers to an established alcohol drinking pattern that carries a risk of harming the drinker's physical or mental health or having harmful social effects on the drinker or others. It is determined by using the World Health Organisation's AUDIT checklist - a score of 8 or more indicates hazardous drinking.

The prevalence of hazardous drinking from the New Zealand Health Survey is shown below. The prevalence of hazardous drinking among 15-17 year olds almost halved from 2006/07 to 2015/16.

Because the survey question changed in 2015/16, comparisons can only be made from 2015/16 onwards. This shows the following:

The 2019/20 New Zealand Health Survey showed a significant increase in hazardous drinking among 15-17 year olds (from 6.3% in 2018/19 to 11.6% in 2019/20). However, further surveys are needed to determine if this is a real trend or random fluctuation. By sex, 13% of adolescent boys and 10% adolescent girls aged 15 to 17 years were classified as hazardous drinkers in 2019/20.

Drinking 6+ drinks on one occasion in the last month, among 15-17 year olds

Around 1 in every 7 (14.7%) adolescents (15-17 years) reported consuming 6 or more standard drinks on one occasion in the last month in 2019/20. Around 1 in every 6 (17.4%) adolescent boys and around 1 in every 9 (11.4%) of adolescent girls drank heavily (6+ drinks on one occasion) at least monthly.

Other surveys of young people

The National Youth Health Survey provides excellent data on drinking among a representative sample of secondary schools students in Aotearoa New Zealand.

In 2001, four in every ten students (40%) were binge drinking at least once per month, decreasing to 34.4% in 2007.

Following 2007, there have been continued declines in the the number of adolescents drinking, and among those that do drink, the number of drinking occasions per month is declining.

In 2007, 61% of all students were current drinkers - this declined to 45% in 2012. The prevalence of weekly drinking declined from 17.8% in 2007 to 8.3% in 2012.

The prevalence of binge drinking was 34% in 2007, declining to 23% in 2012.

In 2019, the Rangatahi Youth Survey found the prevalence of binge drinking continued to decline from 2007 to 2019. Because the survey methods changed, data were recalibrated to ensure comparisons between years was possible. The new results showed that binge drinking prevalence was 34% in 2001, 36% in 2007, 25% in 2012 and 22% in 2019.

Why are young people drinking less?

The reasons for the fewer drinking occasions in New Zealand has been - the strongest independent contributor to the decline was a change in adolescent attitudes toward alcohol use, followed by current cannabis use, then current tobacco use. Collectively, general factors in home, school and leisure settings did not significantly contribute to the downward trend in binge drinking.

Impact of liberalisation of alcohol policies in the 1990s

During this time, adolescents drank more often and heavier amounts in a drinking occasion. From 1995 to 2000, females 18-19 years of age showed the largest increases in the prevalence of drinking, the number of occasions drinking in a year, and the amount consumed in an occasion. These marked were likely to have followed the new Sale of Liquor Act (1989) and its subsequent amendments in 1999. The increases also co-incide with the introduction of Ready to Drinks (RTDs).

In 1999, the minimum legal purchase age was reduced from 20 to 18 years. Research showed this this law change was associated with an increase in a number of alcohol-related harms for young people, including alcohol-related hospitalisations, prosecutions for driving with excess alcohol and disorder, and crashes.

Following the turn of the century, the early 2000s saw some changes in adolescent drinking. By , the number of current drinkers was declining in both girls and boys. However, the usual amount of alcohol consumed in a drinking occasion had not .

For more information on adolescent drinking, click the button ADOLESCENT DRINKING
DRINKING IN NEW ZEALAND

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Trends in adolescent drinking in New Zealand

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The 2019/20 New Zealand Health Survey showed that 57.5% of 15-17 year olds reported drinking in the last year. This equates to 105,000 young people , which is 59,000 less than in 2006/07 (164,000)! This is a fantastic change to see - but we still have a long way to go as over half of all young people in this age group are drinking.

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ABSTRACT

ABSTRACT
Questionnaires about alcohol use were administered to consenting Year 10 students at 10 secondary schools located in regions of Southland, Otago and Hawkes Bay ( n = 579) to examine drinking patterns and attitudes about alcohol of 14-15-year-olds. The average age of first drink was 12.6 years, two years younger than previously reported, with no difference in age of first drink for different socioeconomic statuses or ethnicities. Fifty-four per cent self-reported having consumed alcohol, and 23% had done so at least once within the last four weeks, with 13% reported regularly drinking more than five drinks in one session. While almost half of the 14-15-year-olds in this study reported never drinking alcohol, 75 individuals reported regular binge drinking. This was more common for students in lower socioeconomic schools; almost a third of students in the lowest socioeconomic group reported drinking five or more drinks every time they drink. There may be benefits of alcohol education resources for children as young as 12 years.

Introduction

This study explored attitudes about alcohol and drinking behaviour amongst adolescents in New Zealand, a country with issues of excessive drinking (Conover and Scrimgeour 2013; Ministry of Health 2013a). The New Zealand Ministry of Health conducts surveys asking about frequency and volume of alcohol use (Ministry of Health 2013b) which analyse hazardous drinking or drinking behaviour that involves the risk of harm to the drinker (socially, physically, or mentally) or to others (Babor et al. 2011). Socioeconomic factors, gender and geographical location are predictors of New Zealanders developing alcohol misuse or dependency behaviour. Individuals living in lower socioeconomic areas are more likely to develop hazardous drinking patterns (Ministerial Committee on Drug Policy 2007). Although people from Māori and Pacific cultures are less likely to drink alcohol, those who do drink are more likely to develop hazardous drinking patterns (Ministry of Health 2016). The 2015-2016 survey found 80% of New Zealand adults drank alcohol in the past year, down from 84% in the 2006-2007 survey. In the same 2015-2016 survey, 57% of the New Zealand population aged between 15-17 years reported having an alcoholic drink in the past 12 months, a large decrease from 75% in 2006-2007 (Ministry of Health 2016). Many of the long-term consequences of early alcohol consumption are not completely understood (Maldonado-Devincci et al. 2010). Yet, there is convincing evidence that the brain is vulnerable to the harmful effects of alcohol at this developmental stage (Medina et al. 2008; Guerri and Pascual 2010; Roaten and Roaten 2012). Results from Squeglia and colleagues ( 2009) suggest that youth who participated in heavy drinking behaviour for a period longer than one or two years had small changes in the neural organisation, ultimately showing greater abnormalities and differences in neurocognition. Some of these abnormalities include: brain structure and white matter volume when comparing 15-17-year-olds with and without alcohol use disorders (Medina et al. 2008); and brain activation in cognitive tasks (Squeglia et al. 2009). In addition to anatomical and functional changes in broad areas of the brain, Nixon and McClain ( 2010) reported that alcohol interacts with the reward neurocircuitry of the adolescent brain, in turn encouraging maladaptive behaviours. Thus, the adolescent brain, because of its vulnerability to alcohol-induced harm, is a critical window for developing substance misuse and addiction (Nixon and McClain 2010).

Adolescent drinking behaviour

New Zealand's Ministry of Health identified youth as a group at high-risk of alcohol harm. A binge drinking session, or 'risky drinking' is defined as five or more standard drinks in any one drinking session. Although people in the 18-24 year age bracket do not consume as much total alcohol as those in the 55-65 age bracket, they are more likely to consume large amounts of alcohol in any one drinking session (Ministerial Committee on Drug Policy 2007). Few studies and reports have examined the drinking behaviour of New Zealand youth (Adolescent Health Research Group 2008; Kypri et al. 2009; White 2013). As many as 61% of New Zealand secondary school students have been classified as regular drinkers (Adolescent Health Research Group 2008). In a survey of 2548 undergraduate New Zealand university students (average age 20.2 years), the self-reported recalled the average age of a first drink was 14.6 years (Kypri et al. 2009). The 2007-2008 New Zealand Alcohol and Drug Use Survey found that for people aged 16-64 years who had ever had an alcoholic drink, the median age for when they first tried alcohol was 16 years (Ministry of Health 2009). Nearly one in three people (31.9%) had tried alcohol at 14 years or younger. In that study 14 years or younger was the youngest age bracket to choose from, therefore the results may not accurately identify the age of first drink.

In a Youth Insights Survey, 40% of New Zealand Year 10 students aged between 14 and 15 years had consumed alcohol in the last month and 17% of these youth drinkers self-reported engaging in risky drinking behaviour within the last month (White 2013). Those who reported engaging in risky drinking were also more likely to consume alcohol weekly, without parents' or caregivers' knowledge. Māori were more likely to have experienced risky drinking and consumed alcohol in the last month than any other ethnicity involved in the study (White 2013). Eight per cent of students under the age of 16 years would classify as binge drinkers (Fleming et al. 2014).

A Youth 2000 survey series identified decreased New Zealand secondary school binge drinking between 2001 and 2012 (Adolescent Health Research Group 2012). The largest drop in alcohol consumption was in those aged 15-17 years, where the proportion fell from 75% in 2006-2007, to 59% in 2011-2012 reports (Ministry of Health 2013b). There was a significant decrease in hazardous drinking of those aged 15-17 years between 2006-2007 and 2015-2016 (Ministry of Health 2016). Similarly, while people aged 18-24 years have the highest rates of hazardous drinking, the proportion decreased from 49% in 2006-2007 surveys, to 36% in the 2012 survey (Ministry of Health 2013b). New Zealand remains slightly under (8.7 litres per capita, 2015 and 8.8 litres per capita, 2017) the international OECD average of recorded alcohol consumption of 9 litres of pure alcohol per capita in 2015 of those 15 years and older, equivalent to 96 bottles of wine (OECD 2019). Although New Zealand sits slightly below the OECD average of pure alcohol per capita there is no safe limit for adolescent drinking and therefore warrants further investigation and development of tools to curb adolescent drinking.

Research aims

This study explored attitudes about alcohol use and drinking patterns of New Zealand adolescents in 2015. Questions were asked about the age of first drink, amount and frequency of drinking and how alcohol was obtained.

Materials and methods

Studies have suggested that alcohol harm reduction education is more beneficial when it is provided before adolescents establish a drinking pattern (Perry et al. 2002; Stigler et al. 2011). Since Kypri et al. ( 2009) found the self-reported age of first alcoholic drink by New Zealand youth was 14.6 years, 14-15-year-olds (School Year 10 in New Zealand) were chosen as the target age for this study. The University of Otago's Human Ethics Committee granted approval for the study (15/093). Qualitative and quantitative data were collected via questionnaire as part of a larger study (Campbell 2016). In that study, students were asked questions about alcohol and drinking patterns both before and after exposure to an alcohol educational resource, which resulted in significant changes in awareness in immediate post testing and follow-up test 3-6 weeks later ( P < .001, highly significant) (Campbell 2016). Results reported here are from the questionnaire administered before exposure to the educational resource.

Data collection

The questionnaire was embedded within the introduction to an educational resource, with participants completing it before exposure to the resource. It was administered via Qualtrics TM with the consent of school principals, parents and participants. Participants were reminded of their right to withdraw at any point. Because questions about alcohol use were asked, safety messages and contact numbers for services were displayed throughout the questionnaire and all participants were given a card with contact details for relevant services at the conclusion of the testing.

Questions relating to alcohol use were modelled on those used in the University of Auckland's Youth2000 Survey Series (Adolescent Health Research Group 2008; Campbell 2016). The full questionnaire used in this study can be found in Campbell ( 2016).

Questionnaires were administered at 10 participating schools over a three-week period in August 2015. Data were collected in one class period in classrooms with 14-30 students. The first author gave a five-minute introduction and instructions. Students were reminded that all answers would be kept anonymous and participating schools would not have knowledge of any individual's answers. Students wore headphones during testing and were encouraged not to speak to each other.

Sampling

A pilot test was conducted and consisted of 98 students enrolled in a first-year health science course at the University of Otago; most (78%) of this pilot cohort were between 18 and 20 years old. There were minor modifications to the questionnaire after pilot testing. For example, in the categorical question that asks if students consider themselves a binge drinker, the possible answer of 'I'm not sure what a binge drinker is' was added.

Secondary schools were contacted via email in the Otago, Southland and Hawkes Bay regions of New Zealand, due to availability and funding of the study. Ten consenting schools were selected to represent a range of ethnicities, religions, co-education/single-sex schools and socioeconomic decile ratings. Socioeconomic decile ratings are analysed in this study, rather than geographical location, as not all areas of New Zealand were tested. Decile ratings are generated by the Ministry of Education in New Zealand as an indicator of socioeconomic status (SES). Decile rating is calculated from information provided from the national census and takes homes' income, jobs, dependants and beneficiaries into consideration ( http://www.ero.govt.nz).

Participant demographics

Demographic, religion and ethnicity questions in the survey mirrored those used in the 2013 New Zealand Census. Most students (81%) consider themselves to be of New Zealand European ethnicity. About 26% of the participants in this study self-identified as Māori or Pacific Island ethnicity, 17% as Chinese and just below 1% as Filipino or 'other' (any ethnicity where only one student chose that option). Students could identify with more than one ethnicity.

Most of the cohort was aged 14 (64%) or 15 (35%) years. Students identified as male (56%), female (43%) or other (1%). The majority (71%) of the Year 10 cohort identified as having no religion, 22% self-identified as Christian (Anglican, Catholic, Presbyterian, Methodist, Ratana, Ringatu), 3% (17 students) as having 'other' belief system (Buddhist, Hindu, Jehovah's Witness, Jewish, Mormon, Muslim or atheist) and 4% of students providing no answer about their religion.

Data analysis

Quantitative data collected were continuous or categorical and analysed using IBM SPSS Version 22. Statistical analysis used to examine relationships between demographic data, habitual drinking patterns, attitudes and preferences included the McNemar Test and Cochran's Q Test.

Participants were asked to give three words associated with (1) their own personal use of alcohol and (2) why they think people more generally use alcohol. Answers were collated and streamed into root words. Separate word clouds were developed through a Wordle application online ( http://www.wordle.net/) for those participants who reported they did drink alcohol and for those who reported they did not.

Results

Drinking patterns and perceptions

Over half (54%) of the Year 10 students said that they had drunk alcohol (more than a few sips), 43% said they had never drunk alcohol and 4% reported they were unsure. Age of first drink was recalled by 18% as 14 or 15 years, 15% as 13 years and 21% at 12 years or younger ( Figure 1 A). The average self-reported age of the students' first drink (more than a few sips) was 12.6 years. The actual average may be even lower than this, as the lowest optional answer for this question was nine or under (4.5% of respondents chose that option). For the nine years old or under response, the number 9 was used to calculate the average.

Drinking patterns and attitudes about alcohol among New Zealand adolescents

Of the Year 10 participants, 77% reported not drinking at all in the previous four weeks while 23% reported having drunk one or more times in the previous four weeks. Four individuals reported that they drank alcohol most days ( Figure 1 B). When asked specifically how many times they consumed more than five standard drinks in one occasion (binge drinking) in the previous four weeks, 11% reported that they had binged once in the last four weeks and 9% had binged two or more times in the last four weeks.

Year 10 students were asked how many standard drinks they would usually consume in one session. A number of respondents ( n  = 75; 13%) reported they drink five or more standard drinks when they consumed alcohol. Yet when students were asked if they consider themselves binge drinkers, only 1% answered yes, 8% were not sure and 12% answered that they did not know what a binge drinker was. Most participants reported drinking less, with 39% reportedly not drinking at all, 24% one drink in an average session and 24% two to four drinks per session.

In response to being asked why they drink alcohol, the main reasons given by 14 and 15-year-old students were to have fun (28%), enjoy parties (17%) and relax (15%). Participants were asked to supply three words (free choice, with no lists or words provided) that they themselves would use to describe alcohol. Results are presented separately for those students who do not drink ( Figure 2A and C) and those who do ( Figure 2B and D). The size of the word in a word cloud is related to the frequency of use. Those students who do not drink used words like 'dangerous', 'bad' and 'addictive' more frequently ( Figure 2A). The group who drink alcohol used these same three words but were more likely to use the words 'fun', 'drink' or 'drunk', 'yum', 'good' and 'social' ( Figure 2 B).

Drinking patterns and attitudes about alcohol among New Zealand adolescents

When participants gave three words to describe why other people in general use alcohol, those who do not drink alcohol frequently used words like 'fun', 'party', 'peer-pressure', 'stress-relief', 'relaxation', 'depression' and 'addicted' ( Figure 2C). Participants who self-reported they do drink also frequently used 'fun', 'depression', 'relaxation', 'party' and 'stress-relief' but were more likely to use the words 'good-time' and 'cool' ( Figure 2 D) than participants who do not drink alcohol.

About 14% of the Year 10 cohort who drink are potentially doing so without their parents' knowledge and sourcing alcohol illegally. Two Year 10 students reported that they buy their own alcohol illegally, 5% of students said that their friend's parents bought their alcohol for them and 8% of students said that another adult buys alcohol for them.

Most students (69%) said they would consider turning to their parents for help concerning alcohol ( Figure 3). Over 40% of the students said they would seek help from a school guidance counsellor, friends, drug and alcohol services or other family members, while 9% of students said that they would not look to any of the options listed for help concerning alcohol.

Drinking patterns and attitudes about alcohol among New Zealand adolescents

Socioeconomic status indicators and ethnicity in relation to drinking habits

Data were analysed with SES indicators and self-identified ethnicity as independent variables. Schools were categorised into four different SES groups for analysis ( Table 1). Schools in the lowest SES group D had a higher percentage of Māori or Pacific Island students (60%) than the other SES groups. There was no difference in the average age of 12.6 years for a first drink between any SES groups. However a lower proportion of students at the highest SES group A schools (32%) self-reported having ever drunk alcohol compared to 51%-64% of students in lower SES schools. Of students in the lowest SES group D schools, 30% reported drinking five or more drinks every time they drink and 6% reported they had binged (five or more standard drinks on any occasion) every week in the last four weeks ( Table 1).

Drinking patterns and attitudes about alcohol among New Zealand adolescents

27 June 2019

The average age of first drink of Māori students was the same as that of students of other ethnicities. Nearly 61% of Māori within this study reported having drunk alcohol compared to 50% of non-Māori students. Just under 5% of Māori or Pacific Island students reported having binged every week in the last four weeks compared to 0.5% of non-Māori/Pacific Island students. In this study, SES had a larger effect size than ethnicity in correlation with drinking (medium effect for SES, small effect for ethnicity).

Discussion

The initiation of alcohol use reported in this study (age of first drink) was 12.6 years, two years earlier than previously reported (Kypri et al. 2009). Age of first drink did not vary with SES indicators or ethnicity. Kypri et al. ( 2009) surveyed university students with an average age of 20.2 years, which would have been many years after their first drink. In our study, participants were 14 or 15 years old. While it is possible that participants in this study exaggerated their response, it is likely that these results are more accurate because participants may have better recall of the actual age of their first drink given a more recent occurrence. A limitation of any study of this nature is reliance on self-reporting. The reliability of reported age of first use has been questioned (Bailey et al. 1992). Nonetheless, self-report methods can offer a reliable and valid approach to measuring alcohol consumption (Del Boca and Darkes 2003). While there are reports that adolescent alcohol use in New Zealand is on the decline (Ministry of Health 2013a, 2015, 2016) our data suggest persistent problems of adolescent alcohol misuse.

Almost 70% of participants identified their parents as the primary point for help regarding their alcohol use. This is a critical finding and indicates the need for comprehensive support, investment and advice for parents, as they are a key influencer of drinking behaviour and attitudes (Chung et al. 2013). Nearly half of the participants in this study reported that they would access school counsellors and drug and alcohol services for help regarding their alcohol use, supporting the value of those services in assisting adolescents. This is consistent with studies in the United Kingdom (Fox and Butler 2009), Zimbabwe (Chireshe 2011) and the United States (Anglin et al. 1996) which have shown an important role of student counsellors and health centres in schools, as well as drug and alcohol services and the support they provide to adolescents.

The 13% ( n = 75) of 14-15-year-olds who self-reported binge drinking in this study is lower than the 19.3% of New Zealanders aged 15 years and older reported to have hazardous drinking patterns (Ministry of Health 2016). However, there is no limit considered safe for adolescents to drink. Five standard drinks per occasion are considered hazardous for a person over 18 years of age and the brain is more vulnerable to alcohol-related damage at younger ages (White 2013).

Poudel and Gautam ( 2017) showed that psychosocial problems were significantly associated with the age of onset of substance use. In assessing psychosocial problems among individuals with substance use disorders ( n = 221) residing in a drug rehabilitation centre, those who initiated substance use early (17 years or younger) had higher mean scores of psychosocial problems than those who started substance use later (Poudel and Gautam 2017). It cannot be determined whether the psychosocial problems encouraged the early onset of substance use or alternatively the early onset of substance use resulted in psychosocial problems in the patients.

The 2018 Health Promotion Agency report on New Zealanders' alcohol consumption patterns across the lifespan has shown that men who are high-frequency drinkers, consuming high quantities per occasion, initiated earlier alcohol use in life and had a lower socioeconomic status than males who drank more infrequently (Towers et al. 2018). Also, the report found that for men the presence of parents who were heavy drinkers was linked to high frequency and high quantity drinking behaviours later in life (Towers et al. 2018). The report indicates that, once established, a pattern of drinking (whether hazardous or non-hazardous) is unlikely to be changed and becomes a stable behavioural characteristic throughout life. This illustrates that normalising hazardous drinking patterns is at the point of initiation in adolescence or early adulthood, and is therefore the critical point of intervention to reduce alcohol-related harm (Towers et al. 2018).

In 2010 37 countries participated in the Health Behaviour in School-Aged Children (HBSC) Study, which was comprised of cross-sectional survey data on 13- and 15-year-olds. This study found that high levels of adult alcohol consumption and limited alcohol control policies are associated with higher alcohol use among adolescents (Bendtsen et al. 2014).

A population-based study in the US found that a younger age of first alcohol use was significantly associated with an increased likelihood of heavy alcohol use in the 30 days prior to data being collected (Liang and Chikritzhs 2013). King and Chassin ( 2007) tested whether the age of onset of alcohol and drug use predict alcohol and drug dependence and concluded that early-onset adolescent use of alcohol is a marker of risk for later dependence. Internationally both cross-sectional (McGue et al. 2001; Hingson et al. 2006) and longitudinal studies (Warner et al. 2007; Pitkänen et al. 2008) have suggested that the age of initiation of alcohol consumption is one of the strongest predictors for the development of alcohol dependence later in life. The Dunedin Multidisciplinary Health and Development Study has followed people born in 1972 and obtained data periodically throughout their lifetime. In one study of this cohort ( n = 933), participants were asked questions of alcohol use from age nine. A measure of ease of access to alcohol at age 15 was predictive of both men and women consuming higher typical quantities at ages 18-26 years (Casswell et al. 2003). Casswell et al. ( 2003) found that early onset of drinking before or at the age of 15 years predicted higher frequency of drinking in males aged 18-26 years. Our study involved 14-15-year-olds in 10 secondary schools of diverse SES in three regions of New Zealand. Our results corroborate other reports (Adolescent Health Research Group 2008; Kypri et al. 2009; White 2013) that some young people in New Zealand have already started hazardous drinking at this age. An education resource could benefit young people who are engaging in risky drinking behaviours but may not have accurate knowledge about the effects of alcohol consumption (De Visser and Birch 2011; Campbell 2016). A systematic review between 2002 and 2012 of health, social policy and specialist review databases were searched for the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes and found that there has been mixed evidence for school-based interventions and family- and community-level interventions (Martineau et al. 2013).

This study found there were binge drinking misuse patterns within all SES groups, but prevalence was highest in the lowest SES group. Young people in schools with lower socioeconomic indicators were more likely to drink regularly and more heavily.

Parental monitoring and attitudes are strongly associated with the probability of non-drinking (Larm et al. 2018) and parental supply of alcohol is associated with risky drinking (Gilligan et al. 2012). An Australian study found that drinking behaviours of parents, friends and/or siblings were good predictors of frequent alcohol consumption (Jones and Magee 2014). Jones and Magee ( 2014) also found higher disposable income was a good predictor of frequency of consumption. This is potentially inconsistent with our findings which showed that students in the highest SES schools were more likely to drink less frequently. Our questionnaire assessed links between consumption and school SES but did not ask about individual access to money, which should be included in future studies.

Within the lowest SES schools in this study, 60% of participants self-identified as being of Māori or Pacific Island ethnicity. The findings here are consistent with previous studies that have shown that these youth are more likely to be at risk of dangerous drinking habits. However, it must be considered that this could be due to socio-economic influence, rather than ethnicity/culture driving the risk of alcohol misuse. This should be explored further in future studies, as studies outside of New Zealand have reported ethnicity differences in substance use profiles (Gilligan et al. 2012; Chung et al. 2013). As a result, culturally tailored interventions for use before hazardous drinking patterns are established could be particularly useful in lower economic status communities with higher proportions of Māori and Pacific Island youth.

Summary

We found the initiation of alcohol use (age of first drink) to be 12.6 years, two years earlier than previously recorded in New Zealand. This is the same for students of all SES indicators or ethnicity. Nonetheless, there were differences in proportions and patterns of alcohol use between students in schools with different SES. Students in the highest SES schools were less likely to drink at all. Students in the lower SES schools were more likely to drink and those who did were more likely to exhibit hazardous patterns of alcohol misuse, with nearly 30% of students in the lowest socioeconomic group reporting drinking five or more drinks every time they drink, an amount defined as binge drinking for an adult (White 2013). Thirteen per cent ( n = 75) of all 14-15-year-olds in this study self-identified as binge drinkers.

We recommend educational programmes delivered at a young age to help decrease hazardous use of alcohol. Intergenerational education may be more effective than traditional classroom efforts alone, since parental attitudes and behaviours are associated with adolescent use of alcohol (Chung et al. 2013) and over two-thirds of the participants in our study indicated a willingness to approach their parents for help related to alcohol.

Socioeconomic Status Group/Ethnicity

n

Percentage of students who have drunk alcohol (out of total number of participants)

Percentage of students who have drunk alcohol (% per decile group)

Average age of first drink

Percentage of self-reported binge drinkers

Percentage of those who drink who reported having 5+ standards per occasion

Once in the past 4 weeks (%)

Two or three times in the past 4 weeks (%)

Every week (%)

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The full data set is available from the authors.

Additional information

Funding

This work was supported by University of Otago Postgraduate Publishing Bursary.

References

Adolescent Health Research Group. 2008. Youth '07: The health and wellbeing of secondary school students in New Zealand: initial findings. Auckland: The University of Auckland.

Adolescent Health Research Group. 2012. Youth '12: national health and wellbeing survey of New Zealand secondary school students: data dictionary. Auckland: The University of Auckland.

Babor T , Higgins-Biddle J , Saunders J , Monteiro M. 2011. The alcohol use disorders identification test guidelines for use in primary care. 2nd ed. World Health Organization.Geneva:

Campbell S. 2016. Your brain on booze: impact of a multimedia adolescent alcohol education resource [master's thesis]. Dunedin, NZ: University of Otago.

Chireshe R. 2011. School counsellors' and students' perceptions of the benefits of school guidance and counselling services in Zimbabwean secondary schools. Journal of Social Sciences. 29(2):101-108. doi: 10.1080/09718923.2011.11892960 , [Taylor & Francis Online] [Google Scholar]

Fleming T , Lee A , Moselen E , Clark T , Dixon R. 2014. Problem substance use among New Zealand secondary school students: findings from the Youth '12 national youth health and wellbeing survey. The adolescent health research group. The University of Auckland.Auckland:

OECD. 2019. Alcohol consumption (indicator). [accessed 22 April 2019]. https://doi.org/10.1787/e6895909-en.

Poudel A , Gautam S. 2017. Age of onset of substance use and psychosocial problems among individuals with substance use disorders. BMC Psychiatry. 17(1):10. doi: 10.1186/s12888-016-1191-0

Roaten G , Roaten D. 2012. Adolescent brain development: current research and the impact on secondary school counseling programs. Journal of School Counseling. 10(18):n18.

Towers A , Sheridan J , Newcombe D , Szabó Á . 2018. New Zealanders' alcohol consumption patterns across the lifespan. Health Promotion Agency.Wellington:

White J. 2013. Use of alcohol among year 10 students. [In Fact]. Health Promotion Agency Research and Evaluation Unit. [accessed July 2018]. Wellington: https://www.hpa.org.nz/research-library/research-publications/use-of-alcohol-among-year-10-students-in-fact.

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Drinking patterns and attitudes about alcohol among New Zealand adolescents

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ABSTRACT ABSTRACT Questionnaires about alcohol use were administered to consenting Year 10 students at 10 secondary schools located in regions of Southland, Otago and Hawkes Bay ( n = 579) to examine drinking patterns and attitudes about alcohol of 14-15-year-olds.

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Facial fractures, concussion, broken bones, lacerations, assault-related injuries, verbal abuse, and alcohol poisoning - all are expected to rocket at emergency departments (ED) around the country as another crate day rolls around.

The event was launched by The Rock radio station in 2009 as a publicity stunt encouraging people to mark the first Saturday of summer by buying a crate of beer.

Christchurch Hospital ED doctor Scott Pearson said the number of alcohol-related injuries seen in ED doubled on crate day compared with an average weekend in December.

Comparing the most recent Saturday with the two previous crate days, there was a fivefold increase in people going to ED for alcohol-related issues.

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Last Saturday the ED saw five people with alcohol-related injuries. On crate day in 2018 there were 29, while at last year's event there were 23 injuries.

Pearson said guidelines recommended no more than three standard drinks per day for men and two for women, but a crate would contain 29 standard drinks.

"Not everybody will drink a whole crate, but advertising and marketing seems to support that level of drinking."

Pearson is among a group including ED staff, police, councils, Māori health advocates and public health workers who would like the event banned.

Pearson said injuries from dangerous drinking on crate day included those from associated violence and falls - such as lacerations, broken and twisted ankles, cuts from walking on broken glass and facial fractures.

People arriving at ED heavily intoxicated suffer alcohol poisoning and risk death from choking on their own vomit.

In 2019, crate day was joint top as the day with the highest number of accepted injury claims to ACC for 18- to 24-year-olds.

The Rock's content manager, Brad King, said crate day was not sponsored or owned by The Rock and previous campaigns for the day promoted the message "that this day is about sharing a crate with your mates at your place".

This year the station has been promoting a music countdown, "The Rock's 100 Cratest hits", starting from midday on Saturday.

"The Rock doesn't condone irresponsible alcohol consumption, public nuisance or binge drinking," King said.

Super Liquor chief executive Campbell McMahon said the bottle store company had crate day promotions being advertised on Stuff and The Rock, and with in-store posters.

He said the company was "committed to the highest standards of responsible liquor retail and to ensuring we and our stores meet all the regulations related to the sale, advertising and promotion of alcohol, designed to minimise alcohol-related harm".

David Ratu, a Māori health advocate and a former South Auckland Māori warden, said the day would only increase "grief" for Māori, who have a disproportionately higher rate of harm from alcohol.

"I'm fearful of what will happen. We know from past experiences of crate day that domestic violence, drunk driving and any kind of violence - that tends to peak, no doubt about it."

Ratu, who has taken a claim over the Crown's failure to protect Māori from alcohol-related harm to the Waitangi Tribunal, said he wasn't against drinking, but promotions like crate day just increased problems.

Alcohol Healthwatch executive director Nicki Jackson said the liquor industry made more crates available - including crates of ready-to-drink premixed alcohol - for the day and made "huge profits" from it.

"It's all geared up for this one day which is really just a promotion of heavy drinking."

She said the fact crate day was in its 11th year showed how ineffective the Supply and Sale of Alcohol Act was in reducing binge drinking.

"No amount of host responsibility is going to curb the harm from this event."

Lotta Dann, an author and the manager of alcohol support group Living Sober, said it was surprising how little concern was expressed about crate day.

"What I want to know is: where's the outrage about heavy drug use being promoted? We've got outrage from politicians about drug testing, which is harm reduction ... Where's the outrage here?"

Dann said society had lost sight of the fact that alcohol was a drug.

"We live in a society of double standards and it's just craziness. And you're loath to talk about it because there's nothing worse than being seen as a wowser ... But bugger that - too many people are struggling.

"I'm not saying don't drink, but don't promote binge drinking."

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Another crate day, another nightmare for New Zealand's emergency departments

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Facial fractures, concussion, broken bones, lacerations, assault-related injuries, verbal abuse, and alcohol poisoning - all are expected to rocket at emergency departments (ED) around the country as another crate day rolls around. The event was launched by The Rock radio station in 2009 as a publicity stunt encouraging people to mark the first Saturday of summer by buying a crate of beer.

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A day encouraging drinkers to mark the first weekend of summer with crates of beer has been labelled "dangerous and irresponsible" for contributing to a spike in family violence.

Crate Day was launched by The Rock radio station in 2009 as a publicity stunt. It has since been embraced by the liquor industry, with many suppliers creating crates of ready-to-drink premixed alcohol in addition to beer.

Police data shows family harm incidents on previous Crate Day weekends were 20 to 30 per cent higher compared to other first weekends of the month throughout the year.

In 2019, there were 1193 call outs for the weekend of December 1 (565) and 2 (628).

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This compared to 933 - the yearly average for first weekends of the month.

In 2018, there were 1010 call outs on the weekend of December 1 (484) and 2 (526), compared to 832 for other monthly first weekends that year.

The day with the highest number of call outs for family harm was New Year's Day with 711 in 2018, 755 in 2019.

Women's Refuge chief executive Dr Ang Jury said excessive drinking was a factor in the "vast majority" of domestic violence incidents.

"What alcohol does is it loosens inhibitions and raises tensions and can therefore make things worse."

Heavy drinking would increase the risk of committing or being a victim to domestic violence, Jury said.

"I think the problem with things like Crate Day is that this is an explicit encouragement to get off your face."

Crate Day created "obvious risk" for sexual abuse and assault, she said.

"Over indulgence in alcohol - and I'm not the fun police - does lead to increased risk. It shouldn't because you should be able to do whatever you want to do and know you will be safe but that's not the reality that we live in."

Jury encouraged women to hang out with friends if they were in a heavy drinking environment.

Christchurch Hospital doctor Scott Pearson said the number of alcohol-related injuries seen in the emergency department doubled on Crate Day, compared with an average weekend in December.

Comparing the most recent Saturday with the two previous Crate Days, there was a five-fold increase in people going to ED for alcohol-related issues.

Injuries from dangerous drinking on crate day included those from associated violence and falls - such as lacerations, broken and twisted ankles, cuts from walking on broken glass and facial fractures.

The Rock's content manager, Brad King, said Crate Day was not sponsored or owned by The Rock and previous campaigns for the day promoted the message "that this day is about sharing a crate with your mates at your place".

This year the station has been promoting a music countdown, "The Rock's 100 Cratest hits", starting from midday on Saturday.

"The Rock doesn't condone irresponsible alcohol consumption, public nuisance or binge drinking," King said.

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'Crate Day' increases family violence callouts by nearly 30 per cent

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A day encouraging drinkers to mark the first weekend of summer with crates of beer has been labelled "dangerous and irresponsible" for contributing to a spike in family violence. Crate Day was launched by The Rock radio station in 2009 as a publicity stunt.

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New Zealand's alcohol industry is profiting massively by supplying binge drinkers, new research says.

Dr Sally Casswell, a public health researcher at Massey University, says 40 per cent of all alcohol sold in New Zealand is consumed in a "heavy drinking" session - more than eight full-strength drinks for a man and six for a woman.

New Zealand's booze profits are also thought to be massively reliant on sales to problem drinkers. Just 20 per cent of Australian drinkers are knocking back three-quarters of all the alcohol consumed there each year, a health group revealed this week, and New Zealand's figures are thought to be "very similar".

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Much of the liquor industry's products are consumed "in hazardous or risky circumstances", Casswell said, putting the lie to industry claims of wanting to encourage responsible drinking.

At a liquor trade convention held in New Zealand, retailers were encouraged to identify and target "super consumers" who purchase a disproportionately large part of total sales.

"As little as 10 percent of your customer base can be driving between 40 to 70 percent of your sales," a market researcher told 2014 conference delegates. US research showed certain "super consumers" could be relied upon to buy far higher than average volumes of wine, whisky and vodka, the speaker said.

Robert Brewer, spokesman for Cheers, a drinks industry responsible drinking initiative, said health statistics showed risky drinking and its consequences were coming down and the age at which people started drinking was going up - and that was a good thing.

"The New Zealand drinks industry is committed to helping create a moderate, safe and sociable drinking culture," Brewer said. "We do this collectively through the Cheers programme which industry has invested over $2.5 million in and through the over $11.5 million per annum via an industry levy to government's Health Promotion Agency.

"Ministry of Health surveys also show that 80 per cent of consumers drink responsibly and moderately."

Dunedin liquor retailer Chris Hart, Liquorland's 2014 Franchisee of the Year, had a blunt message for those retailers targeting problem drinkers: "As a responsible retailer you don't want those customers, because they create problems".

Rebecca Williams, director of Alcohol Healthwatch, said it was time to turn attention to the role the alcohol industry played in perpetuating the social harms of alcohol, estimated by research group BERL to cost $5 billion a year.

Williams said an estimated 18 per cent of New Zealand drinkers aged 15 and over drank in a way deemed "hazardous" (as defined using a clinical checklist that includes blackouts, morning drinking, injury while drunk and inability to stop drinking).

"If you were to wave a wand and fix hazardous drinking overnight, the impact on the industry would be running scared, because half their business would go out the door.

"You can say we need to educate, and that people need to make good decisions, but we've been doing that for years, but we're still at 18 per cent."

You would never see an advert that said "Hey, buy our product and binge-drink it". Yet, Williams said, pervasive advertising and sports sponsorship, plus the ready availability of cheap booze, normalised over-consumption.

It was time to put in place the three policies that have repeatedly been shown to work in reducing alcohol harm: reducing access and availability, increasing prices and restricting marketing.

The Government had ignored the most important recommendations made by the Law Commission in a comprehensive review of alcohol law in 2010, she said, and was also sitting on the recommendation of a subsequent "ministerial forum".

SMASHED AND BASHED BY BOOZE

If there ever was an alcohol "super consumer" it would be Sophia Nash.

A drinking habit that started when she was just 10 led to hospitalisation, a car crash and induced coma and nearly to the loss of her two children.

The model, entrepreneur and alcoholic was knocking back up to seven bottles a night during her years of out-of-control drinking.

Nash didn't need a liquor ad to tell her to seek out her next bottle- but marketing still had a powerful impact. "Champagne ads were pretty good," she said.

Often, though, the images that triggered her thirst wouldn't even be liquor adverts. "I'd see an ad about someone on holiday, and they'd be holding a nice drink and relaxing, and I'd think oooh, that would be lovely."

Or it might be a scene in a film - Angelina Jolie having a nice glass of wine, say - "and that might trigger me, because I'd be thinking that looks so decadent and yummy..."

Now, though, Nash would be happy to see the advertising - and indeed the drink itself - banned.

"It should be illegal. It's one of hte most readily available, most stealth-marketed drugs that's ever been, and there are so many people hooked on it that no one wants it to go away. I think that's a sign of how powerful this drug really is."

Nash will tell her story in a social media campaign, being filmed this week, to raise awareness about out-of-control drink and drug use.

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Booze barons drive profit off alcoholics and binge drinkers

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New Zealand's alcohol industry is profiting massively by supplying binge drinkers, new research says. Dr Sally Casswell, a public health researcher at Massey University, says 40 per cent of all alcohol sold in New Zealand is consumed in a "heavy drinking" session - more than eight full-strength drinks for a man and six for a woman.

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Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

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Plummeting prices and prevalence mean methamphetamine is as cheap and available as ever. Georgia-May Gilbertson talks to addicts and experts about the grip P has on communities around the country.
It started by extracting ingredients from pills to treat a common cold, but add a hint of battery acid, a dab of paint thinner, drain cleaner, lantern fuel and antifreeze and you've got yourself one insidious, yet highly addictive drug.

Methamphetamine continues to claw at New Zealand's most vulnerable, to those right at the top of their game; the black widow, a former addict calls it.

What's even more disturbing is many New Zealanders know someone who is taking it, they just can't see the signs.

With all these ingredients, it can be bewildering to think why anyone would ever take something so toxic. But people do and New Zealand is riddled with it.

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Gary*, whose name has been changed for protection purposes, wasn't addicted to drugs, but to perfection in his work, status and financial gain during a successful career in the corporate world.

His drive dissolved into an instant meth addiction one Saturday night after his friends tricked him into thinking it was cocaine he was snorting - a drug he'd tried "once or twice" in the past.

"It seemed different from any cocaine I could ever remember and within 24 hours I was hooked. By Sunday I would have done anything to get it."

Gary estimated he spent at least $150,000 on methamphetamine during his first year of use.

"The expense was down to the addiction, but I was completely new to that world and the kind of people who deal in it screw you over left, right and centre."

For the next year Gary isolated from his friends and social circle and became disinterested in his family.

"If I didn't have the drugs I'd spiral down into powerlessness, depression and un-manageability. I didn't function very well at all. Everything turned into a task."

Gary maintained both poor hygiene and nutrition. His skin broke out, anger constantly bubbled inside him with the smallest of problems rattling him, as everything became centred around the drug.

"To use a metaphor, it's a bit like a black widow - it grabs hold of you and slowly gets stronger."

"There's an inner belief that you're functioning a lot better than you probably are. It's a cunning, powerful... drug."

After a year, Gary left New Zealand attempting to escape the drug's grasp. He started university to distract himself, but within a week he had found a dealer.

This cycle continued for a decade with Gary attending 10 different rehab clinics in New Zealand and overseas.

He's been clean for 17 months and now volunteers at The Retreat in Ōtahuhu, Auckland.

"You really have to have the gift of desperation, because it's that drive that will push you to want to get off it."

Gary said meth was "so widely spread in New Zealand" anyone can get it.

"You just need to make a few phone calls. It's everywhere. It's reflected in the fact the street prices have dropped by 75 per cent. It used to be about $1000 a gram, now it's down to $200-$250. It's just rife in the country."

Programme director at The Retreat, Dave Collins, is a recovered alcoholic and addict, with methamphetamine being one of many things he injected, sniffed or inhaled into his body.

Now he helps others with their journey through recovery as they face battles he once did.

"[The] thing with meth is, we all know someone who is on it, we just might not realise it."

To this day Collins isn't sure why he got involved in drugs, but said when he was growing up he was "drawn to the cool kids."

Collins said the drug has "detrimental" effects on its users and for him, he couldn't eat.

"I've got a very fast metabolism anyway - I can shed a couple of kilos in a few days but it'll take me a few months for me to put them back on again. I tried to eat and half an hour later, I'd still be chewing my food."

"When you've got that kind of chemical in your system and it comes up through your pores, it just causes your skin to flush and you get sores everywhere."

Collins said although there was fear, frustration and anxiety after deciding to get clean, he said "there was always hope."

But both Collins and Gary knew from experience that the drug wasn't going away anytime soon.

In the Bay of Plenty, meth labs have been found in garages and houses, they've been dug into the ground and found in the bush.

There's no overarching trend for lab location, the key element is privacy, detective senior sergeant John Wilson said.

The tie between meth and organised criminal groups was clear, they don't care about the immeasurable harm they're causing in their own community, to their own people.

"As these groups' primary motivation is financial gain, police continue to seize their ill-gotten gains through the Criminal Proceeds Recovery Act and make sure these groups don't see the benefits of peddling misery in the community," Wilson said.

Hawke's Bay's Detective Inspector Mike Foster said police had been working hard against the meth trade, particularly around gangs.

The cooks weren't quite as creative in Hawke's Bay compared to the Bay of Plenty, but more strategic, usually packing their cooking equipment in a van and using motel rooms as temporary labs before moving on.

Despite the region having a high meth wastewater reading, Foster believed police were making progress.

"The jobs we've terminated lately have left significant holes - I think - but in saying that there's always someone there to fill the void.

"We've had some really good results, particularly with [seizing] their cars which mean so much to them, their houses and particularly their Harley-Davidsons."

Foster said the methamphetamine trade in Hawke's Bay was ultimately owned by the gangs from district to district.

"The Eastern District has very high Mongrel Mob numbers who own the meth trade in Hawke's Bay and Tairāwhiti. Other gangs are popping up such as the Mongols who have established themselves in Hawke's Bay now, so we would expect there to be further inter-gang violence as time goes on."

In Wellington, Detective Sergeant Tim Leitch, who has worked against organised crime for the past 15 years, said methamphetamine was more problematic than ever across Wellington.

While it was always a problem in vulnerable communities, Leitch said it was causing destruction within families, particularly tradespeople, builders and professionals.

"When people get that first taste, they get an unbelievable feeling. Then they spend time trying to relive it, by trying to get the drug.

"They end up spending hundreds and hundreds of dollars, and working really long hours just to fund their habit. If things get really desperate then they'll even start committing crime to try to get it."

Leitch said dealers, rather than manufacturers, were problematic in the Wellington area, as the drug was often transported down from the north.

While it was important to target the dealers, Leitch believed more rehab facilities were essential in fighting the drug.

Law expert Alexander Gillespie believed authorities needed to look at their "successes and failures" in terms of supply, demand, harm caused and laws utilised.

"Then we need to look at the experiences of similar countries and work out what is working best, where - and learn from others. We are not winning, and we need to start thinking differently."

Oranga Tamariki chief social worker Grant Bennett said methamphetamine was a factor in about half of cases of children taken into care.

"There's been a real acceleration in terms of meth during the past five years. Normally the most prevalent factor would have been family violence, but what we're seeing now is that addiction issues are just as prevalent - and what's driving that is methamphetamine."

Bennett said meth was problematic in the 40 to 50 per cent of work involving childcare.

"Sometimes it's not the only factor, but it is a factor. Meth makes our work incredibly complex, it exacerbates other vulnerabilities that already exist in the home. So if there's financial issues or family violence, it's only going to make that worse."

Bennett said Oranga Tamariki would work with whānau and offer support for addiction issues.

"One thing that does worry me, is we don't actually know the impact of meth use on unborn children, we know that in a lot of children we deal with have alcohol foetal syndrome, but we don't fully understand the impact of how meth manifests itself later in life."

During the time in his role, Bennett said communities he visited often claimed they were the meth capital of New Zealand.

"Nearly every site I go to will mention meth and why their community is so much worse off. It's a prevalence right across the country.

"I have no data, but you'll hear this from the communities and the people on the front line before the data tells you the story."

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'Anyone can get it': Methamphetamine is cheap and easy to find in New Zealand

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Plummeting prices and prevalence mean methamphetamine is as cheap and available as ever. Georgia-May Gilbertson talks to addicts and experts about the grip P has on communities around the country. Methamphetamine continues to claw at New Zealand's most vulnerable, to those right at the top of their game; the black widow, a former addict calls it.

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Alcohol seen as essentisl during pandemic lockdown

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Alcohol seen as essentisl during pandemic lockdown

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New Zealand has won international praise for its strict lockdown conditions and public health response to Covid-19, but there's one glaring blindspot.

Last month, the World Health Organisation released a new factsheet on alcohol and Covid-19, warning that heavy alcohol consumption increases the risk of respiratory failure, one of the most severe complications of Covid-19.

Yet alcohol was sold as an essential item, along with food, during New Zealand's level 4 lockdown, even though almost half of all alcohol in New Zealand is drunk in heavy and binge drinking sessions.

While this isn't a simple health issue to address - and lockdown might not have been the time to do it - it is an issue we can't ignore. Alcohol is a risk factor not just for Covid-19 but many other conditions, including cancer.

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The World Health Organisation on alcohol and Covid-19

The World Health Organisation's comprehensive factsheet stresses that alcohol weakens the immune system and heavy drinking increases the risk of acute respiratory distress syndrome, which leads to widespread inflammation in the lungs.

This link between heavy alcohol consumption and respiratory disease is not well known, despite a systematic review, published in 2018, which concluded there is comprehensive evidence for it.

It is missing from the burgeoning research effort to quantify other Covid-19 risk factors such as smoking.

This global health blindspot is reminiscent of the lack of awareness of alcohol as a cause of cancer, even though the WHO's International Agency for Research on Cancer stated in 2011 that alcohol is a class one carcinogen - meaning it's a known cause of cancer.

Despite this, alcohol supply was an essential service during New Zealand's lockdown.

This raised concerns, but they focused largely on the increased risk of intimate partner violence and likely impact on families in stressful lockdown situations.

Potential effects on drinkers, such as an increased risk of dependence, were also discussed - but not the health risks from heavy drinking specifically associated with Covid-19.

Access to alcohol during lockdown

So why did the New Zealand government decide access to alcohol was essential during the lockdown?

Given wine and beer are sold in supermarkets in New Zealand and supermarkets were selected to operate as essential businesses, it was unlikely wine and beer sales would be restricted - although some countries such as Thailand have banned alcohol sales.

The question for New Zealand then became one of access to spirits and ready-to-drink premixed alcohol beverages.

These have never been sold in supermarkets, but the decision was complicated by the fact there are some geographical areas, known as Licensing Trusts, where alcohol is not sold in supermarkets but only through local bottle shops.

One option would have been to allow only beer and wine sales from Licensing Trust outlets to create a level playing field with supermarkets elsewhere, but the government chose not to do this. As a consequence, people travelled outside of their area to buy spirits.

The government then allowed online sales of alcohol, initially restricted to existing online-only alcohol businesses but then extended to other premises, provided they consulted with their local council authorities.

This increased potential availability from about 250 online-only businesses to around 1,000 physical bottle shops. And social media were used to promote online sales.

Alcohol as an ordinary commodity

One element of the government's decision to treat alcohol supply as an essential service will have been concern for business interests.

A second may have been concern for heavy drinkers and the possibility of withdrawal symptoms if they could not access alcohol.

The latter is questionable given ongoing beer and wine sales and the availability of addiction support services online.

A third element was undoubtedly a framing of alcohol as an "ordinary commodity". But this is not how alcohol is consumed in New Zealand.

Almost half is consumed as heavy and binge drinking (defined as eight or more cans of premixed alcoholic drinks for men, and six or more cans for women).

For heavy drinkers, premixed drinks are a source of cheap alcohol, and there is every reason to expect much of the spirits and premixed drinks ordered online during this current period of restricted access will be consumed in this way.

Heavy drinking contributes to several diseases that likely exacerbate the effects of Covid-19.

The government's decisions projected the idea of alcohol supply as an essential business, and it appeared to favour commercial interests over public health.

This approach has influenced New Zealand's policy response for many decades, before the present government took office.

Evidence-based recommendations made by the New Zealand Law Commission in 2010 and supported by subsequent inquiries have not been implemented, despite more than 800 deaths that can be attributed to alcohol and NZ$7.8 billion in costs each year.

Going forward into a post-pandemic world, we should learn from the government's science-based response to the threat of coronavirus to inform our response to persistent and ongoing harms from the marketing and over-supply of cheap alcohol.

Sally Casswell is Professor of public health policy at Massey University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Alcohol can make coronavirus worse. So why was it treated as essential?

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New Zealand has won international praise for its strict lockdown conditions and public health response to Covid-19, but there's one glaring blindspot. Last month, the World Health Organisation released a new factsheet on alcohol and Covid-19, warning that heavy alcohol consumption increases the risk of respiratory failure, one of the most severe complications of Covid-19.

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Abstract

A large research literature demonstrates substantive statistical relationships between changes in the minimum legal drinking (MLDA) or purchase age (MPA), youth drinking and alcohol related harms [ 1, 2]. Increases in the MLDA and MPA are related to reductions in use and problems among of-age young adults. New Zealand lowered the MPA from 20 to 18 years on December 1, 1999. Although the prior law was difficult to enforce and included limited exceptions for sales to those age 18 and 19 years [ 3], the 1999 MPA reduction greatly increased retail alcohol access for that age group. To mitigate potential risks, the same act required that customers provide photo age identification, if asked, and increased penalties for sales to minors [ 4]. Early evidence indicated that lowered MPA was associated with increased relative risk of problems such as traffic crashes and presentations for intoxication at emergency departments [ 5- 9]. While most public health researchers and agencies agreed that the lowered MPA would lead to greater use and problems among youth and young adults [ 10], some commentators and New Zealand industry groups argued that the lowered MPA could lead young people to drink in safe controlled environments [ 11- 13] and thus reduce problems in this group. This argument strikes at a weak link in prior assessments of MPA effects, as it is not known to what degree changes in the MPA are associated with changes in the use of drinking contexts among under- and of-age drinkers.

In this paper we estimate the impact of New Zealand's MPA reduction on use of drinking contexts, levels of alcohol use therein, and associated rates of problems using national surveys of New Zealand youth and adults. Although availability theory suggests that MPA reductions will increase opportunities to drink among newly of-age drinkers and drinking will expand into commercial contexts like bars [ 14], until recently there has been no survey-based method for associating drinking in contexts to associated problem risks. We use a recently developed context-specific dose-response model and national survey data to assess frequencies of drinking in contexts by youth and adults before and after MPA reduction; use among newly of-age youth should shift toward commercial outlets following this change, and associated problems may measurably increase or decrease. Numbers of problems may be associated with drinking contexts themselves, regardless of drinking level, or heavier drinking in those contexts. We distinguish these risks using a model developed for this purpose and applied in previous studies [ 14, 15]. The model requires data on drinking frequencies and quantities consumed across contexts that provide good coverage of total alcohol use in a large population, fortunately available for New Zealand [ 16]. We expect that greater risks may arise in licensed drinking establishments like pubs and nightclubs as new of-age drinkers come into those contexts; this may be due either to greater drinking in those contexts or greater problem risks associated with a given drinking amount in those contexts. The arguments parallel those of other investigators who identified greater risks for child abuse and neglect specifically associated with heavier drinking in bars and pubs [ 14] and distinguished risks for intimate partner violence related to the use of drinking contexts from those related to heavier drinking [ 15].

The aims of the current paper are: (1) To determine if greater legal availability is related to increased use of licensed establishments by newly of-age 18 to 19 year old drinkers in the post-MPA period. Conversely, the concurrent enhancements of photo ID requirements and penalties for serving minors may decrease use of licensed establishments by individuals under 18 years of age. (2) To determine whether drinking context use is associated with risks for several drinking problems. (3) To assess the degree to which additional problem risks are associated with greater levels of drinking in those contexts. (4) To evaluate the extent to which context specific risks and risks associated with drinking are related to New Zealand's MPA reduction.

METHODS

New Zealand National Alcohol Surveys of youth and adults were conducted in 1995, 2000, and 2004 with a total of 16,420 respondents 14 to 65 years old [ 16, 17]; response rates were 73%, 71% and 60% respectively. Interviews were conducted by trained personnel from a central location using an in-house computer-assisted telephone interview system. Households were selected using random digit dialing (including listed and unlisted phone numbers) and a computerized random selection process determined those interviewed. Validity and reliability of all drinking, context and problem measures were assessed as "good" in previous studies (e.g., coefficients α and test-retest r ≥ 0.70) [ 16]. The surveys were designed to be nationally representative; here proportional weighting is used to account for purposeful oversampling of youth aged 14 to 19 in 2000 and 2004. Discarding cases missing demographic information reduced the overall sample to 16,240, of which 13,243 had consumed alcohol and provided required drinking data. Of these drinkers, 1,082 (8.2%) were age 16-17 and 919 (6.9%) were age 18-19. (Drinker counts by age, gender and survey year are presented as web-only supplementary material.)

Alcohol use was measured for 15 detailed drinking contexts. For ease of analyses, these were collapsed into five categories: the respondent's own home, others' homes, pubs/hotels/taverns plus nightclubs, restaurants/coffee shops, and a residual category containing all other drinking contexts (including sport clubs, other clubs/meetings, special events, theaters/movies, workplaces, domestic plane trips, private vehicles, sports events, and public places). For every context each drinker reported the number of occasions over the past year drinking at each context (frequency) and the typical quantity of alcohol consumed in each context (drinks per occasion, DPO). Categorical indicators of typical drinking frequency were converted to interval estimates with the top category "more than once per day" coded as 730 occasions per year. Total drinking frequency was calculated as the sum of the context-specific reports. As a result, a small proportion of individual respondents (1.3%) had total annual drinking frequencies greater than 730 occasions (up to 1,927). Specification tests indicated that the results presented here remain essentially unchanged when these values were Winsorized to 365 [ 18].

Respondents reported their typical quantities of alcohol consumed by context using terms familiar to New Zealand drinkers, coded by interviewers using the wide range of containers commonly used to serve and sell specific beverage types [ 16]. Conversions were based on container sizes and standard alcohol content as documented by Statistics New Zealand. This information was converted to standardized 15 ML ethanol units to estimate drinks per occasion. To mitigate problems with extreme outliers, DPO values above 24 were Winsorized to 24 drinks affecting 0.9% of reports across all contexts.

Self-reported alcohol problems were assessed over the previous year without regard to drinking contexts. Respondents reported annual counts across fifteen problem indicators. Following prior research [ 19], these items were combined into four categories: 1) Alcohol Related Disorder (physical fights, serious argument, forced to leave a place); 2) Symptoms of Dependency (drunk when needed to be sober, drank alcohol or experienced hand shakes in the morning, stayed intoxicated for several days); 3) Heavier Drinking Effects (ashamed of actions while drinking, missed work or unable to remember after drinking); 4) Felt Effects of Alcohol the Next Day (overall, at work, on study). A fifth outcome summed all 15 problems. The maximum reported problems ranged from 420 for Alcohol Related Disorders to 1,068 for Symptoms of Dependence.

Demographic and economic covariates included categorical measures of respondent age, survey year, gender, ethnicity, income, education and employment. The coding and reference categories for these covariates are indicated in .

Table 1

Statistical Approaches

The context-specific drinking analyses assessed whether an individual reported any alcohol use and, among drinkers, the frequencies and typical quantities used in different contexts. The analyses included demographic and economic covariates as well as year-specific indicators to account for unexplained population-wide temporal changes. The key indicators of MPA effects were interaction terms identifying post-1999 changes specific to the 16-17 and 18-19 age groups. Logistic analyses were used to assess drinking status and censored Tobit regression analyses were used to assess drinking frequencies and quantities using Stata 13. Tobit analyses correct for biases that arise in ordinary least squares regression analyses of censored interval data [ 20].

The context-specific analyses of risks related to drinking examined drinkers only and assessed relationships between measures of drinking within contexts and the five groupings of drinking problems measured across contexts. All demographic and economic covariates and measures identifying specific effects among age groups were included along with measures of context-specific drinking frequencies, F i, and volumes consumed beyond the first drink (V i−F i). We treat the assessment of risks related to drinking as an essentially actuarial problem. The problem is to estimate associations between drinking measured within contexts and risks for problems across contexts. An explicit quantitative representation of context-specific risk relationships enables us to do so [ 14, 15]. The model generalizes a linear dose-response framework used to quantitatively assess drinking risks [ 21] to include variations in dose-response which may be context specific. Starting with a simple reduced form equation:

Risks related to drinking (R) are assumed to be a linear function of drinking frequencies (F) and total volume (V) minus frequency (V−F) (continued volumes). As applied here, estimates of b represent the number of problems associated with the first drink and estimates of c represent the unit increase in problems related to each additional drink beyond the first (linear dose-response). We extend the model to context-specific risks noting that F and V−F are composed of drinking frequencies and volumes measured within contexts (F=F ₁+F ₂...+F n, V i=F iQ i):

We assume that total risk, the total number of problems R, is the sum of unobserved risks (R i) associated with individual contexts. With data on the frequency, F i, and quantity, Q i, consumed in each context (and thereby V i and V i−F i), the sum of all problem risks R is represented by the expansion of the right side of equation 2 for all contexts (R=R ₁+R ₂+...+R n). Numbers of problems associated with drinking in each context (b i) and the linear increase in numbers of problems per additional drink consumed in each context (c i) can be estimated using expanded Equation 2. This approach reduces collinearity when estimating context specific effects and separates risks related to drinking from risks associated with heavier drinking within contexts.

Since error variance increases with drinking frequencies and volumes and is a source of bias in applications of censored regression models, we conducted analyses using LIMDEP version 9.0 software that corrects for these sources of heteroskedasticity [ 22]. Additional specification tests, not further discussed here, examined whether the MPA was differently related to risks between age groups; these age × time × context interactions were not significant.

RESULTS

presents weighted descriptive statistics for all measures used in the study. Drinkers reported an average of 166 drinking occasions during the prior year across all locations, with half of these occurring at home (88). Typical drinks per occasion averaged 3.8 across all contexts, ranging from 2.3 drinks at restaurants to 5.0 at pubs / nightclubs. The average drinker reported 9.6 drinking problems over the past year, of which over two-thirds were in the "felt effects" category. Median drinking values are uniformly lower than means across all drinking and problem measures, reflecting the influence of extreme cases in estimating the means.

Context-Specific Drinking

presents the key tests of whether respondents in targeted age groups experienced different changes in drinking and context use following MPA reduction than did those in other age categories. The top two sections show drinking outcomes differed across all age groups and all survey years, while the bottom section tests whether two key age categories (16-17 and 18-19) had different post-MPA changes in drinking than did older or younger respondents. The latter results indicate that respondents aged 18-19 experienced a relative increase in likelihood of past-year drinking following the MPA compared to other age groups. The post-MPA period also had significantly increasing rates of context use among 16-17 year olds (42 additional occasions annually) and 18-19 year olds (34 additional occasions) beyond the changes experienced by other age groups. These changes were distributed across contexts in different ways. 16-17 year olds came to drink more often at home (+22 times per year), others' homes (+12), and other contexts (+22). 18-19 year olds came to drink more often at pubs/nightclubs (+15). The lowered MPA was associated with increased frequencies of drinking across all contexts for 16-19 year olds, with 16-17 year olds more frequently drinking in social contexts and 18-19 year olds more frequently drinking in commercial contexts, especially pubs/nightclubs. There was a reduction in use of pubs/nightclubs for drinking among 16-17 year olds. Results for the other demographic and economic covariates are presented as web-only supplementary material. Specification tests that Winsorized context-specific annual frequencies at 365 instead of 730 (for survey responses of "more than once a day") provided nearly identical results. An additional specification test which also Winsorized the total drinking frequency measure at 365 provided very similar results except that the MPA interaction with the age 18-19 group no longer had a significant association with total frequency (b=18.89, z=1.64).

presents equivalent analyses of whether the age groups most affected by the lowered MPA changed their typical quantities consumed in drinking contexts relative to respondents in other age groups. Across all contexts typical quantities consumed rose among 16-17 year olds with greater quantities consumed at home, others' homes, and other contexts. Overall increases were not seen among 18-19 year olds, but some increases were evident for quantities consumed at home and others' homes. A one-tailed marginal reduction in quantities consumed at pubs/nightclubs suggests somewhat less use in these environments. These age-specific post-MPA effects in all remained significant in specification tests that did not Winsorize typical drinks per occasion at 24.

Context-Specific Drinking Risks

presents key tests of relationships between drinking in contexts and risks for problem outcomes. The table is divided into four sections referring to risks for problems related to (A) drinking in each context, (B) greater amounts consumed in each context (dose-response), (C) association of the lowered MPA with problems related to each context, and (D) relationship of the lowered MPA to dose-response. Sections A and B display context-specific drinking risks prior to the MPA change. Sections C and D display associations of the MPA with these relationships. The non-significant direct post-MPA effect displayed at the bottom of the table shows that the context-specific measures statistically explained marginal effects otherwise related to the reduced MPA.

In the aggregate, across the 10 effects displayed in sections A and B of , the context-specific frequency and dose-response effects both contributed significantly to the explanation of problem rates across all problem groups. Likelihood ratio chi-square statistics ranged from G ²=205.94 to 804.74 (df=5) for effects related to the use of drinking contexts and from G ²=93.95 to 734.02 (df=5) for dose-response. Greater numbers of overall problems were associated with drinking in others' homes and pubs/nightclubs, and dose-response was positively associated with greater drinking quantities in all contexts. Looking across the table at specific problem groups, there was considerable variation in context-specific effects with some problems remaining largely unresponsive (symptoms of dependence), but others exhibiting great responsiveness (felt effects of alcohol).

The context specific dose-response model enables comparisons between risks related to drinking in contexts (section A) and risks related to heavier drinking in those contexts (section B). In section A of , it appears that greatest risks related to drinking in contexts arise when drinking in others' homes and pubs / nightclubs. At low levels of drinking, when drinking one drink, risks are greatest when drinking in these places. As shown in section B of , it appears that dose-response is greatest when drinking in restaurants, pubs/nightclubs, and other contexts. Risks increased most in association with heavier drinking in these places. Combining these effects, and assuming an average drinking quantity of 3.79 drinks per occasion (), problem risks related to each context were 0.045 problems per drinking occasion at one's own home, 0.104 at others' homes, 0.129 at pubs/nightclubs, 0.132 at restaurants, and 0.109 in other contexts. Taking into account the very different quantities consumed in each context (), quantity adjusted risks were 0.043 at one's own home, 0.119 at others' homes, 0.166 at pubs/nightclubs, 0.060 at restaurants, and 0.102 in other contexts. Numbers of problems related to each occasion of drinking at pubs/nightclubs were on average 3.9 times as great as those which arose when drinking at one's own home. Since rates are estimated on a per occasion basis for a single average drinker, we can multiply out these estimates by annual frequencies of drinking in each place () and estimate the annual numbers of problems associated with drinking in each context per 1000 drinkers; these become 3,753 problems per year associated with drinking at home, 2,478 problems at others' homes, 3,339 problems at pubs / nightclubs, 690 at restaurants, and 2,657 at other contexts.

Sections C and D of present the estimated relationships of the lowered MPA with context-specific risks for alcohol related problems. With the exception of Symptoms of Dependence (G ²=9.17, df=10, p=n.s.), there were significant changes in context specific dose-response coinciding with the MPA change (G ²=27.45 to 40.42, df=10, p ≤ 0.002). Generally, significant effects were focused in two contexts, pubs/nightclubs and other contexts, for two classes of problems, Heavy Drinking and Felt Effects of Alcohol use. Rates of problems associated with drinking at pubs/nightclubs increased after the MPA change (section C), while the relationships to heavier drinking (section D) declined somewhat. This pattern was most notable for the measures of alcohol related disorder and felt effects of alcohol. Context specific risks related to drinking at pubs/nightclubs increased by a factor of 3.17 from 0.042 to 0.132 problems per drinking occasion. Dose-response decreased by a factor of 0.56 from 0.031 to 0.018. Since dose-response remained positive post-intervention, this translates to a greater than 3-fold increase in rates of problems per occasion associated with drinking at pubs / nightclubs at all drinking quantities. A similar pattern of effects was obtained with respect to other contexts for use, but with a non-significant increase in context specific risks following the MPA and a significant decrease in dose-response (by a factor of 0.45).

Supplementary analyses assessed whether context-specific dose-response changed among directly affected age groups. No significant post-law differences were found across age groups and contexts (G ²=16.76, df=20), or when separately examining effects among 18-19 year olds (G ²=2.14, df=10) and 16-17 year olds (G ²=14.82, df=10, p=0.038). Once again there were substantive and statistically significant relationships between demographic and economic covariates and alcohol related problems; these are presented in the web-only supplementary material.

DISCUSSION

The reduced MPA in New Zealand was related to increases in the proportion of 18-19 year old drinkers, frequencies with which this age group drank in different contexts, especially commercial contexts like pubs/nightclubs (rising an average of 15 occasions per year), and problem risks associated with drinking in these contexts. Among 16-17 year old drinkers, the lowered MPA was associated with more frequent drinking, greater drinking quantities, and more use in non-commercial social contexts. These increases appear to have countered any ameliorating effect of this group's shift away from the use of pubs/nightclubs (an average reduction of 12 occasions per year), with greater drinking frequencies and quantities associated with use in own homes (+22 occasions), others' homes (12 occasions), and other drinking contexts (+22 occasions). This shift to informal access may have also been related to the simultaneous policy change that strengthened photo age identification requirements and increasing penalties for sales to minors through commercial outlets. Importantly, contrary to the claims of advocates for the reduction in the MPA [ 11- 13], problem risks were not ameliorated by changes in drinking patterns or use of drinking contexts; newly of-age drinkers, like all drinkers, reported greater problem risks in association with drinking at bars after the MPA reduction; underage drinkers reported greater drinking and, perforce, problems associated with drinking in non-commercial social environments. From the perspective of protecting youth, the natural experiment posed by the MPA-reduction appears to have failed, presenting more drinking and more problems among 16-19 year olds.

With one important exception, problem rates associated with a given level of drinking in the different contexts remained largely unaffected by the MPA change, either for the population as a whole or among the directly affected age groups. Greater frequencies and quantities of alcohol used among 16-17 year olds thus translated directly into increases in numbers of problems. The greater frequencies but lower quantities consumed by 18-19 year olds in pubs/nightclubs represents the one drinking context that is the exception. There was a 5% increase in the proportion of drinkers among 18-19 year olds, and a corresponding increase in the average frequency of drinking at pubs/nightclubs (+15 occasions). This was accompanied by a decline in average drinking quantities in pubs/nightclubs (−1 drink) but, nevertheless, a 3-fold increase in problems per drinking occasion; evidently the small reduction in drinking quantity was far outweighed by the additional risks for problems that accrued among drinkers in these contexts. As other published work has indicated, drinkers who frequent bars generally drink greater average quantities, are more likely to take risks, exhibit low impulse control, and are likely to be embedded in friendship networks with other heavy drinkers [ 23]. Following the MPA reduction more young people drank in commercial settings and these places became, on the whole, settings where more alcohol related problems accrued.

As a final observation, the increase in drinking frequencies and decrease in drinking quantities observed in association with drinking in bars among 18-19 year drinkers may best be understood as a compositional effect: a large number of relatively new moderate-drinking 18-19 year old drinkers likely began to use pubs/nightclubs after the MPA was reduced. As a consequence the average quantities used in those contexts also decreased. For complementary reasons, average quantities correspondingly increased among 18-19 year olds drinking at home or others' homes (). In this case the lower costs of alcohol purchased off-premise, possibly for the purpose of preloading (drinking in unlicensed contexts before attending a licensed premise), may have led to greater use in these contexts [ 24].

This study clearly demonstrates how context-specific dose-response models provide one means of disentangling different social and behavioral effects related to the reduction in the New Zealand MPA. Following the lowered MPA more drinkers began to use alcohol, drank more frequently, drank greater quantities on average in some new environments, and experienced some additional risks related to drinking in those environments. The results of these analyses provide detailed support for previously demonstrated changes following the MPA change [ 5- 9]. They also show that the notion that commercial drinking venues provide safe drinking environments is quite likely erroneous [ 11- 13]. Overall, newly of-age youth shifted use away from one set of drinking venues with relatively moderate risks to another with more substantial risks. In this group, accounting for shifts in frequencies and quantities of use coincident with the MPA, annual numbers of problems related to drinking increased 7.5% across all contexts, rising most in pubs and nightclubs (35.3%) and decreasing most in other contexts (−18.8%). Underage youth generally increased their use of alcohol in non-commercial social contexts, presumably reflecting increased retail availability for their now of-age acquaintances.

Policy Implications

This study joins many others demonstrating that lowered MPAs are related to increased use and alcohol related problems. The current study goes on to identify specific licensed establishments, pubs/nightclubs, as being particularly utilized and high risk among the cohort of newly legal drinkers 18-19 years of age. It also goes on to demonstrate that increased frequencies and quantities of use among underage 16-17 year old drinkers are distributed across social venues in which there may be limited legal or social control over risky drinking behaviors (i.e., home, others' homes, and other contexts.) Certainly, greater regulation of alcohol sales through retail on-premise establishments can reduce problem risks associated with drinking in those contexts. This could be achieved through increases in beverage prices, especially least prices, reductions in outlet densities or hours and days of sale, provisions for responsible beverage service, and other policy options [ 25, 26]. However, efforts to extend regulatory control over problem alcohol use among underage (or young of-age) drinkers in social contexts is at a nascent stage. Social host laws attempt to regulate use of alcohol in private settings among underage drinkers (e.g., at parties sponsored by adults, [ 27]) and may help reduce underage drinking in private settings [ 28]. Nuisance regulations can limit the negative impacts of alcohol parties on neighborhoods and communities [ 29] and alcohol control policies and enforcement activities oriented toward adult use often have secondary benefits with respect to underage drinking [ 30]. The current study demonstrates that high-risk drinking contexts can be identified, thus informing and providing guidance to the development of context-specific preventive intervention strategies.

Limitations

The timing of the New Zealand national surveys were not ideal for analyzing impacts of the MPA reduction, with only one pre-intervention survey four years before the law took effect. Response rates declined across survey years, which could bias estimated MPA effects if non-responders drink differently. Furthermore, the impacts of the MPA reduction on population-wide drinking and problems after 1999 cannot be distinguished from those of related changes in other alcohol polices or economic changes that also occurred at that time (i.e., introduction of Sunday trading and beer for sale in grocery outlets [ 31]). This expansion in off-premise availability could explain the overall increases in drinking quantities and frequencies subsequently observed in 2000 and 2004, focused on drinking within the home (-). These concurrent policy changes could also serve to explain some of the temporal shifts seen in as greater risks were observed in other drinking contexts. However, regardless of the merit of these speculations, the increase in use of commercial outlets, especially bars, by the newly at-risk group of 18-19 year olds remains the clearest signal of an MPA effect. It is highly unlikely that either Sunday trading hours or greater alcohol availability through grocery stores should be specifically related to greater drinking at bars in this age group.

While the results show that risks for problems increased substantially at pubs/nightclubs, we cannot determine if this effect was related to these contexts or a change in the composition of people who chose to drink there; risk taking impulsive heavier drinkers appear to preferentially drink at pubs/nightclubs [ 23], so a shift in the composition of the pub/nightclub drinking population in this direction could explain this effect. Distinguishing the determinants of the selection of drinking contexts from the social and behavioral influences which affect drinking in those contexts is not possible within the limitations of neither the context-specific dose-response model, nor New Zealand national survey data. Specific micro-ecological studies of selection and influence are required for this purpose [ 32].

Supplementary Material

Revised supplement tables 1-4

Acknowledgements

Research for and preparation of this manuscript was supported by National Institute on Alcohol Abuse and Alcoholism (NIAAA) Research Grants No. R21-AA020633 and Center Grant No. P60-AA06282.

Footnotes

Authors report no conflicts of interest.

References

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Impacts of New Zealand's Lowered Minimum Purchase Age on Context-Specific Drinking and Related Risks

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The minimum purchase age (MPA) for alcohol in New Zealand (NZ) was reduced from 20 to 18 years in 1999. We assessed the degree to which this change was associated with alterations in uses of drinking contexts, drinking, and related problems.NZ National ...

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10th June 2011, Volume 124 Number 1335

Nick Wilson, Fiona Imlach Gunasekara, George Thomson

Alcohol presents a relatively complex policy problem, partly because there is a range of benefits and harms that accrue at individual, community and national levels. Nevertheless, national and local politicians are in a position to use laws and regulations to maintain the benefits of alcohol use while further reducing the harms. This year (as of April 2011) a Parliamentary Select Committee has been considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. ¹ The international context for this includes good evidence that interventions to reduce alcohol-related harm are cost-effective, ² and even cost-saving to government (e.g. alcohol taxation and advertising restrictions). 3,4

In an attempt to identify some of the major issues, we generated a very brief summary of benefits and harms of alcohol use in the Table below. These findings suggest to us that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts.

Given the issues raised in Table 1, we also suspect that politicians from different parts of the political spectrum might generally favour a shift towards stronger regulation and to higher alcohol taxes. For example, politicians on the "political right" may particularly favour reducing the cost to taxpayers from alcohol-related harm. They may also focus on protecting the rights of individuals who might be harmed by drinkers (e.g., particularly those harmed by alcohol-related violence, crime, and car crashes) and reducing the proportion of police resources used to deal with alcohol-related harm.

Politicians of the "political left" may particularly consider the overall societal benefits from enhanced alcohol regulation and the benefits to disadvantaged New Zealanders. Possibly the only political groupings to oppose any regulatory advances are those of the "far right" of the political spectrum, if they have an ideological opposition to all new government regulation. But even this grouping may be conflicted, if some members recognise that poorly regulated alcohol imposes an extra burden on taxpayers and imposes harms on non-drinkers, including children.

While major political perspectives are probably consistent with improved regulatory responses to reduce alcohol-related harm, the alcohol and retail industries will tend to oppose enhanced new regulatory or fiscal controls. Overall, these industries have historically voiced opposition to new measures that limit total sales and the size of the discount alcohol market (e.g., which appears to be used to attract shoppers to supermarkets in New Zealand). It is therefore critical for New Zealand politicians to consider industry arguments with appropriate scepticism, and to dispassionately weigh the benefits and harms of alcohol according to the evidence available.

Summary

The New Zealand Government is currently considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. To inform discussions we briefly summarise the benefits and harms of alcohol use in this country. The most substantive benefits to society are probably pleasure to users and economic benefits (largely to industry). The most substantive harms are probably those to mental and physical health, harm to society (e.g., from crime) and adverse net economic impacts. Overall the picture is suggestive that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts. The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.

Abstract

The New Zealand Government is currently considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. To inform discussions we briefly summarise the benefits and harms of alcohol use in this country. The most substantive benefits to society are probably pleasure to users and economic benefits (largely to industry). The most substantive harms are probably those to mental and physical health, harm to society (e.g. from crime) and adverse net economic impacts. Overall the picture is suggestive that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts. The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.

Author Information

Nick Wilson, Associate Professor; Fiona Imlach Gunasekara, Senior Research Fellow; George Thomson, Senior Research Fellow; Department of Public Health, University of Otago, Wellington

Correspondence

Dr Nick Wilson, Department of Public Health, University of Otago Wellington, PO Box 7343 Wellington South, New Zealand.

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

While we do not consider it a "competing interest", we note that two of the authors (FI and NW) have previously performed work on alcohol issues for health sector agencies. All the authors are regular/occasional alcohol consumers.

References

1. New Zealand Law Commission. Alcohol in Our Lives: Curbing the Harm (NZLC R114). Wellington: New Zealand Law Commission, 2010.http://www.lawcom.govt.nz/project/review-regulatory-framework-sale-and-supply-liquor/publication/report/2010/alcohol-our-lives

2. WHO Regional Office for Europe. Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. Copenhagen: WHO Regional Office for Europe, 2009. http://www.euro.who.int/document/E92823.pdf

3. Cobiac L, Vos T, Doran C, et al. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction. 2009;104:1646-1655.

4. Chisholm D, Rehm J, Van Ommeren M, et al. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol. 2004;65:782-93.

5. Stefano GB, Bianchi E, Guarna M, et al. Nicotine, alcohol and cocaine coupling to reward processes via endogenous morphine signaling: the dopamine-morphine hypothesis. Med Sci Monit. 2007;13:RA91-102.

6. Connor J, Gray A, Kypri K. Drinking history, current drinking and problematic sexual experiences among university students. Aust N Z J Public Health. 2010;34:487-94.

7. Cashell-Smith ML, Connor JL, Kypri K. Harmful effects of alcohol on sexual behaviour in a New Zealand university community. Drug Alcohol Rev. 2007;26:645-51.

8. Connor J, You R, Casswell S. Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand. N Z Med J. 2009;122:10-20.

9. Casswell S, You RQ, Huckle T. Alcohol's harm to others: reduced wellbeing and health status for those with heavy drinkers in their lives. Addiction. 2011;[E-publication 13 January].

10. Brien SE, Ronksley PE, Turner BJ, et al. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ. 2011;342:d636.

11. Ronksley PE, Brien SE, Turner BJ, et al. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.

12. Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373:2223-33.

13. Connor J, Broad J, Rehm J, et al. The burden of death, disease, and disability due to alcohol in New Zealand. N Z Med J. 2005;118:U1412.

14. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Geneva: The World Health Organization, 2009.

15. Rehm J, Baliunas D, Borges GLG, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105:817-843.

16. Schutze M, Boeing H, Pischon T, et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ.2011;342:d1584.

17. Humphrey G, Casswell S, Han DY. Alcohol and injury among attendees at a New Zealand emergency department. N Z Med J. 2003;116:U298.

18. Morton SMB, Atatoa Carr PE, Bandara DK, et al. Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Auckland: Growing Up in New Zealand, 2010.http://www.growingup.co.nz/media/12254/growing%20up%20in%20new%20zealand%20before%20we%20are%20born%20nov%202010.pdf

19. Connor J, Casswell S. The burden of road trauma due to other people's drinking. Accid Anal Prev. 2009;41:1099-103.

20. Ministry of Health. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health, 2008.http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health

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24. South G. Flying the flag for Kiwi wine. NZ Herald, 1 January 2010. http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=10618013

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The benefits and harms of alcohol use in New Zealand: what politicians might consider

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10th June 2011, Volume 124 Number 1335 Nick Wilson, Fiona Imlach Gunasekara, George Thomson Alcohol presents a relatively complex policy problem, partly because there is a range of benefits and harms that accrue at individual, community and national levels.

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Nigel Latta takes a serious look into our drinking culture.

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A NZ Health issue

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OPINION: Illegal drugs are unregulated drugs. No country in the world, through pleas for abstinence nor ratcheting up penalties, has been able to eradicate them.

Instead, we have chaos in the shadows. In the words of Chasing the Scream's Johann Hari, we have "unknown armed criminals selling unknown chemicals to unknown drug users".

Last week, 10 reportedly unrelated people were hospitalised in Christchurch after consuming synthetic cannabis. Around the same time, after public and official consultation, the justice select committee reported back to Parliament on National MP Simeon Brown's Psychoactive Substances (Increasing Penalty for Supply and Distribution) Amendment Bill.

Brown's bill would increase penalties for selling or supplying psychoactive substances to align with the penalty for Class C drugs in the Misuse of Drugs Act 1975 - meaning the maximum prison term would rise from two years to eight years.
READ MORE:
* In the war on synthetics, is anyone winning?
* Simeon Brown: 'Ensuring suppliers understand consequences'
* Helen Clark: The need to rethink drug policy
* Meth programme producing encouraging results
Sixty-eight per cent of submissions on the bill were in opposition to it, a large number aligning with the New Zealand Police Association suggestion that "we would like to see an emphasis on a holistic approach to dealing with these illicit substances - one which prioritises factors contributing to addiction." As has been reported multiple times from the frontlines, police are deeply aware that they will not be able to arrest their way out of the problem.

Those who supported Brown's Bill, such as the Manurewa Local Board - which Brown chaired prior to being elected to Parliament - noted, "The current penalty of two years is extremely disproportionate to the potential and actual harm being perpetuated in our communities."

In a broad brushstroke, those in support cited proportionality of punishment, whilst those in opposition called for a holistic response unanchored from criminalisation.

The issue with "proportional punishment" is twofold. First, it ignores the evidence reported by the justice select committee that "increasing penalties does not necessarily produce a corresponding deterrent effect".

Second, it operates within artificial boundaries by appealing to the pre-existing penalties for other drugs, which have demonstrably failed for nigh on half a century to reduce consumption or access, perpetuating a self-referencing failure. We cannot build a solution with broken tools. We need new tools.

The elephant in the House is the War on Drugs - increasing penalties on a hiding to nowhere - is an abject catastrophe. At this point in human history, criminalising people who use drugs falls squarely within the definition of 'virtue signalling': the conspicuous display of values through ostensible action providing zero meaningful outcomes.

But I'd argue it's worse than virtue signalling, because we have explicit evidence that it's not only not going to work, but it'll multiply harm by pushing the problem further into the shadows while sucking resources from genuine solutions. For those charged with representing our country and solving the problems of our time, knee-jerk criminalisation is delusion and self-aggrandising of the highest order; it's cowardice to act contrary to decades of research for sake of hollow rhetoric. All the while, people are literally dying.

Proponents of stronger penalties cite "how easy it is to get these drugs", neglecting to mention evidence from the likes of specialised academics Shore & Whariki Research Centre, who submitted on the bill that "experience from overseas is that increasing penalties for drug trafficking increases conviction and prison numbers while only having a minimal impact on drug prices and availability".

So too, while methamphetamine (P) carries the highest Class A penalty of life imprisonment, Ministry of Health data shows there's been no notable decrease in consumption in the last 10 years.

The chief coroner has provisionally linked 40-45 deaths in New Zealand in the past 12 months to synthetic cannabis. If past coroners' reports on "synnies" are anything to go by, these people are among our most vulnerable: often homeless, out of work, and/or having sought help. In a recent interview, Lifewise chief executive Moira Lawler provided vivid illustration of the issue: "[We] had one of our whānau arrested and charged with dealing and one of the things the police said that really stuck with me was that their unit was full of coins. You don't make your fortune dealing synthetics ... People use it because it's all they can afford."

So what if we walked the talk and treated drugs as a health issue?

That looks like expanding already existing, successful projects such as Te Ara Oranga, the collaboration undertaken by Northland DHB and police, focused on reducing methamphetamine demand by transferring resources into the health system.

We can act imminently. Health Minister David Clark is presently scrutinising a review of the Psychoactive Substances Act's efficacy, five years since implemented, and is statutorily required to release it "as soon as practicable". At the end of October, the Independent Mental Health and Addiction Inquiry will report back to Parliament. And for the past six months, I've been working with colleagues across the House to bring together a cross-party group on drug harm reduction.

I believe all politicians fundamentally want the same thing: safer communities, reduction in drug harm, and investment in solutions that actually work.

My challenge to fellow MPs is to be bold enough to look clearly at the failures of the past and boldly at the opportunities to fix a sensible and effective future in drug policy. So too, I challenge the media who report on us and the public who elected us to dig further than rhetoric, to investigate the evidence and raise the bar of expectations.

Let's swap fear for courage, and tackle the heart of drug (including alcohol) abuse and addiction problems - isolation, poverty, escapism, mental health, homelessness - with evidence and, God forbid, compassion.
* Chlöe Swarbrick is the Greens' spokesperson on drug law reform
- Stuff

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It's time we walked the talk on treating drugs as a health issue

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OPINION : Illegal drugs are unregulated drugs. No country in the world, through pleas for abstinence nor ratcheting up penalties, has been able to eradicate them. Instead, we have chaos in the shadows. In the words of Chasing the Scream's Johann Hari, we have "unknown armed criminals selling unknown chemicals to unknown drug users".

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This story was originally published on Saturday

Ross Bell has opened Pandora's Box. He should be happy.

He leads an organisation that has long campaigned for sensible, evidence-based policy and legislation around drugs.

The Government has responded with an early Christmas present. It's just passed legislation to create a market for medicinal cannabis, and is set to go further with the details and timing of a referendum on cannabis use, possibly to be held next year but more likely 2020.

That could pave the way for decriminalisation and possibly even legalise its consumption and sale, something the New Zealand Drug Foundation executive director and others have been advocating for many years.

READ MORE:
* Turning New Zealand's black market cannabis economy green
* How much could New Zealand earn from taxing legal cannabis?
* Cannabis could be sold by non-profits and funds fed back to community: Massey paper
* Peter Dunne says 'Class C' drugs like cannabis should be made legal and regulated

But Bell is a little anxious, even worried.

The foundation has produced a report to help inform the debate. Estimating the Impact of Drug Policy Options, produced in association with economist Shamubeel Eaqub's Sense Partners consultancy, will have industry and political insiders drooling.

The report states that a legalised and regulated cannabis industry could cultivate $450 million for the country. The Government could make up to $240m in tax revenue and also save many millions in reduced burdens on justice and policing.

Also, if much of that revenue were redirected to treatment and prevention through a more health-based regime, that could produce a net social benefit of $225m a year, including improved educational, employment and life outcomes.

It's a gift that keeps on giving: gangs are supposedly sidelined, the black market undermined, drug use becomes a health issue rather than a crime that permanently marks a life, and everyone makes a bit of green. What's not to like?

But the deeper Bell looks into the box, the more concerned he is.

He's wondering if an industry run by powerful corporates and sharp suits will be any better or safer than a market controlled by gang members in tinny houses. Others have similar concerns.

Bell recently visited North America. He toured boutique-style retail stores and busy factory floors.

Colorado threw the doors open in 2014, when it created the world's first regulated recreational marijuana regime. That followed its creation of a medicinal cannabis market four years earlier. At least 10 other states have since followed, and Canada legalised sales in October.

It's early days but the greatest beneficiaries have been big corporate players taking a largely commercial approach.

"We had a tour of a company called Tweed," says Bell. "They trade on the Canadian sharemarket as Canopy Group and the valuation right now is C$15 billion."

Canadian firm Tilray, considered a pioneer in the research, cultivation, production and distribution of cannabis, trades at about $100 a share on the Nasdaq.

"In Washington state, California and Canada, their regulatory models mean quite big players get involved and even if the jurisdiction has a scheme where they're trying to promote access to family operators or people with previous convictions, communities of colour, those folks who have been harmed by the drug war, even if they've got those schemes it does seem it's the corporate folks that dominate."

That's because it's only the larger businesses that can cope with the costs incurred from stringent quality controls, large-scale production and other burdens of the regulatory regime.

In Canada, other significant producers of medicinal and recreational cannabis include Aurora Cannabis, worth C$5b; and Aphria , valued at $2.1b.

And even bigger sharks are circling. Constellation Brands, the American drinks company that owns Corona beer, is investing $4b in the market, with plans to produce cannabis-based drinking products.

It's just the latest innovation inspired by a relentless drive to increase profit and market share in a new global business potentially worth many hundreds of billions of dollars, says Bell.

As part of that push, overseas markets have quickly graduated from the rolled-up joint passed around at parties to edibles, pills, vapours, suppositories, even lollies. New breeding techniques have tweaked and heightened potency as well, as part of a commercially driven campaign to grow a base of loyal, heavy users.

That's what makes Bell and many others nervous about what might happen in New Zealand.

They're seeing the development of a commercial model that mirrors the sale of other harmful, but legal, products like alcohol and tobacco.

Bell is particularly worried about the comparison with alcohol and its 80/20 rule, acknowledged in studies by the World Health Organisation and others.

To maintain profits and margins, alcohol companies need 20 per cent of their customers to consume 80 per cent of their product. They rely on that base of heavy users. The rest of us, mainly moderate users, are the froth on top.

Bell and others believe that is being followed in the cannabis market overseas and may become part of any future business model in New Zealand. "We would want to avoid that," he says. "Critics will say these guys are in it for the profit and the only way to make profit is by targeting that heavy use . . . encouraging that type of use.

"These are legitimate concerns, but actually what that means for New Zealand is that we don't need to be ignorant of this; we know that those kinds of commercial markets have that type of motivation."

But the signs don't look good here. "Our nervousness now is that four licences have been given out by the Ministry of Health for medical marijuana - cultivation licences - in anticipation that the medical cannabis law is changing," says Bell, "and of the four, three of them are new players who, I think, have money in their eyes."

That's of little concern to Peter Dunne.

The former minister of revenue and associate minister of health was responsible for the 2013 Psychoactive Substances Act, which established a regulated market for synthetic drugs. And he played a key role in advancing policy to create a similar market for cannabis-based medicines, before leaving politics in 2017.

That knowledge and experience will be invaluable in his new role, leading the advisory board at SETEK, a business working towards production and promotion of medicinal cannabis products.

"Certainly there are substantial amounts to be made and capacity for the government to derive significant amounts of revenue from a regulated cannabis market," says Dunne. "It's inevitable that if you have a regulated market there will be some people who will become very wealthy as a result of it.

"But you cannot have, in my view, an unregulated market, for the health reasons, for the issues; who takes control then? The gangs control production and distribution and they would simply intensify their stranglehold.

"The prospect of some people getting wealthy out of this is far outweighed by the potential to actually do something that is safe and proper."

Safe and proper includes greater state control of what is grown and how, the products produced and who benefits, says Dunne.

"The government, through its agencies, has better oversight of registered companies, certain tests that directors have to pass, a fit and proper person, all those sorts of things; they are better able to regulate any potential criminal activity than in the current situation."

And Dunne is comfortable about comparisons with the alcohol and tobacco markets. "People may not like it but the model by and large in both of those instances works and I can't see how you wouldn't want to adapt that to regulate a cannabis market."

Chris Wilkins and Lynette Hutson disagree strongly. They say both may be legal, regulated products but tobacco kills 5000 people a year and costs the healthcare system somewhere between $350m and $1.6b annually, while alcohol kills up to 1000 people and costs an estimated $5b in wider social harm.

Both have seen that for themselves: Associate Professor Wilkins leads the drug research team at Massey University's SHORE & Whariki Research Centre, and Hutson is the Salvation Army's national director of addiction services.

Wilkins can understand the enthusiasm for a regulated market: "Quality control over the cannabis produced, regulating pesticides and fertilisers used in cannabis cultivation; at the moment, as part of the illegal market, there are no controls over that."

But, like Bell, he too senses the circling of corporate sharks with little interest in mitigating social harm of the products they peddle.

"There's a lot of commercial and financial interests that can smell the money, because if you think about medicinal cannabis, that's worth about $100 billion worldwide, and that's going to be a small portion of the recreational market."

Like Bell, he too has watched developments overseas and is worried New Zealand might follow the same troublesome path.

"There's a whole lot of lobbyists talking to government about how many people we could employ, how much tax revenue we could earn, and that really is the wrong route to go down because, yeah, you'll make a lot of money and employ a few people, but also the taxpayer has to pay for all the social and health problems that would come from an out-of-control cannabis market," he says.

Colorado offers an interesting comparison, with a similar population size to New Zealand.

Figures from the state's Department of Revenue show the legal cannabis market was worth US$1.56b last year, up from $680m in 2014, with the state government collecting just under $250m in tax revenue, up from $68m.

Wilkins says it's early days but Colorado's regulated market has not eliminated the criminal element: "About 40 per cent of its cannabis is still coming from the black market . . . if you have an age-limit so no sales to anyone under 18, then there's going to be a whole bunch of people who are going to buy from the black market."

Results in other key areas are mixed.

There have been far fewer arrests and prosecutions since Colorado legalised the market (marijuana charges filed in courts fell 81 per cent between 2012 and 2015, from 10,340 to 1954), largely because of a greater focus on health and education.

Other figures show a small drop in property crime and little movement in violent offending.

The Denver Police Department has reported a small increase in marijuana-related traffic violations, but this has been attributed to a greater awareness since the law change. And it appears the jury is still out on the impact of cannabis use on driver impairment.

Fatalities with a link to marijuana use rose from from 55 in 2013 to 79 in 2014 but, again, authorities are reluctant to single out the drug as a primary cause.

One figure of concern is the rise in teenage visits to hospital.

A report presented at the 2017 Paediatric Academic Societies Meeting in San Francisco said visits to a Colorado children's hospital emergency department for cannabis-related issues quadrupled between 2005 and 2015, a year into the new regime, from 146 to 639.

Adolescents with symptoms of mental illness made up the biggest portion (66 per cent).

And general use of marijuana appears to have risen. The National Survey on Drug Use and Health reported that cannabis users made up 5.4 per cent of the Colorado population in 2006. In 2014 that had jumped to 12.4 per cent.

A 2017 survey by Yahoo News and Marist College put the number of regular marijuana users nationally at 35 million, or 14 per cent of adults in the US; 55m (22 per cent) admitted to trying it at least once or twice in the past year.

The Salvation Army's Hutson leads a team operating in 22 centres, from Kaitaia to Invercargill. She's more than a little concerned about those figures.

In the last financial year they helped more than 5500 people with a variety of addictions, from alcohol and drugs to gambling.

She sees merit in legislation that focuses more resources and funding on a health, rather than punitive justice, approach.

"We know from experience that the two areas that are under-funded are the after-care element, where you have quite a focused period of providing treatment in their life, and being able to follow that person back into the community," says Hutson, "and then the other bit, before you get to the chaos, using some of the sound, evidence-based approaches to a public health approach and prevention."

She agrees with Dunne that a market maintained by gangs and other criminal elements is unacceptable.

"But if you treat cannabis like alcohol, where it's promoted and advertised, that's a disastrous model," she says. "It would really be an equally harmful, if not more harmful, model."

The Salvation Army would be keen to be involved in a regime that increased funding for treatment and education.

But, like Bell and Wilkins, she wonders how much of any tax revenue or licensing derived from a possible cannabis market might actually end up funding treatment and education.

Much of the money from alcohol and tobacco makes it into the consolidated fund for general expenses; just 1.5 per cent of pokie machine profits is used to help problem gamblers.

"Treasury hate these tied taxes," says Bell, "but you could actually ignore Treasury advice, because I think the public would be 100 per cent behind all of the money going into prevention and treatment."

The former minister of revenue acknowledges the risk.

"The Government will certainly say that they will use the increased revenue to boost health and related funding, but they will be very reluctant to tie it specifically to that," says Dunne.

Wilkins believes that before anyone starts counting the money, the framing of both the referendum question and any subsequent legislation will be vital pointers to which path New Zealand takes.

It doesn't have to be a wholly commercial model; Uruguay's government controls the country's cannabis market, with sales through its pharmacies.

"There's at least 10 or more different options between the extremes of gang and corporate control that we could pick," he says.

These range from encouraging mum and pop community operations to establishing charitable trusts and other non-profit organisations with a social agenda.

Wilkins says one model could be a tweaked version of the country's alcohol licensing and pokie machine trusts.

"They would be required by law to give a percentage of all gross revenue, not profit but the actual every dollar you spend," he says. "Forty per cent would go back to the community where that dollar was spent, would pay for things like youth sport, cultural events and arts, but also drug prevention and treatment in your community.

"If you don't do that then it just goes towards Ferraris for cannabis growers."

Whatever the nation decides, it needs to think carefully.

"People think cannabis legalisation is easy and you'll get all of these benefits, but there's a long, rocky process to go through to make sure you've got the right regulation, and there's no guarantee that you'll get there," says Wilkins.

"We're going to have one shot to make sure there's a regulatory regime that is focused on health and the public good. And if they don't get it right then we're going to live with that for at least our lifetimes."

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Sharp suits v gang patches: The battle for NZ's legal cannabis market

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This story was originally published on Saturday Ross Bell has opened Pandora's Box. He should be happy. He leads an organisation that has long campaigned for sensible, evidence-based policy and legislation around drugs. The Government has responded with an early Christmas present.

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"Social Farter" PSA by Canadian Health Ministry - YouTube

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Otago University strategies for reducing alcohol harm

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Otago University strategies for reducing alcohol harm

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ideas
on how to reduce alcohol related harm

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A decade long study has revealed the drinking habits of New Zealand's university students.

The study commenced in 2004 and surveyed the amounts and ways students at Otago University were drinking. It also surveyed three control universities.

Ten years later, the student population was surveyed again - and the results are surprising.

The study, published in The International Journal of Environmental Research and Public Health has shown "overall, there has been a shift among Otago students to drinking less than weekly and across fewer locations."

"Intoxication was less prevalent over time among university students overall in New Zealand. The reduction [around a third] was large among Otago students."

The study says that research suggests "with concerted effort, it is possible to change a drinking culture".

This effort refers to the measures implemented by Otago University between 2006 and 2009 to try and prevent students getting drunk and disorderly.

Within those four years, the University amended their Code of Student Conduct, allowing them to expel students for disorderly behaviour on and off campus, banned alcohol advertising and sponsorship at University events and finally in 2010, bought half of the pubs closest to campus and converted them to study spaces and offices.

Researchers are proposing that the pub closures, as well as the reduction of the blood alcohol limit in 2014 have contributed to the decline in hazardous drinking at Otago.

"It seems likely that the actions of the university along with the reductions in pubs surrounding campus have helped to reduce hazardous drinking in the Otago student population."

Newshub.

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Ten year study shows that university students are drinking more safely

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A decade long study has revealed the drinking habits of New Zealand's university students. The study commenced in 2004 and surveyed the amounts and ways students at Otago University were drinking. It also surveyed three control universities. Ten years later, the student population was surveyed again - and the results are surprising.

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This is how Iceland turned its teenagers from heavy drinkers to model citizens.

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Police are going bar to bar in Christchurch, handing out pamphlets on drink-spiking after receiving a cluster of complaints.

The initiative comes as a 33-year-old man faces charges of stupefying two women - sexually assaulting one and trying to sexually assault the other - in July. The women, who knew each other, had been drinking at Mama Hooch on Colombo St, but the alleged offending happened at another inner city location.

Detective Senior Sergeant Scott Anderson said there had been an increase in drink-spiking reports over the last month.

Police officers handed pamphlets to people outside licensed premises in the city centre between 9pm and 2am last weekend.

READ MORE:
* Women allegedly drugged and sexually assaulted in central Chch
* Women 'stop a rape' after they witness man spiking his date's drink
* Marlborough bar workers call for vigilance following reports of drinks being spiked
* Drink-spiking not a myth - NZ experts

"Due to the increase in reporting ... it's about educating the community to be aware that this sort of thing could possibly be happening and be vigilant around their drinking when out in licensed premises," Anderson said.

The pamphlet warns people to buy their own drinks and be wary of accepting drinks from strangers or people they do not know well, including bar staff, "even if they seem really genuine".

"Keep an eye on your drink and your friends' drinks at all times - when dancing, going to the toilet or talking to other people.

"If your drink looks cloudy, or changes in colour/consistency, or doesn't taste right, don't drink it," it says.

Police advised people to keep any suspicious drinks for evidence and to tell the bar manager or police.

Anyone feeling drowsy or suddenly "out of it", should have a friend or someone they trust take them to a safe place, rather than hoping it will pass.

"If a friend is drunk, feeling sick, uncoordinated, confused or faint, stay with them. Don't leave them alone," the pamphlet says.

Anderson said police had not yet decided how long they would continue handing out the pamphlets.

Hospitality New Zealand business development manager Amy McLellan-Minty applauded police for "doing their bit around education with the bars".

"Drink-spiking may, unfortunately, be on the increase, which is disappointing and not something our organisation would ever condone," she said.

The association recently held sexual abuse prevention training seminars, which covered dealing with drink-spiking.

"Staff need to remain vigilant as they do for intoxication ... If there was ever an incident at one of our members' establishments we would encourage our members to work collaboratively with the police.

"If they [staff] see anyone acting suspiciously [they should] ask that person to leave and even go as far as looking back on their CCTV and, if anything is found, hand all the details to the police."

A Mama Hooch spokesman earlier said: "We're doing everything we can to help with the investigation."

The accused man, who has interim name suppression, first appeared in the Christchurch District Court on August 24. He was charged with unlawful sexual connection, attempted unlawful sexual connection, two counts of stupefying, and supplying, administering or dealing in ecstasy. He was granted bail. ​

WHERE TO GET HELP (SUPPLIED BY POLICE):

- New Zealand Police - there are police officers specially trained to work with sexual assault situations.

- Local hospital emergency centre - staff are used to dealing with all types of physical assault.

- Rape Prevention Education (09 360 4001) provides information for those affected by sexual violence. It also provides education and promotion/prevention activities.

- The Alcohol Drug Helpline (0800 787 787) can answer questions you have about the use of alcohol and other drugs. It can also provide interventions and tools to help you change.

- In an emergency call 111.

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Police spread advice pamphlets around Christchurch bars after drink-spiking complaints

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Police are going bar to bar in Christchurch, handing out pamphlets on drink-spiking after receiving a cluster of complaints. The initiative comes as a 33-year-old man faces charges of stupefying two women - sexually assaulting one and trying to sexually assault the other - in July.

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The world's most comprehensive study on alcohol consumption suggests there is no safe level of drinking, with any known health benefits outweighed by the adverse effects alcohol has on the body.

Alcohol has been found to be a leading risk factor for death and disease worldwide and is associated with nearly one in 10 deaths in people aged 15-49 years old, according to the new study, published on Friday in medical journal The Lancet.

The US-based authors, who combined 26 years of alcohol data from 195 countries including New Zealand, concluded that while there was evidence of some beneficial effects against heart disease, the risk of developing all other health problems increased with the number of alcoholic drinks consumed each day.

They estimated that, for one year, in people aged 15-95, drinking one alcoholic drink a day increased the risk of developing one of 23 alcohol-related health problems by 0.5 per cent compared with not drinking at all.
READ MORE:
* Alcohol should come with a health warning, argues expert
* Death of a chronic alcoholic: 'This can never happen again'
* Warning labels on alcohol could change New Zealand's 'ignorance'
That figure increased to seven per cent in people who drank two drinks a day, meaning 977 people in every 100,000 would develop an alcohol-related health problem. Drinking five drinks a day increased the statistic to 37 per cent.

Currently, New Zealand's Ministry of Health guidelines recommend that men drink no more than three standard units a day and no more than 15 standard units a week. Women's figures are two a day and 10 a week.

Drinking patterns varied globally with the highest number of current alcohol drinkers in Denmark - 95.3 per cent of women, and 97.1 per cent of men - while New Zealand had the fifth highest prevalence of female drinkers at 88 per cent. Kiwi men didn't feature in the top 10.

Lead author Dr Max Griswold from the University of Washington acknowledged that alcohol had a complex association with health, affecting it in multiple ways.

Regular consumption had adverse effects on organs while acute intoxication could lead to injuries or poisoning. There had, however, been previous research suggesting that low levels of consumption could have a protective effect against heart disease and diabetes.

"Previous studies have found a protective effect of alcohol on some conditions but we found that the combined health risks associated with alcohol increase with any amount of alcohol. The strong association between alcohol consumption and the risk of cancer, injuries and infectious diseases offset the protective effects for ischaemic heart disease in women in our study," Griswold said.

Globally, one in three people drink alcohol - equivalent to 2.4 billion people - including 25 per cent of women and 39 per cent of men.

While in 2016, drinking alcohol was the seventh leading risk factor for premature death and disease, in people aged 15-49 years old, alcohol was the leading risk factor, with almost four per cent of deaths in women and 12.2 per cent of deaths in men attributable to alcohol.

The main causes of alcohol-related deaths in this age group were tuberculosis, road injuries, and self-harm. For people over 50, cancers were a leading cause of alcohol-related death.

Co-author Emmanuela Gakidou, also from the University of Washington said alcohol could have dire ramifications for future population health in the absence of urgent policy action worldwide.

She suggested excise taxes on alcohol, controlling the physical availability of alcohol and the hours of sale, as well as controlling the advertising around alcohol.

- Stuff

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Experts conclude there's no 'safe' level of alcohol consumption after global study

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The world's most comprehensive study on alcohol consumption suggests there is no safe level of drinking, with any known health benefits outweighed by the adverse effects alcohol has on the body.

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Legalising cannabis has been given a cautious thumbs up from health and addiction experts as Kiwi voters face a binding referendum on the drug's criminality.

Several leaders within the sector see decriminalisation as "the best way of reducing harm" from the drug, as long as it is done correctly.

However, police and some in business sector are concerned more widespread availability will add to existing challenges they face.

Justice Minister Andrew Little acknowledged at Tuesday's announcement there "a bit of detail still to work through".

READ MORE:
* Cannabis reform advocates preach education over 'smoke-ups' outside Parliament
* Alcohol licensing trusts model looked at as option for cannabis regulation
* Growing number of Kiwis want cannabis law reform
* NZ First are on their own calling for a referendum on decriminalising cannabis

Canterbury medical officer of health Dr Alistair Humphrey said there would be "benefits and drawbacks" to legalising or decriminalising any drug.

His was a personal view, having run a methadone clinic in Australia for "many years".

"Legalising cannabis does not necessarily mean that cannabis use will go up. We don't know that yet," he said.

"But ... the use of the criminal justice system to deal with the problem will go down, obviously. At this stage, it's what is the context in which we want to manage the use of this drug, along with other drugs? I think a social and health context is a better context than putting people in jail."

Former National Addiction Centre (NAC) director Doug Sellman said legalising cannabis was "the best way of reducing harm" from it.

But that needed to be done through a regulated system that meant private companies could not make money from its sale.

"We need a regulated market through the Government so we undermine the black market," he said.

Dr Sue Bagshaw, director of 298 Youth Health, said a style of managing drug use similar to that of the Portuguese would be "ideal" for her.

According to the Drug Foundation, Portugal "massively" reformed its drug policy about two decades ago and has since become "a global leader of evidence-based policy [around drug use], grounded on the principle of harm reduction".

The country decriminalised drugs. More people were in treatment and there were fewer new cases of HIV as a result.

Bagshaw said cannabis "should be regulated, without a doubt", but making people criminals for using it was not the answer.

"We put a whole load of energy into punishment and law enforcement, but we put no energy whatsoever into why people use drugs in the first place."

Police Association president Chris Cahill welcomed the announcement coming "nice and early" so informed public debate could be had ahead of the referendum.

"We don't have a position on what the vote should be - police, obviously, will police what is decided - but we do think there needs to be a very good debate and that all the issues, and the implications of a 'yes' vote, are understood."

What it meant for any additional strain on mental health and addiction services needed to be discussed, as did what legalisation could mean for young people. Then there was "some practical stuff around policing", Cahill said.

How much people could have and how officers would police any excess needed to be worked through. Drug driving already posed challenges, he said.

"You can test positive for cannabis but is there an impairment? That's a challenge that already presents for employers now.

"Cannabis remains in your system for up to a fortnight but there's not necessarily any impairment."

On Tuesday, the mood on the streets of Christchurch was generally in support of legalisation.

Christchurch couple Arnika and David Macphail said the referendum would allow people to have an educated discussion on legalisation. It could also offer parents of sick children an alternative to pharmaceutical drugs.

"It would be nice if there wasn't a stigma of it being illegal so you can talk to your kids rather than them hiding it from you ... it would be out there in the open," David Macphail said.

Petros Chakwizira, 21, said he would like to see cannabis legalised as an alternative medicine, as long as it was regulated.

"I personally think they should be 18 or above or have a doctor's permission slip explaining a valid reason for treatment before they can be issued it."

University of Otago associate professor Dr Joseph Boden said the Government needed to be clear on the options available to people before the referendum.

The substance abuse researcher said people needed to know what sort of regulations would be in place before deciding whether or not to legalise.

"It's very important on the lead up to the referendum we present as much relevant and current information as possible, so people make a good and informed choice."

Boden said early research suggested legalising cannabis and cutting drug dealers from the equation could potentially remove any gateway properties usually associated with cannabis use.

Grey District Mayor Tony Kokshoorn was cautious about cannabis growing on the West Coast.

"We already have enough addictive substances around. So it could be an extra burden on our young people. We already have a major problem with drugs and employers have problems recruiting people because of drug detection."

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Health experts: Regulation key to proposed drug reform

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Legalising cannabis has been given a cautious thumbs up from health and addiction experts as Kiwi voters face a binding referendum on the drug's criminality. Several leaders within the sector see decriminalisation as "the best way of reducing harm" from the drug, as long as it is done correctly.

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Health Minister Dr David Clark wants synthetic cannabis reclassified to a Class A drug, alongside heroin and cocaine, so police can "go after the peddlers [and] interrupt the supply of them into the community".

His plea follows the death of a Christchurch man on Monday, believed to have died as a result of synthetic cannabis use, while 19 people were admitted to hospital in two weeks.

A decision on reclassification would be taken in the coming weeks, but Clark wanted to reassure New Zealanders the Government was taking the matter seriously.

"These drugs are killing people. We have health, police, customs and corrections all working closely on this," Clark said.

READ MORE:
* 'Ultrapotent', 'zombie' drug AMB-FUBINACA has come to town
* Synthetic cannabis: Why you should care
* Synthetic cannabis is this easy to buy
* Addict says she will smoke anything
* Child addict thought he was going to die
* Why are the drug laws failing?

"We are talking to service providers and drug users to identify areas of need and how we can reduce harm. We are also focusing in on community based initiatives, such as those operating in Porirua and the Far North that may be expanded."

It's important to acknowledge that reclassification is not a silver bullet. We need to treat drug abuse, including synthetic cannabis, as a health issue, he said.

* Have you been adversely affected by synthetic cannabis? newstips@stuff.co.nz

Earlier, a St John spokesman confirmed authorities were investigating the death, which was suspected to be synthetic drug-related.

A police spokeswoman said officers assisted ambulance staff when the man was found unconscious on the footpath on Mairehau Rd about 7.30pm on October 1.

"The death has been referred to the Coroner, who will ultimately rule on the cause of death," the spokeswoman said.

The death comes after the Canterbury District Health Board's warning on September 21, when 10 people were admitted to Christchurch Hospital in a 48-hour period.

A Canterbury District Health Board spokeswoman confirmed on Wednesday a further nine people had since been admitted to hospital, most were either unconscious or having seizures. Two remained in intensive care.

St John territory manager for Christchurch metro Craig Downing said on Wednesday there had been a "substantial" rise in the number of patients using synthetic drugs and the level of their aggression.

People using synthetic drugs were unpredictable and challenging to manage, he said.

"Our staff are getting exposed to patients who are acting out both physically and verbally."

Staff had to sedate some patients for their own safety and the safety of staff, he said.

"I'm extremely worried because we don't know, from one patient to the next, what's in this particular substance," he said.

"Our strong message is ... keep your hands off our ambos. They're not to be touched.

"We do our job because we care ... we're empathetic, we want to do the best we can, but that doesn't give anyone, irrespective of the case, a right to touch our staff."

Detective Inspector Greg Murton said people using the drug were taking chances with their lives.

He could not comment on the number of deaths related to synthetic drugs because the death or deaths were still before the Coroner.

Christchurch Hospital emergency specialist Dr Mark Gilbert earlier said the patients were from all over the city.

There was no safe level of the drug to smoke, Gilbert said. There seemed to be a "bad batch" in Christchurch.

"There's no doubt that if you're smoking this stuff you're gambling with your life.

"It destroys people's lives. They're unable to function at work, they're spending all their money on feeding their addiction so it essentially ruins their life."

Toxicology analysis identified the substance taken by the earlier patients as either AMB-FUBINACA or AB-FUBINACA.

AMB-FUBINACA has been linked to several deaths in the North Island during the past year.

Health Minister David Clark earlier said a review of the Psychoactive Substances Act was under "active consideration", and would be tabled in Parliament within weeks.

"One of the first things we did when we formed the Coalition Government was establish the Government Inquiry into Mental Health and Addiction, a powerful and broad inquiry that is looking directly at the problem of addiction and access to drugs like synthetic cannabis."

A decision on the possible reclassification of two synthetic cannabinoids as Class A controlled drugs would be taken in coming weeks, Clark said.

Reclassification under the Misuse of Drugs Act would give police broader search and seizure powers.

"It's important to acknowledge that reclassification is not a silver bullet. We need to treat drug abuse, including synthetic cannabis, as a health issue. That's why the Ministers of Health, Justice, Police and Customs are working together on this issue - to find real solutions."

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Health minister wants synthetic cannabis reclassified after Christchurch death

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Health Minister Dr David Clark wants synthetic cannabis reclassified to a Class A drug, alongside heroin and cocaine, so police can "go after the peddlers [and] interrupt the supply of them into the community". His plea follows the death of a Christchurch man on Monday, believed to have died as a result of synthetic cannabis use, while 19 people were admitted to hospital in two weeks.

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Caught in a cycle of guns, gangs, violence and meth addiction, she lost everything she ever cared about. Now she is rebuilding her life. This is Rachel's story. VICKI ANDERSON reports.
As she regains consciousness, she feels every grain of sand beneath her shivering body. Rachel*, 19, discovers her vision is hazy. She cannot tell from looking up at the sky if it is dawn or dusk. As the waves crash onto the shore nearby, gently ebbing and flowing with driftwood and other offerings from the sea, she wakes fully to realise her husband is raping her.

Wildly she searches the vast expanse of sand around her and sees an old man walking with a dog.

"Help me," she yells to him with all of her strength. "Help me."

But the old man doesn't stop. To do so would likely result in him being beaten too. She thought "I am gone".

READ MORE:
* 'It's right under your nose': Meth problem growing
* What happens when you become addicted to meth
* Police seize, cash, cars, and methamphetamine in

Their relationship had been abusive from the start. "For the first six months I got the best hidings of my life."

In the gang he was associated with, he had reached a high rank.

She recounts details of the beatings factually and with little emotion. Her face is pale but her voice is strong and doesn't falter. Her eyes go blank in the retelling.

At one point I am so shocked by what she is saying I gasp out loud and she is jolted back to the warm, airless room.

Rachel, now in her early 30s, is in hiding under police advice. She moves her hands back and forth on her knee as if she is rolling a cigarette.

"It is what it is," she says, looking me in the eye, tap, tap, tapping her leg where the imaginary tobacco should be.

"The last straw was when he chased me down the road with an axe."

Before that, police had been to their home "seven or eight times" on domestic violence callouts.

"There were a few public incidents too."

Her husband would assault her for having a shower without permission.

As he routinely beat and tortured her, she held her Bible tight, mentally beseeching God to rescue her.

"Eventually I lost faith in my faith."

LIFE ON THE STREET AT 13

Rachel grew up in Wellington with her mother, an "alcoholic".

At 13, one day she came home to find a note saying her mother had moved to Palmerston North with her new boyfriend.

Rachel began living on the streets.

"I started going to gang pads. Maybe I was trying to find a father figure? With the gangs I felt a false sense of security."

A pastor from a church "committed to classical evangelical Christianity" found her when she was 15. He took her into his home, where she lived alongside his children.

"He taught me how to look after myself, clean myself, he was an amazing man."

She became a youth group leader. Life was good for two years.

When she was 17, the pastor, who was doing ministry in prisons, took a man into his care.

"Long story short," says Rachel with a steely expression. "I get married to this man. He is 32 and I am 17. He is a senior gang member now.

"Because you have to be 18 to be legally married and I wasn't 18, he took me to Palmy and enticed my mum to sign the papers. He gave her a couple of boxes of alcohol and a vehicle that wasn't worth $2000 ... my mum was quite happy with that."

After he threatened to kill her with an axe, her husband was arrested and served time in prison.

Rachel wasn't the first woman he'd assaulted and raped. She knew she wouldn't be the last.

"I tell the church that I am going to testify against him. The church tells me to forgive and forget as I chose him as a life partner. I said 'I value my face, my teeth, I'm not going to be one of those girls who stays in these relationships, stick the church - see you later, I'm gone'."

While he is in prison, she serves him with divorce papers.

Eventually, she finds love with a "good" man. They have a daughter together and build a life.

"Then my ex-husband starts contacting me from inside prison," says Rachel. "I contact the prison and ask how he is doing that and he obviously has a smuggled cellphone...

"At the age of 20 I thought, 'I've got my daughter now, a lion has come out of me, no way ... I am not going to let him win'."

THE AUSSIE 'CRACK QUEEN'

She was working in the public sector during the day, and going home to smoke a methamphetamine (meth) pipe at night.

Describing herself as a "high-functioning meth addict" she says she "kept it under wraps."

When she talks about this part of her life, it is clear she cared about her work.

When contacted, none of her employers in the seven or eight years of her addiction problems had any idea she was on meth at work.

Looking back, she knows it was the breakdown of her relationship with her daughter's father in 2010 that ignited her drug addiction.

"I ended up in a new relationship. This person was accustomed to meth and this was the first time I tried it."

A year later, the couple moved to Australia and her addiction quickly escalated.

"In Australia meth, or ice as it's known over there, was a whole lot cheaper and easier to access. I became ill with the sickness of being addicted for a good eight months."

Rachel became associated with a high-rolling meth supplier in Brisbane she nicknamed the Crack Queen.

"She was selling high volumes of ice, there was a lot of money involved. Sometimes if she was not able to work out her bills with her suppliers they would threaten her with a boot ride - them taking her hostage and assaulting her. I would see her sleeping with her suppliers and she had quite a few suppliers."

When Rachel and her partner "had issues", she stayed with the Crack Queen.

"One night she told me she wanted a threesome. I ended up with five pipes and three cocktails in my room to entice me. I saw her for what she was. The loyalty is only to the meth."

Rachel jumped on a plane for a weekend visit to family in New Zealand.

"While I was in New Zealand the Crack Queen's house was raided and she ended up doing a big lag (time in prison). It really hit me then that I needed to clean up."

​The longest she stayed "up" without any sleep, high on meth, was eight days.

"When I was high I noticed my vision was going. Financially ... I was missing work so I stopped working."

She owned two properties in New Zealand, luxury cars and even a boat, but any money coming through for the mortgage was spent buying ice.

In 2013 "things were starting to pile up".

"I noticed I was becoming suicidal."

Rachel wanted to clean up her life for her daughter's sake.

"I thought 'I am going to clean up, get stable'. I got clean."

Her daughter moved to Australia and lived with her for just over a year.

Life was looking up. They moved home to New Zealand.

'HIGH ON METH' WORKING FOR ORANGA TAMARIKI

On her return, a much-needed job opportunity fell through. Rachel began self-medicating with marijuana and wrestled with depression.

"I then found another employment opportunity with Oranga Tamariki, working with youth in care aged 9-17."

She managed to hide her addiction while employed as a casual or fixed-term youth worker for the organisation, regularly working an early shift then going home to "smoke the pipe with the people". She was also dealing meth.

"Some of the kids had been taken from meth homes and here I was on meth looking after them."

By that stage Rachel's new relationship had deteriorated into emotional abuse.

"He was calling me a fat c..., that sort of thing, verbal abuse. My self-esteem was at an all-time low and I started using meth again."

She worked hard to hide her addiction from her colleagues. She felt embarrassed and ashamed. But no concerns were raised formally about her drug use or addiction.

"I thought I was doing a good job of hiding it. I was what you'd call a high-functioning addict."

Last year, if she was doing early shifts, she'd go home for a nap and catch up with friends.

"The pipe would come out," she says. "Sometimes I would not have slept for three days and I was working."

Her addiction grew.

"Before I knew it, I wasn't paying rent. All the money was going toward my addiction."

A q or "quarter" of meth cost $250.

"But often what happens in that crowd is you tee up with people, you put extra money together to get a bit more and then maybe you might sell to get some of your money back."

That was the pattern Rachel fell into.

"The types of people I got involved with were gang members, patched members, I was fortunate, I didn't want to become tied to any particular gang so I went across the board ... then I had boarders who were meth suppliers, so now my addiction becomes free. Go to work, come home, puff with the people."

She'd wake up to find "random strangers" wandering around her house.

"My house had opened up, had become known as a meth house. I was quite embarrassed about that considering my job. It came to a stage where I was like, 'no, enough, out' and I kicked my flatmates out. I could notice the types of people that were coming in were criminal, organised people ... and I felt quite vulnerable."

At the end of last year, in the midst of her addiction, her house was robbed three times.

As a high-functioning addict, she wants others who find themselves in this space to know that they should not hide their problems but speak up and get help.

"At that time I would never admit I was addicted to meth. Over that seven or eight-year period there were times when I wasn't using frequently and times when I was in the midst of my addiction. I'm so embarrassed about it but now I have come through it, I can be truthful about it."

People from all walks of life tried to score meth from her.

"It's in the high life of society too, the lawyers ... I had radiologists and gynaecologists asking me where to get some from ... Like myself, they hide it under the carpet because they are ashamed.

'CRYING ON THE END OF A PIPE'

Why meth?

"I smoked meth because it is easier to get meth than it is to find weed."

In a relationship with a gang member, and dealing meth herself, she observed the way meth united gangs.

"There is no rivalry in the gangs when it comes to meth," she says. "Cobras, Tribesmen, Mobsters... At the end of the day if they have got none they end up picking up some. I was involved with Black Power, Killer Beez, Mobsters, those were my go-tos. Often the Killer Beez would drop off meth to the Mobsters to help them start off again."

A gram of meth, at street value at top end, is $600.

"If you were closer to the cook or, say for the likes of higher-up gang members, it is $450 bottom end. A dollar bag, a point, is $80 in some places."

She's been clean for several months but has occasionally "slipped up".

When it happens, she confesses she ends up "crying on the end of a meth pipe".

When burning the pipe, she says, if it is yellow or brown it's been cut and isn't pure.

"Sometimes they might have added glucose or a bit of Ritalin in there to make the size heavier for the scales ... Meth, if it's pure, should come back clear, it should be a pillowy white. You should get a feijoa taste come back, then you know you're close to the pure."

She admits she's had some "funny-tasting" meth.

"Some tasted like battery acid, some tasted like perfumes... A meth user's game is to get close to the cook, the closer you can get to the cook the cheaper it is and the more pure it is, the further down the chain the more cut it is going to be."

Gang members are manufacturing meth themselves but they are also paying, and sharing, meth cooks.

"I know in a particular case a cook wasn't assigned to a gang but he had different gangs coming to him, paying him top dollar, to make the cook so he was cooking for a load of different gangs."

She recalls sitting in car in a driveway of one Wellington gang headquarters when, through the passenger window, she saw arch-rivals from another gang walking past the car.

"I thought 'shit, something is going to go down now'," she says. "But they were just there to buy meth."

Those in debt to the gangs have their cars or, as she'd seen in Wellington, their homes taken from them.

"Go to the police and you face a boot ride," she says. "I've seen that happen over a $3000 debt. I even saw one gang member stand aside watching another member of his own gang being brutally attacked by a rival gang. They were all on meth. Back in the days their culture would be to stick up for each other. It's different now, they're not even loyal to their own colours because of the meth."

Rachel doesn't call it meth or P, she calls it "demon".

"When it comes to gangs it doesn't matter what colour they are wearing, that's what I have seen. It is actually the same person, same demon but in a different colour. Regardless of the person, when it comes to meth I am dealing with that demon."

'PULL THE TRIGGER MATE'

New Year's Eve, 2018.

Rachel is getting a tattoo when one gang member starts talking to another in a language she doesn't understand. She cracks a joke asking what they are talking about.

One of the men produces a gun from "nowhere" and holds it to her throat..

She leans forward in her chair to show me how he held it. Her small frame is tense. But she's not frightened, she is still angry.

"I said 'pull a gun on me, then you pull the trigger mate'," she says. "He had it at my throat. I moved it to my head and held it there for ages. He was trying to take the gun away but I said 'you pull the trigger' but he didn't. He was testing me to see if I was afraid. In the midst of my addiction I hated myself anyway. I knew my daughter was safe, it didn't really matter if he pulled the trigger.

"But then we finished having a pipe and there was more to go around."

Known as a car enthusiast, the next day one of the gang members suggests she go with him to pick up a vehicle.

"He said 'Let's go for a spin, tell me what you think of the car', that's what it was."

The man then told Rachel he'd drop her home.

"We were heading towards my property when we got pulled over by police. He said 'I want to make a run'. I said 'no, you'll be right mate'. He said 'no, because of this bag' and he pointed at the bag in the backseat... I wish I had known what was in the bag and what he was carrying."

When police opened the bag they found firearms, ammunition, a sawn-off shotgun, a pistol and 11 rounds of ammunition, and "multiple grams of meth".

Now she's in hiding because the gang is trying to persuade her to take the rap.

It was the prompt she needed to "seriously lay the drugs down".

"It's cost me enough."

When she found herself in custody in January, surrounded by former colleagues she'd known and respected, she was "overcome with shame".

"That was my biggest turning point, 'have I come this low?' I lost face with even my colleagues. I hope they know I am innocent, just caught in a bad place at a bad time."

'REHAB 101'

Rachel says women on low incomes who are using meth are actively "targeted" by gangs and suppliers.

"It's degrading ... girls sleeping with men for the drug. Men saying 'if you want a root offer a quick pipe'. Some women have a weakness on the drug, they're quite happy to be involved in that and a part of me breaks for them. I had too much respect to walk that path but I saw it all the time. These women were mocked for their addiction... especially women on benefits when their money is restricted."

Now that she's cleaning up her life, she is in counselling. Telling her story is part of her cleansing. One day she might write a book. For now she wants to reach out to other addicts, especially women.

She has also reconnected with her mother.

"At first I was like 'I haven't needed you since I was 13, I don't need you now'. But now we are talking weekly and she is getting updates on how my counselling is going.

"In the midst of it I introduced meth to the closest people next to me, unfortunately my brother is now an addict, my cousin too. It hurts because I introduced it to them... Now they call my place Rehab 101."

She's been clean for more than six months but each day is a struggle.

"The hunger for it is always going to be there, I think. I get the taste in my mouth ... There is an odd occasion where it pops into my head, 'I can do with a puff'. If I wanted to I could have it in my hand in half an hour.

"The drug still has control. I'm powerless, helpless ... Unfortunately in the meth game it does end either in death, guns or you are looking at a lag."

One day she wants to use her experiences to help others walk a different path. She could have remained silent - her employers were unaware of her addiction - but she is doing the right thing and standing up. She wants other high-functioning addicts in positions of responsibility to know they should face their "demon", not live a double life as she did.

"That's another drive for me to why I'm speaking out. I want to try and save at least one woman from the grips of meth and becoming victims of the drug and the things that go with this meth life."

The next time I see Rachel she is standing on the street, cigarette in hand, talking to a friend, smoke wafting up around them. A woman is explaining her troubled relationship with a violent boyfriend.

"Girl, you need to just let him go," Rachel advises her definitively, arms raised Oprah Winfrey-style. "Let him go and look after you and your babies, that is the real gold."

WHERE TO GET HELP:

Alcohol Drug Helpline - 0800 787 797

1737, Need to talk? Free call or text 1737 any time for support from a trained counsellor

Lifeline - 0800 543 354 or (09) 5222 999 within Auckland

Youthline - 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat

Samaritans - 0800 726 666

Suicide Crisis Helpline - 0508 828 865 (0508 TAUTOKO)

What's Up - 0800 942 8787 (for 5-18 year olds). Phone counselling is available Monday to Friday, midday-11pm and weekends, 3pm-11pm. Online chat is available 7pm-10pm daily.

Kidsline - 0800 54 37 54 (0800 kidsline) for young people up to 18 years of age. Open 24/7.

thelowdown.co.nz - or email team@thelowdown.co.nz or free text 5626

Anxiety New Zealand - 0800 ANXIETY (0800 269 4389)

Supporting Families in Mental Illness - 0800 732 825.

Alcoholics Anonymous - 0800 AA WORKS, or aa.org.nz.

* Name changed to protect her identity.

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'Crying on a P pipe': Rachel's life on meth

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Caught in a cycle of guns, gangs, violence and meth addiction, she lost everything she ever cared about. Now she is rebuilding her life. This is Rachel's story. VICKI ANDERSON reports. As she regains consciousness, she feels every grain of sand beneath her shivering body. Rachel*, 19, discovers her vision is hazy.