In an article published today in the New Zealand Medical Journal, Sally Casswell, of Massey University, and Benedikt Fischer of the University of Auckland, comment on the four substance use-related recommendations in the inquiry’s report.

Casswell and Fischer praise the inquiry’s consideration of substance use issues, which are “fundamentally connected” with mental health.

“Substance use and mental health disorders are strongly associated and commonly co-occur (‘dual diagnosis’) especially in those individuals with severe problems,” the article says.

Casswell and Fischer also applaud the inquiry’s focus on upstream alcohol use intervention, noting the necessity of strengthened supply and marketing controls to reduce alcohol-related harm.

The authors call the recommendations around the reform of control of personal drug use “important and well-advised,” but urges for there to be “thoughtful consideration of various challenges and potential pitfalls.”

Casswell and Fischer call for the diversification of available modes of treatment, improvements regarding service access, especially in rural and remote areas, and an urgent expansion of culturally sensitive and appropriate services, given “the disproportionate experience of problematic substance use among Māori.”

“Progress on this front is primarily a matter of committed governmental resource provision and delivery,” the article says.

The authors note that a shift in the control of personal drug use from criminalisation to a health-centred approach will require law reform, namely of the Misuse of Drugs Act 1975. Casswell and Fischer advocate for an evidence-based approach, with consideration of international examples.

They warn against un-intended negative consequences of policy adjustments in this area, such as the undue provision of discretion to criminal justice authorities, to which disadvantaged segments of society are frequently the victim.

The article also points out that some people who end up in the clutches of the criminal justice system do not require, or else will not benefit from treatment, rendering options like mandatory treatment orders or diversion schemes inappropriate, or “a double-edged sword”. Rather, the authors say these alternatives should be applied on “solid case-by-case assessments.”

Casswell and Fischer note that ‘criminalisation’ of those with substance use problems primarily occurs through related criminal behaviours rather than directly through substance use offences, and that substance use is often driven by factors like poverty or lack of housing. Addressing these factors requires systemic and upstream, rather than downstream interventions.

The authors also note the Inquiry’s silence on drug supply, a key driver of problematic substance use facing potential further complications by the recreational cannabis referendum. The authors say regarding impending cannabis legislation, that use and supply regulations should be meaningfully coordinated with corresponding regulations for other drugs like alcohol and tobacco.

Ultimately, Casswell and Fischer urge stakeholders to continue to hold the government to account on implementing the recommendations. The inquiry presented its report in November 2018. The Government has accepted, accepted in principle or agreed to further consideration of 38 of the 40 recommendations.

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