Harm reduction

The sixth International Harm Reduction Day was marked on 7 May.

Harm reduction is an approach that recognises that most of us use substances in our lives at one stage or another and that simply stating don’t use them has not and will not stop use or the risks associated with substance use. At its simplest harm reduction is about ameliorating some of these risks through advice about how to use a substance more safely and providing resources to prevent harms. Harm reduction approaches in NZ are mainly apparent in our highly successful needle exchange programmes, which have for the past 30 years contributed to the very low prevalence of HIV in the injecting drug use community, 0.2% in NZ as opposed to 13% internationally. Other well-known harm reduction initiatives include ‘safer’ drinking (alcohol) guidelines, pill testing and vaping.

It is however timely to explore what other harm reduction strategies are available to us, especially in light of both the proposed amendments to the Misuse of Drugs Act (MODA) and the referendum on legalisation and regulation of cannabis use. 

The focus of the amendments to the MODA are a mix of making two synthetic cannabinoids Class A substances, and thus subject to harsher legal sanctions when supplying other people, and mandating Police to use discretion regarding prosecuting people who use substances, not just synthetic cannabinoids, and taking a health stance, ie referral to treatment, with them in the first instance. The proposed amendments follow the deaths of over 50 people who have used synthetic cannabinoids in the last two years. 

The recommendation for the Police to take a health approach to substance use and not prosecuting people for simple possession for personal use when it is in the ‘public interest’ is welcome and to be applauded.

The recommendation for the Police to take a health approach to substance use and not prosecuting people for simple possession for personal use when it is in the ‘public interest’ is welcome and to be applauded. One of the major harms associated with substance use, apart from alcohol, tobacco, is the risk and consequences of a criminal conviction. Also, it is likely that most people who come to the attention of the Police where substance use is apparent are likely to have potential substance use issues and addressing this though treatment and support has the potential to reduce harm. For these reasons the amendment is a harm reduction approach. However it does beg the question about where people will be able to access addiction treatment as anecdotally most services in NZ report that they are working at and beyond full capacity. 

Making these two synthetic cannabinoids (5F-ADB and AMB-FUBINACA) Class A substances is sadly a reflection of the failure of the MODA to protect the most vulnerable in society.  Most people who have died have been homeless, vulnerable and/or disadvantaged, and have been further exploited by people who did not have the knowledge to ensure that the amount of synthetic cannabinoid they added to plant material for smoking was safe. Because these substances are not regulated, apart from being illegal to possess or use, there is no quality control in place to ensure that people consuming synthetic cannabinoids are not poisoned or even are aware of what they are taking. 

This lack of quality control is true for all substances that are not regulated. When we, as adults over the age of 18, purchase a bottle of wine from the supermarket, we know the alcohol content and the number of standard drinks it contains. This information is clearly marked on the label and we are able to make our own decisions about how many standard drinks we consume at any one time reduce the risks of harm. These decisions can be informed by the harm reduction messages about ‘safer’ drinking levels that the Health promotion Agency promotes. 

The referendum on legalising use of cannabis offers us the opportunity to develop a coherent harm reduction strategy to address some of the risks associated with cannabis use that the current law does not allow. Under the proposed regulations associated with legalisation of personal cannabis use when people, adults over the age of 20, purchase cannabis from a licensed supplier they will know the potency of what they are buying in both smokable and edible forms and will be able to judge for themselves how much is safe to use at any one time, hopefully informed by similar ‘safer’ use messages.