Imagine a future in which we were able to successfully tackle methamphetamine harm in New Zealand.
Imagine Aotearoa coming up with its own uniquely local solution to methamphetamine harm, and forging a path as it successfully did with the creation of the needle exchange scheme in the 1980s to prevent HIV transmission, and the recent world-first legalisation of drug checking.
An evaluation of a ground-breaking methamphetamine programme in Northland, Te Ara Oranga, shows that this is indeed possible, with proper funding and a nationwide roll-out of the approach.
The programme is a collaborative effort of Police, the District Health Board, iwi health providers and the community. It is likened to the 'Portugal' model, or put simply is more of a 'health-based' approach to methamphetamine.
The partners have worked to reduce demand, not just supply. Help is more accessible, and the objective is to give it within 48 hours of referral to anyone who needs it. Collaboration has seen partners change their mindset, take on new approaches and work towards shared goals.
The evaluation wraps evidence around the programme's innovation with extremely promising results. The effort has reduced criminality for those referred by 34 per cent. The return on investment is estimated in the range of $3.04 to $7.14 for every dollar spent. The approach is worth every penny.
Approximately 1 per cent of New Zealanders use methamphetamine, with an even smaller number using it regularly. Use impacts a range of people, but harm caused by its sale and use is particularly severe among Māori, Pacific people, and those living in areas of socio-economic deprivation.
These are also the groups most likely to want help but not receive it.
One wonders why the important evaluation of the Northland programme was quietly released two days before Christmas with no accompanying promises of a funding injection for expanding this proven initiative?
While it has been near impossible to get cross-party support for drug policy in New Zealand to date, this homegrown innovation in Northland has enjoyed exactly that.
Te Ara Oranga was launched by the last National Government and has enjoyed ongoing support from National in opposition.
The current Government made extending the programme an election promise, and Health Minister Andrew Little recently announced that it would be rolled out in the Bay of Plenty.
The Greens have also been supportive. Outside Parliament, civil society organisations like the NZ Drug Foundation have repeatedly called for increased funding and a nationwide roll out of Te Ara Oranga.
Perhaps the evaluation was quietly put up on a website without fanfare because, aside from the announced Bay of Plenty extension, the programme has yet to be allocated the priority and funding required for a nationwide rollout.
Or perhaps its quiet release was because of some of the more cutting-edge proposals made by the report's authors.
Firstly, they say that to drive demand for methamphetamine down, we need to work to reduce the stigma attached to people who are using the drug, as that can contribute to someone delaying getting help for several years.
But even more bravely, off the back of describing the sophisticated criminal business model driving methamphetamine supply the evaluation's authors suggest trialling something that might remove the teeth from organised crime's business model – in effect a substitution programme as has long been available here for opiates with 'methadone'.
Close to 3 decades ago, Switzerland implemented a similar substitution approach with heroin.
That was hugely successful, resulting in a massive drop in a number of adverse health impacts, including HIV transmission.
Given that methamphetamine treatment often results in a huge improvement in wellbeing and reduced use, although doesn't necessarily result in complete abstinence, we should make space for this idea to be explored further.
It would surely be better to trial tightly controlled supply to those who are using the drug, rather than leave supply to organised crime which has no incentive to drive use down.
Stigma and our inherited 'war on drugs' thinking, however, make this conversation hard to have.
Ultimately there are a lot of issues vying for the public purse and airtime, not least of them COVID-19.
But if anything, COVID-19's impact has hit this group of people harder than many others, and last year gave COVID-19 a way into the wider community.
Policy solutions around drug issues almost never have the widespread political support which Te Ara Oranga has had. We have a programme here that can make a huge difference and is uniquely homegrown.
The Government has some important choices to make about how to take it forward.
• Helen Clark is a former Prime Minister of New Zealand, the chairperson of the Global Commission on Drug Policy and the patron of the Helen Clark Foundation.