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

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.

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Police use of referrals and warnings instead of prosecutions has increased since a 2019 law change, especially for methamphetamine. Source / Ministry of Health

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.

"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.

The impact of the 2019 law change has been different in each police district. Eastern has seen the lowest increase in the use of warnings and referrals instead of prosecutions for drug use.

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.

Police wastewater results show that about 90 per cent of drug use out of methamphetamine, cocaine and MDMA in the eastern Bay of Plenty is methamphetamine. Source / Police

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 MP Chlöe Swarbrick says the 46-year-old Misuse of Drugs Act makes a mockery of the Government's pledge to take a health-based approach to drug use. Photo / Dean Purcell

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."

Inspector Chris McLellan leads the police component of Te Ara Oranga in Northland, where he says it has made a huge difference to communities. Photo / Supplied

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.

Health Minister Andrew Little says access to and availability of alcohol and drug treatment services varies around the country. Photo / Mark Mitchell

"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."