The Price of everything The Value of Nothing: A (Truly) External Review Of BERL’s Study Of Harmful Alcohol and Drug Use

In March 2009, Business and Economic Research Limited ("BERL") published “Costs of Harmful Alcohol and Other Drug Use,” a report jointly commissioned by the Ministry of Health and ACC. BERL was asked to measure the costs of drug and alcohol abuse to New Zealand society, but not to evaluate specific interventions. BERL calculated annual social costs of alcohol and illicit drug consumption of $6.8 billion, including$4.8 billion in social costs from alcohol alone. The report was cited by Law Commission President Sir Geoffrey Palmer as evidence in support of greater regulation, gaining considerable media coverage. We find substantial flaws in BERL’s method that together account for well over 90% of BERL’s calculated costs of alcohol use. Corrected external costs of alcohol use amount to $662 million and are roughly matched by the$516 million collected in alcohol excise taxes. The BERL report is wholly inadequate for use in assisting policy development.costs and benefits of alcohol usage; alcohol policy; New Zealand; adequacy of consultancy reports

Monograph no. 13: Scoping the potential uses of systems thinking in developing policy on illicit drugs.

This monograph (No. 13) summarises pilot work to scope the potential uses of systems thinking for developing illicit drug policy. Systems approaches have the potential to offer much to drug policy analysis through their use of participatory methods, capacity to deal with multiple simultaneous policy options, and appreciation of the complexity, interconnectedness and dynamic feedback loops associated with policy decisions. The monograph outlines six systems approaches used by the New Zealand team in exploring illicit drug policy. The results of in-depth interviews with five experienced policy makers and a demonstration project around a policy issue are described. The potential utility of systems approaches in illicit drug policy are demonstrated

Towards a transparent, credible, evidence-based decision-making process of new drug listing on the Hong Kong Hospital Authority Drug Formulary: challenges and suggestions

The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms

Monograph No. 13: Scoping the potential uses of systems thinking in developing policy on illcit drugs

This monograph (No. 13) summarises pilot work to scope the potential uses of systems thinking for developing illicit drug policy. Systems approaches have the potential to offer much to drug policy analysis through their use of participatory methods, capacity to deal with multiple simultaneous policy options, and appreciation of the complexity, interconnectedness and dynamic feedback loops associated with policy decisions. The monograph outlines six systems approaches used by the New Zealand team in exploring illicit drug policy. The results of in-depth interviews with five experienced policy makers and a demonstration project around a policy issue are described. The potential utility of systems approaches in illicit drug policy are demonstrated

A Bitter Pill to Swallow: Portugal's Lessons For Drug Law Reform in New Zealand

On 1 July 2001, Portugal decriminalised all drugs, replacing criminal sanctions with administrative ones. Portugal's decriminalisation policy focused on individual possession and use of drugs. It was thought that possession and use would be best dealt with outside of the criminal process. In New Zealand, the Law Commission is revisiting the Misuse of Drugs Act 1975. The author seeks to analyse the first two terms of reference: whether the legislative regime should reflect the principle of harm minimisation underpinning the National Drug Policy; and the most suitable model or models for the control of drugs. This paper examines the principles around the criminalisation of possession and use of drugs. In particular, it examines the experience of Portugal, some eight years after decriminalisation. It is argued that New Zealand should adopt a policy of harm minimisation and that the model Portugal presents ought to be seriously considered as a possibility for New Zealand reform

Divergent spender: State‐societal and meso‐organisational mechanisms in the containment of public spending on pharmaceuticals in a liberal capitalist democracy

For two decades, New Zealand has been placed consistently at the foot of OECD rankings for state expenditure on pharmaceuticals. In this article, we explore New Zealand's containment of pharmaceutical spending as a ‘divergent’ case of pharmaceutical policy in a liberal democracy. To elucidate the likely institutional mechanisms and interests behind this phenomenon, we conducted a case study of New Zealand's drug reimbursement policy. In doing so, we derived sensitising concepts from major accounts of pharmaceutical policymaking (Corporate Bias Theories and Reputational Theory) and theories of the western state (Historical Institutionalism and Corporate Domination Theory). Drawing on 28 expert interviews and documentary analysis, we identified three main mechanisms of spending containment. First, New Zealand's state bureaucracy use pricing strategies that rely on a spending containment strategy coordinated by bureaucratic managers. Second, these managers shape the policy preferences of expert committees involved in scientific drug assessment. Third, on a meta-level, conditions for spending containment are enabled by the judicial-legislative arena. As such, we find support for Historical Institutionalism and Reputational Theory and more limited support for Corporate Bias Theory and Corporate Domination Theory. Our explanation posits further conceptual linkages between the macro/societal and meso-organisational theoretical levels

A critical analysis of New Zealand's Psychoactive Substances Act 2013 and its implementation process : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Albany, New Zealand

Listed in 2017 Dean's List of Exceptional ThesesIntroduction: In July 2013, the New Zealand Parliament passed the Psychoactive Substances Act (PSA), the world’s first law to regulate the availability of new psychoactive substances (NPS, “legal highs”, LH). Under the “interim PSA regime” 47 products were permitted to be sold subject to new retail and other regulations. In May 2014, the Government abruptly ended the interim regime following public protests. This thesis aims to critically evaluate the PSA and its implementation. Methods: A mixed methods approach combined qualitative and quantitative methods of data collection and analysis. Legal analysis of the PSA and related legislation, and content analysis of parliamentary debates and public submissions were completed. Semi-structured interviews were then conducted with key informants (KI) including politicians, government officials, health professionals, and LH industry actors (n=30). Questions about health perceptions and social acceptability of approved products were added to an annual survey of police arrestees (n=834). Analyses of primary data included thematic analysis of interview transcripts and statistical analysis of data from the arrestee survey. Results: The legal definition of “psychoactive substance” (s. 8, 9(1) PSA) overlaps with other regulatory regimes (e.g. medicines, dietary supplements) resulting in an unclear legal status for some products. Interviewed KIs identified a number of issues with the “interim regime”, including the safety of interim products, speed and efficiency of withdrawing problem products, the lack of regulations on price and retail opening hours, slowness of developing regulations for the full PSA regime, and the effectiveness of communicating the new policy to stakeholders and the public. As the market commercialised, the LH industry adopted business and lobbying strategies previously attributed to the alcohol and tobacco sectors, including targeting vulnerable customers. Surveyed police arrestees considered approved synthetic cannabis (SC) products higher health risk and less socially acceptable than alcohol, tobacco and many illegal drugs, reflecting problems with interim product approvals. The ban on animal testing of prospective products is likely to prevent further implementation of the PSA, unless a new political consensus is achieved. Conclusions: The issues experienced during PSA implementation highlight the significant challenges of establishing a legal market for psychoactive products. The time, resources and planning required to successfully implement the PSA may have been underestimated

Doctor or drug dealer? International legal provisions for the legitimate handling of drugs of abuse

© The Author(s) 2020. The final, definitive version of this paper has been published in: Gallagher, C. T., Atik, S. K., Isse, L., & Mann, S. K. (2020). Doctor or drug dealer? International legal provisions for the legitimate handling of drugs of abuse. Drug Science, Policy and Law. by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/2050324519900070In this paper, we compare how five jurisdictions (the USA; UK; Canada; New Zealand; and Australia) balance the disparate objectives of preventing the misuse of drugs to the detriment of society and allowing their legal for societally-beneficial purposes. The statutory law underpinning each country’s method of categorising drugs depict distinctive outlooks from the different jurisdictions, as each works towards these same goals. In examining how each country’s legislation deals with controlled substances, initial consideration will be given to whether drugs are categorised once only, or twice: once for dealing with their criminal misuse; and again for ensuring their safe medicinal use. In effectively dealing with criminal activities associated with drugs of abuse, Australia’s system of imposing penalties based on the quantity of a drug possessed, rather than on its grouping with other drugs of a broadly similar type offers the most flexibility. In terms of managing the legitimate use of such drugs, however, it is perhaps the least flexible of the four jurisdictions operating parallel systems of categorisation. The greatest level of flexibility is offered by Canada and the UK, which have functionally very similar protocols in this respect.Peer reviewedFinal Accepted Versio

The history of drug crime and policy in New Zealand.

New Zealanders are among the world’s highest consumers of a number of illicit substances. This, however, has not always been the case. There was a time when there was no use of drugs in this country. It is often thought that prior to European contact, Māori were one of the few societies that did not partake in the recreational use of drugs. This thesis aims to provide a comprehensive outline of New Zealand’s history of drugs. Tracing how New Zealand went from being a country with no drug use, to one where drug use is frequent. It investigates the social and political responses to drugs and highlights how these have emerged and shifted over time. The conclusions of this thesis were drawn from an extensive review of academic literature, reports from relevant departments, and legislation and other government papers. Thematic analysis of these documents was used to detail the primary themes that have been exhibited throughout New Zealand’s history of drugs. This analysis found two themes to be particularly evident. The first being the influence of international drug control policy on the local response to drugs, and the other being the punitive nature in which issues related to drugs have been dealt with in New Zealand. The role that these themes have had in developing and shaping drug policy in New Zealand will be examined in this thesis

Mass incarceration: the juggernaut of American penal expansionism

A plethora of evidence confirms that America continues to lead the world in imprisonment. No serious commentator doubts mass incarceration is a major issue for the nation. The America penal industrial complex incarcerates close to a quarter of all the prisoners on the planet. The American rate of incarceration remains stubbornly locked at a substantially higher level than those of comparable parliamentary democracies. There is no doubt that America’s penal institutions contain some individuals who pose a substantial public risk. However, there is significant scope to limit incarceration for a range of offenders, including those convicted of drug offences. There is a recognition the decades-long ‘War on Drugs’ has ultimately been counterproductive. At the end of 2014, some six years into Obama’s presidency, the USA’s total incarcerated population included some 2,306,100 prisoners It is only now that the United States may be witnessing the end of an ill-starred forty year experiment with mass incarceration and that American penal expansionism has finally begun to ease. The overall picture is of a pause, and even a slight reverse, in the race to incarcerate.non