Use of flavored cannabis vaping products in the US, Canada, Australia, and New Zealand: findings from the international cannabis policy study wave 4 (2021)

Background: Vaping is an increasingly popular mode of cannabis use. Few studies have characterized the role of flavors in cannabis e-liquids.Objectives: To explore the prevalence of flavored vaping liquids, including differences between countries and correlates of use.Methods: Data were from Wave 4 (2021) of the International Cannabis Policy Study with national samples aged 16-65 in Canada, the United States (US), Australia, and New Zealand. The sample comprised 52,938 respondents, including 6,265 who vaped cannabis e-liquids in the past 12-months (2,858 females, 3,407 males). Logistic regression models examined differences in the use of flavored e-liquids between countries and sociodemographic characteristics.Results: The prevalence of vaping cannabis e-liquids was highest in the US (15.3%) and Canada (10.7%) compared to Australia (4.0%) and New Zealand (3.7%). Among past 12-month cannabis consumers, 57.5% reported using flavored vaping liquids, 34.2% used unflavored vaping products and 8.3% did not know. People who vape in Australia were most likely to report using flavored liquids compared to New Zealand (OR = 2.29), Canada (OR = 3.14), and the US (OR = 3.14) (p < .05 for all). Fruit was the most reported vaping flavor (40.8%), followed by candy/dessert (20.4%) and vanilla (15.2%). Use of flavored vapes was greater among younger, ethnic minorities, female, higher education and income adequacy, and more frequent consumers (p < .05).Conclusion: Many cannabis consumers reported using flavored e-liquids, with highest levels among young people aged 16-35. Given the high prevalence of vaping in legal markets, regulators should consider the role of flavored vaping products in promoting cannabis use among this group.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Exploring Differences in Daily Vaping of Nicotine and Cannabis among People Who Use Drugs in New Zealand

Background: Little is known about daily vaping of different substances, particularly cannabis. Aim: To explore daily vaping of cannabis and nicotine products in a sample of people who use drugs in New Zealand. Method: The online New Zealand Drug Trends convenience survey (N = 23,500) was promoted to those aged 16+ via a targeted Facebook™ campaign, with 9,042 reporting vaping in the past six months. Multivariate logistic regression models were fitted to identify predictors of daily vaping of: (i) nicotine e-liquids, (ii) no-nicotine e-liquids, (iii) cannabis e-liquids/oils, (iv)cannabis herb. Results: Forty-two percent of past 6-month vapers used a vaporizing device "daily or near daily" (n = 3,508). Nicotine was most common substance used by daily vapers (96%), followed by dry herb cannabis (12%), no-nicotine e-liquids (10%) and cannabis e-liquid (6%). Daily vaping of no-nicotine e-liquids was associated with abstinence from tobacco use. Frequency of cannabis use was negatively correlated with daily vaping of nicotine liquids and positively correlated with daily vaping of no-nicotine and herbal cannabis. Younger age strongly predicted daily vaping of nicotine and no-nicotine liquids, but the reverse association was observed for daily vaping of herbal cannabis. Māori were less likely to daily vape cannabis herb than NZ Europeans. Daily vaping of both cannabis e-liquid and cannabis herb was associated with medicinal cannabis use. Conclusion: Daily vapers of nicotine and cannabis differed by several characteristics. Younger age group is at risk of daily vaping nicotine and non-nicotine, while herbal cannabis vaping is associated with older and medicinal use, suggesting a need for a nuanced vape policy response.

Cannabis Social Clubs in Contemporary Legalization Reforms: Talking Consumption Sites and Social Justice

There is ongoing debate about what policy approaches to cannabis use might best address health and social related harm. Profit-driven, adult-use cannabis markets have been introduced in the United States and Canada, where legalization reform has had mixed effects to date in terms of public health and has made limited progress in achieving social justice aims. Meanwhile, several jurisdictions have seen an organic evolution of alternative cannabis-supply regimes. Cannabis social clubs (CSCs), the focus of this commentary, are nonprofit cooperatives that supply cannabis to consumers with the goal of harm reduction. The peer and participatory aspects of CSCs may have positive effects on health-related outcomes of cannabis use, such as through encouraging the use of safer products and responsible use practices. The nonprofit objectives of CSCs may diminish the risk for increasing cannabis consumption in wider society. CSCs have recently made an important transition from grassroots organizations in Spain and elsewhere. In particular, they have become key players in top-down cannabis legalization reform in Uruguay and, most recently, Malta. The history of CSCs in reducing harm from cannabis use is an important advantage, but there might be concerns around the grassroots origins, low taxation opportunities, and capacity to sustain social objectives. Also, the CSC model might not seem unique, as contemporary cannabis entrepreneurs have absorbed some features of their community-based predecessors. CSCs can play an important role in future cannabis legalization reform due to their unique strengths as cannabis-consumption sites and can be effective in advancing social justice by giving people affected by cannabis prohibition agency and direct access to resources.

Lessons from the implementation of residential methamphetamine contamination policies in New Zealand

INTRODUCTION

Methamphetamine contamination of housing has been discussed as a significant issue in New Zealand. However, scientific evidence to determine a threshold level at which health harms occur is inconclusive, resulting in conflicting and changing guidance. The initial strong precautionary policy, with significant unintended impacts on vulnerable public housing tenants, dramatically changed following a scientific review. This study explores the policy response to residential methamphetamine contamination in New Zealand over the past decade.

METHODS

Thematic analysis of semi-structured interviews with 13 key stakeholders involved in policy development/implementation, including those from government, industry, residential housing and academic sectors.

RESULTS

Consistent application of a methamphetamine contamination threshold for housing has been problematic due to legislative and regulatory gaps. Stakeholders in the residential sector have been influenced by perceptions of methamphetamine contamination as a health risk, political views on drug use, media coverage and the testing industry's business practices. Public housing tenants have faced disadvantages when resolving methamphetamine contamination disputes. The testing industry's participation in committees shaping the regulatory response presents a possible conflict of interest. Wide media coverage heightened public anxiety about the problem but may also have stimulated policy changes to alleviate unintended consequences of the precautionary approach.

DISCUSSION AND CONCLUSIONS

New Zealand's fragmented policy response to residential methamphetamine contamination is likely rooted in the lack of scientific evidence, with some key actors further exacerbating the response. Future policy development should seek to produce overarching regulation that guides the whole sector while balancing powers of the stakeholders involved.

Legal sourcing of ten cannabis products in the Canadian cannabis market, 2019-2021: a repeat cross-sectional study

BACKGROUND

One of the objectives of cannabis legalization in Canada is to transition consumers from the illegal to the legal market. Little is known about how legal sourcing varies across different cannabis product types, provinces, and frequency of cannabis use.

METHODS

Data were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted annually from 2019 to 2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models estimated the association between legal sourcing ("all"/ "some"/ "none") of ten cannabis product types, province, and frequency of cannabis use over time.

RESULTS

The percentage of consumers who sourced "all" their cannabis products from legal sources in the past 12 months varied by product type, ranging from 49% of solid concentrate consumers to 82% of cannabis drink consumers in 2021. The percentage of consumers sourcing "all" their respective products legally was greater in 2021 than 2020 across all products. Legal sourcing varied by frequency of use: weekly or more frequent consumers were more likely to source "some" (versus "none") of their products legally versus less frequent consumers. Legal sourcing also varied by province, with a lower likelihood of legal sourcing in Québec of products whose legal sale was restricted (e.g., edibles).

CONCLUSION

Legal sourcing increased over time, demonstrating progress in the transition to the legal market for all products in the first three years of legalization in Canada. Legal sourcing was highest for drinks and oils and lowest for solid concentrates and hash.

Correction: The role of cannabis clinics in the health system: a qualitative study of physicians' views in New Zealand

An amendment to this paper has been published and can be accessed via the original article.

The role of cannabis clinics in the health system: a qualitative study of physicians' views in New Zealand

BACKGROUND

Privately-owned cannabis clinics have sprung up in many jurisdictions where medicinal cannabis has been legalised and provide an alternative pathway for patients who are unable or unwilling to access a prescription for cannabis-based medicinal products from their usual healthcare providers.

AIMS

This study aimed to explore physicians' views on cannabis clinics, including their perceptions of the role cannabis clinics play in the wider health system.

METHODS

A qualitative study using in-depth, semi-structured interviews with thirty-one physicians affiliated with private and community clinics in New Zealand (including cannabis clinicians, GPs, and specialist doctors). The interviews were conducted from July to December 2021. Data were transcribed and analysed using inductive thematic analysis.

RESULTS

Cannabis clinicians positioned themselves as (1) "service providers", facilitating consumer access to cannabis prescriptions and products, and (2) "educators", providing advice to patients and the wider physician community. While general practitioners and specialists recognised the benefits of specialised cannabis clinics (i.e., knowledge of products and a non-judgmental environment), they questioned the limited evidence of clinical efficacy for cannabis, potential financial conflicts of interests of cannabis clinicians that may blur their clinical judgement, and the risk of compartmentalising patients' healthcare.

CONCLUSIONS

Our paper raises a number of challenges with attempting to integrate cannabis clinics into the wider health system.

'Choice' of social media platform or encrypted messaging app to buy and sell illegal drugs

Social media is increasingly being utilized to facilitate the buying and selling of illegal drugs, particularly by young people. However, the range of social media and messaging platforms means people must make 'choices' around which platforms they will use to conduct drug transactions. Polymedia theory suggests that people use different media to manage their social relationships, 'choosing' appropriate channels or platforms based on platform features and the social context of the relationship. This paper uses polymedia theory to explore how buyers and sellers navigate platform 'choice' for drug trading, and how this bears similarities to the ways in which they move between different platforms in their daily lives. We conducted anonymous online interviews with thirty-three people who buy and/or sell drugs via social media and encrypted messaging apps in New Zealand to explore the factors shaping their selection of platforms for drug transactions. Our findings highlight the importance of the relationship between the buyer and seller in shaping how interviewees weighted the relative importance of platform security and convenience. Though more commercial drug sellers exercised considerable influence in directing buyers of drugs towards a given platform, this pattern was less characteristic of how platform 'choice' was navigated in contexts of drug supply between friends. In social supply contexts, platform 'choices' were often not explicitly made, but rather exchanges were channelled through platforms already in use within the social group. We highlight the tensions that arise between seller preferences for a more secure platform and buyer preferences for greater convenience in contexts of friendship. Our findings highlight the importance of understanding social media drug market engagement as shaped by broader patterns of social media engagement, and the distinctions between different social contexts and personal relationships, consistent with polymedia theory.

Professional Discipline for Vaccine Misinformation Posts on Social Media: Issues and Controversies for the Legal Profession

Misinformation has challenged the rollout of COVID-19 vaccination around the world. In 2021, professional bodies for several regulated occupations (including doctors and lawyers) initiated investigations into the conduct of members who engaged in vaccine misinformation, including on social media. This commentary discusses key controversies surrounding this novel disciplinary issue, with the focus on the legal profession in New Zealand and Australia. We consider the difficulties of defining "vaccine misinformation", differentiating between public and private social media use, giving proper scope to rights of free speech, and challenges in identifying financial conflicts of interest and unethical client solicitation practices (eg, profiting from spreading vaccine misinformation). The chilling effect upon freedom of expression when lawyers are disciplined for their social media posts that are deemed unscientific is discussed.

Measuring drug harm in New Zealand: a stocktake of current data sources

AIMS

The availability of legal and illegal drugs is widespread across New Zealand. All drugs have the potential to cause harm to those who use them, and to others. Understanding the nature and extent of these harms depends upon the ongoing and systematic collection of relevant data, which is crucial in achieving the current national policy goal of minimising drug harm. Thus, we aim to describe how information on drug harm is currently collected and measured in New Zealand.

METHODS

This article maps and evaluates harm data within New Zealand, explores data collection methods and timing, and identifies the substances and types of harm assessed to date. We review large and predominantly administrative datasets that provide a measure of harm, which are collected more than once and/or are updated periodically.

RESULTS

We highlight a number of key gaps and limitations that exist within the current data landscape, and outline barriers to ensuring greater utilisation. We recommend more frequent data collection, including improved data on harms to others, and inclusion of a wider range of drugs.

CONCLUSIONS

Implementation of these recommendations will improve the understanding of comprehensive drug harm in New Zealand, to guide effective local harm reduction policies and interventions.

Exploring the Adjudication of Methamphetamine-related Housing Contamination Cases in New Zealand

Residential methamphetamine contamination in New Zealand has resulted in substantial clean-up costs and evictions. Disputes between tenants and landlords have been adjudicated by the New Zealand Tenancy Tribunal (NZTT). However, the adjudication processes applied are not covered in specific legislation, and scientific advice and related regulatory standards have evolved over time, leading to uncertainty about the consistency of decisions. This study explores the factors that have influenced adjudicators' decisions by thematically analysing 685 NZTT orders from 2014 to 2019. Landlords filed 84% of applications and tenants were deemed liable for 96% of the NZ$2.8 million damages awarded. The Tribunal's decisions were unevenly influenced by baseline testing, presence of children, experience of health issues, police intervention, and neighbours' reports. Several factors contributed to inconsistent decisions, including the contamination threshold applied, sampling methodology, establishing liability for contamination, and assessing "cleanliness". This study suggests more judicial guidance and legislation is required to resolve these cases more equitably.

Criminal Convictions of Disciplined Health Practitioners in New Zealand

This study investigates the rates and types of criminal convictions encountered by New Zealand's Health Practitioners Disciplinary Tribunal (HPDT) over a 15-year period. Criminal convictions appeared in 24% (n = 101) of cases, with male practitioners (p < 0.01) and pharmacists (p < 0.05) being significantly over-represented. The most frequent types of convictions included crimes against rights of property (33.6%), sexual/morality/decency crimes (21.9%) and misuse of drugs (8.4%). Criminal behaviour settings were evenly split between personal and professional life for medical practitioners (56.5% professional life) and nurses (56.5% professional life) but disproportionately in professional life (85%) for pharmacists. Criminal conviction cases were significantly more likely to result in registration cancellation (p < 0.001) and practice suspensions (p < 0.05) when compared with non-criminal cases, although fewer fines were ordered (p < 0.001). Profession-specific risk factors, alongside how to rehabilitate members of the subgroup who may later seek to renew their practice are areas for further research, are discussed.

Policy influence and the legalized cannabis industry: learnings from other addictive consumption industries

BACKGROUND AND AIM

New Zealand has recently legalized medicinal cannabis and has explored the possibility of legalizing large-scale recreational cannabis supply. In the process, concerns have emerged regarding whether corporations involved in the large-scale production and sale of legalized cannabis will invest in tactics of influence with policymakers and the public. This paper aimed to examine the various ways a legalized cannabis industry could seek to influence governments and the public in the New Zealand reform context.

METHOD

Based on the study of industry tactics with alcohol, tobacco and gambling, we applied a three-chain model of industry influence that breaks tactics into the 'public good', 'knowledge' and 'political' chains.

RESULTS

Exploratory analysis of the nascent cannabis industry's activity in New Zealand provided signs of industry influence strategies related to all three chains. The medicinal cannabis industry has associated the establishment of a legal cannabis sector with regional economic development and employment, supported lobbying for recreational law reform, funded NGOs involved in lobbying for law reform, established research partnerships with universities, invited ex-politicians on advisory boards, and participated in government public sector partnerships.

CONCLUSION

There is emerging evidence that the legal cannabis industry is using strategies to influence the regulatory environment in New Zealand.

Predictors of voter support for the legalization of recreational cannabis use and supply via a national referendum

BACKGROUND

A national referendum to legalise recreational cannabis use and supply in New Zealand via the Cannabis Legalisation and Control Bill (CLCB) was recently narrowly defeated. Understanding the underlying factors for this result can inform the cannabis legalisation debate in other countries.

AIMS

To investigate predictors of voter support for and opposition to the CLCB.

METHOD

A representative population panel of 1,022 people completed an online survey of intended voting on the CLCB referendum, which included questions on demographics, drug use history, medicinal cannabis, perceptions of the health risk and moral views of cannabis use, political affiliation, religiosity, community size and reading of the CLCB. Regression models were developed to predict support for the CLCB, with additional predictor variables added over successive iterations.

RESULTS

The most robust predictors of support for the CLCB were use of and policy support for medicinal cannabis use, voting for a left-wing political party, having a positive moral view of cannabis use, living in a small town and having read the CLCB. Predictors of opposing the CLCB were voting for right-wing parties, considering "frequent" cannabis use to be a high health risk, and lifetime use of other drugs. Age, ethnicity, education, employment status, religiosity and lifetime cannabis use were not significant predictors after controlling for other variables.

CONCLUSIONS

Support for cannabis legalization was not based on broad demographics, but rather specific views concerning the medicinal benefit, morality of cannabis use, health risk of frequent cannabis use, political party affiliation, and knowledge of the proposed regulatory controls of the CLCB. The influence of moral views of cannabis use on voting behaviour suggest the need to debate the right to use cannabis. The importance of knowledge of the proposed regulatory controls of the CLCB on voting underlines the need to raise awareness of proposed regulatory controls during debate.

Predictors of using social media to purchase drugs in New Zealand: Findings from a large-scale online survey

BACKGROUND

There are increasing reports of social media being used to buy and sell illegal drugs internationally. Studies of social media drug markets to date have largely involved general explorations of social media drug transactions in select countries. Social media drug markets may operate differently for different drug types and in different country contexts.

AIMS

To identify predictors of the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA in New Zealand using a large-scale online survey sample.

METHODS

The annual New Zealand Drug Trends Survey (NZDTS), an online convenience survey promoted via targeted Facebook™ campaign, was completed by 23,500 respondents aged 16+. Logistic regression models were fitted to identify demographic, drug use and drug market predictors of reporting the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA.

RESULTS

Fifty-one percent of the sample had purchased cannabis, methamphetamine, ecstasy/MDMA or LSD in the past six months, of which 22% had done so via social media (n = 2,650). Cannabis was the drug type most purchased from social media among drug purchasers (24%), followed by ecstasy/MDMA (13%). Sixty percent of social media purchasers had used Facebook™, 48% Snapchat™, and 20% Instagram™. The leading advantages of social media purchasing were "high convenience" (74%), and "fast transaction speed" (43%). Younger age was a significant predictor of social media purchasing for all drug types (particularly among 16-17 year olds). Purchasing from someone identified as a "drug dealer" was a predictor of social media purchasing among respondents for all drug types.

CONCLUSION

Social media drug markets may have significant implications for drug purchasing by youth through providing greater access to supply and breaking down age-related barriers between social supply and commercial drug markets. Our findings highlight the importance of incorporating social media platforms into youth drug prevention and harm minimisation strategies.

Predictors of medicinal cannabis users' willingness to utilise a new prescription Medicinal Cannabis Scheme in New Zealand

AIM

To investigate medicinal cannabis users' intentions to transition to the new prescription Medicinal Cannabis Scheme (MCS) in New Zealand.

METHOD

An online survey of 3,634 past-year medicinal cannabis users completed prior to implementation of the MCS in New Zealand in April 2020. Logistic regression models were fitted to identify predictors of intended future engagement with the MCS.

RESULTS

Seventy-eight percent of respondents were aware of the new MCS and 66% intended to use it. Higher income (OR=1.57), younger age (OR=1.02) and smoking cannabis (v. vaping (OR=2.0) or oral ingestion in edible form (OR=2.22)) predicted intention to engage with the MCS. Conversely, Māori (OR=0.63) and those who grew their own cannabis (OR=0.52) were less likely to intend to engage with the new prescription MCS.

CONCLUSION

The lower intended engagement with the MCS by Māori, lower income groups and those who home-grow cannabis may reflect their perceptions of the MCS as restrictive and expensive.

Foreign investment in emerging legal medicinal cannabis markets: the Jamaica case study

INTRODUCTION

The establishment of a legal market for medicinal cannabis under the Dangerous Drugs Amendment Act 2015 has positioned Jamaica at the forefront of cannabis law reform in the developing world. Many local cannabis businesses have attracted investment from overseas, including from Canada, US and Europe.

AIM

To explore the opportunities and risks of foreign investment in an emerging domestic legal cannabis market in a developing country.

METHODS

Thematic analysis of semi-structured face-to-face interviews with 22 key informants (KIs) from the Jamaican government, local cannabis industry, academia and civil society, and field observations of legal and illegal cannabis cultivators.

RESULTS

KIs from the Jamaican public agencies and domestic cannabis entrepreneurs saw foreign investment as an essential source of capital to finance the start-up costs of legal cannabis businesses. Local cannabis entrepreneurs prioritised investors with the greatest financial resources, brand reputation and export networks. They also considered how allied an investor was with their business vision (e.g., organic cultivation, medical vs. recreational). The key benefits of partnering with a foreign investor included transfer of technical knowledge and financial capital, which enhanced production, quality assurance and seed-to-sale tracking. Some KIs expressed concern over investors' focus on increasing production efficiency and scale at the expense of funding research and development (R&D) and clinical trials. KIs from the local industry, government agencies and civil society highlighted the risks of 'predatory' shareholder agreements and domestic political interference. Concerns were raised about the impact of foreign investment on the diversity of the domestic cannabis sector in Jamaica, including the commitment to transition traditional illegal small-scale cannabis cultivators to the legal sector.

CONCLUSION

While foreign investment has facilitated the commercialisation of the cannabis sector in Jamaica, regulatory measures are also needed to protect the domestic industry and support the transition of small-scale illegal cultivators to the legal regime. Foreign investments may alter the economic, social and political determinants of health in transitioning from illegal to legal cannabis market economy.

Why did New Zealand's referendum to legalise recreational cannabis fail?

New Zealand recently held the world's first national referendum on cannabis legalisation involving a detailed bill to regulate retail sale and supply of cannabis for recreational (non-medical) adult use (i.e. the Cannabis Legalisation and Control Bill; CLCB). The referendum generated significant domestic debate and lobbying from both sides of the issue. The CLCB was narrowly defeated, with 48.4% voting to support versus 50.7% opposed. In this commentary, we discuss the referendum campaigns and other political and social factors that may have contributed to the result. Voting patterns appeared to largely follow traditional conservative-liberal, urban-rural and age divides. The referendum format created a public campaigning environment that encouraged persuasion and selective use of evidence rather than rational discussion of all the evidence and related knowledge gaps. The self-imposed neutrality of the centre left Labour Party and its popular leader may have been a decisive factor in the narrow defeat. It did not appear to be the case that anti-CLCB groups outspent the pro-CLCB movement in online promotional advertisements, and the leading digital media appeared largely neutral or mildly in favour of reform. The recent New Zealand experience illustrates the uncertainties of attempting to achieve cannabis law reform via a public referendum vote.

Assessing New Zealand's Cannabis Legalization and Control Bill: prospects and challenges

BACKGROUND

Few countries have developed detailed legislative proposals for legalizing cannabis. New Zealand recently released the Cannabis Legalization and Control Bill (CLCB) that will be the subject of a referendum in September 2020.

AIMS

To assess the CLCB, drawing on emerging evidence from cannabis legalization overseas, public health research on alcohol and tobacco and the attempt to establish a regulated market for 'legal highs' in New Zealand.

DISCUSSION

The CLCB proposes a strictly regulated commercial cannabis market that resembles the Canadian approach, but notably without on-line sales or regional heterogeneity in retail distribution. The objective of the CLCB of lowering cannabis use over time appears at odds with the largely commercial cannabis sector that will focus on expanding sales. The CLCB includes provision for home cultivation and social benefit operators, but it is not clear what priority these operators will receive. A potency cap of 15% tetrahydrocannabinol (THC) for cannabis plants is included, and this is at the high end of black-market cannabis. The proposed progressive product tax based on THC will be challenging to implement. There is no formal minimum price, but rather discretionary powers to raise the excise if the price drops too much. The CLCB includes a comprehensive ban on advertising, but non-conventional on-line promotion will be difficult to suppress. The central government cannabis authority is tasked with developing local retail outlet policies. We caution against the temptation to employ an interim regulatory regime following a positive referendum result, because a partially regulated market will expose users to health risks and undermine public support.

CONCLUSIONS

New Zealand's Cannabis Legalization and Control Bill's objective of reducing cannabis use via a commercial market will be challenging to achieve. The bill could be strengthened with formal minimum pricing, lower potency cap and greater clarity concerning social benefit operators and the role of local government.

Fifteen Years On: What Patterns Continue to Emerge from New Zealand's Health Practitioners Disciplinary Tribunal?

Disciplinary tribunals are deserving of review, in the interests of fairness, transparency and educational value for key stakeholders. New Zealand's Health Practitioners Disciplinary Tribunal (HPDT) determines whether registered health practitioners have engaged in misconduct that warrants discipline. The current study considers patterns regarding HPDT hearing processes and outcomes (2004-2020) (420 decisions), expanding knowledge from a previous analysis of HPDT decisions (2004-2014). The findings suggest that the HPDT has largely upheld its goal of consistency. However, shifts over time have included a reduced rate of appeals, and changing patterns for both the grounds for discipline and penalties applied. Differences in HPDT processes and penalties between medical practitioners, nurses and pharmacists were largely accounted for by the factors of practitioner attendance and legal representation at the hearing. This study contributes to understanding who transgresses, how they transgress and the penalties imposed. Such insights may be applied preventively for the benefit of all stakeholders.

Issues in the establishment of a therapeutic cannabis market under Jamaica's Dangerous Drugs Amendment Act 2015

INTRODUCTION

In 2015, Jamaica became the first Caribbean country to decriminalise personal cannabis possession, legalise home cultivation and establish a commercial therapeutic cannabis market via the passage of the Dangerous Drugs Amendment Act (DDAA).

AIM

To critically analyse implementation of the legal therapeutic cannabis market under the DDAA.

METHODS

Synthesis of findings from semi-structured face-to-face interviews with 22 key informants (KIs) from the government, industry, academia and NGO sector, unstructured interviews with illegal growers, and field observations of licensed and illegal operators.

RESULTS

KIs identified a number of challenges in implementing therapeutic market provisions under DDAA, including a limited buy-in from key government agencies; delays in developing a framework for quality assurance; and lack of access to banking services. Public sector actors stressed the challenges imposed by the UN drug conventions and need to maintain favourable diplomatic relationship with the US federal government, with the consequence of prioritising enforcement to prevent diversion and inversion. Implementation of the Alternative Development Programme in two traditional cannabis-growing communities experienced challenges with land titles and frictions in local communities. High compliance costs and limited skills to meet the envisioned medical standards presented barriers for traditional farmers. Many KIs conceptualised the purchasing of cannabis from the regulated market as "recreational" rather than medical, reflecting the marketing and limited information on medical applications at point of sale. Licensees' reliance on foreign investment puts local industry at risk of predatory shareholder agreements, but also provides needed investment and expertise.

CONCLUSION

External international factors (e.g. UN treaties, correspondent banking with the US) and conflicting domestic government agency visions for the reform played a significant role in the DDAA implementation. As cannabis law reform spreads beyond Western jurisdictions, consideration of pre-existing social, cultural and economic conditions of developing countries will be important.

Exploring medicinal use of cannabis in a time of policy change in New Zealand

AIMS

To explore patterns of medicinal cannabis use prior to implementation of the new Medicinal Cannabis Scheme (MCS) in New Zealand.

METHODS

An anonymous online convenience survey of 3,634 last-year medicinal users of cannabis promoted via Facebook™ from May to August 2019.

RESULTS

Fifty percent of the sample were female, 18% were Māori and the median age was 38 years. The medical conditions for which cannabis was most often used were pain (81%), sleep (66%) and mental health conditions (64%). Respondents perceived cannabis to be an effective therapy and reported reducing use of other pharmaceutical medicines. Fifty-two percent reported side effects from cannabis use, including increased appetite (29%), drowsiness (12%), eye irritation (11%), dependency (10%), memory impairment (10%) and lack of energy (9%). Smoking was the dominant route of administration. Nearly half (47%) had discussed their use of cannabis with a medical professional in the previous year, while 14% had requested a prescription and 5% accessed a prescribed cannabis-based product (mostly oral CBD).

CONCLUSION

Respondents self-medicated with cannabis to treat a wide range of health complaints. Only half discussed medicinal cannabis use with their medical professional, and a minority requested a prescription and used a prescribed cannabis-based product.

Determinants of the retail price of illegal drugs in New Zealand

INTRODUCTION

New Zealand has a number of unusual geographical features that may influence the price of illegal drugs including international isolation, numerous rural communities, and two separate islands (North and South Islands).

AIMS

(1) Collect data on the prices of different drug types from all regions of New Zealand; (2) Identify independent predictors of the reported prices.

METHOD

An online drug survey was promoted via a targeted Facebook™ campaign. A total of 6331 respondents completed the survey. Normal regression models were constructed to identify predictors of the reported price of an ounce of cannabis, gram of methamphetamine, pill of ecstasy and tab of LSD using demographics, drug use frequency, drug market indicators, region, community size, type of seller, and location of purchase as predictor variables.

RESULTS

Higher availability was a predicator of lower prices for cannabis (-3% per higher availability category), methamphetamine (-4%) and ecstasy (-5%). Those living in the North Island (-26%) and buying from gangs (-5%) paid lower prices for methamphetamine. Those living in rural communities reported higher prices for methamphetamine (+5%) but lower prices for cannabis (-3%). Daily cannabis users (+4%) and those on social welfare (+2%) paid higher prices for cannabis.

CONCLUSION

Lower prices for methamphetamine in the North Island may reflect the concentration of methamphetamine manufacture there. The fact that gangs offer lower prices for methamphetamine suggests they do not have monopoly control of this market. Gangs may be able to offer lower prices for methamphetamine due to scale of production/trafficking and lower risk of victimisation. Higher prices for methamphetamine in rural areas may reflect less competitive markets. Lower prices for cannabis in rural communities may be due to proximity to growing locations. Daily cannabis users and those on social welfare may be less able to delay their cannabis purchases to low price harvest months.

Breaches of New Zealand's Health and Disability Services Consumers' Rights: Human Rights Review Tribunal Decisions

This article illuminates New Zealand's legal response to breaches of rights within the health and disability services context. Alleged breaches of the Code of Health and Disability Services Consumers' Rights may be heard by the Human Rights Review Tribunal. The article describes this body's composition and powers, as well as patterns within the 44 relevant decisions published between 1 January 2002 and 30 June 2019. New Zealand's unique medico-legal system created a distinctive legal response to breaches of the rights of "consumers". The Tribunal decisions in this article relate to breaches of consumers' rights by both registered and unregistered providers. The research contributes to international scholarship regarding how justice is administered when consumers' rights are breached. Also, it contributes to international debates devoted to public protection and complaints resolution, through constructive critique.

Investigating the New Zealand policy response to methamphetamine-contaminated houses

The contamination of houses from clandestine methamphetamine manufacture emerged as an issue in New Zealand in the early 2000s. This perspective reviews and discusses the series of policies developed to address methamphetamine contamination in New Zealand houses over a 15-year period, ending with the reversal of the established policy approach in 2018. The policies addressing methamphetamine contamination of New Zealand properties were influenced by a range of sources including overseas scientific guidelines, local scientific reviews, public housing agency policies, and the local methamphetamine testing industry. A post-remediation methamphetamine level of 0.5 μg/100 cm² was initially implemented in 2010, leading to the termination of public housing tenancies, suspensions from the public housing list, and financial charges for decontamination on public housing tenants. Subsequent reviews of the policy led to some increase in the thresholds (up to 1.5-3.8 μg/100 cm² ) and the adoption of less punitive sanction processes. A scientific review in 2018 recommended a substantial threshold increase to 15 μg/100 cm² (a 30-fold increase on the 2010 standard), resulting in HNZ initiating a plan to compensate previously sanctioned tenants. Overreliance on the "precautionary principle"; strict interpretation of scientific guidelines; and the public housing agency's "zero tolerance approach" to drug use, contributed to an overly punitive policy approach to methamphetamine contamination in New Zealand that negatively impacted vulnerable public housing tenants, landlords, and property owners. Investigation into the extent that all possible influences had on the development of the policies, as well as the consequences of their implementation, should be undertaken.

"You have to make some money before you can do some good": Balancing the commercial, social and public health objectives in a "community enterprise" regulatory model for alcohol and cannabis

INTRODUCTION

New Zealand's alcohol licensing trusts are social enterprises that operate retail alcohol outlets in their districts and distribute profits back to the community. There have been calls for a similar "social enterprise" approach to legal cannabis sales. However, social enterprises face unique challenges in balancing commercial and social objectives.

AIM

To explore mechanisms that support the balancing of commercial, social and public health objectives in alcohol trusts and identify learnings for cannabis reform.

METHOD

Thematic analysis of interviews with 16 internal and external key informants (trust board members, trust retail managers, community activists, law enforcement) from two alcohol trust districts.

RESULTS

Key informants overwhelmingly conceptualised alcohol trusts as business entities, but commercial success was also seen as a means to help the community. Interviewees' perceptions of trusts' social mission ranged from simple "corporate social responsibility" to a "genuine" community orientation. Despite a near-monopolistic market position, forces within and outside the trusts create pressures to conform to standard commercial behaviour, including strategic placement of alcohol outlets. Participants attributed the potential public health benefits of the trusts to reduced density of alcohol retail outlets and ease of enforcement. The pragmatic political goal of maintaining a favourable public image (to secure survival of the trust and re-election of individual trustees) was the key mechanism balancing commercial and social objectives. Ethical dilemmas related to the sale of alcohol and conflicts of interest in allocating community funds were evident. Discord was "negotiated" with the community via the public discussion and voting, providing opportunity to correct mission drift.

CONCLUSIONS

The need to maintain a positive public image (to ensure favourable electoral results) was a key mechanism helping to balance the commercial and social goals of alcohol trusts. A community trust model for retail cannabis sales could similarly provide constraints on commercial behaviour while funding community services.

Consensual Sexual Relationships between Health Practitioners and Their Patients: An Analysis of Disciplinary Cases from New Zealand

Consensual sexual relationship between health practitioners and their patient are considered one of the most serious breaches of professional boundaries. Prevalence rates are difficult to establish since underreporting may occur, yet media attention may conflate the perception of prevalence. In this study we first reviewed the literature for risk factors for health practitioners and patients, professional standards, and responses of disciplinary bodies. Following this, we quantitatively summarised case characteristics and disciplinary outcomes from a 14-year cohort of New Zealand's Health Practitioners Disciplinary Tribunal proceedings. From the 26 cases identified, four themes were discussed in detail and illustrated with cases. These include: female practitioners working in correctional settings; zero tolerance but no registration repercussions; patient vulnerabilities when help-seeking for mental health issues; and the use of rehabilitative penalties. Despite the difficulties in conducting research on sexual boundary violations, this raises awareness, encourages proactive reporting, and inspires constructive strategies.

Teachers' Health, Wellbeing and Professional Misconduct. An Exploratory Analysis of Cases from New Zealand's Teachers Disciplinary Tribunal 2017-2018

Teachers' professional misconduct is rarely researched but of great public concern, given the potential impact upon students. Further, international concern has been expressed regarding teachers' wellbeing, including their working conditions. This study investigates the relationship between teachers' wellbeing and professional misconduct. We conducted a thematic analysis of disciplinary cases from the New Zealand Teachers Disciplinary Tribunal (NZTDT) between 2017 and 2018. Of the 41 disciplinary decisions from this period, 34 included references to teachers' health and wellbeing, including psychological stress at work and in their personal lives; psychiatric diagnoses; use of alcohol and other drugs; and emotional maturity. Breach of professional boundaries and inappropriate use of force were the leading reasons for discipline. The analysis illuminates a complex relationship between teachers' wellbeing and discipline, whereby diminished wellbeing may contribute to misconduct and be further affected by the disciplinary proceedings. Preventive strategies could include health-based interventions as part of professional development.

Understanding the development of a regulated market approach to new psychoactive substances (NPS) in New Zealand using Punctuated Equilibrium Theory

BACKGROUND AND AIMS

The short-lived regulated legal market for new psychoactive substances (NPS) in New Zealand marked a radical departure from the traditional prohibition-based approach to drugs. This paper aimed to enhance understanding of this policy change using Punctuated Equilibrium Theory (PET).

METHODS

The analysis draws on 3 years of evaluative research, including interviews with key stakeholders, analysis of legislation and policy documents and academic and grey literature.

RESULTS

The reframing of the NPS issue from one of drug control to the need for stricter market regulation was achieved by the efforts of strategic policy entrepreneurs, including the legal high industry, drug law reform advocates, influential politicians and an independent legal advisory institution. This reframing was aided by the perceived saliency of the NPS problem and ineffectiveness of previous prohibition-based responses. In the absence of any political opposition to the regulatory approach, the Psychoactive Substances Act rapidly progressed through the Parliament. However, once the interim legal market was established, portrayal of the issues shifted away from experts and lobbyists to critique from local communities, local government, animal rights activists and the media, who viewed the new regime as a source of social and health problems. The mobilization of criticism ('Schattschneider mobilization') drew on ideas of animal welfare and community safety. With a looming national election, the government responded by ending the interim market with the urgent passage of amendment legislation.

CONCLUSIONS

Punctuated Equilibrium Theory (PET) helps explain how New Zealand's Psychoactive Substances Act (PSA) policy first emerged on the political agenda and how the initial positive tone of expert support for reform shifted to a tide of popular criticism during the interim regime. However, with its emphasis on explaining agenda-setting, PET does not account for the legislative design shortcomings of the PSA.

Recent Trends in Alcohol and Other Drug Use Among Police Detainees in New Zealand, 2010-2015

BACKGROUND

New Zealand has unusual patterns of recreational substance use by international standards including low levels of cocaine and heroin use, and high methamphetamine use.

AIMS

This paper examines recent trends in alcohol and other drug use among police detainees in New Zealand over the past six years.

METHOD

The paper utilises data from the New Zealand Arrestee Drug Use Monitoring (NZ-ADUM) study. NZ-ADUM interviewed approximately 800 police detainees each year at four central city police watch houses (i.e. Whangarei, Auckland, Wellington, Christchurch) from 2010 to 2015.

RESULTS

The proportion of police detainees who had used methamphetamine in the previous year increased from 28% in 2012 to 36% in 2015. Drinking prior to arrest declined from 41% in 2013 to 28% in 2015. The use of cannabis in the past year declined slightly from 76% in 2011 to 69% in 2015. The proportion using ecstasy in the previous year steadily declined from 28% in 2011 to 19% in 2015. Only small minorities had recently used cocaine or an opioid. Use of methamphetamine and ecstasy increased in Christchurch.

CONCLUSION

Growing methamphetamine use is consistent with record seizures of methamphetamine over the past 2-3 years. Increasing drug use in Christchurch may reflect factors related to the devastating earthquakes in 2011 and the subsequent city rebuild, including an influx of construction workers, more organised trafficking groups and earthquake-related stress. The decline in cannabis use may be related to the emergence of 'legal' synthetic cannabinoids. The decline in ecstasy use may be the result of recent domestic enforcement operations and the overall global shortage of MDMA. The decline in alcohol drinking may be due to the introduction of pre-charge formal warnings for minor alcohol and disorder offences, and new restrictions on alcohol premise opening hours. Acknowledgements: The New Zealand Drug Use Monitoring (NZ-ADUM) research study is funded by the New Zealand Police and is conducted by SHORE and Whariki Research Centre, College of Health at Massey University, Auckland. We would like to thank New Zealand Police staff at Whangarei, Auckland Central, Wellington Central and Christchurch Central police watch houses for their assistance and cooperation with this research. We would also like to thank all the interviewers who worked with us on NZ-ADUM and all the police detainees who agreed to be interviewed for the study. The views expressed in this paper are entirely our own and do not necessarily reflect those of New Zealand Police.