We cannot afford to turn our back on what works

For more than 25 years I have worked alongside people experiencing homelessness, poverty, mental health challenges and substance use issues, both in New Zealand and the United Kingdom. During that time, one belief has become stronger than ever. If we genuinely want to reduce the harm caused by substance use, we must respond through a health framework rather than a criminal justice framework.

I deliberately say substance use rather than addiction because they are not the same thing.Every one of us sits somewhere on a continuum. At one end is abstinence. At the other is dependence. Most people fall somewhere in between. Yet too often we focus our services almost exclusively on addiction, when there are many people experiencing harm from substance use long before dependency develops.

Addiction describes physical or psychological dependence. Substance use is broader than that. Someone may never become dependent but still experience significant harm depending on the circumstances. Context is everything. A person who has an occasional drink in a social setting is in a very different situation from someone who drinks before flying a commercial aircraft. Frequency alone does not define harm.

Harm and support

In my work at the Auckland City Mission - Te Tāpui Atawhai, I regularly meet people whose lives are being affected by alcohol or other drugs, regardless of whether they meet a formal definition of addiction. What matters is the harm they are experiencing and the support they need. Unfortunately, our systems have often approached these issues through the lens of criminal justice.

Having worked extensively in correctional environments in both New Zealand and the UK, I have seen the consequences of that approach. Too many people enter the courts and prison system when the underlying issues driving their behaviour are fundamentally health issues. Their support needs remain unmet while the justice system attempts to deal with the consequences. That approach rarely produces better outcomes.

Evidence based

The evidence consistently points towards health-based interventions reducing harm more effectively than punishment alone. When we support people to address their substance use, we also reduce many of the wider impacts affecting their lives, including housing instability, poor health and ongoing interaction with the justice system.

Equity dimension

There is also an important equity dimension. We know Māori are disproportionately represented throughout our criminal justice system. That over-representation extends into substance use-related offending. If we are serious about improving equity, then we need to ensure our responses are grounded in health rather than criminalisation. The inverse is also true. It's difficult for people to meaningfully address substance use issues when the social determinants of health are unmet.

The overseas conundrum

Recently I had the opportunity to visit Canada while attending the Global Leadership Exchange. Alongside the conference itself, I met with organisations supporting people experiencing homelessness and substance-related harm in Vancouver and Toronto. What I saw has stayed with me.

Canada continues to grapple with a devastating opioid epidemic. Walking through parts of Vancouver, I encountered large numbers of people openly using fentanyl in public spaces. Many were experiencing profound health complications. It was immediately obvious how severely substance use was affecting every aspect of their lives, including their ability to maintain housing, relationships and physical wellbeing.

Even after decades working in this sector, I found it confronting.

Constant crisis mode

The people working on the frontline described operating in constant crisis mode. Much of their effort is devoted simply to keeping people alive. At the same time, they are trying to navigate increasingly difficult public and political conversations about how best to respond.

Canada attempted to introduce aspects of decriminalisation, drawing on evidence from overseas, including Portugal. The intention was to respond to substance use as a health issue rather than relying solely on criminal sanctions. From my conversations with policymakers and practitioners, however, the implementation fell short.

Four essential pillars

They spoke about four essential pillars that needed to work together:

Prevention
Treatment
Harm reduction
Enforcement.

While some elements progressed, there was insufficient emphasis on helping people move towards treatment and support.

As a result, public confidence weakened, political support declined and much of the discussion shifted away from evidence towards frustration.

Consequences

Evidence-based interventions, including safer consumption sites, have been scaled back in some areas. In Toronto, the number of safer consumption sites has reduced dramatically. Those working directly with affected communities told me they are now seeing increased overdoses, more overdose deaths and growing mistrust between people using substances and the services that have historically supported them.

A lesson for us all

For me, that is one of the most important lessons New Zealand can learn.The problem was not simply the idea of a health-led response. The problem was poor implementation.When implementation fails, public confidence suffers, regardless of what the evidence says.

That creates an environment where it becomes much harder to have rational conversations about effective policy because people understandably point to what they have seen rather than what the evidence demonstrates. New Zealand should pay close attention to that lesson.

We already have many evidence-based interventions that help reduce harm. We should never assume those interventions are permanently secure simply because they exist today.We have to continue advocating for them. Recent debates around tobacco policy demonstrate how quickly evidence-based public health approaches can be revisited or reversed. Progress should never be taken for granted.

Here's what I think we need to be mindful of

We need to continue building the evidence
We need to continue explaining why particular approaches work
We need to be prepared for political environments that shift over time and ensure the evidence remains available when opportunities for change arise.

Above all, we should not lose confidence in responding to substance use as a health issue simply because another jurisdiction struggled with implementation.

I remain optimistic

Despite what I witnessed, I returned home with a genuine sense of optimism. Travelling overseas reminded me that New Zealand has much to be proud of.

We have a sector that collaborates. We have strong relationships across organisations. We are willing to have open conversations about complex issues. While there is always more work to do, we are not facing the scale of crisis currently confronting parts of Canada.

That should give us confidence, but not complacency.

My hope is that we continue

Continue protecting what already works
Continue strengthening the evidence behind our decisions
Continue advocating for health-led responses that place people, rather than punishment, at the centre of our thinking.

We should never wait for a crisis before recognising the value of the systems we already have.

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