Wagner NickySUBSTANCE ADDICTION (COMPULSORY ASSESSMENT AND TREATMENT) BILLThird ReadingHon NICKY WAGNER (Associate Minister of Health) on behalf of the Hon Peter Dunne (Associate Minister of Health): I move That the Substance Addiction (Compulsory Assessment and Treatment) Bill be now read a third time. I am pleased to see that the bill has now reached this stage in its progress. The change to the legislation is long overdue. People with addictions have formerly been regarded as criminals or at least less deserving of health services than other members of New Zealand society. Our approach to treatment has tended towards the punitive and people with addictions are often subject to considerable stigma and discrimination.The cohort of people who will come within the scope of the new legislation are people who are very unwell. They repeatedly present at emergency departments with a range of serious medical conditions. They are often unreported victims of offences have chronic medical conditions are often estranged from their family and whānau. It is not an exaggeration to say that without treatment we are looking at a group of people who are suffering significant hardship and for whom serious illness and death are likely.The current legislation governing compulsory treatment for addiction namely the Alcoholism and Drug Addiction Act 1966 is focused on detention rather than on comprehensive treatment and recovery. Furthermore people detained under the Act do not have recourse to the same avenues of appeal and rights protection as those provided for people undergoing compulsory treatment for mental disorder. Most people with an addiction cannot and should not be forced to undergo treatment against their will. Indeed the imposition of compulsory treatment can be ineffective. People who abuse alcohol or drugs including those who have an addiction will for the most part choose to engage in treatment when they are ready to do so. On a related topic those of my colleagues who have tried to stop smoking will know that it might take several attempts and it is about a range of social and personal dynamics rather than simply abstaining from a particular substance.To detain people without their consent is a decision that should never be taken lightly. In 2010 the Law Commission considered whether New Zealand needs to have legislation governing the compulsory treatment of people with substance addiction and concluded that such legislation was necessary but it should be narrow in focus. The conclusions reached by the Law Commission were reflected in the bill. Those conclusions include the need for compulsory treatment to be applied only to people who have severe substance addiction and have severely impaired capacity to consent to the treatment for that addiction the need for treatment to be applied for a limited period of time the importance of the protection of rights of patients and the preference for compulsory treatment to be an option of the last resort.Not everyone with severe substance addiction will be appropriately treated under this new legislation. Some people will be so unwell that they are in need of palliative care. Other individuals may choose not to engage voluntarily with treatment services even after having undergone compulsory assessment and treatment on more than one occasion.I am aware that the addiction treatment sector has been waiting for this legislation for a long time. There are inevitably some challenges around the implementation of the legislation and the need for services to operate in a different way. There has been some concern from the services about the impact of the new legislation. But the Ministry of Health has been working with the sector for over 6 months to assist services to accurately define the ways in which the legislation will impact on services and on the addictions workforce. The addictions workforce will need to operate with a different legislative base and need to develop a model of care that encompasses compulsory assessment and treatment.I understand that the addiction treatment sector has embraced the challenge of implementing the new legislation with a changed model of care and that services are working to ensure that they are able to effectively implement the legislation. I find it particularly heartening that the sector's focus on the legislation is not limited to statutory processes and procedures. Rather addiction treatment services appreciate that compulsory treatment is part of a comprehensive treatment pathway and that compulsory treatment inevitably fits within a far wider scope of voluntary treatment. It is only in compulsory assessment and treatment one part of a wider treatment pathway. It is also a feature of the legislation that the treatment for addiction is part of a focus on the social and physical dynamics of well-being.The bill also reflects and respects the importance of the family and the whānau in the individual's journey to recovery. The bill has the potential to reduce the overall costs of addiction to society to families and whānau hapū and iwi to people suffering from addiction and to a group of people who are gravely ill as a result of their addiction.This is an important and an effective piece of legislation. It has been a long time coming and has been the subject of rigorous scrutiny by the Health Committee. I commend it to the House.