Reti Shane: Substance Addiction (Compulsory Assessment and Treatment) Bill — First ReadingText is incorporated into the Bound VolumeReti Shane: Substance Addiction (Compulsory Assessment and Treatment) Bill — First Reading[Sitting date: 15 March 2016. Volume:712;Page:9717. Text is incorporated into the Bound Volume.]Dr SHANE RETI (National—Whangarei): It is a pleasure to speak to this the Substance Addiction (Compulsory Assessment and Treatment) Bill a bill that looks to help people who have severe substance addiction and substance problems get assessment and treatment. I mention both of them specifically because we have all gone to the compulsion to treatment; just remember that the first step is actually the compulsion to assessment. And certainly I found that the most challenging.When you are on duty doing after hours in a city and you get called by the “DAO” which was the 1992 definition—the duly authorised officer—to come along with them because they have got a patient they are concerned about you go out the back of a block of flats and there is this really large male in various stages of undress who is clearly not coherent. You are always very mindful and grateful to have the experts around you but you are stuck with what the step is. The step to assessment was very complex; it was not clear. And we were looking at each other saying: “Well who does what? What’s the next step? Clearly this person needs assessment.” Well this bill looks to clarify that and it gives us the opportunity to talk about that pathway to assessment because I believe that once people have touched the system and got specialist attention the best outcome that can happen generally does.What this bill says is that when people have a loved one or someone they are concerned about who has substance abuse problems often one of the first contacts is what the bill is calling an authorised officer. That will be a health professional and that professional is appointed by the area director and the area director makes sure there are always enough authorised officers in the region. The first thing that authorised officer does is seek voluntary compliance from the patient. Is there a way that you can help them with their own consent? If that fails what then happens is the authorised officer approaches a medical practitioner. That medical practitioner has two tasks. The first is to assess whether that person has severe substance abuse and the second is to assess whether they have capacity to make informed decisions.As has been mentioned there are four criteria for whether a person has severe substance abuse. Two of those four criteria are required. The first one is neuro-adaptive changes. With substance abuse the common pathway is dopamine in the brain. What neuro-adaptive changes mean effectively is you get down regulation of the dopamine receptors. You get fewer of them and they become less sensitive. We know that as tolerance. So they are looking for evidence of that: craving unsuccessful attempts to control the use of the product and ongoing use despite harmful consequences. I think the second criteria the capacity to make informed decisions can be quite complex. There is a lot of contemporary discussion around what autonomous decision-making means but I think there is a good piece of work here in clause 9 saying it is to understand the relevant information retain that information and be able to communicate that decision.What happens then is the medical practitioner has to document their findings. They have to attest that they are not a relative of the applicant or of the client themselves. If for any reason you cannot get a medical practitioner to do that the authorised officer is able to do that by completing a memorandum. The authorised officer then makes the arrangements and those arrangements can also involve the police and then the person enters the system. They are able to be assessed and hopefully the best of care can be obtained.I think this adds clarity to an area that I have personally found in practice to be really complex. When someone is shouting and when they are threatening you often it is unclear as to who does what. I believe this adds clarity. I personally have no issue with compulsory incarceration or detention for treatment. When you see some people who are clearly a harm to themselves and clearly a harm to the public you just want to get them back to that state where they can make their own decisions. However you do that in a clear and concise way I think is a good thing. I think in its first reading this is a good bill. I support it and commend it to the House.