Drug and Alcohol Review (March 2009), 28, 166–174

DOI: 10.1111/j.1465-3362.2008.00043.x

Onset and lifetime use of drugs in New Zealand: Results from Te

Rau Hinengaro: The New Zealand Mental Health Survey 2003–2004

JESSIE ELISABETH WELLS1, MAGNUS A. McGEE1, JOANNE BAXTER2, FRANCIS AGNEW3 &
JESSE KOKAUA4 FOR THE NEW ZEALAND MENTAL HEALTH SURVEY RESEARCH TEAM
1
Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand, 2Department of Pre-
ventive and Social Medicine, University of Otago, Dunedin, New Zealand, 3Waitemata District Health Board, Auckland,
New Zealand, and 4Mental Health Directorate, Ministry of Health,Wellingon, New Zealand

Abstract
Introduction and Aims. Onset and lifetime use of drugs have not previously been reported for all adult ages in New
Zealand. This paper reports such results and, for people born in New Zealand, compares age of onset across ethnic groups.
Design and Methods. A nationally representative cross-sectional survey was carried out in 2003–2004, with oversampling
of Māori and Pacific people. Participants were aged 16 years or more, living in permanent private dwellings. In the Composite
International Diagnostic Interview (CIDI 3.0), participants were asked if they had ever used drugs (alcohol, tobacco and five
groups of other drugs) and the age of first use (except for tobacco). Estimates are weighted. Results. The response rate of 73.3%
yielded 12 992 interviews.The percentage of participants who had ever used drugs was: 94.6% for alcohol, 50.8% for tobacco
and 42.6% for any extramedical drug, including 41.6% for cannabis, 4.2% for cocaine and 2.9% for opioids. Use was much
more common in recent cohorts for extramedical drugs.The median age of onset in each age cohort was always lowest for alcohol,
then cannabis, then opioids, then cocaine. Among those born in New Zealand, Māori were more at risk of use than ‘Others’
with the lowest risk for Pacific people. Discussion and Conclusions. Interventions to prevent or to delay the onset of drug
use need to occur before and during adolescence.The major cohort differences and the widespread experience of cannabis use help
to explain the diversity of opinion in New Zealand about how to deal with this drug. [Wells JE, McGee MA, Baxter J, Agnew
F, Kokaua J for the New Zealand Mental Health Survey Research Team. Onset and lifetime use of drugs in New
Zealand: Results from Te Rau Hinengaro: The New Zealand Mental Health Survey 2003–2004. Drug Alcohol Rev
2009;28:166–174]

Key words: alcohol, cannabis, street drugs, epidemiology, ethnic groups.

in a country. The proportion of the population who

Introduction
The burden of disease attributed to smoking and
alcohol use places them as fourth and fifth among risk
factors globally [1]. There is also international concern
about the use of drugs such as cannabis, cocaine and
opioids as well as other illicit drugs or drugs used for
non-medical purposes [2]. There is a need for data on
onset of use and the proportion of the population who
have ever used a drug. Information on the onset of drug
use indicates the appropriate age range to target for
primary prevention. Furthermore, comparisons across
birth cohorts provide a history of the onset of drug use
have ever used a drug is relevant to understanding
social context; whether or not someone has ever used a
drug is one factor which may influence their views on
regulation of drugs and their attitudes towards use of
drugs by young people.
Drug use differs markedly across drugs, countries
[3,4] and historical time [5]. Hence, it is necessary for
each country to investigate its own patterns of onset
and use. This paper describes the onset of drug use in
New Zealand and lifetime use, the percentage of the
population who have ever used drugs. It also investi-
gates ethnic differences in onset across ethnic groups

Jessie Elisabeth Wells PhD, Research Associate Professor, Magnus A. McGee MSc, Research Fellow, Joanne Baxter MBCHB, MPH, FAFPHM,
Senior Lecturer, Francis Agnew MSc (Hons), MBCHB, FRANZCP, Consultant Psychiatrist, Jesse Kokaua MSc, Analyst. Correspondence to
Associate Professor Jessie Elisabeth Wells, Department of Public Health and General Practice, University of Otago, PO Box 4345, Christchurch
8140, New Zealand. Tel: +64 3 364 3616; Fax: +64 3 364 3614; E-mail: elisabeth.wells@chmeds.ac.nz
Received 30 October 2007; accepted for publication 17 March 2008.

© 2009 Australasian Professional Society on Alcohol and other Drugs


born in New Zealand as such differences indicate where
interventions for addressing ethnic inequalities should
be targeted.
One source of information on the onset of drug
use comes from longitudinal studies starting in child-
hood. In New Zealand there are two such studies:
the Dunedin Multidisciplinary Study [6,7] (http://
dunedinstudy.otago.ac.nz/) and the Christchurch
Health and Development Study (CHDS) [8] (http://
www.chmeds.ac.nz/research/chds). These studies
provide quite precise estimates of the onset of drug use
and each has a rich set of prospectively collected cova-
riates. However, as these two cohorts were both born
during the 1970s, they provide no information about
earlier or later birth cohorts whose use of drugs would
have been affected by changes in the availability and
acceptability of various drugs and by changes in drug
preferences.
A second set of information on the onset of drug use
comes from cross-sectional surveys of current use
[9–15]. However, current use will always underestimate
lifetime use because it excludes those who have used a
drug and then stopped or whose use was only ever
experimental.
The third possible source is data from cross-sectional
surveys which ask about onset of use. Such surveys are
vulnerable to recall errors, but do provide data across a
wide age range, reflecting the experience of different
birth cohorts. At older ages differential survival also
begins to produce survivor bias in estimates based on
cross-sectional surveys; users of some drugs may have
died or moved to institutional care so that their birth
cohort may appear to have been less likely to use drugs
than was actually the case [16]. Questions about life-
time use and age of onset have been used in a number
of surveys of adults in the USA [16–18], Australia
[19,20]and Mexico [21], and in one recent national
drug survey [15] in New Zealand. However, the focus
of the New Zealand report [15] was on trends over time
in current use, rather than on onset and the cumulative
proportion who had ever used drugs. Also, no one more
than 45 years of age was surveyed.
This paper reports the lifetime use and onset of drug
use in New Zealand based on data from the New
Zealand Mental Health Survey (NZMHS) [22–24], a
national cross-sectional survey. It covers:
• Lifetime use, namely the proportion of the popu-
lation who, at the time they were interviewed,
reported ever having used alcohol, tobacco, can-
nabis, cocaine, opioids or any other illicit drug or
prescribed drug used for non-medical purposes (a
composite category of extramedical use of drugs
included all drugs except for alcohol and tobacco)
• The age of onset of use of these drugs
Onset of drug use in New Zealand 167
• Ethnic comparisons of the onset of drug use in
young adults born in New Zealand.
The ethnic comparisons contrast Māori, Pacific people
and a composite ‘Other’ group who are mostly of Euro-
pean descent. Māori are the indigenous people of New
Zealand. The term ‘Pacific’ is used to refer to the eth-
nicity of the indigenous inhabitants of Pacific islands
such as Samoa,Tonga, the Cook Islands and Fiji.These
ethnic groups have been shown to differ in current use
of alcohol, tobacco and other drugs [12–14,23].
Design and methods
Design
The design of the NZMHS was for a national cross-
sectional probability sample [24,25] of New Zealanders
aged 16 years or more living in permanent private
dwellings. To provide estimates of acceptable precision
for Māori and for Pacific people, as well as for the total
population, the number of Māori was doubled and the
number of Pacific people quadrupled relative to that
expected without oversampling. The survey was carried
out in late 2003 and throughout 2004.
Ethics
All 14 health ethics committees throughout New
Zealand approved the survey.
Interview
Computer-assisted personal interviews were carried
out face-to-face using the World Mental Health Sur-
veys Composite International Diagnostic Interview
(CIDI 3.0) (http://www.hcp.med.harvard.edu/wmhcidi)
with some non-diagnostic modifications for New
Zealand (http://www.moh.govt.nz/moh.nsf/by+unid/
3195F8D3155E1C2ACC2571FC00131A6D?Open).
Measurement of lifetime drug use and onset
No age of first use was reported for tobacco, merely
whether someone was a current or past smoker or vol-
unteered that they had tried smoking a few times. Age
of first use was asked for alcohol. Everyone was asked if
they had ever used each of five drug classes: cannabis,
cocaine, prescription drugs used without the recom-
mendation of a health profession or for any reason
other than they were supposed to be used, opioids and
other drugs such as lysergic acid diethylamide or glue.
Anyone who had used a particular drug or drug class
was asked about age of first use and use in the past 12
months. Alternative names were given for drugs. For
© 2009 Australasian Professional Society on Alcohol and other Drugs
168 J. E.Wells et al.
cannabis, cocaine and opioids this was straightforward.
For prescription drugs the list was long and confusing,
and it is possible that some respondents replied incor-
rectly about legitimate use of drugs. The main purpose
of these questions was to establish if drug use had
occurred so that only respondents who had used drugs
were asked the symptom questions which could lead to
diagnoses of abuse or dependence.
Ethnicity
The New Zealand 2001 census ethnicity question was
used; this permits self-identification with multiple eth-
nicities. Anyone reporting Māori ethnicity was classi-
fied as Māori, anyone else reporting any Pacific
ethnicity was classified as Pacific and the remainder
were placed in a composite ‘Other’ group (this is the
standard prioritisation used in health research in New
Zealand—http://www.nzhis.govt.nz/moh.nsf/pagesns/
402?Open).
Analysis
Weights were used to take account of unequal prob-
abilities of selection arising through selection of one
person per household, oversampling of Māori and
Pacific people through targeting and screening, adjust-
ment for non-response and post-stratification to the
New Zealand 2001 census distribution of age, sex and
ethnicity (Māori/Pacific/Other) [25]. SUDAAN soft-
ware (Research Triangle Institute, Research Triangle
Park, NC, USA) was used to take account of the
complex sample design using Taylor series linearisation
(TSL). Cross-tabulations were used to investigate asso-
ciations of age with lifetime use of drugs. Onset was
analysed with survival analysis using 1 year intervals.
The median age of onset of those going on to use a drug
was taken as the age corresponding to 50% of the
observed maximum cumulative incidence [26].
Kaplan–Meier curves were produced in SAS (SAS
Institute, Cary, NC, USA). Proportional hazards
models were fitted in SUDAAN. All P-values reported
are based on Wald tests from TSL design-based coeffi-
cient variance–covariance matrices. All intervals quoted
are 95% confidence intervals.
Results
The survey produced 12 992 interviews. The response
rate was 73.3%. Table 1 shows that alcohol had been
used by 94.6% of the population, nearly twice as much
as the next most frequent drug, tobacco (50.9%),
although the tobacco percentage may be an underesti-
mate as the question was about ever being a smoker.
Any extramedical use of drugs (other than alcohol or
© 2009 Australasian Professional Society on Alcohol and other Drugs
tobacco) was only slightly higher than the use of can-
nabis (42.6% vs. 41.6%) which indicates that very few
people had used any other drugs without also using
cannabis. Cocaine use (4.2%) was only a tenth as
common as cannabis and opioid use was also uncom-
mon (2.9%). In addition, prescription drugs had been
used for non-medical purposes by 6.5% (n = 861) and
9.5% (n = 1199) had used any of the fifth residual
category of drugs such as LSD, glue, peyote; which
drugs were used in these two composite groups is not
known as respondents merely indicated if they had used
any drug in the group. In summary, almost everyone
had used alcohol at some time, half had been smokers
and more than 40% had ever used cannabis, whereas
only a very small minority had used cocaine or opioids,
even once. There was some misuse of prescription
drugs and use of other illicit drugs.
Table 1 also presents lifetime use of drugs by birth
cohort, as indicated by the age at interview. With inter-
views in 2003/2004, the age group of 16–24 years, for
instance, was born between 1979 and 1988. The
pattern across birth cohorts differs by drug. Cohort
differences were small for alcohol; the percentage
reporting ever smoking was lower in the more recent
birth cohorts as expected from attempts to reduce
smoking in New Zealand, and for all other drug cat-
egories the percentage who had ever used rose slightly
from the age group of 16–24 years to the age group of
25–44 years, then decreased steeply across the two
older age groups. In addition to alcohol and tobacco, all
further results are presented only for cannabis, cocaine
and opioids. This is because the composite extramedi-
cal use of drugs category produced results very similar
to those for cannabis, and because it is not known what
drugs had been used in the prescription and residual
other drug groups. The results for the extramedical use
of drugs are available on request.
A consistent finding across all drugs is the lower
percentage of the age group of 16–24 years who reported
ever having used drugs compared with the age group of
24–45 years.To determine if this resulted from a decline
in use or less time to initiate use, it is necessary to make
use of the data on the age at the first use of a drug. In
survival analysis, cohorts can be compared across the
same ages to see if by any given age one group is more or
less likely to have ever tried a drug. Therefore, the
remainder of results reported are from survival analyses.
Onset of drug use
Figure 1 shows the onset curves for use of alcohol,
cannabis, cocaine and opioids for the four birth
cohorts. These show the cumulative percentage of the
population who have ever used a particular drug by any
given age. There is no onset curve for tobacco because
 Table 1. Lifetime use of drugs: the percentage of the population who had ever used each drug by current age (N = 12 992)

Extramedical
Alcohol Tobaccoa use of drugsb Cannabis Cocaine Opioids
Current age (birth
years)c % SE % SE % SE % SE % SE % SE

All ages 94.6 0.3 50.8 0.6 42.6 0.7 41.6 0.7 4.2 0.2 2.9 0.2
(No. users) (12 030) (7 221) (5 453) (5 292) (520) (364)
16–24 92.7 0.9 46.2 1.8 54.3 1.7 53.6 1.7 4.4 0.8 2.6 0.6
(n = 1535)
(1979–1988)
25–44 95.4 0.4 49.7 0.9 58.6 1.0 57.6 1.0 6.4 0.4 4.3 0.3
(n = 5304)
(1959–1979)
45–64 95.9 0.4 54.3 1.2 34.5 1.0 33.6 1.0 3.2 0.4 2.6 0.3
(n = 3909)
(1939–1959)
65+ 92.0 0.7 51.9 1.2 4.5 0.5 3.1 0.4 0.1 0.0 0.1 0.1
(n = 2244)
(ⱕ1939)
c2(3) [P] 34.2 [<0.0001] 16.3 [0.001] 1657.0 [<0.0001] 1546.6 [<0.0001] 283.7 [<0.0001] 181.5 [<0.0001]

a
Tobacco was asked about differently and may not include some who experimented. bIncludes cannabis, cocaine, opioids, prescription drugs and all other drugs except
for alcohol and tobacco. cBecause of the duration of the survey there is a 1 year overlap in birth years between age groups. SE, standard error.
Onset of drug use in New Zealand
169

© 2009 Australasian Professional Society on Alcohol and other Drugs

170 J. E.Wells et al.

100 100
16-24 Maximum 58.3%
Cumulative % who have ever drunk alcohol

90 90
25-44 Maximum 58.7%

Cumulative % who had ever used cannabis

45-64 Maximum 33.8%
80 80 65+ Maximum 2.7%

70 70

60 60

50 50
16-24 Maximum 94.6%
40 40
25-44 Maximum 95.7%
30 45-64 Maximum 96.0% 30
65+ Maximum 91.8%
20 20

10 10

0 0
0 10 20 30 40 50 60 0 10 20 30 40 50 60
Age (years) Age (years)

1a. Alcohol 1b. Cannabis

20 20
16-24 Maximum 7.5% 16-24 Maximum 3.5%
25-44 Maximum 7.0%
Cumulative % who have ever used cocaine

Cumulative % who have ever used opioids

45-64 Maximum 3.3% 25-44 Maximum 4.5%
65+ Maximum 0.1% 45-64 Maximum 2.5%
15 15 65+ Maximum 0.1%

10 10

5 5

0 0
0 10 20 30 40 50 60 0 10 20 30 40 50 60
Age (years) Age (years)

1c. Cocaine 1d. Opioids

Figure 1. Onset curves for use of alcohol, cannabis, cocaine and opioids for four groups defined by age at interview (namely birth cohort).

the age of first use was not recorded. The onset curve 65 years of age, the survival estimate of the median age
for the composite extramedical use of drugs (not of onset for those who do go on to use a drug was
shown) was almost identical to that for cannabis except always lowest for alcohol (14, 15, 16 years), intermedi-
for barely visible differences for the oldest cohort. ate for cannabis (17, 18, 21 years), higher for opioids
The cohort differences seen in the percentage of the (19, 22, 23 years) and highest for use of cocaine (21,
population who had ever used a drug by the time of 24, 26 years).
interview (Table 1) are seen even more clearly in the Table 2 complements Figure 1 by providing numeri-
onset curves in Figure 1. The lower percentage with cal estimates of how much higher the risk of onset of use
lifetime use in the youngest age group, compared with of each drug was for each successive cohort. It shows a
the age group of 25–44 years, occurred because some monotonic progression in risk for each cohort, but the
young people had not yet begun using, not because the slope varies markedly across the drugs with a maximum
cumulative percentage of the population who had ever hazard ratio of 2.7 for alcohol, 55.5 for cannabis, 74.8 for
tried a drug was lower by any given age. The key fea- opioids and 248.7 for cocaine. Temporal trends are
tures of Figure 1 are that: (i) for all drugs the cumula- much more marked for drugs other than alcohol.
tive percentage of the population who have ever used a
drug is higher for more recent cohorts at any given age;
Ethnic differences in the onset of drug use
and (ii) all curves rise steeply during adolescence and
are almost flat after approximately 25 or 30 years of age, Ethnic comparisons in this survey of the use of alcohol
indicating that few people tried a drug for the first time or drugs in the past 12 months have shown marked but
after this age. Differences in the median age of onset are inconsistent ethnic differences [23]. The percentage
less obvious in Figure 1. In the three age groups under using drugs was highest for Māori (26.2%) and lower
© 2009 Australasian Professional Society on Alcohol and other Drugs
 Onset of drug use in New Zealand 171

Table 2. Hazard ratios (HR) from survival models for the risk of onset of use for each drug

Alcohol Cannabis Cocaine Opioids

Age (years) HR 95% CI HR 95% CI HR 95% CI HR 95% CI

16–24 2.7 2.4, 2.9 55.5 42.4, 72.7 248.7 81.1, 762.8 74.8 14.8, 378.6
25–44 2.1 2.0, 2.2 36.6 28.4, 47.0 99.6 33.5, 295.7 53.0 12.4, 226.7
45–64 1.7 1.6, 1.8 14.1 10.9, 18.3 40.2 13.4, 121.0 28.6 6.5, 126.6
65+ 1.0 — 1.0 — 1.0 — 1.0 —
X23 [P] 618.7 [<0.001] 1594.9 [<0.001] 155.9 [<0.001] 53.6 [<0.001]

CI, confidence interval.

Table 3. Ethnicity and onset of drug use in young adults (<45 years) born in New Zealand: hazard ratios (HR)

Alcohol Cannabis Cocaine Opioids

Ethnicity HR 95% CI HR 95% CI HR 95% CI HR 95% CI

Ethnicity alone
Māori (n = 1682) 1.0 0.9, 1.1 1.7 1.5, 1.8 1.6 1.2, 2.2 1.7 1.2, 2.3
Pacific (n = 688) 0.6 0.5, 0.7 1.0 0.9, 1.2 0.5 0.3, 0.8 0.4 0.2, 0.7
Other (n = 2654) 1.0 — 1.0 — 1.0 — 1.0 —
F(2) [P] 36.8 [<0.001] 62.2 [<0.001] 12.5 [<0.001] 10.1 [<0.001]
Ethnicity adjusted for age, sex and age ¥ sex (ages 16–24 vs. 25–44 years at the time of interview)
Māori (n = 1682) 1.0 0.9, 1.0 1.7 1.5, 1.9 1.6 1.2, 2.1 1.7 1.2, 2.4
Pacific (n = 688) 0.6 0.5, 0.6 0.9 0.8, 1.2 0.5 0.3, 0.8 0.4 0.2, 0.7
Other (n = 2654) 1.0 — 1.0 — 1.0 — 1.0 —
F(2) [P] 39.3 [<0.001] 59.8 [<0.001] 12.5 [<0.001] 10.2 [<0.001]

Age ¥ sex: P < 0.001 for cannabis and alcohol, as men and women were very similar in the most recent cohort (16–24 years at
interview), but among those born earlier (25–44 years at interview) men were more likely than women to have begun use of these
drugs by any given age. Models with ethnicity ¥ age or ethnicity ¥ sex had non-significant interaction terms for the drugs in
Table 3 except for a marginally significant interaction between ethnicity and age for cocaine use (P = 0.03). Inclusion or exclusion
of interaction terms had little effect on the ethnic difference estimates. CI, confidence interval.

and similar for Others (12.1%) and Pacific people
(11.3%). In contrast, Māori (80.2%) or Others
(80.4%) were equally likely to drink, whereas Pacific
people were much less likely to do so (51.7%). Under-
standing the onset of drug use in these ethnic groups is
complicated by the high proportion of New Zealand
residents surveyed who were born elsewhere (26.8%)
and the marked differences across the ethnic groups in
the proportion born in New Zealand. Almost all Māori
(99.0%) were born in New Zealand. Only 33.6% of
Pacific people were born in New Zealand and this
percentage differed with age from 65.1% of those aged
16–24 years down to 1.8% of those 65 years and over.
Three-quarters (75.8%) of the composite ‘Other’ group
were born in New Zealand and this differed only
slightly across the age groups from 72.2% to 78.3%.
To understand ethnic differences in the onset of drug
use in New Zealand, comparisons were restricted to
those born in New Zealand. Furthermore, because of
the small numbers of Pacific people aged 45 years and
over born in New Zealand (n = 62), only those under
45 years of age were included.These restrictions ensure
that the results do reflect onset experiences in New
Zealand rather than elsewhere.
Table 3 presents ethnic comparisons of the hazard
ratios for the use of each drug. For alcohol, Māori and
the composite ‘Other’ ethnic group had similar risk
whereas Pacific people had lower risk. For cannabis
Māori had the highest risk, but the risk was equal for
Pacific people and the ‘Other’ group. For cocaine and
opioids, the risk of use was highest for Māori, followed
by Others, and lowest for Pacific.Adjustment for age, sex
and their interaction made little difference to the hazard
ratios. Because of age differences and age-by-sex inter-
actions, Figure 2 shows ethnic comparisons only for the
age group of 16–24 years, the age group most relevant to
the current situation in New Zealand. Pacific people in
this birth cohort do eventually drink alcohol, but onset is
© 2009 Australasian Professional Society on Alcohol and other Drugs
172 J. E.Wells et al.

100 100
Maori Maximum 97.5%

Cumulative % who have ever used cannabis

90 90 Maori Maximum 76.3%
Cumulative % who have ever drunk alcohol

Pacific Maximum 96.0% Pacific Maximum 57.8%

80 Other Maximum 97.8% 80 Other Maximum 65.5%
70 70

60 60

50 50

40 40

30 30

20
20
10
10
0
0
0 5 10 15 20 25
0 5 10 15 20 25
Age (years) Age (years)

2a. Alcohol 2b. Cannabis

20
20
Maori Maximum 14.1%
Cumulative % who have ever used cocaine

Pacific Maximum 1.2% Maori Maximum 4.5%

Cumulative % who have ever used opioids

Other Maximum 7.0% Pacific Maximum 0.9%
15
Other Maximum 2.7%
15

10
10

5
5

0 0
0 5 10 15 20 25 0 5 10 15 20 25
Age (years) Age (years)

2c. Cocaine 2d. Opioids

Figure 2. Onset curves for use of alcohol, cannabis, cocaine and opioids for Māori (n = 404), Pacific people (n = 248) and Others
(n = 534) who were 16–24 years old at interview and who were born in New Zealand.

delayed. For other drugs, it appears that a lower percent- the CDHS [8] is possible for the cumulative risk of use
age of Pacific people will ever use those drugs. by the age of 25 years for those born in New Zealand.
The longitudinal CHDS found 88.5% of Māori and
75.1% of non-Māori had ever used cannabis; the cross-
Discussion
sectional NZMHS found 76.3% for Māori and 65.5%
This survey (NZMHS) shows New Zealand to be a for Others. A likely explanation is the advantage of
country in which almost everyone has tried alcohol, at longitudinal data collection in reducing errors of recall.
least half have been smokers (more may have tried Overall, the CHDS (which has 11% Māori) found
tobacco) and more than 40% have tried cannabis. 9.1% had ever used cocaine and 3.7% for opioids; for
Much smaller proportions have ever tried cocaine the NZMHS, the results were 14.1% for Māori and
(4.2%) or opioids (2.9%). Non-medical use of pre- 7.0% for Others for cocaine, and 4.5% for Māori and
scription drugs was reported by 6.5% and 9.5% had 2.7% for Others for opioids. Another New Zealand
used any other drugs. birth cohort study has estimated that 70.1% had used
Comparison with other studies is complicated by the cannabis by the age of 26 years [6].
clear differences across cohorts for drugs other than For comparable cohorts, lifetime use of drugs is
alcohol and tobacco, different age breakdowns and dif- similar in New Zealand and Australia [19,20].
ferent age ranges. Nonetheless, the overall pattern in However, the use of cocaine is only approximately a
the NZMHS is similar to that in a 2001 New Zealand quarter of that in the USA [16,17], which is not sur-
national telephone drug survey [15]. Comparison with prising given the distance from principal cocaine
© 2009 Australasian Professional Society on Alcohol and other Drugs

trafficking routes. For each drug similar cohort patterns
have been found in all three countries. Nonetheless, the
patterns are not the same across drugs, with small
cohort differences for legal drugs and large cohort dif-
ferences for illegal drugs.
This New Zealand survey is part of the World Mental
Health Survey Initiative. Comparison of 17 countries
shows that almost everyone in the developed countries
had used alcohol. The USA and New Zealand had by
far the highest use of cannabis (42%). The USA was an
outlier for high use of cocaine whereas New Zealand
was similar to Latin American countries and higher
than most European countries. The use of cannabis or
cocaine was uncommon in the Middle East, Africa and
Asia [28].
For people who had grown up in New Zealand,
Māori, the indigenous people, were at higher risk of
starting to use drugs than Pacific people, even though
both have similar socioeconomic disadvantages
[25,27]. The risks for the composite ‘Other’ group
were between those for Māori and Pacific. Nonethe-
less, the magnitude of the hazard ratios differed across
drugs, showing the importance of looking at indi-
vidual drugs.
Apart from those born before 1939, the age of first
use is almost always before 25 years for alcohol, and 30
years for cannabis, cocaine and opioids with the steep-
est rise in onset in mid-adolescence. Interventions to
prevent or delay first use, or to minimise the harm
caused by use, need to be before and during adoles-
cence. The challenge is to find the appropriate range of
strategies to apply to illegal drugs, and to alcohol, which
is illegal to purchase below 18 years of age in New
Zealand. The recent Australian report on preventing
substance use, risk and harm [29] provides a compre-
hensive evaluation of possible options for prevention
and is largely applicable to New Zealand. Some school-
based programs have been successful [30,31], but there
are also many other ways of making some difference to
drug use in a population, by intervening at a national or
local level.
The strengths of this survey are that it was nationally
representative yet, through oversampling, had sufficient
Māori and Pacific people to enable ethnic comparisons.
At 73.3% the response rate was good for such a com-
munity survey, but there could be non-response bias,
particularly from heavy users of drugs, even though it
was introduced as a mental health survey, not a drug
survey. There will have been some loss to age cohorts
through death, particularly for the oldest age group.
Age of onset was recalled which undoubtedly intro-
duced inaccuracy and possibly bias. The major disad-
vantage, however, for understanding of recent drug
trends in New Zealand is that methamphetamines and
‘herbal highs’ were not asked about separately.
Onset of drug use in New Zealand 173
Acknowledgements
Te Rau Hinengaro: The New Zealand Mental Health
Survey was funded by the Ministry of Health, Alcohol
Advisory Council and Health Research Council of New
Zealand. Funding for further analyses came from the
New Zealand Lottery Grants Board. The survey was
carried out in conjunction with the World Health Orga-
nization World Mental Health (WMH) Survey Initia-
tive. We thank the WMH staff for assistance with
instrumentation, fieldwork and data analysis. These
activities were supported by the US National Institute
of Mental Health (R01MH070884), the John D and
Catherine T MacArthur Foundation, the Pfizer Foun-
dation, the US Public Health Service (R13-
MH066849, R01-MH069864 and R01 DA016558),
the Fogarty International Center (FIRCA R01-
TW006481), the Pan American Health Organization,
Eli Lilly and Company, Ortho-McNeil Pharmaceutical,
Inc., GlaxoSmithKline and Bristol-Myers Squibb.
WMH publications are listed at http://www.hcp.med.
harvard.edu/wmh/.
References
[1] Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray
CJL, eds. Global burden of disease and risk factors. New
York: Oxford University Press and The World Bank, 2006.
[2] Mental Health Evidence and Research, Department of
Mental Health and Substance Abuse, eds. Disease control
priorities related to mental, neurological, developmental
and substance abuse disorders. Geneva: World Health
Organization, 2006.
[3] ter Bogt T, Schmid H, Nic Gabhainn S, Fotiou A, Volle-
bergh W. Economic and cultural correlates of cannabis use
among mid-adolescents in 31 countries. Addiction 2006;
101:241–51.
[4] World Health Organization. Guide to drug abuse epidemi-
ology. Geneva: Department of Mental Health and Sub-
stance Dependence, Noncommunicable Diseases and
Mental Health Cluster, 2000.
[5] Brecher EM. Licit and illicit drugs: the Consumers Union
Report on narcotics, stimulants, depressants, inhalants, hal-
lucinogens and marijuana—including caffeine, nicotine and
alcohol. Boston, MA: Little Brown & Co., 1972.
[6] Poulton R, Moffitt TE, Harrington H, Milne BJ, Caspi A.
Persistence and perceived consequences of cannabis use
and dependence among young adults: implications for
policy. N Z Med J 2001;114:544–7.
[7] Poulton RG, Brooke M, Moffitt TE, Stanton WR, Silva PA.
Prevalence and correlates of cannabis use and dependence
in young New Zealanders. N Z Med J 1997;110:68–70.
[8] Boden JM, Fergusson DM, Horwood LJ. Illicit drug use
and dependence in a New Zealand birth cohort. [see
comment] Aust N Z J Psychiatry 2006;40:156–63.
[9] Habgood R, Casswell S, Pledger M, Bhatta K. Drinking in
New Zealand national surveys; comparison 1995 and 2002.
Auckland: Alcohol and Public Health Research Unit, Uni-
versity of Auckland, 2001.
[10] Huakau J, Asiasiga L, Ford M, et al. New Zealand Pacific
peoples’ drinking style: too much or nothing at all? N Z
Med J 2005;118:U1491.
© 2009 Australasian Professional Society on Alcohol and other Drugs
174 J. E.Wells et al.
[11] Huakau J, Asiasiga L, Pledger M, et al. Pacific drugs and
alcohol consumption survey 2002–2003. Final Report:
Volume 1. Auckland: Pacific Research and Development
and SHORE/Whariki, 2004.
[12] Minister of Health. Taking the pulse: the 1996/97
New Zealand Health Survey. Health Survey. Wellington:
Ministry of Health, 1999.
[13] Ministry of Health. A portrait of health: key results of the
2002/03 New Zealand Health Survey. Public Health Intel-
ligence Occasional Bulletin No 21 2004 August, 2004.
Available at: http://www.moh.govt.nz/moh.nsf/pagesmh/
3333?Open (accessed 12 March 2008).
[14] Ministry of Health. Alcohol use in New Zealand: analysis of
the 2004 New Zealand Health Behaviours Survey—alcohol
use. Wellington: Ministry of Health, 2007.
[15] Wilkins C, Casswell S, Bhatta K, Pledger M. Drug use in
New Zealand: national surveys comparison 1998 and 2001.
Auckland: Alcohol and Public Health Research Unit, Uni-
versity of Auckland, 2002.
[16] Degenhardt L, Chiu WT, Sampson N, Kessler RC,
Anthony JC. Epidemiological patterns of extra-medical
drug use in the United States: evidence from the National
Comorbidity Survey Replication, 2001–2003. Drug Alcohol
Depend 2007;90:210–23.
[17] Johnson RA, Gerstein DR. Initiation of use of alcohol,
cigarettes, marijuana, cocaine, and other substances in US
birth cohorts since 1919. [see comment] Am J Public
Health 1998;88:27–33.
[18] Johnson RA, Gerstein DR. Age, period, and cohort effects
in marijuana and alcohol incidence: United States females
and males, 1961–1990. Subst Use Misuse 2000;35:925–48.
[19] Australian Institute of Health and Welfare. National Drug
Strategy Household Survey: detailed findings. AIHW Cat.
No. PHE 66. Canberra: Australian Institute of Health and
Welfare, 2005.
[20] Degenhardt L, Lynskey M, Hall W. Cohort trends in the
age of initiation of drug use in Australia. Aust N Z J Public
Health 2000;24:421–6.
[21] Medina-Mora ME, Borges G, Fleiz C, Villatoro J, Aguila-
Gaxiola S. Prevalence and correlates of drug use disorders
in Mexico. Rev Panam Salud Publica 2006;19:265–76.
© 2009 Australasian Professional Society on Alcohol and other Drugs
[22] Oakley Browne MA, Wells JE, Scott KM, eds. Te Rau
Hinengaro: the New Zealand Mental Health Survey. Well-
ington: Ministry of Health, 2006.
[23] Wells JE, Baxter J, Schaaf D, eds. Substance use disorders in
Te Rau Hinengaro: the New Zealand Mental Health
Survey. Wellington: Alcohol Advisory Council, 2007.
[24] Wells JE, Oakley Browne MA, Scott KM, McGee MA,
Baxter J, Kokaua J. Te Rau Hinengaro: the New Zealand
Mental Health Survey: overview of methods and findings.
Aust N Z J Psychiatry 2006;40:835–44.
[25] Wells JE, McGee MA, Oakley Browne MA. Methods. In:
Oakley Browne MA, Wells JE, Scott KM, eds. Te Rau
Hinengaro: the New Zealand Mental Health Survey. Well-
ington: Ministry of Health, 2006:218–51.
[26] Elandt-Johnson RC, Johnson NL. Estimation of waiting
time onset distribution from retrospective data. In: Elandt-
Johnson RC, Johnson NL, eds. Survival models and data
analysis. New York: John Wiley and Sons, 1980:403–11.
[27] Baxter J, Kokaua J, Wells JE, Oakley Browne MA, for the
New Zealand Mental Health Survey Research Team. Ethnic
comparisons in Te Rau Hinengaro: the New Zealand
Mental Health Survey (NZMHS). Aust N Z J Psychiatry
2006;40:905–13.
[28] Degenhardt L, Chiu WT, Sampson N, et al. Toward a
global view of alcohol, cannabis, and cocaine use: findings
from the WHO World Mental Health Surveys. PLoS Medi-
cine 2008;e141.
[29] Loxley W, Toumbourou JW, Stockwell T, et al. The pre-
vention of substance use, risk and harm in Australia: a
review of the evidence. Perth, WA: The National Drug
Research Institute and the Centre for Adolescent Health,
2004.
[30] Cuijpers P. Effective ingredients of school-based drug pre-
vention programs. A systematic review. Addict Behav
2002;27:1009–23.
[31] Skara S, Sussman S. A review of 25 long-term adolescent
tobacco and other drug use prevention program evalua-
tions. Prev Med 2003;37:451–74.
Copyright of Drug & Alcohol Review is the property of Wiley-Blackwell and its content may not be copied or
emailed to multiple sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.