Background: Methamphetamine is a significant contributor to drug harm in Aotearoa New Zealand. Social and community damage are significant components of this harm, and this is experienced inequitably by Māori communities. In our project, we aim to identify programs and approaches that aim to reduce social and community harm, and those that incorporate Māori (indigenous) perspectives. Specifically, we aim to answer; what would a public health approach to methamphetamine look like in practice, in Aotearoa New Zealand?

Methods: We conducted a systematic search of recent systematic reviews related to reducing methamphetamine-related harms (part one, complete), and of recent studies pertaining to indigenous and select harm reduction approaches to reducing methamphetamine related harm (part two, complete). This was conducted to provide an up-to-date synopsis of the evidence to guide a scenario planning exercise (part 3), using back-casting to outline the steps towards a public health response to methamphetamine in Aotearoa New Zealand.

Results: Our initial search yielded 1301 deduplicated records. The full texts of 123 records were assessed, resulting in 57 inclusions. Four additional records were included after supplementary searching, totalling 61 included studies. Only 6 studies related to indigenous approaches. Within most of the included systematic reviews of RCTs, abstinence was the most common primary outcome. In contrast, harm reduction approaches that do not have this primary aim still lead to significant benefits for people who use methamphetamine, including reductions in use. This is a particularly important knowledge gap in Aotearoa New Zealand, given that both treatment and education interventions have mixed findings on efficacy.

Conclusion: The paucity of findings relating to indigenous approaches to methamphetamine harm reduction is a clear research gap. Given the importance of culturally informed practice for both cultural safety and treatment efficacy, future research endeavours for (and led by) indigenous people ought to be prioritised to reduce these inequities. Similarly, little research was found that focussed on supporting others who are close to an individual who consumes methamphetamine, with only two studies included from a single review on this topic. Given the support that families often provide within the context of substance dependence, particularly among Indigenous populations, significantly more research attention should be focused on enabling families and caregivers to support their loved ones who use methamphetamine.