Stretched and struggling to cope - that's the alarming message in a Waitematā DHB doctor's letter to the government.
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Dr Adrian Kerner's letter to Justice Minister Kris Faafoi, obtained by Checkpoint, says Auckland's emergency rooms are overwhelmed by patients showing up with alcohol and drug problems.
It also warns of people in their 20s and 30s who are alcohol dependent and showing signs of organ damage.
Meanwhile, data provided under the Official Information Act shows the problem is costing the taxpayer hundreds of millions of dollars.
Dr Kerner, a senior doctor and emergency medicine consultant, was unavailable for this story, but excerpts of his letter to Faafoi bore out just how much of a strain alcohol and drug misuse was having on the health system.
"The emergency departments are already overwhelmed by volume of attending patients," he wrote.
"Our resources are stretched, and we are struggling with the volume of patients who present with alcohol and drug problems and associated mental health and other psychosocial problems."
Dr Natalie Anderson is a senior lecturer at the University of Auckland, but she has held onto her other day job as a practising emergency department nurse.
When it comes to out-of-control, alcohol-fuelled scenes in the emergency room, she has pretty much seen it all.
"Having people screaming and yelling and vomiting and urinating and being threatening makes for a really challenging workplace," she told Checkpoint.
"I'm sometimes spending so much time with people who are vomiting and drunk, and perhaps aggressive or shouty, when I know that there are other people who also really need my time and aren't getting it because I can only be in one place at a time".
Some patients were waking up so drunk, they had no idea how they were injured the night before and therefore unable to fill out ACC forms.
"Our departments are absolutely at the very limits of managing the kind of complexity and acuity - how sick our people are [and] how complex their needs are - and that alcohol abuse is just really tipping the scales often so that we just can't manage to cope," Dr Anderson said.
In his letter, Dr Kerner backed potential changes to the Sale and Supply of Alcohol Act, such as targeting irresponsible promotions.
"We are seeing many people in their 20s and 30s who are alcohol dependent with evidence of organ damage."
Data provided by all three Auckland DHBs under the Official Information Act showed that between early 2019 and late 2020, Counties Manukau DHB spent more than $16.5 million treating more than 5500 people who showed up to its emergency department with alcohol issues.
Waitematā DHB spent $18.1m treating 3807 people over the same nearly two-year period.
Neither come close to Auckland District Health Board, which spent more than $37.5m treating patients presenting with alcohol problems in 2019 alone. It did not yet have data for 2020.
Health Coalition Aotearoa board member Dr David Galler spent 31 years as an intensive care specialist at Middlemore Hospital.
"We've seen people who have been drunk and tripped and become quadriplegics," he said.
That's not to mention the thousands of alcohol-fuelled falls and car crashes and brawls that have left people in Middlemore's emergency department.
"That's a real problem in some areas where there is high density of liquor stores," he said.
"There certainly would be no place like South Auckland for the high density of liquor stores. There's nowhere at the moment in the country I would expect."
Dr Galler has written his own letter to the Justice Minister, pointing out New Zealand was not on track to achieve a World Health Organization target of a 10 percent relative reduction in the harmful use of alcohol.
He wanted alcohol taxes increased, marketing regulated on platforms like social media and sponsorship of public events banned altogether.
Faafoi's office told Checkpoint the Justice Ministry had been asked to assess its ability to review the Sale and Supply of Alcohol Act.
Cabinet would decide on the scope and timing of alcohol reforms.
