The official holiday road toll is more than double last year's with five days still to go, according to official data.
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Ministry of Transport provisional figures show 320 people were killed on New Zealand roads in 2020.
That is 32 fewer deaths than in 2019.
Four people died during the official Christmas-New Year holiday period in 2019, compared to nine this year with five days to go.
National Road Policing Manager Acting Superintendent Gini Welch said any life lost on the roads was one too many.
She said most crashes were caused by inattention, speed and alcohol, all of which were preventable.
"You can do that by putting away your phone, ensuring you drive free from alcohol, drugs and fatigue, wear your seatbelt, and drive to the conditions within speed limits," she said.
St John Ambulance attended 363 incidents between 10pm and 3am last night, which is about double its usual workload.
The main troublespots were Auckland, Whangamata, Napier and Queenstown.
Assistant Director of Operations Stu Cockburn said people were treated for falling over and becoming unconscious, breathing problems, as well as drugs and alcohol.
"We do know there's been a great deal of MDMA, or what people are saying is MDMA, and that was having a significant impact on our young people," he said.
He said nearly 40 additional ambulances were operating last night.
Meanwhile, the highways are expected to be busier with people driving back home from holiday hotspots over the long weekend.
The Transport Agency, Waka Kotahi, is reminding travellers to plan their journeys and expect delays at peak times.
Regional Transport Systems Manager Mark Owen said queues heading back to Wellington, for example, were expected to be long during parts of the day.
"Expecting over the next two or three days from mid-morning to late afternoon, traffic will be very heavy - particularly on State Highway 1 Kapiti Coast.
He said people should make sure they slow down around road works and if the weather deteriorates.