Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes
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《英国医生杂志》
1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia, 2 Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
Correspondence to: C Day carolyn.day@unsw.edu.au
Introduction
We found a sustained reduction in the number of needles and syringes distributed in NSW after a considerable decrease in heroin supply. Given the widespread and easy availability of needles and syringes in NSW, the data on provision are a useful proxy for changes in the number of injecting drug users or in the frequency of injecting, or both. The trends observed here were also consistent with estimated reductions in the number of regular heroin users after the heroin shortage.3 These data suggest an overall reduction in the prevalence of injecting drug use after a decrease in heroin supply.
We relied on secondary data sources as indirect measures of the prevalence of injecting drug use. None the less, the coherent pattern of changes outlined in this study is not easily explained by any other hypotheses and is consistent with other research on the consequences of the heroin shortage.3
Our findings are also consistent with a reduction in notifications of hepatitis C among people aged 15-19 years, which started around the time of the reduction in heroin supply.4 Nearly all such infections are related to injecting drug use, and there are no alternative explanations for the decrease in notifications, which was not predicted by mathematical models of the hepatitis C epidemic in Australia.5 However, the true impact of reduced supply is unlikely to be detectable for some time. Reduction in injecting drug use, as indicated by reduced output in the needle and syringe programmes, would be consistent with reduction in such infections at the population level. We are currently exploring further impacts of the shortage on overdose, treatment, and crime.
What is already known on this topic
The impact of reduced heroin supply on injecting drug use (where this is the drug of choice) has not previously been determined
What this study adds
Reduced heroin supply is associated with reduced injecting drug use
This article was posted on bmj.com on 3 August 2004: http://bmj.com/cgi/doi/10.1136/bmj.38201.410255.55
We thank the many agencies and individuals who provided advice and data for inclusion in the study; Linette Collins, Amy Gibson, and Elizabeth Conroy for assistance with the project; and Owen Westcott and Jenny Iverson from the AIDS and Infectious Diseases Branch of NSW Health for facilitating access to NSW notification and programme data. We also thank Greg Dore, Lisa Maher, and Margaret MacDonald for comments on an earlier draft of the paper.
Contributors: CD (guarantor), LD, and WH conceived the study. LD supervised the research. CD led the writing. SG conducted the analysis for the study. All authors helped to conceptualise ideas, interpret findings, and review drafts of the manuscript.
Funding: This work was completed as part of a larger project funded by the Australian National Drug Law Enforcement Research Fund (NDLERF). The National Drug and Alcohol Research Centre is funded by the Australian Government Department of Health and Ageing. CD was funded by a postgraduate award from the Australian Government Department of Health and Ageing.
Competing interests: None declared.
Ethical approval: The study was approved by the University of New South Wales human research ethics committee and the human research ethics committees of the South Eastern Sydney Area Health Service, South Western Area Health Service, and Central Sydney Area Health Service.
References
Darke S, Topp L, Kaye S, Hall W. Heroin use in New South Wales, Australia, 1996-2000: 5 year monitoring of trends in price, purity, availability and use from the illicit drug reporting system (IDRS). Addiction 2002;97: 179-86.
Topp L, Kaye S, Bruno R, Longo M, Williams P, O'Reilly B, et al. Australian drug trends 2001: findings from the illicit drug reporting system (IDRS). Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2002.
Degenhardt L, Day C, Hall W, eds. The causes, course and consequence of the heroin shortage in Australia. Adelaide: Australasian Centre for Policing Research, 2004.
National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2003. Sydney: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 2003.
Law M, Dore G, Bath N, Thompson S, Crofts N, Dolan K, et al. Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001. Int J Epidemiol 2003;32: 717-24.(Carolyn Day, doctoral can)
Correspondence to: C Day carolyn.day@unsw.edu.au
Introduction
We found a sustained reduction in the number of needles and syringes distributed in NSW after a considerable decrease in heroin supply. Given the widespread and easy availability of needles and syringes in NSW, the data on provision are a useful proxy for changes in the number of injecting drug users or in the frequency of injecting, or both. The trends observed here were also consistent with estimated reductions in the number of regular heroin users after the heroin shortage.3 These data suggest an overall reduction in the prevalence of injecting drug use after a decrease in heroin supply.
We relied on secondary data sources as indirect measures of the prevalence of injecting drug use. None the less, the coherent pattern of changes outlined in this study is not easily explained by any other hypotheses and is consistent with other research on the consequences of the heroin shortage.3
Our findings are also consistent with a reduction in notifications of hepatitis C among people aged 15-19 years, which started around the time of the reduction in heroin supply.4 Nearly all such infections are related to injecting drug use, and there are no alternative explanations for the decrease in notifications, which was not predicted by mathematical models of the hepatitis C epidemic in Australia.5 However, the true impact of reduced supply is unlikely to be detectable for some time. Reduction in injecting drug use, as indicated by reduced output in the needle and syringe programmes, would be consistent with reduction in such infections at the population level. We are currently exploring further impacts of the shortage on overdose, treatment, and crime.
What is already known on this topic
The impact of reduced heroin supply on injecting drug use (where this is the drug of choice) has not previously been determined
What this study adds
Reduced heroin supply is associated with reduced injecting drug use
This article was posted on bmj.com on 3 August 2004: http://bmj.com/cgi/doi/10.1136/bmj.38201.410255.55
We thank the many agencies and individuals who provided advice and data for inclusion in the study; Linette Collins, Amy Gibson, and Elizabeth Conroy for assistance with the project; and Owen Westcott and Jenny Iverson from the AIDS and Infectious Diseases Branch of NSW Health for facilitating access to NSW notification and programme data. We also thank Greg Dore, Lisa Maher, and Margaret MacDonald for comments on an earlier draft of the paper.
Contributors: CD (guarantor), LD, and WH conceived the study. LD supervised the research. CD led the writing. SG conducted the analysis for the study. All authors helped to conceptualise ideas, interpret findings, and review drafts of the manuscript.
Funding: This work was completed as part of a larger project funded by the Australian National Drug Law Enforcement Research Fund (NDLERF). The National Drug and Alcohol Research Centre is funded by the Australian Government Department of Health and Ageing. CD was funded by a postgraduate award from the Australian Government Department of Health and Ageing.
Competing interests: None declared.
Ethical approval: The study was approved by the University of New South Wales human research ethics committee and the human research ethics committees of the South Eastern Sydney Area Health Service, South Western Area Health Service, and Central Sydney Area Health Service.
References
Darke S, Topp L, Kaye S, Hall W. Heroin use in New South Wales, Australia, 1996-2000: 5 year monitoring of trends in price, purity, availability and use from the illicit drug reporting system (IDRS). Addiction 2002;97: 179-86.
Topp L, Kaye S, Bruno R, Longo M, Williams P, O'Reilly B, et al. Australian drug trends 2001: findings from the illicit drug reporting system (IDRS). Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2002.
Degenhardt L, Day C, Hall W, eds. The causes, course and consequence of the heroin shortage in Australia. Adelaide: Australasian Centre for Policing Research, 2004.
National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2003. Sydney: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 2003.
Law M, Dore G, Bath N, Thompson S, Crofts N, Dolan K, et al. Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001. Int J Epidemiol 2003;32: 717-24.(Carolyn Day, doctoral can)