Elsevier

Drug and Alcohol Dependence

Volume 79, Issue 3, 1 September 2005, Pages 397-404
Drug and Alcohol Dependence

Age differentials in the impacts of reduced heroin: Effects of a “heroin shortage” in NSW, Australia

https://doi.org/10.1016/j.drugalcdep.2005.03.028Get rights and content

Abstract

Background

: This paper uses a unique event, the Australian heroin shortage, to see whether an abrupt, substantial and sustained change in heroin supply had different effects on harms related to heroin use among younger and older heroin users.

Method

: Indicator data were examined by age group on the number of persons entering treatment for heroin and amphetamine dependence, arrests for heroin use/possession and number of drug related deaths in NSW, Australia. Data were analysed using times series analysis.

Results

: There was a 41% reduction in the number of new registrations for opioid pharmacotherapy per month among 25–34 year olds, and a 26% reduction among 15–24 year olds, but no apparent changes among older age groups. Similarly, reductions in the number of non-pharmacological heroin treatment episodes were most pronounced among younger age groups. There was a 49% reduction in the number of heroin possession/use offences among those aged 15–24 years, compared to declines of 31–40% among older age groups. Declines in heroin related deaths were greatest among 15–24 year olds (65% reduction). There was no change in other drug related deaths in any age group.

Conclusions

: A reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people, across a number of outcome domains.

Section snippets

The NSW heroin market

During the 1990s, there was a substantial increase in the scale of Australian heroin markets. In New South Wales during the years 1993–1999, the price per gram of heroin reached an historic low, the purity of street heroin was 60%, and heroin was the drug most commonly injected by regular injecting drug users (IDU) (Darke et al., 2002, MacDonald et al., 2001, Topp et al., 2002). In the late 1990s, there were substantial rises in the number of persons treated for heroin dependence, in heroin

The setting

NSW is the most populous jurisdiction in Australia. NSW contains the largest heroin market in the country; it is thought that heroin largely enters Australia through the State's capital city, Sydney (Australian Crime Commission, 2003), and it has been estimated that approximately half of dependent opioid users in Australia live in the State (Hall et al., 2000). The heaviest patterns of heroin use were historically documented among regular injecting drug users in NSW (Topp et al., 2001), and

Drug treatment

Among those aged 15–24 years, the month during which the heroin shortage began was associated with a significant increase (for 1 month) in new registrations for opioid pharmacotherapy (Fig. 1) from 98 to 134. This decreased, on average, by 26% (p < 0.0001) after February 2001. There was a 41% (p < 0.0001) decrease in the mean number of new registrations per month among those aged 25–34 years following the reduction in heroin supply. There was no significant change in trend among older age groups.

Discussion

This study found that a reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people. This suggests that supply reduction was more likely to result in a reduction of the use of that drug type among younger users than among older users. The reasons for this differential age effect are less clear, and a number of possibilities could be related to it, such as: (a) younger users may not be as driven by physiological dependence upon heroin to

Conclusions

A reduction in heroin supply in NSW, Australia was associated with larger reductions in heroin related harms among younger (less than 25 years) than older persons (25–45 years). At the same time, there was suggestive evidence that these users probably shifted to other drug use. Nonetheless, the shift to other drugs among some younger users was not accompanied by any concomitant offsetting increase in overdoses, or in police incidents for drug possession. This suggests that these two types of

Acknowledgements

This research was part of a larger project funded by the National Drug Law Enforcement Research Fund. The authors wish to thank Ms. Linette Collins, Ms. Amy Gibson, Dr. Libby Topp, Professor Peter Reuter and Professor William Dunsmuir for their input to the project. Thanks to staff at NSW Police, NSW Health and to Dr. Don Weatherburn and colleagues at the Bureau of Crime Statistics and Research for providing data and assisting with interpretation. Thanks to Associate Professor Shane Darke for

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