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