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Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38201.410255.55 (Published 19 August 2004) Cite this as: BMJ 2004;329:428
  1. Carolyn Day, doctoral candidate (carolyn.day@unsw.edu.au)1,
  2. Louisa Degenhardt, lecturer1,
  3. Stuart Gilmour, statistician1,
  4. Wayne Hall, professor2
  1. 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
  2. 2 Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
  1. Correspondence to: C Day
  • Accepted 23 June 2004

Introduction

In early 2001 there was a dramatic decline in the availability of heroin in New South Wales (NSW), Australia, where previously heroin had been readily available at a low price and high purity.1 The decline was confirmed by Australia's strategic early warning system, which revealed a reduction in heroin supply across Australia and a considerable increase in price,2 particularly from January to April 2001.

This “heroin shortage” provided a natural experiment in which to examine the effect of substantial changes in price and availability on injecting drug use and its associated harms in Australia's largest heroin market,2 a setting in which harm reduction strategies were widely used. Publicly funded needle and syringe programmes were introduced to Australia in 1987, and methadone maintenance programmes, which were established in the 1970s, were significantly expanded in 1985 and again in 1999.

Methods and results

In NSW needle and syringe programmes are delivered primarily within the public sector through area health services. There is also a private sector programme, subsidised by the government, delivered through pharmacies (known as “fitpacks”). …

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