Commentary The " lessons " of the Australian " heroin shortage "

Heroin use causes considerable harm to individual users including dependence, fatal and nonfatal overdose, mental health problems, and blood borne virus transmission. It also adversely affects the community through drug dealing, property crime and reduced public amenity. During the mid to late 1990s in Australia the prevalence of heroin use increased as reflected in steeply rising overdose deaths. In January 2001, there were reports of an unpredicted and unprecedented reduction in heroin supply with an abrupt onset in all Australian jurisdictions. The shortage was most marked in New South Wales, the State with the largest heroin market, which saw increases in price, dramatic decreases in purity at the street level, and reductions in the ease with which injecting drug users reported being able to obtain the drug. The abrupt onset of the shortage and a subsequent dramatic reduction in overdose deaths prompted national debate about the causes of the shortage and later international debate about the policy significance of what has come to be called the "Australian heroin shortage". In this paper we summarise insights from four years' research into the causes, consequences and policy implications of the "heroin shortage". Background Heroin use causes considerable harm to individual users through the development of dependence upon the drug, fatal and nonfatal overdose, mental health problems, and blood borne virus transmission. It also adversely affects the community through drug dealing, property crime and reduced public amenity. Recent decades have seen an increase in the prevalence of heroin use in many developed (and increasingly, developing) countries as reflected in rising overdose deaths [1]. Australia had a particularly steep increase in heroin overdose deaths between the mid and late 1990s with the result that in 1999 there were 1116 opioid overdose deaths among those aged 15 to 54 years [2]. Such deaths accounted for one in eight deaths among young Australians aged 15–24 years at that time [2]. There were also substantial rises in the number of people: treated for heroin dependence, arrested for heroin offences, and diagnosed with hepatitis C infections [3-5]. It had been estimated that injection drug-related hepatitis C will become the largest cause of liver transplants in Australia [5]. In January 2001, the increase in overdose deaths was reversed by an unpredicted and unprecedented reduction in heroin supply that abruptly affected all Australian jurisdictions. The shortage was most marked in New South Wales, the State with the largest heroin market [6,7], where there were increases in price, dramatic decreases in Published: 02 May 2006 Substance Abuse Treatment, Prevention, and Policy 2006, 1:11 doi:10.1186/1747-597X-1-11 Received: 20 January 2006 Accepted: 02 May 2006 This article is available from: http://www.substanceabusepolicy.com/content/1/1/11 © 2006 Degenhardt et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.