The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

Carolyn Day,Louisa Degenhardt,Wayne Hall,Stuart Gilmour

doi:10.1186/1471-2458-5-84

Abstract

BackgroundIn early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures.MethodsTime series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15–19 years.ResultsThere were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15–19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications.ConclusionA marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Highlights

In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'
Needle and syringe sharing continues to be reported in Australia, the available evidence suggests that the prevalence of this behaviour has remained stable at 15–20% sharing in the past month [31]. Given these changes in drug use in an established harm reduction setting, this study aimed to examine population level changes in harms associated with injecting drug use, such as hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B (HBV) that occurred after the change in heroin supply in New South Wales (NSW), the State containing Australia's largest heroin markets [32]
Not all hepatitis B virus (HBV) and HIV notifications are due to injecting drug use, this is true across all time points examined, and there is no extraneous reason to believe that this pattern would have changed over the period examined

Summary

Introduction

In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage' This 'shortage has been linked to a decrease in needle and syringe output and possibly a reduction in injecting drug use. Injecting drug use is an important risk factor for the transmission of blood-borne viral infections (BBVI) such as the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) [1]. Harm reduction strategies such as needle and syringe programs have been instrumental in maintaining low HIV prevalence among injecting drug users (IDU) in settings where they were implemented early [2],. We take advantage of recent changes in the Australian heroin market to answer this question empirically

Objectives

Methods

Results

Discussion

Conclusion