NDARC Technical Report No. 206 (2004)
EXECUTIVE SUMMARY
Heroin use and related harms increased dramatically in Victoria in the late 1990s (Dietze & Fitzgerald, 2002). Reports from various sources suggested a dramatic decline in the supply of heroin in Victoria in late 2000/early 2001. Commonly termed the heroin ‘drought’ this change in heroin supply was reflected in media reports of changes in heroin use and associated harms such as heroin overdose. A number of research projects investigated the heroin drought (hereafter heroin shortage) and its consequences in Melbourne and Victoria more widely (Dietze, Fry, Miller et al., 2001; Fitzgerald, Dovey, Dietze, & Rumbold, submitted; Miller, Fry, & Dietze, 2001). The aim of the current research was to investigate the heroin shortage in Melbourne in more detail with a view to examining the longer-term consequences of the heroin shortage in Victoria. The research is part of a broader research program conducted in three Australian states (Victoria, New South Wales and South Australia), coordinated by the National Drug and Alcohol Research Centre and funded by the National Drug Law Enforcement Research Fund.
The objectives of the research were to:
- Document the changes that have taken place in the heroin market during the heroin drought and consider the heroin supply issues that remain in light of recent reports of a return to more consistent, higher-grade supply of the drug in Melbourne and Sydney during November 2001.
- Describe the long-term changes in heroin distribution and consumption patterns that have resulted from changes in the heroin markets in Melbourne.
- Document the long-term changes in drug using behaviours amongst IDU that appear to result of these reported changes in the heroin market.
- Analyse trends in heroin-related harms across the heroin ‘hotspots’ in Melbourne and examine their relation to the changes in supply observed over the period 2000-2001.
The project relied upon collection and analysis of existing data sources that capture information pertinent to a consideration of the effects of the heroin shortage (eg ambulance attendance at non-fatal heroin overdose) as well as a series of Key Informant interviews conducted specifically for the project. The effects of the heroin shortage have generally been considered in their own right largely independent of the characteristics of the heroin supply evident in Victoria in years immediately prior to the shortage (that have been referred to as a heroin ‘glut’, see Dietze & Fitzgerald, 2002). The effects of the heroin shortage were considered within the following domains:
- Characterising (documenting) the heroin shortage
- Changes in drug use among Injecting Drug Users
- Changes in the health effects of injecting drug use
- Changes in drug treatment
- Changes in drug-related criminal activity associated with the heroin shortage
- Changes in health and law enforcement agency operations as a result of the heroin shortage
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Key Informant impressions of the heroin shortage
Key findings
The data collected for this research show that there was a dramatic decrease in the supply of heroin in Victoria. This effect was at its most acute in December 2000 – January 2001 and was reflected in Injecting Drug User (IDU) perceptions of key characteristics of the heroin market and indicators directly and indirectly associated with heroin use. The summary sections of this report detail the major findings across the different domains considered in this study and the intention is not to repeat these findings in detail in this section of the report. Nevertheless, the key findings of the study in terms of the characteristics and immediate effects of the heroin shortage included:
- decreases in the purity of samples of heroin analysed in Victoria (although the decline appeared established prior to the onset of the acute period of the shortage)
- reports of decreased availability (ease of access) and purity, and increased price, of heroin among sampled IDU in Melbourne
- a decrease in the reported use of heroin, and overall injection frequency reported by samples of IDU in Melbourne
- a dramatic decline (85%) in the number of heroin related deaths in Victoria
- a dramatic decline in the number of non-fatal heroin overdoses in Melbourne (52%) that was most acute in the Central Business District of Melbourne (an additional decline of 20%)
- a dramatic decline (61%) in the number of opioid hospitalisations in Victoria
- a decline in the number of courses of treatment for opioids provided by the specialist drug treatment service system in Victoria
- a short-term increase in the number of robbery incidents recorded by Victoria Police
These effects were generally mirrored in the reports of Key Informants. The effects had major implications for the operations of agencies such that the shortage produced an ability to focus on other issues and/or drugs that were unable to be addressed during the heroin epidemic that was evident in Victoria in the late 1990s/early 2000.
One of the most important findings of the research presented in this report relates to the extent of injecting drug use in Melbourne and Victoria more widely. Available indicators and reports from Key Informants suggest that the overall extent of injecting drug use changed little in Victoria as a result of the heroin shortage. This finding suggests that IDU shifted their drug use patterns as a result of the shortage. Findings from this research suggested that amphetamine, benzodiazepine, prescribed opioid and cannabis use increased among sampled IDU that was consistent with treatment service data. Overall the findings suggest the emergence of a market for prescribed pharmaceuticals among IDU that has been sustained in the longer term. These changes had consequences for health agency operations and the following effects were suggested and/or noted for clients presenting at services and the experiences of agencies:
- A decline in the general physical health of IDU
- A decline in the mental health of IDU (primarily associated with the use of stimulant drugs)
- An increase in the rate of presentation of pregnant women with stimulant-related issues and associated increases in problems for neo-nates
- An increase in the prevalence of injection-related problems among IDU
- An increase in injecting practices related to risks for blood-borne virus transmission
- a decrease in the rate of presentation for opioids at specialist drug treatment agencies
However, unlike other jurisdictions, there did not appear to be an increase in the use of other drugs such as cocaine.
The heroin shortage was seen as resulting in a decline in the street-based drug markets that had come to dominate Melbourne’s heroin-using scene. However, this decline appeared to commence prior to the onset of the most acute period of the heroin shortage. Nevertheless, there was a substantive decline in heroin related incidents recorded in the areas of Melbourne containing street-based drug markets that could be attributed to the heroin shortage and this was not offset by an increase in reported incidents related to drugs other than heroin.
There were few other quantifiable effects of the heroin shortage on reported rates of crime indirectly linked to the consumption of heroin in Victoria. This meant that Key Informant and IDU reports of increased property, sex related and violent crime were not supported by available crime data. This divergence could be explained by Key Informant reports suggesting that the reported increases in crime attributed to the heroin shortage may have been perpetrated against other heroin market participants who are probably less likely to report their experience of crime than other members of the public. Nevertheless, the absence of clear findings on the patterns of crime in relation to an abrupt change in heroin supply suggests the need for further research in this domain.
The consequences of the shortage in terms of law enforcement operations included:
- less resources being devoted to the policing of heroin
- an increased focus on other crime
- improved linkages between health and law enforcement agencies
- increased job satisfaction
Conclusions and implications
The implications of the heroin shortage in terms of its short- and long-term effects are many. The decline in heroin related mortality and morbidity noted in this research is an unambiguously positive outcome of the change in supply. However, many of the short-term changes in the patterns of drug use that appear to have been entrenched in the longer term have significant implications for service provision and research.
The changes in patterns of drug use evident among IDU resulted in a change in the presentation of IDU at services that produced pressures in terms of client management and the types of services offered. In this regard it is clear that the options for treatment of IDU for the use of drugs other than heroin is limited (Dietze, Richards et al., 2003). Further work on expanding the skills base in terms of client management and the range of services offered to IDU needs to be undertaken as a matter of priority in Victoria.
Recent data on heroin seizure purity do show an increase in purity from the time when the effects of the heroin shortage were most acute, implying a recent increase in the supply of the drug in Victoria. This finding is consistent with reports from IDU and Key Informants. In the context of the shortage producing little change in the size and extent of injecting drug use in Victoria it is unsurprising that heroin use continued during the period during which the effects of the shortage were most acute and then increased as availability increased. The question therefore remains whether the major impacts of the heroin shortage, decreases in heroin related mortality and morbidity, can be sustained in the longer-term.