How patterns of injecting drug use evolve in a cohort of people who inject drugs

This research found an overall movement away from street based drug purchasing and drug use, towards more activity in private settings, which has important implications for the harms experienced by people who inject drugs. Foreword This paper investigates the frequency of intravenous drug use in a cohort of people who inject drugs, and the decline in use over time. It provides an important indication of the effectiveness of current interventions at reducing the consumption of illicit drugs. Comparisons are made between the injection frequency of participants on or off Opioids Substitution Therapy (OST), and according to the settings in which drugs are most frequently purchased and used (eg street, house). This research found an overall movement away from street based drug purchasing and drug use, towards more activity in private settings. This has important implications for the harms experienced by people who inject drugs. Intravenous drug use was persistent, with only slow declines observed in the frequency of the cohort’s overall use. Lower injection frequency was associated with use in private rather than public locations as well as the uptake of OST. Additional work is needed to understand how this change in setting is affected by and also affects current interventions, and whether it can be used to help further reduce injecting drug use

Bulletin No. 5: Estimating the number of heroin users in Australia

Estimating the prevalence of drug use is one of the key focal areas of alcohol and drug epidemiology. Estimation of the extent of alcohol and drug use in the Australian community has primarily been undertaken using surveys of the general population. Nevertheless, it is widely understood that prevalence estimates derived from general population surveys underestimate the true extent of drug use in the community for drugs of low use prevalence (e.g. heroin) because of issues around sampling (e.g. response rates and the extent to which crucial samples such as the homeless are missed in household surveys) and the truthfulness of responses to questions concerning illegal or hidden behaviours. In response, epidemiologists have applied specialised statistical techniques to the analysis of data sources on the extent of drug-related harm (e.g. Opioid overdose deaths) to produce estimates of the extent of problematic drug use in the Australian community. Prevalence estimation using secondary data sources has generally been undertaken only in relation to heroin use in Australia. This work has used a variety of techniques (e.g. capture-recapture, back-projection, multiplier) in accordance with a general consensus that has emerged around the application of such techniques to the estimation of problematic drug use. In applying these methods Australian work has developed multiple estimates using available statistical estimation tools with convergence among estimates used as the source of the most parsimonious estimate (e.g. the median of the estimates derived). While this approach is appealing, the resultant ‘best’ estimates are derived primarily from the application of simple mortality multipliers (e.g. 1% annual mortality rate for heroin users) to the number of opioid overdose deaths occurring in specific Australian jurisdictions (generally NSW). The problem of this multiplier approach is highlighted by the effect of the heroin shortage in Australia. The aim of this component of the DPMP was to develop plausible estimates of the prevalence of heroin use in Melbourne with a view to informing various elements of DPMP projects. The work was also designed to provide a method for estimating the extent of injecting drug use more widely (specifically through application to amphetamines). It was funded by a Travelling Scholarship from the Victorian Premier’s Drug Prevention Council awarded to Paul Dietze

Bulletin No. 6: Illicit drugs in Australia: What do we know about the role of price?

There has been an increasing awareness of the importance of using price information to understand illicit drug markets. Internationally, researchers have found relationships between illicit drug prices and other market characteristics such as the numbers of drug users, the proportion of arrestees testing positive to drugs and the number of drug-related emergency department incidents. This work aimed to assess whether the Australian heroin market shares the same basic characteristics (e.g. real prices falling over time, significant price variability) as other illicit drug markets where more price analysis has been done; and begin to explore the relationship between price and harm. It is hard to measure how much heroin is being consumed with any precision, making it extremely difficult to understand the relationship between drug use and the harmful consequences that result from use. On the other hand other market characteristics, such as price, can be better measured. If there are relationships between price (as an indirect measure of consumption) and harms, we can use price (and potentially other market data) to assess harms and policy responses

Characteristics of medication overdose presentations to the ED: how do they differ from illicit drug overdose and self-harm cases?

Background Medication overdose accounts for >80% of hospital presentations for self-harm. Previous research has identified typical characteristics of medication overdose cases; however, these cases have not been well differentiated from other similar presentations, namely (1) illicit drug overdose and (2) self-harm by means other than overdose. Method A 12-month audit of medication overdose cases (both intentional and unintentional) attending the emergency department (ED) of a major metropolitan public hospital in Melbourne, Australia was conducted. Comparison was made with patients attending for illicit drug overdose or for self-harm by means other than overdose.Results Medication overdose cases (n=453) showed a broadly comparable profile with those found in earlier studies (predominantly female gender, aged in their 30s and referred for psychosocial assessment). A similar though not identical profile was noted for self-harm cases (n=545). In contrast, patients attending for illicit drug overdose (n=409) could be characterised as male, in their 20s and not referred for psychosocial assessment. Illicit drug overdose cases were more likely than either the medication overdose or self-harm cases to be triaged in the most urgent category (19.3, 3.8 and 3.9% respectively), suggesting a high level of acuity in this group. However, the illicit drug overdose group on average spent less time in the ED than medication overdose patients, and were less likely to require hospital admission. Conclusion On both demographic and treatment variables, patients attending the ED following a medication overdose more closely resemble those attending for self-harm by means other than overdose than those attending for illicit drug overdose

Experiences of and attitudes towards injecting drug use among marginalised African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterised as unnatural, risky and immoral. IDU was highly stigmatised and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use, in order to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalised

Public injecting and public amenity in an inner-city suburb of Melbourne, Australia

Background: Public drug markets and injecting impose significant burden on individuals and the community. This study aimed to document public injecting and amenity in North Richmond, an inner-city suburb of Melbourne, Australia. Methods: A rapid assessment methodology was employed. Data comprised: secondary data on drug use indicators, structured observations and interviews with key stakeholders. Primary data were collected from May to October 2012. Quantitative data are summarised using descriptive statistics. Basic content analysis was performed on interview transcripts. Results: An average of 1843 needle–syringes (NS) were collected per month from syringe disposal bins and street-sweeps in the period January–December 2012. Discarded NS and other injecting paraphernalia were observed in a variety of locations. Stakeholder interviews indicated substantial concerns over the presence of NS and witnessing injecting and overdose. Discussion: Public injecting is widespread, frequent, and highly visible in North Richmond and has a substantial negative effect on public amenity. The research identified two main priorities: (1) enhance access to harm reduction services and materials; and (2) improve public amenity. Among other responses, the study findings support the introduction of a supervised injecting facility (SIF) as a viable component of a comprehensive harm reduction response to illicit drug use in this area