Impact of a reduction in heroin availability on patterns of drug use, risk behaviour and incidence of hepatitis C virus infection in injecting drug users in New South Wales, Australia

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street‐drug users

“…Consistent with previous study findings in Canada and in Australia (27,31,32,35), cocaine injection was an independent risk factor for HCV transmission. Injection cocaine use was not associated with PO use, and did not explain the relation between HCV seroconversion and PO use among non-heroin users.…”

“…52, 5.45)), whereas the association was not statistically significant for participants who reported using both drugs (HR: In Australia and Vancouver, Canada, a reduction of heroin availability was implicated in significant shifts in drug-use patterns and possibly in increased drug-related harms (8,(27)(28)(29). In Estonia, a shift in use from heroin to POs was observed following heroin shortages in 2001 (30).…”

The effectiveness of harm reduction in preventing HIV among injecting drug users

“…37 An increasing number of studies suggest that vigorous drug law enforcement can inadvertently increase the potential for transmission of HIV and other bloodborne infections among IDUs. [38][39][40][41][42][43] Adoption of harm reduction approaches The scientific debate about harm reduction is now over. Harm reduction approaches to HIV prevention among IDUs have faced relentless international and national opposition and criticism.…”

Dilemmas in harm minimization

“…The harms associated with supply reduction or the law enforcement practices associated with it include loss of civil liberty [10], increased risk of overdose and disease [11] and greatly increased rates of imprisonment [12]. The risk of imprisonment may assist in keeping retail drug prices high, but imprisonment reduces substantially an individual's future legitimate employment and earnings prospects [13].…”

“…The risk we take when supply side drug law enforcement pushes up the price of one illegal drug is that drug users will switch to another. There is some evidence that efforts to restrict the supply of heroin have prompted some street-based heroin users to switch to methamphetamine and cocaine [11]. These are drugs that, if used frequently over a prolonged period, can produce aggression, hostility and paranoia [15].…”