Supervised injection services: What has been demonstrated? A systematic literature review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)69374-4.pdf

Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study

Risky health behaviors such as smoking, drinking alcohol, drug use, unprotected sex, and poor diets and sedentary lifestyles (leading to obesity) are a major source of preventable deaths. This chapter overviews the theoretical frameworks for, and empirical evidence on, the economics of risky health behaviors. It describes traditional economic approaches emphasizing utility maximization that, under certain assumptions, result in Pareto-optimal outcomes and a limited role for policy interventions. It also details nontraditional models (e.g. involving hyperbolic time discounting or bounded rationality) that even without market imperfections can result in suboptimal outcomes for which government intervention has greater potential to increase social welfare. The chapter summarizes the literature on the consequences of risky health behaviors for economic outcomes such as medical care costs, educational attainment, employment, wages, and crime. It also reviews the research on policies and strategies with the potential to modify risky health behaviors, such as taxes or subsidies, cash incentives, restrictions on purchase and use, providing information and restricting advertising. The chapter concludes with suggestions for future research.

The Economics of Risky Health Behaviors

In mid-1995, a government effort to reduce the supply of methamphetamine precursors successfully disrupted the methamphetamine market and interrupted a trajectory of increasing usage. The price of methamphetamine tripled and purity declined from 90 percent to 20 percent. Simultaneously, amphetaminerelated hospital and treatment admissions dropped 50 percent and 35 percent, respectively. Methamphetamine use among arrestees declined 55 percent. Although felony methamphetamine arrests fell 50 percent, there is no evidence of substantial reductions in property or violent crime. The impact was largely temporary. The price returned to its original level within four months; purity, hospital admissions, treatment admissions, and arrests approached preintervention levels within eighteen months. (JEL I12, K42).

The War on Drugs: Methamphetamine, Public Health, and Crime

Humans have always used drugs, probably as part of their evolutionary and nutritional heritage. However, this previous biological adaptation is unlikely to be so in the modern world, in which 2 billion adults (48% of the adult population) are current users of alcohol, 1.1 billion adults (29% of the adult population) are current smokers of cigarettes and 185 million adults (4.5% of the adult population) are current users of illicit drugs. The use of drugs is determined largely by market forces, with increases in affordability and availability increasing use. People with socio-economic deprivation, however measured, are at increased risk of harmful drug use, as are those with a disadvantaged family environment, and those who live in a community with higher levels of substance use. Substance use is on the increase in low-income countries which, in the coming decades, will bear a disproportionate burden of substance-related disability and premature death.

Global use of alcohol, drugs and tobacco.

AIMS: To examine the effects of supply-side drug law enforcement on the dynamics of the Australian heroin market and the harms associated with heroin. SETTING: Around Christmas 2000, heroin users in Sydney and other large capital cities in Australia began reporting sudden and significant reductions in the availability of heroin. The changes, which appear to have been caused at least in part by drug law enforcement, provided a rare opportunity to examine the potential impact of such enforcement on the harm associated with heroin. DESIGN: Data were drawn from a survey of 165 heroin users in South-Western Sydney, Australia; from the Drug Use Monitoring in Australia (DUMA) project; from NSW Health records of heroin overdoses; and from the Computerized Operational Policing System (COPS) database. FINDINGS: Heroin price increased, while purity, consumption and expenditure on the drug decreased as a result of the shortage. The fall in overall heroin use was accompanied by a significant reduction in the rate of overdose in NSW. However, the health benefits associated with the fall in overdose may have been offset by an increase in the use of other drugs (mainly cocaine) since the onset of the heroin shortage. There does not appear to have been any enduring impact on crime rates as a result of the heroin 'drought'. CONCLUSION: Supply control has an important part to play in harm reduction; however, proponents of supply-side drug law enforcement need to be mindful of the unintended adverse consequences that might flow from successfully disrupting the market for a particular illegal drug. Language: en

Supply control and harm reduction: lessons from the Australian heroin 'drought'.

The current study aimed to model the effect of Australia's first Medically Supervised Injecting Centre (MSIC) on acquisitive crime and loitering by drug users and dealers. The effect of the MSIC on drug-related property and violent crime was examined by conducting time series analysis of police-recorded trends in theft and robbery incidents, respectively. The effect of the MSIC on drug use and dealing was examined by (a) time series analysis of a special proxy measure of drug-related loitering; (b) interviewing key informants; and (c) examining trends in the proportion of Sydney drug offences that were recorded in Kings Cross. There was no evidence that the MSIC trial led to either an increase or decrease in theft or robbery incidents. There was also no evidence that the MSIC led to an increase in 'drug-related' loitering at the front of the MSIC after it opened, although there was a small increase in 'total' loitering (by 1.2 persons per occasion of observation). Trends in both 'drug-related' and 'total' loitering at the front of the MSIC steadily declined to baseline levels, or below, after it opened. There was a very small but sustained increase in 'drug-related' (0.09 persons per count) and 'total' loitering (0.37 persons per count) at the back of the MSIC after it opened. Key informant interviews noted an increase in loitering across the road from the MSIC but this was not attributed to an influx of new users and dealers to the area. There was no increase in the proportion of drug use or drug supply offences committed in Kings Cross that could be attributed to the opening of the MSIC. These results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering.

The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime.

Given the centrality of drug treatment to the drug court framework, the proliferation of drug courts in the United States, and their emergence more recently in Australia, it is surprising that such little attention has been given to assessing their therapeutic effect. This evaluation aimed to assess the health and well-being of drug-dependent offenders diverted to the New South Wales Drug Court, and monitor changes in their health and well-being throughout 12 months of programme participation. The study consisted of baseline interviews with 202 offenders accepted into the programme between February 1999 and April 2000, and follow-up interview at 4, 8 and 12 months with participants who remained on the programme. Health and well-being was assessed at each follow-up using the Short Form-36 Health Survey (SF-36) the OTI social functioning scale, and self-reported spending as a proxy for illicit drug use. The health of male Drug Court participants prior to commencing the programme was significantly poorer than Australian population norms. The results provided evidence of significant and sustained improvements in health and well-being for the 51 participants who competed each follow-up interview. Furthermore, significant improvements were found for offenders who remained on the programme for at least 4 months but less than 12 months. However, the positive health outcomes are limited by the low programme retention rate. These results indicate that significant health outcomes can be achieved for at least some heavily drug-dependent, recidivist offenders through the drug court model.

Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme.

The first Drug Court in New South Wales began operation on 8 February 1999. It was set up on a trial basis, initially for a period of two years. Modelled on US Drug Courts, the New South Wales Drug Court provides an intensively supervised program of treatment for drug-dependent offenders, with the aim of assisting them to overcome their drug dependence and end their involvement in criminal activity. This bulletin describes the operation of the Court and the means by which it will be evaluated. Summary data from the first 12 months of the Court's operation are presented. The key findings to date are that 224 persons have been placed on the Drug Court Program and two-thirds of these were still on the Program as at 31 January 2000; progress through the Program has been somewhat slower than anticipated; urine testing has proved to be an unreliable indicator of program success; but only about 13 per cent of participants have been sentenced for new offences committed while on the Program. This last result is encouraging given the normally high level of recidivism of heroin-dependent property offenders.

New South Wales Drug Court Evaluation: Program and Participant Profiles

In 1999 the New South Wales government implemented an evaluated trial of the first drug court in Australia. This paper outlines the initial design and legislative framework of the Court, and the Court's operation over the first six months. For the benefit of policymakers and researchers, challenges that arose in the initial implementation and evaluation process are outlined. Although the Court is based on a North American model, some aspects of the court proved a challenge in the Australian context (such as the development of rewards and sanctions). Difficulties in implementation are outlined, including differences in orientation of a health and welfare perspective compared to a criminal justice perspective and the importance of adequate IT resources for evaluation purposes and for a 'paperless' court. In outlining these challenges this article concentrates on the initial implementation phase of a new policy initiative. Long-term evaluation of the project will determine the true success of the Court.

Karen Freeman

Papers

Supply control and harm reduction: lessons from the Australian heroin 'drought'.

The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime.

Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme.

New South Wales Drug Court Evaluation: Program and Participant Profiles

Design and Implementation of Australia's First Drug Court