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

FRANÇAIS :
A la période de Noël 2000, à Sydney et dans d'autres grandes villes australiennes, les usagers d'héroïne ont signalé un manque d'approvisionnement (manque en partie dû au renforcement de la loi). Le prix de l'héroïne a augmenté, la consommation a diminué ainsi que le nombre d'overdose. Les bénéfices en matière de santé n'ont pas été perceptibles du fait d'un report de la consommation sur d'autres drogues, particulièrement la cocaïne. Egalement aucun impact durable n'a été observé sur la criminalité.
ENGLISH :
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 Ieast 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. (Editor' s abstract)