Closure of an open drug scene--a case register-based analysis of the impact on the demand for methadone maintenance treatment

A trial of Criminal Infringement Notices as an alternative to criminal penalties for illicit drug offences in New South Wales, Australia: Estimated savings

INTRODUCTION AND AIMS

In 2019, legislation was introduced allowing New South Wales police to issue Criminal Infringement Notices (CIN) instead of criminal charges for prohibited drug possession offences, excluding cannabis leaf. This initiative was trialled across NSW music festivals from 25 January to 1 August 2019. This paper aims to examine the number of CINs administered and to estimate the associated (actual and potential) savings.

DESIGN AND METHODS

Data were obtained from the NSW Bureau of Crime Statistics and Research (Recorded Crime Statistics, Reoffending Database). To estimate the monetary savings associated with administering CINs for drug possession offences, as opposed to processing them through the criminal justice system, data were obtained from the 2020 Report on Government Services.

RESULTS

From January to June 2019, 300 CINs were issued for illicit drug possession (mostly for ecstasy possession; n = 256), resulting in an estimated saving to the criminal justice system of 194 400 AUD (or 314 400, if generated revenue included). We estimate that issuing CINs for all illicit drug possession offences would have provided savings of over 5 million AUD in that same six-month period, or approximately 1.7 million AUD if CINs were only issued to people with no prior convictions.

DISCUSSION AND CONCLUSION

Issuing CINs for illicit drug possession has the potential to yield substantial monetary savings. However, to avoid unintended consequences (e.g. disproportionate impact on disadvantaged populations), we would argue that police also be given the discretion to issue cautions for illicit drug possession offences.

Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment-a case register analysis

BACKGROUND

We have sought to identify ethnic- and gender-specific differences in HIV prevalence among heroin users receiving opioid maintenance treatment in the canton of Zurich, Switzerland.

METHODS

We used a generalized linear model (GEE) to analyze data from the anonymized case register for all opioid maintenance treatments in the canton of Zurich. Patients who received either methadone or buprenorphine between 1991 and 2012 (n=11,422) were evaluated for gender (male vs. female), ethnic background (Swiss vs. non-Swiss), and lifetime method of drug use (ever injector vs. non-injector). We addressed missing data by multiple imputation.

RESULTS

The overall prevalence of HIV among patients declined substantially from 33.7% in 1991 to 10.6% in 2012 in the complete dataset. In the imputed datasets, the respective prevalence dropped from 32.8% in 1991 to 9.7% in 2012. Non-injectors had a four to five times lower risk ratio (RR) compared to the reference group, 'Swiss males who ever injected'. In addition, we found a significantly higher risk ratio of HIV prevalence among females who had ever injected; this was true both for the complete dataset and the imputed dataset (Swiss RR 1.18 CI 95% 1.04-1.34, non-Swiss RR 1.58 CI 95% 1.18-2.12).

CONCLUSION

In this population, gender, ethnic background, and lifetime method of drug use influenced the risk of being HIV positive. Different access to treatment and different characteristics of risk exposure among certain subgroups might explain these findings. In particular, the higher risk for women who inject drugs-especially for those with an immigrant background-warrants additional research. Further exploration should identify what factors deter women from using available HIV-prevention measures and whether and how these measures can be better adapted to high-risk groups.

Open drug scenes: responses of five European cities

BACKGROUND

Open drug scenes are gatherings of drug users who publicly consume and deal drugs. The authors conducted a study of five European cities that have met such scenes constructively. The aim was to investigate shared and non-shared interventions and strategies in order to increase the understanding of this type of problem.

METHODS

First a description was made for the cities of Amsterdam, Frankfurt, Vienna, Zürich and Lisbon. These descriptions were sent to contact persons in each city prior to visit by the researchers. The methods and strategies in each city were discussed and core choices and efforts extracted. A report was sent to the contact group for corrections and clarifications. The paper analyses shared and non-shared traits and strategies.

RESULTS

All of the cities had initially a period with conflict between liberal and restrictive policies. A political consensus seems to be a prerequisite for effective action. A core shared characteristic was that drug dependence was met as a health problem and drug use behaviour as a public nuisance problem. Low threshold health services including opioid maintenance treatment were combined with outreach social work and effective policing.

CONCLUSION

Prevention, harm reduction and treatment should be combined with law enforcement based on cooperation between police, health care and social services. The aim should be "coexistence" between society and users of illegal substances and the strategy based on several years planning and conjoint efforts. The solutions are found in appropriate combinations of harm reduction and restrictive measures.

A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs

While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2-6, 6-15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36-14.20); daily crack use (AOR = 2.70; 95% CI, 2.07-3.52); encounters with police (AOR = 2.11; 95% CI, 1.62-2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14-1.95). Regular employment (AOR = 0.50; 95% CI, 0.38-0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45-0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.

Mexico's methamphetamine precursor chemical interventions: impacts on drug treatment admissions

AIMS

To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences.

DESIGN

Quasi-experiment: autoregressive integrated moving average (ARIMA)-based intervention time-series analysis.

INTERVENTIONS

precursor chemical restrictions implemented beginning November 2005; major rogue precursor chemical company closed (including possibly the largest single drug-cash seizure in history) March 2007; precursor chemicals banned from Mexico (North America's first precursor ban) August 2008.

SETTINGS

Mexico and Texas (1996-2008).

MEASUREMENTS

Monthly treatment admissions for methamphetamine (intervention series) and cocaine, heroin and alcohol (quasi-control series).

FINDINGS

The precursor restriction was associated with temporary methamphetamine admissions decreases of 12% in Mexico and 11% in Texas. The company closure was associated with decreases of 56% in Mexico and 48% in Texas; these decreases generally remained to the end of the study period. Neither intervention was associated with significant changes in the Mexico or Texas quasi-control series. The analysis of Mexico's ban was indeterminate due largely to a short post-ban series.

CONCLUSIONS

This study, one of the first quasi-experimental analyses of an illicit-drug policy in Mexico, indicates that the country's precursor interventions were associated with positive impacts domestically and in one of the Unites States' most populous states--Texas. These interventions, coupled with previous US and Canadian interventions, amount to a new, relatively cohesive level of methamphetamine precursor control across North America's largest nations, raising the possibility that the impacts found here could continue for an extended period.

Investigating the effects of San Francisco's Treatment on Demand Initiative on a publicly-funded substance abuse treatment system: a time series analysis

This study investigated effects of San Francisco's Treatment on Demand Initiative, which was designed to increase substance abuse treatment capacity, on the host treatment system. Secondary data on substance abuse treatment admissions, from 1995 through 2000, were obtained from the Department of Public Health, Community Substance Abuse Services, San Francisco, California. Data on 73,988 admissions were retained and grouped by week of admission. Time series analysis was used to assess the effects of time and treatment on demand (independent variables) on weekly number of admissions, sociodemographic characteristics and types of treatment received (dependent variables). As a function of treatment on demand, the number of weekly new admissions significantly increased. Standard outpatient treatment and comprehensive care admissions constituted greater proportions of admissions after treatment on demand. Persons with a primary heroin, cocaine or alcohol problem constituted greater proportions of admissions, and first-time treatment clients constituted a smaller proportion of admissions. Findings suggest that a capacity expansion initiative can increase system wide admissions and redistribute admissions among modalities towards more comprehensive care treatments.

"A magnet for curious adolescents": the perceived dangers of an open drug scene

During the summer of 2004 the police closed Plata, an open drug scene in the midst of Oslo. The most important argument for the closure was that the drug scene made it easier for curious, city-dwelling adolescents to start using drugs. This research sought to assess this assumption. Ethnographic research methods including twenty 2-hr field observations and qualitative semi-structures interviews were employed. Interviews were conducted with 30 adolescents in the centre of Oslo, as well as with 10 former drug users, three police officers and three field workers. We were also given access to police statistics and authorised to do our own analysis of the material. The most important result was that adolescents seemed rather to avoid than to be attracted to this open drug scene in Oslo. Based on the presentation of qualitative data we suggest that this was due to the social definition of the drug scene. Because they experienced a great social distance between themselves and the regulars at the open drug scene, adolescents seemed to avoid Plata. Moreover, the scene was symbolically associated with heroin and injection as the route of administration, which had low prestige among the adolescents. Despite these findings, adolescents' recruitment to drug use was the key issue in the political debate following the closure. We point to the shared rhetorical interest among important institutional actors in framing the issue in this way. The argument was also embedded in widely shared public representations of adolescents and drug users as passive and irrational.

Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis

BACKGROUND

Switzerland has been criticised for its liberal drug policy, which could attract new users and lengthen periods of heroin addiction. We sought to estimate incidence trends and prevalence of problem heroin use in Switzerland.

METHODS

We obtained information about first year of regular heroin use from the case register of substitution treatments in the canton of Zurich for 7256 patients (76% of those treated between 1991 and March, 2005). We estimated the proportion of heroin users not yet in substitution treatment programmes using the conditional lag-time distribution. Cessation rate was the proportion of individuals leaving substitution treatment programmes and not re-entering within the subsequent 10 years. Overall prevalence of problematic heroin use was modelled as a function of incidence and cessation rate.

FINDINGS

Every second person began their first substitution treatment within 2 years of starting to use heroin regularly. Incidence of heroin use rose steeply, starting with about 80 people in 1975, culminating in 1990 with 850 new users, and declining substantially to about 150 users in 2002. Two-thirds of those who had left substitution treatment programmes re-entered within the next 10 years. The population of problematic heroin users declined by 4% a year. The cessation rate in Switzerland was low, and therefore, the prevalence rate declined slowly. Our prevalence model accords with data generated by different approaches.

INTERPRETATION

The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Our model could enable the study of incidence trends across different countries and thus urgently needed assessments of the effect of different drug policies.

Interpreting changes in heroin supply in Melbourne: droughts, gluts or cycles?

In this Harm Reduction Digest Paul Dietze and John Fitzgerald provide another possible way of understanding what has come to be referred to as Australia's heroin 'drought'. They examine evidence from Melbourne, Victoria and suggest that the apparent downturn in heroin availability in 2000 may, in part, be the result of an end of a heroin 'glut' and that perceptions of this phenomenon may be coloured by the development of more sophisticated indicators of the heroin market. They conclude with claims that the reasons for the reduction in drug consumption and adverse health outcomes, such as those attributed to interdiction, are thus premature