Wednesday, 25 May 2011

Heroin - part I

Back in early May, Bob Carr wrote two pieces on his blog Thoughtlines about the safe injecting centre that was set up in Kings Cross during his tenure. You can read them here and here. I do enjoy Bob's blog, but he has a bad habit of leaving some of my comments in moderation forever - such as this one that I penned on the 12th of May.

But let's not get wrapped up in Bob's policy on comments. Maybe he's got better things to do these days than moderate comments from people like moi.

In his posts, Bob made a number of statements about the effectiveness of the injecting rooms. I thought I'd do a bit of reading and see how they stack up (yes, that's partly why I've been very quiet of late). Amongst other things, Bob wrote:

At the end of the 1999 drug summit convened by the government in parliament house two ministers, Craig Knowles and John Della Bosca, stood in my office with a proposal for a medically supervised injecting room and persuaded me. The ultimate argument ? It might just save lives – the lives of people who are using heroin until a time ( often their late 30s ) when they get sick of it and decide to make a break with that life. We need to sustaint them till they reach that point. 

The facility, as my government designed it, would be a gateway to treatment. It would mean paramedics would not be called to dark carparks or back alleys to rescue a victim of an overdose at the risk of needlestick injury to themselves. By taking injecting indoors it would mean the streets of Kings Cross would be improved.

There have been approximately 600,000 visits over 10 years. There are about 200 injections a day – that is, with medical supervision on hand, whereas without the centre…? 

To reinforce this point, the number of drug overdoses successfully managed stands at more then 3,500. 

Now this is also important : there have been more than 8,500 referrals for addiction treatment, mental health, homelessness or acute medical problems. We always envisaged this as a portal to treatment. 

There are 90 supervised injecting centers in the world but not all of them provide such a gateway to treatment. 

By the way, there is no evidence of a “honey pot” effect, drawing addicts to Kings Cross.
All those injections – 200 a day – would have taken place in public places or, at least, without access to medical intervention. Kings Cross had the highest concentration of drug overdose deaths in the country. 

Good policy or not?

It was the last line that got me - "Good policy or not?" I'm going to make a big assumption here - Bob's blog is generally followed by fellow travellers, so most are likely to agree with the idea that it was good policy. Since Bob pushed that policy, he would also think it was a fabulous idea. Trouble is, there are pernickety people like me out there that like to test these assertions using things like evidence and logic instead of feelings.

As I write this, I haven't made up my mind as to whether it was good policy or not - that will come out as I examine each bit of evidence that I've trawled up over the last few weeks. I'll take you through what I've found, and you can make your own mind up.

I've read through quite a lot of stuff over the last few weeks, and here's a short list of the most relevant ones:

Heroin Related Overdoses Position Paper - this is where the recommendation for the supervised injecting room came from

The NSW Drug Summit: Issues and Answers - a good summary from the NSW Parliamentary Library

High Risk Groups and Behaviours - this explains everything you ever wanted to know about heroin overdoses in NSW

Psycho-stimulant use, health and criminal  activity among injecting heroin users - how often do heroin users shoot up, and how much do they spend on drugs?

Estimating the number of current regular heroin users in NSW and Australia 1997-2002 - also includes data on death rates from overdoses

The impact of heroin dependence on long-term robbery trends - in case you were wondering how junkies fund their habit

Heroin Overdose: Prevalence, Correlates, Consequences and Interventions (2000) - another paper that recommended the establishment of the supervised injecting rooms

Cost of heroin - pretty self evident what this is about

Drug Law Enforcement Policy and its Impact on the Heroin Market - also shows the impact of heroin use on property crime

So there's a bit of light reading if you're interested in this topic. Most of the research is from the late 1990s or early 2000s - I couldn't find anything really up to date. Either no one is funding such research, or it's a work in progress. However, I doubt the behaviour of heroin users has changed much since 1999, so let's not get our knickers in a knot about the research not being hot off the press. Note that I was looking for research that was specific to NSW - there is tonnes of stuff out there about the experience of other countries, but I wanted to stay focused on NSW.

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