The impact of a reduction in drug supply on demand for and compliance with treatment for drug dependence.
BACKGROUND
In early 2001, Australia experienced a sudden, dramatic and sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity--the so-called "heroin shortage". These unprecedented changes occurred in a context of widespread treatment availability, which made it possible for the first time to examine the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Given the evidence of drug substitution by some users, the current paper also examines the effects of the shortage on entry to treatment for other forms of drug dependence.


METHODS
Interrupted time-series analysis of the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for the treatment for other types of drug dependence.


RESULTS
The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy. There was a dramatic decrease in the number of persons entering heroin withdrawal or "assessment only" treatment episodes. There appear to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases were observed in numbers being treated for cocaine dependence.


CONCLUSIONS
In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. l.degenhardt@unsw.edu.au
Louisa
L
Degenhardt
Elizabeth
E
Conroy
Carolyn
C
Day
Stuart
S
Gilmour
Wayne
W
Hall
D003042:Cocaine / Q000191:economics; D005260:Female; D003932:Heroin / Q000191:economics; D006556:Heroin Dependence / Q000191:economics / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000191:economics; D009517:New South Wales; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D016320:Substance Abuse Treatment Centers; D013997:Time Factors
D008694:Methamphetamine; D003932:Heroin; D003042:Cocaine