title: The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia.
abstract: BACKGROUND
  In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures.
  
  
  METHODS
  Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15-19 years.
  
  
  RESULTS
  There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15-19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications.
  
  
  CONCLUSIONS
  A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales Level 2, Darlinghurst, NSW 2010, Australia. cday@nchecr.unsw.edu.au
authors.forename: Carolyn
authors.initials: C
authors.lastname: Day
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Stuart
authors.initials: S
authors.lastname: Gilmour
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D017848:Blood-Borne Pathogens; D019992:Databases as Topic; D018563:Disease Notification / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D003932:Heroin / Q000600:supply & distribution*; D006801:Humans; D013287:Illicit Drugs / Q000600:supply & distribution*; D009517:New South Wales / Q000453:epidemiology; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D013594:Syringes / Q000600:supply & distribution*; D013997:Time Factors
chemical_list: D013287:Illicit Drugs; D003932:Heroin