Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia.

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001 - 2004). The rate of morphine prescription per person aged 15 - 54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

Community attitudes towards cannabis law and the proposed Cannabis Infringement Notice scheme in Western Australia.

Western Australia (WA) became the fourth Australian jurisdiction to adopt a prohibition with civil penalties scheme for minor cannabis offences when its Cannabis Infringement Notice (CIN) scheme became law on 22 March 2004. Previous criminological research has demonstrated the importance of public attitudes towards the law in determining the effectiveness of legislation. This survey represents the first phase of a pre-post study that attempted to gauge public attitudes towards the legal status of cannabis, the proposed legislative reforms surrounding the drug and their likely effects. A random telephone survey of 809 members of the WA population was conducted prior to the implementation of the new laws with a view to exploring contemporary views of the existing legal status of cannabis, attitudes to the proposed legislative model and respondent perceptions of its likely effects. Despite cannabis being viewed negatively by large numbers of the sample, criminal penalties for minor cannabis offences were viewed as inappropriate and ineffective. Once explained, the proposed civil penalty scheme was viewed as 'a good idea' by 79% of the sample, despite significant differences due to personal experience of cannabis use, political affiliation, religiosity and age of offspring. Most believed that the legislative change would not result in changes to levels of cannabis use (70%) or ease of obtaining cannabis (59%). These data suggest that prior to its implementation the new legislation was highly acceptable to the majority of the community. These baseline data will be compared with data to be collected at the post-change phase of the study to allow empirical observations of attitudinal and behavioural changes occurring in the community.

Expected impacts of the Cannabis Infringement Notice scheme in Western Australia on regular users and their involvement in the cannabis market.

The effect on the cannabis market is one area of interest in the evaluation of the new 'prohibition with civil penalties' scheme for minor cannabis offences in WA. One goal of the scheme is to reduce the proportion of cannabis consumed that is supplied by large-scale suppliers that may also supply other drugs. As part of the pre-change phase of the evaluation, 100 regular (at least weekly) cannabis users were given a qualitative and quantitative interview covering knowledge and attitudes towards cannabis law, personal cannabis use, market factors, experience with the justice system and impact of legislative change. Some 85% of those who commented identified the changes as having little impact on their cannabis use. Some 89% of the 70 who intended to cultivate cannabis once the CIN scheme was introduced suggested they would grow cannabis within the two non-hydroponic plant-limit eligible for an infringement notice under the new law. Only 15% believed an increase in self-supply would undermine the large scale suppliers of cannabis in the market and allow some cannabis users to distance themselves from its unsavoury aspects. Only 11% said they would enter, or re-enter, the cannabis market as sellers as a result of the scheme introduction. Most respondents who commented believed that the impact of the legislative changes on the cannabis market would be negligible. The extent to which this happens will be addressed in the post-change phase of this research. Part of the challenge in assessing the impact of the CIN scheme on the cannabis market is that it is distinctly heterogeneous.

Recidivist drink drivers' self-reported reasons for driving whilst unlicensed--a qualitative analysis.

AIM: This paper presents qualitative data from an in-depth interview study of 40 repeat drink drivers in Perth Western Australia to inform countermeasures for these high risk offenders. BACKGROUND: Licence sanctions are effective countermeasures for most drink drivers but the small group of repeat offenders are less responsive. Many choose to drive whilst unlicensed as the probability of detection is low and the social and economic costs of not driving can be high. This undermines other drink drive countermeasures. RESULTS: Most respondents who had had their licence suspended admitted to driving whilst under suspension. Employment and social factors were key themes emerging in respondents' accounts of driving whilst under licence suspension. CONCLUSIONS: Whilst a range of enforcement countermeasures are needed to deter drunk and unlicensed driving, this study suggests that where possible we aim to keep offenders within the system that consists of formal laws and informal social controls, rather than apply penalties in ways that undermine adherence to the law by increasing unlicensed driving. Allowing for interlock installation early in the driving suspension period, and allowing fines to offset cost of interlock installation and monitoring, may maximise community benefit and reduce unlicensed driving.

The epidemiology of methamphetamine use and harm in Australia.

INTRODUCTION AND AIMS: There has been considerable media attention recently upon possible increases in methamphetamine use in Australia. Much of this debate has focused upon extreme cases of problematic crystal methamphetamine use, without reference to the broader population context. This paper provides data on methamphetamine use in Australia, and documents trends in methamphetamine-related harms. DESIGN AND METHODS: Data used were from: (1) Australian Customs Service drug detections; (2) Australian Crime Commission drug seizure, arrest and clandestine laboratory detections data; (3) National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (4) data from the Illicit Drug Reporting System (IDRS) and Ecstasy and related Drug Reporting System (EDRS); and (5) data from NSW Emergency Department Information System, National Hospital Morbidity Database and Australian Bureau of Statistics causes of death databases. RESULTS: There appears to have been an increase in both importation and local manufacture of meth/amphetamine. Population data show that meth/amphetamine use remains low and stable. However, clear increases in crystal methamphetamine use have occurred among sentinel groups of regular drug users. Frequent crystal use among regular injecting drug users is associated with earlier initiation to injecting, greater injection risk behaviours and more extensive criminal activity. In recent years, indicators of meth/amphetamine-related harm have stabilised, following steady increases in earlier years. DISCUSSION AND CONCLUSIONS: Some methamphetamine users experience significant problems related to their use; harms are particularly prevalent among regular IDU. Methamphetamine users, however, are a diverse group, and strategies need to be appropriately targeted towards different kinds of users.

Drug use and risk among regular injecting drug users in Australia: does age make a difference?

INTRODUCTION AND AIMS: To examine age-related differences in drug use and risk among regular injecting drug users (IDU) in Australia. DESIGN AND METHODS: Cross-sectional data from the 2006 Illicit Drug Reporting System were examined for age-related differences in demographic characteristics, drug use history and current use patterns and self-reported risk behaviours. RESULTS: IDU under 25 years of age were more likely to have initiated injecting at a younger age, to identify as Aboriginal and/or Torres Strait Islander, and to be injecting daily or more often than their older counterparts. They reported more frequent heroin use in the preceding 6 months, and were more likely to report morphine as the first drug injected than were IDU aged 35 years or over. Younger IDU were also more likely to report providing used needles to others, engaging in recent property crime and drug dealing and arrest in the last year. CONCLUSIONS: Younger IDU reported significantly different drug use patterns and higher rates of risk behaviours than their older counterparts. Treatment services need to ensure that harm and demand reduction services deliver messages to new cohorts of IDU, particularly given that their drug use patterns may be different to those of older users.