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Background:Methamphetamine-related harms have been increasing in Melbourne, Australia, yet little is known of how users interact with the drug market. We describe methamphetamine purchases and use as reported by a Melbourne-based cohort of people who inject drugs (PWID). Methods:A total of 2862 interviews from 757 participants of the Melbourne Injecting Drug User Cohort Study between April 2008 and February 2015 were used to generate descriptive statistics for the: size, search time and setting (e.g. house, street) of methamphetamine purchases, and the percentage that were shared; and the time of day, time between purchasing and using and setting of methamphetamine use. Results:No meaningful differences were observed between the powder and crystal methamphetamine markets. The most frequently purchased amount of methamphetamine was $100 with much larger transactions common; however 42% of purchases were shared, most commonly 50/50 with a partner or friend. The median time to obtain methamphetamine was 20 minutes (interquartile range (IQR) 5–30 minutes) and the median time between purchasing and using methamphetamine was 5 minutes (IQR 5–10 minutes). Most purchases were used between 10 am and 2 pm (43% of purchases), but 33% were used outside of business hours. Both purchasing and using methamphetamine occurred more frequently in houses than public settings. Conclusions:It was common for PWID in our sample to obtain >$100 of methamphetamine with a partner or friend, with relatively little search time. Support services for methamphetamine users may need to increase their operating hours to adapt to the large amount of use occurring outside of business hours. [ABSTRACT FROM AUTHOR]

Background: Understanding of substitution patterns in drug using careers is limited. Between 2009 and mid-2013, the purity-adjusted price of methamphetamine declined sharply in Melbourne in absolute terms and relative to the purity-adjusted price of heroin. We determine whether there were associated increases among people who inject drugs (PWID) in (1) use of methamphetamine and (2) citing methamphetamine as the drug of choice.Method: Responses to “drug of choice” and “most used drug” were obtained from baseline and follow-up interviews of the 688 PWID enrolled in the Melbourne Injecting Drug User Cohort Study between April 2008 and August 2013, categorised as heroin, methamphetamine, cannabis or other. Previous month heroin and methamphetamine use was reported at baseline by 82% and 41% of participants, respectively, and 51% had completed four or more interviews in this period. A Markov model that included marginal effects for methamphetamine purity-adjusted price was used to calculate (1) transitions between drug of choice and (2) conditional probabilities for most used drug. Parameters were determined by fitting multinomial logistic models to appropriate data subsets.Results: At baseline, the majority of participants reported heroin as both their preferred drug and the drug they used most. There were no significant increases in reports of methamphetamine as drug of choice, or as the most used drug.Conclusion: In a cohort of PWID who reported a range of drug behaviours, there was little evidence of drug substitution into methamphetamine, despite substantial declines in its purity-adjusted price. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Decisions on whether and how to 'schedule' drugs (i.e. to determine their legal status and penalties to be applied for sale or possession) are often heavily criticized. We sought to assess more comprehensively the results of such decisions for newly emerging drugs. Methods Through analysis of legislation and secondary sources, we identified 63 substances that have emerged since 1971, including all that have been added to the most restrictive schedule by the United Nations, United States, United Kingdom, Canada, Australia and/or New Zealand. Measurements For each jurisdiction we recorded whether, when, and how the substance was scheduled and note what decisions engendered substantial criticism or controversy within the international treaties' framework of balancing medical benefits with risk of abuse. Findings (i) The rate of emergence of new drugs has been fairly steady. (ii) There is broad cross-national agreement on what should be scheduled. (iii) The United States often acts first. (iv) Temporary bans that delay final decisions by 12-18 months can sometimes allow final decisions to be grounded on a substantially expanded research base. (v) It appears that no more than seven of the decisions reached by the United States with respect to the 63 substances are candidates for being considered errors, and arguably the United States has committed at most one serious Type I and one serious Type II error. Results for other countries are broadly similar. Conclusions The process for determining the legal status of new psychoactive substances appears to function reasonably well, within the framework of international treaty obligations. Most criticisms relate to one or a few substances (e.g. 3,4-methylenedioxymethamphetamine) and/or complaints that the decisions discount benefits that are not recognized by the treaties (e.g. recreational or religious use). [ABSTRACT FROM AUTHOR]

An empirically-derived model of national drug initiation is combined with a compartment model of trends in illicit drug use parameterized for Australia. Numbers of initiates seem to oscillate over time but with fluctuations whose aplitude diminishes over time. Lags and interpersonal variation in drug use careers smooth those oscillations for measures of problem use and total drug-related social cost, so even abrupt changes in initiation barely ripple the trajectory of drug-related social cost. Hence, the benefits of interventions that successfully disrupt initiation may be "hidden in plain sight" by being spread broadly over time so that they leave only the faintest finger-print detectable by before-and-after comparison. Thus, the absence of clear drops in drug-related problems does not imply that an upstream ntervention such as prevention or supply disruption did not produce substantial social benefits. More generally, drug use and related problems are often perceived of as stubborn, even intractable. Some of that perception stems from real limitations in the effectiveness of drug-control interventions. However, inertia inherent in the evolution of drug use can make even cost-effective interventions appear weak (and detrimental interventions appear benign). [ABSTRACT FROM AUTHOR]

A five-state compartment model of trends in illicit drug use in Australia is parameterized using data from multiple sources. The model reproduces historical prevalence and supports what-if analyses under the assumption that past trajectories of drug escalation and desistance persist. For fixed initiation, the system has a unique stable equilibrium. The chief qualitative finding is that even though some users escalate rapidly, regular injection drug use still adjusts to changes in incidence with considerable inertia and delay. This has important policy implications, e.g., concerning the timing of reductions in drug-related social cost generated by interventions that reduce the social cost per injection user versus those that cut drug initiation. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Changes in Canadian heroin supply coinciding with the Australian heroin shortage," by E. Wood and colleagues in a 2006 issue. The approach used by Wood and colleagues as straightforward. However, for the higher frequency and longest series, frequency of daily heroin injection by Vancouver injecting drug users, they indicated only that there is a difference between pre- and post-2001. They failed to state whether 2001 is the optimum break point.

Introduction and Aims: This study compares the costs and consequences of three interventions for reducing heroin dependency: pharmacotherapy maintenance, residential rehabilitation and prison., Design and Methods: Using Australian data, the interventions' cost - consequence ratio was estimated, taking into consideration reduction in heroin use during the intervention; the length of intervention; and post-intervention effects (as measured by abstinence rates). Sensitivity analyses were conducted, including varying the magnitude and duration of treatment effects, and ascribing positive outcomes only to treatment completers. A hybrid model that combined pharmacotherapy maintenance with a prison term was also considered., Results: If the post-programme abstinence rates are sustained for 2 years, then for an average heroin user the cost of averting a year of heroin use is approximately AUD$5000 for pharmacotherapy maintenance, AUD$11,000 for residential rehabilitation and AUD$52 000 for prison. Varying the parameters does not change the ranking of the programmes. If the completion rate in pharmacotherapy maintenance was raised above 95% (by the threat of prison for non-completers), the combined model of treatment plus prison may become the most cost-effective option., Discussion and Conclusions: Relative performance in terms of costs and consequences is an important consideration in the policy decision-making process, and quantitative data such as those reported herein can provide insights pertinent to evidence-based policy.

Cost-of-illness (COI) studies seemingly provide a solid foundation for quantifying the potential benefits of illicit drug policy interventions that reduce drug use at the population level. However, their usefulness is severely limited. In this paper, we suggest several improvements to substance abuse COI studies. The first set of improvements can be implemented with little change to the current framework: developing estimates that reflect the best available information, rather than using lower bound estimates that represent 'conservative' figures; dealing with uncertainty explicitly by developing estimation ranges; and disaggregating social costs by particular illicit drug types. The second set of improvements address key conceptual problems in transferring a health approach to a 'condition' where healthcare costs are a minor component: dealing with the intangible costs of drug dependence; valuing property crime; including systemic crime; and considering the spillover effects of drug abuse on human capital formation. COI studies can become valuable sources of policy-relevant information if their authors improve the current approach by making changes such as those identified here.