Ethical issues in harm reduction for adolescent illicit drug users: the Adolescent Forensic Health Service approach

Child-centred harm reduction

Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority - both relating to their own use and the effects of drug use among parents or within the family - are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as 'child-centred harm reduction'. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.

Mortality in young offenders: retrospective cohort study

OBJECTIVES

To estimate overall and cause specific standardised mortality ratios in young offenders.

DESIGN

Comparison of mortality data in cohort of young offenders.

SETTINGS

State of Victoria, Australia.

SUBJECTS

Cohort of young offenders aged 10-20 years with a first custodial sentence from 1 January 1988 to 31 December 1999.

MAIN OUTCOME MEASURES

Deaths ascertained by matching with the national death index, a database containing records of all deaths in Australia since 1980. Death rates in the reference Victorian population used to calculate standardised mortality ratios.

RESULTS

The offender cohort comprised 2621 men and 228 women with 11 333 person years of observation. The median age of first detention was 17.9 years for men and 18.4 years for women. Median follow up was 3.3 years for men and 1.4 years for women. Overall standardised mortality ratio adjusted for age (expressed as a ratio) was 9.4 (95% confidence interval 7.4 to 11.9) for men and 41.3 (20.2 to 84.7) for women. Cause specific standardised mortality ratios for men were 25.7 (17.9 to 36.9) for drug related causes, 9.2 (5.8 to 15) for suicide, and 5.7 (3.6 to 9.2) for non-intentional injury. A quarter of drug related deaths in men aged 15-19 years were in offenders.

CONCLUSIONS

Social policies for young offenders should address both the prevalent drug and mental health problems as well the high levels of social disadvantage.