Supreme Court ruling opens doors to drug injection clinics across Canada

[cal_guy]

Originally Posted by Hesla

ok..

Impact on blood-borne viruses
The 2003 evaluators of the Sydney MSIC found that it “had not increased blood-borne virus transmission”[18] with the data more specifically showing no improvement re HIV infection incidence, no improvement in Hep B infections,[36] either worse or no improvement (depending on the suburb studied) in new Hep C notifications,[37] no improvement in reuse of others' syringes and injecting equipment, no improvement in tests taken for HIV and Hep C and initial improvement in tests taken for Hep B but worsening again in 2002.[38] The 2010 evaluation found no measurable impact on blood-borne diseases.[39]
The Expert Advisory Committee for Vancouver’s Insite found that journal studies with mathematical modeling by researchers from self-reports of users generated a wide range of estimates for HIV cases averted, but they were not convinced that the assumptions were valid.


Seems to me it is still all over the place on if there is actually a benefit.

http://www.ecmaj.ca/content/179/11/1143.full

Results: Focusing on the base assumption of decreased needle sharing as the only effect of the supervised injection facility, we found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When we also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when we considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility.

[VO #23]

Originally Posted by Hesla

ok..

Impact on blood-borne viruses
The 2003 evaluators of the Sydney MSIC found that it “had not increased blood-borne virus transmission”[18] with the data more specifically showing no improvement re HIV infection incidence, no improvement in Hep B infections,[36] either worse or no improvement (depending on the suburb studied) in new Hep C notifications,[37] no improvement in reuse of others' syringes and injecting equipment, no improvement in tests taken for HIV and Hep C and initial improvement in tests taken for Hep B but worsening again in 2002.[38] The 2010 evaluation found no measurable impact on blood-borne diseases.[39]
The Expert Advisory Committee for Vancouver’s Insite found that journal studies with mathematical modeling by researchers from self-reports of users generated a wide range of estimates for HIV cases averted, but they were not convinced that the assumptions were valid.


Seems to me it is still all over the place on if there is actually a benefit.

From Wikipedia, though it provides links to the actual studies:

A 2008 cost-benefit analysis of the site in the Canadian Medical Association Journal observed net-savings of $18 million and an increase of 1175 life-years over ten years.[21] Another cost-benefit analysis published in the International Journal of Drug Policy in 2010 determined that the site prevents 35 cases of HIV and about 3 deaths per year, indicating a yearly net-societal benefit of more than $6 million.[22] A 2011 study in The Lancet found overdose deaths have dropped 35% in the Insite area since it opened, much more than 9% drop elsewhere in Vancouver.[23] An editorial in the Canadian Medical Association Journal noted that after three years of research "a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department."

[Bring_Back_Shantz]

Originally Posted by VO #23

That's a really bad example because assault is not analogous to drug use at all. Assault requires the application of force on an unconsenting second party. And in fact, this is allowed in some circumstances (sanctioned boxing and MMA matches, and even bar fights where 'consent' is an available defence in some factual circumstances).

The issue here is that Harper and Co. see fit to throw drug users in jail, where they are left to rot under the false belief that they will come out clean and reformed. Insite at least acknowledges there is a problem not only with drug use, but rampant HIV-rates that are accelerated largely by sharing infected needles. Do you think it is a good idea, as part of public policy, to turn a blind eye to the fact that Vancouver's DTES has the highest HIV-infection rates in the industrialized world? Insite gives those with serious addiction issues a place that they can safely inject themselves without risking infection to themselves and further spread infection in the area.

Ultimately, this is a cheaper and more effective way to deal with the problem than building jails and filling them with sad, broken, poor people who have unfortunate and hellish addiction issues.

Like I said, if someone can show me some stats that back up one of the following:

A signicant number of individuals who use this site:

a) seek and succesfully complete treatment and cease their drug use
or
b) cease criminal activities associated with their drug use (ie theft, prostitution etc)

Or that the overall health benefit to the individuals is greater than the benefit that could be seen through targeted treatment programs funded to the level of this site.

If this site isn't producing some tangible benefits, then to me all it is is a place where we can send junkies to get high, feel good about making them "Safer", but not actually do anything about the problem, all while giving them absolutely ZERO incentive to quit, as we've made it easier and safer for them to get high, thus made it harder for them to hit rock bottom, something that needs to happen for a lot of addicts to finally seek treatment.

[Knut]

Originally Posted by cal_guy

http://www.ecmaj.ca/content/179/11/1143.full

Thanks for the info.

I should add... i am neither for nor against it. I just worry that the reach is too small and that the money could be spent elsewhere.

Like Mykalberta said earlier, as long as my tax dollars do not go to funding an injection site in Vancouver i am ok with it.

[CaptainCrunch]

these are questions that I would be curious about, I'm also wondering if there's a use limit before you have to get treatment.

If its just a feeder system where people continue to go to get free needles, and there's a concern that they're still using outside of the clinics and sharing needles, then I wonder where the true benefit is, not form a theoretical budget number, but to the addicts.

[Flash Walken]

Originally Posted by Hesla

ok..

Impact on blood-borne viruses
The 2003 evaluators of the Sydney MSIC found that it “had not increased blood-borne virus transmission”[18] with the data more specifically showing no improvement re HIV infection incidence, no improvement in Hep B infections,[36] either worse or no improvement (depending on the suburb studied) in new Hep C notifications,[37] no improvement in reuse of others' syringes and injecting equipment, no improvement in tests taken for HIV and Hep C and initial improvement in tests taken for Hep B but worsening again in 2002.[38] The 2010 evaluation found no measurable impact on blood-borne diseases.[39]
The Expert Advisory Committee for Vancouver’s Insite found that journal studies with mathematical modeling by researchers from self-reports of users generated a wide range of estimates for HIV cases averted, but they were not convinced that the assumptions were valid.


Seems to me it is still all over the place on if there is actually a benefit.

Here's something to consider:

http://www.ncbi.nlm.nih.gov/pmc/arti...tool=pmcentrez

Focusing on the base assumption of decreased needle sharing as the only effect of the supervised injection facility, we found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When we also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when we considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility.

...

Our model estimated that the prevalence of HIV and hepatitis C virus infections among injection drug users would continue to increase (Figure 1). The model also estimated that, with the introduction of the supervised injection facility, the size of the population of injection drug users would increase owing to fewer HIV and hepatitis C virus infections and reduced associated mortality (Table 2). We calculated that, over the 10-year time horizon, 1191 cases of HIV infection and 54 cases of hepatitis C virus infection would be averted with the introduction of the facility (Table 2). More optimistic modelling assumptions were associated with significantly greater health benefits (Table 2).

...

When we considered decreased needle sharing as the only effect of using the facility, the net costs of treatment of hepatitis C virus infection and of methadone maintenance treatment were higher with the supervised injection facility than with no such facility (Table 3). The net costs of HIV-related treatment were lower with the facility than without such a facility (Table 3). The net cost was negative, which indicated that the facility both saved money and improved life expectancy (Table 4).

...

We found that our model was most sensitive to 3 assumptions. First, the facility was not associated with cost savings if the rates of injection drug use and needle sharing were very low or very high. The model showed no cost savings if the average number of injections was less than 490 per year (1.3 injections per day) or more than 1762 per year (4.8 injections per day) (Figure 2). The cost-effectiveness ratio exceeded $50 000 per life-year gained if the number of injections was 284 per year (0.78 per day) or fewer. The incremental cost-effectiveness ratio, under the base assumption of decreased needle sharing as the only effect of the facility, also exceeded $50 000 per life-year gained if the proportion of injections in which needles were shared was very low (less than 5.1%).


...

Limitations
Our model has several limitations. First, we modelled the efficacy of the facility by focusing on the injecting behaviours of regular users of the facility. We may have overestimated efficacy if injection practices of users injecting outside the facility did not change; however, available analyses to date suggest a general change in injecting practices.3 We may also have underestimated efficacy by ignoring the decreased risk associated with injections within the facility by casual users.
Second, we excluded from our analysis potentially important health benefits such as decreased overdose, reduced transmission of hepatitis B, and reduced incidence of soft-tissue infections, endocarditis and other harms associated with unhygienic injection. We also did not account for benefits such as increased access to, and delivery of, other health services, social services and crisis management as well as societal benefits such as decreased cost of crime and improved social order, which may be particularly important in economic terms.59
Third, we considered methadone maintenance treatment as the only form of drug addiction treatment and not more expensive treatments such as residential care.
Finally, we did not consider quality of life or a full probabilistic analysis.
Our estimates are specific to the characteristics of the Vancouver supervised injection facility and may not be generalizable to other settings, since the size and geographic location of the population of injection drug users and the baseline prevalence of HIV and hepatitis C virus infections will differ across cities.

I think even if you're sole approach to understanding this issue is economic, the results seem to be there.

As a casual observer blocks away, I've noticed a difference.

[VO #23]

Originally Posted by Bring_Back_Shantz

Like I said, if someone can show me some stats that back up one of the following:

A signicant number of individuals who use this site:

a) seek and succesfully complete treatment and cease their drug use
or
b) cease criminal activities associated with their drug use (ie theft, prostitution etc)

Or that the overall health benefit to the individuals is greater than the benefit that could be seen through targeted treatment programs funded to the level of this site.

If this site isn't producing some tangible benefits, then to me all it is is a place where we can send junkies to get high, feel good about making them "Safer", but not actually do anything about the problem, all while giving them absolutely ZERO incentive to quit, as we've made it easier and safer for them to get high, thus made it harder for them to hit rock bottom, something that needs to happen for a lot of addicts to finally seek treatment.

But this site IS producing tangible benefits. See the studies cited by Wikipedia earlier in this thread. And why does this clinic need to be directly tied to treatment? That's not its mandate: preventing the transmission of blood borne illnesses and preventing overdoses is. The province should increase Insite's budget for those results, or addicts should be using existing social and public health services to deal with that.

[Ark2]

At some point, you need to take a stand morally. Simply pointing to some bottom line that has increased shouldn't be justification for anything you can think of. The argument that people are going to inject themselves with illicit drugs so you might as well give them a safe place to do it is akin to saying that people are going to drink and drive so you might as well put in a drunk driver's lane.

[Titan]

Originally Posted by Ark2

At some point, you need to take a stand morally. Simply pointing to some bottom line that has increased shouldn't be justification for anything you can think of. The argument that people are going to inject themselves with illicit drugs so you might as well give them a safe place to do it is akin to saying that people are going to drink and drive so you might as well put in a drunk driver's lane.

OR you could MORALLY do what you can to reduce the harm and risk by providing a safe place to do their thing which may reduce the harm and may reduce the impact on the immediate area. The MORAL alternative of letting them shoot up in alleys and crack houses seems to me very IMMORAL and only appeases the conscience of the MORAL majority and allows them to freely ignore the problem because they never go into the area where the problem lives. By having this site it forces people to acknowledge the problem which MAY help come up with better solutions.

To bring it home a bit would you rather have your daughter or son shooting up in an alley or in a facility like this? That seems like a pretty easy choice too me, heaven forbid it should happen, but these are someone's kids.

[Ark2]

Originally Posted by Titan

OR you could MORALLY do what you can to reduce the harm and risk by providing a safe place to do their thing which may reduce the harm and may reduce the impact on the immediate area. The MORAL alternative of letting them shoot up in alleys and crack houses seems to me very IMMORAL and only appeases the conscience of the MORAL majority and allows them to freely ignore the problem because they never go into the area where the problem lives. By having this site it forces people to acknowledge the problem which MAY help come up with better solutions.

It's a moral obligation to enable people to shoot junk up their arm? Seriously?

To bring it home a bit would you rather have your daughter or son shooting up in an alley or in a facility like this? That seems like a pretty easy choice too me, heaven forbid it should happen, but these are someone's kids.

I would rather help them get clean than shoot up in some clinic. That's just me though.

[Titan]

It is a moral obligation to help sick people that can't help themselves. If the only way to help them is to provide a safe place then that is the first step. How can you argue it is more moral to make them shoot up in an alley. I would rather they get clean too. They can't or won't so we should just turn our back on them? That to me seems the far more immoral choice.

[Ark2]

Originally Posted by Titan

It is a moral obligation to help sick people that can't help themselves. If the only way to help them is to provide a safe place then that is the first step. How can you argue it is more moral to make them shoot up in an alley. I would rather they get clean too. They can't or won't so we should just turn our back on them? That to me seems the far more immoral choice.

I guess I'm just not understanding how it is helping them overcome their addiction. You give them a clean, safe place to shoot up, great. That gets them off the needle how exactly? Society does not have an obligation to get other people high, and simply waving your hands and saying that you are doing something good does not change reality. I think that's the issue with your typical white, middle class North American these days. They have no real social issues to fight for of their own, so they adopt those of others. However, since it doesn't really affect them, they don't care if what they are doing truly has any positive value, just as long as it feels like it does. That's basically what is happening here. Just keep shovelling #$%@ against the tide and tell yourself that you're doing something good.

Strange times indeed where some can actually try to argue that helping someone else get high is a moral obligation.

[blankall]

Originally Posted by Bring_Back_Shantz

Like I said, if someone can show me some stats that back up one of the following:

A signicant number of individuals who use this site:

a) seek and succesfully complete treatment and cease their drug use
or
b) cease criminal activities associated with their drug use (ie theft, prostitution etc)

Or that the overall health benefit to the individuals is greater than the benefit that could be seen through targeted treatment programs funded to the level of this site.

If this site isn't producing some tangible benefits, then to me all it is is a place where we can send junkies to get high, feel good about making them "Safer", but not actually do anything about the problem, all while giving them absolutely ZERO incentive to quit, as we've made it easier and safer for them to get high, thus made it harder for them to hit rock bottom, something that needs to happen for a lot of addicts to finally seek treatment.

How have you made it easier for them to get high? They are goign to get high less if they don't have a safe injection site? Unlikely, they are just going to use a dirty needle instead.

It seems like the standard of proof you are looking for here is not attainable. You want definite proof on an issue that we have fuzzy statistics on at best.

Surely you can see, from a common sense and rational point of view, how giving drug addicts clean needles and counselling options is a good thing for the addicts and society as a whole.

[Flash Walken]

Originally Posted by Ark2

The argument that people are going to inject themselves with illicit drugs so you might as well give them a safe place to do it is akin to saying that people are going to drink and drive so you might as well put in a drunk driver's lane.

What an absolutely ######ed attempt at an analogy.

[CaptainCrunch]

Originally Posted by fotze

I don't think getting them clean is really the upside, since that is rare, it's to keep them from getting really expensive side diseases that can spread to others. It's letting them kill themselves as cheaply as possible and limit taking others with them.

Man that's pretty terrible.

And unless these centers are open 24 hours a day, I have my doubts that these people aren't doing the questionable things that lead to these illnesses.

If they're not there to break the cycle, then I have trouble with them.

I was watching on the news this morning that there are some people that think that these centers should provide the drugs as well.

[Ark2]

Originally Posted by Flash Walken

What an absolutely ######ed attempt at an analogy.

What an absolutely ######ed attempt at a reply.

[casucks]

Originally Posted by Caged Great

This is good because all the data shows that the best way to reduce/eliminate drug use in an individual is to treat them, instead of jailing them.

Hopefully this does get used everywhere.

Allowing someone to shoot up in a clean environment is NOT TREATMENT! No we shouldn't jail them we should support them and encourage detox and a treatment facility!

[CrusaderPi]

Because you can force a junkie to quit. I guess "force" isn't the right word. Trick?

My point is junkies are going to use whether we like it or not. Once we come to grips with that the next step is figuring out how to deal with that reality as efficiently as possible.

[Flash Walken]

Originally Posted by CaptainCrunch

I was watching on the news this morning that there are some people that think that these centers should provide the drugs as well.

Count me among those that think that.

[Caged Great]

Originally Posted by casucks

Allowing someone to shoot up in a clean environment is NOT TREATMENT! No we shouldn't jail them we should support them and encourage detox and a treatment facility!

Clean needles, safe environment in which to do so is better than dirty needles that can spread things like aids etc, so in a way disease prevention is a method of care.

Additionally, the people that work there actively pursue the people in the situation they're in therapies that will help them get clean if they want to. Some times a helping hand can change people's lives around, even if they aren't quite ready to give it up.



To Azure, from coroner reports from 2001-2005 (the safe injection site in Van opened in 03), marked that there were 300 deaths over that span from ODing. No overdoses were recorded at the facility in the two years and ODing dropped by 35% in the surrounding area, compared to a 9% decline in the rest of Vancouver. Additionally, with the fact that they get clean needles etc, the cases of Hepatitis and HIV have dropped significantly. So it does have financial benefits as well. Those people would not then have to clog up the medical system even on a small part, thereby saving money. Plus if people get clean from the therapeutic assistance that they provide and become functioning members of society again, then all the better.