4 ms·

What do you think Safe Injection sites are, if not exactly that?

by Afton 8y ago

NotAnEconomist 8y ago
Yes -- that's the logic I was referring to. However "safe injection sites" are anything but safe to the surrounding community, and may increase usage rates while only mildly decreasing fatality rates. By keeping the sickly ones around, we're actually making the whole herd less healthy -- particularly when we enable them spreading their illness. I think the medical professionals involved in "safe injection sites" should be seriously questioned about their medical ethics: they're failing to quarantine sick patients, and in treating them without that buffer, spreading the disease to the healthy population. It's quack "medicine", just like HAES/HAMS.
- diminoten 8y ago
  Are you implying we kill/let die the "sickly"? Seems extreme...
  - minikites 8y ago
    It's the entire Republican plan for healthcare: http://www.slate.com/articles/news_and_politics/the_big_idea/2011/09/let_him_die.html http://www.slate.com/articles/news_and_politics/the_big_idea... >Blitzer pressed the point. "But, Congressman, are you saying the society should just let him die?" At that point, the rabble erupted in cheers and whoops of "Yeah!"
  - NotAnEconomist 8y ago
    > Are you implying we kill/let die the "sickly"? What's the choice? Make other people ill and have the original sick people die anyways? That's all slowing mortality down in heroin abuses does, and it's definitely not how we treat other kinds of diseases, particularly those which have reached epidemic proportions, where the prime objective is arresting transmission. So, yes -- I think we should follow standard medical practices, and it's unfortunate that strong measures are needed to confront an epidemic level problem. Just like it always is when you have to make medical triage decisions. But we have to prioritize maintaining the healthy population ahead of the comfort or longevity of the already ill, in broad strokes.
    - diminoten 8y ago
      What you're suggesting is not standard medical practice, to be clear. Treatment for heroin addiction is to get that person off of heroin, not let them die. And no, we don't have to prioritize maintaining a healthy population, not to the degree that treating the ill is excluded. That implies a limitation of resources that simply does not exist. We can and do both.
- towelr34dy 8y ago
  Every bit of research I've seen contradicts this. I'm talking about NHI in the UK and several peer reviewed papers which seem to support safe injection sites as being a cost effective way of dealing with social addiction issues (we already know the war on drugs hasn't worked) Care to share any sources on the ineffectiveness of these sites?
  - NotAnEconomist 8y ago
    I came across most of my sources while studying for proposals to open another one, and don't have them convenient anymore. However, looking through NIH reports -- The site in Vancouver appears to lower the fatalities marginally (1-10 less fatalities per year). Several other studies indicate that fatalities related to opioid overdose, ambulance calls, etc decrease in the immediate area of various sites. I can't find anything on the Vancouver site in the last decade, it's all circa 2006 or 2007 -- and seem to recall in my earlier research that the initial results looked good, but later studies basically reported that we saw a decrease in fatalities that was offset by an increase in usage, and the whole thing came out as sort of a wash. RAND seems to suggest that supervised consumption is not settled in terms of scientific study, even now. [0] > We conducted our own assessment of the individual studies and found that the evidence base concerning the overall effects of SCSs is limited in quality and location. Although we identified 65 outcome-related articles (as opposed to commentaries or studies that gauge opinions), none involved an RCT, and just nine employed a quasi-experimental design with control groups. These nine studies were based on just four SCSs in three cities: Sydney (five studies), Vancouver (two studies), and Barcelona (two studies). There was considerable overlap in the design, methods, authorship, and data employed, so that four of the nine are arguably superseded by later studies using better methods or longer time series, in some sense reducing the effective number of quasi-experimental studies to five. Worth noting, however, that many of these seem to indicate reduced petty crime in the area immediately around the site. Indicative I might be wrong, but not conclusive because of problems in the methods used, samples chosen, etc. Looking at a compilation by Brookings, broadly on the topic [1] -- > New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin. > Another popular harm-reduction effort is distributing naloxone, a drug that can save someone’s life if administered during an opioid overdose. Recent work by Doleac and Mukherjee (2018) finds that broadening naloxone access had mixed results. While some states saw beneficial effects of these policy changes, broad naloxone access increased opioid-related mortality by 14 percent in the Midwest, the region hardest-hit by the opioid epidemic. So reports that I do find seem to suggest that this is a concern that is valid, at least in some contexts, and that the studies purporting to show outcomes are a) very narrowly done, b) often don't measure what I'd consider to be the complete set of externalities, and c) aren't particularly scientific. It certainly seems reasonable that narrow focus on improving the outcomes of the addicts, particularly a narrowly defined set of metrics, actually lowers the group outcome. Sorry I can't provide better sources to support that, though. [0] -- https://www.rand.org/pubs/research_reports/RR2693.html https://www.rand.org/pubs/research_reports/RR2693.html [1] -- https://www.brookings.edu/blog/up-front/2018/12/07/research-roundup-what-does-the-evidence-say-about-how-to-fight-the-opioid-epidemic/ https://www.brookings.edu/blog/up-front/2018/12/07/research-...
- Afton 8y ago
  I'm glad you are willing to come out and state your positions clearly. For that I thank you. I disagree with essentially everything you have said. While SIS may not be a panacea, they are definitely on the right track.
towelr34dy 8y ago
Safe injection sites are a socially responsible way of using resources. It costs society money for ambulances to be running around to OD people. Safe injection makes sense. It doesn't promote heroin. No one is saying: Heroin in a Healthy Manner. They are simply saying: Let's spend a stitch in time. You don't even have to think of it as being kind, just rational.
- Afton 8y ago
  It is an opportunity to say "Ok, we can't stop these people from doing heroin. But we can make it as safe as possible, and we can provide a vector for additional health care interventions". It also means that you aren't psychologically torturing addicts by telling them that if they were only 'strong enough' they could cure their addiction. You might not like the way HAES or fat acceptance is packaged, but this is exactly the same thing.
  - towelr34dy 8y ago
    The key difference: Social stigma. HAES seeks to remove stigma. Safe injection sites don't. Both being fat, smoking cigarettes or being a heroin addict are things to be, at the least, slightly ashamed of. *exceptions go out to anyone with thyroid or other such medical conditions, just as to people who are opioid dependent due to pain management.

What do you think Safe Injection sites are, if not exactly that?

by Afton 8y ago

What do you think Safe Injection sites are, if not exactly that?

Yes -- that's the logic I was referring to. However "safe injection sites" are anything but safe to the surrounding community, and may increase usage rates while only mildly decreasing fatality rates. By keeping the sickly ones around, we're actually making the whole herd less healthy -- particularly when we enable them spreading their illness. I think the medical professionals involved in "safe injection sites" should be seriously questioned about their medical ethics: they're failing to quarantine sick patients, and in treating them without that buffer, spreading the disease to the healthy population. It's quack "medicine", just like HAES/HAMS.

diminoten 8y ago
Are you implying we kill/let die the "sickly"? Seems extreme...
- minikites 8y ago
  It's the entire Republican plan for healthcare: http://www.slate.com/articles/news_and_politics/the_big_idea/2011/09/let_him_die.html http://www.slate.com/articles/news_and_politics/the_big_idea... >Blitzer pressed the point. "But, Congressman, are you saying the society should just let him die?" At that point, the rabble erupted in cheers and whoops of "Yeah!"
- NotAnEconomist 8y ago
  > Are you implying we kill/let die the "sickly"? What's the choice? Make other people ill and have the original sick people die anyways? That's all slowing mortality down in heroin abuses does, and it's definitely not how we treat other kinds of diseases, particularly those which have reached epidemic proportions, where the prime objective is arresting transmission. So, yes -- I think we should follow standard medical practices, and it's unfortunate that strong measures are needed to confront an epidemic level problem. Just like it always is when you have to make medical triage decisions. But we have to prioritize maintaining the healthy population ahead of the comfort or longevity of the already ill, in broad strokes.
  - diminoten 8y ago
    What you're suggesting is not standard medical practice, to be clear. Treatment for heroin addiction is to get that person off of heroin, not let them die. And no, we don't have to prioritize maintaining a healthy population, not to the degree that treating the ill is excluded. That implies a limitation of resources that simply does not exist. We can and do both.
towelr34dy 8y ago
Every bit of research I've seen contradicts this. I'm talking about NHI in the UK and several peer reviewed papers which seem to support safe injection sites as being a cost effective way of dealing with social addiction issues (we already know the war on drugs hasn't worked) Care to share any sources on the ineffectiveness of these sites?
- NotAnEconomist 8y ago
  I came across most of my sources while studying for proposals to open another one, and don't have them convenient anymore. However, looking through NIH reports -- The site in Vancouver appears to lower the fatalities marginally (1-10 less fatalities per year). Several other studies indicate that fatalities related to opioid overdose, ambulance calls, etc decrease in the immediate area of various sites. I can't find anything on the Vancouver site in the last decade, it's all circa 2006 or 2007 -- and seem to recall in my earlier research that the initial results looked good, but later studies basically reported that we saw a decrease in fatalities that was offset by an increase in usage, and the whole thing came out as sort of a wash. RAND seems to suggest that supervised consumption is not settled in terms of scientific study, even now. [0] > We conducted our own assessment of the individual studies and found that the evidence base concerning the overall effects of SCSs is limited in quality and location. Although we identified 65 outcome-related articles (as opposed to commentaries or studies that gauge opinions), none involved an RCT, and just nine employed a quasi-experimental design with control groups. These nine studies were based on just four SCSs in three cities: Sydney (five studies), Vancouver (two studies), and Barcelona (two studies). There was considerable overlap in the design, methods, authorship, and data employed, so that four of the nine are arguably superseded by later studies using better methods or longer time series, in some sense reducing the effective number of quasi-experimental studies to five. Worth noting, however, that many of these seem to indicate reduced petty crime in the area immediately around the site. Indicative I might be wrong, but not conclusive because of problems in the methods used, samples chosen, etc. Looking at a compilation by Brookings, broadly on the topic [1] -- > New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin. > Another popular harm-reduction effort is distributing naloxone, a drug that can save someone’s life if administered during an opioid overdose. Recent work by Doleac and Mukherjee (2018) finds that broadening naloxone access had mixed results. While some states saw beneficial effects of these policy changes, broad naloxone access increased opioid-related mortality by 14 percent in the Midwest, the region hardest-hit by the opioid epidemic. So reports that I do find seem to suggest that this is a concern that is valid, at least in some contexts, and that the studies purporting to show outcomes are a) very narrowly done, b) often don't measure what I'd consider to be the complete set of externalities, and c) aren't particularly scientific. It certainly seems reasonable that narrow focus on improving the outcomes of the addicts, particularly a narrowly defined set of metrics, actually lowers the group outcome. Sorry I can't provide better sources to support that, though. [0] -- https://www.rand.org/pubs/research_reports/RR2693.html https://www.rand.org/pubs/research_reports/RR2693.html [1] -- https://www.brookings.edu/blog/up-front/2018/12/07/research-roundup-what-does-the-evidence-say-about-how-to-fight-the-opioid-epidemic/ https://www.brookings.edu/blog/up-front/2018/12/07/research-...
Afton 8y ago
I'm glad you are willing to come out and state your positions clearly. For that I thank you. I disagree with essentially everything you have said. While SIS may not be a panacea, they are definitely on the right track.

towelr34dy 8y ago

Safe injection sites are a socially responsible way of using resources. It costs society money for ambulances to be running around to OD people. Safe injection makes sense. It doesn't promote heroin. No one is saying: Heroin in a Healthy Manner. They are simply saying: Let's spend a stitch in time. You don't even have to think of it as being kind, just rational.

Afton 8y ago
It is an opportunity to say "Ok, we can't stop these people from doing heroin. But we can make it as safe as possible, and we can provide a vector for additional health care interventions". It also means that you aren't psychologically torturing addicts by telling them that if they were only 'strong enough' they could cure their addiction. You might not like the way HAES or fat acceptance is packaged, but this is exactly the same thing.
- towelr34dy 8y ago
  The key difference: Social stigma. HAES seeks to remove stigma. Safe injection sites don't. Both being fat, smoking cigarettes or being a heroin addict are things to be, at the least, slightly ashamed of. *exceptions go out to anyone with thyroid or other such medical conditions, just as to people who are opioid dependent due to pain management.