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::::First, one fault above. [http://www.drugfree.org.au/fileadmin/Media/Reference/DFA_Injecting_Room_Detailed_Research.pdf This] is the partisan source that requires attribution - Health Canada is fine with me and I have never said anything else. |
::::First, one fault above. [http://www.drugfree.org.au/fileadmin/Media/Reference/DFA_Injecting_Room_Detailed_Research.pdf This] is the partisan source that requires attribution - Health Canada is fine with me and I have never said anything else. |
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::::Second, I still argue that there was a synthesis. Such as when cost-inefficiency is implied by letting the "facts speak for themselves" by stating cost and lives saved - refresh your knowledge of [[WP:NOR]] if you doubt me. In fact, there are lots of other benefits that effect cost-effectiveness then saved lives that where omitted and both [http://www.sydneymsic.com/__data/assets/file/0017/29501/FACE_UP_4_-_July_2003.pdf Sidney] and [http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#a11 Vancouver]] seem to be cost-effective. In the latter case even according to the source he used for the cost figure. [[User:Steinberger|Steinberger]] ([[User talk:Steinberger|talk]]) 13:21, 30 May 2010 (UTC) |
::::Second, I still argue that there was a synthesis. Such as when cost-inefficiency is implied by letting the "facts speak for themselves" by stating cost and lives saved - refresh your knowledge of [[WP:NOR]] if you doubt me. In fact, there are lots of other benefits that effect cost-effectiveness then saved lives that where omitted and both [http://www.sydneymsic.com/__data/assets/file/0017/29501/FACE_UP_4_-_July_2003.pdf Sidney] and [http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#a11 Vancouver]] seem to be cost-effective. In the latter case even according to the source he used for the cost figure. [[User:Steinberger|Steinberger]] ([[User talk:Steinberger|talk]]) 13:21, 30 May 2010 (UTC) |
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:::::If Health Canada is fine with you why did you revert it? Why did you revert Drug Free Australia then if all that was required was mentioning who the source was from (attribution)? That is not synthesis, it is reporting two facts side by side from the ''same source''. It was not coming up with a "new conclusion" based on combining two sources which is what a synthesis is. It reported the facts as described in [http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php this source] that the service cost 3 million dollars and saved an estimated 1 life per year. If other benefits were ommitted then you could have expanded on the source to add balance.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]] | [[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 13:36, 30 May 2010 (UTC) |
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== Safe Injection Site Evaluations == |
== Safe Injection Site Evaluations == |
Revision as of 13:41, 30 May 2010
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Harm reduction, or harm minimisation, . . .
Can "or harm minimisation" be removed from the opening sentence please? Harm Reduction & Harm Minimisation are not the same thing. Harm Minimisation is a threefold model which is inclusive of Harm Reduction, Supply Reduction & Demand Reduction. See the "Policy Response" section of http://en.wikipedia.org/wiki/Illicit_drug_use_in_Australia for clarification. Thanks, Swampy 203.48.101.131 (talk) 23:41, 20 September 2009 (UTC)
The Safer sex article, which this one summarizes, has suffered from edit warring and talk page mis-communications for a while. One of the issues appears to be whether the article should be primarily about what the idea is, or about what the name is (and the many, many, slightly different definitions). There are legitimate reasons for Wikipedia to have articles about ideas, and also to have articles about terminology/definitions (e.g., for obsolete medical terms). Talk:Safe sex#Scope_of_the_article asks any and all editors to express an opinion about what they think the proper scope of the article is. For example, you might think that the article should be about the term, or about the idea as most commonly understood ("how person A can avoid catching a disease from person B, who is infected"), or about something else (e.g., rape avoidance, or emotional safety in sexual relationships, or pregnancy prevention).
Whatever your idea, if you want to express an opinion, I'd be happy to hear it. (Please respond at Talk:Safe sex, not here.) Thanks, WhatamIdoing (talk) 05:51, 23 September 2009 (UTC)
Evidence & validity of Harm Minimisation as public health
I've just removed a large number of edits to the page. I've included below my specific reasons for each section, but in general it harks to wider debates about Harm Reduction. Wikipedia is not a battleground for this topic, but rather it should seek to portray each side as objectively as possible. I'm happy for the article to include the perspective Minphie wants to write, however it needs to have good references (as opposed to some of the bad ones pointed out below) and should avoid weasel words.
... Where Harm Reduction is used to alleviate the harms of illegal practices or behaviours, critics ([who?]) of the approach cite concerns about its strategies sending a message of sanctioned acceptance of the very behaviours which the community, through its legislators, do not accept. (References?)
...
Critics [who?] of this intervention cite the high costs to any community providing heroin maintenance programs. For instance, the British heroin trial initiated in 2005 [1] costs the British government £15,000 pounds per participant per annum. (Adam Baxter's article actually supports opiate treatment as having better financial outcomes for the community and psychosocial outcomes for the client. This article appears to have been deliberately misquoted by Minphie to say that heroin treatment is costing the community money when in fact the author says that prescription heroin has huge savings in the long run.)
The trial claims that the illicit heroin use of participants is reduced from £300 to £50 per week, that is from £15,600 acquisitive crime per year to £2,600 per year. Yet for the £15,000 investment, the community is still £2,000 worse off in terms of ongoing acquisitive crime.(This simplistic maths classes as original research. Academics spend months producing research to support claims like this, it's not verifiable to make assumptions like this.)
Alternatively, Sweden’s policy of compulsory rehabilitation of drug addicts has yielded the lowest illicit drug use levels in the developed world.[2] (Firstly, on what page of this mammoth document is this fact drawn from? Secondly, Sweden is not opposed to harm reduction at all - http://www.ihra.net/Assets/1556/1/HarmReductionPoliciesandPractiveWorldwide5.pdf ) ... Critics [who?] of this harm reduction intervention reject the harm reductionists’ (What is a harm reductionist? Another weasel word) claims of ensuing lower rates of blood-born viruses on the grounds that there has never been a weight of scientific evidence which supports the claim. See Needle Exchange Programme for discussion of the evidence. (Needs to be referenced properly.)
... Critics [who?] of this intervention point to evaluations of safe injection sites.
For example, the 2003 evaluation of the Sydney Medically Supervised Injecting Centre[13] found:
○ that there was no evidence that the injecting room reduced the number of overdose deaths in the area (p. 60)
○ no improvement in ambulance overdose attendances in the area (p. 60)
○ no improvement in ambulance overdose attendance during hours the injecting room was open (p.60)
○ no improvement in overdose presentations at hospital emergency wards (p. 60)
○ no improvement re HIV infections (p. 71)
○ no improvement in Hep B infections (p. 72)
○ either worse or no improvement (depending on the suburb studied) in new Hep C notifications (p. 80)
○ discarded syringe counts on street reduced only in line with reductions in numbers handed out due to heroin drought (p. 123)
○ drug-related loitering and drug dealing worsened at the station entrance immediately opposite the centre (p. 147) (As for this section, I don't have the time to address each one, however the general consensus regarding the matter is that the first evaluation had methodological flaws which have been corrected in later evaluations. See Dr. Van Beek's book, Eye of the Needle [[1]] around page 85 for further info. Secondly, the centre has been running for seven years since that report came out and there is more evidence of the positive outcomes the centre achieves.)
An analysis of this evaluation by an epidemiologist, addiction medicine practitioner, and social researchers and practitioners found overdose levels in the MSIC 36 times higher than on the surrounding streets of Kings Cross, with clients averaging only one in every of their 35 injections in the room, evidencing low utilization rates in light of the ever-present risk of fatal overdose to each heroin user.[14] Testimony of ex-clients of the MSIC reported to the NSW Legislative Council[15] alleged that the extremely high overdose rates were due to clients experimenting with poly-drug cocktails and higher doses of heroin in the knowledge that staff were present to ensure their safety. (Hansard is a good source for references, however the section in question was a comment made by a former client. No analysis or research was included. There are many other comments from current and former clients who strongly support the centre however they are of no more value as references than my opinion or Minphie's)
The 2003 evaluation noted that, “In this study of the Sydney injecting room there were 9.2 heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.[16] (Overdose does not equal death - the MSIC reports clinical overdoses which are very precisely assessed and recorded. Overdoses on the street are not. Also, see previous comment about the 2003 report.)
It is this injecting room effect of increasing the trade for local drug dealers that has been condemned by critics . [who?]
... --rakkar (talk) 13:41, 18 January 2010 (UTC)
I am returning text vandalized by Rakkar on the grounds that there is no substance to his rationales for removing text. It is not enough to dream up some sort of fanciful rationale, not based in fact, as reason for removing carefully cited and factual information from Wikipedia.
1. Rakkar removes text because specific critics have not been named for a very general criticism of harm reduction. I point out that if a critique of a particular intervention is typed into Wikipedia that there is ipso facto 'critics' of the view. Thus the term 'critics' is accurate, not requiring further elucidation, where a valid criticism is entered into the text. Valid criticism is judged, of course, by the logic or evidence adduced. Therefore the paragraph "Where harm reduction . . . " is correct and needs no further citation. I could of course add some of the organisations, such as the many involved in the International Taskforce on Strategic Drug Policy, or the UN International Narcotics Control Board, that do make this critique, but it would be entirely superfluous to the argument.
2. Rakkar again appeals to unspecified 'critics', but because there is a criticism entered into the text 'critics' are in fact already validly implied.
Further Rakkar appeals to the private perspectives of a staff member in the program, Adam Baxter, wishing to promote his private views of cost effectiveness over the very clear mathematics that are related in newspaper articles elsewhere quoting John Strang, the leader of the project. It should be noted that until there is a peer-reviewed journal article on the outcomes (psycho-social or whatever else) on this project, we cannot take the private views of a staff member as guidance for Wikipedia. Presently, there is no journal article on outcomes, only Strang's financial comparisons in a media release.
3. It is not enough to remove a properly cited fact ie Sweden having the lowest drug use levels in the OECD, as found in the comparison figures of the UN World Drug Report (pages are given in the citiation). To remove this text, the onus is on Rakkar to disprove the UN World Drug Report data. And of course my statement is correct, so cannot be removed by whim or unfounded contentiousness.
4. See above on the use of word 'critics'. Again a clear and valid criticism is outlined, so there are ipso facto critics.
5. The term harm reductionist is an accurate title, used by the movement itself. Just as those who advance prohibition are called prohibitionists, with no concern about the labeling by its proponents, Rakkar's criticism of the term is unfounded. Of course, Rakkar is welcome to change the term to 'proponents of harm reduction' if he wishes, but to remove a whole paragraph is clearly vandalism.
6. Rakkar removes a section on needle exchange, in which the linked article on Wikipedia is very tightly and carefully referenced (at least for the critique part of the article). If Rakkar removes this section again I will take the right to reproduce ALL the needle exchange references on that other WIKIPEDIA page, making it a much more cumbersome article, but all the more damning of the intervention.
7. Critics of the safe injecting sites are many, but again who they are is not germane to the critiques. The critiques speak for themselves. Drug Free Australia's website carries a comprehensive critique, of course. Rakkar has removed the entire added text on suppositions simply not supported by fact. This is clear vandalism.
a. Stating that the first evaluation had 'methodological flaws' is no reason to remove the facts. In fact, every one of the cited facts from the evaluation, where each can be checked according to the page number listed, has not been contested by anybody. Dr van Beek has taken issue with the estimate of users in Kings Cross on a daily basis, from which overdose statistics are extrapolated, but has not taken issue with any of the data that Rakkar lists above his fanciful criticism (above).
b. If Rakkar wants to take issue with the overdose statistical comparisons he is welcome to add, in brackets, that Dr van Beek, Medical Director of the MSIC, has questioned whether the evaluation estimated too high a number of users in Kings Cross on a daily basis, but there is absolutely no justification for removing something which is entirely factual, as per the 2003 evaluation. Even when van Beek's concerns are taken into account the number of overdoses inside the room remain many times higher than on the streets. This discussion can be found on Australia's Update listserver.
c. Rakkar quite evidently has no idea whatsoever as to what is in later evaluations on the MSIC, guessing at their contents for the sake of contentiousness. There is only one, Evaluation 4, which has data which contradicts anything in the 2003 first evaluation. This is the statement that ambulance callouts have dropped by 80%, (but which is clearly the result of the heroin drought - heroin deaths AUSTRALIA-WIDE dropped by 75% in the same period, so we would expect ambulance callouts to drop similarly whether there is an injecting room or not in Kings Cross). Also there is data in Evaluation 4 that quite intriguingly conflicts with the first evaluation, whereby no. 4 states that the Kings Cross area had a greater drop in callouts than other adjacent suburbs. The 2003 evaluation said there was NO DIFFERENCE between Kings Cross and adjacent suburbs, while Evaluation 4 has a graph showing differences. Who are we to believe? This is not for Wikipedia to resolve. And there is no case for removal of a factual statement by Minphie.
d. The testimony of ex-users is extremely important. These are ex-clients who have gone to rehab, and who are more likely to speak with honesty and candour. The debate in NSW Parliament is as good a reference as is required for this kind of evidence, and Rakkar cannot remove the sentence simply because he doesn't like the reality.
e. Rakkar's intended rebuttal of overdoses inside and outside the room shows no basic understanding whatsoever of statistical comparisons. These comparisons were checked by one of Australia's most internationally renowned epidemiologists, Dr D'arcy Holman of WA Uni, and his e-mail to Drug Free Australia can be found on the Drug Free Australia full analysis website documentation.
Minphie —Preceding unsigned comment added by Minphie (talk •contribs) 11:30, 1 March 2010 (UTC)
I've changed the article somewhat. Minphie has reverted the article again, so rather than start a revert war, I've tagged some of the weasel words in the article as well as some of the unverified claims. It's been good actually, I've tagged a few other unverified claims already in the article. I don't want to spend hours arguing every point above, and I don't want this to turn into an edit war. Minphie's edits have a place in this article, hopefully we can all turn this into a better article. --rakkar (talk) 02:21, 3 March 2010 (UTC)
I have removed the spurious 'refuted' from the text re criticisms of SIFs because the cited evidence most certainly does not refute the statement that was previously written. I have also removed any reference to reduced hospital presentations because there was no data comparison available to make any such judgment.
Rakkar has cited an unpublished Addiction article which relies on the 4th Evaluation of the MSIC dated June 2007. This evaluation does claim that there were reduced ambulance attendances in the immediate area of the MSIC, a reduction of 80%, according to their figures, which also coincided with Australia's heroin drought during the period studied. It is noted that heroin deaths Australia-wide reduced by 67% over the period studied by the 4th evaluation due top the heroin drought. However it should be noted that Evaluation 4 contradicts Evaluation 1 despite purportedly using the exact same dataset. Whereas Evaluation 4 found a greater reduction in ambulance attendances in postcode 2011, which surrounds the MSIC, than in the 2010 postcode adjacent, the 2003 conclusion from exactly the same data contradicted the 2007 evaluation. The 2003 evaluation clearly says on p 49, commenting on Table 3.1 which compares ambulance attendances AFTER the MSIC opening against the heroin drought effects between January 2001 and May 2001 that "Analysis of the postcode areas 2010 and 2011 separately showed no different pattern of results" and yet the graph in Evaluation 4 shows a recognizable difference. This contradiction has yet to be explained.
Also Evaluation 4 was not able to compare Kings Cross hospital presentations with the rest of NSW and clearly says that no conclusions can be made in light of the heroin drought. —Preceding unsigned comment added by Minphie (talk • contribs) 11:51, 24 March 2010 (UTC) Signed ---minphie
Hi Minphie, I have removed your new headings and combined each reply into a single discussion. Helps other editors know this is an ongoing conversation. You obviously fundamentally object to Harm reduction on principle, but it would be helpful if you could acknowledge that it does have it's strengths as well as weaknesses. It would be good to work together on this, I certainly acknowledge that it has failings. You're obviously fairly well up on the debate here in Australia, do you work in a related field?
- I have removed the sentence "See Needle Exchange Programme for discussion of the evidence." again because it is not in keeping with [[[wikipedia:Summary style#References,_citations_and_external_links|http://en.wikipedia.org/wiki/Wikipedia:Summary_style#References.2C_citations_and_external_links]] Summary style]. We don't reproduce all information on a topic whenever it is mentioned, we direct readers to the main article to read further. As you noted, reproducing it would make the article cumbersome and unreadable.
1 - I have removed the sentence "(but it is also noted that data from this later study uses the data for the same ambulance services as the 2003 evaluation, but with obviously conflicting data for the years 2001 and 2002)". It obviously references something from the Salmon, van Beek et al article, but I don't know what. As noted on the edit summary, its possible to analyse the same data with different methodology and get valid results. Plus, it's probably a bit long to be in brackets.
2 - In regards to ambulance call outs, I changed the word balanced to corrected, as the conflict was not in opinion but in statistical analysis. It didn't balance the old analysis, it replaced it.
3 - Removed mention of claim in DFA pamphlet that on average users only visit MSIC for 1 in 35 injections. The maths underlying the statement is BAD, and has not been reproduced by anyone else. It assumes that EVERY client of the centre uses 3 times a day, every day. Some would use more, some would use less.
4 - Removed sentence - "and drug-related loitering and drug dealing worsened at the station entrance immediately opposite the centre (p. 147). This claim has been disproved - "[The] results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering" from From "Freeman K., Jones C. G. A., Weatherburn D. J., Rutter S., Spooner C. J., Donnelly N. The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime. Drug Alcohol Rev 2005; 24: 173–84. Here's the whole abstract "The current study aimed to model the effect of Australia’s first Medically Supervised Injecting Centre (MSIC) on acquisitive crime and loitering by drug users and dealers. The effect of the MSIC on drug-related property and violent crime was examined by conducting time series analysis of police-recorded trends in theft and robbery incidents, respectively. The effect of the MSIC on drug use and dealing was examined by (a) time series analysis of a special proxy measure of drug-related loitering; (b) interviewing key informants; and (c) examining trends in the proportion of Sydney drug offences that were recorded in Kings Cross. There was no evidence that the MSIC trial led to either an increase or decrease in theft or robbery incidents. There was also no evidence that the MSIC led to an increase in ‘drug-related’ loitering at the front of the MSIC after it opened, although there was a small increase in ‘total’ loitering (by 1.2 persons per occasion of observation). Trends in both ‘drug-related’ and ‘total’ loitering at the front of the MSIC steadily declined to baseline levels, or below, after it opened. There was a very small but sustained increase in ‘drug-related’ (0.09 persons per count) and ‘total’ loitering (0.37 persons per count) at the back of the MSIC after it opened. Key informant interviews noted an increase in loitering across the road from the MSIC but this was not attributed to an influx of new users and dealers to the area. There was no increase in the proportion of drug use or drug supply offences committed in Kings Cross that could be attributed to the opening of the MSIC. These results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering."
--rakkar (talk) 06:32, 25 March 2010 (UTC)
In light of not being able to find the Wikipedia convention that would point readers in the Harm Reduction page to the evidence against the effectiveness of needle exchanges on the Needle-exchange programme page, I have reproduced the relevant evidence in the Harm Reduction page.
If Rakkar wants to provide a correct link to the Needle-exchange programme page he could help readers to find the information they need there rather than be reproduced on the Harm reduction page. But the removal of the link that was there serves to remove any reference to evidence whatsoever when the evidence is indeed against any claims of proven effectiveness. --- Minphie —Preceding unsigned comment added by Minphie (talk • contribs) 11:53, 26 March 2010 (UTC)
Rakkar has removed, again, sections which are factual and cited, and I have reinstated these for the following reasons.
1. Rakkar's statement, "Later research corrected these initial findings, noting that "the Sydney MSIC reduced the demand for ambulance services, freeing them to attend other medical emergencies within the community" immediately follows my paragraph citing 4 conclusions in the 2003 MSIC evaluation which showed no evidence of change after the commencement of the MSIC.
It is a distortion to say that Evaluation 4, in 2007, corrected all of these four findings because Evaluation 4 studied only two of the 2003 conclusions, failing once again to demonstrate an effect on overdose deaths in the area, and secondly stating that there was a 20% drop in ambulance attendances which applied to the postcode surrounding the MSIC. Note that they did not make conclusions in the 2007 evaluation on ambulance attendances over every 24 hour period, and did not have comparative data to judge hospital presentations. Curiously the 2007 evaluation used the same dataset as the 2003 evaluation, and the 2003 evaluators had compared postcodes at that date without seeing any comparable differences in postcode attendances (p 49) as per the 2007 evaluation. So I have changed the wording to reflect the reality of the two evaluations.
2. Rakkar removed, in an act of vandalism, the Drug Free Australia analysis conclusion that injecting room clients had only one of every 35 injections in the room. His rationale is that Drug Free Australia worked on a multiplier of 3 injections per day to get that figure. He also stated that some users have less injections per day and some more. Drug Free Australia has surveyed users and find use of between 1 and 6 injections per day are quite normal.
What Rakkar needed to do was read the full Drug Free Australia documentation before hitting the delete key. The Drug Free Australia detailed documentation clearly states (and reproduces in screen copy from the evaluation document) that the MSIC's own 2003 evaluators used three injections per day as the realistic daily injections multiplier in their calculations. As now stated in the text, Drug Free Australia used precisely the same methodologies and data as did the 2003 evaluators. The Drug Free Australia analysis was conducted by an epidemiologist, an addiction medicine practitioner with one of the largest practices in Australia, a medical doctor/social researcher, another senior social researcher and a welfare industry senior manager.
Furthermore, the Drug Free Australia analysis was verified by one of Australia's best known epidemiologists internationally, Dr D'Arcy Holman of WA University. D'Arcy is reportedly sympathetic to Drug Law Reform, so his verification is notable. His e-mail confirming the same is reproduced in the very reference which is given for Drug Free Australia's conclusions. There really is no excuse for Rakkar to unilaterally assume what he thinks is correct without being able to soundly refute Drug Free Australia's analysis. Rakkar, read the evidence before you swing into print.
3. Rakkar further claimed that "Numerous health professionals working in the addiction medicine field have pointed out the errors in the various calculations and extrapolations in the Drug Free Australia report." There is absolutely no truth to this statement. Of course professionals in support of injecting rooms will say anything - what counts is whether they can falsify the Drug Free Australia analysis or not, verified as it is by a very eminent Australian epidemiologist. This has never been done.
The only issue of note is that Dr van Beek has taken issue with the EVALUATOR'S assumptions regarding the number of heroin users in Kings Cross on a daily basis. Drug Free Australia uses the evaluator's assumptions and data, and so Dr van Beek has claimed that the Drug Free Australia conclusions (which are absolutely and correctly deducted from the evaluation data) are based on evaluator's assumptions which may distort the picture somewhat. Even using Dr van Beeks's own revised estimates, the injecting room still has 9 times the street rate of overdoses, still hugely greater than on the street.
4. In a clear act of vandalism, Rakkar has removed a conclusion he may not like, but which is a clear deduction from the quote immediately above which comes from the 2003 MSIC evaluation itself. If the evaluation says that injecting room clients are injecting higher doses of heroin, and drug dealers are at the station opposite (as per p 147) then the clear deduction is that the drug dealers opposite the injecting room, or elsewhere for that matter, are being paid more money for the extra heroin sold which is consumed in greater quantities in the injecting room. Please leave the statement where it is - it is an absolutely correctly-deducted statement.
5. The removal of the statement about the station opposite the MSIC being a site for drug dealers and loitering is unconscionable and is an act of vandalism once again. Rakkar, please desist.
Here is the evidence with quotes directly from the 2003 evaluation.
“We’ve got problems at the entrance [of the train station] with people just hanging around. We’ve got members of the public complaining about drug users, homeless and drunks hanging around the entrance on Darlinghurst Road.” (City Rail worker, 12 months interview – p 146)”
“The police who participated in the twelve-month discussion group commented that they had received complaints from the public and the City Rail staff about the increase in the number of people loitering at the train station. They noted that, while other factors, such as police operations, would have contributed to the increase in loitering outside the train station, there was a notable correlation between the loitering and the MSIC opening times.” (MSIC Evaluation p 146)
“The increase in loitering was considered to be a displacement of existing users AND DEALERS (my emphasis) from other locations.” (MSIC Evaluation p 146)
“The train station never featured as a meeting place before. It used to be Springfield Mall and Roslyn Street.” (Police 12 month interview – p 147)
Rakkar, if you make changes like this again I am going to take this further. —Preceding unsigned comment added by Minphie (talk • contribs) 11:32, 27 March 2010 (UTC)
Minphie, First, please be civil to me and assume that my edits are in good faith, as per wikipedia policies, WP:AGF & WP:CIV. Threatening to "take this further" doesn't make it sound like you're trying to reach a consensus here. I also moved the opening sentence that had just been written into the safer injection sites as it pertained only to SIFs. I'll have a look at the rest later.--rakkar (talk) 09:02, 30 March 2010 (UTC)
Discussion moved to Talk:Safe_injection_site#Evidence_.26_validity_of_Harm_Minimisation_as_public_health
A Balanced introduction
Rakkar has relocated a general criticism of Harm Reduction, making it a specific criticism of SIFs particularly, when in fact the citation given as AN EXAMPLE of the criticism is used by Rakkar to justify removing the general criticism. This is simply not valid.
The rationale for moving it back is that the statement is manifestly general to ANY harm reduction for illegal activities, and drug-taking happens to be just one eminent example which is the most visible example. Not only SIFs are seen as promoting illegal behaviours, but also needle exchanges attract this same criticism, heroin prescription programs and other non-drug issues.
So Rakkar's moving this to the SIF section because the example citation focuses on SIFs in particular could appear as a cynical attempt to rid the introduction of its balance. But balance is surely what Wikipedia idealises, as does any mature discussion.
I will happily add INCB citations for other harm reduction approaches which it deems as promoting drug use, but it will only add to the bulk of the footnotes when one example suffices. Minphie (talk) 12:17, 30 March 2010 (UTC)
Minphie, I'm going to revert the changes, because I think it worked quite elegantly as an introduction to criticisms of SIFs. Can I suggest rewriting the intro with a more general focus, and quoting sources that refer to Harm Min in general rather than just the MISC.--rakkar (talk) 23:50, 30 March 2010 (UTC)
Shortening
I have started trying to shorten this article as the Safer injecting facility sub-heading was becoming longer than the Safer injecting facility article itself. I've tried to write a succint summary of the criticisms of SIFs and moved the longer discussion to the Safer injecting facility article. Minphie, all your content is there, could we resume the discussion about what to include there? --rakkar (talk) 00:27, 31 March 2010 (UTC)
Rakkar has removed the general criticism of harm reduction, refashioning it into a criticism of one intervention only. But of course the criticism is used generally, and therefore must be entered in the general introduction.
Further, Rakkar has written a totally uncited and incorrect statement alleging that Drug Free Australia and Drug Free America wish to lock up users or have them thrown into compulsory treatment. While compulsory treatment is one option that Drug Free Australia recommends on the basis of Sweden's success, (as is explained in the United Nations Office of Drug Control booklet on their successful policies), the uncited nature of the comment indicates that there is no evidence that either organisation advocates for such responses to the exclusion of a whole range of other earlier interventions. It is a clear and spiteful distortion to say that these organisations just want to lock users up and there is no place for such subjective provocation in Wikipedia.
Minphie (talk) 11:24, 31 March 2010 (UTC)
Minphie, I haven't removed anything - everything you wrote is now located at Safe injection site. This article is a brief overview of Harm Mimisation, and detailed critical and supporting arguments are now located on the new page. I'm happy to continue working on it over there. As for the new paragraph I wrote, I didn't at all intend for it to be a one sided criticism of DFA, I intended it to be a fair summary of their position. Please feel free to rewrite the paragraph and outline what anti-harm-minimisation organisations believe should be done instead. We should just keep the content brief on this page. I haven't vandalised anything and would be happy to discuss this with other editors. Appealing to "administrators" is a last resort, and wikipedia policy directs editors to make a thorough effort to resolve these things by consensus. Sadly, we have only been discussing it between ourselves and it has descended into a fairly adversarial process. I'm going to revert the changes back to my edits from earlier today as they are not vandalism, all your content is intact on a more relevant page. If you are unhappy with my synopsis of criticisms of harm min, please re word it, but I think brevity is the key. Save the details for the main article. --rakkar (talk) 12:01, 31 March 2010 (UTC)
I'd like to suggest the following plan for shortening & avoiding revert wars:
- The opening paragraph: We keep it as the current three line structure, and if you could write the third line outlining objections to the approach. Can you find a source that talks about general objections to the philosophy, rather than just SIFs? For example, United Nations International Narcotics Control Board only objects to a few harm min programs relating to drugs, not the philosophy in general. If you look at the other two references in the opening paragraph, you'll see that they are broad in scope.
- Syringe exchange and related programs: Currently there are two paragraphs describing NSPs and four criticising them. The article is too long, when editing the whole article, this warning is up the top- "Warning: This page is 45 kilobytes long; some browsers may have problems editing pages approaching or longer than 32kb. Please consider breaking the page into smaller sections." Can you condense the four paragraphs into one? If readers want more, they can go to the main article.
- Safe injection sites: Again, let's discuss the content later, but I feel this section needs to be condensed. I have replicated your content on the main SIFs article and we can carry on the discussion there. Could you shorten your content down into one paragraph again? And I feel that in it's current form, it's too focused on the Sydney MISC, could it be more about SIFs in general?
--rakkar (talk) 03:01, 2 April 2010 (UTC)
I've been waiting for Minphie comment on the proposed changes above, but it's been 8 days without a reply so I've made the edits myself. If other editors don't like them, feel free to rewrite them, however, the aim of the exercise to keep them short :) --rakkar (talk) 07:31, 8 April 2010 (UTC)
Reinstatement of evidenced and factual statement on HR critics
I have reinstated a statement about critics of harm reduction removed by other contributors on the grounds that the citation only covered drug use (so I have added a citation on HR and illegal prostitution) or that the statement about the community not accepting various behaviours or actions through their legislators was not evidenced. Of course the latter rationale for removal shows a clear ignorance of the meaning of government, which is foundationally and definitionally by the will of the people or for some nations ostensibly by the will of God which in turn determines the will of the people. It is the most basic concept of government that if it does not rule according to the will of the people it will be removed and replaced by one that does. So the statement about critics is entirely factual and correct. There is a possibility that other editors may not like the fact, but this is never a reason for removal of a factual statement. Minphie (talk) 02:41, 21 April 2010 (UTC)
- I believe that every monarch by divine right would disagree with your "basic concept of government". The idea of "the people" getting to choose their government is, in fact, a rather new idea in human history.
- However, the major issue here is proving that someone else has published this specific opinion. If you can show reliable sources that explicitly connect harm reduction (not just drug use) to these ideas, then we can probably find a good way to present that. If not, though, then we shouldn't include it. WhatamIdoing (talk) 05:40, 21 April 2010 (UTC)
Minphie, I've made a few changes, to your edits, and I've done them one edit at a time. Hopefully this will help to avoid block reverting.
- Heroin maintenance programs: We discussed this in January & March 2010 on talk page - you commented noted that "It should be noted that until there is a peer-reviewed journal article on the outcomes (psycho-social or whatever else) on this project, we cannot take the private views of a staff member as guidance for Wikipedia. Presently, there is no journal article on outcomes, only Strang's financial comparisons in a media release." As you noted, the article is more subjective qualitative evidence than a proper assessment. It also means that we shouldn't synthesise conclusions from the figures noted in there as that would be WP:OR. why not find some of the good evidence you mentioned from John Strang?
- Syringe exchange and related programs: Firstly, I changed the location of your reference as the link you provided was dead.
- Syringe exchange and related programs: I though that the quotes you had used appeared somewhat out of context with the page referenced. Page 149 said that NSPs had an at least modest effect on BBV infection rates if done properly. The line multiple studies show that NSEs do not reduce transmission of HCV went on to explain that this was the case because injectors were not getting alcohol swabs, cotton, sterile water etc. I've updated the article to reflect this.
--rakkar (talk) 03:20, 24 April 2010 (UTC) Also, I'm not sure you can cast Harm Min initiatives like the MISC as clearly "undemocratic". Harm Minimisation doesn't equate to drug legalisation. As the "2007 National Drug Strategy Household Survey: first results." shows, there isn't much of a mandate for legalisation. However, in 2007 support for SIFs is almost at 50% (page43), up 10% from 2004 figures. People can see that methadone, NSPs, SIFs etc... are not explicitly promoting the free use of drug. Also, as a measure of the democratic support for MSIC, see this page, MSIC Supporters, for a list of democratically elected representatives who support the operation of the centre. The Mayor of Sydney & the State Member (moot difference, I know :) was elected with a platform of support for the MSIC. So was the Federal Member for Sydney. Many (all?) of the churches in the local area involved in providing support to disadvantaged groups support it. A large number of professional organisations support the service.
I know it's not clear cut and there are many who oppose harm min, but it think there is enough demonstrated support for the running of the MSIC to be within community expectations.
--rakkar (talk) 06:22, 24 April 2010 (UTC)
Replacement of heroin trial financial figures
Rakkar has removed factual and correct statements on the costs of the British heroin trial, citing that a previous discussion about the reliability of an opinion by a nurse, or some such other employee in the trial, regarding the source of heroin user income, was not valid grounds for Wikipedia evidence. However Rakkar has removed the financial figures which are undisputed, most definitiely not opinion in this case, and are otherwise well-evidenced elsewhere, although we note that the CONCLUSIONS from these figures have not been submitted yet for peer-review. Of course there is no reason to doubt the figures, which any peer-reviewer would accept before scrutinising what John Strang and his team wish to extrapolate from these figures. Our statement does not represent any extrapolation beyond the facts of the figures themselves and therefore cannot be disputed. Minphie (talk) 03:29, 25 April 2010 (UTC)
Better clarity on needle exchange section
1. Rakkar replaced a quote from the IOM 2006 review with his own interpretation, which said less than the direct quote I had written into the text. The IOM conclusion was not just that there was insufficient quality evidence to make highly reliable conclusions about needle exchange, but for the 14 or so studies that did pass muster for the IOM, when balanced against each other they remained INCONCLUSIVE on NSP effect. Rakkar's removal of text relating to the inconclusive nature of the acceptable studies is not permissible. Also changing the object of the IOM study on this point from "HIV' to the much braoder 'BBV' is inaccurate and changes the intent of their conclusion.
2. I have also ensured that Rakkar's paraphrasing of the IOM quote re NSP and HCV is rendered without his interpretation, which is not true to their statement. The IOM note that the failure of NSP regarding HCV transmission is 'attributed to' various reasons which they quote from other reviewers. This is of course speculation on the part of other reviewers, and the IOM record of the fact that they attribute this to these various other reasons does not give the weight of IOM authority to those speculations. Indeed, Australia has NSP supply regarding clean needles which is at saturation point - they cannot give away any more, and they have extensive education on sharing the rest of injecting equipment yet they still have HCV rates like anywhere else that doesn't have NSPs. There is at least some anecdotal likelihood that HCV transmission is happening with NSP-provided needles which certain users might otherwise have not used if they were not already intoxicated with other illicits first. Minphie (talk) 03:56, 25 April 2010 (UTC)
Steinberger has reverted my factual and fully-cited text to a sanitized and incorrectly interpreted version of previous text written by Figs Might Ply, who thinks remarkably like the holidaying Rakkar who worked on this paragraph back in March/April. The IOM report cited is NOT saying that no assessment of needle programs can be made at all from the available studies. They cite 14 studies (case controlled. ecological etc) with SUFFICIENT SCIENTIFIC RIGOUR to make conclusions about the effectiveness of needle exchanges. Indeed the World Health Organization's paper on needle exchange effectiveness by Wodak and Cooney did claim a conclusive case for their effectiveness from much the same studies, but unfortunately could only do so by misrepresenting the conclusions of a number of the studies. But because these studies have MIXED RESULTS (NOT INCONCLUSIVE RESULTS FOR EACH STUDY as Figs Might Ply's text might possibly imply) they give an inconclusive result which FAILS to demonstrate the effectiveness of needle exchanges. The text by Figs Might Ply suggests something quite otherwise by its use of words, thus misrepresenting the IOM. Figs Might Ply wrote that "the current evidence has not yet delivered a conclusive assessment of the programs" which is really only saying what the previous part of the same sentence had said - that more studies need to be done before a conclusive result might be possible - however Fogs Might Ply's sentence assumes that the results of these many studies SHOULD BE or WILL BE conclusive either for or against needle exchanges, which may never be the case. The many new studies may only give more mixed results which would then yield the conclusion that despite sufficient studies the results are STILL inconclusive regarding the effectiveness of needle exchange. We must be careful not to say something that the IOM hasn't said, and my more literal rendering of the IOM statement is more correct. Maybe the direct quote from the IOM would best be placed into the text and I am open to that discussion.Minphie (talk) 23:53, 18 May 2010 (UTC)
Greater accuracy on British heroin trial
Having noted that prostitution in England can be legal within certain strictures, I have attempt to reflect that some heroin users funding their habit from prostitution are not doing it illegally, and this may not all be an added burden to the public. If heroin users are street prostitutes then they are funding their heroin habits illegally, but if operating from their own home with no other shared occupancy they are procuring it legally. Of course legal prostitution would seem to be less likely than the illegal for heroin users. Minphie (talk) 01:32, 26 April 2010 (UTC)
Balance seems difficult
Looking over the evidence provided in the overly extensive "criticism" section attached to each drug initiative seems to reveal three groups of evidence. Spurious conclusions, outdated reports and papers from small organisations with little or no support from wider literature.
Example, the argument in the opening sentence, "concerns about [it] sending a message of sanctioned acceptance of ... behaviours which the community ... do not accept" is rather speculative. There is huge support in the Australian population for the idea of NSPs (67%) and SIFs(49%). Of the other 33% & 51%, there is no break down of those who have no opinion and those who oppose. It's possible to oppose drug use and support these measures as a public health measure. I do, and I'd say that many Australians do too.
As I see it, there is a problem with two opposing views on responses drug use that haven't been reconciled. The vast majority of scientific research supports harm min programs like Methadone, SIFs and NSPs. Then there is the "Abstinence Only" lobby, who believe that Harm Min is morally/ethically unsound. It looks like the abstinence only view has informed the content of the criticism paragraphs. Evidence abounds that NSPs, SIFs, etc are an effective but small part of drug policy. They should be specifically targeted towards at risk populations, and remain so.
So, ranting aside, how do we work this out? I believe that we need to re-examine all evidence given in this article and weed out the spurious and the unsupported assertions.--Figs Might Ply (talk) 16:22, 1 May 2010 (UTC)
- It would be helpful to find a couple of top-quality scholarly sources (books, maybe?), and to structure the article around that. Right now, there's too much reliance on sources that amount to "Last night, some politician read a speech that said..." or "A politically motivated poll produced the following meaningless numbers..." WhatamIdoing (talk) 16:58, 6 May 2010 (UTC)
- Figs Might Ply, I don't think that it is as clear cut as you make it out to be. There are legitimate concerns regarding "controlled addiction" and managed addiction etc. For example many heroin addicts are not employed and the supply of methadone can significantly boost their weekly income, and it is often resold on the street. Also heroin addicts often use illicit drugs on top of methadone, although there is evidence of reduced illicit drug use. Granted there is evidence of benefit in some outcomes but there are two sides to the debate and it is a hugely controversial area. Also a lot of it is bureaucracies and governments chasing statistics of "more addicts in treatment", "drug related crimes reduced" etc so it is not entirely a health initiative unless it is the health and wellfare of gov stats we are talking about. Abstinence is of course the ultimate harm reduction strategy, although admittedly this is not always possible and other harm reduction strategies have merit. There is more grey than black and white. As has been suggested, improved sourcing and following WP:WEIGHT and WP:NPOV should help improve this article and resolve disputes.--Literaturegeek | T@1k? 11:43, 8 May 2010 (UTC)
Reinstatement of Sweden having gained lowest drug use levels in developed world
Removal of the statement about Sweden having the lowest levels of drug use in the developed world is inappropriate because the statement is indeed evidenced by the UN World Drug Reports since the year 2000, when figures were first comprehensively released for 2000, then 2002, then annually. An aggregated average of drug use for OECD countries (opiates, cocaine, amphetamine, cannabis) in 2000 gives the percentages below.
Australia 5.9 Austria 1.0 Belgium 1.6 Canada 2.3 Czech Repub.1.0 Denmark 1.4 Finland 0.7 France 1.4 Germany 1.3 Greece 1.3 Hungary 0.5 Ireland 2.4 Italy 1.6 Luxembourg 1.3 Mexico 0.5 Netherlands 1.6 New Zealand 4.4 Norway 1.2 Portugal 1.3 Spain 2.7 Sweden 0.2 Switzerland 2.6 UK 3.0 USA 4.2
For the 2009 report the averages across 5 drug types (ecstasy added) are:
Australia 4.0 Austria 1.2 Belgium 1.8 Canada 4.4 Czech Repub. 2.8 Denmark 1.6 Finland 1.1 France 2.1 Germany 1.3 Greece 0.5 Hungary 0.8 Ireland 2.0 Italy 3.8 Luxembourg 2.1 Mexico 0.9 Netherlands 1.6 New Zealand 3.9 Norway 1.5 Portugal 1.1 Spain 3.1 Sweden 0.8 Switzerland 2.7 UK 3.5 USA 3.7
Across the decade of reports Sweden has had the lowest levels, with Greece achieving a lower level of drug use from the 2006 - 2009 reports. Sweden is the second lowest in 2009.
The citation does indeed support the statement that rehab has yielded for Sweden the lowest levels of drug use in the developed world. However the footnoting of 9 UN Drug Reports is daunting, so I have referenced the last report as citation indicating that the figures are found in the UN Drug Reports. Minphie (talk) 12:59, 3 May 2010 (UTC)
- Compulsory treatment was introduced in 1982, since then the numbers of problem drug users have more then doubled. It is inappropriate to suggest a link between the two, where the former depresses the latter. Steinberger (talk) 13:06, 3 May 2010 (UTC)
But Steinberger's rationale does not have any relevance here. Drug use is established by the percentages of surveyed population using various illicit drugs from survey to survey. This is the standard measure, rather than country estimates of drug user numbers which have differing assumptions involved as to what constitutes a problem drug user. And we have some idea as to the levels of drug use back in the early 80's from school surveys, which are directly comparable to now.
I also doubt whether Steinberger can give a figure for problem drug user numbers pre 1982 when Swedish Drug Policy came into effect. I have never seen such a number, or what percentage of the population it was. So I figure this is just an uncited response that has no substance.
Added to this is the issue that if Sweden moves from an average of 0.2% of its population to 0.8%, but still experiences amongst the lowest levels in the developed world then the statement that its drug policy has worked remains correct despite a rise off a very low base. Minphie (talk) 01:30, 4 May 2010 (UTC)
Minphie's data, made more readable
2000 | 2009 |
---|---|
|
|
--Figs Might Ply (talk) 08:40, 4 May 2010 (UTC)
- Minphie, your criticism of Steinberger's observation is equally valid against the original sentence. "Alternatively, Sweden’s investment in a policy of compulsory rehabilitation of drug addicts has yielded the lowest illicit drug use levels in the developed world" is original research. I see the point you are trying to make, however, your aggregate data does prove this, the section you referenced only makes one unrelated mention of rehab. I'm going to delete the sentence again and await a properly researched piece of evidence that proves the point.--Figs Might Ply (talk) 08:48, 4 May 2010 (UTC)
Deletion of speculation and untrue assertion re Sweden
I have deleted Steinberger's false statement about illicit drug use increasing in Sweden when the data shows exactly the opposite.
1. Have a look at pp 26,27 of the UNODC publication 'Sweden's Successful Drug Policy' and you will see that it has been decreasing for a number of years after rises during the time when Sweden allocated less funds to its drug policy. Antonio Samaranche makes this point in his Preface to the document and there is indeed a correspondence between funding and decreasing use levels.
2. An appeal to the UNODC World Drug Report is not valid either because, despite its time-lagged figures for all countries, it too shows a decrease in drug use for Sweden in the 2009 report. My aggregate average for all OECD countries was based on the upper level of ranges, where there is a range calculated by the UNODC. Taking the lower range for Sweden the decreases in the 2009 report are more marked than the decrease using the upper levels of the ranges calculated.
I have also deleted the speculative rationales given by Steinberger regarding Sweden's low rates of illicit drug use on the following grounds.
Sweden has had, despite Steinberger's listed rationales of lower unemployment and temperance culture, illicit drug use levels on their student surveys in 1971 that only began to be matched by other European countries in the 1990s with the increases in illicit drug use experienced world-wide. See the EMCDDA Annex for its 2000 Annual Report for European figures on student lifetime prevalence. All this despite Sweden having lower unemployment and a temperance culture, as Steinberger and others have speculated. But Sweden brought these levels back to 3-4% by the early 90s via a restrictive drug policy - nothing else explains the drop - not changing employment levels or changes in the temperance culture. I might note that Australia's lifetime prevalence for young people was 52% for the same late 90s period as is addressed in the EMCDDA report for 2000. Australia is not on the drug trafficking routes (another explanation used by critics of Sweden), and has employment levels lower than many other countries, as with Sweden. But Australia, despite these benefits, has had the highest levels of drug use in the developed world for a decade. So arguments about causes can be easily falsified by other country's data or by Sweden's previous high levels of drug use. Minphie (talk) 01:11, 5 May 2010 (UTC)
- The youth unemployment is a better explanation then the policies, at least according to the widely cited sources I have given. That most Sweidsh politicans and UNODC thinks different might be notable but is not true. Steinberger (talk) 12:32, 5 May 2010 (UTC)
Hi Minphie and Steinberger,
Minphie, you're probably going to hate me, but I took out the criticism section of Heroin maintenance programs. The content was either inconclusive or original research/synthesis.
Firstly, who are the critics you mention? Regarding the RIOTT program, the reference given was highly supportive of said programs, and made a point of the savings it made to government spending.
Secondly, the second point about Sweden has not addressed my point above: ...[It] is original research. I see the point you are trying to make, however, your aggregate data does prove [that compulsory rehab affects levels of drug use ], the section you referenced only makes one unrelated mention of rehab. I'm going to delete the sentence again and await a properly researched piece of evidence that proves the point
Minphie, unless you find a valid source that addresses the above points, I don't think we should include your claims in the article.
- Included below are the sections I removed for ease of reference.
- Minphie's section, removed as the assertions are questionable and are backed up with original research/synthesis
- Critics of this intervention cite the high costs to any community providing heroin maintenance programs. For instance, the British heroin trial initiated in 2005 [3] costs the British government £15,000 pounds per participant per annum. This is roughly equivalent to average heroin user habits of £15,600 pounds per annum which were funded significantly by crime, and yet participants still average a continued use of illegal heroin of £2,600 per year, again funded significantly by crime despite the provision of free heroin. Alternatively, and according to UNODC, Sweden’s investment in, and commitment to, a drug free society where a policy of compulsory rehabilitation of drug addicts is integral, has yielded the lowest illicit drug use levels in the developed world.[4]
- Steinberger's section, no longer needed as the point it was responding to was not valid.
- However, UNODC findings have been criticized for using selective data to prove their point.[5] Nils Christie, have among others, pointed out Sweden as the hawk of international drug policy, being a welfare alibi and giving legitimacy to the US drug war. Adding that the two countries have an extraordinary influence on UNODC as the biggest donor countries.[6] Some more common explanations to Swedens low prevalence rates are socioeconomical and cultural factors, such as a strong temperance culture and a very low youth unemployment - the latter known to be correlating strongly with drug experimentation among youths, elsewhere, such as in most of Europe and Australia, as well as in Sweden.[7][8][9] Drug use is presently on the rise again.[10]
Finally, I think we are including this debate on the wrong page. The Harm Reduction page is almost too long, and nitpicking over Sweden might be better done on a page like Drug policy.
--Figs Might Ply (talk) 14:05, 5 May 2010 (UTC)
- Fair enough. Steinberger (talk) 20:25, 5 May 2010 (UTC)
I have retained the previous wording re Critics of the heroin trial on the following grounds.
1. User Pigs Might Fly is only using frivolous and needless objections to keep a properly cited and evidenced section of text off the page. Therefore my adding a citation for the source of such criticisms is gratuitous on my part - there are hundreds of pages in Wikipedia where the word 'critics' is used without citing any individual or organisation and I won't tolerate this clear obstructionism in the future.
2. The texts on costs of the heroin program in Britain cited the actual costs of the program as released by the program organisers themsleves. The rest of the text is a straight logical deduction. Go to any manual on logic and you will find that deduction is not synthesis in any shape or form, rather the opposite. So Pigs Might Fly obstructs on indefensible grounds here. Of course the organisers of this trial see it as saving money, but the cost of 15,000 pounds per annum is correct in terms of the cost to the government. The savings they speak of are in less acquisitive crime, but they point out that few have ceased using street heroin altogether, meaning that there will be ongoing acquisitive crime, though at a lesser level for as long as any government keeps funding such a program. In stark contrast is the International Taskforce's assertion that a restrictive drug policy such as Sweden's, where coerced rehab actually reduces the number of active drug users (this is DEFINITIONAL of the word 'rehab' and not synthetic or otherwise. When a person is successfully rehabilitated from drug use they no longer commit ANY acquisitive crime. Some acquisitive crime as per the heroin trial in the UK is worse than no acquisitive crime. This is not original research, or synthesis. This is linear logic. So Pigs Might Fly's deleting of my text is only based on a carping obstructionism that has no basis in either logic or validated observation and I am noting this as an instance of such if I later want to take this matter further.
I have removed Steinberger's speculations about Sweden's success with their drug policy because as Pigs Might Fly has noted, it makes the text overly long over a point (of current rises and falls in drug use) which makes not one bit of difference to whether Sweden had the lowest drug use levels as per my proven citation, which they indeed did. Steinberger has appealed to the 6% figure for school student 12 month prevalence in 2008, up from 5% for 2006 and 2007, going back to match the 2005 6%. Steinberger needs to note that one swallow doesn't make a summer, and that one year of increase does not constitute a trend.
Pigs Might Fly objects that he can't find sufficient proof of Sweden having a coerced rehabilitation policy. A simple typing of 'coerce' into the pdf search for that same document will produce numerous references. And my text is not saying that coerced rehab is the only thing in Swedish policy that might have led to its success - their policy is much broader than that. But coerced rehab stands in stark contrast to heroin maintenance, which maintains an addiction in their ongoing drug use, as against rehab which ends it. The argument is ipso facto. Minphie (talk) 00:22, 6 May 2010 (UTC)—Preceding unsigned comment added by Minphie (talk • contribs) 00:20, 6 May 2010 (UTC)
- As UNODC is a heavily criticized organization, its findings should not stand alone without the criticism that exsits. That would breach NPOV. Either with or not at all. And moreover, the critique of the criticizers it is not more speculative then UNODC and others critique. Steinberger (talk) 11:51, 6 May 2010 (UTC)
Steinberger, this deletion is intolerable in that it is, primarily, mostly deletion of text which has nothing whatsoever to do with the argument you have mounted. Deleting properly cited and factual text is vandalism and I a not prepared to put up with your vandalism of properly cited and factual text. I am reverting the text on Sweden on two grounds.
1. Virtually the only criticisms of the UNODC come from the drug legalization lobby and of course they are very vociferous but out of step with the world at large. . . in 2009 when the UN Committee on Narcotic Drugs (CND) was pressured by the international drug legalization lobby to alter the illicit drug conventions to include 'harm reduction' as a policy plank, it declined to do so, representing the vote of the vast majority represented on that UN committee of more than 70 countries. They had faith in the UNODC and its resistance to certain harm reduction interventions (eg injecting rooms), and backed it up with a UN majority vote. The drug legalization lobby was mightily upset, as I can demonstrate from their commentaries during the whole 2009 process, but their discontent with the UNODC is expected but not necessarily valid just because they voice something. Their criticisms come moreso from a different starting assumption - individual rights - while the UNODC gives more weight to the community's rights to protect itself from harms. We know where the community stands on this issue because no country has legalized drugs anywhere but US' Alaska some decades back, and they reverted that as a bad idea once their school-kids' use skyrocketed.
2. Here is the reason I won't tolerate any further deletions on the Sweden issue. The point that you have deleted, the sentence on Sweden's success, has absolutely nothing to do with the UNODC. I have demonstrated from the World Drug Report of 2000 that Sweden has had the lowest drug use in the developed world. These are not UNODC statistics but figures from each country's own population surveys that just happen to be in the UNODC document. The point about coerced rehab being one of their central strategies can be backed up from a thousand other sources. If the UNODC states something abundantly factual about Sweden having coerced rehab, then you can't change the facts. You may try to delete the facts from the page because you do not like something about this, but that again is vandalism. I will take this matter further if you delete this section again. —Preceding unsigned comment added by Minphie (talk • contribs) 22:58, 6 May 2010 (UTC)
CEDRO of Amsterdam was an state-sponsored but independent research institute. Stockholms University is a ordinary university (Lenke and Olsson). Nils Christie got his salary from Oslo University but now he is retired. Non represents "the legalization lobby" and their findings can not be considered to be politically motivated. Contrary to UNODC who is a political organization and has as it stated goal to suggest policies. That our queen and "drug minister" voted no to harm reduction in Vienna, together with the lot does not change that. Nor was that is a scientific vetting of the "harm reduction" ideas. If CEDRO and others find the link between forced treatment and low drug prevalence numbers to be bull, that is relevant. Regardless of what UNODC and other hawkish organization find with their selective data. I will delete it again. Provide peer-reviewed articles if you really what to make the point. Steinberger (talk) 08:13, 7 May 2010 (UTC)
- Minphie, we are changing your contributions to the article because we believe they are inappropriate or wrong. You are changing our contributions to the article because you believe they are inappropriate or wrong. This process is not vandalism if we make a reasonable attempt to discuss it on the talk page, as we are doing. Please assume good faith in us. Also, I think we should all read this, from WP:TE
- It is important to recognize that everybody has bias. Whether it is the systemic bias of demographics or a political opinion, few people will edit subjects in which they have no interest. Bias is not in and of itself a problem in editors, only in articles. Problems arise when editors see their own bias as neutral, and especially when they assume that any resistance to their edits is founded in bias towards an opposing point of view. The perception that “he who is not for me is against me” is contrary to Wikipedia’s assume good faith guideline: always allow for the possibility that you are indeed wrong, and remember that attributing motives to fellow editors is inconsiderate.
- I also think that we should bear in mind the considerations raised in WP:WEIGHT regarding the amount of criticism being raised here.
- Regarding your comment about the tagging of critic, I agree with your point, there are other articles where the word has not been tagged where it might need to be. I invite you to rectify this problem by tagging any instance where you see it occurring. You can't claim that I am being obstructionist by editing this page in accordance with the guidelines.
- Regarding the section about Sweden, I realise that I actually was looking in the 2009 WDR, not the 2000 edition. However, a simple typing of 'coerce' into the pdf search for that same document will not produce a single mention of the word. So, I support Steinbergerger's decision to remove the section as you haven't really addressed my earlier points.
- Minphie, we are changing your contributions to the article because we believe they are inappropriate or wrong. You are changing our contributions to the article because you believe they are inappropriate or wrong. This process is not vandalism if we make a reasonable attempt to discuss it on the talk page, as we are doing. Please assume good faith in us. Also, I think we should all read this, from WP:TE
--Figs Might Ply (talk) 14:37, 8 May 2010 (UTC)
Figs Might Ply, I am reverting your edits with small sections unreverted on the grounds that you are looking at the wrong UNODC document. Go to the one on Sweden Drug Policy previously cited above (easily found on the net) and type in 'coerce'. Re the bias question taking an evidenced point of view is not evidence of bias, but rather of dispassionate evidence being lodged on the page for one side of an argument. That is not bias, or else I would have to say that Rakkar and Steinberger are biased because they have not entered one criticism of harm reduction initiatives or policies in the many pages they have contributed to - I have reviewed all of them. Re critics, my comment was about pages on Wikipedia where the collective term 'critics' is used on any of the pages of Wikipedia, not drug policy pages. I could hardly do as you ask. But the point remains that they do not cite critics on those other pages simply because the criticism demonstrates that critics exist or there would be no criticism, if you understand. I take this point up further in the Talk page with Rakkar).
Steinberger, as I said, CEDRO has a history of demonstrated drug legalization activism. My comments stand. Also see my comments at Wikipedia:Wikiquette alerts Minphie (talk) 02:16, 14 May 2010 (UTC)
- Demonstrate that with sources thanks. Moreover, you misinterpret kingshealthpartners.org; they suggest that it is cost-effective as the alternative to the 15k£ of heroine maintenance is 44k£ of prison. Infact, what you are doing is called WP:Original research and that is forbidden according to policy. Steinberger (talk) 04:43, 14 May 2010 (UTC)
Steinberger, have a look at the publications of CEDRO outside of their epidemiological studies and it is abundantly clear that they are into the strongest advocacy against prohibition. If they are wanting to end prohibition they are ipso facto promoting drug legalization. Go to http://www.cedro-uva.org/lib/index.html. Minphie (talk) 12:19, 16 May 2010 (UTC)
Harm reduction and Sweden
Minphie seems to believe that Sweden have fared well without harm reduction, persistently citing it as an example of non-harm reduction success. However, that is a strange view for me that is a Swede as I know it is wrong. In fact, some harm reduction measures have indeed already been introduced to lower the embarrassingly high death rate among drug addicts, albeit under other names. [2] But that will soon change. According to the governments special investigator on abuse, the next SoU-report (that is to be published in December) will recommend the explicit introduction of harm reduction measures. Or as it is written in the discussion-PM [3]:
- "Missbruksutredningens kartläggningsarbete hittills indikerar att så kallade skadebegränsande åtgärder (harm reduction) av olika slag kan vara en underutnyttjad strategi i Sverige. Utredningen kommer närmare att analysera orsakerna till detta samt lämna förslag som innebär att insatser enligt denna strategi kan utnyttjas i större omfattning i hela landet."
- "The abuse investigations surveys have so far indicated that so called harm reducing measures (harm reduction) of different types is a underutilised strategy in Sweden. The survey will further analyse the reasons to this, and come with recommendations that will involve measures according this strategy that can be used to a larger extent in the whole country."
So, Sweden is not an good example of non-harm reduction. Steinberger (talk) 12:24, 14 May 2010 (UTC)
Steinberger, you might kindly point to where I have allegedly said that Sweden's success is due to having no harm reduction. I believe you will not find any such statement. My statement, which you continue to debate, is a very simple one which talks about the success of Sweden's restrictive drug policy (their own term) and the correlation between its implementation in the early 80's and the sharp decreases in drug use. You also need to know that it has always been freely acknowledged by organizations questioning the claims of harm reduction that Sweden has some level of harm reduction. I would prefer not to be spending time on straw men or inaccurate allegations which seem to be clutching at straws to keep an adequately demonstrated argument off the page. Minphie (talk) 12:31, 16 May 2010 (UTC)
- "...a drug free society where a policy of compulsory rehabilitation of drug addicts is integral, has yielded the lowest illicit drug use levels in the developed world" you wrote in the article at a place that made Sweden an alternative to "Heroin assisted treatment" or implicitly harm reduction in general. The SoU-investigator say specificity about cohesive treatment that it is ineffective, inconsistent and fails due process. He further say that it is unethical to commit people to a treatment that have a neutral if not bad outcome. He is recommending either scraping the special law on cohesive treatment of abusers (and an corresponding reworking of the standard law on involuntary commitment) or a major rewrite of that law. Steinberger (talk) 19:36, 17 May 2010 (UTC)
Steinberger, I have very clearly and unmistakably juxtaposed the costs of heroin maintenance versus the costs of a drug free ex-user on society and commented that critics of heroin maintenance support the indubitable and uncontestable fact that it is a far cheaper long-term strategy to get users clean, something which one country, Sweden, is committed to with its coerced rehab. This is not the place to discuss the ethics of coerced rehab - it is irrelevant. This is not the place to have a discussion as to whether Sweden has harm reduction or not - it is irrelevant to the costs of a rehabilitated drug user. The only relevant argument is whether my statement that Sweden's restrictive drug policy, which includes the relevant notion of coerced rehab, has been successful because of its restrictive drug policy (which may include some harm reduction but where the emphasis in harm reduction is still to get their users drug free). I have given the UNODC document as citation - UNODC documentation that drug legalizers won't accept, but neither do they accept the world's consensus against illicit drug use (called prohibition - ratified again in Vienna CND March 2009) either. So that was not a valid argument. Minphie (talk) 00:39, 18 May 2010 (UTC)
- Read WP:OR for god sake, I am not going to try to convince you about something that I don't have to. You can't "juxtapose" facts and make an argument, that is specificity breaching WP:SYN. There is nothing in the sources that you use that say that heroin maintenance is cost-ineffective. Then you can̈́'t make that argument. End of story. Steinberger (talk) 09:49, 18 May 2010 (UTC)
Steinberger, to the contrary, a contrast is not a synthesis in any shape, form, or book of logic. A juxtaposition is decidedly not a synthesis, quite the opposite. If I find that tomatoes at my local supermarket cost $30.00 per kilo but that I can get them for $2.00 a kilo elsewhere, my conclusion that the cheaper tomatoes are indeed cheaper are in the nature of a deduction, certainly not a synthesis. If you are hoping that Wikipedia should not allow straightforward deductions or contrasts to be made from two carefully cited and factually correct sources, then I suspect that Wikipedia could have no existence, because deductions are important to every work. You say you are a student in Sweden. I urge you to go and clarify these two terms of logic, 'synthesis' and 'deduction' with a professor of philosophy and then take your flag off the page. It is incorrect, and this is indubitably demonstrable. Minphie (talk) 22:40, 18 May 2010 (UTC)
- It is quite evident that you have not read WP:OR. Try again. Steinberger (talk) 08:50, 19 May 2010 (UTC)
Steinberger, having added additional citations to remove any doubt that you might have that these criticisms have actually been voiced by various organisations or individuals amongst the International Taskforce, I have also removed the Original Research tag you added to the British Heroin Trial statement. There is nothing that can possibly be construed as synthesis in this statement. The weekly costs of heroin and weekly costs of crime have been shown as per annum figures rather than the weekly figures published, but our calculations are not synthesis in any shape or form, rather a deduction which can only yield one conclusions (ie there are 52 weeks in a year and 52x300 equals roughly 15,000 pounds). I have placed the cited cost of the trial into the text because the reader will have no idea of costs unless I cite them. And facts are facts. I could, of course, go on to say that Strang says that there is a saving to the community from the 15,000 pounds shelled out yearly by the UK government, but any saving he cites does not change the fact that the community still spends 15,000+ per year per participant. The Taskforce organisation's alternative - an insistence on rehabilitation/treatment to abstinence - is very evidently the cheaper option because the cost of once-off rehab is followed by zero burden on the community year after year while the UK is spending its 15,000 pounds ad infinitum per person. Its logic is clear, and Strang's views (unlike his figures) are superfluous to the Taskforce argument.Minphie (talk) 03:06, 20 May 2010 (UTC)
- No, that is still a wp:synthesis and you can only make that argument if it is made explicitly in the source you cite. Neither can you imply that someone have cited Sweden's policies as an alternative to heroine maintenance if they explicitly have not. As you did now, bringing sources that make similar, yet not the same criticism, does not make it legitimate to indulge in it. I will now remove the original research once and for all. However, I will retain your new sources and further them. That is quite okay. Steinberger (talk) 09:14, 20 May 2010 (UTC)
Steinberger, I have added an additional citation of a critic of the UK Strang heroin trial to my existing citation list to remove your erroneous objection of synthesis. The citation from the Centre for Policy Studies does not reference MY words but HER words so therefore is not original research. The cited costs of the British heroin trial are not my words and are cited, so this is not original research. Neither is there any synthesis involved in citing the exact figures of the Strang trial, because there is no new proposition being added to the idea of 'expensive' to create a new synthesized conclusion. Rather the Strang citation is only adding detailed costs from a cited source which illustrate the proposition 'expensive'. Again, there is nothing remotely like synthesis because there is no new proposition.
Likewise, your concerns about critics juxtaposing the costs of maintenance with the non-ongoing costs of rehabilitated ex-users are simply based on another error in your thinking. There is no hint of synthesis if the critic I cited states concern about the costs of harm reduction, where he specifically mentions maintenance programs which don't try to cure the addiction, and where heroin maintenance is mentioned as a sub category of maintenance in his discussion. There is no requirement that this critic specifically mention the UK trial - his general criticism of the costs to society and government of maintenance hold true for the subcategory of heroin maintenance. Again there is no new proposition or synthesis involved. Go and read wp:synthesis again. Likewise, if critics mention Sweden as an example of a successful policy, this is a separate point to the others made and introduces no synthesis. It is a new criticism added which is relevant to the question of heroin maintenance, but only furthers the critics opinion on the more successful outcome of a rehabilitated user and a drug policy which seeks the same. No synthesis whatsoever. No new proposition. Just an extra facet of criticism.Minphie (talk) 01:10, 21 May 2010 (UTC)
- Sorry, I have read WP:NOR and it is quite clear on this issue and the folks at WP:NORN#harm reduction concur with my interpretation. And the new source you bring does not directly support your synthesis so it should go. Swedens drug policy is not mentioned as a counter-example to heroin prescription, as they explicitly must do, so it should also go. If you have problems with this, try consverapedia. They might have another standards for inclusion. Steinberger (talk) 08:08, 21 May 2010 (UTC)
Steinberger, I have reordered the sentences of the heroin prescription trial section such that it cannot possibly be construed as synthesis or as original research. This simple reordering demonstrates that even as ordered before there was absolutely no question of synthesis or original research. There is no original research because the British heroin trial is cited. There is no synthesis because the critics are only commenting on the facts of the trial, as is their right. I further have to take issue with the information you sent to the NOR forum, which failed to make mention of my critic citations which supported EVERY assertion. You did not tell them that, and this is seeking decisions on something where half the truth has been told.
So there are citations: 1.for who the critics are, including Taskforce member citations 2. showing that these critics are criticizing heroin trials and not something else 3. for the criticisms of harm reduction programs, including heroin prescription which is mentioned in the citation and which is a sub-category of the maintenance programs criticized 4. critics' support for the Swedish drug policy 5. UNODC's support of Swedish drug policy 6. UN figures showing lowest levels of use. No original research here. All cited as they were when you made your last deletions. If you want to link ECAD to pro-Swedish drug policy go to http://www.drugfree.org.au/fileadmin/Media/Global/WFAD_InfoLetter.pdf. It is quite explicit. Minphie (talk) 08:23, 23 May 2010 (UTC)
- Have you read what other editors said on WP:NORN#Harm reduction as I suggested on your talkpage? If not, they said that it was original research. Steinberger (talk) 14:13, 23 May 2010 (UTC)
Statement about Amundsen Study on Needle Exchange Questionable
Steinberger has disputed the statement about the Amundsen study (Needle and Syringe Programs section), saying that the methodology of this study has been criticized, citing a document in Swedish which cannot be checked by an English-speaking contributor.
His statement was:
- Although that study have been criticized for having a flawed methodology, for example it failed to recognize that both Norway and Sweden did have needle exchange programs for a large proportion of its intravenous drug users.[11]
I have taken the liberty of e-mailing Dr Kerstin Kall in Sweden. Dr. Kerstin Käll holds an MD and PhD as well as a Specialist in Psychiatry which she received in 1996. She has practiced as a clinical psychiatrist working with dependence issues and since 1998 has been in charge of drug rehabilitation at the Clinic for Dependency Disorders at the University Hospital in Linköping, Sweden. Her reply to my question on the cited study was:
Hello (Minphie)
I have missed that comment. The truth is as follows:
In Sweden, there are so far (2010) only two needle exchange services, both in the very South of Sweden (Malmö and Lund). We have injection drug users in all major cities of Sweden and none of these except those in Malmö and Lund do not have access to needle exchange services. In fact they can not buy needles and syringes in pharmacies either, since you need a prescription for that. It is now free for all communes to start needle exchange services and within short there will probably be one in Stockholm.
Best wishes
Kerstin Käll
With the reality that there is very little needle exchange in Sweden, (quite the contrary to what Steinberger appears to allege) and with the Amundsen study asserting that "in Sweden there was no legal access to drug injection equipment except for two NEPs in low HIV prevalence areas" (p 256) Steinberger's charge appears misguided. Perhaps this discussion can progress if Steinberger is able to translate the Swedish criticism of Amundsen into English, ensuring that the translation is correct, and then any issues can be checked against her study which I have filed. Minphie (talk) 07:44, 4 May 2010 (UTC)
- Hey Minphie, can you clarify? Quite literally, the email says that there are IDUs all over Sweden and that they all have access to NSPs except those in Malmö and Lund.
--Figs Might Ply (talk) 10:09, 4 May 2010 (UTC)
- Minphi wanted a translation of the source SPRUTBYTESFRÅGAN - En granskning av en forskningsgenomgång om effekter av sprutbytesprogram:
- "... Av de elva studier som anförs [av Käll et al] är det bara en som försöker att jämföra effekterna av sprutbytesprogram med andra interventioner. Det är en svagt underbyggd och metodologiskt mycket tveksam norsk undersökning av Ellen Amundsen et al. (2003) som försöker påvisa att hiv-test och information är bättre än sprutbytesprogram genom en jämförelse mellan Sverige, Norge och Danmark. Ingen av de andra undersökningarna har som ambition att jämföra sprutbytesprogram med alternativa interventioner."
- "Of the eleven studies cited [by Käll et al], the only one who tries to compare the effects of syringe exchange programs with other interventions. That is a weakly founded and methodologically doubtful Norwegian study by Ellen Amundsen et al. (2003) that tries to demonstrate that HIV testing and information is better than syringe exchange programs through a comparison between Sweden, Norway and Denmark. None of the other tests have the ambition to compare the syringe exchange program with alternative interventions."
- Fruther down:
- "Författarna anger följande slutsats:
- A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syring/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment (Amundsen et al., 2003, s256).
- "Författarna anger följande slutsats:
- Men jämförelsen haltar i högsta grad. I Norge finns både möjlighet att köpa sprutor på apotek och tillgång till sprutbytesprogram. I Sverige har omkring en sjundedel av landets injektionsmissbrukare tillgång till rena sprutor, hiv-information och testning via sprutbytesprogrammen i Malmö och Lund. Författarna väger inte in hiv-spridningen bland andra riskgrupper och hur dessa påverkar gruppen injektionsmissbrukare i respektive land. Inte heller tas hänsyn till skillnader mellan länderna avseende vårdsituationen, traditioner i samband med injicerandet, boendesituationen för injektionsmissbrukare – faktorer som i andra undersökningar visat sig ha stor betydelse för riskbeteenden. Det finns i författarnas material inte underlag för slutsatsen att hiv-information och testning skulle vara mer effektiv än sprutbytesprogram. Det är märkligt att studien är inkluderad i en genomgång som har den angivna ambitionen att enbart ta med högklassiga vetenskapliga studier som mäter effekter och har en kontrollgrupp (vilket inte är fallet här).
- "The authors indicate the following conclusion:
- A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syring/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment (Amundsen et al., 2003, s256).
- But it's a very lame comparison. In Norway there is the ability to buy syringes at pharmacies and [IDU have] access to needle exchange program. In Sweden, about one-seventh of the country's intravenous drug users access to clean syringes, HIV information and testing via syringe exchange programs in Malmo and Lund. The authors do not consider the HIV spread among other risk groups and their impact on group of injecting drug users in the respective country. Nor does it reflect the differences between countries in respect to the heathcare situation, traditions associated with injecting, living conditions for injecting drug users - factors that in other studies have proven to have significant effects on risk behaviors. The the authors' material does not support the conclusion that HIV information and testing would be more effective than syringe exchange programs. It is curious that the study is included in a review which has the stated ambition to bring only high-quality scientific studies measuring impact and have a control group (which is not the case here)."
Steinberger (talk) 10:47, 4 May 2010 (UTC)
Harm Reduction and Community Non-Approval of Illicit Drug Use
WhatamIdoing deleted text which is definitionally correct, questioning whether Harm Reduction has anything to do with people's acceptance or otherwise of illicit drug use. This is a clear misreading of what the sentence says, because it posits absolutely nothing about the community's acceptance or otherwise of harm reduction measures, which are quite a separate issue to their acceptance or otherwise of illicit drug use, which is what the evidenced statement addresses. Minphie (talk) 03:54, 18 May 2010 (UTC)
'No empirical evidence' of HR concern by critics
I have removed the statement that "There is no available empirical evidence to support this argument" - the argument being that HR may create perceptions that lead to increased drug use - on the grounds that there is empirical evidence that suggests that it can. Taking cannabis decriminalization as a harm reduction measure:
- In 1975 California introduced a law that classified minor marijuana offences as misdemeanors. A survey took place 11 months before and 10 months after. Following the change, in the 18-29 age group, the increase in marijuana use was 15 percentage points. Adult use of marijuana rose 7 percentage points. 3% began using marijuana as a direct result of the change. The proportion who described themselves as current users rose 5 percentage points. And this after 10 months. (See Cuskey Berger and Richardson (1978) Contemporary Drug Problems 7(4) 491-532). The US Household Surveys show an increase in marijuana use during these years, but far more moderate than the sharp increases experienced in California.
- Oregon changed its laws in 1973, with surveys of the use of marijuana at one and four years after the change. In the 18-29 age group, the increase was 12% immediately after the change. There was a rise of 6% in the overall population immediately after the change. In 1974 46% of 18-29 year olds stated that they had ever used drugs while in 1976 it had risen sharply to 62%. (See Cuskey Berger and Richardson (1978) Contemporary Drug Problems 7(4) 491-532 and also Maloff D. (1981) Contemporary Drug Problems 10(3) 307-322). These increases are further contrasted with the US National figures from the Household surveys which showed no appreciable increase during the years of these two studies.
The National Household Surveys in Australia conducted between 1988 and 1995 show that the ACT, with liberalisation in 1993, has had permanent and sharp increases, and SA, with liberalisation in 1987 also showed sharp increases in use. www.health.gov.au/pubhlth/publicat/document/mono31.pdf Added to this is the injecting room experience in Sydney, Australia where p 59 of the 2003 evaluation document, found at the Sydney MSIC website, suggested that the extremely high overdose numbers were due to more heroin being used in the room. Minphie (talk) 06:39, 18 May 2010 (UTC)
Unformatted contribution
I've deleted the following contribution by 98.174.205.214 (talk) as it is unformatted and not worked into the structure of the article. I dump it below so there is the possibility to salvage useful information or whatnot. Steinberger (talk) 16:32, 20 May 2010 (UTC)
Harm Reduction
Rehabilitation programs have, until now, predominantly used abstinence as their major goal for treatment. Even the laws in the U.S. regarding alcohol and drug use are characterized by prohibition and abstinence. Even though alcohol remains legal for those over the age of 21, there still exist ‘zero-tolerance’ mandates for underage drinking (MacMaster, 2004). Although prevention and rehabilitation has been the dominant policy for most of this century, there continues to be a significant rise in the number of people serving time for drug and alcohol related offenses (more than 1,000 percent between 1980 and 1997)(MacMaster, 2004). The critical thinker would be inclined to ask why this is so, it is evident that the way we are treating the problem of alcohol dependence is not working for the most part.
Harm reduction is increasingly used within substance abuse practices and was introduced in the 1980s with regards to lessening the spread of viral diseases, namely, HIV. Harm reduction was defined in 1993 at an International Conference on Reduction of Alcohol Related Harm by Ernst Buning. Buning stated, “If a person is not willing to give up his/her drug use we should assist them in reducing harm to himself or herself and others” (Cameron, 2003). Harm is identified as any detrimental alcohol-related consequences; examples of this could be blackouts, DUI’s, family conflict, health problems, etc. A common term associated with harm reduction is controlled drinking, which entails continued use of alcohol but under controlled circumstances and quantities. Harm reduction involves educating people about their drug use and teaching ways in which to reduce harm caused to themselves or others by their drug/alcohol use.
Harm reduction is a conceptual framework that provides for individuals willing to be engaged in services, but not immediately seeking abstinence. Practitioners using this perspective develop interventions that reduce drug/alcohol related harm without necessarily promoting abstinence as the only solution.
In 1992, Prochaska introduced a model for the process of change. The model of change involves different stages of which a person will go through when making any type of change in their life. The five stages of change are:
- Precontemplation; during this stage there is no intention to change. This is often due to a lack of awareness. A client may attend substance abuse services because of outside influences, however the individual resists recognizing that there is a problem.
- Contemplation; an awareness of the problem develops at this point of the process. The individual begins to consider that he/she may want to overcome the problem, but has not yet made the commitment to act.
- Preparation; this stage combines intention to make a change with behavioral modification plans, the individual has decided to act and makes plans to do so in the near future.
- Action; at this point in the process the individual incorporates actual changes in behavior and surroundings to overcome their problem.
- Maintenance; the behavior change enacted in the action phase is maintained and the individual works to prevent relapse (MacMaster, 2004).
An individual attempting to incorporate change in their life may sway from one phase to another in either direction as they progress or relapse through the stages of change. Rather than viewing these individuals as treatment failures or questioning the usefulness of substance abuse programs, it is of vital importance to provide services relevant to the individual’s needs. It is estimated that 85 to 90 percent of addicted people seeking the assistance of substance abuse programs are not yet in the action stage (Fromm & Orrick, 2004). Total abstinence, which is what many existing programs insist, occurs at the action phase of change.
Many counselors have dedicated their research to the field of rehabilitation. The main focus is to discover whether or not harm reduction has a validated position within drug and alcohol programs. Geubaly (2005) asks in his article whether or not attempts at moderate drinking by patients with alcohol dependency are a form of Russian roulette. Geubaly reports that it appears to be situational dependent. The level of dependency plays a large role in predicting the ability of a person to continue controlled drinking habits. Socioeconomic status, age, and gender also have an effect on the ability to continue controlled drinking. The more money someone has is typically indicative of the type of social network that is available to them, the stronger the social network, the more of a chance the person has to continue controlled drinking. Younger individuals were more able than older people to engage in controlled drinking as well as women in comparison to men. MacMaster (2004) has already identified harm reduction as a substantial form of therapy and explores ways in which to incorporate it into social work practice in his article entitled “Harm Reduction: A New Perspective on Substance Abuse Services”. MacMaster advises that it is important to meet the client where they are in the process of change and to carefully monitor their progress towards change. Cameron explores the importance of listening and meeting the client where they stand instead of forcing them to conform to constructs they may not be ready for (2003). The new “Alcohol Reduction Strategy for England” is discussed by John Foster as well as the reasons for implicating these strategies. England has discovered that attempts at abstinence regarding alcohol have been in vain and educating the general public regarding avenues of harm reduction has shown more promising results (2004). Neil McKeganey (2004) explores the perspectives of drug users and what they are personally looking for when they seek out treatment. McKeganey reports that many drug users are unaware of the services available to them and because of this they have the tendency to think that abstinence is the only road to change. He concludes that clients should be educated about the services available so that they can participate in the type of rehabilitation best suited for their individual needs. An interesting article written by Kim Fromm explores a new movement taken by colleges of using harm reduction when counseling college students. Fromm states that when a ‘just-say-no’ approach is not applicable to college students who have already made the choice to drink alcohol “a “harm reduction” or “risk reduction” approach holds much promise to successfully minimize the direct effects of heavy alcohol consumption” (2004). These articles are a great beginning to discovery of what the literary world is saying about harm reduction.
It is crucial that we decide what methods are useful in treating people who use drugs and alcohol because drug and alcohol use is one of the leading problems in our society. There are thousands of drug and alcohol related deaths each year and we have not succeeded in reducing these numbers (Geubaly, 2005).
References
- Cameron, D. (2003). Much, much more important than that. Addiction Research and Theory, 11, 367-369.
- Esterberg, K.G. (2001). Qualitative Methods in Social Research.: United States: McGraw-Hill.
- Foster, J. (2004). The alcohol harm reduction strategy for England: Introduction. Drugs: Education, Prevention, and Policy, 11, 349- 350.
- Fromm, K. (2004). The lifestyle management class: A harm reduction approach to college drinking. Addiction Research and Theory, 12, 335-351.
- Guebaly, N. (2005). Are attempts at moderate drinking by patients with alcohol dependency a form of Russian roulette? Can J Psychiatry, 50, 266-268.
- MacMaster. S.A. (2004). Harm reduction: A new perspective on substance abuse services. Social Work, 49, 356-363.
- McKeganey, N. (2004). What are drug user looking for when they contact drug services: Abstinence or harm reduction? Drugs: Education, Prevention, and Policy, 5, 423-435.
Tobacco, Sex and Self-mutilation
"Harm reduction" as a concept have for me always been something exclusively associated with illicit drugs. Sure, there is ways to reduce harm in other areas, but are they in the scoop of "harm reduction"? Non of the sources used speak seem to speak of harm reduction in that sense, so it might be OR. Steinberger (talk) 16:40, 20 May 2010 (UTC)
I will have to correct myself to drugs in general, including tobacco (EMCDDA talks of it in their monograph). But still sex (when it does not involve IDU prostitutes) and self-mutilation seems to be WP:OR. Input? Steinberger (talk) 11:43, 30 May 2010 (UTC)
Support for Safe Injecting Sites a Minority View World Wide
Steinberger, you are now insisting on a novel reason for deleting my text from the Harm Reduction page re SISs. Undue weight, you have averred, should not be given to a minority view, and it seems that you are wanting to delete this section on that basis. But SISs are most demonstrably the world's minority view in drug policy. (Go to the Safe Injection Site: Discussion for evidence on who has the majority). We of course can be sure that you are not deleting anything due to your erroneous assumptions of 'synthesis' or 'original research' because the reference listed after the first word 'Critics' list the Taskforce and other references, all published, which give these critiques. The text is now best left alone.Minphie (talk) 06:05, 23 May 2010 (UTC)
Steinberger, I am replacing the text on Safe Injecting Sites because the concerns expressed by Figs Might Ply on the Safe Injection Site Discussion page have clearly been demonstrated to:
- not engage the Drug Free Australia criticisms of SISs in any defensible way ie they don't even address the arguments in the Opposition section
- contain irrelevant arguments, as outlined in that Discussion, which address issues others than those discussed in the Opposition section
- be an appeal to extraneous positives for the MSIC which Figs Might Ply appears to think should negate any criticism whatsoever of the MSIC. See the full discussion again as to why this is indefensible in any forum, not the least Wikipedia
- based on cited evidence which is speculative and demonstrably in error
- have not engaged the citations re Vancouver's Insite, or European consumption rooms, despite these being summarily deleted for no given reason.
- be totally incorrect re Drug Free Australia publications (in what I am supposing is an assertion) that only peer-reviewed publications can be cited, rather than an organisation's publications (sent to every politician in Australia, used by Parliamentary inquiries etc) per se.
Given that this section on the harm reduction page references the work of critics of safe injection sites which cover Australia, Canada and Europe, there is no case for original research that can be made.Minphie (talk) 09:58, 24 May 2010 (UTC)
- Read WP:Citation; References are not supposed to include an assortment of sources in one reference. There is nothing wrong in having multiple references after one statement, one for each source.
- As pointed out in the header of this discussion page, this subject is within WP:MED. The standards of sources should be higher here then in more trivial subjects. See: WP:MEDRS So, propaganda papers from DFA should not be treated as equal to more reputable articles or reviews, although there is no policy forbidding their use.
- Don't selectively pick what you what to present from sources, and by so implying that reviews you cite are more critical then they are. For example, noting that the Canadian expert panel feel doubts about the validity of self-reported decreases in risk behavior, while omitting that they feel reluctance towards the mathematical models projection "only" one saved life as well.
- Note that what we are warring about was presented as evidence at WP:NORN and was deemed to fail WP:NOR. Don't put it back without addressing the issues. Steinberger (talk) 14:05, 24 May 2010 (UTC)
Steinberger, very happy to create separate citations and have changed these, however beyond that I see no need to yield to desperate obstructions.
- safe injecting sites are not medical facilities nor are they in any shape or form dealing with modern medicine. Heroin is specifically rejected for medical use by the International Conventions against illicit drug use. Heroin used in the rooms is not legalized as medicine either. So your quibble about this being a medical article is just more baseless obstructionism. You also need, in assessing the quality of the evidences for SISs, to remember that the Sydney MSIC evaluations are by and large not peer-reviewed.
- I have changed my description of the Canadian Expert Advisory Committee to include their own words.
- I am happy to accept your concern about caution re 'lives saved' mathematical modelling, and have modified the statement which will nevertheless remain because this is one of their conclusions.
- You are referencing my text here on Safe Injection Sites and there has been no such discussion on WP:NORN. This is another baseless obstruction.
- Go to SIS Discussion page for the credentials of the Drug Free Australia analysts who created our materials. They are authors of multiple peer-reviewed research articles or well-attested professionals. This negates any assertions you make about the lack of credibility for the Drug Free Australia publications.
- The formatting of citations is not a Wikipedia criteria for deleting slabs of text off the page. These are things I can do at my leisure if some other kind soul doesn't come and do it for me beforehand, as Wikipedia suggests they might.Minphie (talk) 07:10, 25 May 2010 (UTC)
- Stop writing in the references. They are exclusively for sources. Didn't you click on that link?
- See at the header in this discussion page: This article is assessed as mid-importance within WP:MED. It is within scoop of WP:MEDRS. Don't bundle sources of different quality together. Disclose when you are quoting problematic sources. Moreover, "Medically supervised injection centers" as it is called in Sidney are very mush medical/healthcare facilities. Further, any drug on the Single Convention on Narcotic Drugs can be used medically, including heroin.
- Do not falsely imply Insite experts review as if it would be negative. Do not imply anything that is not explicitly stated in the sources. That is WP:OR.
- It have been discussed at NORN, look at the diffs I provided there. (eg, this) Steinberger (talk) 08:01, 25 May 2010 (UTC)
- Steinberger, this article is not a pure medical article, infact it is not even 50 percent medical article in my view. It has significant, political, social as well as medical implications and involvement. WP:MEDRS, only applies for when talking about specific medical statements. Currently I feel the article does not reflect the controversies and criticisms of harm reduction fairly. Instead of mass deleting large additions of sourced content added by Minphie, based on "writing in the references", failure of attributing who the source is from etc etc, why don't you make those changes instead of mass deleting? I do agree that Miniphie's editing is not perfect but I also am concerned that you may not understand WP:NPOV and do not understand WP:OWNERSHIP of this article as well as the WP:TRUTH. Why is this article so biased in favour of harm reduction when there is extensive controversies throughout the world? Can anyone enlighten me? I do not know who is most or least to blame for this but the article is not balanced.--Literaturegeek | T@1k? 00:11, 30 May 2010 (UTC)
- On a further point, I am concerned to see an RfC has been filed and I have expressed additional concerns on that RfC.--Literaturegeek | T@1k? 00:12, 30 May 2010 (UTC)
- Steinberger, this article is not a pure medical article, infact it is not even 50 percent medical article in my view. It has significant, political, social as well as medical implications and involvement. WP:MEDRS, only applies for when talking about specific medical statements. Currently I feel the article does not reflect the controversies and criticisms of harm reduction fairly. Instead of mass deleting large additions of sourced content added by Minphie, based on "writing in the references", failure of attributing who the source is from etc etc, why don't you make those changes instead of mass deleting? I do agree that Miniphie's editing is not perfect but I also am concerned that you may not understand WP:NPOV and do not understand WP:OWNERSHIP of this article as well as the WP:TRUTH. Why is this article so biased in favour of harm reduction when there is extensive controversies throughout the world? Can anyone enlighten me? I do not know who is most or least to blame for this but the article is not balanced.--Literaturegeek | T@1k? 00:11, 30 May 2010 (UTC)
- Have you have looked at his actual edits and looked at his actual sources? Then you would have noticed that WP:RS in general was a question to. The discussed section was like: There are critics(four links) that point to evaluations.(going back to the four links, one link, a blog, does in fact mention some of the evaluations to come) The most evaluated...(no sources) The cost of those are...(source to support the figures, although in this context of "criticizers" they should also say that that is a high cost as that is what is implied) One life is saved there (link to a expert review, they openly doubt the models used witch is disclosed) less then a life are saved there (unattributed and from a partisan evaluation, they have no doubt in their models, although other have - witch is not disclosed) And so it goes.
- I can agree that there is a slight slant now, omitting the opposition that exists and their arguments. However, look at the history and you will find that it was even worse before the war started and way worse from a wiki-policy standpoint when Minphie have his way. Steinberger (talk) 08:49, 30 May 2010 (UTC)
- REAL Women of Canada seems to be notable enough for a criticisms section as it has its own wikipedia article and is a non-governmental organisation (NGO), although admittedly I am sure better quality sources could be found. Drug Free Australia document seemed comprehensive and from my brief look the organisation seems to be notable. This source, is a government source but was part of the revert, certainly a reliable source for a criticisms section. This source, is another reliable source but was also reverted. I have got about half way through reading the large revert of text you performed and much of it seemed to be fairly cited. For example, one source did say it costs $3,000,000 per year for their injection room and they also estimated that they save just one life per year. That is a huge amount of money and not statistically significant outcome, 1 life saved, a very valid criticism, why did you revert it? It was not WP:SYN or original research and Health Canada is not a partisan source as claimed. Almost all sources it can be argued are partisan, the idea of WP:NPOV is to report all of the notable viewpoints and allow the facts to speak for themselves. I could think of a lot of drug and alcohol services who could do immense benefit to society with 3 million dollars.--Literaturegeek | T@1k? 12:24, 30 May 2010 (UTC)
- You should not be mass reverting these content additions but rather if other views exist then add them for balance. If the content section gets too big then we can always split it off into a new article called harm reduction controversy.--Literaturegeek | T@1k? 12:32, 30 May 2010 (UTC)
- First, one fault above. This is the partisan source that requires attribution - Health Canada is fine with me and I have never said anything else.
- Second, I still argue that there was a synthesis. Such as when cost-inefficiency is implied by letting the "facts speak for themselves" by stating cost and lives saved - refresh your knowledge of WP:NOR if you doubt me. In fact, there are lots of other benefits that effect cost-effectiveness then saved lives that where omitted and both Sidney and Vancouver] seem to be cost-effective. In the latter case even according to the source he used for the cost figure. Steinberger (talk) 13:21, 30 May 2010 (UTC)
- If Health Canada is fine with you why did you revert it? Why did you revert Drug Free Australia then if all that was required was mentioning who the source was from (attribution)? That is not synthesis, it is reporting two facts side by side from the same source. It was not coming up with a "new conclusion" based on combining two sources which is what a synthesis is. It reported the facts as described in this source that the service cost 3 million dollars and saved an estimated 1 life per year. If other benefits were ommitted then you could have expanded on the source to add balance.--Literaturegeek | T@1k? 13:36, 30 May 2010 (UTC)
Safe Injection Site Evaluations
Steinberger
I am making some small changes to your text re evaluations of SISs simply because the two most rigorously evaluated sites did not reliably show a decrease in blood-borne diseases. The MSIC did not show any demonstrated positive effect and Insite's evaluators questioned the validity of the assumptions in the journal studies asserting any proven BBV success for Insite. I am happy to leave the bit about public disorder because it is generally true (but not always) for the Euro rooms, but is balanced by the evidence in my Critics section.
I have reverted the Critics section because there is no evidence of original research. Your quibbles about the credibility of Drug Free Australia's analysis have been well and truly answered on the SIS Discussion page. Given that credibility, I invite you to do your best to find arguments out in the public domain that have attempted to specifically fault the Drug Free Australia analysis which was done by researchers who are themselves peer-reviewed authors in dozens of other journals. You will need to identify cogent arguments against the DFA analysis, and then we can discuss their validity. But you cannot blank this section on false grounds that have been thoroughly refuted previously on the SIS Discussion page.Minphie (talk) 02:33, 27 May 2010 (UTC)
- WP:RSN#Drug Free Australia - DFA should be used with attribution. There is also speculation, such as when you are implying that the most evaluated centers are those in Australia and Canada. There is also blatant misrepresentation of sources, such when you say the Vancouver expert panel summarize the European picture as haven been mix when it comes to loitering and crime in the vicinity. Steinberger (talk) 13:52, 27 May 2010 (UTC)
- ^ Baxter, A. "Heroin and the road to self-respect". Retrieved 2010-01-09. The Guardian, Friday 18 September 2009
- ^ UNODC "World Drug Report 2009" (PDF). Retrieved 2010-01-09. 2009 pp 235-259
- ^ "Untreatable or Just Hard to Treat?". Retrieved 2010-04-20.2009
- ^ UNODC "World Drug Report 2000". Retrieved 2010-05-04. 2001 pp 162-165 (see aggregated average for each OECD country in Harm Reduction Discussion page)
- ^ Cohen, Peter (2006). Looking at the UN, smelling a rat. Amsterdam: CEDRO.
- ^ Christie, Nils (Mar 2004). A Suitable Amount of Crime. Routledge. ISBN 978-0-415-33611-6.
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- ^ Lenke, L. & Olsson, B. (1996) “Sweden: Zero tolerance wins the argument”, i Dorn, N., Jepson, J. & Savona, E. (red.) European drug policies and enforcement. London: McMillan.
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- ^ CAN CANs Rapportserie - Drogutvecklingen i Sverige 2009 (Diagram) page 25f
- ^ Antoniusson, E. et al SPRUTBYTESFRÅGAN En granskning av en forskningsgenomgång om effekter av sprutbytesprogram Socialhögskolan, Lunds Universitet