TimG Posted October 3, 2011 Report Share Posted October 3, 2011 you're the one who said the scientists who advocate insite are biased. i'm asking you to show me a research that you wouldn't call biased which shows that insite is not working.I am saying that I don't take claims of research at face value. It could be true. Might not. We don't know.what do you suggest should be done about insite? about the research?My doubt cuts both ways. Just because I say I don't trust the science that claims it works that also means I can say it does not work. So I guess it should keep going. My only misgivings are about emphasis placed on getting people into detox. If they are getting more people into detox then I would say insight is worth it. Quote Link to comment Share on other sites More sharing options...
waldo Posted October 3, 2011 Report Share Posted October 3, 2011 Does this help? http://bigblog.dukechronicle.com/backpages/supervised-injection-injecting-the-facts/ good find... I was attempting to extend upon the following to present actual studies following the described methodology; as your linked article highlights, as my following link identifies, a strict condition on operation (tied to the legal exemption) calls for rigorous evaluation of Insite: Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users The SIF was granted a legal exemption to operate on the condition that its impacts be rigorously evaluated. In order to ensure that the evaluation is appropriately open to scrutiny among the public health community, the present article was prepared to outline the methodology for evaluating the SIF and report on some preliminary observations . The evaluation is primarily structured around a prospective cohort of SIF users, that will examine risk behavior, blood-borne infection transmission, overdose, and health service use. These analyses will be augmented with process data from within the SIF, as well as survey's of local residents and qualitative interviews with users, staff, and key stakeholders, and standardised evaluations of public order changes. Preliminary observations suggest that the site has been successful in attracting IDUs into its programs and in turn helped to reduce public drug use. However, each of the indicators described above is the subject of a rigorous scientific evaluation that is attempting to quantify the overall impacts of the site and identify both benefits and potentially harmful consequences and it will take several years before the SIF's impacts can be appropriately examined. Quote Link to comment Share on other sites More sharing options...
capricorn Posted October 3, 2011 Report Share Posted October 3, 2011 If the provincial government is allowing them to continue, then yes, they are approving these sites. You miss my point. The decision says "provincial governments", leaving the reader to believe all provincial governments approve. Whereas I believe the Court wanted to say the provincial government (singular), i.e. BC. Quote Link to comment Share on other sites More sharing options...
waldo Posted October 3, 2011 Report Share Posted October 3, 2011 You miss my point. The decision says "provincial governments", leaving the reader to believe all provincial governments approve. Whereas I believe the Court wanted to say the provincial government (singular), i.e. BC. no - plurality does not imply 'all'... I thought you were quite bold in challenging the actual written decision of the SCC! Quote Link to comment Share on other sites More sharing options...
capricorn Posted October 3, 2011 Report Share Posted October 3, 2011 The only trouble is all of the studies are done by advocates for the harm reduction approach. Therefore you cannot expect them to be unbiased assessments of its success. Yeah, as in "Peer reviewed by our peers that agree with the need for Insite". Quote Link to comment Share on other sites More sharing options...
waldo Posted October 3, 2011 Report Share Posted October 3, 2011 Yeah, as in "Peer reviewed by our peers that agree with the need for Insite". don't hesitate to step forward and present those peer-review challenges to the success of Insite... or just sit back and perpetuate said (unfounded) bias. Quote Link to comment Share on other sites More sharing options...
segnosaur Posted October 3, 2011 Report Share Posted October 3, 2011 Does this help? http://bigblog.dukechronicle.com/backpages/supervised-injection-injecting-the-facts/ Not really... Ok, this is a blog run by some sort of student newspaper. (Not exactly a peer reviewed paper or major media outlet.) However, I'm going to give it the benefit of the doubt and assume its all correct. Lets see what it says about HIV: Researchers found that Insite users are 70 percent less likely to share syringes than injection drug users who do not utilize the facility. Notice however that it does not say they never share needles with others. So Insite users do sometimes share needles, and that can spread HIV. The problem is now they may spread it to people they meet at the Insite site (instead of just their original circle of friends.) A second article in the American Journal of Infectious Diseases examined the syringe sharing of users in the Downtown Eastside and did not find a single instance of used syringe lending of HIV-positive individuals who reported exclusive use of Insite. So? The problem may not be those who use Insite exclusively. The problem is those that use Insite sometimes, and then inject drugs outside of Insite later on. The journal, Addiction, compiled another study of SIFs in Spain and Insite in Vancouver and found that regular users of SIFs have a 69 percent less chance of sharing syringes, further supporting these results. Which of course is not the same as never sharing syringes. Hey, I'm willing to admit that the incidence of needle sharing does go down through both Insite and other needle exchange programs. I never claimed otherwise. The problem is what happens when they do share needles. Quote Link to comment Share on other sites More sharing options...
waldo Posted October 3, 2011 Report Share Posted October 3, 2011 Hey, I'm willing to admit that the incidence of needle sharing does go down through both Insite and other needle exchange programs. I never claimed otherwise. The problem is what happens when they do share needles. the "problem"?... which has what relevance and immediacy to the facility, proper? fyi: Insite Statistics - more than 1.8 million visits since opening in 2003 - currently more than 12,000 users registered at InSite 2010 user statistics - 312,214 visits to the site by 12,236 unique individuals - An average of 855 visits daily, up to a maximum of 1,110 visits daily - An average of 587 injections daily - 221 overdose interventions with no fatalities - 3,383 clinical treatment interventions - 26% of participants were women - 17% of participants identified as Aboriginal - Principle substances reported were heroin (36% of instances), cocaine (32%) and morphine (12%) - 5,268 referrals to other social and health services, the vast majority of them were for detox and addiction treatment - 458 admissions to OnSite detox In 2010 alone, Insite counsellors made more than 5,000 referrals to other social and health service agencies, the vast majority of which were for detox and addiction treatment. The calendar year 2010 also saw 458 admissions from Insite into Onsite, the adjoining detox treatment facility which recorded a program completion rate of 43 per cent in 2010. Quote Link to comment Share on other sites More sharing options...
TimG Posted October 3, 2011 Report Share Posted October 3, 2011 (edited) The calendar year 2010 also saw 458 admissions from Insite into Onsite, the adjoining detox treatment facility which recorded a program completion rate of 43 per cent in 2010.How many of those 458 were the same people being re-admitted? How many of the 43% stayed clean for 1 year? These are the numbers that matter. i.e. is Insight revolving door that simply enables addicts and allows them to continue their addiction or does it actually help people get clean? Edited October 3, 2011 by TimG Quote Link to comment Share on other sites More sharing options...
bud Posted October 3, 2011 Report Share Posted October 3, 2011 How many of those 458 were the same people being re-admitted? How many of the 43% stayed clean for 1 year? These are the numbers that matter. i.e. is Insight revolving door that simply enables addicts and allows them to continue their addiction or does it actually help people get clean? those are good questions. however, i should mention that whatever the answer is to those questions, it would be a lot higher than if insite was not around. Quote Link to comment Share on other sites More sharing options...
TimG Posted October 3, 2011 Report Share Posted October 3, 2011 (edited) those are good questions. however, i should mention that whatever the answer is to those questions, it would be a lot higher than if insite was not around.Based on what? Your gut feeling? They have had detox centers in DTES for decades and they are always full. Yet only a small percentage of the clients would stay clean for a year. I doubt that Onsight does much better - but if it did then that would be a strong argument in its favour. If it does worse then that would suggest that Insight is enabling addicts without helping them. Edited October 3, 2011 by TimG Quote Link to comment Share on other sites More sharing options...
waldo Posted October 3, 2011 Report Share Posted October 3, 2011 Based on what? Your gut feeling? They have had detox centers in DTES for decades and they are always full. Yet only a small percentage of the clients would stay clean for a year. I doubt that Onsight does much better - but if it did then that would be a strong argument in its favour. If it does worse then that would suggest that Insight is enabling addicts without helping them. my referencing the detox and referral stats was simply to highlight Insite is an avenue for both immediate and referred social and health service... that it's more than just saving lives related to injection (e.g., 221 overdose interventions with no fatalities in 2010). As for recidivism, as the saying goes, "relapse is a part of the recovery cycle"... Quote Link to comment Share on other sites More sharing options...
TimG Posted October 3, 2011 Report Share Posted October 3, 2011 (edited) that it's more than just saving lives related to injection (e.g., 221 overdose interventions with no fatalities in 2010). As for recidivism, as the saying goes, "relapse is a part of the recovery cycle"...The question I care about is whether the money spent on insight would be better spent on more detox and treatment beds. If we have a situation where addicts who experience a 'moment of clarity' have to wait several weeks to get into over booked treatment then we are missing opportunties to help because of the obession with harm reduction. Edited October 4, 2011 by TimG Quote Link to comment Share on other sites More sharing options...
cybercoma Posted October 4, 2011 Report Share Posted October 4, 2011 I know most of you like to sit around and split hairs all day, but can any of you describe a situation where a drug addict can use a drug without being first in possesion of a drug? Also, where did that drug come from, how did the drug user come to posess that drug? Their is a whole chain of illegality before the use of the drug, so if a place is helping drug users they are affecting the whol chain of illegality that they rely on, there will be other legal implications to this ruling. Again how can one use what one does not posses? Exemptions are made to the CDSA. Insite is one of those exemptions because the need to have access to medical treatment directly relates to a person's s. 7 rights under the Charter and that supercedes possession charges (according to the SCC). Quote Link to comment Share on other sites More sharing options...
cybercoma Posted October 4, 2011 Report Share Posted October 4, 2011 Sorry about joining this thread rather late. The thread seems to have rapidly grown; I skimmed through it, but didn't see anyone address a few issues that were brought up way on the first page... Hey look! Science! http://aje.oxfordjournals.org/content/146/12/994.abstract Risk elevations for HIV infection associated with Needle Exchange programs attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injection drug users. So, what that says that there is some evidence that, even though Needle Exchange programs are supposed to reduce HIV, they can have the opposite effect. (Basically what happens is that, while clean needles are provided, drug users don't always use the clean needles. However, the presence of the needle exchange is that it causes drug users who might never have met otherwise to interact, thus enabling the spread of HIV and HepC.) I do want to point out that this was a more general study... (i.e. it was not specifically examining the Insite situation.) And not all studies or exchange programs have the same result.) I also want to point out that yes, Insite might save some lives by preventing overdoses, etc. But its quite possible that the presence of Insite and other systems could increase the spread of HIV and HepC, and thus counteract the lives saved through overdose prevention. Except BC is the only province where the prevalence of HIV has actually dropped. This study actually is about BC and finds the exact opposite. Quote Link to comment Share on other sites More sharing options...
cybercoma Posted October 4, 2011 Report Share Posted October 4, 2011 That is an assumption. In narrow fields "peer review" is often "pal review" where the reviewers are collaborators with the authors on other papers.You have absolutely no idea how the academic peer review process works, do you? That question was rhetorical. Anyone here that has ever had anything published already knows the answer. Quote Link to comment Share on other sites More sharing options...
TimG Posted October 4, 2011 Report Share Posted October 4, 2011 (edited) You have absolutely no idea how the academic peer review process works, do you? That question was rhetorical. Anyone here that has ever had anything published already knows the answer.I know how it works and the flaws that are inherent in the system. People who claim that "peer review" is the gold standard for science don't have a clue how the system works. The gold standard for science comes from independently reproduceable results - not peer review. Edited October 4, 2011 by TimG Quote Link to comment Share on other sites More sharing options...
cybercoma Posted October 4, 2011 Report Share Posted October 4, 2011 I know how it works and the flaws that are inherent in the system. People who claim that "peer review" is the gold standard for science don't have a clue how the system works. The gold standard for science comes from independently reproduceable results - not peer review. It does, but you made the claim that peer review is "pal review". Pal review isn't even possible when the process is double-blind. Quote Link to comment Share on other sites More sharing options...
TimG Posted October 4, 2011 Report Share Posted October 4, 2011 (edited) It does, but you made the claim that peer review is "pal review". Pal review isn't even possible when the process is double-blind.The authors of the papers are NOT anonymous - only the reviewers are. In many cases, the author can request reviewers so the reviewers are known too. Peer review really does become "pal review" in fields where there are only a few qualified experts in the world. Edited October 4, 2011 by TimG Quote Link to comment Share on other sites More sharing options...
cybercoma Posted October 4, 2011 Report Share Posted October 4, 2011 Aside from your comment being completely false, since any reputable academic peer-review journal uses a double-blind system where the reviewers don't know who the author is and vice versa, do you actually think the study of HIV and drug-use only has "a few qualified experts"? Quote Link to comment Share on other sites More sharing options...
waldo Posted October 4, 2011 Report Share Posted October 4, 2011 In many cases, the author can request reviewers so the reviewers are known too. Peer review really does become "pal review" in fields where there are only a few qualified experts in the world. oh please! Do you ever have an original thought... "pal review"... the latest coined buzzword of the disaffected, disgruntled and petulant climate change denying blowhards. An authors proposed reviewers, if sought, are simply recommendations... subject to journal practice/editor selection within the greater whole. Simply stated, since deniers can't challenge the consensus with actual science, they perpetuate conspiracy themes riddled with, "pal review", "gate-keeping", "group think", blah, blah, blah... Quote Link to comment Share on other sites More sharing options...
olp1fan Posted October 4, 2011 Report Share Posted October 4, 2011 still nutz how people are against this when it has been proven to work Quote Link to comment Share on other sites More sharing options...
jacee Posted October 4, 2011 Report Share Posted October 4, 2011 I am saying that I don't take claims of research at face value. It could be true. Might not. We don't know. My doubt cuts both ways. Just because I say I don't trust the science that claims it works that also means I can say it does not work. So I guess it should keep going. My only misgivings are about emphasis placed on getting people into detox. If they are getting more people into detox then I would say insight is worth it. Yes they are, which you would know if you read the research links already posted instead of running off at the mouth about "bias". Now why would we trust anything you say? Quote Link to comment Share on other sites More sharing options...
jacee Posted October 4, 2011 Report Share Posted October 4, 2011 oh please! "pal review"... the latest coined buzzword of the disaffected, disgruntled and petulant climate change denying blowhards. Ahh yes, the anti-climate change, pro-oil blowhards ... but they're not biased! Quote Link to comment Share on other sites More sharing options...
jacee Posted October 4, 2011 Report Share Posted October 4, 2011 The authors of the papers are NOT anonymous - only the reviewers are. In many cases, the author can request reviewers so the reviewers are known too. Peer review really does become "pal review" in fields where there are only a few qualified experts in the world. Has no one ever explained to you that those "few experts" are usually in competition with each other and love to tear apart each other's work? Of course not. The people you listen to aren't researchers they're spin doctors. Whoever's paying them gets to hear what they're paying for, facts be damned. Quote Link to comment Share on other sites More sharing options...
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