Now is the time at SDA when we juxtapose!
Regina Leader Post, Feb.24 – Of the nearly 3.9 million needles distributed last fiscal year, about 3.5 million were returned for exchanges.
CBC, March 19 – New infections with HIV, the virus that causes AIDS, were detected in 174 people in Saskatchewan in 2008 […] a 40 per cent increase over the 124 new cases detected in 2007
Note: Saskatchewan’s population was estimated in 2008 at 1,020,847
More – “Multiperson use of syringes among injection drug users in a needle exchange program : A gene-based molecular epidemiologic analysis”
Syringe-sharing behaviors among injection drug users (IDUs) are typically based on self-reports and subject to socially desirable responding. We used 3 short tandem repeat (STR) genetic biomarkers to detect sharing in 2512 syringes exchanged by 315 IDUs in the Baltimore needle exchange program (NEP; 738 person-visits). Demographic characteristics as well as direct and indirect needle-sharing behaviors corresponding to the closest AIDS Link to Intravenous Experience (ALIVE) study visits were examined for association with multiperson use (MPU) of syringes. Overall, 56% of the syringes exchanged at the Baltimore NEP had evidence of MPU. Less MPU of syringes (48% vs. 71%; P < 0.0001) was seen with more rapid syringe turnaround (<3 days). IDUs always exchanging their own syringes ("primary" syringes) were less likely to return syringes with evidence of MPU (52%) than those who exchanged syringes for others ("secondary" syringes; 64%; P = 0.0001) and those exchanging primary and secondary syringes (58%; P = 0.004).
Via readers Loki and Langmann (check out their comments in this thread) including this;
Another phenomenon I witnessed in Vancouver was people deliberately infecting themselves with HIV in order to be able to collect welfare for life. If someone is able-bodied and collecting welfare, they are urged to get work. OTOH, if someone is HIV+ then they are assumed to be incapable of working (something my population of gainfully employed HIV+ patients would vehemently disagree with). Becoming HIV+ was a quick and dirty way of getting the welfare office off ones back and opening the door to all sorts of additional support.”
If you build it, they will come.
So, just how many needles a day are these Yoyos going through !?
10,685
…or 445 per hour.
One every 8.1 seconds. Which tells you nothing per se.
Doesn’t that also mean that there are 400,000 needles still unaccounted for? Most of them in parks and playgrounds just for good measure.
I heard an interview with a victim of AIDS. Her cousins have it, her brother has it and the 12,14 and 15 year old nieces she shot up with have it. She stated they could use 20 needles a day. She stated quite often they do not get diagnosed due to being treated like a junkie so they don’t seek out help.
Here’s a near jux: People’s opinion of Bernie Madoff vs Obama
http://video.nytimes.com/video/2009/03/23/opinion/1194838854667/bloggingheads-obama-s-ponzi-scheme.html
If there were 5,000 users of this “program”, and each used two needles per day, and kept 5 days worth before recycling them, that would account for the numbers above, and for one half of one percent of Sasketchewan’s population. About 0.017 percent of Saskatchewan’s population would have contracted the human imunodifficency virus last year. Few people in Canada die from HIV infections any more because the antivirals tend to work, and though they’re perhaps a bit pricey, they’re going generic fairly soon. Risk analysis, anyone, or would you rather just drink every proffered cup of bile in an attempt to ruin what’s left of your life?
Risk analysis Vitruvius? Applied to HIV? You NEOCON! You’re not allowed to do that! Its racist… or something!
Can’t we all just get along?! I’m gonna hit you with my purse, you racist b@st@rd!
I purse my lips in your general direction.
Other cities like Calgary and Winnipeg have started to promote crack instead of IV drug use.
The numbers in of HIV in these cities have gone down.
Why doesn’t sask health do the same.
Have those cities started to “promote crack”, or are you smokin’ it?
Interesting that the Leader Post states quite boldly that taxpayers are saving $4 million from having fewer HIV cases, but it doesn’t state anywhere how much the needle exchange program costs.
Not that this issue can be looked at from a $ perspective; it’s people’s lives after all (but I still disagree with the solution as it only perpetuates the root problem). But it’s disingenuous of the LP to talk about financial motives for the program and subsequently not mention its cost.
Lets just say as far as the savings go if the Feds paid their bills it would be good. The Prov. sent the Feds a bill for the health costs incurred by people under Fed. care. To the best of my knowledge it never got paid.
Vitruvius
http://www.health.gov.sk.ca/needle-exchange-review-report
Programs in Alberta and Manitoba offer drug users safer crack kits — equipment for smoking cocaine — because of the use of crack cocaine in those provinces. Saskatchewan does not currently offer such kits. Programs in other major prairie cities encourage needle return, but do not require one-to-one exchange.
Smoking equipment
Distribution of foil packs for heroin smoking can be successful in switching heroin users’ drug use behaviour away from injecting (Pizzey & Hunt, 2008). Some Canadian programs are now distributing safe crack smoking kits (Johnson et al., 2008; Leonard et al., 2008) as a means to encourage safer drug use.
Neighbouring provinces have already experienced a shift to crack cocaine, which is mostly smoked. Harm reduction programs in Winnipeg and Calgary are distributing smoking equipment to facilitate and encourage this trend.
always fun to point out the obvious. a disease that can be eliminated by changing behaviour and morals seems to beyond the understanding of todays society. how do ya spell stupid again?
*
ya figgur saskatchewan ready for my innovative
“motorcycles for drunk drivers” initiative?
hey, it’s harm reduction bub… would you rather
get run over by a 600 pound motorcycle or a
two ton suv?
sponsored by honda canada.
*
The lion’s share of those needles are given out in Regina, Saskatoon and Prince Albert – representing about half that population number.
The drug dealers send kids with pails full of empty needles, and they’re given pails full of new ones in exchange. That isn’t exaggeration – they physically bring them in with pails.
Then, they fill them with one-shot doses and sell them individually in drug dens.
Think how easy it is to recruit new customers when they can just walk in and get their first needle, already fully loaded, for about the price of a pack of cigarettes.
Now, there’s harm reduction in action!
You take away Bedlam, you get bedlam.
“Victim” of HIV, when she knowingly shared needles. I would call her an idiot, not a victim.
If you asked the physician proponents of needle exchange programs if they practiced evidence based medicine they’d answer yes, but there all of the evidence demonstrates that needle exchange programs increase HIV rates.
The persistence of needle exchange programs despite overwhelming evidence against their effectiveness is another example of the triumph of ideology over science.
Some years back, when I still had some iv drug using patients in my Vancouver practice, I did some research into why, despite having access to sterile syringes, were people still getting HepC and HIV. The answer turned out to be cocaine.
Heroin users shoot up a few times/day and aren’t in desperate need of another fix once they awaken from their heroin induced stupor. In an exclusive population of heroin users the needle exchange paradigm would probably hold.
The majority of Vancouver drug users in the east Hastings area use both cocaine and heroin and iv cocaine needs to be administered every 10-15 minutes. Cocaine’s duration of action when given iv are much shorter albeit significantly more intense than when snorted. Also iv cocaine is followed by what can be an extremely dysphoric crash which leads the users to grab any syringe lying around to shoot more cocaine. When people are crashing on coke they don’t care if the first syringe they grab has blood in it; all they’re focused on is how to most quickly deliver their highly craved drug into the nearest vein.
Trying to get people to switch to smoking free base cocaine rather than injecting it runs into unsurmountable economic difficulties. Injected cocaine results in almost 100% of the purchased drug being delivered to the addicts brain. Smoking free base cocaine is an inherently inefficient process with significant losses occurring from combustion of the cocaine, thermally induced isomerizations to non-active compounds and losses of the sublimed cocaine in its path through the atmosphere to the users lungs. Extraction of inhaled freebase cocaine is virtually complete once it enters the lungs and the CNS effects are identical to injected cocaine. I’d be surprised if one could do better than 75% efficiency in sublimating cocaine for inhalation and from my observations of people smoking cocaine I’d think 50% efficiency would be high.
The problem with most cocaine users is that they never have enough cocaine. The pattern I saw in Vancouver was for people to sit down with a pile of coke and shoot up either until they ran out of coke or become too psychotic to figure out how to use a syringe. It doesn’t take a genius to figure out that one can do a lot longer run on cocaine hydrochloride than on the same amount of freebase cocaine.
Another phenomenon I witnessed in Vancouver was people deliberately infecting themselves with HIV in order to be able to collect welfare for life. If someone is able-bodied and collecting welfare, they are urged to get work. OTOH, if someone is HIV+ then they are assumed to be incapable of working (something my population of gainfully employed HIV+ patients would vehemently disagree with). Becoming HIV+ was a quick and dirty way of getting the welfare office off ones back and opening the door to all sorts of additional support.
The solution is to stop needle exchange programs immediately and let iv drug users buy their syringes the same way that diabetics and other patients do. Also, welfare rules should be ammended so that HIV positivity is no longer a magic don’t work again for life diagnosis. Legalizing cocaine and heroin wouldn’t solve the problems of this miniscule group of drug users, but it would sure help to reduce the crime associated with their trying to obtain enough money to buy their drugs.
I am all for limiting risk to everyone else. I could care less that a junkie wants to shoot up or smoke crack. If risky behavior endangers other people then we should be looking for a way to reduce the risk for everyone else.
The idea of 500,000 needles floating around which could be infected by HIV is scary.
Not to mention that needles have turned up in areas that I go to and that my friends and family goes to.
If giving these guys a crack pipe slows down the spread of needles, then I am all for it.
I don’t want anyone I know getting HIV from a dirty needle in a school yard.
@ other idea:
The use of crack cocaine, even if they are only apparently smoking it, is strongly associated with Hepatitis C for a reason still unexplained. So its not really fixing the situation.
This issue makes me very very angry! Resisting urge to curse…
loki,
The Sask health report supports what you say.
The problem being that addicts shoot up about 20 times a day on binges. They don’t care where the needles come from.
However free crack kits and expensive needles should lead to more crack use and less injection use. This has happened in Winnipeg, Calgary and Edmonton.
It is all about costs.
Fixing the situation would be reducing the amount of people using any form of injectable drug.
While that is a noble goal. It doesn’t solve the problem in the near term.
I would rather have a junkie use a multi-use item like a pipe then a single use item like a needle, that can be easily discarded anywhere.
As I said before, I am more concerned about the injuries to the innocent people, then the harm that one causes to themself.
Posted by: loki at March 24, 2009 5:17 PM
Thanks for that tutorial. Very interesting, and explains why SK needle exchanges are giving away so many more needles, yet still has a skyrocketing infection rate.
I work in a hospital lab. Yes, we’ve noticed a huge increase in HIV and Hep C positive patients. It’s bad for everyone, and very expensive for healthcare.
Wendy
langman, I’ve also seen the data on smoking cocaine and HepC and don’t think much of it. I very much doubt that HepC contaminated cocaine would be infectious as high temperatures should kill the virus. Sharing of crack pipes might transmit HepC but HepC is not particularly infectious and is best transmitted through direct blood to blood transfer.
What I suspect this association demonstrates is that the subgroup of people who are likely to smoke cocaine are also more likely to engage in other risky activities which put them more at risk of Hepatitis C. I’m sure that the incidence of tattoos in this group is higher than in the non-cocaine smoking population. I would also expect that they were more likely to have injected drugs at some point in their life.
I’ve found people are a lot more ready to admit to snorting or smoking cocaine than they are to having injected it. IV drug use still carries a social stigma and it has taken me years with some of my HepC positive patients before they’ve admitted that yes, they did share needles when they were “young and stupid” despite my having asked them directly multiple times if they’d ever used iv drugs.
other idea: if cost of cocaine was no object, then free crack kits would cut down the transmission of HepC/HIV. However, the inherent inefficiences of drug sublimation vs drug injection will cause people to begin injecting drugs. The cost of syringes relative to cocaine is quite low and injection will be the preferred route of administration for those of limited financial means.
@ loki,
As an MD as well, I agree with you that sorting out the evidence for Needle Exchange Programs is difficult. Most of the reviews support it’s effectiveness, but my main concern with the majority of these papers is that they are based on surveys. I don’t trust surveys and I certainly don’t trust drug users to self report. One paper I found interesting examined using genetic samples, the number of different users of needles turned into Needle Exchanges. They found that 50% of the needles had multiple users. Even in Needle Exchange Programs, 50% of the needles are used by multiple people. That supports the hypothesis some folks have that needle exchanges simply slow length of time (perhaps insignificantly) until someone aquires HIV/Hep C.
@ the other idea:
The problem with the crack pipe evidence is that it is based on surveys of drug users. Having worked (as an MD) with those folks, I have to say I don’t trust them worth squat. Especially if I give them the idea that I am going to give them a free crack kit – something they may or may not sell. loki is correct, those guys love to shoot it if they can.
@ loki,
I just noticed your post in reply to mine. 100% agree, which is my point to “the other idea”, just didn’t go into as much detail.
The article on multiperson use of Needle Exchange syringes was in J. AIDS 2006.
hey I take the advice of 2 doctors over 1 engineer any day. Its not my field.
What would be the best way in your guys opinion to reduce the risk to non-drug users.
Seeing that needles still make to playgrounds and public washrooms.
As one who’s job involved being in the scummiest downtown areas of Vancouver late at night, I have a slightly different way of looking at solving the problem.
If someone is unable to take care of themselves; that is they are lying in a doorway and defecated themselves and cannot stop repeating the process, is it not the State’s responsibility to take care of them?
Then I propose a paddy wagon be used to round them up. They could be placed in a suitable facility to help them for as long as it took.
That would solve several problems in one swoop. The drug dealers would go out of business, The streets would be cleaned up, and the addicts would be cared for and the death rate would fall.
How about a little compassion?
langman, glad to see we agree on this issue. What I’ve found curious is that whenever I talk to my colleagues about the issue of needle exchange programs I get similar agreement that they are useless. Who are the doctors who support such programs?
other idea: the risk of contracting HIV and HepC from a discarded syringe is close to zero if it is old. HepB infection risk is still significant and I advise all my patients who might be exposed to discarded syringes in the course of their work to be vaccinated against HepB.
The risk of infection is highest in the case of syringe discarded a few minutes ago but is greatly reduced if the puncture occurs through a plastic barrier such as garbage bag or gloves. I’ve had one needlestick injury from an HIV+ patient with a high viral load which passed through 2 layers of plastic before entering my finger. Aside from 6 months of worrying while waiting for HIV test results there were no long term sequelae. I declined antiretrovirals because I figured that the plastic would have sealed the needle hole and also wiped any blood off the needle. The risk at that time was estimated to be ~1% seroconversion risk for a needlestick injury through gloves in a medical setting; I suspect it is lower since most needlestick injuries are unreported in hospitals.
For a needle that has lain around in a sandbox in the sun for months the primary risk is that of bacterial infection especially if cats have been using the sandbox as a latrine. The level of anxiety I see in patients who have had needlestick injury from a long discarded syringe is out of proportion to any potential risk and I’ve been guilty of prescribing a 2 week course of antiretrovirals a number of times when a benzodiazepine would have been the most medically appropriate treatment. The problem is people want me to assure them that the risk of infection is zero; the risk is so close to zero it might as well be zero but that isn’t good enough for a lot of people.
Gee, maybe the problem isn’t that they can’t get clean needles. Maybe, going out on a limb here, the problem is they’re addicted to really nasty destructive drugs? Which makes them do stupid things that normal people won’t do?
Dunno, just sayin’.
Kate,
The multiperson use study summary was really really confusing to me – and it ended with this statement:
“These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections.”
which seems to be the opposite conclusion to what people are assuming here. Am I completely off-base?
@ the other idea,
Once again I agree with loki. The risk of direct transmission with HIV needles is small according to the literature. It is much higher for Hep C (after immediate use) and even higher for Hep B. loki pretty much summed it up. I would also mention that the bore size of the needle itself may increase the risk. Most intravenous needles used for IV drug use have small bores and are therefore smaller risk.
I don’t think in reality there is a big issue from dirty syringes in the evironment. (that being said I do have one documented person who did aquire Hep C that way). Getting dirty needles “off the street” is simply a device politicos use to rouse a population that is generally annoyed by IV drug users.
The bigger issue is them spreading HIV/Hep in their own population, causing morbidity/mortality and costing us taxpayers money. Moreover them stealing to get funds to pay for their habit, violence etc.
I don’t know really how to stop it. A lot of people sucked into that are psychiatric patients who have been booted out of institutions by the whole de-institutionalization strategy of governments since Kennedy. There is some evidence methadone programs help prevent crime.
What I think loki and I do agree on is that both of us are very likely to be annoyed if the government decides to make us prescribe heroin, it looks like they are going that way in Europe.
@ loki,
I don’t know any of the MD’s pushing the whole thing either. Many MD’s I know are generally of the same opinion from experience, and as well flabergasted at times by the extent some IV users go through to manipulate the system.
I suspect the ones involved in that stuff are the usual busybodies that infect the political side of our profession as well as whatever dreamy-well-meaning-medical students they can find to help out with research.
Phantom
“”Which makes them do stupid things that normal people won’t do?””
right on, having known addicts in a social setting (one of my kids amongst them) they all say that their thought process differs when they are on drugs (not just when they are stoned, but also in between stones), and therefore do stupids things
How much does all this needle “exchange” stupidity cost ?
Maybe the money should go to real hospitals to be used on real sick people instead of repeat needle users.
The solution is to TAX the drugs; just as the gument taxes tobacco and liqueur. If the drugs were taxed then taxpayers could at least recoup some of their losses.
On the sad side, the loss of adult citizens is immeasurable. The dangers of a whiff of tobacco smoke is hysterically exaggerated, while the health police ignore the dangers of drugs. Even alcohol is much less dangerous to the people ingest it than pot is to the misguided souls who inject and smoke pot and drugs. Some people say pot is harmless but alcohol is destructive. I don’t ‘buy’ that because alcohol is water soluble, consequently it passes from the system in 24 hours; pot, however is fat soluble so it settles in a persons fat (most fat is around the brain and reproductive organs) for 7 years. Less harmful? Depends on what a person values, I guess!
Sorry Jema I have to disagree.
I will council my kids that alcohol is WAY MORE DESTRUCTIVE than pot.
I agree with most of what you write and I respect your views; but, you appear to be speaking from a position of ignorance wrt to the harm pot does vs. alcohol.JMO
@ Meeker:
Now you made me look up the study and read it again…
At the end when the authors of the study write “These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections” it is called “editorializing”. In other words they are making a giant leap of faith based on the results of their study. Or to put it another way “speaking the party line”.
Their study simply showed that needles from the Baltimore exchange program, 56% of them had multiple users. The only solid evidence one can derive from this study is that their needle exchange program is not very effective.
Conceivably, if everyone had an unlimited number of needles at their immediate reach they would never infect each other. However this doesn’t take into account multiple other factors like their reuse of filter material which comes into contact with dirty needles etc. It also doesn’t take into account something economists call “transaction costs”. In other words if I am doped up and I run out of needles (ie: the needle gets plugged) I have to wander down to the exchange place to get more or I can use my friend’s and not have to leave the shack. There is a cost even for a “free needle”, it is the cost of getting one’s self to the free needle dispensing area.
There is also an inherent cultural aspect of simply doping up together.
A truly effective study would examine the rate of multiple needle use in a program where the availability of free needles was ideal, such as in Vancouver. I suspect that we’d still see a high number of multiple users per needle.
The other interesting part of the study is that they excluded their needles which were exchanged by those folks who sell needles. These people obtain a large number of needles from the exchange programs and then sell them on the street, in essense they provide a service by lowering the transaction costs of a person having to leave their hole and wander down to the exchange place, or they, much like scalpers, are smart enough to obtain and control a large supply. Would you trust the cleanliness of a needle scalper? Therefore this is an inherent bias of the study and a major failure of the study as well. That alone invalidates the study, because they throw out a large number of needles which were likely used a multiple amount of times.
GYM, it sucks that you had to see that. My condolences, hope stuff is getting better there.
At any rate, common sense tells us that expecting “normal” behavior out of a drug addict is something only a liberal academic would do. A normal person would use a needle exchange program to keep from getting AIDS, because having AIDS would suck. Liberal academics think that way.
But an assumption like that is idiotic. Opiates, amphetamines, steroids, even alcohol, tobacco and lowly safe old marijuana create measurable changes in the body and the brain. Sometimes these changes are benign, sometimes they make you so completely non-functional you do stuff like let your children freeze in a snow storm. Or share needles with your unhealthy scumbag friends, even though they give the damn things away two doors down the street.
Hence langman’s irritation at the prospect of being required to prescribe heroine to junkies, because its “safer”.
Then there’s Kate’s “if you build it they will come” observation. They will come. Every time. Its like day following night.
Kathy Shaidle posted a book review the other day which got me thinking. After the pain stopped I wrote this post:
phantomsoapbox.blogspot.com/2009/03/are-people-stupid-or-are-they-not.html
Thing is, people are not stupid. Drug addiction is a rational response to a set of conditions, made by a person of normal intelligence for the most part. A pretty common response.
These people do not start out stupid. The drugs will MAKE the person stupid, which is for the most part what kills them in the end. They can’t function sufficiently to eat, so they get weak, then they get sick and die of pneumonia. Which may in fact be what they were after.
So the problem behavior is a rational solution to another, bigger problem. You think about it, being a junkie is actually not much of a problem for the junkie. Its a problem for the rest of us.
I don’t have an answer. Historically there hasn’t been a good answer. Most societies just shun them and let them die at their own speed. But I do know that these needle exchange/welfare/social services/free medical systems we’ve built are not just failing, they are making it worse and making us poor at the same time.
Maybe we can find a way to fail that’s cheaper and doesn’t actually get more kids hooked, eh?
Nobody has been more outspoken about the disastrous drug policies & programs in Vancouver than David Berner. But he has come up against the brick wall of officialdom.
Nobody has been more outspoken about the disastrous drug policies & programs in Vancouver than David Berner: http://thebernermonologues.blogspot.com/search?q=addiction“
But he has come up against the brick wall of officialdom.
Amazing how the liberal mind works! Let’s have free medical care for everyone (lay abouts and junkies included) and then when the lay abouts and junkies start to cost beaucoup dollars in medical care lets make their lifestyle cheaper by subsidizing it under the banner “harm reduction”. I have a better idea. Let’s be judgmental and tell junkies we will not pick up their medical tab because they are scuz ball junkies.
The statistics are hard to sort out because sharing needles is not the only way to acquire HIV. Many users also prostitute themselves to purchase the injectble drug of choice.
Stating ppl are getting HIV on purpose is absurd in my view. Street ppl are at a much greater risk of acquiring HIV than other groups due to lifestyle and to say they are contracting it on purpose is a real stretch.
If this hypothosis does have a grain of truth, I suspect the numbers of people eargerly seeking HIV to be miniscule and it goes to show these same ppl obviously have a mental illness if that is what they are doing. So in effect, the getting HIV on purpose would be co-occuring/comorbid disease due to a pre-existing mental illness.
Anyway – the goal is to legalize all substances-like Amsterdan so it can be heavily taxed along with the the addiction industry that will inevitabily result. Canada is so progressive.
I had a young apprentice who is diabetic , he has to supply his own needles. Is there something wrong with this picture???
No. It is the Modern Liberals’ way – reward those that invite failure and punish those that act responsibly.
There can be no discrimination – none what so ever.
We cannot punish someone just because they are stupid, irresponsible, lazy, freeloaders.
PET enshrined this decades ago. Now smarten up, go to work and pay your taxes.
Pot should be legalized and taxed to high heaven, just like booze and smokes, as long as ALL the money went towards health care, addiction counselling and support.
From my experience, I would rather hire a pot smoker than a heavy drinker. Pot smokers are well rested in the mornings while alckeys are miserable and don’t come around till noon.
Lots of decent folks are closet smokers.