Pubdate: Wed, 08 Dec 2004 Source: Vancouver Courier (CN BC) Copyright: 2004 Vancouver Courier Contact: http://www.vancourier.com/ Details: http://www.mapinc.org/media/474 Author: Thomas Kerr, Mark Tyndall and Julio Montaner Referenced: http://www.mapinc.org/drugnews/v04/n1670/a03.html Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?142 (Safe Injecting Rooms) TOO EARLY TO DRAW CONCLUSIONS ABOUT INJECTION SITE To the editor: Is the Vancouver supervised injecting site (SIS) having a positive impact? ("Cop union boss questions injection site impact," Nov. 24). Let's consider the available evidence. In September, the Canadian Medical Association Journal published a study showing that the SIS had reduced public drug use and publicly discarded syringes. However, according to a recent Courier report there have been three more overdose deaths between January and September of this year than there were during the same period last year. So has the SIS failed to reduce overdoses? The answer is simply, "It is too soon to tell." The study of health outcomes is a complex business and requires careful consideration of the many factors that can influence health, and an overly simple comparison of two years' of overdose statistics is fraught with potential pitfalls. For example, years of scientific study have demonstrated that overdose rates are predicted by a multitude of factors, including the changing purity of street drugs. In light of this, consider a situation where a SIS was reducing fatal overdoses during a time when heroin purity was increasing, as is presently occurring in many places in North America. Under these circumstances, we might see an increase in overdoses despite the underlying benefit of SIS. Alternatively, in a situation where an SIS was ineffective at reducing overdoses, a reduction in street purity of drugs could give the mistaken impression that the SIS was helpful. Changes in drug use patterns can also affect overdose rates, which leads us to wonder if Courier writer Mike Howell investigated whether recent overdose deaths are in fact occurring among injection drug users (i.e. people who can use SIS)? Quick and simple analysis such as those recently offered in the Courier are problematic for many reasons, but more importantly have the potential to undermine public support for an intervention before it has been rigorously evaluated. Given that we are dealing with a problem that has taken the lives of literally thousands of British Columbians, such superficial analysis are highly inappropriate and potentially dangerous. Thomas Kerr, Mark Tyndall and Julio Montaner, British Columbia Centre for Excellence in HIV/AIDS - --- MAP posted-by: Terry Liittschwager