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