Canadian Political Events

Beyond Ottawa => Provincial and Local Politics => Topic started by: MH on August 14, 2018, 07:04:33 am

Title: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 14, 2018, 07:04:33 am
I believe and trust in officials who tell me that safe injection sites are a good idea.  But I'm one of the liberal elite.  In fact, my unthinking trust is what proves I am one of those people the populists mistrust so much.  As such, I don't trust my own subjectivity so I try to be media literate and look a little more closely at what is being said.

The Ontario government has now said they will be shutting down safe injection sites:

https://www.cbc.ca/news/canada/toronto/ontario-safe-injection-sites-limbo-1.4760002
Quote
"Health Minister Christine Elliott said Tuesday the government is reviewing evidence on the sites to see if they "have merit" and are worth continuing."

""We need to take a look at the evidence and understand what the experts are saying, so I want to hear that. The premier wants to hear that. He wants to know that continuing with the sites is going to be of benefit to the people of Ontario," she said."

""We're going to be looking at all of the sites, and we're going to be making a decision based on the evidence relating to the individual sites as well as the situation overall," she said."

"During the spring election campaign, Premier Doug Ford said he was opposed to safe injection and overdose prevention sites, though his party says Ford has since committed to reviewing evidence on the issue."

"There is overwhelming evidence from experts and from other jurisdictions around the world that supervised consumption sites save lives and help people dealing with addiction connect with other types of support when they are ready, he said."


FIVE mentions of evidence, but the CBC deigns to not give us the specific evidence being discussed because "the" public doesn't need to know that. (?)

How are we supposed to make decisions ourselves without the data ?  Can we blame the rise of populists when media refuses to educate ?

Let's check around some more:

https://globalnews.ca/news/4384804/ontario-overdose-prevention-sites/

Quote
"Elliott said she believes there is “contrary evidence” that suggests the sites are not as effective as believed."

"NDP Leader Andrea Horwath said the Tory government is ignoring evidence that suggests the sites save lives while it tries to please supporters.

“Look, it’s not an easy thing,” she said. “But to suggest that somehow the evidence isn’t there is wrong.”"

“We’re going to look and see what the best course of action is,” said James Hutt, an organizer with Overdose Prevention Ottawa. “We’re going to be … telling (the government) to listen to science and evidence and to not deny health service.”


Again five mentions of 'evidence'.  One slight improvement Global News has over the CBC is that they give general statistics on overdoses, ie. "Statistics Canada data shows that in the first six months of 2017, there were 1,460 opioid-related deaths in the country and that count is expected to rise as data becomes available."

City TV doesn't do much better, although I browsed it quickly: https://toronto.citynews.ca/2018/08/13/ontario-pauses-opening-three-overdose-prevention-sites-conducts-review/

Only The Star (!) puts something on paper we can look at objectively:

https://www.thestar.com/opinion/editorials/2018/08/13/fords-government-starts-its-misguided-moves-against-safe-injection-sites.html

Staff at The Works, a supervised injection site operated by Toronto Public Health, for example, have reversed 213 overdoses since it opened a year ago. And in just nine months staff at a temporary facility in Toronto’s Moss Park reversed more than 200.

Now, I know people are going to take this thread and talk about the content of the issue and that's fine.  But please, if you can, make a separate post about our shitty information ecology and how our political media have lapsed into idiocy.  It's almost like the journalists' biases make them think it's unnecessary to explain WHY safe injection sites are effective, because they themselves believe it.  It's a different take on liberal media bias but it seems apt to me.

Thoughts ?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 07:30:28 am
It's almost like the journalists' biases make them think it's unnecessary to explain WHY safe injection sites are effective, because they themselves believe it.  It's a different take on liberal media bias but it seems apt to me.
Good observation. The problem with scientific evidence is not all evidence is equal yet the media seems to treat it as the same. i.e. the evidence supporting the theory a gravity is much better than the evidence supporting the tobacco cancer link which, in turn, is much better than the evidence that says alcohol is good for you in small quantities. The hierarchy of evidence is exacerbated by the self selection problem in science: only scientists that choose to dedicate their careers to a topic choose to research it which makes it very unlikely that they will discover anything that renders their chosen field less important.

When it comes to injection sites I believe almost all of the studies are being done by people who wish to see the government spend money on harm reduction research which means they set up their studies in a way to make injections sites look as good as possible by emphasizing the positive while minimizing the negative. So it comes as no surprise that the "evidence" says they work. Whether they actually work or the evidence is a simply a reflection of the biases of the researchers is open question. A lot depends on who gets to set to criteria that are being used to judge if they are effective. For example, the only criteria I think are important are the number of addicts who get clean as a result of their interactions with professionals at these clinics. If addicts are not getting clean then the clinics are a failure that may be prolonging addictions by enabling addicts.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 08:49:09 am
When it comes to injection sites I believe almost all of the studies are being done by people who wish to see the government spend money on harm reduction research which means they set up their studies in a way to make injections sites look as good as possible by emphasizing the positive while minimizing the negative.
This is total bullshit. You're claiming people are fabricating results without any evidence whatsoever of that happening.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: kimmy on August 14, 2018, 08:49:43 am
Quote
FIVE mentions of evidence,

Premier Dug wants to review the evidence before closing SIS's.  Christine Elliot says she's reviewing evidence. Andrea Horvath says the evidence shows they work.  Expert-guy from an advocacy group says there's overwhelming evidence they work.

The article is about whether the Ontario PCs close safe injection sites, not whether SIS's actually work.  Hence a bunch of politicians referring to evidence.  Some politicians say they are basing their decision on closing SIS's on what they find when they look at "the evidence".  Other politicians are claiming that "the evidence" shows closing SIS's would be a bad decision.  I think those politicians might have more success in making their case making a specific claim like "it's been proven that SIS's save lives" or "it's been proven that SIS's safe money in the long term."  Referring to "the evidence" to support your claim without actually saying what it is just sounds like an appeal to authority type argument... citing the view of unspecified "experts" is the kind of thing that rubs voters the wrong way.

Claiming that SIS's "work" is not a compelling argument if you don't even define what "working" actually means in this context.  Specific claims to demonstrate what good SIS's have been demonstrated to do in other communities would be helpful in convincing voters they are valuable.

"Working" in this context could have numerous meanings.  It could mean:
 -saving lives
 -saving money
 -getting people into treatment programs to get off drugs

Providing specific reasons why safe injection sites are good is a lot more persuasive than telling people that anonymous experts think they're good.  If you're inclined to think that SIS's are just a comfortable spot for deadbeats to get high, then maybe you're not inclined to care whether they "work" or not.  If you tell people specific things that will be achieved, they're more likely to support your position.

 -k
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 08:54:51 am
Specific claims to demonstrate what good SIS's have been demonstrated to do in other communities would be helpful in convincing voters they are valuable.

Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 08:57:58 am
Who's responsible for digging deeper into it? You've got a 5 min segment on the news. Interviewees get 15-30 seconds at best to answer each question. If you want details on the effectiveness of safe injection sites, you need to take responsibility for your own edification and look up the studies and data. These sites have been talked about for ages and there is tons of information on them. Hell, Ontario didn't even set them up until they were proven effective in British Columbia and there's mountains of data from those sites. I'm sorry, but I have no patience for people who willingly remain ignorant and complain that they're not being spoon-fed information that's readily available.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 08:59:52 am
Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.
They're liars. It's not either or. We have the data and have seen the results.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: kimmy on August 14, 2018, 09:03:09 am
Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.

It doesn't even matter.  If Horvath only has time for a 5 second sound bite, she should say "Safe injection sites save money and lives" instead of "the evidence shows safe injection sites work".

 -k
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 09:36:58 am
This is total bullshit. You're claiming people are fabricating results without any evidence whatsoever of that happening.
Yawn. Yet another complete misrepresentation of what I said which you insist on doing because being dishonest is easier than acknowledging the limitations and biases inherent inherent in the research process that exists today.

A little hint: scientists are human and all humans are biased therefore all scientists are biased. Get over yourself and try to understand how the real world works.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 09:57:55 am
Yawn. Yet another complete misrepresentation of what I said which you insist on doing because being dishonest is easier than acknowledging the limitations and biases inherent inherent in the research process that exists today.

A little hint: scientists are human and all humans are biased therefore all scientists are biased. Get over yourself and try to understand how the real world works.
Thanks for your utterly useless hint. Here's what you need to do. If you're going to suggest that studies are biased at best and imply that they're outright fabricated, then you need to provide evidence of such a thing happening. Otherwise, your claim is bullshit.

Your assumption is predicated on the notion that everyone is biased, so we can't really know anything. It calls on us to abandon all research and just rely on our own opinions and biases to draw conclusions.

Now if you have actual concrete evidence that supports your claim that all of the data and results on the effectiveness of SIS is garbage, then provide it. Otherwise, you're just spreading bullshit partisan propaganda with not a single shred of support.

Prove your claim.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 10:34:32 am
Your assumption is predicated on the notion that everyone is biased, so we can't really know anything. It calls on us to abandon all research and just rely on our own opinions and biases to draw conclusions.
Spare us the melodrama. All humans are biased and interpret evidence in ways that maximize the personal benefit and minimize the personal harm. This is self evident fact that should be obvious anyone paying attention. That does not mean that we 'can't know anything'. It means any discussion of "evidence" must also include a discussion of biases of the people collecting the evidence.

I also gave a concrete example of how bias affects SIS research. Specifically, if the SIS do not increase the rate at which addicts get off drugs then they are failure. Yet most of the headlines are about how "lives are saved" by preventing overdoses. If all they do is prolong addictions by reducing the incentive to clean up then SIS would be very bad for society even if a few lives are saved. Different researchers could come up with very different conclusions by simply choose with  "evidence" to emphasize. There is no need to fabricate any evidence.

The reality is you know this, however,  you simply assume that scientists saying things which you disagree with biased and those that you agree with are paragons of objectivity. It is hypocritical nonsense. Researchers telling you what you want to hear are just as biased and those saying things you don't want to hear.



Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 11:22:56 am
I don't think you understand what constitutes evidence and proof for your claim. You are saying that the studies which show SIS are effective are based on the biased judgments of the researchers. You have not: 1) clearly demonstrated that bias, 2) after establishing bias shown that it affected research outcomes, nor 3) provided any evidence whatsoever to the contrary, namely that SIS are ineffective.

All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.

You want people to buy into the idea that everyone is biased, therefore all results must be biased. Suffice it to say, that's a ludicrous position and it's based entirely on partisan bullshit.

If you want to have an actual discussion, then you need to do what I outlined above. You need to first demonstrate bias. Then you need to prove that the bias resulted in an alternative outcome from what would be expected were there no bias. Finally, you need to produce evidence that the alternative outcome is valid, unbiased, and demonstrates that SIS are ineffective. You've done none of that and have instead asked people to accept your wild ass claims about "faulty" science without actually having any evidence whatsoever to support such stupidity. What you are offering isn't evidence nor reason, but rather mush-brained propaganda.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: SirJohn on August 14, 2018, 11:42:23 am
Claiming that SIS's "work" is not a compelling argument if you don't even define what "working" actually means in this context.

It's even less compelling when we've seen ample evidence of bias in reporting, and when most of the data on safe injection sites comes from activists and supporters of safe injection sites. I believe they probably do have a positive impact, at least for that tiny minority of injection users who actually go there (and it IS a tiny minority), but I'd prefer seeing a completely independent study with its own data by people who had no feelings one way or the other to validate that.


Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 12:02:49 pm
I don't think you understand what constitutes evidence and proof for your claim. You are saying that the studies which show SIS are effective are based on the biased judgments of the researchers. You have not: 1) clearly demonstrated that bias, 2) after establishing bias shown that it affected research outcomes, nor 3) provided any evidence whatsoever to the contrary, namely that SIS are ineffective.

All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.

You want people to buy into the idea that everyone is biased, therefore all results must be biased. Suffice it to say, that's a ludicrous position and it's based entirely on partisan bullshit.

If you want to have an actual discussion, then you need to do what I outlined above. You need to first demonstrate bias. Then you need to prove that the bias resulted in an alternative outcome from what would be expected were there no bias. Finally, you need to produce evidence that the alternative outcome is valid, unbiased, and demonstrates that SIS are ineffective. You've done none of that and have instead asked people to accept your wild ass claims about "faulty" science without actually having any evidence whatsoever to support such stupidity. What you are offering isn't evidence nor reason, but rather mush-brained propaganda.

Here is some evidence which doesn't seem terribly biased to me about the SIS effectiveness in Vancouver.
One thing it does point out is that 70% of users of that SIS live within half a km. I guess hard core drug users don't like to travel. Maybe they need more sites.


Best evidence from cohort and modeling studies suggests that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections. Effects on hospitalizations are unknown.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 12:59:46 pm
All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.
You seem to be completely missing the point. I will repeat what I have said above: the bias comes from the criteria chosen to define "effective". i.e. just because you decide that that reducing the number of drug overdoes deaths means the SIS is "effective" that does not compel me to to agree that your criteria are reasonable. As I also stated above: to be effective the SIS would have to increase the rate at which addicts get clean and there is little evidence of that.

So there no onus on me to prove anything. I simply do not agree with the criteria that you want to use. The onus is on you to provide an argument for why your criteria are more appropriate that mine. i.e. please explain why keeping addicts alive but addicted is defined as success when what these addicts really need is to get off drugs. How many resources are been taken away from detox centers and recovery homes because governments are obsessing about enabling drug addictions by reducing the incentive to clean up?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 01:05:15 pm
You seem to be completely missing the point. I will repeat what I have said above: the bias comes from the criteria chosen to define "effective". i.e. just because you decide that that reducing the number of drug overdoes deaths means the SIS is "effective" that does not compel me to to agree that your criteria are reasonable. As I also stated above: to be effective the SIS would have to increase the rate at which addicts get clean and there is little evidence of that.

So there no onus on me to prove anything. I simply do not agree with the criteria that you want to use. The onus is on you to provide an argument for why your criteria are more appropriate that mine. i.e. please explain why keeping addicts alive but addicted is defined as success when what these addicts really need is to get off drugs. How many resources are been taken away from detox centers and recovery homes because governments are obsessing about enabling drug addictions by reducing the incentive to clean up?

So the effect of saving lives is not a worthwhile effect in your mind. Sheesh!
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 01:15:22 pm
just because you decide that that reducing the number of drug overdoes deaths means the SIS is "effective" that does not compel me to to agree that your criteria are reasonable. As I also stated above: to be effective the SIS would have to increase the rate at which addicts get clean and there is little evidence of that.

Come clean or die?

You are saying that addicts do not deserve to live. Yes, overcoming their addiction is the ultimate goal but sometime we have to settle for something less than best. Yes the statistics on them coming clean are good to know, but they are only one part of how effective the clinics are.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 01:20:14 pm
So the effect of saving lives is not a worthwhile effect in your mind. Sheesh!
Saving a few lives while prolonging the duration of addiction for many more is hardly a net benefit for society. We need to help addicts get clean. That has to be the primary objective of any intervention.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 01:28:00 pm
Yes, overcoming their addiction is the ultimate goal but sometime we have to settle for something less than best.
But what if the clinics makes things worse by enabling addictions? The first thing any relative of an addict is taught that they must not enable the addiction because enabling the addiction prolongs the addiction. Why would SIS be any different? Everyone wants to jump on the "lives saved" statistic because it is easy to measure and makes great headlines, however, it is a smoke screen. To make progress we must save lives by getting people clean.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 01:32:07 pm
But what if the clinics makes things worse by enabling addictions? The first thing any relative of an addict is taught that they must not enable the addiction because enabling the addiction prolongs the addiction. Why would SIS be any different? Everyone wants to jump on the "lives saved" statistic because it is easy to measure and makes great headlines, however, it is a smoke screen. To make progress we must save lives by getting people clean.

Now your "logic" seems to suggest people go to a SIS to become addicted. Here's a hint: they go there because they are already addicted. And they don't just get supervision that helps keep them alive, they also have access to counseling to help them to beat their addiction. Your silly notion would simply cause more people to die.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: wilber on August 14, 2018, 01:40:13 pm
It seems logical that they would prevent many OD deaths but their proponents should be able to provide some statistical evidence anyway.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 01:44:26 pm
It seems logical that they would prevent many OD deaths but their proponents should be able to provide some statistical evidence anyway.

I posted a link a while ago that shows that type of evidence from a YVR SIS.

And it was not only OD deaths prevented but also various infections including HIV from dirty needles.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 01:58:52 pm
Here's a hint: they go there because they are already addicted. And they don't just get supervision that helps keep them alive, they also have access to counseling to help them to beat their addiction.
And how effective is this counselling? What percentage of addicts go into detox after a referral by the SIS? How does this compare to communities with outreach programs but no SIS? Is there evidence that addicts are less likely to enter detox if a SIS is available? These are all very reasonable questions but are ignored because people want to jump on the "lives saved" bandwagon and don't really care about the complicated, expensive and harder to measure question of recovery.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 02:08:39 pm
Is there evidence that addicts are less likely to enter detox if a SIS is available?

There is clear evidence that detox clinics are not available due to budget constraints. Socioeconomic forces are a huge enabler of addiction, many thousand times more than SIS.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 02:12:04 pm
And how effective is this counselling? What percentage of addicts go into detox after a referral by the SIS? How does this compare to communities with outreach programs but no SIS? Is there evidence that addicts are less likely to enter detox if a SIS is available? These are all very reasonable questions but are ignored because people want to jump on the "lives saved" bandwagon and don't really care about the complicated, expensive and harder to measure question of recovery.
And why do you keep demeaning the saving of lives as some sort of "bandwagon"? You're talking about lives FFS!

People who go to a SIS are offered counseling and ways to enter detox.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: SirJohn on August 14, 2018, 03:12:10 pm
I posted a link a while ago that shows that type of evidence from a YVR SIS.

To determine if it was unbiased you'd need to know something about the two doctors doing it and what evidence they used and where they got it from.
I don't readily find out anything about one of them, but the other is listed as Medical Director of the Portland Hotel Society, which is an advocacy group for 'marginalized' people in the lower east side which opened its own illegal injection site. As such it can't qualify as unbiased.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: SirJohn on August 14, 2018, 03:17:15 pm
And why do you keep demeaning the saving of lives as some sort of "bandwagon"? You're talking about lives FFS!

There's math at play here which we can't do because we don't know the numbers to plug in.
It's something like how many lives saved from an OD minus those who stayed on drugs longer because they felt enabled and died through some other drug related cause.

And, from a broader societal standpoint, the good these sites do for the community vs whatever ill affects the might have.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 03:32:43 pm
There's math at play here which we can't do because we don't know the numbers to plug in.
It's something like how many lives saved from an OD minus those who stayed on drugs longer because they felt enabled and died through some other drug related cause.

And, from a broader societal standpoint, the good these sites do for the community vs whatever ill affects the might have.

And it's like how many don't die because, even if they fail to beat their addiction, they can use safely.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 05:51:16 pm
There is clear evidence that detox clinics are not available due to budget constraints.
Which is my point. Politicians pushing SIS are using it as an excuse to avoid spending money on the real problem which is messy and complicated. The studies that provide "evidence" about how SIS "works" simply serve a smoke screen to distract a public that does not understand the real issues.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Gorgeous Graham on August 14, 2018, 06:09:10 pm
When it comes to injection sites I believe almost all of the studies are being done by people who wish to see the government spend money on harm reduction research which means they set up their studies in a way to make injections sites look as good as possible by emphasizing the positive while minimizing the negative. So it comes as no surprise that the "evidence" says they work.

Interesting and much discussed theory, but do you have any evidence to support it?

Obviously confirmation bias exists, but to what extent?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: wilber on August 14, 2018, 06:18:05 pm
There is clear evidence that detox clinics are not available due to budget constraints. Socioeconomic forces are a huge enabler of addiction, many thousand times more than SIS.

True. If someone decides they want to get off drugs, you can't tell them to wait a couple of months. Addiction doesn't work that way. The time is the time, not a month from now.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 06:30:11 pm
Obviously confirmation bias exists, but to what extent?
How could it be any other way? Researchers are forced to specialize. Once they commit to a specialty they need to make sure it stays relevant lest they be out of work or have to start over in a new field. They simply cannot afford to say anything that undermines their specialty or their career prospects.

Let's put it another way: if scientists work for a oil company or a drug company most people will assume, without proof, that any science produced by these scientists is biased. I am saying that the same thing is true for every scientist but it can be more difficult to figure out how the incentives in their field create their bias.

If you are going to insist on accepting all science at face value unless someone provides "proof" of bias then I can dig out any number of studies by tobacco companies which you have to accept at face value unless you can *prove* bias. Is that the standard you really want to set? Or are you going to be a hypocrite and argue proof of bias is only required when you decide it is necessary?


Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Gorgeous Graham on August 14, 2018, 08:30:18 pm
How could it be any other way? Researchers are forced to specialize. Once they commit to a specialty they need to make sure it stays relevant lest they be out of work or have to start over in a new field. They simply cannot afford to say anything that undermines their specialty or their career prospects.

Let's put it another way: if scientists work for a oil company or a drug company most people will assume, without proof, that any science produced by these scientists is biased. I am saying that the same thing is true for every scientist but it can be more difficult to figure out how the incentives in their field create their bias.

If you are going to insist on accepting all science at face value unless someone provides "proof" of bias then I can dig out any number of studies by tobacco companies which you have to accept at face value unless you can *prove* bias. Is that the standard you really want to set? Or are you going to be a hypocrite and argue proof of bias is only required when you decide it is necessary?

It's a good theory, very plausible, confirmation bias happens, but theories need evidence, especially if we're talking about academic research which relies on evidence.  You can't brush off entire fields of social science as hogwash without evidence, we don't even know the extent of this problem if there is one.  Maybe there's even studies out there done on this subject.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 14, 2018, 08:32:59 pm
Tim, You know “researchers” are often tenured professors, right? The entire reason for tenure is the freedom to research what you want without having to worry about your next pay cheque. That’s the whole reason professors “can’t” be fired.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 08:38:48 pm
You can't brush off entire fields of social science as hogwash without evidence, we don't even know the extent of this problem if there is one.
Except I am not saying it is "hogwash". In this thread I acknowledged the evidence that SIS reduce overdose deaths. What I question is the definition of success as defined as advocates. Saving lives is good but for every life saved how many languish longer in addiction because the SIS enable their addiction or because resources are being spent on SIS instead of expanding detox beds? None of the evidence I have seen addresses these concerns. The reason is most likely because of the bias I noted above. The researchers are keen to report areas of success while they play down the negative consequences.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 08:48:49 pm
Tim, You know “researchers” are often tenured professors, right? The entire reason for tenure is the freedom to research what you want without having to worry about your next pay cheque. That’s the whole reason professors “can’t” be fired.
So what? Their professional stature and status among their peers depends on the relative respect conferred on their specialty. More importantly, tenure does not fund labs or graduate students. The ability to get their next grant has to always be a top priority for any tenured professor. When professor Peterson started vocally expressing his views the funding bodies quickly found excuses to cut off his grants because they did not like what he was saying. It did not affect him personally but he lost his students and that has to matter to any tenured professor.

IOW, your idea 'tenured professors' are free of bias because they don't fear the loss of their paycheck is nonsense. Bias can come from many sources and tenured professors are not immune.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 09:25:42 pm
Except I am not saying it is "hogwash". In this thread I acknowledged the evidence that SIS reduce overdose deaths. What I question is the definition of success as defined as advocates. Saving lives is good but for every life saved how many languish longer in addiction because the SIS enable their addiction or because resources are being spent on SIS instead of expanding detox beds? None of the evidence I have seen addresses these concerns. The reason is most likely because of the bias I noted above. The researchers are keen to report areas of success while they play down the negative consequences.

Please try and explain to us how a SIS "enables" addiction. People who show up at a site are already addicted. They go to the site for some safety to do what they are going to do anyway. And they can get help to battle their addiction as well, so your theory falls apart.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 09:26:59 pm
Please try and explain to us how a SIS "enables" addiction.

It prevents them from overdosing or getting AIDS so they live longer to continue their addiction.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 09:34:41 pm
It prevents them from overdosing or getting AIDS so they live longer to continue their addiction.

Ah I get it. Let them die and then they disappear. That oughta work.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 09:50:25 pm
It prevents them from overdosing or getting AIDS so they live longer to continue their addiction.
I can't believe how ignorant you guys are about what addiction is. If someone has an addict in the family he first thing any professional will tell the person is about the importance of not enabling the addict because enabling the addict can discourage the addict from seeking help:

https://alcoholrehab.com/addiction-articles/enabling-addiction/

Quote
Enabling is one of the key aspects of addiction and substance abuse. Many people who struggle with addiction find that they have a close relationship with a person who enables them to deny that they have a problem with drugs or alcohol. This dysfunctional relationship also allows them to ignore and be disconnected from the consequences of their behavior An enabler will provide emotional and financial support, help them to hide their addiction, fund their addiction and even make excuses for their problems. The addict knows that there is always someone there to help them, even if they permit the most hurtful, painful and even criminal acts.

Enabling addiction can have disastrous consequences. Health problems, financial ruin, relationship breakdown, injuries and incarceration are all very real outcomes of a persons drug or alcohol addiction. Allowing a person to continue to abuse alcohol and drugs without any repercussions can mean that they will not face up to their problems and addiction until it is too late.
So enabling an addict *is* a serious concern and SIS are a type of enabling and will result in more addicts delay facing their problems. The question is how to balance the lives saves by preventing overdose vs. the lives destroyed by keeping the addict comfortable with their addiction. It is delusional to pretend this trade off does not exist.

More from the op:
Quote
Enabling is borne out of good intentions, love and care for another person however it has disastrous consequences. An enabler means well by their actions, but their actions simply prolong the consequences of an addicts behavior.
IOW, the road to hell is paved with good intentions.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 09:58:38 pm
If someone has an addict in the family he first thing any professional will tell the person is about the importance of not enabling the addict because enabling the addict can discourage the addict from seeking help:

That is based on AA program, but not backed up by a single piece of evidence. Please provide the research that supports your theory.

What we do know about supervised injection is they reduce overdose mortality, cut transmission of HIV and hepatitis C, decrease public injecting and the presence of dirty needles in streets and parks, and even reduce local crime and violence rates — all while improving health.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Gorgeous Graham on August 14, 2018, 09:58:54 pm
So enabling an addict *is* a serious concern and SIS are a type of enabling and will result in more addicts delay facing their problems. The question is how to balance the lives saves by preventing overdose vs. the lives destroyed by keeping the addict comfortable with their addiction. It is delusional to pretend this trade off does not exist.

Don't the sites have counseling support ready if they want to quit?  What's the quit rate vs the general population?  And the death rate? etc.

We don't have the time to delve into the stats and all the literature here, but as MH eluded in the OP, the people in government should and decisions should all be based on evidence based on what outcomes are desired and not knee-jerk emotion.

The thing with Doug Ford is he's not anything near an academic, he doesn't know anything about the scientific process or research & evidence so things will get canned based on emotion and ideology.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 10:03:04 pm
That is based on AA program, but not backed up by a single piece of evidence. Please provide the research that supports your theory.

What we do know about supervised injection is they reduce overdose mortality, cut transmission of HIV and hepatitis C, decrease public injecting and the presence of dirty needles in streets and parks, and even reduce local crime and violence rates — all while improving health.

I guess if we follow Tim's logic the way to get rid of alcoholism is to simply shut down all the bars.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 10:09:32 pm
Don't the sites have counseling support ready if they want to quit?  What's the quit rate vs the general population?  And the death rate? etc.
What is the quit rate compared to an outreach program where the same counselling is made available without a SIS? We want an apples to apples comparison.

The thing with Doug Ford is he's not anything near an academic, he doesn't know anything about the scientific process or research & evidence so things will get canned based on emotion and ideology.
I am not convinced Doug Ford's motivations are any different from the majority of SIS supporters who refuse to acknowledge the trade offs.

 
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 10:12:57 pm
I guess if we follow Tim's logic the way to get rid of alcoholism is to simply shut down all the bars.

Bars are improving with bartenders now being held to account for not looking out for their patrons. If we added the notion that nobody was allowed to drink alone at a bar (friends looking out for each other) then they might become closer safe/supervised drinking sites.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 10:15:25 pm
That is based on AA program, but not backed up by a single piece of evidence. Please provide the research that supports your theory.
AA/NA is the most widespread addiction treatment program largely because it is free and ubiquitous. It has lasted 80+ years and if it did not help people it would not exist. That is evidence that is far superior to any so called study. There is also are almost no professionals who work with addicts that does not see the value of AA/NA although they will likely see as a supplement to go a long with other treatments. You will get a few professionals who have a hate on for it but they are a small minority.



Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 10:16:15 pm
What is the quit rate compared to an outreach program where the same counselling is made available without a SIS? We want an apples to apples comparison.
I am not convinced Doug Ford's motivations are any different from the majority of SIS supporters who refuse to acknowledge the trade offs.

DoFo's motivations are to garner support from his supporters by showing how he can save tax money while pretending a real problem doesn't exist.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 10:18:26 pm
AA/NA is the most widespread addiction treatment program largely because it is free and ubiquitous. It has lasted 80+ years and if it did not help people it would not exist. That is evidence that is far superior to any so called study. There is also are almost no professionals who work with addicts that does not see the value of AA/NA although they will likely see as a supplement to go a long with other treatments. You will get a few professionals who have a hate on for it but they are a small minority.

So you have no research.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 10:26:32 pm
AA/NA is the most widespread addiction treatment program largely because it is free and ubiquitous. It has lasted 80+ years and if it did not help people it would not exist.

Yes, AA does some good work, but it is far from a solution.

40% of people drop out after a few meetings
27% remain sober for a year
24% remain sober for 1-5 years
13% remain sober for 5-10 years

I have not seen good statistics on success for narcotics, but I would expect them to be much lower.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 10:53:03 pm
Yes, AA does some good work, but it is far from a solution.
I never said it was the entire solution. I was only responding to your earlier dismissal of the program. It has its place and many of the philosophies are based on decades of a experience dealing with addicts. This experience should not be dismissed.

13% remain sober for 5-10 years
Compared to what exactly? All addiction treatment programs have very high relapse rates. Moreover, including the 40% of the people who show up and make no effort is like judging a medication based on the number of people that refuse to take it.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 11:03:23 pm
I never said it was the entire solution. I was only responding to your earlier dismissal of the program. It has its place and many of the philosophies are based on decades of a experience dealing with addicts. This experience should not be dismissed.
Compared to what exactly? All addiction treatment programs have very high relapse rates. Moreover, including the 40% of the people who show up and make no effort is like judging a medication based on the number of people that refuse to take it.

So you do understand that relapse rates are high no matter where counselling is made available. But you seem to ignore that SIS's do save lives as well as serious infections from needles. Why is that?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 11:04:39 pm
I never said it was the entire solution. I was only responding to your earlier dismissal of the program.
...
Compared to what exactly?

I didn't dismiss the program, just put it in its place. Remember it is mainly a Christian program with little research behind it. If you look at the 12 steps, clearly 12 of them deal with religion and God (2, 3, 5, 6, 7, & 11). I don't include step 12 as religious, even though it talks about spirituality because that is a bit broader and the real benefit is applying lessons to the rest of your life beyond the addiction.

There are other addiction programs with higher success rate, but yes even they are far from perfect and none of them compete in bringing the benefits to as many people. The real competition however is not solving the addiction but at least keeping people alive and relatively healthy and minimizing the impact on others; and it should not be considered competition but complementary.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 14, 2018, 11:25:13 pm
Remember it is mainly a Christian program with little research behind it.
1) People figured stuff out by trial and error for the the last 6000 years. Formal research is not a requirement for knowledge to be correct.
2) It is not Christian. It is spiritual. There is a huge difference. The AA literature has specific suggestions for how an atheist can adopt the program to help them.

here are other addiction programs with higher success rate.
And how many of those are free and available to anyone with a desire to access at any time? The ones I have seen are expensive and their claims are likely biased by the desire to attract customers.

In any case, AA/NA gets more people clean and sober simply because more people have access to the program so a lower success rate (even if it is true) still means a larger number of people are helped. That is good for addicts and good for society.

The real competition however is not solving the addiction but at least keeping people alive and relatively healthy and minimizing the impact on others;
Addicts have specific behaviors and enabling and addict is known to prolong an addiction. This is an accepted fact among addiction professionals.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 14, 2018, 11:29:30 pm
1) People figured stuff out by trial and error for the the last 6000 years. Formal research is not a requirement for knowledge to be correct.
2) It is not Christian. It is spiritual. There is a huge difference. The AA literature has specific suggestions for how an atheist can adopt the program to help them.
And how many of those are free and available to anyone with a desire to access at any time? The ones I have seen are expensive and their claims are likely biased by the desire to attract customers.

In any case, AA/NA gets more people clean and sober simply because more people have access to the program so a lower success rate (even if it is true) still means a larger number of people are helped. That is good for addicts and good for society.
Addicts have specific behaviors and enabling and addict is known to prolong an addiction. This is an accepted fact among addiction professionals.

Once again, where's your evidence?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 14, 2018, 11:51:46 pm
Addicts have specific behaviors and enabling and addict is known to prolong an addiction. This is an accepted fact among addiction professionals.

Here is what the Betty Ford clinic has to say about enabling:

Enabling behavior:

Only the first of those enabling behaviors could partially be considered to come from SISs, in so far as we are protecting he addict from AIDs and/or death. I think that is a worthwhile compromise.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 15, 2018, 12:27:51 am
Only the first of those enabling behaviors could partially be considered to come from SISs, in so far as we are protecting he addict from AIDs and/or death. I think that is a worthwhile compromise.
Great. So we are at the point where we agree there is a trade off. It would be challenging to actually quantify the actual effects of both factors. I am not convinced it is as small as you suggested given my experience with the addicts. They are masters at rationalization and justification. That said, my main concern is misdirection of resources because everyone is obsessing about SIS when detox beds are more important when it comes to getting people off drugs sooner.  How many deaths would be prevented if an addict could get a detox bed with 72 hours of asking for help?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 15, 2018, 12:41:19 am
Great. So we are at the point where we agree there is a trade off. It would be challenging to actually quantify the actual effects of both factors. I am not convinced it is as small as you suggested given my experience with the addicts. They are masters at rationalization and justification. That said, my main concern is misdirection of resources because everyone is obsessing about SIS when detox beds are more important when it comes to getting people off drugs sooner.

And one avenue to a detox bed is via a SIS.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 15, 2018, 06:11:58 am

The article is about whether the Ontario PCs close safe injection sites, not whether SIS's actually work.  Hence a bunch of politicians referring to evidence.

There is a debate happening - why shouldn't we get a link, at least, to some reasons it's considered to be a success ?

Quote
Claiming that SIS's "work" is not a compelling argument if you don't even define what "working" actually means in this context.  Specific claims to demonstrate what good SIS's have been demonstrated to do in other communities would be helpful in convincing voters they are valuable.

"Working" in this context could have numerous meanings.  It could mean:
 -saving lives
 -saving money
 -getting people into treatment programs to get off drugs
 

You are right I didn't think about context either.  But we didn't get that except in the Star article, which measured deaths.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 15, 2018, 06:13:02 am
I have no patience for people who willingly remain ignorant and complain that they're not being spoon-fed information that's readily available.

I think spoon-feeding might help.  Why not just provide a link to an article about the study ?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 15, 2018, 09:30:01 am
IOW, your idea 'tenured professors' are free of bias because they don't fear the loss of their paycheck is nonsense.
Nonsense? It directly refutes your claim that chasing funding in order to have job security is the reason they're biased. Now you've moved the goalposts because your argument is junk.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 15, 2018, 09:35:02 am
I think spoon-feeding might help.  Why not just provide a link to an article about the study ?
Because then you'll ask why a link to the study wasn't provided and there are numerous studies. Here's one systematic review for you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 15, 2018, 09:53:58 am
Nonsense? It directly refutes your claim that chasing funding in order to have job security is the reason they're biased.
Except I a never made such a claim. Try reading what I write instead of making stuff up.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: guest4 on August 16, 2018, 12:00:14 am
AA/NA is the most widespread addiction treatment program largely because it is free and ubiquitous. It has lasted 80+ years and if it did not help people it would not exist. That is evidence that is far superior to any so called study. There is also are almost no professionals who work with addicts that does not see the value of AA/NA although they will likely see as a supplement to go a long with other treatments. You will get a few professionals who have a hate on for it but they are a small minority.

Happen to have watched a documentary on addiction treatment some time ago.  AA was, for a long time, the only game in town  and it became very familiar; that is the secret of its longevity, not effectiveness.   It does work for some people, clearly, but the evidence suggests it's one of the least effective methods.  Here's an article that covers many of the same points made in the documentary.

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 06:32:05 am
It does work for some people, clearly, but the evidence suggests it's one of the least effective methods.
Your article mentioned that it is impossible to study AA properly because it is "anonymous" so any comparisons to other treatments have to be taken with a grain of salt. More importantly, you can't judge addiction treatment like a black box where addicts are fed in one side and count the number of sober people that come out the other. It just does not work that way. Relapse is a part of recovery so measuring effectiveness requires a longer term outlook (i.e. number of sober days after 1, 3, 5 and 10 years). The author's clear bias against AA was shown by her dismissal of the need to actually "try the program" before it can help. No other medical intervention is judged based on the number of people that refuse to follow the treatment plan. Why should AA be judged by that metric?

More importantly, addiction is a multi-faceted problem and trying to find a single one size fits all solution is wrong headed. i.e. AA cannot help with detox or dual diagnoses (people who are addicts with other conditions such as bipolar disorder). It is a means to deliver cognitive therapy and support to a large number of people cheaply. If naltrexone helps with cravings then it should be used but after 1 year physical cravings are gone and relapse occurs because of a failure to deal with the psychological issues that led to substance abuse in the first place. That is where peer support is invaluable. Who do you really think has a better chance of helping a addict through a crisis: a therapist charging 100/hour who is available 9/5 workdays or a fellow addict that has 20 years of recovery that can be called any time of the day?

Lastly, an abstinence based program is essential to recovery. Telling addicts that they can consume their drug of choice in moderation will generally lead to failure because once under the influence of the drug the addict is no longer going make rational decisions and is much less likely to control consumption. That does not mean that some individuals can make moderation work - it just means that the primary objective of any useful treatment has to be abstinence.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 06:55:28 am
Your article mentioned that it is impossible to study AA properly because it is "anonymous" so any comparisons to other treatments have to be taken with a grain of salt.

Yes, AA is anonymous so we don't have complete data on it. Generally people quote between 8-15% success rates, compared to 20-45% rates for more modern clinics. The numbers I gave the other day however are based on a study completed about 5 years ago from a sample size of 6,000 people who agreed to long-term monitoring. Again, they were based on people attending for alcohol treatment, not narcotics:

40% of people drop out after a few meetings
27% remain sober for a year
24% remain sober for 1-5 years
13% remain sober for 5-10 years
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 07:04:12 am
40% of people drop out after a few meetings
You don't judge a treatment based on the number of people that refuse to follow the treatment plan. So based on your stats 23% of people who actually try the program are sober after 5 years which is pretty good. But even then such stats are misleading because someone may relapse 3 times after 1 year before "getting it" and achieving long term sobriety. How would those kinds of examples fit into the data you quoted?

I also question 20-45% for modern clinics if these numbers are provided by clinics that seek to be paid for treatment. There is a strong incentive to define success in ways that make the clinics look as good as possible while minimizing the benefit of free programs.

More importantly, I don't believe there is any 'magic bullet' out there are all treatment programs have poor success rates but I doubt any can come close to competing with AA/NA on % success/dollar spent.


Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 07:26:15 am
You don't judge a treatment based on the number of people that refuse to follow the treatment plan.

Perhaps the reason AA has such a high initial dropout rate is that people realize that it is just a front for the Bible thumpers.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 07:40:36 am
Perhaps the reason AA has such a high initial dropout rate is that people realize that it is just a front for the Bible thumpers.
Except it isn't. People who make AA/NA work for them understand the need to move beyond the literal imagery of the steps and find a way to look at them that helps them - even if it means replacing references to "god" with some other image that works for them.

I realize you have a big hate on for anything that smells like religion but you should not let your irrational prejudices cloud your judgement. Remember that addiction is a fundamentally an irrational problem and if using god/spirituality allows an addict to manage their obsessions then why is that a concern?

 As far as the drop rate goes: what is the drop out rate for your unnamed "modern treatments"? My bet is they have manipulated their stats to avoid counting drop outs.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 08:28:29 am
My bet is they have manipulated their stats to avoid counting drop outs.

More likely they "manipulate" the methods to build on what works and drop that which doesn't. Unlike the Bible thumpers that havn't changed their 12 steps since they were founded 80 years ago, because they are used to following scripture.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 09:00:48 am
More likely they "manipulate" the methods to build on what works and drop that which doesn't.
IOW, you have no clue. You throw around stats without understanding how they were calculated because they give you an excuse to criticize a program that you don't like because of the "god" thing.

The bottom line is AA/NA does work for many people and it is unlikely that its success rate is much less than other treatments once you make sure you are comparing apples to apples. And even if its success rate is lower it helps more people because it is low cost. So the question becomes: what exactly is the problem with AA/NA?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 09:12:38 am
IOW, you have no clue. You throw around stats without understanding how they were calculated because they give you an excuse to criticize a program that you don't like because of the "god" thing.

The bottom line is AA/NA does work for many people and it is unlikely that its success rate is much less than other treatments if once you make sure you are comparing apples to apples. And even if its success rate is lower it helps more people because it is low cost. So the question becomes: what exactly is the problem with AA/NA?

If you go back to my first comment on the matter, I clearly said that AA does some good work. I am not knocking them, just putting them in their place. It seems very clear that success rates of other programs are better, and yes I do have a clue. I am not saying to get rid of AA, just be realistic. Don't allow people to die of overdoses or infections, just because AA gives them a faint hope of curing their addiction therefore if they don't follow it they deserve to die as you seem to think.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 09:27:57 am
Don't allow people to die of overdoses or infections, just because AA gives them a faint hope of curing their addiction therefore if they don't follow it they deserve to die as you seem to think.
This tangent started because you rejected my argument that SIS prolong addiction because they enable addicts because it was a 'AA thing' and therefore not real. You later seemed to accept that the risk of enabling an addicts is real but felt it is worth the trade off if lives can be saved. The latter is a reasonable argument that I don't necessarily agree with.

My primary concern about SIS is they suck limited resources away from the programs that are really needed such as detox beds and recovery support services. If detox and support services were fully funded then I could see the value of SIS but as long as these services are underfunded SIS are a distraction that allow politicians to get away with under-funding recovery supports services because they are seen to be "doing something" even if that "something" is making the problem worse.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 09:49:27 am
My primary concern about SIS is they suck limited resources away from the programs that are really needed such as detox beds and recovery support services.

It is right wing politicians that suck resources away from programs. The money spent on SISs is very minimal compared to the number of lives they save. Yes lets have more and better detox facilities, but you will still have better return from an SIS. Most significant is the money saved in the health care system due to fewer infections is far more than what is spent on SISs.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 09:57:56 am
Yes lets have more and better detox facilities, but you will still have better return from an SIS.
Not if addiction is prolonged because addicts are more comfortable continuing in their addiction. A shortage of detox beds will make this outcome more likely.

Most significant is the money saved in the health care system due to fewer infections is far more than what is spent on SISs.
This argument I agree with but I am more concerned with saving lives by getting addicts clean.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 10:15:42 am
Not if addiction is prolonged because addicts are more comfortable continuing in their addiction.

You know very little about addiction if you think fear of infection or death is an effective motivation factor.

If we followed your wasting resource logic, then we should get rid of ambulances and spend that money on more hospital beds.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 10:31:26 am
You know very little about addiction if you think fear of infection or death is an effective motivation factor.
I am very familiar with addiction with 2 recovering family members and 1 dead from suicide. I know how addicts think and making indulging their addiction convenient and comfortable will make it less likely that they will accept treatment. The fact that  you call AA/NA "bible thumpers" shows that you are clueless and know nothing about addiction and recovery.

If we followed your wasting resource logic, then we should get rid of ambulances and spend that money on more hospital beds.
Logic fail. No one is arguing that ambulances increase the number of emergencies.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 10:39:38 am
I know how addicts think and making indulging their addiction convenient and comfortable will make it less likely that they will accept treatment.
...
No one is arguing that ambulances increase the number of emergencies.

A SIS does not indulge the addiction or make it more convenient and comfortable. It simply reduces instances of the most severe consequences.
...
Are you arguing that an SIS increases the number of something? It does not provide drugs, only clean needles and monitoring for overdose.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 11:07:24 am
A SIS does not indulge the addiction or make it more convenient and comfortable. It simply reduces instances of the most severe consequences.
SIS provide a clean and safe place to indulge one's addiction. That, by definition, means indulging the addition and making it more comfortable to use.

Are you arguing that an SIS increases the number of something? It does not provide drugs, only clean needles and monitoring for overdose.
It is hard to discuss this with you because you appear to have no understanding of why it is so hard to help people with addictions. It is not simply a question of physical withdrawal from a substance. Addiction is a complex psychological problem where addicts delude themselves into believing they can function while using their drug of choice. Any action that it makes easier/safer/convenient will feed the denial impulse and potentially delay the date when an addict breaks through their denial and seeks treatment.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 11:19:55 am
Any action that makes easier/safer/convenient will feed the denial impulse and potentially delay the date when an addict breaks through their denial and seeks treatment.

Seeking treatment is not the problem, succeeding is. Available of better treatment could improve that, but is far from reality.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 16, 2018, 11:22:36 am
IOW, you have no clue. You throw around stats without understanding how they were calculated
Says the guy who assumes the stats are manipulated without showing any evidence whatsoever to support that claim.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 16, 2018, 11:25:20 am
Why are we even indulging Tim's completely unsubstantiated claims? He has no evidence or data to support any of the wild assumptions he's making, but here we are wasting energy trying to have a discussion about something that has no merit. Until Tim provides evidence for his nonsensical claims that SIS do more harm than good, he can piss off.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 11:29:41 am
Seeking treatment is not the problem, succeeding is. Available of better treatment could improve that, but is far from reality.
Actually it is. The biggest barrier to addiction treatment is the need to convince the addict that they actually need treatment. Once you break down that barrier then you need to deal with the physical withdrawal which is why immediate access to detox beds is do important. If an addict reaches a point where they are willing to seek treatment but have to wait 4-6 weeks for help with the withdrawal symptoms then they will often return to their addiction and the opportunity will be lost.

The reason so many people don't stick it out with AA is because they are still in denial and look for excuses to go back drinking. In patient facilities that keep patients in the program with threats of consequences can reduce the number of dropouts. This will have the effect of increasing success rates but you can't compare a program where people forced to stay to a voluntary program.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 11:33:49 am
Why are we even indulging Tim's completely unsubstantiated claims? He has no evidence or data to support any of the wild assumptions he's making, but here we are wasting energy trying to have a discussion about something that has no merit. Until Tim provides evidence for his nonsensical claims that SIS do more harm than good, he can piss off.
My claims are not unsubstantiated. They based on years of experience dealing with people in active addiction and recovery.

In any case, how exactly would one design a study to determine if people delay seeking treatment when SIS facilities are available? I don't see how one could collect the data.

Your attitude that all knowledge can be ignored unless there are "studies" is just plain dumb.
People who work with addicts on the daily basis will agree that everything I say about denial and enabling is very true.
The only real question is if it is a significant factor but too many people like you refuse to take it as a serious concern.
 
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 16, 2018, 11:42:34 am
My claims are not unsubstantiated. They based on years of experience dealing with people in active addiction and recovery.
Your anecdotal "experience" does not supersede researched evidence of the effectiveness of these programs. You provide no data, no analysis, no research whatsoever to support your claims.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 11:54:22 am
Your anecdotal "experience" does not supersede researched evidence of the effectiveness of these programs. You provide no data, no analysis, no research whatsoever to support your claims.
And you have no data to support your claims because no one has looked at this particular issue. Why should your opinion that it has no effect be given any consideration given the overwhelming anecdotal evidence that it is a serious concern?

Aside: this is a game that see played by your ilk all of the time:

1) Find a study that looks at a narrow set of problems;
2) Assert that no one can question your ideologically driven preferences because of the study;
3) Accuse people of "not having data" when someone points out problems that the study did not look it;

This BS is tiresome. If you are so convince that risk of enabling addicts is not a concern then show me the studies that looked at the problem specifically and what methodology they used.

If you can't do that then just admit you are hypocrite.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 12:23:43 pm
And you have no data to support your claims because no one has looked at this particular issue. Why should your opinion that it has no effect be given any consideration given the overwhelming anecdotal evidence that it is a serious concern?

These sites save lives, there is ample evidence of that. O/D's, HIV/AIDS, various infections from shared needles, all can be fatal and are prevented by provision of clean needles used under medical supervision. There is also evidence that people who use A SIS are more likely to seek detox and counseling to quit. This may not occur immediately be successful immediately, but if you die in a back alley it's unlikely you will ever seek that type of help.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 12:36:03 pm
There is also evidence that people who use A SIS are more likely to seek detox and counseling to quit.
Where is this evidence? How did they create their control group?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 12:41:49 pm
Where is this evidence? How did they create their control group?

There are a number of others but you need to do your own homework.

https://www.healthline.com/health-news/supervised-injection-sites-for-drug-users#1

Four studies in the review showed that people who used the supervised injection site were more likely to enter a detox program or addiction treatment.

VCH also operates an adjoining detox treatment facility called Onsite. Akins said that during the past year, 443 people visiting Insite were referred to this facility. They stayed an average of 11 days, with 179 people no longer needing detox services.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 12:59:28 pm
Four studies in the review showed that people who used the supervised injection site were more likely to enter a detox program or addiction treatment.
Does not say how they created their control group. Surveys of people on the street that don't come  into the SIS?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 01:21:39 pm
Does not say how they created their control group. Surveys of people on the street that don't come  into the SIS?

See reply # 80.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 16, 2018, 01:25:37 pm
Does not say how they created their control group. Surveys of people on the street that don't come  into the SIS?
What the hell are you even talking about?

"Last year a group of researchers reviewed 47 previous studies."

It's a meta-analysis of a series of studies that all point to the same or similar conclusions. The meta-study lists the various study designs in it:
https://link.springer.com/article/10.1007/s11904-017-0363-y

Some are simulations, others are ecological, others time-series, others cross-sectional designs. All of the methods consistently point to the same outcome. SIS reduce deaths from overdoses and communicable diseases related to IV drug use.

From the study itself:

In the present systematic review, we identified consistent, methodologically sound evidence demonstrating the effectiveness of SCFs in achieving their primary health and public order objectives. Further, the available evidence does not support concerns regarding the potential negative consequences of establishing SCFs, including that these promote drug use or attract crime.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 16, 2018, 01:27:14 pm
Also, as far as your non-sensical question about control groups:

Overall, high-quality scientific evidence derived from the observational and simulation studies included in this review demonstrates the effectiveness of SCFs in meeting their primary public health and order objectives. Although randomized controlled trials (RCTs) are typically defined as the ‘gold standard’ for yielding level-one evidence on the effectiveness of a given intervention, it should be noted that RCTs of SCFs have been deemed unethical due to a lack of clinical equipoise and therefore have not been conducted
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 03:30:58 pm
From the study itself:
The devil is in the details:
https://www.nejm.org/doi/full/10.1056/NEJMc052939

First, confirmation that my concern is valid and your previous dismissals of my "anecdotal" claims where arrogant BS:
Quote
In September 2003, the first safer injecting facility in North America opened in Vancouver, Canada. Here, injection-drug users can inject preobtained illicit drugs under medical supervision.1 A concern regarding such facilities is that they may lessen the likelihood that injection-drug users will seek addiction-treatment services.

Second, this study does not measure what you think it does:
Quote
In multivariate analyses with the use of Cox regression, an average of at least weekly use of the supervised injecting facility and any contact with the facility's addictions counselor were both independently associated with more rapid entry into a detoxification program
The key element here is contact with an addictions counselor and access to detox - not SIS itself.

More importantly, the comparison is between users of the SIS - there is no data comparing the users of the SIS to what would happen if the same addictions counselors and detox services were made available without the SIS.

This is a good example of how you misrepresent scientific knowledge in order to advance your pet ideological objectives while denigrating people who call you on your BS.
 
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 03:42:12 pm
The devil is in the details:
https://www.nejm.org/doi/full/10.1056/NEJMc052939

First, confirmation that my concern is valid and your previous dismissals of my "anecdotal" claims where arrogant BS:
Second, this study does not measure what you think it does:The key element here is contact with an addictions counselor and access to detox - not SIS itself.

More importantly, the comparison is between users of the SIS - there is no data comparing the users of the SIS to what would happen if the same addictions counselors and detox services were made available without the SIS.

This is a good example of how you misrepresent scientific knowledge in order to advance your pet ideological objectives while denigrating people who call you on your BS.

The good example is the one you provide as to either your inability to comprehend scientific knowledge, or simply to dismiss it to try and promote your anecdotal claims.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 03:56:12 pm
The good example is the one you provide as to either your inability to comprehend scientific knowledge, or simply to dismiss it to try and promote your anecdotal claims.
If you do not understand how my my response accurately represented linked paper then the person lacking comprehension is you.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 04:08:35 pm
If you do not understand how my my response accurately represented linked paper then the person lacking comprehension is you.

Your posted cite refutes your own claims. Sheesh.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 04:49:46 pm
Your posted cite refutes your own claims. Sheesh.
If you believe that you cannot read.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 16, 2018, 04:57:44 pm
The devil is in the details: A concern regarding such facilities is that they may lessen the likelihood that injection-drug users will seek addiction-treatment services.

You are quoting a letter to the editor that is quoting others concerns about a clinic that open two and half years earlier and was the first of its kind in North America.

One of those others is Dr. Andrea Barthwell (working for George Bush administration) who thinks methadone clinics or residential care are a superior option. She stated that about 2 months after the clinic in Vancouver opened, and it dosn't appear that she even visited the clinic. I would be very hard pressed to recommend a methadone clinic. Yes residential care is superior, we have already discussed that before and are well aware of the cost and success rate. The other was John Walters, director of the US National Drug Control Policy (not quite sure what that organization is part of), and I doubt he visited either.

You are right, the devil is in the details.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 04:57:59 pm
If you believe that you cannot read.

Because our study design was observational, it is possible that other factors may explain the observed associations; for example, greater concern for one's health or a tendency to “comply” might lead to greater use of the supervised injecting facility, as well as more ready acceptance of detoxification. In this regard, we have previously shown that greater use of the supervised injecting facility is associated with markers traditionally associated with reduced access to care, including a higher intensity of drug use and homelessness.5 In addition, contact with the addictions counselor was among the strongest independent predictors of more rapid entry into a detoxification program. Our findings provide reassurance that supervised injection facilities (Figure 1) are unlikely to result in reduced use of addiction-treatment services.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 05:11:33 pm
Our findings provide reassurance that supervised injection facilities (Figure 1) are unlikely to result in reduced use of addiction-treatment services.
Except they did no such thing because they did not compare there results with any control group. All they did is determine that if someone talked to an addiction counselor they were more likely to seek detox when compared to other users of the SIS. All this shows is that having addiction counselors on hand is important but does not tell us whether addicts are less likely to seek detox as a result of the SIS. The only way to get that data is to look at the life-cycle of addict in cities with and without a SIS while controlling for factors like the availability of detox beds and addiction counselors.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 05:14:35 pm
You are quoting a letter to the editor that is quoting others concerns about a clinic that open two and half years earlier and was the first of its kind in North America.
IOW, the entire "paper" was exercise in propaganda by motivated activist-researchers. That explains why the headline claims of the study have no relationship with the data/methodology they actually had.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 05:20:40 pm
Except they did no such thing because they did not compare there results with any control group. All they did is determine that if someone talked to an addiction counselor they were more likely to seek detox when compared to other users of the SIS. All this shows is that having addiction counselors on hand is important but does not tell us whether addicts are less likely to seek detox as a result of the SIS. The only way to get that data is to look at the life-cycle of addict in cities with and without a SIS while controlling for factors like the availability of detox beds and addiction counselors.

So you agree that talking to an addiction councilor is a good thing, as opposed to sitting in a dark alley shooting up. Maybe you are finally getting it.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 16, 2018, 05:23:25 pm
So you agree that talking to an addiction councilor is a good thing, as opposed to sitting in a dark alley shooting up. Maybe you are finally getting it.
Never said it was not. But you don't need a SIS to have access to addiction counselors. BC health has been running services for years that provide that in communities without any SIS. Unfortunately, they have been cut back while funding for SIS is increased. Pretty irrational when you look at this data.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 16, 2018, 05:27:20 pm
Never said it was not. But you don't need a SIS to have access to addiction counselors. BC health has been running services for years that provide that in communities without any SIS. Unfortunately, they have been cut back while funding for SIS is increased. Pretty irrational when you look at this data.

BUT YOU DO have access to a councilor if you go to a SIS. Why is that so difficult for you to understand?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 17, 2018, 06:07:51 pm
Because then you'll ask why a link to the study wasn't provided and there are numerous studies. Here's one systematic review for you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/

I will ?  I am divided on the broad political awakening of the deplorables/real people however I am willing to meet them half way by providing some information.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 17, 2018, 06:15:29 pm
So far there isn't much about how we use 'evidence' in the media in these discussions.

A little bit about the corruptibility of academia, but it's mostly it's arguing about whether SIS work or not. 

The odd thing is that people have given up on the idea of rationality being important, so we're kind of back to pre-democracy - as evidenced by the birthplace of western democracy electing an illiterate as president.

Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 17, 2018, 06:52:01 pm
The devil is in the details:
https://www.nejm.org/doi/full/10.1056/NEJMc052939

First, confirmation that my concern is valid and your previous dismissals of my "anecdotal" claims where arrogant BS:
Second, this study does not measure what you think it does:The key element here is contact with an addictions counselor and access to detox - not SIS itself.

More importantly, the comparison is between users of the SIS - there is no data comparing the users of the SIS to what would happen if the same addictions counselors and detox services were made available without the SIS.

This is a good example of how you misrepresent scientific knowledge in order to advance your pet ideological objectives while denigrating people who call you on your BS.
You responded to a more recent meta-analysis of 47 separate studies with a single study dating back to 2006 and you have the nerve to try to lecture anyone on here about scientific validity? Get the fuck outta here.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: cybercoma on August 17, 2018, 06:55:17 pm
The odd thing is that people have given up on the idea of rationality being important, so we're kind of back to pre-democracy - as evidenced by the birthplace of western democracy electing an illiterate as president.
Some people have given up rationality and I suggest that we go back to treating them as they ought to be treated: like irrational lunatics that offer nothing to society.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 17, 2018, 10:14:54 pm
Some people have given up rationality and I suggest that we go back to treating them as they ought to be treated: like irrational lunatics that offer nothing to society.

Fair enough.  I don't know how to roll back the clock though.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 17, 2018, 10:25:00 pm
Fair enough.  I don't know how to roll back the clock though.

Ooooh the endless platitudes. You don't role anything back you move forward armed with knowledge and hope the nitwits catch on.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 17, 2018, 10:30:02 pm
Ooooh the endless platitudes. You don't role anything back you move forward armed with knowledge and hope the nitwits catch on.

Your post makes no sense:

1) I didn't make a platitude
2) Regardless of whatever metaphor I used, the point is that it's difficult to enact what Cyber is suggesting. 
3) You provided no suggestion of your own, after accusing me of delivering platitudes.

All I was saying is... "Ok, not a bad idea but it's hard to do.  How do we do this ?"
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 17, 2018, 10:47:17 pm
Your post makes no sense:

1) I didn't make a platitude
2) Regardless of whatever metaphor I used, the point is that it's difficult to enact what Cyber is suggesting. 
3) You provided no suggestion of your own, after accusing me of delivering platitudes.

All I was saying is... "Ok, not a bad idea but it's hard to do.  How do we do this ?"

Conflating electing Trump and the validity of the purpose and effectiveness of SIS's is a rather large wander from the focus of the subject at hand.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 17, 2018, 10:49:24 pm
Conflating electing Trump and the validity of the purpose and effectiveness of SIS's is a rather large wander from the focus of the subject at hand.

Hey goofy - read the OP again.  This whole thread is about how evidence is largely ignored and I even predicted how this thread would go down.  Please go away now...
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 17, 2018, 10:54:50 pm
Hey goofy - read the OP again.  This whole thread is about how evidence is largely ignored and I even predicted how this thread would go down.  Please go away now...

Happily, Goofy.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 17, 2018, 10:58:18 pm
I even predicted how this thread would go down

Can you show me any examples of threads, especially ones of politically charged topics, that go down differently?
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 18, 2018, 08:20:17 am
Happily, Goofy.

Sorry I called you Goofy.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 18, 2018, 08:21:07 am
Can you show me any examples of threads, especially ones of politically charged topics, that go down differently?

Maybe not, however I stated at the top that this thread wasn't about that and tried to inoculate it, in vain.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: MH on August 18, 2018, 08:22:21 am
Conflating electing Trump and the validity of the purpose and effectiveness of SIS's is a rather large wander from the focus of the subject at hand.

So the connecting filament to those two topics is how people rationalize behaviour and thinking.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: TimG on August 18, 2018, 10:47:59 am
You responded to a more recent meta-analysis of 47 separate studies with a single study dating back to 2006 and you have the nerve to try to lecture anyone on here about scientific validity?
I had a specific concern about the lack of any attempt to study the risk of prolonging addictions. I found the 1 study that claimed to address that particular issue and discovered it was a joke that did not actually measure what it claimed to measure.

And your dogmatic response is "no one other that you is allowed to comment on what those studies say and do not say".

Same BS propaganda tactics that I see from you over and over again.
If you want to talk science then be precise about the questions asked and the reliability of the methods used.
If you are not willing to at least acknowledge that the question I would like answer has not been studied then you are the one rejecting science.

And stop whinging about red herrings. I never claimed SIS did not reduce over dose deaths or reduce disease transmission.
I never claimed that SIS increased drug use or crime. Studies on those points are irrelevant to my concern.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Gorgeous Graham on August 18, 2018, 01:00:41 pm
With the fentanyl crisis, there were approx. 4,000 opioid-related fatalities in Canada in 2017, a nearly 50-per-cent increase from the previous year.  Personally I think the injection sites are needed more than ever.  If politicians want to shut them down, they really need to crunch the number and consider the consequences. 
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: Omni on August 18, 2018, 01:16:16 pm
On one day back in July BC reported 130 overdose cases being treated. Luckily no one died because EMS personnel were able to treat them. If anything we likely need more SIS's so people don't die and can get access to counselling toward getting them clean.
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: SirJohn on September 09, 2018, 11:08:23 am
Something that is perhaps of value in examining the value of such sites is a meta analyses of existing studies.
The most interesting quote in the story is the following:

But this might be the most rigorous analysis yet conducted. “If you impose even a modest methodological bar, and then (supportive studies’) effects go away, to me that’s worrisome,” Stanford health policy professor Keith Humphreys told Vox.

He was commenting on the fact the majority of studies supporting the sites were tossed out by the authors of the meta analyses. If the suggestion is most of the supportive studies were scientifically invalid then where does that leave us?


https://nationalpost.com/opinion/chris-selley-studys-inconvenient-evidence-on-safe-injection-sites-could-be-bad-news-for-proponents
Title: Re: Safe Injection Sites in Ontario and the Idea of 'Evidence'
Post by: ?Impact on August 03, 2019, 02:47:16 pm
The National Film Board posted a 360° video the other day about the Insite clinic in Vancouver.

https://www.youtube.com/watch?v=M_Ix8qU3oHM&t=222s