Author Topic: Safe Injection Sites in Ontario and the Idea of 'Evidence'  (Read 623 times)

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Offline cybercoma

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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.
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Offline cybercoma

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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

Offline TimG

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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.
 
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Offline Omni

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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.

Offline TimG

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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.
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Offline Omni

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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.

Offline TimG

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Your posted cite refutes your own claims. Sheesh.
If you believe that you cannot read.

Offline ?Impact

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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.
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Offline Omni

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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.

Offline TimG

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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.

Offline TimG

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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.

Offline Omni

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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.

Offline TimG

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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.

Offline Omni

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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?

Offline MH

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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.