Talk:Harm reduction

"Soft bigotry" quote

Is there anearlier source than this? http://www.ed.gov/news/pressreleases/2003/03/03122003.html(March 2003) ? === Vernon White (talk) 12:56, 28 December 2006 (UTC)

Or this? http://www.newsmax.com/archives/articles/2004/1/9/110923.shtml(Jan 2004), or is there an earlier statement? ===Vernon White (talk) 13:01, 28 December 2006 (UTC)

Harm Minimisation

Sources that I've read in the past, especially on Bluelight, proposed the idea that Harm Reduction and Harm Minimisation are different ideologies with the same goals. I've read that Harm Minimisation should be considered to minimise harm by focusing on the reduction of use rather than safer use and thus employs tactics such as supply line reduction, strengthened law enforcement etc etc. Harm Reduction being more like the philosophy explained in the wiki article. Within this article the terms Harm Minimisation and Harm Reduction seem to be interchangeable. Is there a generally accepted standard or has any one else heard of an alternate meaning for the term Harm Minimisation? --Spuzzdawg (talk) 14:41, 18 November 2007 (UTC)

Yeah, the terms do cross over in their use. The National Drug Strategy of Australia has this to say on the matter:

Harm minimisation does not condone drug use, rather it refers to policies and programs aimed at reducing drug-related harm. It aims to improve health, social and economic outcomes for both the community and the individual, and encompasses a wide range of approaches, including abstinence-oriented strategies. Australia’s harm-minimisation strategy focuses on both licit and illicit drugs and includes preventing anticipated harm and reducing actual harm.

Harm reduction strategies to reduce drug-related harm to individuals and communities.

Here in Australia, Harm Minimisation is the oerall policy that involves supply reduction (stopping drugs reaching users), demand reduction (reducing the number of people using drugs) and harm reduction (minimising the damage caused by what the other two don't stop).

We coined the idea in 1985 with the national campaign against drug abuse, which was the first in the world to use this three way approach. Do people think that is an authoritative source? rakkar (talk) 01:55, 26 May 2008 (UTC)

Addition of weasel tag

Harm reductionists contend that ...

Critics of harm reduction contend that ...

These are classic weasel terms, so I am adding the weasel tag. perhaps someone can cite a "harm reducionist"? —Preceding unsigned comment added by 164.97.245.84 (talk) 00:15, 4 January 2008 (UTC)

I would recommend Gabor Mate' MD —Preceding unsigned comment added by 70.24.12.130 (talk) 02:14, 24 November 2008 (UTC)

criticism of harm reduction

I recommend rewriting the paragraph copied below. No sources are cited (though I agree with the author's sentiment). I think it could be expressed less colloquially, and should be cited where possible, and edited where not. The author states several unreferenced "facts" and makes some unfounded claims...

"...Ironically anti-drug information can have the same effect, because of it's sometimes false information and the statement of some myths as certain fact, someone realizing that information given to them was false may lead to them disbelieving the other statements that are made about other drugs and this may increase use of illicit drug use.[citation needed] The fact that anti-drug information often emphasizes the statement "Don't do this drug, it's bad", but fails to give proper information on the drug's risks and those risk's causes and how they can be managed can lead to more chance of someone having a negative reaction and not knowing how to deal with it leading to possible harm or death.[citation needed]..."

I've produced a rewrite below as a suggestion.

".... Anti-drug information often fails to give factual information on a drug's risks or risk management, leaving the user without objective knowledge needed to make an educated decision.[citation needed] ..." —Preceding unsigned comment added by 24.85.245.11 (talk) 10:40, 6 August 2008 (UTC) - hell, I'll remove it completely myself. —Preceding unsigned comment added by 24.85.245.11 (talk) 10:42, 6 August 2008 (UTC)

Responsible drug use

Hi, I just changed your link on the Harm Reduction page from a Main Article to a See Also, because I feel that while they are related, Harm Reduction is a public health philosophy, and responsible drug use seems to be more a personal matter.--rakkar (talk) 04:47, 12 December 2008 (UTC)

That's fine with me (I don't have a rabid opinion), but I don't think I entirely agree with your reasoning. "Harm reduction" is primarily a personal philosophy, also. The fact that it is a personal philosophy about public health does not ipso facto make it a public health policy. It is certainly ALSO a public policy in places where it has actually been enacted into law, but it doesn't cease to be "harm reduction" in places where it hasn't! Which is a great many places, if you take all aspects of the philosophy together. Most of your article is about harm reduction arguments as applied to places where it is NOT public policy, so you can't exactly define it the way you're suggesting

The other problem is that "Harm reduction" is badly defined in the article on it, because it doesn't include the explicit requirement that we're talking about illegal activities. Nobody calls safety training "harm reduction" for legal activities, no matter how risky they are. That includes riding the space shuttle or climbing Mr. Everest. We already have a word for that, and it's "safety." Why invent another, when it's not needed? Second, although some harm reductionists aim to reduce the harm from certain victimless illegal activities in part by decriminalizing them, but the moment they succeed in this, they're no longer taking about harm reduction, but again are merely taking about safety, like Driver's Ed or scuba classes. So again that part of "harm reduction" philosophy actualy requires the activity to be illegal, and that's why getting training for the safest way to do an illegal thing is so difficult to get enacted as actual public policy. I'll repost this on the Harm reduction TALK page to see if anybody else has something to say on the issue. SBHarris 03:13, 13 December 2008 (UTC)

Of course harm reduction is a public health policy. It's a pillar of the national drug policy of many countries. Basically it means upholding drug prohibition, while minimising harm to drug users. And it's not a philosophy, the term is often used as "evidence-based methods of harm reduction", meaning that harm reduction methods are only enacted when they haven proven to be beneficial. In countries like Denmark, even conservative parties voted for enacting those policies. In Germany the federal leadership of the conservatives was against heroin assisted treatment, but many state-level conservatives were for it.--Hisredrighthand (talk) 10:30, 4 September 2009 (UTC)

Citation

There is a great book on Harm Reduction called "Over The Influence" by Patt Denning Jeanine Little and Adina Glickman which could be cited as a reference for many of the statements made in this article. I don't know how to make citations or I would do it myself. —Preceding unsigned comment added by 68.127.27.199 (talk) 20:37, 17 January 2009 (UTC)

Removed "Soft bigotry" quote

Hi,

This is a strange paragraph:

"There is a third group that advocates an approach which is sometimes referred to as gradualism. Gradualism advocates are of the opinion that harm reduction programs are sometimes rooted in pessimism about the ability of addicts to stop their addictive behaviors and represent the "soft bigotry of low expectations." They are unlikely to categorize interventions as "good" or "bad". Rather, they tend to be more concerned that programs should urge clients toward abstinence when windows of opportunity open."

What's unusual about it is that it seems to construct a false binary between abstinence and harm reduction. If you're moving someone through Prochaska's stages of change, that person may decide that they're ready to make alcohol/drugs/etc not part of their life any more. This is harm reduction, not "gradualism." As well, the "soft bigotry" is problematic. If we look at the Webster's definition of a bigot: "a person obstinately or intolerantly devoted to his or her own opinions and prejudices ; especially : one who regards or treats the members of a group (as a racial or ethnic group) with hatred and intolerance" it seems to me that the use of "bigotry" in the context of the above paragraph is with respect to racial/ethnic groups, rather than obstinate devotion to prejudice. It's a muddled quote that mixes issues and has little to do with harm reduction, unless you think most/all drug/alcohol/substance abusers are members of certain racial/ethnic groups, which would be racist. 128.189.137.17 (talk) 07:48, 19 February 2009 (UTC)

Against prohibition?

The article seems to imply that "harm reductionists" are all members of some movement putting forward strategies against and to replace prohibition laws
Is this the case?
I can see prescription of contraceptives to someone under the legal age for consensual sex as motivated by a desire to "reduce harm", or mitigate the effects of illegal activity, without actually condoning the activity or seeking to legitimate it
I can see providing clean needles to injectors of prohibited drugs similarly
Laurel Bush (talk) 10:30, 24 February 2009 (UTC)

I have heard at least some of the proponents of "harm reduction" want their "solutions" to be applied within a prohibition approach to the drug issue. They are opposed to drugs, and believes that harm reduction, in conjunction with demand and supply reduction and a more open and fact-based debate on drug issues in general will make the problems associated with drugs smaller. I really think this is the larger group. Sure, they are polemic against the very-anti-drug-movement but not against legal constraints on drugs and the supply thereof per se.

So, I think you are right, harm reduction is not a alternative to, but a progressive approach within prohibition. Steinberger (talk) 17:36, 24 February 2009 (UTC)

Most harm reductionists are people who have personal experience working with drug addicts. They include all walks of life from the doctors who attempt to treat these addictions through prescribing other drugs, the police officers who see first hand the sort of lives addicts live on the street, probation officers, councilors and nurses who work in rehab programs, as well as addicts themselves who have managed to stay clean, and are helping others to also stay clean. These people have seen the damage that drug addiction can cause, and believe that addicts need all the help they can get to stay away from drugs, which of course would include restricted access. Of course some supporters may have their own political agendas, and might be members of anti-prohibition groups, but they are generally the minority here. The basic fact is that punitive anti-drug laws are not a solution to the drug problem. Fines and jail are only a deterrent, they are not a cure, and in most cases they actually exacerbate the problem. There is actually a group -- Law Enforcement Against Prohibition -- of law enforcement officers who after years of first hand experience enforcing punitive drug laws, have come to realize that they are a very poor attempt to solve a complex problem. The harm reduction movement is an attempt to work within the existing laws to reduce the harm done by them, and also to lobby for changes to the laws to allow further reduction of harm. --Thoric (talk) 22:58, 24 February 2009 (UTC)

As I see it, harm reductionists may be (1) prohibitionist, (2) anti prohibitionist, or (3) uncommitted with respect to the prohibition/anti-prohibition divide
Also, anti prohibitionists may or may not condone breaches of current law
In its current form, however, the article seems intent on branding all harm reductionists as anti prohibitionists
This seems to represent a less biased approach to the subject:

Harm reduction is action to reduce harm associated with activites such as illegal sex and illegal drug use. Harm reductionists do not necessarily condone the illegal activity or seek to ligitimate it.

Laurel Bush (talk) 13:56, 26 February 2009 (UTC)

They don't condemn illegal activity either... My suggestion on a lead is:

Harm reduction refers to certain controversial public health policies meant to reduce the harm associated with illegal activities such as prostitution and illicit drug use. The practices are non-condemning in nature and no demands is put on the patient to cede its illegal activity in order to receive the services. In a broader discussion, harm reductionists may not necessarily condone the illegal activity or seek to legitimate it.
Steinberger (talk) 14:36, 26 February 2009 (UTC)

Cheers Steinberger

Does look like an improvement on what we have at present

By The practices are non-condemning in nature and no demand is put on the patient to cede its illegal activity ..., do you mean Practioners are non-condemning in their approach and put no demand on the client to cede the illegal activity ...?

Laurel Bush (talk) 15:10, 26 February 2009 (UTC)

Yes, but after giving it a thought, maybe an "are often" should be put somewhere... In Sweden for example, the needle-exchange programs are non-condemning and does not force there clients to cede with their drug use, however, a persons on on methadone or buprenorphine must quit all other drugs and subject to drug tests to get the treatment. In for example the Netherlands, a person on methadone does not have to cede its additional drug usage. However, Sweden is quite extreme and we might implement these ideas in a still-very-anti-drug way that is atypical. Steinberger (talk) 16:17, 26 February 2009 (UTC)

... usually put no demand ...?

Laurel Bush (talk) 17:08, 26 February 2009 (UTC)

Sure... Steinberger (talk) 18:21, 26 February 2009 (UTC)

I am thinking now we may need a lot of may and may nots

Maybe to be expected in an article about controversial subject:

Harm reduction refers to certain controversial public health policies intended to reduce the harm associated with illegal activities such as illicit prostitution and drug use.

Advocates and practitioners of harm reduction may or may not be condemning of the illegal activity, and may or may not require abstinence from it as a condition of access to harm reduction services. Those who condone illegal activity may put their own legal status as risk.

Where abstinence is required, a licensed alternative is offered, such as prescribed methadone or, even, diamorphine (also known as diacetylmorphine), instead of illegal heroin.

Advocates and practitioners may favour moves to make laws less prohibitionist. Equally, they may favour maintenance of relevant laws as they are, or moves to make the laws more prohibitionist. There are similar divisions of opinion as regards law enforcement.

For those who support existing laws, or favour more prohibitionist laws, harm reduction is a supplement to law. For those who favour less prohibitionist laws, harm reduction is the alternative.

Many advocates argue that prohibitionist laws cause harm, because, for example, they oblige prostitutes to work in dangerous conditions and oblige drug users to obtain their drugs from unreliable criminal sources

Note I do not assume all prostitution is illegal

Laurel Bush (talk) 12:39, 2 March 2009 (UTC)

Looks good. Its better then the "Harm reductionsist contend..."-thing anyway. Steinberger (talk) 13:55, 2 March 2009 (UTC)

Cheers
I have decided to try changing the intro
Laurel Bush (talk) 14:51, 2 March 2009 (UTC)

Introduction Paragraph

I've seen a lot of discussion about the first paragraph, but some of the information is wrong and needed a tweak. here are the rationale for my edits.

• Harm reduction is set of policies based on research and evidence. There should be little to no room for "supposed harm"

• Harm reduction is not strictly concerned with illegal activities, the focus is on risky or harmful behaviours. Most areas of harm reduction have some illicit element to them, but it is the risk not the illegality that is the qualifier

• Harm reduction does not require abstinence, that would cease to be harm reduction. it aims to try and protect people while they partake in the harmful behaviour. So later, when they no longer want to take part in that behaviour, they are still alive/better off than without harm reduction.

• Harm reduction is a public health initiative, it does not seek to break the law. There may be "guerilla harm minimisation" organisations in operation, but they are operating outside the public health framework, for example, the same as doctors who perform organ trafficking transplants are not working as health professionals.

• Methadone and other opiate substitute treatments are not harm minimisation. they are strictly controlled medical treatments.

--rakkar (talk) 12:43, 25 March 2009 (UTC) I reverted the changes made to the opening paragraph this afternoon. While I acknowledge what it was trying to say, it was unsourced, in the wrong part of the article and was attempting to create unfounded controversy. It also made the opening sentence very clunky.--rakkar (talk) 07:43, 1 April 2009 (UTC)

Number of safer injection facilites

The number of 47 SIFs worldwide is too low. There are 18 in Switzerland, 16 in Germany, 16 in the Netherlands, thats 50 in those 3 countries already.

Article too broad

I think this article should be entirely about harm reduction as part of an evidence-based national drug policy. At least that is the way the term is used in discussions, like at the recent UNODC conference in vienna. Decriminalization is separate thing, although some form of localized toleration is needed e.g. to maintain a safer injection facility.

Decriminalization is more of a means to reduce the harm done by prohibition (e.g. through incarceration) than a means to reduce the harm done by drugs. In Switzerland they tried decriminalization first (needle park comes to mind) and then abandoned it to implement harm reduction strategies. Now h.r. is one pillar of their national drug policy, but repression remains another. --Hisredrighthand (talk) 10:44, 4 September 2009 (UTC)

Harm reduction, or harm minimisation, . . .

Can "or harm minimisation" be removed from the opening sentence please? Harm Reduction & Harm Minimisation are not the same thing. Harm Minimisation is a threefold model which is inclusive of Harm Reduction, Supply Reduction & Demand Reduction. See the "Policy Response" section of http://en.wikipedia.org/wiki/Illicit_drug_use_in_Australia for clarification. Thanks, Swampy 203.48.101.131 (talk) 23:41, 20 September 2009 (UTC)

Opinions wanted at related article

The Safer sex article, which this one summarizes, has suffered from edit warring and talk page mis-communications for a while. One of the issues appears to be whether the article should be primarily about what the idea is, or about what the name is (and the many, many, slightly different definitions). There are legitimate reasons for Wikipedia to have articles about ideas, and also to have articles about terminology/definitions (e.g., for obsolete medical terms). Talk:Safe sex#Scope_of_the_article asks any and all editors to express an opinion about what they think the proper scope of the article is. For example, you might think that the article should be about the term, or about the idea as most commonly understood ("how person A can avoid catching a disease from person B, who is infected"), or about something else (e.g., rape avoidance, or emotional safety in sexual relationships, or pregnancy prevention).

Whatever your idea, if you want to express an opinion, I'd be happy to hear it. (Please respond at Talk:Safe sex, not here.) Thanks, WhatamIdoing (talk) 05:51, 23 September 2009 (UTC)

Evidence & validity of Harm Minimisation as public health

I've just removed a large number of edits to the page. I've included below my specific reasons for each section, but in general it harks to wider debates about Harm Reduction. Wikipedia is not a battleground for this topic, but rather it should seek to portray each side as objectively as possible. I'm happy for the article to include the perspective Minphie wants to write, however it needs to have good references (as opposed to some of the bad ones pointed out below) and should avoid weasel words.

... Where Harm Reduction is used to alleviate the harms of illegal practices or behaviours, critics () of the approach cite concerns about its strategies sending a message of sanctioned acceptance of the very behaviours which the community, through its legislators, do not accept. (References?)

...

Critics of this intervention cite the high costs to any community providing heroin maintenance programs. For instance, the British heroin trial initiated in 2005 costs the British government £15,000 pounds per participant per annum. (Adam Baxter's article actually supports opiate treatment as having better financial outcomes for the community and psychosocial outcomes for the client. This article appears to have been deliberately misquoted by Minphie to say that heroin treatment is costing the community money when in fact the author says that prescription heroin has huge savings in the long run.)

The trial claims that the illicit heroin use of participants is reduced from £300 to £50 per week, that is from £15,600 acquisitive crime per year to £2,600 per year. Yet for the £15,000 investment, the community is still £2,000 worse off in terms of ongoing acquisitive crime.(This simplistic maths classes as original research. Academics spend months producing research to support claims like this, it's not verifiable to make assumptions like this.)

Alternatively, Sweden’s policy of compulsory rehabilitation of drug addicts has yielded the lowest illicit drug use levels in the developed world. (Firstly, on what page of this mammoth document is this fact drawn from? Secondly, Sweden is not opposed to harm reduction at all - http://www.ihra.net/Assets/1556/1/HarmReductionPoliciesandPractiveWorldwide5.pdf ) ... Critics of this harm reduction intervention reject the harm reductionists’ (What is a harm reductionist? Another weasel word) claims of ensuing lower rates of blood-born viruses on the grounds that there has never been a weight of scientific evidence which supports the claim. See Needle Exchange Programme for discussion of the evidence. (Needs to be referenced properly.)

... Critics of this intervention point to evaluations of safe injection sites.

For example, the 2003 evaluation of the Sydney Medically Supervised Injecting Centre[13] found:

○ that there was no evidence that the injecting room reduced the number of overdose deaths in the area (p. 60)

○ no improvement in ambulance overdose attendances in the area (p. 60)

○ no improvement in ambulance overdose attendance during hours the injecting room was open (p.60)

○ no improvement in overdose presentations at hospital emergency wards (p. 60)

○ no improvement re HIV infections (p. 71)

○ no improvement in Hep B infections (p. 72)

○ either worse or no improvement (depending on the suburb studied) in new Hep C notifications (p. 80)

○ discarded syringe counts on street reduced only in line with reductions in numbers handed out due to heroin drought (p. 123)

○ drug-related loitering and drug dealing worsened at the station entrance immediately opposite the centre (p. 147) (As for this section, I don't have the time to address each one, however the general consensus regarding the matter is that the first evaluation had methodological flaws which have been corrected in later evaluations. See Dr. Van Beek's book, Eye of the Needle [[1]] around page 85 for further info. Secondly, the centre has been running for seven years since that report came out and there is more evidence of the positive outcomes the centre achieves.)

An analysis of this evaluation by an epidemiologist, addiction medicine practitioner, and social researchers and practitioners found overdose levels in the MSIC 36 times higher than on the surrounding streets of Kings Cross, with clients averaging only one in every of their 35 injections in the room, evidencing low utilization rates in light of the ever-present risk of fatal overdose to each heroin user.[14] Testimony of ex-clients of the MSIC reported to the NSW Legislative Council[15] alleged that the extremely high overdose rates were due to clients experimenting with poly-drug cocktails and higher doses of heroin in the knowledge that staff were present to ensure their safety. (Hansard is a good source for references, however the section in question was a comment made by a former client. No analysis or research was included. There are many other comments from current and former clients who strongly support the centre however they are of no more value as references than my opinion or Minphie's)

The 2003 evaluation noted that, “In this study of the Sydney injecting room there were 9.2 heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.[16] (Overdose does not equal death - the MSIC reports clinical overdoses which are very precisely assessed and recorded. Overdoses on the street are not. Also, see previous comment about the 2003 report.)

It is this injecting room effect of increasing the trade for local drug dealers that has been condemned by critics .

... --rakkar (talk) 13:41, 18 January 2010 (UTC)

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I am returning text vandalized by Rakkar on the grounds that there is no substance to his rationales for removing text. It is not enough to dream up some sort of fanciful rationale, not based in fact, as reason for removing carefully cited and factual information from Wikipedia.

1. Rakkar removes text because specific critics have not been named for a very general criticism of harm reduction. I point out that if a critique of a particular intervention is typed into Wikipedia that there is ipso facto 'critics' of the view. Thus the term 'critics' is accurate, not requiring further elucidation, where a valid criticism is entered into the text. Valid criticism is judged, of course, by the logic or evidence adduced. Therefore the paragraph "Where harm reduction . . . " is correct and needs no further citation. I could of course add some of the organisations, such as the many involved in the International Taskforce on Strategic Drug Policy, or the UN International Narcotics Control Board, that do make this critique, but it would be entirely superfluous to the argument.

2. Rakkar again appeals to unspecified 'critics', but because there is a criticism entered into the text 'critics' are in fact already validly implied.

Further Rakkar appeals to the private perspectives of a staff member in the program, Adam Baxter, wishing to promote his private views of cost effectiveness over the very clear mathematics that are related in newspaper articles elsewhere quoting John Strang, the leader of the project. It should be noted that until there is a peer-reviewed journal article on the outcomes (psycho-social or whatever else) on this project, we cannot take the private views of a staff member as guidance for Wikipedia. Presently, there is no journal article on outcomes, only Strang's financial comparisons in a media release.

3. It is not enough to remove a properly cited fact ie Sweden having the lowest drug use levels in the OECD, as found in the comparison figures of the UN World Drug Report (pages are given in the citiation). To remove this text, the onus is on Rakkar to disprove the UN World Drug Report data. And of course my statement is correct, so cannot be removed by whim or unfounded contentiousness.

4. See above on the use of word 'critics'. Again a clear and valid criticism is outlined, so there are ipso facto critics.

5. The term harm reductionist is an accurate title, used by the movement itself. Just as those who advance prohibition are called prohibitionists, with no concern about the labeling by its proponents, Rakkar's criticism of the term is unfounded. Of course, Rakkar is welcome to change the term to 'proponents of harm reduction' if he wishes, but to remove a whole paragraph is clearly vandalism.

6. Rakkar removes a section on needle exchange, in which the linked article on Wikipedia is very tightly and carefully referenced (at least for the critique part of the article). If Rakkar removes this section again I will take the right to reproduce ALL the needle exchange references on that other WIKIPEDIA page, making it a much more cumbersome article, but all the more damning of the intervention.

7. Critics of the safe injecting sites are many, but again who they are is not germane to the critiques. The critiques speak for themselves. Drug Free Australia's website carries a comprehensive critique, of course. Rakkar has removed the entire added text on suppositions simply not supported by fact. This is clear vandalism.

a. Stating that the first evaluation had 'methodological flaws' is no reason to remove the facts. In fact, every one of the cited facts from the evaluation, where each can be checked according to the page number listed, has not been contested by anybody. Dr van Beek has taken issue with the estimate of users in Kings Cross on a daily basis, from which overdose statistics are extrapolated, but has not taken issue with any of the data that Rakkar lists above his fanciful criticism (above).

b. If Rakkar wants to take issue with the overdose statistical comparisons he is welcome to add, in brackets, that Dr van Beek, Medical Director of the MSIC, has questioned whether the evaluation estimated too high a number of users in Kings Cross on a daily basis, but there is absolutely no justification for removing something which is entirely factual, as per the 2003 evaluation. Even when van Beek's concerns are taken into account the number of overdoses inside the room remain many times higher than on the streets. This discussion can be found on Australia's Update listserver.

c. Rakkar quite evidently has no idea whatsoever as to what is in later evaluations on the MSIC, guessing at their contents for the sake of contentiousness. There is only one, Evaluation 4, which has data which contradicts anything in the 2003 first evaluation. This is the statement that ambulance callouts have dropped by 80%, (but which is clearly the result of the heroin drought - heroin deaths AUSTRALIA-WIDE dropped by 75% in the same period, so we would expect ambulance callouts to drop similarly whether there is an injecting room or not in Kings Cross). Also there is data in Evaluation 4 that quite intriguingly conflicts with the first evaluation, whereby no. 4 states that the Kings Cross area had a greater drop in callouts than other adjacent suburbs. The 2003 evaluation said there was NO DIFFERENCE between Kings Cross and adjacent suburbs, while Evaluation 4 has a graph showing differences. Who are we to believe? This is not for Wikipedia to resolve. And there is no case for removal of a factual statement by Minphie.

d. The testimony of ex-users is extremely important. These are ex-clients who have gone to rehab, and who are more likely to speak with honesty and candour. The debate in NSW Parliament is as good a reference as is required for this kind of evidence, and Rakkar cannot remove the sentence simply because he doesn't like the reality.

e. Rakkar's intended rebuttal of overdoses inside and outside the room shows no basic understanding whatsoever of statistical comparisons. These comparisons were checked by one of Australia's most internationally renowned epidemiologists, Dr D'arcy Holman of WA Uni, and his e-mail to Drug Free Australia can be found on the Drug Free Australia full analysis website documentation.

Minphie —Preceding unsigned comment added by Minphie (talk •contribs) 11:30, 1 March 2010 (UTC)

---

I've changed the article somewhat. Minphie has reverted the article again, so rather than start a revert war, I've tagged some of the weasel words in the article as well as some of the unverified claims. It's been good actually, I've tagged a few other unverified claims already in the article. I don't want to spend hours arguing every point above, and I don't want this to turn into an edit war. Minphie's edits have a place in this article, hopefully we can all turn this into a better article. --rakkar (talk) 02:21, 3 March 2010 (UTC)

---

I have removed the spurious 'refuted' from the text re criticisms of SIFs because the cited evidence most certainly does not refute the statement that was previously written. I have also removed any reference to reduced hospital presentations because there was no data comparison available to make any such judgment.

Rakkar has cited an unpublished Addiction article which relies on the 4th Evaluation of the MSIC dated June 2007. This evaluation does claim that there were reduced ambulance attendances in the immediate area of the MSIC, a reduction of 80%, according to their figures, which also coincided with Australia's heroin drought during the period studied. It is noted that heroin deaths Australia-wide reduced by 67% over the period studied by the 4th evaluation due top the heroin drought. However it should be noted that Evaluation 4 contradicts Evaluation 1 despite purportedly using the exact same dataset. Whereas Evaluation 4 found a greater reduction in ambulance attendances in postcode 2011, which surrounds the MSIC, than in the 2010 postcode adjacent, the 2003 conclusion from exactly the same data contradicted the 2007 evaluation. The 2003 evaluation clearly says on p 49, commenting on Table 3.1 which compares ambulance attendances AFTER the MSIC opening against the heroin drought effects between January 2001 and May 2001 that "Analysis of the postcode areas 2010 and 2011 separately showed no different pattern of results" and yet the graph in Evaluation 4 shows a recognizable difference. This contradiction has yet to be explained.

Also Evaluation 4 was not able to compare Kings Cross hospital presentations with the rest of NSW and clearly says that no conclusions can be made in light of the heroin drought. —Preceding unsigned comment added by Minphie (talk • contribs) 11:51, 24 March 2010 (UTC) Signed ---minphie

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Hi Minphie, I have removed your new headings and combined each reply into a single discussion. Helps other editors know this is an ongoing conversation. You obviously fundamentally object to Harm reduction on principle, but it would be helpful if you could acknowledge that it does have it's strengths as well as weaknesses. It would be good to work together on this, I certainly acknowledge that it has failings. You're obviously fairly well up on the debate here in Australia, do you work in a related field?

1. I have removed the sentence "See Needle Exchange Programme for discussion of the evidence." again because it is not in keeping with [[[wikipedia:Summary style#References,_citations_and_external_links|http://en.wikipedia.org/wiki/Wikipedia:Summary_style#References.2C_citations_and_external_links]] Summary style]. We don't reproduce all information on a topic whenever it is mentioned, we direct readers to the main article to read further. As you noted, reproducing it would make the article cumbersome and unreadable.

1 - I have removed the sentence "(but it is also noted that data from this later study uses the data for the same ambulance services as the 2003 evaluation, but with obviously conflicting data for the years 2001 and 2002)". It obviously references something from the Salmon, van Beek et al article, but I don't know what. As noted on the edit summary, its possible to analyse the same data with different methodology and get valid results. Plus, it's probably a bit long to be in brackets.

2 - In regards to ambulance call outs, I changed the word balanced to corrected, as the conflict was not in opinion but in statistical analysis. It didn't balance the old analysis, it replaced it.

3 - Removed mention of claim in DFA pamphlet that on average users only visit MSIC for 1 in 35 injections. The maths underlying the statement is BAD, and has not been reproduced by anyone else. It assumes that EVERY client of the centre uses 3 times a day, every day. Some would use more, some would use less.

4 - Removed sentence - "and drug-related loitering and drug dealing worsened at the station entrance immediately opposite the centre (p. 147). This claim has been disproved - "[The] results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering" from From "Freeman K., Jones C. G. A., Weatherburn D. J., Rutter S., Spooner C. J., Donnelly N. The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime. Drug Alcohol Rev 2005; 24: 173–84. Here's the whole abstract "The current study aimed to model the effect of Australia’s first Medically Supervised Injecting Centre (MSIC) on acquisitive crime and loitering by drug users and dealers. The effect of the MSIC on drug-related property and violent crime was examined by conducting time series analysis of police-recorded trends in theft and robbery incidents, respectively. The effect of the MSIC on drug use and dealing was examined by (a) time series analysis of a special proxy measure of drug-related loitering; (b) interviewing key informants; and (c) examining trends in the proportion of Sydney drug offences that were recorded in Kings Cross. There was no evidence that the MSIC trial led to either an increase or decrease in theft or robbery incidents. There was also no evidence that the MSIC led to an increase in ‘drug-related’ loitering at the front of the MSIC after it opened, although there was a small increase in ‘total’ loitering (by 1.2 persons per occasion of observation). Trends in both ‘drug-related’ and ‘total’ loitering at the front of the MSIC steadily declined to baseline levels, or below, after it opened. There was a very small but sustained increase in ‘drug-related’ (0.09 persons per count) and ‘total’ loitering (0.37 persons per count) at the back of the MSIC after it opened. Key informant interviews noted an increase in loitering across the road from the MSIC but this was not attributed to an influx of new users and dealers to the area. There was no increase in the proportion of drug use or drug supply offences committed in Kings Cross that could be attributed to the opening of the MSIC. These results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering."

--rakkar (talk) 06:32, 25 March 2010 (UTC)

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In light of not being able to find the Wikipedia convention that would point readers in the Harm Reduction page to the evidence against the effectiveness of needle exchanges on the Needle-exchange programme page, I have reproduced the relevant evidence in the Harm Reduction page.

If Rakkar wants to provide a correct link to the Needle-exchange programme page he could help readers to find the information they need there rather than be reproduced on the Harm reduction page. But the removal of the link that was there serves to remove any reference to evidence whatsoever when the evidence is indeed against any claims of proven effectiveness. --- Minphie —Preceding unsigned comment added by Minphie (talk • contribs) 11:53, 26 March 2010 (UTC)

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Rakkar has removed, again, sections which are factual and cited, and I have reinstated these for the following reasons.

1. Rakkar's statement, "Later research corrected these initial findings, noting that "the Sydney MSIC reduced the demand for ambulance services, freeing them to attend other medical emergencies within the community" immediately follows my paragraph citing 4 conclusions in the 2003 MSIC evaluation which showed no evidence of change after the commencement of the MSIC.

It is a distortion to say that Evaluation 4, in 2007, corrected all of these four findings because Evaluation 4 studied only two of the 2003 conclusions, failing once again to demonstrate an effect on overdose deaths in the area, and secondly stating that there was a 20% drop in ambulance attendances which applied to the postcode surrounding the MSIC. Note that they did not make conclusions in the 2007 evaluation on ambulance attendances over every 24 hour period, and did not have comparative data to judge hospital presentations. Curiously the 2007 evaluation used the same dataset as the 2003 evaluation, and the 2003 evaluators had compared postcodes at that date without seeing any comparable differences in postcode attendances (p 49) as per the 2007 evaluation. So I have changed the wording to reflect the reality of the two evaluations.

2. Rakkar removed, in an act of vandalism, the Drug Free Australia analysis conclusion that injecting room clients had only one of every 35 injections in the room. His rationale is that Drug Free Australia worked on a multiplier of 3 injections per day to get that figure. He also stated that some users have less injections per day and some more. Drug Free Australia has surveyed users and find use of between 1 and 6 injections per day are quite normal.

What Rakkar needed to do was read the full Drug Free Australia documentation before hitting the delete key. The Drug Free Australia detailed documentation clearly states (and reproduces in screen copy from the evaluation document) that the MSIC's own 2003 evaluators used three injections per day as the realistic daily injections multiplier in their calculations. As now stated in the text, Drug Free Australia used precisely the same methodologies and data as did the 2003 evaluators. The Drug Free Australia analysis was conducted by an epidemiologist, an addiction medicine practitioner with one of the largest practices in Australia, a medical doctor/social researcher, another senior social researcher and a welfare industry senior manager.

Furthermore, the Drug Free Australia analysis was verified by one of Australia's best known epidemiologists internationally, Dr D'Arcy Holman of WA University. D'Arcy is reportedly sympathetic to Drug Law Reform, so his verification is notable. His e-mail confirming the same is reproduced in the very reference which is given for Drug Free Australia's conclusions. There really is no excuse for Rakkar to unilaterally assume what he thinks is correct without being able to soundly refute Drug Free Australia's analysis. Rakkar, read the evidence before you swing into print.

3. Rakkar further claimed that "Numerous health professionals working in the addiction medicine field have pointed out the errors in the various calculations and extrapolations in the Drug Free Australia report." There is absolutely no truth to this statement. Of course professionals in support of injecting rooms will say anything - what counts is whether they can falsify the Drug Free Australia analysis or not, verified as it is by a very eminent Australian epidemiologist. This has never been done.

The only issue of note is that Dr van Beek has taken issue with the EVALUATOR'S assumptions regarding the number of heroin users in Kings Cross on a daily basis. Drug Free Australia uses the evaluator's assumptions and data, and so Dr van Beek has claimed that the Drug Free Australia conclusions (which are absolutely and correctly deducted from the evaluation data) are based on evaluator's assumptions which may distort the picture somewhat. Even using Dr van Beeks's own revised estimates, the injecting room still has 9 times the street rate of overdoses, still hugely greater than on the street.

4. In a clear act of vandalism, Rakkar has removed a conclusion he may not like, but which is a clear deduction from the quote immediately above which comes from the 2003 MSIC evaluation itself. If the evaluation says that injecting room clients are injecting higher doses of heroin, and drug dealers are at the station opposite (as per p 147) then the clear deduction is that the drug dealers opposite the injecting room, or elsewhere for that matter, are being paid more money for the extra heroin sold which is consumed in greater quantities in the injecting room. Please leave the statement where it is - it is an absolutely correctly-deducted statement.

5. The removal of the statement about the station opposite the MSIC being a site for drug dealers and loitering is unconscionable and is an act of vandalism once again. Rakkar, please desist.

Here is the evidence with quotes directly from the 2003 evaluation.

“We’ve got problems at the entrance [of the train station] with people just hanging around. We’ve got members of the public complaining about drug users, homeless and drunks hanging around the entrance on Darlinghurst Road.” (City Rail worker, 12 months interview – p 146)”

“The police who participated in the twelve-month discussion group commented that they had received complaints from the public and the City Rail staff about the increase in the number of people loitering at the train station. They noted that, while other factors, such as police operations, would have contributed to the increase in loitering outside the train station, there was a notable correlation between the loitering and the MSIC opening times.” (MSIC Evaluation p 146)

“The increase in loitering was considered to be a displacement of existing users AND DEALERS (my emphasis) from other locations.” (MSIC Evaluation p 146)

“The train station never featured as a meeting place before. It used to be Springfield Mall and Roslyn Street.” (Police 12 month interview – p 147)

Rakkar, if you make changes like this again I am going to take this further. —Preceding unsigned comment added by Minphie (talk • contribs) 11:32, 27 March 2010 (UTC)

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Minphie, First, please be civil to me and assume that my edits are in good faith, as per wikipedia policies, WP:AGF & WP:CIV. Threatening to "take this further" doesn't make it sound like you're trying to reach a consensus here. I also moved the opening sentence that had just been written into the safer injection sites as it pertained only to SIFs. I'll have a look at the rest later.--rakkar (talk) 09:02, 30 March 2010 (UTC)

Discussion moved to Talk:Safe_injection_site#Evidence_.26_validity_of_Harm_Minimisation_as_public_health

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A Balanced introduction

Rakkar has relocated a general criticism of Harm Reduction, making it a specific criticism of SIFs particularly, when in fact the citation given as AN EXAMPLE of the criticism is used by Rakkar to justify removing the general criticism. This is simply not valid.

The rationale for moving it back is that the statement is manifestly general to ANY harm reduction for illegal activities, and drug-taking happens to be just one eminent example which is the most visible example. Not only SIFs are seen as promoting illegal behaviours, but also needle exchanges attract this same criticism, heroin prescription programs and other non-drug issues.

So Rakkar's moving this to the SIF section because the example citation focuses on SIFs in particular could appear as a cynical attempt to rid the introduction of its balance. But balance is surely what Wikipedia idealises, as does any mature discussion.

I will happily add INCB citations for other harm reduction approaches which it deems as promoting drug use, but it will only add to the bulk of the footnotes when one example suffices. Minphie (talk) 12:17, 30 March 2010 (UTC)

Minphie, I'm going to revert the changes, because I think it worked quite elegantly as an introduction to criticisms of SIFs. Can I suggest rewriting the intro with a more general focus, and quoting sources that refer to Harm Min in general rather than just the MISC.--rakkar (talk) 23:50, 30 March 2010 (UTC)

Shortening

I have started trying to shorten this article as the Safer injecting facility sub-heading was becoming longer than the Safer injecting facility article itself. I've tried to write a succint summary of the criticisms of SIFs and moved the longer discussion to the Safer injecting facility article. Minphie, all your content is there, could we resume the discussion about what to include there? --rakkar (talk) 00:27, 31 March 2010 (UTC)

Rakkar has removed the general criticism of harm reduction, refashioning it into a criticism of one intervention only. But of course the criticism is used generally, and therefore must be entered in the general introduction.

Further, Rakkar has written a totally uncited and incorrect statement alleging that Drug Free Australia and Drug Free America wish to lock up users or have them thrown into compulsory treatment. While compulsory treatment is one option that Drug Free Australia recommends on the basis of Sweden's success, (as is explained in the United Nations Office of Drug Control booklet on their successful policies), the uncited nature of the comment indicates that there is no evidence that either organisation advocates for such responses to the exclusion of a whole range of other earlier interventions. It is a clear and spiteful distortion to say that these organisations just want to lock users up and there is no place for such subjective provocation in Wikipedia.

Minphie (talk) 11:24, 31 March 2010 (UTC)

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Minphie, I haven't removed anything - everything you wrote is now located at Safe injection site. This article is a brief overview of Harm Mimisation, and detailed critical and supporting arguments are now located on the new page. I'm happy to continue working on it over there. As for the new paragraph I wrote, I didn't at all intend for it to be a one sided criticism of DFA, I intended it to be a fair summary of their position. Please feel free to rewrite the paragraph and outline what anti-harm-minimisation organisations believe should be done instead. We should just keep the content brief on this page. I haven't vandalised anything and would be happy to discuss this with other editors. Appealing to "administrators" is a last resort, and wikipedia policy directs editors to make a thorough effort to resolve these things by consensus. Sadly, we have only been discussing it between ourselves and it has descended into a fairly adversarial process. I'm going to revert the changes back to my edits from earlier today as they are not vandalism, all your content is intact on a more relevant page. If you are unhappy with my synopsis of criticisms of harm min, please re word it, but I think brevity is the key. Save the details for the main article. --rakkar (talk) 12:01, 31 March 2010 (UTC)

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I'd like to suggest the following plan for shortening & avoiding revert wars:

• The opening paragraph: We keep it as the current three line structure, and if you could write the third line outlining objections to the approach. Can you find a source that talks about general objections to the philosophy, rather than just SIFs? For example, United Nations International Narcotics Control Board only objects to a few harm min programs relating to drugs, not the philosophy in general. If you look at the other two references in the opening paragraph, you'll see that they are broad in scope.
• Syringe exchange and related programs: Currently there are two paragraphs describing NSPs and four criticising them. The article is too long, when editing the whole article, this warning is up the top- "Warning: This page is 45 kilobytes long; some browsers may have problems editing pages approaching or longer than 32kb. Please consider breaking the page into smaller sections." Can you condense the four paragraphs into one? If readers want more, they can go to the main article.
• Safe injection sites: Again, let's discuss the content later, but I feel this section needs to be condensed. I have replicated your content on the main SIFs article and we can carry on the discussion there. Could you shorten your content down into one paragraph again? And I feel that in it's current form, it's too focused on the Sydney MISC, could it be more about SIFs in general?

--rakkar (talk) 03:01, 2 April 2010 (UTC)

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I've been waiting for Minphie comment on the proposed changes above, but it's been 8 days without a reply so I've made the edits myself. If other editors don't like them, feel free to rewrite them, however, the aim of the exercise to keep them short :) --rakkar (talk) 07:31, 8 April 2010 (UTC)