NEEDLE EXCHANGE

August 22, 2017

          I have some reservations about the claim that Needle Exchange Centres  prevent the spread of HIV and Hepatitis C. There has been a significant escalation in the intravenous drug using population since the establishment of NECs. As a result of this increase in users, there has also been an increase in the number of Hepatitis C cases.

 One is left to ponder cause and effect. Studies from various parts of the world; Canada, the USA, Sweden, Italy, and Australia have found that between thirty and forty per cent of intravenous drug users share injecting equipment or materials.

So could the increasing numbers of IDUs and the fact that many users do not return their needle but reuse them be the real reason or at the very least be a contributing factor, in the spread of Hepatitis C?

It should be noted that according to Dr. Greg Dore from the National Centre of HIV Epidemiology and Clinical Research:

  • Adolescents are being infected with Hepatitis C at three times the rate that they did five years ago.

  • Rising use of injecting drugs is mainly to blame.

  • Ages 15-19 are shooting up twice as much as they did in the mid 1990s.

  • About 200,000 Australians have Hepatitis C.

  • About 11,000 are infected each year.

The general public has been lulled into a state of complacency, one could almost say acceptance of street drugs as a part of the Australian way of life.  This in turn begs the question: do young people see NECs as tacit approval for their intravenous drug use?

A recent study from the Dalgarno Institute refutes any suggestion that NEC’s have prevented the spread of Hep C. This particular report stresses the fact that the evidence does not support previous studies claiming that NECs prevented the spread of Hep C.  Even more disturbing are recent articles published in scientific journals by well known researchers and academics, including internationally acclaimed biostatisticians and epidemiologists expressing concern about the quality and proficiency and even the ethics of modern scientific research, especially in the field of illegal drug use.

There is now even some doubt about the integrity of peer review and editorial decisions that have traditionally been relied upon for impartial and even-handed reporting. Apparently in the last few decades the increasing use of meta-analysis and ecological studies has meant that the time-honoured methodologies that have been used in the past to evaluate the efficacy of scientific research no longer apply. Dr. A. Lanfranchi on a study published in the Lancet made the following statement:

“Studies that take data from many previous studies and reanalyse them (or put them into a meta-analysis) need to have sound scientific reasons for excluding some published studies. Without valid exclusion and inclusion criteria, the results can be skewed and inaccurate because they allow an author’s personal bias to consciously or subconsciously enter the selection process, thus corrupting the conclusion (and the inferences that flow from that conclusion). Undoubtedly this sort of bias is what has led some observers to call (much modern) epidemiology a pseudoscience.”

If it is proven that the establishment of NECs are based on faulty evidence this will be a terrible blow. Particularly to all the ‘novice’ drug addicts that are growing at an alarming rate and are under the assumption that NECs are protecting their interests. It could also damage the reputation of Australia’s scientific community because many major scientific authorities and governments have established Needle Exchange Centres in hundreds of cities and regional areas around the world based on the assurances of leading Australian ‘experts’ that the evidence that NECs prevented the spread of Hep C was irrefutable.

I believe that this latest development is so alarming and the stakes are so high that the only possible solution is to have a government inquiry at the highest possible level.To have any hope of achieving a honourable and authoritative decision about the effectiveness of NECs would be to invite world authorities, particularly expert biostatisticians and epidemiologists, to present their commentaries at a government inquiry. Under no circumstances should advice be sort only from Australian health bureaucrats or drug and alcohol ‘experts’.

If it turns out that NECs have prevented the spread of Hepatitis C I am sure no one would object to them continuing.  However if the results prove that the spread of Hepatitis C is due to needle sharing then these facilities should be closed down.      

                                                                                           

Another perspective.

Great emphasis is placed on the cost saving factor when presenting a case for maintaining NECs, but there has been no costing on the damaging effect these facilities have on other members of the community.

 Twenty years ago one of Melbourne’s well-known western suburbs was a place with great potential and at its centre there was a most attractive Mall. It was the focus of thriving small businesses and shops and attracted families and customers who could sit there to have lunch or enjoy a break from their shopping.

When property owners were notified that an area close to the Mall was being considered for the establishment of a needle exchange programme, I was asked to present their case at a Victorian Government Tribunal. The shop owners were opposed to a Needle Exchange Centre being established near their businesses because they believed that they would be seriously disadvantaged.

Firstly there was concern about the ‘honey pot effect’. In other words it would not only be drug users who congregate around the area but also drug dealers.

Because of this concentration of drug users, there would be drug overdoses that would require the constant attendance of ambulances and police.

There would also be the problem of dangerously discarded needles.

However their greatest concern was that having NECs in the area it would diminish the authority of police.

And this is exactly what has happened. Nonetheless authorities are establishing even more NECs and the police are directed under the auspices of these baffling harm minimisation policies, to turn a blind eye to the users and dealers. However, at the same time, the police are expected to deal with the increase in assault, theft and other criminal activities that resulted from the increase in drug using population.

Bearing in mind that  for many years I counselled and cared for heroin addicts and have great sympathy for their plight, I nevertheless believe it is totally unfair to prioritise the rights of heroin addicts over those of law-abiding members of the community. These shopkeepers are family people, educating their children, paying their taxes and contributing to the prosperity of the community. The establishment of NECs has had a devastating effect on their businesses and their quality of life. I doubt if their loss of income and stress related illnesses are taken into account when assessing the costing of NECs.

Dalgarno Institute Research Report. P.O. Box 7005 Dandenong 3175. HIVand HCV transmission among Intravenous Drug Users.

  Dalgarno Institute Research Report. HIV and HCV Transmission Among Intravenous Drug Users. P O Box 7005 Dandenong Rd. 3175.

 

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