Category Archives: Drug Free Australia

Drug Free Australia’s attack on Insite really an attack on individual scientists

Posted in Anti-Drug Lobby, Drug Free Australia, Human Rights, Illicit Drug Policy, Legal, Religion by

A close look at Drug Free Australia’s recent attack on research supporting Vancouver’s Safe Injecting Facility, Insite, suggests a long planned attack on individual authors, not evidence.

Recently I wrote a piece on Drug Free Australia’s selective and misleading use of peer reviewed publications, government reports and pseudoscience to mislead readers with the claim of academic fraud and professional misconduct in the Lancet.

Their target was Insite, Vancouver’s Supervised Injecting Facility. Yet more specifically three authors of the Lancet piece, Evan Wood, Julio S G Montaner and Thomas Kerr have earned the retributive ire of Drug Free Australia’s parent body, Drug Free America Foundation. DFAF’s “division”, the Institute on Global Drug Policy fund the Journal of Global Drug Policy and Practice, which is not a journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. The JGDPP was initially funded by the US Department of Justice, presently under investigation for corruption.

One of the co-authors of the paper was Robert DuPont. Present DFAF board member, past White House Drug czar and former first director of NIDA, DuPont’s history is “impressive” but shamefully controversial. A champion of drug war tactics, the long debunked random drug testing of kids in schools and suppression of individual rights suggest he’d be better suited to the role of a cat-stroking super villain in a Bond movie.

The scale of human rights abuses and the litany of egregious conduct orchestrated by the ultra-conservatives drawn toward DFAF and the morally bankrupt satellite groups they inspire, is impressive indeed. DFAF was founded by Betty Sembler. Betty and husband Mel, both lacking any qualifications founded Straight Incorporated in 1976. Over 15 years this “coercive” rehabilitation programme, based upon the infamous and crime riddled Church of Synanon‘s approach, racked up hundreds of accounts of abuse of clients and their families. Synanon called it a day in 1989, by which time tax evasion, civil suits and attempted murder cases had eventually outshone their claims of Divine Detoxification.

Neither Drug Free America Foundation nor it’s pretend “Institute” on Global Drug Policy is a scientific organisation. The purpose of the IGDP is spelled out on the DFAF website:

The Institute is charged with creating and strengthening international laws that hold drug users and dealers criminally accountable for their actions. It will vigorously promote treaties and agreements that provide clear penalties to individuals who buy, sell or use harmful drugs. […] The institute supports efforts to oppose policies based on the concept of harm reduction.

Over recent years some rather spectacular junk science was produced by Dr. Colin Mangham, (then) president of the Drug Prevention Network of Canada. Whilst harm reduction initiatives save countless lives per year Mangham’s DPNC claims it “leads to terror, degradation and the eventual death of the addict”. Consequently Mangham writes accordingly and publishes in the discredited Journal of Global Drug Policy and Practice. In volume 1, issue 2; Summer 2007, Mangham wrote a critique of Insite’s “parent philosophy”.

In a stunning display of self sabotage he churned through 20 peer reviewed articles from journals including The New England Journal of Medicine, the Lancet and The British Medical Journal. All articles had published positively on Insite’s potential. Primarily Mangham used largely belief, irrelevance, moral outrage and assumption to mount his criticisms. The Royal Canadian Mounted Police (at that time opposed to Insite) had commissioned the review and later dismissed it themselves because it “did not meet conventional academic standards”.

It’s impossible to miss Mangham’s primary evaluation targets on his self-annointed meandering journey to Super Scientific Autonomy. Evan Wood, Julio S G Montaner and Thomas Kerr.

Conservative health minister, Tony Clement, desperate for even a hint of science to uphold the government’s case against Insite seized upon it as validation. In Canada’s National Review of Medicine, September 2007, Clement is quoted as saying to the Canadian Medical Association:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite.

The article continued:

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research Mr Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, “To see if Insite is getting people to programs to help them get off drugs.” However, the NEJM study, published June 9, 2006, concluded that Insite increased admissions into detoxification programs and addiction treatment.

The piece, written by Colin Mangham, PhD, argues that the studies carried out by researchers from the BC Centre for Excellence in HIV/AIDS and elsewhere have been flawed and misleading. Questions about the article’s trustworthiness have arisen. Dr Mangham is the president of the Drug Prevention Network of Canada, an organization run by former Conservative MP Randy White, and has previously written commentaries criticizing the philosophy of harm reduction….

Writing in Open Medicine on September 7th, 2007 Thomas Wood noted the unscientific nature and discredited status of Journal of Global Drug Policy and Practice. He further highlighted that the non scientific conservative lobby group Drug Free America Foundation and it’s ill disguised front shop (the so-called Institute on Global Drug Policy) were behind this ambitiously named “new research”. Wood calmly observed:

We stand by the published findings from the evaluation and believe that the limitations of the research are well described in these published reports. We agree with Colin Mangham, however, that there are many instances where media reports go beyond what is described in scientific studies. A colourful example of this is the large amount of media attention given to Mr. Mangham’s recent essay in the Journal of Global Drug Policy and Practice which was funded by the Royal Canadian Mounted Police.

As scientists, we are strongly in favour of scientific debate and academic critique, but we believe what is contained in Mr. Mangham’s essay falls well short of this. The paper is fraught with a host of outright factual inaccuracies and unsubstantiated claims, which we would be happy to list should the readers of Open Medicine wish. We strongly encourage the readers of Open Medicine to read Mr. Mangham’s essay alongside the various reports examining Insite’s impacts and to judge for themselves the state of the science in this area.

Yet Dr. Colin Mangham was beyond saving. None would come to his aid. From mountain top to valley floor, from deep blue sea to desert sand, from darkened ghetto to opulent penthouse from… okay, you get the idea – his demise was complete.

By September 30th, 2007 Wood, Montaner, Kerr and Mark Tyndall had submitted to The Global Journal on Drug Policy, an article questioning the conservative Canadian government’s treatment of the scientific process and evidence. The abstract includes [bold mine]:

Although the recommendations of scientific review bodies have traditionally been free of political interference in Canada, there have recently been growing concerns raised about Canada’s new federal government’s treatment of scientific processes and evidence. This concern is relevant to the scientific evaluation of Canada’s first medically supervised safer injecting facility… […]

This commentary describes what may be a serious breach of international scientific standards relating to the Canadian government’s handling of the SIF’s scientific evaluation, and the circumstances which eventually led to a moratorium on SIF trials in other Canadian cities.

The genesis of such striking criticism was the government’s observance of a single cancer in illicit drug policy. One that had metastasised into Colin Mangham’s Drug Prevention Network of Canada, DFAF’s unscientific Institute of Global Drug Policy and the dumping ground for all conspiracy pieces by those opposed to progressive HIV control and human rights observance, the Journal of Global Drug Policy and Practice. The Australian arm of DFAF is Drug Free Australia.

Added to this was a petition signed by over 130 physicians and scientists. Released the day after Clement’s speech noted above, it condemned the government’s “potentially deadly” misrepresentation of evidence for harm reduction programs. This misrepresentation encompassed “the overwhelmingly positive evidence” of Vancouver’s Insite safe-injection site.

In September 2008 The Lancet Infectious Diseases, published Illicit Drug Addiction, Infectious Disease Spread and the need for an evidence based response, by Wood, Montaner and Kerr. It included:

To our knowledge, this is the first time a lobby group such as the Drug Free America Foundation has created for itself a venue for the dissemination of opinion essays, which to the untrained eye could easily be mistaken for a scientific journal

There is no doubt that in just a couple of years, Montaner, Wood and Kerr continually exposed and dismantled a politically driven, pseudoscientific ideology and it’s masters simply by addressing the evidence at hand. One could be forgiven for thinking these chaps might be upsetting a certain group of fundamentalists.

By this time a suit had been filed with the BC Supreme Court arguing closure of Insite would violate the Charter right of Insite patrons regarding “security of the person.” As late as May 2011 the federal government was still claiming indecision of whether to keep Insite open or not. As this was in contrast to Clement’s previous statements everybody had heard enough from the government. On May 12th the Supreme Court reserved it’s decision on whether the government could close Insite or not. On September 29th, 2011 the Canadian Supreme Court ruled unanimously to uphold Insite’s exemption from the Controlled Drugs and Substances Act, allowing indefinite operation.

A win for human rights, humane disposition and indeed for evidence based public health.

Almost certainly planning revenge for months prior was a team under Drug Free Australia’s Secretary, Gary Christian. Consisting of three Aussies of biblical repute: Joe Santamaria, Stuart Reece and Gregory Pike. Also included was present DFAF board member yet past White House Drug czar and former first director of NIDA, Robert DuPont. Finally, none other than one disgraced PhD holder, Colin Mangham.

The Lancet report, Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study published in April 2011 was compelling evidence on reduced overdoses in a vicinity around Insite, and accepted by the Supreme Court. The problem for DFAF was that three of the five authors were Kerr, Montaner and Wood. The same three who had demolished so much of the amateur ideologists and DFAF’s non scientific lobby groups.

On September 13th hoping to besmirch the reputations of these men, the team struck. They released a collection of misleading claims cobbled together in a free range “analysis” enveloped in thunderously accusatory tone. It was designed to rebuke harm reduction in general and injecting facilities specifically. In this light it inexplicably republished many of Mangham’s already debunked criticisms as if new, misrepresented existing reputable studies by comparing unrelated data sets and publishing outright falsehoods.

If we dig up Clement referring to Mangham, from the National Review of Medicine September 2007, we can almost hear the echo:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite

Fortunately history did not repeat. This re-choreographed material has been addressed more than once and found to be entirely baseless on each occasion. Despite the pollution of the material by Colin Mangham’s unprofessional accounts it becomes stranger when we note the “analysis” was conducted for Mangham’s Drug Prevention Network of Canada and REAL Women of Canada (the only supporting interveners for the government during the Supreme Court hearing).

Predictably published in the DFAF funded opinion rag Journal of Global Drug Policy and Practice, it’s accompanying media release included:

Three Australian doctors are part of an international team which has exposed major, inexcusable errors in a highly influential 2011 Lancet study on Vancouver’s Insite injecting facility, errors which nullify the study’s claim that it has demonstrably reduced overdoses in its immediate surrounding area.  The international team’s analysis has been sent by the Drug Prevention Network of Canada to the Ethics Committee of the agency which funded the Lancet study with questions regarding research fraud and professional misconduct.

The article was influential in the Canadian Supreme Court hearings of May 12 this year, where the court reserved its decision on whether the Canadian Government is rightfully able to close the facility.  The Canadian government has been trying to close Insite since 2006, but has been hampered by court action by harm reduction activists.

A full two more paragraphs are spent attacking the individual researchers for acting dishonestly, much of which relies on the already debunked material from Mangham 2007. Using bitterly crude figures to inflate “overdose” deaths – including suicides and homicides – they maintain the authors “knew” they were acting dishonestly. They challenge the findings by increasing the sample area by a factor of 10, and hold this against the original sample area.

Christian’s team selectively quote the Lancet authors earlier work on displacement of users from the area due to an increase in policing. This would be a splendid point were it not that “this policing initiative ended within weeks of Insite’s opening and was not ongoing throughout the study period”. This claim was also a resurrection of Mangham’s still unpublished and disgraced 2007 academic corpse. The vicious “media release” finished:

Drug Free Australia’s Research Coordinator, Gary Christian, said, “…. Inexplicable errors and memory lapses is the price the Canadian government has paid for entrusting injecting facility lobbyists with its scientific evaluation. Activists are never likely to provide objective science and there are dozens of other Insite studies that must now be under a cloud as a result.”

A complaint was lodged with the University of British Columbia by Mr. Christian. This and the JGDPP piece were independently reviewed and found to be “without merit”.

Yet so many questions arise as to why this apparently devastating material was not presented in court. When I first asked Mr. Christian on December 2nd he took a superior tone claiming that they could not because they did not have it available until September 2011. “It would have been a good point but for you not checking your facts”, he replied. Let’s review these facts I supposedly failed to check.

On June 8th, 2011, the (new) President for Colin Mangham’s Drug Prevention Network of Canada, Gwendolyn Landolt insisted that data supporting Insite is flawed. In an extraordinary claim (for June) she asserted in a letter to Canada’s National Post that OD’s had actually increased around Insite in most years since it had opened and thus, Thomas Kerr was in error for accusing DPNC as presenting misinformation (as he had earlier done):

Mr. Kerr tried to discredit a report from the B.C. government — which stated that since the site opened, the area has seen an increase in drug-induced deaths every year — by claiming that it included deaths unrelated to drug use

I say! That claim seems to be lifted straight from Christian’s September debacle. The one they didn’t have… until, er… September. And what do we read on page 2 of Christian’s piece about “a report from the B.C. government”, also mentioned above?

The claims of this article are very curious from the outset, simply because a review of the statistics by the British Columbia Coroner’s Service, found at clearly indicates the contrary – since Insite commenced operations on 21 September 2003 illicit drug deaths have very clearly and unmistakably increased, not decreased.

Okay, the same claim. So they had access to this data 2 1/2 years before the Supreme Court sitting in May 2011. Every other accusation – the impact of policing, the supply of drugs, criticisms from Mangham go back to 2007. Other papers and studies used are also well before 2011. That the president of the Drug Prevention Network of Canada is shooting off unpublished material in response to a May 30th statement by Kerr suggests they were keeping their powder dry.

I put this to Mr. Christian on the same day he dismissed my poor fact checking (December 2nd). He replied on December 10th as follows:

I have received an e-mail back from Gwen Landolt of Real Women of Canada explaining that Colin Mangham’s work was not admissable to the Supreme Court because it was not available for lower court hearing. The truth, Paul, is that there were court-imposed limitations on evidence which have nothing to do with your fanciful fabrications here.

Okay. So the material was available (despite his earlier claims it wasn’t), but could not be submitted due to “court-imposed limitations on evidence”. My “inability to check facts” had disappeared in a puff of reality, but was now replaced with my “fanciful fabrications”. Oh dear!

Of course before the Court in May, the government was armed with the figures mentioned, but had stated it had “no evidence” to submit. So, a day later on December 11th, 2011 I replied in part to Mr. Christian:

The time to strike was in the Supreme Court. Exactly why information from 2007 (Mangham) and 2008 (BC report on OD’s) was not admissible for lower court hearing in 2011 is a question best answered by your colleagues, Mangham and Landolt. If there is a genuine technical reason I would be grateful if you could provide it.

Otherwise it must remain possible, indeed probable, that it was excluded due to a.) the paucity of evidence presented by Mangham in attempting to debunk 20 peer reviewed studies from esteemed journals, and b.) that the BC report on OD’s was irrelevant as a variable effecting the efficacy of Insite and thus the SC sitting itself.

If so, this renders Landolt’s comments to the media and your own use of both sources impotent.

Failing this, you must explain… exactly why it was unavailable given 4 and 3 years respectively to craft an effective rebuttal of Insite’s success with these figures.

What were those “court imposed limitations” and why were they not mentioned in your article or your media release which explicitly referred to the [Supreme Court] decision as influenced by the Lancet article and “harm reduction activists”?

As one may expect those points have never been addressed. No-one is any more the wiser as to why this apparently cutting edge demolition of the court accepted Lancet article, was not itself either in total or in substance, presented to the Supreme Court. Are we to believe an ambiguous and unmentioned “court imposed limitation” prevented the exposing of “research fraud and professional misconduct” by five authors in one of the world’s most prestigious journals, the Lancet? That these supposed academic crimes were overlooked by the Supreme Court of Canada, as they examined the material in question itself?

Or shall we accept the demonstrable trend and tone exercised throughout the ideological attempts to sabotage Insite, is now manifestly clear as an attempt to smear researchers and their work? As the media release claimed, “dozens of other Insite studies that must now be under a cloud as a result”.

The anti-drug brigade may be cruel but they are not stupid. I point this out to Mr. Christian very clearly above, and still await a cogent reply. An academic mirage supposedly good enough to undermine the work of five authors. But not offered in objection to their work. What then was it’s purpose?

It was clear any such opinion from known offenders would have no bearing against over 30 papers in 15 peer reviewed journals. The singular attack upon Kerr, Wood and Montaner is striking. Christian has never answered my queries, preferring to accuse me of “imaginations and suppositions” without facts. Exactly why this argument was not published anywhere until after the Supreme Court hearing has never been made clear.

Why it was not raised by DPNC or REAL Women of Canada (both for whom the final “analysis” was supposedly written) in court is unknown. “No evidence”, was the official position.

Yet Gary Christian gives the game away himself. On November 30th, 2011 I had written in response to his refusal to accept his ploy was found to be “without merit”:

You write as if Montaner and Kerr are under scrutiny. You had your chance. It and the complaint have been found to be without foundation.

He replied on December 19th suggesting conflicts of interest assumed on his part override the independent analysis of his attack. He offered two mundane sources and extraordinarily suggests intentional favouritism on the part of the University of British Columbia and independent reviewer, Dr. Mark Wainberg toward the Lancet authors:

Of course our complaint to the University of British Columbia was not progressed because Dr Mark Wainberg absolved Dr Montaner, Dr Kerr and Dr Wood of any errors in their Lancet article, claiming that it was exemplary science.

However, if you look at the relationship between Wainberg and Montaner, I think that you will find that the relationship breaches the most liberal guidelines in the corporate or political world as to who is qualified to conduct an independent inquiry. […]

Now tell me that the University of Britush Columbia’s ‘Independent Advice’ was absolutely according to the common understanding of independence.

More accusations of corruption. More suggestion of conspiracies. More of the same junk.

What were these devastating pieces of insight? At a meeting of the International AIDS society, 2009 Julio Montaner congratulates, “my friend and colleague, the esteemed Dr Mark Wainberg” on getting the conference to Durban in his capacity as IAS president. The other is a humdrum op-ed piece written with Stephen Lewis on urging the Canadian government to ensure HIV/AIDS therapies remain central topics.

To this day Gary Christian remains unapologetic and impervious to volumes of criticism and questions generated by his single opinion piece. There has been no apology, no explanation nor any correction of demonstrable falsehoods.

Attacks on Evan Wood, Julio S G Montaner and Thomas Kerr however, continue apace.

The “drug free” ideology is as free from compassion and evidence as it ever was.

Drug Free Australia manipulate, misrepresent data to discredit Insite

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Health, Illicit Drug Policy by

In April 2011 the Lancet published an article written by authors from the British Columbia Centre for Excellence in HIV/AIDS, the UBC Faculty of Medicine, the UBC School of Population and Public Health and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

The title was Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study, by Brandon D L Marshall, M-J Milloy, Evan Wood, Julio S G Montaner, Thomas Kerr was followed by a media release from The University of British Columbia which included:

Researchers compared nearly 300 case reports from the British Columbia Coroners Service documenting all illicit drug overdose deaths in Vancouver between January 1, 2001 and December 31, 2005.

Compared to the 35 per cent reduction in overdose deaths in the immediate vicinity of Insite following its opening in September 2003, overdose deaths in the rest of Vancouver declined only nine per cent over the same period. No overdose deaths have been recorded at Insite since the facility’s opening. The researchers also noted that there was no evidence of significant changes in drug supply or purity during the study period.

“This study provides the first unequivocal scientific evidence of the benefits of supervised injection facilities, and clearly demonstrates that facilities such as Insite are saving lives and playing a vital role in reducing the harms associated with illicit drug use,” says co-author Dr. Julio Montaner, director of the BC-CfE and Chair of AIDS Research at the UBC Faculty of Medicine.

The Abstract can be read here. Insite which opened in September 2003 has also been the subject of more than 30 studies in 15 peer reviewed journals. These have cited a number of benefits including increased access to rehabilitation services, detoxification, reduced syringe litter, reduced public injecting and most importantly reduced needle sharing which serves to reduce blood borne virus spread.

Background

In 2006 the new Conservative government which did not support the initiative threatened to let the site’s legal exemption lapse before the project was complete. On September 1st 2006, Health Minister Tony Clement cited a need for more research as he deferred his decision to extend the site’s legal exemption. On the same day the Government cut all funding for future research. In August 2007 two addicts and the Portland Hotel Society filed suit in the B.C. Supreme Court arguing violation of rights – “security to the person”. What followed was from a legal and human rights perspective remarkable including the May 2008 strike down of sections of the Canadian criminal code on drug trafficking and possession as a breach of the Canadian Charter of Rights and Freedoms.

The struggle between progression and conservatism continued with the federal government appealing this legal advance in human rights. The B.C. Court of Appeal dismissed this in a 2-1 ruling. The government announced a further appeal to the Supreme Court of Canada. There were nine interveners in the Supreme Court Case. Only one supported the stance of the conservative government to close Insite. That group was the socially conservative, anti-women’s rights lobby group REAL Women of Canada.

National vice president of REAL Women…, Gwen Landolt, argued against the Canadian Medical Association and other supporters. She claimed that Insite would allow users to get “worse and worse until they die” and that such facilities “are assisting in the suicide of drug addicts.” The government had to admit it had no credible research to show Insite was not working. There were no valid data to show Insite was not reducing drug related harm. In essence the government and REAL Women of Canada were mounting non evidence based claims.

The Supreme Court of Canada ruled unanimously on September 29th, 2011 to uphold Insite’s exemption from the Controlled Drugs and Substances Act. This allowed the site to stay open indefinitely. The ruling was highly critical of Health Minister Tony Clement’s application of the CDSA to Insite stating it was grossly disproportionate and undermined “the very purposes of the CDSA, which include public health and safety”.

Drug Free Australia’s Bogus Critique

Drug Free Australia (DFA) is a conservative right wing prohibitionist lobby group of loosely affiliated extremists masquerading as a quasi-official body critical of Australia’s illicit drug policy. Regarding Injecting Facilities they have a discredited history (indeed presence) in maintaining the highly flawed opinion piece Case For Closure attacking Sydney’s Medically Supervised Injecting Centre. The Drug Misuse and Trafficking Amendment (MSIC Bill) was passed in October 2010 with considerable support from then Premier Kristina Keneally, The Australia Medical Association and the Royal Australasian College of Physicians. All three along with countless other individuals, MPs and organisations rejected the efforts of Drug Free Australia under the auspices of Secretary Mr. Gary Christian to sabotage over a decade of trial success.

On September 17th 2011, perhaps in a final effort to sway the Supreme Court of Canada (at that time yet to hand down it’s decision) DFA presented a media release claiming to have “exposed major, inexcusable errors” alleging “research fraud and professional misconduct” in the Lancet paper by Marshall et al. They cited an article headed Analysis of the 2010 Lancet study on deaths from overdose in the vicinity of Vancouver’s Insite Supervised Injection Facility published in the Journal of Global Drug Policy and Practice (JGDPP).

The authors were familiar names. Dr. Greg Pike co-author of the Case for Closure, and already profiled here. Dr. Stuart Reece and Dr. Joe Santamaria, also both co-authors of the Case for Closure of the Sydney MSIC. Prohibitionist Robert DuPont, former “White House Drug War Czar” under Richard Nixon and present board member of Drug Free America Foundation and finally Dr Colin Mangham, Director of Research, Drug Prevention Network of Canada. Their coordinator was anti-Harm Reduction campaigner Gary Christian.

In a comprehensive response the Lancet authors note their methodology and data was subjected to extensive scientific peer review and that this independent process “confirmed the appropriateness of the data and methods that we employed”. They further note Mr. Christian’s source has not been subject to peer review nor published in any scientific journal.

Nevertheless this formed the basis of a complaint by “research coordinator”, DFA Secretary Mr. Gary Christian to the University of British Columbia. The media release included:

The international team’s analysis has been sent by the Drug Prevention Network of Canada to the Ethics Committee of the agency which funded the Lancet study with questions regarding research fraud and professional misconduct.

Mark Wainberg, professor of medicine and director of the McGill University AIDS Centre was called upon to independently review the matter. Wainberg reviewed DFA’s analysis, the Lancet paper and the author’s response. He concluded in part:

In my view, the allegations that have been made by ‘Drug Free Australia’ are without merit and are not based on scientific fact. In contrast, it is my view that the work that has been carried out by the team of Thomas Kerr et al is scientifically well-founded and has contributed to reducing the extent of mortality and morbidity in association with the existence of the safer injection facility. . . . The University of British Columbia should be proud of the contributions of its faculty members to the important goal of diminishing deaths due to intravenous drug abuse.

The JGDPP analysis and complaint were found to be entirely without merit and the complaint was dismissed.

Drug Free Dishonesty

Along with the Lancet author’s response and the independent review there are a number of elements which render this amateurish attack particularly offensive. As noted above the “analysis” is not peer reviewed nor published in any recognised scientific journal. It was published in the JGDPP which is a collection of non peer reviewed articles and opinion pieces. Described as a “glorified blog” by The Media Awareness Project, the JGDPP is run by DFA’s parent body Drug Free America Foundation (on whose board sits DuPont). It was initially funded by the US Department of Justice which is presently under investigation for corruption. It has an international reputation for hosting articles seeking to sabotage human rights oriented policy initiatives successful in controlling the spread of blood borne viruses. Many authors hold extreme and archaic religious and/or anti-science views.

Essentially the JGDPP piece argues that the 35% reduction in overdose deaths in a delineated area following the opening of Insite and documented in the Lancet by Marshall et al. is flawed. Tactics by which this is done obfuscate context and manipulate the import of data in such a way as to misrepresent it to the reader. By using flawed population analysis and failing to state the nature of deaths across a much larger area it seeks to claim overdose deaths increased. The JGDPP team also suggest the Lancet authors should have dismissed an entire year as irrelevant because doing so decreases the overall decline in mortality. Thus it was, in their minds, only included by Marshall et al. to skew results.

The Lancet authors note the JGDPP report:

[U]ses crude Vital Statistics data, which included all accidental poisonings to define its estimate of overdose deaths, and it did not exclude deaths unlikely to be affected by a supervised injecting facility (e.g., suicides, adverse effects of drugs in therapeutic use). We note that the REAL Women/DPNC (JGDPP) critique seeks to call into question the Lancet paper’s findings using these crude data, and then goes on to argue that the Lancet paper’s findings cannot be relied upon because they use similarly unrefined death counts. We would argue that you cannot have it both ways.

The JGDPP article also fails to admit it used crude death counts and not population-adjusted mortality rates. This fails to account the relevance of death rates in a changing population. The Lancet study used annual population estimates from Statistics Canada to conclude on overdose mortality. Most shocking however was the increase by the JGDPP authors in area consulted by around a factor of 10. The Lancet studied mortality in 41 city blocks. The JGDPP article refers to mortality in a 400 block area. This further obscures the fact that the greatest reduction in overdose is within 4 blocks of Insite and significantly decreases outside that area.

The area in green is that studied by the Lancet authors showing a 35% reduction in overdose mortality. The area in red is that used by the JGDPP authors to misrepresent the Lancet finding.

The JGDPP article was written as an analysis for REAL Women of Canada and the Drug Prevention Network of Canada (DPNC). It is demonstrably a collation of highly selective, misleading, out of context and academically discredited material. The “analysis” relies time and again on a 2007 “critique of [the Insite] parent philosophy” written by co-author Dr. Colin Mangham of the DPNC. The DPNC holds a highly partisan irrational anti Harm Reduction position claiming it “leads to terror, degradation and the eventual death of the addict”, refers to supporters of HR as “enablers” and presents a grossly distorted misrepresentation of HR on it’s website.

They are dedicated to:

…advance abstinence-based drug and alcohol treatment and recovery programs, to promoting a healthy lifestyle free of drugs and to opposing legalization of drugs in Canada.

Their Mission Statement freely includes, Lobbying in the media, at the community level and in government for the support of our stated principles. At no point does the DPNC propose to hold to an evidence based approach or accommodate advances in scientific consensus. Not surprisingly the previous 2007 article by Mangham is critical of research which supports harm reduction and Insite. Even less surprisingly it too is published in Journal of Global Drug Policy and Practice.

Along with accusations of fraud, professional misconduct and research errors directed at the Lancet authors, the media release From Gary Christian also expanded on the supposed impact of the work of Marshall et al:

The article was influential in the Canadian Supreme Court hearings of May 12 this year, where the court reserved its decision on whether the Canadian Government is rightfully able to close the facility. The Canadian government has been trying to close Insite since 2006, but has been hampered by court action by harm reduction activists.

This is extraordinary. The JGDPP analysis that has so emboldened Mr. Christian was written for REAL Women of Canada and the DPNC. REAL Women of Canada were interveners in the Supreme Court in favour of the Canadian Government. The JGDPP analysis relied significantly upon material critical of Insite produced by the DPNC in 2007. The same DPNC with a mission statement to lobby community and government. Surely the time for accusations and presentation of evidence was in the Supreme Court itself. Yet the reasons why the government could produce none of this flawed “evidence” are manifestly clear.

The JGDPP piece cites the 2007 critique of Mangham in formulating the claim that changes in policing, “could account for any possible shift in overdose deaths from the vicinity of Insite”, arguing this was intentionally ignored by Marshall et al. Mangham is also cited as refuting Insite as having any impact on public crime or public disorder. Yet the Royal Canadian Mounted Police who had commissioned Mangham’s 2007 report claimed it, “did not meet conventional academic standards”.

Although every injection within Insite is sterile and safe from contraction of blood borne viruses, Christian’s JGDPP analysis further cites Mangham 2007 in arguing:

Added to this [the impact of policing] are the spurious claims by Insite researchers that the facility has impacted HIV and HCV transmission, despite the claim being possible only if ALL injections by those HIV or HCV positive are hosted by Insite, which has rarely been the case.

Unsurprisingly Mangham’s 2007 report was ignored by Canada’s Expert Advisory Committee on Injecting Site in formulating their own report. This doesn’t stop the JGDPP piece from citing data from Canada’s Expert Advisory Committee on Injecting Site that Insite statistically saves only one life per year. It’s argued that “this would not be detectable at the population level. This estimate is backed by the European Monitoring Centre’s methodology and avoids the error of naively assuming overdose rates in the facility match overdose rates in the community.”

At first blush this sounds compelling but is in fact a rogue construct manipulating entirely different methodologies, which yield entirely unrelated data sets, to imply naivety on behalf on Marshall et al. Regardless of what is “detectable at the population level”, neither study is relevant to the other. Citing the European Monitoring Centre’s methodology is simple weasel wording applied to distract the reader from the straw man of “one life per year”.

In truth the “one life per year” comes from person to person intervention in a clinical facility. It actually underscores the safety of the Insite environment in averting dynamics which may predicate a potentially fatal overdose. Community overdose rates considered by Marshall et al. cover 41 blocks surrounding Insite. The Lancet authors seek to quantify the impact of Insite’s presence on these rates.

Canada’s Expert Advisory Committee on Injecting Site is in no way at all dismissive of the “one life per year”. They write plainly [bold mine]:

INSITE staff have successfully intervened in over 336 overdose events since 2006 and no overdose deaths have occurred at the service. Mathematical modelling (see caution about validity below) suggests that INSITE saves about one life a year as a result of intervening in overdose events.

Marshall et al. write in their abstract [bold mine]:

We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city.

Furthermore it is interesting that the EMCDDA 2004 report notes such rooms can be expected to reduce high-risk behaviour beyond the consumption room setting itself and reduce exposure to and transmission of drug-related infectious diseases [p.25]. On public order and crime the same report lists two main objectives of 1.) to reduce public drug use and associated nuisance and 2.) to avoid increases in crime in and around the rooms [p. 61].

It should be noted each of these four points is in dissonance to the position of the JGDPP authors and every point they cite from Mangham 2007. More so, as noted during the Supreme Court Case the Canadian Government and the government’s only supporting intervener REAL Women of Canada, chose not to produce Dr. Mangham’s 2007 report. They effectively admitted they had no evidence to support their case to close Insite. As such it is remarkable Mr. Christian relied so heavily on Mangham to argue there were, “questions regarding research fraud and professional misconduct.”

Mr. Christian’s problem is not that the Canadian Government, “has been hampered by court action by harm reduction activists” since 2006. It is the simple reality that despite having had five years in which to produce convincing evidence in a court of law to close Insite, the Canadian Government has been unable to do so all the way to the Supreme Court of Canada. Apart from criticising Clement for undermining the purpose of the Controlled Drugs and Substances Act the ruling also acknowledged the dysfunctional nature of the prohibitionist mindset, stating:

…the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.

Other shonky tactics employed by Christian’s team include intentionally misrepresenting the findings and recommendations of other research. In attacking cost effectiveness of sterile injecting the JGDPP report states:

The 2009 Andresen and Boyd cost-benefit study calculated savings to government from 35 supposed HIV/AIDS transmissions averted by Insite annually, despite the most authoritative international review to date not finding any demonstrated effectiveness of clean needle provision reducing HIV transmission via needle exchanges.

This is a misrepresentation of the cited IOM review. Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence, states:

The report provides evidence-based recommendations regarding drug dependence treatment, sterile needle and syringe access, and outreach and education. The report urges high-risk countries to take immediate steps to make effective HIV prevention strategies widely available.

Page 2 of the report brief includes [bold mine]:

Avenues for making clean injecting equipment more widely available—and thus reducing drug-related HIV risk—include needle and syringe exchange; the legal and economical sale of needles and syringes through pharmacies, voucher schemes, physician prescription programs, and vending machines; supervised injecting facilities; and disinfection programs….. Multi-component HIV prevention programs that include sterile needle and syringe access are effective in reducing drug related HIV risks such as the sharing of needles and syringes.

Gary Christian also claimed in his media release as part of the allusion that policing, not Insite had caused a reduction in mortality:

These researchers cannot truthfully claim they knew of no policing changes in the immediate area around Insite when some of their number produced an indignant study condemning the changed policing.

Yet in their response the authors indicate that the police initiative referred to ended “within weeks” of Insite opening. It was not ongoing during the study – which is what Christian’s team had falsely suggested. More so if the crackdown was the cause of a reduction in mortality after Insite opened then it was the cause of an increase in overdose deaths in the area prior to Insite opening. Even more crushing for Gary Christian, is that this means the decline in drug related overdose clearly demonstrated in the Lancet occurred because the policing initiative ended.

Perhaps most scurrilous as mentioned above is the suggestion by Gary Christian’s JGDPP team that the Lancet authors included 2001 in their methodology in order to skew results in favour of overdose reductions. The JGDPP report suggests a review from 2002 onwards would show an increase. Yet the Lancet authors had written an earlier report in 2009 showing stable use from 2001 to 2005:

As shown in a figure from that report (below), although the proportion of IDU reporting daily heroin use declined from 1998 to 2001, the proportion of IDU reporting daily heroin injecting remained stable from 2001 to 2005 (i.e., the period considered in our Lancet study).

Figure showing that daily heroin use from 2001 to 2005 remained stable

Whilst this is a look at the most prominent manipulations and misrepresentations authored by Gary Christian’s team a quick reading of the Lancet author’s response – below – reveals a more comprehensive overview. Accusations of careless assessment are put to rest and a read of the original paper shows the lengths gone to in the Discussion to acknowledge other factors that may contribute to a reduction in drug induced mortality. There are also many other absurdities presented in the JGDPP article (such as “recommended reading” and citing a speech by “Christian voice in politics”, Gordon Moyes) that must condemn Christian and his team even further.

Of course like an antivaccination lobbyist Christian has not budged an inch, still insisting he is completely correct and that peer review and science itself is flawed. Now, in the shadow of their complete demolition we can review the hypocrisy and misplaced confidence of Mr. Christian in his ability to scam the public and academics alike.

 Activists are never likely to provide objective science and there are dozens of other Insite studies that must now be under a cloud as a result.

Drug Free Australia has never produced any science and peer reviewed research. This shows their inhumane prohibitionist world view as without merit, and data supporting Insite as entirely safe.

Bad politics vs good drug policy and prison health

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Health, Human Rights, Illicit Drug Policy by

Australia’s National Drug Strategy consists of the three pillars of Harm Minimisation

To hear major parties speak of Australia’s national drug strategy one may be forgiven for assuming it is a competition of muscle. To be sure, we’ve come a long way since the great stupor of the Howard years, as then federal Health Minister, Tony Abbott taunted Opposition leader, Kim Beasley for being “soft on drugs”. Translation? Taking the evidence based advice of global drug strategists.

Terrified of losing votes, Beasley all too readily took the bait. In this way successive debates and policy changes had a ratcheting effect on absurd non evidence based and wasteful attempts to be seen to be “tough” on drugs. Manfully tearing up cannabis plants and thrashing them against rocky outcrops or cursing at bags of cocaine aside, it follows quite logically that “tough on drugs” is nothing less than tough on people.

Should Abbott become PM we will quickly find that there is more to Aussie politics than just carbon taxes, boat arrivals and the odd NBN slur. It wasn’t just Howard’s homophobia, weapons of mass destruction lies and black and white 1950’s relativism we’d woken up from. Howard’s skill as a politician is rivalled very well by his inability to understand the 21st century. Indeed, perhaps the last third of the one before.

I’m not suggesting drug policy should become a national focus to the exclusion of any other policy. It never will. Yet, the list of human rights abuses ushered in by stealth and without reason under Howard is a long one. It was Tony Abbott himself who funded the extreme right evangelical lobbyists, Drug Free Australia with the explicit aim of destroying Neal Blewett’s 20 year old successful policy of Harm Minimisation. Howard’s sabotage of our role as world leaders in Harm Reduction is legendary.

Even in 1997 going against the advice of then health minister Michael Wooldridge, and taking that of (later) DFA board member, evangelist and disgraced Salvation Army Major, Brian Watters (initial Chair of the ANCD) to dump the heroin on prescription trial. From The Politics Of Heroin – ABC 4 Corners:

KATE CARNELL: The approach that we put, or I put, to that meeting, was that this was a small trial, only 20 people or so in the first instance. That the trial would be a medical trial with appropriate science backup.

ANDREW FOWLER: The vote came as a huge surprise. The Federal Health Minister, four States and the ACT voted for the trials to go ahead.

A 6-3 result. The decision marked a radical shift in policy.

KATE CARNELL: This is not just a heroin trial. It’s an integrated, national approach that brings in the majority of States in this country. I think it shows a huge amount of maturity and it really is a mammoth step forward.

ANDREW FOWLER: The Federal Health Minister, Michael Wooldridge, telephoned the Prime Minister to tell him the news. But a few minutes later, as he made his way back into the meeting, observers say he looked shaken.

Nothing to this day has beaten Bronwyn Bishop’s 2007 Parliamentary Committee Inquiry. A despicable abuse of our parliament and the role of standing committees, the final report was rejected by every D&A body in Australia. All except our installed enemies of humane policy, lobbyists Drug Free Australia. As Chair and at John Howard’s urging she intoned to field experts that, “the PM says he doesn’t want that” (Harm Minimisation), sounding much like an Inquisitor instructed to reject reference to heliocentrism. That this was her governments policy was entirely lost on her. It was a predetermined farce to attack progressive successes, and demonstrably so.

Her attacks upon Alex Wodak‘s internationally respected skill and evidence in favour of biblical stories from fundamentalist zealot Dr. Stuart Reece, left jaws agape. A bastard baptising, bible wielding, Jesus summoning fruit cake who’d knocked off 25 of his patients in 20 months with reckless naltrexone treatment. The investigation into which he described as “a conspiracy”. “They’re only drug addicts anyway”, he informed a grieving parent who later wrote to me.

As reported in Crikey by Ray Moynihan in Naltrexone II: no trials, just the power of prayer:

In lengthy evidence to a current parliamentary committee inquiry into illicit drugs, being run by Bronwyn Bishop, Reece suggested one of the biggest problems at the moment was a disease called “drugs, s-x and rock and roll.” As part of his evidence, Stuart Reece cited Sodom and Gomorrah, the Biblical cities destroyed by God for their immorality.

Reece’s testimony then suggested Australia’s civilisation was under threat of being destroyed by the scourge of injecting rooms, give-away syringes, and methadone. These of course are the well-established strategies of “harm minimisation”, the approach that underpins the way Australia deals with the dangers of illicit drug use. In contrast to his attacks on harm minimisation, Stuart Reece spoke reverentially of the work of Dr George O’Neil, and the immense value of the still unproven naltrexone implant.

Asked during an interview whether he currently prescribed naltrexone implants to heroin addicts, Dr Reece answered cryptically, “Yes and No”.

Suffice it to say, Reece as a member of Drug Free Australia still marches front and centre with the most dangerous and most irrational opponents to Harm Minimisation. Our National Drug Strategy. What they call “the noramlisation of illicit drug taking”.

However, the Public Health Association report below on the proposed Needle, Syringe Program (NSP) trial at the Alexander Maconoche Centre is clear:

The Australian government web page on the National Drug Strategy (NDS) identifies that

“the National Drug Strategy, a cooperative venture between Australian, state and territory governments and the non-government sector, is aimed at improving health, social and economic outcomes for Australians by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in our society”. (Australian Government Department of Health and Ageing-DoHA, 2011)

The NDS is based on three inter-related strategic approaches to dealing with drugs in our community – the NDS refers to them as the “three pillars” of the overall approach of harm minimisation.
Harm minimisation, therefore, is our agreed national approach to drug policy which encompasses the three pillars of:

Demand Reduction

Demand reduction to prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs; reduce the misuse of alcohol and the use of tobacco and other drugs in the community; and support people to recover from dependence and reintegrate with the community. To achieve this requires effort to:

  • prevent uptake and delay onset of drug use
  • reduce use of drugs in the community
  • support people to recover from dependence and reconnect with the community
  • support efforts to promote social inclusion and resilient individuals, families and
    communities

Supply Reduction

Supply reduction to prevent, stop, disrupt or otherwise reduce the production and supply of illegal drugs; and control, manage and/or regulate the availability of legal drugs. To achieve this requires effort to:

  • reduce the supply of illegal drugs (both current and emerging)
  • control and manage the supply of alcohol, tobacco and other legal drugs

Harm Reduction

Harm reduction to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs. To achieve this requires effort to:

  • reduce harms to community safety and amenity
  • reduce harms to families
  • reduce harms to individuals

Our NDS does not simply limit its scope to the broad community but states categorically:
“The approaches in the three pillars will be applied with sensitivity to age and stage of life, disadvantaged populations, and settings of use and intervention”. (DoHA 2011)

Over the years we’ve had the rants of Alan Jones and John Laws. The rubbish of Piers Akermann and Andrew Bolt. The fear mongering of the anti-science mob. Still many fail to appreciate not just good policy but the responsibility under human rights which (as I’ll get to in time) is exactly what Alexander Maconochie is about. Right down to using the name of the great penal reformer himself.

This Lateline segment from October 2009 gives excellent insight. On October 2nd 2009 they reported, “The Australian drugs conference in Melbourne has today called for a trial of needle and syringe programs in Australian prisons. One in three Australian inmates has hepatitis C, and it is thought that a needle and syringe program could reduce the incidence of blood-borne viruses in jail.”

Resistance born of political will, not evidence, continues today. It will be a great shame if ignorance prevails.

Lateline

Public Health Association Report on NSP Trial at the Alexander Maconochie Centre

Needle, Syringe Programs needed in Aussie prisons

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Health, Human Rights, Illicit Drug Policy, Science by

Needle Syringe Programs in prisons have proven successful across the globe, including in Iran.
Gains are directly transferred to
individuals, family members, community members, custodial officers, law enforcement officers and health professionals.

Australia once led the world in Harm Reduction initiatives, a number of which pertain to safe injecting of illicit drugs.

Because of the illegality, potential for tragedy and high risk associated with IV drug use it is very easy to be led astray from the evidence base supporting harm reduction initiatives. Primary amongst these is the funding of over 1,000 Needle, Syringe Programs (NSPs) across Australia. Although introduced against considerable opposition, community acceptance is now very high. More to the point, similar misinformation and conservative opposition was raised against another harm reduction initiative when introduced. Condom use amongst men having sex with men (MSM).

Harm Reduction measures were introduced by then federal health minister, Neal Blewett in 1985, ushering in unprecedented acceptance, understanding and management of high risk behaviour leading to the spread of HIV in Australia.

Led by the Minister for Health under the Hawke government, Neal Blewett, Australia undertook several unprecedented and pragmatic steps: it introduced a needle exchange program for intravenous drug users, encouraged open discussion of safe sex, and created the famous Grim Reaper advertising campaign.

There was fierce opposition from the religious right, but 25 years after the initial AIDS outbreak, Australia’s decision to accept human nature in policy making has saved thousands of lives – especially when compared to the USA where ‘morality’ has outweighed practicality in dealing with the illness.

Harm Reduction (HR) is one of the three major prongs of Australia’s illicit drug policy. The policy is called Harm Minimisation. Not “tough on drugs”, not “zero tolerance”. Harm Minimisation includes Supply Reduction, Demand Reduction and Harm Reduction. Over the years the gay lobby and LGBTQ community has forged itself a formidable legal and social identity. I pity the conservative zealot who would insult their ontology. Not so for IV drug users. This is due to many reasons, the more obvious being the transient nature of drug use (experimentation), the social, professional and personal cost of outing oneself as a chronic addict, the complete lack of intention to politically mobilise and the volume of comorbid mental health problems.

To be rather crude whilst it is demonstrably bigoted to discriminate against Australia’s disabled population they are not a force of reckoning. Our communities remain poorly suited to accommodate disabilities. Stigma persists leading to discrimination and inequality.

Similarly whilst we clinically accept the disease model of addiction, many community members still remain blinded to this very real health problem in favour of pop culture “bad guy” stereotypes. This is sheer manna for those with political interests to be seen to be “tough on drugs” or who seek to exploit individuals with a range of disabilities, including drug dependence.

Most Aussie addicts are alcoholics and cigarette smokers. The bulk of public health money dealing with drug induced harm is spent here. Illicit drug addiction consumes under 5% of the total expense. Writing in, Redefining Addiction in MJA Insight Paul Haber noted:

The American Society of Addiction Medicine (ASAM) grappled with this problem for 5 years before releasing its new definition of addiction, which has stimulated interest from around the world with commentaries in The Lancet, Time and elsewhere. ASAM proposes that addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is a chronic relapsing and remitting disorder that manifests in continuing use of substances or alcohol despite accumulating harm to the individual and to others. [….]

This addiction disease concept facilitates a medical approach to management, including the need for quality evidence to support clinical interventions and it encourages engagement of medical professionals in this field. Acceptance of the disease model can also reduce the stigma of the disorders. Specific neurobiological abnormalities have been identified such as certain dopamine receptors in the reward system and these are targets for therapeutic intervention.

The funding pittance that is dealt to illicit drug harm reduction in part reflects the dwarfing of this demographic alongside drinkers, smokers and gamblers. The rest is explained in that the lions share is consumed by futile supply reduction efforts in the endless cycle of importation, distribution, dealing and administration. Demand reduction – fighting the demand for drugs through education, rehabilitation and disincentives also receives more money than harm reduction. It remains far, far too easy to raise a voice of ignorance and accuse HR initiatives of “allowing” or “encouraging” drug use.

The ABC news items below discuss the need for needle exchange programs in Australian prisons and the potential for a trial beginning in Canberra’s Alaxander Maconochie prison. It’s probable an HIV epidemic beginning in injecting drug users, and placing the wider Australian community at risk, would begin in Australian prisons. Questions are also raised as to the “shameful” state of Australia’s Harm Reduction initiatives that have fallen behind what is considered effective evidence based practice for prison population health. This is further evidenced by successful programs in other countries around the world. Needle Syringe Programs are strongly supported by a large global evidence base. Significantly, one public health success story is Australia.

Indeed return on investment research in 2009 [PDF] show that “investments in needle and syringe programs were yielding a twenty seven fold return in health, productivity and other gains.” Gino Vumbaca, Executive Director of the Australian National Council on Drugs wrote at the time:

What is striking is the level of public support for the program. The largest regular survey on drug use issues we have, the National Household Survey on Drugs, now records public opposition to the program at less than 20%. The Hawke, Keating, Howard and now Rudd Governments, as well as a myriad of state and territory governments of varying hues over the past 20 years have all lent their support to the program. For some this was in the face of strident opposition. A truly admirable achievement based on evidence, common sense and humanitarian grounds

Discussing the 2009 report findings Anex wrote:

The World Health Organization commissioned a review of evidence of the effectiveness of Needle and Syringe Programs to reduce HIV which concluded:

There is compelling evidence that increasing the availability and utilisation of sterile injecting equipment for both out-of-treatment and in-treatment injecting drug users contributes substantially to reductions in the rate of HIV transmission. Research from around the world clearly indicates that NSPs make a significant contribution to preventing the spread of HIV/AIDS and hepatitis C.

Between 2000 and 2009, the Australian Government invested $243 million in Needle and Syringe Programs. This resulted in the prevention of an estimated 32,050 new HIV infections and 96,667 cases of hepatitis C. $1.28 billion dollars were saved in direct healthcare costs. [….] The report states: “If NSPs were to decrease in size and number, then relatively large increases in both HIV and hepatitis C could be expected with associated losses of health and life and reduced returns on investment. Significant public health benefits can be attained with further expansion of sterile injecting equipment distribution.”

Countries, like Australia, that have implemented NSPs have averted HIV epidemics among injecting drug users and, therefore, the community at large.  Those countries that have not implemented these measures have often experienced uncontrolled HIV epidemics. There is strong evidence to suggest that when HIV becomes endemic among the injecting drug user community it can then spread to their sexual partners and children, resulting in high mortality rates and large social and economic costs to the entire community.

Conservative ideologues and those with vested interests in punitive measures, have attempted to discredit NSP efficacy. Nations without proper NSPs, such as Sweden are deemed in breach of the UN International Right to Health. See page 3, item D. Religious fundamentalists & other totalitarian belief systems frequently reference Sweden’s “war on people” mentality, obfuscating the human rights abuse. As revealed by WIKILEAKS, the USA work actively to sabotage Harm Reduction initiatives as part of their War On Drugs policy, citing Stockholm as a reliable ally. An excellent discussion of this matter is to be found at Neurobonkers. The Global Commission on Drug Policy has demonstrated the failure of the Drug War. [CNN News]

With respect to needle exchange, rather than advance challenges to NSP efficacy with new research the tactic of a small minority is to attack existing methodology in an out of context, subjective fashion creating the illusion of an argument. An analogue today might be “pertussis diagnoses have increased, therefore the vaccine is ineffective” – a claim advanced by comparison of unrelated data sets.

In May 2010 Norah Palmateer et al. produced a meta-analysis using what they called “Critical appraisal criteria” to challenge the methodology of NSP research. However, even whilst selecting particular modes of distribution and leaving out others, a conclusion that “New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission”, was delivered. This is scarcely revolutionary, yet is falsely cited as discrediting NSP efficacy by fundamentalist conservative groups. In truth Palmateer et al actually argue for a shift in analytical focus to biological rather than behavioural data. More so, they write:

The findings of this review should not be used as a justification to close NSPs or hinder their introduction, given that the evidence remains strong regarding self-reported IRB and given that there is no evidence of negative consequences from the reviews examined here. [….] We recommend a step change in evaluations of harm reduction interventions so that future evaluations: (i) focus on biological outcomes rather than behavioural outcomes and are powered to detect changes in HCV incidence; (ii) consider complete packages of harm reduction interventions rather than single interventions; (iii) are randomized where possible (preferably at the community level); and (iv) compare additional interventions or increased coverage/intensity of interventions with current availability.

“The findings of this review should not be used as a justification to close NSPs or hinder their introduction”. Yet this is exactly what the enemies of reason have done, misquoting Palmateer at every turn. The “AVN” of Blood Borne Virus control is a group of far right evangelical lobbyists known as Drug Free Australia. Their “Meryl Dorey”, as it were is their “secretary”, young earth creationist and climate change denialist, Gary Christian. The similarities between Dorey and Christian are striking. No medical or health qualifications, citing of global conspiracies, “social experiments” – not evidence based public health, saving Australians, provision of “truth”, attacking certain research identities, cherry picking of data and outright lies.

When a 27 fold return on investment for NSPs was claculated after years of research, Mr. Christian promptly dismissed this claiming NSPs actually serve to promote drug use and spread viruses. WHO data would prove this if properly adjusted he cried, mimicking Dorey’s claims to “properly read research”. Thus he was able to immediately dismiss what is absolute proof opposition to NSPs is baseless. Indeed, Christian went further.

Harm Reduction is the “normalisation of illicit drug use” not just correlating to, but causing a rise in drug use. Hands up if knowing about NSPs motivates you to experiment with IV drugs. This new take on “condoms cause AIDS” is demonstrably flawed. Just as abstinence, not condoms will prevent STD’s, Christian claims “free HIV testing” not NSPs or harm reduction will control HIV, citing discredited non peer reviewed sources.

Thus arguments raised against the value of exchange program efficacy in cutting blood borne virus spread are emotive, supposedly backed by misrepresented, spurious and/or biased “research” and driven by discredited, conservative fringe lobby groups.

Unsurprisingly the opposition to NSPs in Aussie prisons is based on misinformation and a lack of evidence.

ABC TV News October 15th

ABC AM Program October 15th

NSP Information, Q&A. Australian Government

Progressive policy and fundamentalist resistence

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Illicit Drug Policy by
A close look at the rejection of evidence and application of religious belief as guiding principles for members of the Negative team, in debating if drugs should be legalised. Jade Lewis, Greg Pike and Paul Sheehan.
Last post we looked at the debate All drugs should be legalised held by Intelligence Squared. One of the greatest moral, social and human rights based questions today is: Should illicit drugs be legalised?
We ask this question because the harm caused at the community and personal level by prohibition is irrefutable. To this we can add the devastating effects of The War On Drugs – crafted initially by Nixon on the back of the Vietnam war. Few realise the first head of the US Drug Enforcement Administration had his office in Saigon. Returning veterans had to produce clean urine to show they were not using heroin.
Once begun, this foreign policy bonanza worked much like Dr. Whoʼs “psychic paper” pass. Flash it at a sentry and they read whatever convinces them of ones legitimacy. But more so was the USAʼs powerful control over the UNODCP and hence, UN drug policy. Most in the Western world have knowledge of Harm Reduction. The acceptance that punitive measures for drug users ultimately inflicts personal, monetary and social cost on the wider community, and accepting use whilst minimising harm reaps benefits for all.
For this reason nations who focus on evidence and the international right to health provide clean needles through NSPʼs – needle and syringe programmeʼs. Safe injecting facilities are provided increasingly in Europe and elsewhere. Australia has over 1,000 NSPʼs and one Medically Supervised Injecting Facility – MSIC – in Kings Cross, Sydney.
These programmeʼs and facilities serve to manage high risk behaviour, control the spread of blood borne viruses, motivate/provide for users to seek treatment, and they meet community discontent arising from obvious illicit drug use. Most users can return to work, pay taxes, raise a family and remain healthy. But what of intractable addiction? More recently several heroin on prescription schemes in Europe have shown dramatic results in reducing crime, death/illness, uptake of heroin use and length of heroin addiction. Portugal has full decriminalisation and demonstrates a resounding success to date.
Once world leaders in harm reduction, Australia was ready to be the first nation since the War On Drugs began to introduce a heroin on prescription trial in 1997. Despite State government sanction of 6-3, John Howard personally intervened to stop this, and weʼve been backsliding ever since. The rise of Christian Evangelical lobbyists has caused bemusement, angst and disgust.
Australiaʼs full policy is Harm Minimisation – HM. Supply reduction, demand reduction and harm reduction. Zero Tolerance has only ever been rhetoric. Harm reduction is the least funded, with the struggle to repel supply and the education and (usually failed) advertisements thrust at young Australianʼs taking the two highest shares respectively.
Those who resist drug legalisation seek to distort the argument by misrepresenting the success of harm minimisation. Indeed despite overall reduction in drug use they fraudulently and falsely argue that HM encourages, condones, increases or has no positive effect on use. Attacks on successful initiatives with peacock terminology and weasel worded opinion pieces are common. Published as “research” these are brought up time and again.
In the case of Drug Free Australiaʼs Case For Closure [PDF] against the MSIC, written during itʼs trial status, it is simply rehashed, republished and recirculated. One speaker, Greg Pike is co-author and “statistical analyst”. Greg is best known from his role as Director of the Southern Cross Bioethics Institute, which presently promotes his part in the upcoming debate. Another co-author is the infamous “naltrexone fatality” doctor, Stuart Reece. Embattled DFA secretary Gary Christian is another.
You may wonder why, if supply and demand reduction are funded more than harm reduction, that such groups attack harm reduction – HR. My psychological profiling days may be behind me, but this is clear. HR already attracts right wing condemnation and is easy to misrepresent. The evil druggie and his/her filthy lifestyle is a false pop culture phenomenon. However, conservative Christians cast HR in pop culture format usually in the context of blaming HM. Enter the suggestion of why we need demand reduction. Young Aussies take drugs. Kids from all walks of life. From all faith backgrounds.
For the religiously conservative mind this is an affront. An insult to parenting skills, the instillation of Christian values and indeed, Godʼs work. God “cures” addiction. He does not leave vacuums of vulnerability, in the mind of the fundamentalist. Thus HM in totality is an affront to conservative Christians. Overlaying this is the fear of the success of HR education. An analogue of sex education and condom availability, no proper child would fail to just say no to sex and drugs – or rock n roll for that matter. With two down, supply reduction must be increased along with punitive measures for users. And DFA are adamant they speak for “all Australians”, promoting behaviour control: Harm Prevention.
Another speaker and DFA identity – whose intentions I kind of understand – Jade Lewis wants a drug free Australia, [surprise!] through application of biblical values and the never ending sale of her “story” on DVD. Not your story, or the story of drug policy, or evidence based material – her amazing religious conversion. Jade is ruthlessly exploited by DFA. The excessively priced, only-seen-if-you-buy-it DVD, “Golden Haze” earned Jade the title “The goose that laid the golden haze” – (more on Jade later).

Greg Pike
Greg is co-author of the Case for Closure and a crusader against humane or progressive policy and free choice. His “bioethics institute” gig is a misleading peacock in some of today’s most pressing health issues. Abortion to him is of course, murder and at one time he claimed – as a research outcome – most women do not want choice. His argument against euthanasia once included the appalling claim that a patient travelled to Switzerland – with others – to die with dignity, as “… a case of someone wanting to pursue death under activist like circumstances.” [ABC 7:30 Report Feb. 2007].

Greg Pike

The right to die for the terminally ill is supported by as many as 85% of Aussies according to some polls. The reluctance of politicians shows the grip of the Australian Christian Lobby on vote wary parties. Prior to the above debacle, Pike wrote “Once the killing starts, there’s no stopping it” in January 2007. It included;

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