Om sprututbyte – hur 8 organisationer begår harakiri

Lägg organisationerna Ungdomens nykterhetsförbund (UNF), Sveriges blåbandsförbund, IOGT NTO, Hassela solidaritet, Svenska narkotikapolisföreningen, Riksförbundet narkotikafritt samhälle (RNS), Kriminellas revansch i samhället (KRIS) och Riksförbundet anhöriga mot droger på minnet. När de försöker debattera och presentera fakta inom missbruksområdet är det förmodligen manipulerade och osanna fakta. Det visar åtminstone den senaste tidens agerande. Det handlar om sprututbytesfrågan där dessa organisationer med en dåres envishet slåss mot vetenskapen med manipulerad vetenskaps hjälp.

Detta förfarande fungerar förmodligen för de ”nyttiga idioter” som är medlemmar i dessa organisationer, de som saknar förmåga att tänka själva och leta upp källorna. I dagens SvD lyfter dessa organisationer fram två forskningsrapporter.

Det är en från den vetenskapliga tidskriften Addiction. Denna som är en sammanfattning av all känd vetenskaplig forskning om sprututbyte och som är från mars i år säger:

”The main public health implications of the findings are that a higher level of coverage of interventions, including (needle and syringe programs), is likely required to reduce blood-borne virus transmission.
(…)
there was ”strong” evidence across the reviews that needle-exchange programs reduce the sharing or reuse of dirty needles, and no evidence of harmful effects.
(…)
Palmateer and her colleagues conclude, there appears to be ”tentative” evidence that needle-exchange programs reduce HIV transmission among injection-drug users”

Om någon (t ex från de uppräknade organisationerna) behöver en översättning av dessa slutsatser så skriv i kommentarerna. Annars är det väldigt uppenbart att de slutsatser som ovanstående organisationer drar är helt i strid med vetenskapen inom området.

Vidare citerar organisationerna en forskning publicerad i tidskriften AIDS år 1999. De ovan uppräknade organisationerna försöker på Brännpunkt med citatet ”visar på motsatt resultat, nämligen att de som går på sprutbyte är smittade i högre grad” antyda att denna forskning visar att sprututbyte ger dåligt resultat och kanske t o m leder till mer smitta. De aktuella forskarna i denna artikel (1999, samt den från 1997) Dr. Martin T. Schechter och Dr. Stephanie Strathdee har utifrån annat fall där deras forskning använts i oseriöst syfte skrivit ett klargörande brev som finns i sin helhet längst ner, men där essensen är denna:

Att som organisationerna mena att sprututbyte ”should be considered harmful. This interpretation is simple, direct and straightforward.  Unfortunately, it is incorrect. (…)

to take the Vancouver data out of context, is selective and self-serving.  One shudders to think what might have occurred in this setting in the absence of harm reduction programs.”

Dvs organisationernas tolkning av denna forskning är felaktig och forskarna menar att resultatet utan sprututbytet i den miljö som undersökts skulle nog ha varit mycket värre.

Det är verkligen helt oförståeligt varför det är så angeläget för dessa organisationer att manipulera forskningsresultat. Det är dessutom olyckligt då dessa organisationer behövs i det offentliga samtalet om bruk och missbruk av sinnesförändrande substanser. Tyvärr har deras trovärdighet i stort sett suddats ut för lång tid framöver. De har gjort den socialpolitiska debatten i samhället en stor otjänst genom deras oseriösa förfarande. DET är olyckligt.

Brevet:

April 30, 2004

Honorable Elias A. Zerhouni, M.D.
Director
National Institutes of Health
9000 Rockville Pike
Bethesda, Maryland 20892

Dear Dr. Zerhouni:

We are in receipt of a letter sent to you by Mark E. Souder, Chairman, Subcommittee on Criminal Justice, Drug Policy and Human Resources.  In this letter, Mr. Souder refers to data regarding needle exchange and HIV infection derived from the Vancouver Injection Drug User Study.  His letter unfortunately contains a number of misinterpretations of these data.  As two of the lead investigators of the study [1], we are writing to provide you with a clarification.

Regarding our investigation, Mr. Souder writes ”the study found that HIV-positive IDUs were more likely to have attended NEP and to attend NEP on a more regular basis compared with HIV-negative IDUs”.  Unfortunately, there are ways to misinterpret data such as these.  The simplest misinterpretation is as follows: If a greater proportion of those who visit the NEP frequently have HIV than those who visit less frequently, then the NEP must be responsible for causing HIV infection among its attendees.  Under the circumstances, NEP should be considered harmful. This interpretation is simple, direct and straightforward.  Unfortunately, it is incorrect.

Perhaps the simplest way to illustrate the error in logic is with an analogy.  Consider hospitals and their patients.  It is clearly the case that people who are admitted to hospitals have higher death rates than people who are not admitted.  Should one conclude that hospitals are responsible for killing the patients it admits?  If so, the logical policy recommendation would be to close hospitals down.

A moment’s reflection should bring the misinterpretation into clear relief.  The reason why people who are admitted to hospitals have higher death rates than people not admitted, is that people requiring hospital admission are inherently sicker.  Indeed, that is presumably the reason they are in the hospital.  The hospital is not responsible for its higher death rates; they occur because the hospital is coping with a population in far worse health than those who remain out in the community.

Is the needle exchange program in Vancouver responsible for the higher prevalence rates of HIV among its frequent attendees?  Or is it simply the case that those injection drug users who most use the services of the NEP are the very ones whose behaviors put them at greater risk of contracting HIV?

To answer this, we subsequently conducted a comparison of the HIV behavioral risk factors in frequent versus infrequent NEP attendees within our study [2].  And as expected, we found very different risk profiles in the two groups.  With regard to virtually every risk factor we know of that puts IDUs in our study at higher risk for contracting HIV, the frequent attendees had greater evidence of each.  Specifically, when compared to infrequent attendees of the NEP, frequent attendees were younger, more likely to have poor housing situations, more likely to inject in so-called ”shooting galleries”, more likely to inject cocaine on a daily basis, more likely to be involved in prostitution, more likely to have been incarcerated in the prior 6 months, and finally, less likely to be in methadone treatment for addiction.  Is it any wonder that they have higher rates of HIV than infrequent attendees?  In fact, we went on to show that the excess in HIV rates among frequent attendees was precisely what one would expect based on their higher risk profiles.  What this article showed is that the NEP was reaching precisely the target population it sought to reach, and provided clean syringes to those most capable of transmitting the disease.  This second article [2] was not cited by Mr. Souder.

It is certainly the case that Vancouver experienced an explosive outbreak of HIV among IDUs in the period around 1996-97.  We have analyzed this and have shown that it was primarily due to a major switch in drug use from heroin to injection cocaine in the middle of the decade.  Indeed, we have published an article showing the outbreak in Vancouver was related to cocaine injection in a clear dose-related fashion [3].

That a lone NEP, with a restrictive policy of point-for-point exchange in the face of a massive cocaine injection epidemic in a setting with inadequate treatment and social support programs, failed to curb an HIV outbreak, cannot be used as an indictment of this intervention as a whole.  For Mr. Souder to take the Vancouver data out of context, is selective and self-serving.  One shudders to think what might have occurred in this setting in the absence of harm reduction programs.

Yours sincerely,

Dr. Martin T. Schechter
University of British Columbia

Dr. Stephanie Strathdee
University of California, San Diego
References:

1. Strathdee SA, Patrick DM, Currie S, Cornelisse PGA, Rekart ML, Julio S.G. Montaner JSG, Schechter MT, O’Shaughnessy MV.  Needle exchange is not enough: Lessons from the Vancouver Injection Drug Use Study. AIDS 1997; 8:F59-65.

2. Schechter MT, Strathdee SA, Cornelisse PG, Craib KJ, Currie S, Patrick DM, Rekart MLO’Shaughnessy MV.  Do needle exchange programmes increase the spread of HIV among injection drug users: An investigation of the Vancouver outbreak.  AIDS 1999; 13:F45-F51.

3. Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, Schechter MT.  Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS 2003; 17:887-93.

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