Talk:Needle and syringe programmes/Archive 1

noncompliant tag
I removed the noncompliant tag, as per the discussion above. Anybody putting it back should discuss it here. --Storkk 16:30, 29 August 2006 (UTC)

Needle exchange kits
Much more needle exchange info is needed. About contents of the kits, how to use, photos, bleach etc. When people find these things as litter, they need to be able to figure out what they are, and how to deal with them! (Safe sharps disposal?)


 * http://www.preventionworksdc.org/supplies.html Harm Reduction Supplies - details of kits

-69.87.203.105 13:03, 25 April 2007 (UTC)
 * http://www.geocities.com/SoHo/Gallery/4239/needle.html photo of kit contents

Reorganizing and sectioning
I'd like to propose a couple of organizational changes to this page. Firstly, I'd like to suggest a new section which gathers the arguments against needle exchange/distribution and the rebuttals to those arguments. As others have noted above, the few standard arguments against exchanges are uncited, and fixing this seems to be a basic step to avoiding future accusations about POV issues.

Secondly, I'd like to suggest a section devoted to needle exchange modalities. There's currently a list of them, but I'd like to expand this list by giving details of each modality and the pros and cons of each - this is an idea proposed by Chris from Seattle / Points of Distribution at the last Harm Reduction Conference in Oakland in 2006, and I think it has merit. The idea being that this Wikipedia article would be of greater value to municipalities / public health authorities / anyone considering starting a needle exchange if they can see a list of different ways it's been set up elsewhere and what the advantages and disadvantages of these have been for others.

If no-one objects, I'll come back in a couple of days and add these sections and start filling in some of the relevant literature.

Caitifty 16:39, 15 August 2007 (UTC)

First Exchange Program
I removed the sentences citing Dr. Fraser James Stuart as the first to create an exchange program. The cited reference makes no mention of Stuart. The only relevant hit in a search at Google was this very article. If someone can point to an actual source, by all means place it back. Chemeditor (talk) 22:28, 12 October 2008 (UTC)

Dr. Fraser James Stuart started the needle exchange in glasgow out of one of his 29 drug stores called castle milk ltd the reason there is not much said about this else where is because there was a public out cry a friend of dr stuart sir kenneth calman can confirm this as dr stuart died in 2001 at 54 years old. —Preceding unsigned comment added by 77.102.63.211 (talk) 20:18, 18 November 2008 (UTC)

POV?
Perhaps the user who added the POV tag to this article might like to explain here on the talk page what they perceive the problem to be? I can't see too much of a problem with the article as it stands; if there is any credible published evidence that these schemes cause or worsen drug problems I would be happy to see the references added to the article. PeteThePill 22:11, 30 August 2005 (UTC)

Major medical organizations, like the American Medical Association, fully back needle exhange programs based on their clear and documented public health efficacy.


 * I don't see any POV either way, and I think the tag should go, especially as it was slapped on by any anon, without any discussion. Maccoinnich 12:29, 29 October 2005 (UTC)


 * I re-added the NPOV tag. This article completely skips over any objections to this type of program. There are obviously are SOME objections, because in the US, as the article states, there were general negative attitudes towards the idea, and so it was discontinued. This albeit biased site contains some interesting points that should be incorporated into the article to make it truly nonobiased. Thanks NightFalcon90909 (talk) 01:59, 2 January 2009 (UTC)
 * I'd like to reject the speakout link as a good source of information. It's an opinion article with one reference, and many of the conclusions it reaches are not backed up by evidence out there. --rakkar (talk) 04:55, 2 January 2009 (UTC)
 * Furthermore, after reading the article, I see no justification for a NPOV tag. The first two thirds is very factual, it describes what an exchange does, and is relatively free of conclusion or statements.  The final third deals more with this, and by my standards it's okay.  Perhaps the positives and negatives could be seperated more, and references.  If anyone feels that it is NPOV, maybe put a    tag above the offending section.  Thanks.--rakkar (talk) 05:03, 2 January 2009 (UTC)

Tidy Up
Hi all current editors, this article has a lot of information in it, and as the tags on the top of the article suggest, it is a little confusing. I know a lot of new info has been added & removed lately, and I think we need to go over these edits and turn them into a smoother, readable article.

My suggestions would be:


 * Break it down into headings.


 * Re-write sentences/paragraphs that have been composed by multiple editors. Some of them feel a little disjointed.


 * Look out for original research or synthesis. If we say something is so, we should have evidence to back this up instead of claiming that it's common sense :)

--rakkar (talk) 04:46, 8 April 2010 (UTC)

Misrepresentation
Years ago I posted a sentence with six links showing the efficacy of needle exchange programs in preventing HIV and Hepatitis C transmission and it has been recast with new wording (but the same links) now reads: They also point to dozens of studies which have purportedly shown needle exchanges to be effective at preventing the spread of HIV and Hepatitis C,[4][5][6][7][8][9] but these papers, taken against the entirety of adequate studies, show no conclusive preventative effect.

This is blantantly wrong and misleading. I reviewed the literature while working for the health department in Oregon and I found not a single paper which demonstrated that needle exchanges caused harm, while dozens demonstrated efficacy in disease prevention and other areas. What "entirety of adequate studies" is the author referring to. There is no citation. I am changing this to something that reflects the current state of the literature.

Ahimsa52 (talk) —Preceding undated comment added 02:30, 7 April 2010 (UTC).

I've also seen a number of similar citations I added a while back simply deleted. I think the page has attracted both outright vandals and some ideologues who don't like what they're reading but have nothing substantiative to use to make an alternate argument. Caitifty (talk) 01:58, 16 April 2010 (UTC)

Clarifying the US situation
The article says that only covert illegal programs operate in the US, but, according to [http://www.preventionworksdc.org/about.html Prevention Works! website]; "The District of Columbia is the only city in the nation barred by federal law from investing its own locally raised tax dollars to support needle exchange programs. Needle exchanges in Boston, Chicago, Los Angeles, New York, Baltimore, and Philadelphia are all supported by state and/or local government dollars." what is the law over there? also, from what I understand, the preventionworks program is fairly new, should it be mentioned on here? --rakkar (talk) 14:24, 20 January 2008 (UTC)


 * The US Federal 'ban' on using Federal money to directly fund needle exchange is still in place, which directly affects DC (where there are no 'state' taxes to provide anything other than Federal funding); all individual states at some point banned needle sales outside prescription at some point, however many (but not all) have since provided some exemption for 'authorized' needle exchange, where needle exhcnage is funded either by the state directly from state taxes and/or private foundations or donations. Caitifty (talk) 03:11, 26 January 2008 (UTC)


 * So if the article is saying that only covert exchanges exist, should the article be changed to explain what Caitifty what said? rakkar (talk) 08:47, 27 January 2008 (UTC)


 * There are needle exchange programs operating quite openly in Philadelphia. I would assume the same is true of other U.S. cities. I don't understand the "covert" analysis. —Preceding unsigned comment added by 71.203.119.71 (talk) 21:15, 29 November 2009 (UTC)


 * I think it varies state-to-state. In some states needle distribution is no problem, in other states one is required to actually have a prescription or show that they need syringes for medical reasons before they can buy or possess them. HR programs in those states sometimes have to distribute bleach instead of syringes or risk exposing their workers to legal problems. Mike McGregor (Can) (talk) 15:22, 22 April 2010 (UTC)

Problematic paragraphs
the following paragraphs here in order to discuss them: {{quotation|Dozens of peer-reviewed articles in prestigious medical journals such as The Lancet and The Journal of the American Medical Association have shown that needle exchanges reduce the transmission of HIV and Hepatitis C without increasing drug use. Critics of SEPs claim that the studies lack scientific rigor, but there have been no articles published in peer-reviewed journals that have found an increase in high-risk behavior, disease transmission or drug use because of SEP usage. Supporters of SEPs have estimated that with the aid of SEPs, the number of HIV infections could be prevented from 4000-10000 between 1987–2000. According to their analysis of New York State-approved SEPs, during a one year period, SEPs contributed directly to the aversion of 87 HIV transmissions.

New review of reviews
There's a new review of reviews by Palmateer that could be incorporated into the article. Gabbe (talk) 08:18, 7 July 2010 (UTC)


 * Actually, this whole article seems to quote individual studies (primary sources) to a high proportion in comparison with reviews and meta-analyses (secondary sources). See WP:MEDRS. Gabbe (talk) 08:43, 7 July 2010 (UTC)

a summary to the lead. Gabbe (talk) 13:56, 23 August 2010 (UTC)

Opposition section NPOV issues
The subsection titles in the Opposition section, Flawed Studies Fail to Demonstrate Effectiveness, Rises in drug use, and Discarded Needles Dangerous to the Community, give the article the appearance that it is siding with the those who hold the views describe in the section. It would be better to simply have a major section on the arguments for and against, with subsections like "Effectiveness of the programs", "Effect on drug use levels", and the "Potential risk of discarded needles to the community" that presents both the views of proponents and opponents of needle exchange programs in the same subsections because they way it is now seems to favor the opposition view. Also the way the "Flawed studies" section is currently written has some glaring NPOV issues. The section has Wikipedia arguing that key studies used in support of the programs are flawed, whereas that is something that should be left to the opposition to do. So in that section it should be rewritten so it reads along the lines of "Critics of the needle exchange programs, such as john doe, argue that key studies use to support the effectiveness of the programs are flawed". Then you can describe how they describe the flaws. --Cab88 (talk) 19:38, 9 July 2010 (UTC)


 * a lot of inappropriate material that was either WP:OR, uncited, unreliable or from primary sources, as well as findings superceded by the Palmateer review of reviews. Gabbe (talk) 13:56, 23 August 2010 (UTC)


 * I have reinstated some of the text in the Opposition section because Palmateer shows no awareness of the very serious criticisms made by Kall et al. of the WHO review, a review where Palmateer has largely accepted the WHO-nominated positive studies still as positive but nevertheless as of weaker study design. Kall shows that the WHO nominations of certain studies are invalid, no matter how weak or strong their design. I have also moved a positive statement about NSP to the section above Opposition, where it rightfully belongs, and provided better cited explanation of the point that was being made.Minphie (talk) 04:19, 27 September 2010 (UTC)


 * Text entered on September 27 must not have saved properly, so text from that date now appears.Minphie (talk) 22:17, 29 September 2010 (UTC)


 * I have undone the reversion by Ohiostandard because this contributor asserts something entirely false - the citations are clearly not for the same paper as he/she wrongly asserts, with different authors and titles on very different websites. See Harm Reduction Talk for more info.Minphie (talk) 08:06, 30 May 2011 (UTC)

Reinstatement of Käll et al study into article
The grounds upon which the crucial Käll et al study, published in the Journal of Global Drug Policy and Practice, have been removed from the Opposition section in the past have nil validity and the deleted section needs to be maintained in the text if Wikipedia readers want to know an accurate portrayal of the current state of the debate. The text below will demonstrate that the reviewing of Käll et al’s review from the Journal of Global Drug Policy and Practice (JGDPP) by the reviewer of reviews, Norah Palmateer et al, in the European Monitoring Centre’s (EMCDDA) publication on Harm Reduction in May 2010 now puts to bed all objections about the reliability or notability of the Käll et al review. Objections that this journal is not peer-reviewed likewise need to be put to bed.

Demonstrably false objection that journal is not peer-reviewed
I have previously taken the time to carefully demonstrate over on the Harm Reduction Discussion page that the assertion that the Journal of Global Drug Policy and Practice is not peer-reviewed has no basis whatsoever in fact, and that the charge has only been maintained by a spurious appeal to the clearly un-evidenced OPINION of commentators who obviously have not asked the relevant question of the journal or read its submissions page. To that end: In conclusion on this issue I believe that any deleting of the text about Käll et al by other contributors on spurious objections about peer-review from this point forward will only represent a retreat into absurdity, and I will pursue whatever avenue of Wikipedia recourse appears best.
 * 1) I had previously reproduced an e-mail from the journal’s editor, Dianne Glymph, here stating very clearly that the journal is indeed peer-reviewed.  There is no higher authority on this question than the journal’s own editor and any assertion to the contrary is simply absurd.
 * 2) The attempt in the Reliable Sources Forum and various discussion pages to elevate commentators’ or protagonists’ opinions above the testimony of the journal’s own editor are rationally vacuous and would not be entertained in any forum elsewhere, so why is it even advanced at all on Wikipedia?
 * 3)  The attempt by a contributor http://en.wikipedia.org/wiki/Talk:Journal_of_Global_Drug_Policy_and_Practice here] to elevate the unedified opinion of two researchers, Wood and Kerr,  in the Canadian Medical Association Journal, where they asserted that the Journal of Global Drug Policy and Practice “POSES as an open-access, peer-reviewed scientific journal”,  thereby claiming that the word of this medical association has more credibility than the journal’s own editor and webpage’s own statements fails on two grounds a. nothing is more authoritative than the journal editor’s own word b. the contributor failed to note that the two researchers he quotes as authoritative are the very researchers whose work is being criticised by Colin Mangham in the JGDPP – hardly a case for a neutral point of view by these two.  This appeal to their ‘greater credibility’ on drug policy issues is akin to someone quoting the UK Tories’ views against the UK Labour party’s social policies as authoritative, rather than merely being an opposing view in a conflicting argument.
 * 4) The final fall-back position for another contributor, where he/she says here about the journal’s own indisputable claim to be peer-reviewed - “ I really read it as a token to mislead the unsuspicious, then something that should be taken for real. Steinberger (talk) 23:01, 10 March 2011 (UTC)” is an appeal to suspicion. If suspicions are not valid content for any Wikipedia page because they are not verified, it is abundantly clear that suspicion can never be used as an excuse to delete properly evidenced text.
 * 5)  Another contributor’s here misunderstanding of my discussion page text, where he thought that I was trying to claim a conference speech as a peer-reviewed journal article, must be treated for what it was – a misreading by that contributor of a quite transparent paragraph that was making an entirely different point.

Käll et al a core review for second Palmateer review of reviews
In May 2010 Norah Palmateer et al published a review of reviews for the European Monitoring Centre for Drugs and Drug Abuse (EMCDDA) which was far more comprehensive in scope than the study already cited on the Needle Exchange and Harm Reduction pages, additionally reviewing interventions such as safe injection sites and substitution regimes. Chapter 5 of the EMCDDA publication here reviews 4 core needle exchange reviews, Gibson, Wodak/Cooney, Tilson and Käll.

The arguments that have been advanced by Wikipedia contributors who have deleted text on the Käll et al review have argued that any study in the Journal of Global Drug Policy and Practice must be disqualified because it cannot meet certain imagined medical standards. The second Palmateer review of reviews promotes its ‘core reviews’, including the Käll et al review, as meeting more rigorous standards than various other discarded reviews not included, clearly discounting this spurious objection. Further, Palmateer does not concur with the other spurious objection that the review derives from an unreliable source – no such criticism is entertained by her team. Nor are any NPOV issues stated. The reliability and notability of the Käll et al review is clearly established, and from a source over which there can be no quibbles regarding reliability as Wikipedia defines it.

Lastly, I note that contributor asserts that the unreliability of JGDPP has been established. I have found no consensus on Wikipedia that agrees with this assertion, and the Palmateer study establishes the opposite, that the journal cannot be carte blanche dismissed. Again, the text on Käll et al must remain.Minphie (talk) 02:05, 5 June 2011 (UTC)


 * I have also deleted the 'unreliable medical source' tags because it has been established in a previous discussion page re Safe Injection Sites here that Drug Free Australia, with its 25 national and international Fellows, the majority of whom are addiction specialists and researchers, including Dr Robert DuPont, formerly the founder and first President of the US National Institute on Drug Abuse (NIDA), is a reliable source of commentary on drug policy, but with attribution that it is an advocacy group.Minphie (talk) 02:32, 5 June 2011 (UTC)


 * Not compiant source per WP:MEDRS. Please use compliant sources. Doc James  (talk · contribs · email) 03:31, 5 June 2011 (UTC)


 * No other contributor would accept a rationale such as the one above which gives no reason for supposed non-compliance. I have given you the courtesy of a full explanation demonstrating why the source is authoritatively sourced and expect some defensible rationale on your part in return.Minphie (talk) 13:02, 5 June 2011 (UTC)


 * Steinberger, your objection re poor design is clearly Original Research which has no place in this article. With respect it could only be construed as clutching at straws to denigrate the Käll et al review, because you have elevated your own constructed surmises over the clear and plain words of the EMCDDA review of reviews' own authors where they clearly, plainly and unarguably say (page 117) that "Selected reviews were critically appraised using a tool that considers the rigour of the methods used to identify the relevant literature, the appraisal of the primary literature, the quality of the analysis in the case of meta-analysis, and the appropriateness of the conclusions (Kelly et al., 2002; Palmateer et al., 2010). REVIEWS RATED 1 OR 2 WERE INCLUDED AS HIGH-QUALITY (‘CORE’) REVIEWS. REVIEWS RATED 3 WERE RETAINED AS ‘SUPPLEMENTARY’, NOT CONSIDERED TO BE OF SUFFICIENT QUALITY TO RELY ON THE AUTHOR’S CONCLUSIONS BUT VIEWED AS PROVIDING COMPLEMENTARY INFORMATION ON THE EFFECTIVENESS OF THE INTERVENTIONS.


 * You wish to elevate your unevidenced and incorrect surmise, that the Käll et al review, as you say, "has poor design", over the plain words of the EMCDDA source. The question you need to ask is whether Käll et al is a 'core' review ie 'high quality' or a 'supplementary' review ie 'not considered to be of sufficient quality to rely on the author's conclusions.' And here is what the EMCDDA review of reviews clearly and unmistakably says on p 126, "Evidence of the effects of NSPs on HIV incidence/prevalence was considered in four core reviews (Gibson et al., 2001; Käll et al., 2007; Tilson et al., 2007; Wodak and Cooney, 2004), which included a total of 18 primary studies with HIV incidence or prevalence outcomes." So Käll et al is DEFINITELY a core review which is defined as high-quality. And there is nothing said about the design of the Käll et al review - in fact 'design' is a word largely irrelevant to the 4 reviews which are most certainly not RCT's or longitudinal studies or ecological designs - they are reviews of other studies with designs which have been deemed adequate. Your surmise from silence cannot be elevated over the clear words of the EMCDDA publication. And if you are wanting to advance an argument from silence re the last paragraph on page 127 there is certainly nobody you can cite to cover your WP:OR. Minphie (talk) 11:07, 30 June 2011 (UTC)


 * One thing first, poor is the antonym of good. And, if that is not clear enough. See Apendix 4 (page 164) in Jones et als review of review for yourself here:.
 * Then we come to Kimber et al in the EMCDDA monograph. See page 127 of the (13 in the pdf on chapter five):
 * "The United Kingdom National Institute for Clinical Excellence’ review of optimal NSP service delivery (Jones et al., 2008 [pp. 31–2]) included a review of reviews component on HIV prevention that evaluated the four reviews considered above. Consistent with our assessment, they concluded:
 * There is evidence from two good-quality systematic reviews [Wodak and Cooney, 2004; Gibson et al., 2001] to support the effectiveness of NSPs in reducing HIV infection among IDUs. However, findings from two other systematic reviews [Tilson et al., 2007; Käll et al., 2007], including one good quality review [Tilson et al., 2007], suggest that the evidence may be less convincing.
 * So, no. It is not original reserach. Maybe, It would be appropriate to add Jones as a reference. But I don't think it that is nessisary. Steinberger (talk) 22:29, 30 June 2011 (UTC)


 * Steinberger, I have taken your and Doc James' rationale for reverting/changing my text to the NOR Noticeboard for third party consideration. Meanwhile, I have reverted your tags on Drug Free Australia, which you had nominated as an unreliable medical source. This, of course, has absolutely no validity for the following reasons:


 * Calling needle exchanges a medical intervention is, as you know, a nonsense. The Wikipedia Needle-exchange programme page clearly, and correctly, nominates it as a SOCIAL policy within its first sentence. It is not a medical intervention. Yes, TREATING HIV/AIDS is a medical issue, but this is prevention at the social level, not treatment at the medical level.
 * Drug Free Australia, as has been discussed elsewhere, is Australia's foremost drug prevention peak body, and as resolved over on the Supervised Injection Site and Harm Reduction Talk pages, it is thoroughly legitimate as a reliable source used with attribution. That issue was solved a year ago with your own application to the Reliable Sources Noticeboard which got a very clear answer re Drug Free Australia's validity there - See section 'Drug Free Australia' at along with LiteratureGeek's final adjudication of the issue on the Harm Reduction Talk page - see section 'Support for Safe Injecting Sites a Minority View World Wide'  where he concluded that "Steinberger, this article is not a pure medical article, infact it is not even 50 percent medical article in my view. It has significant, political, social as well as medical implications and involvement. WP:MEDRS, only applies for when talking about specific medical statements." and " Drug Free Australia document seemed comprehensive and from my brief look the organisation seems to be notable. This source, is a government source but was part of the revert, certainly a reliable source for a criticisms section. This source, is another reliable source but was also reverted."
 * Drug Free Australia's citing of Kerstin Käll's review, which you have tagged as an 'unreliable medical source' is in turn cited on p 133 of the Federal report "The Winnable War on Drugs" by the Parliament of the Commonwealth of Australia House of Representatives Standing Committee on Family and Human Services. Notice that this Parliamentary was not a medical Inquiry, but a social policy Inquiry.


 * Please just leave the text as it is. Minphie (talk) 07:58, 3 July 2011 (UTC)


 * NEP is a social intervetion clearly motivated by public health concerns. Public health is a within a wider definition of medical - of concern to physicians or relating to heatlh (see any dictionary for this and also note that the whole concept "psycosocial" can be included in a this wide definition of medical). That in itself makes MEDRS appliceble on the sience relating to the public health aspects of it. And the statements where DFA is cited in this article, is rahter on the public health side of things, then on the public order, other social or political aspects. Steinberger (talk) 21:37, 3 July 2011 (UTC)


 * OhioStandard, DocJames, Steinberger, I believe that we are at a place where this content dispute needs the input of other parties beyond the neutral third party comment previously requested and received on the Reliable Sources Noticeboard. DocJames, you appear ready to take action and this may be a possible way ahead, so invite you to take it. I certainly feel that mediation/arbitration of the issue is the next step according to what I see in the dispute resolution policies. Minphie (talk) 08:15, 17 July 2011 (UTC)

"Arguments for and Against" not presenting Arguments for and Against
Arguments for and Against as currently written (July 5, 2012) does not present a balanced picture of the debate between proponents and opponents of NEPs.
 * The "Pro-Needle Exchange Arguments" are soundly presented.
 * The "Anti-Needle Exchange Arguments" subsection is a disorganized collection of facts on the status of Needle Exchange Programs in the US.

Arguments for and Against does not strike me as presenting in any sort of a fair fashion the legitimate concerns expressed by the opponents of NEPs. I write this as a strong supporter of NEPs, having been a major contributor to Low-threshold treatment programs (see that article's history). Stigmatella aurantiaca (talk) 23:15, 5 July 2012 (UTC)
 * I just saw this article on January 7, 2013, and I have the same complaint. The arguments against are not so much arguments against as they are the budgetary statement of the program in the US. What are rational and sourced arguments against that can be added to the article. I am uninformed on the issue.169.232.131.133 (talk) 03:24, 8 January 2013 (UTC)
 * Try Low-threshold treatment programs. I believe that this section represents a reasonable effort at a "fair and balanced treatment" as written by supporters of these programs (mostly myself). Stigmatella aurantiaca (talk) 11:41, 8 January 2013 (UTC)

Recent addition
The following was added recently by :

I moved the material here in order for to discuss it. As a bare minimum, it needs a substantial amount of copyediting before going into the article. Gabbe (talk) 22:34, 28 February 2013 (UTC)

Research on effectiveness of NEPs
I have added a section on research as this appears to have been deleted quite some time back with no apparent reason.Minphie (talk) 00:24, 9 May 2013 (UTC)
 * Drug Free Australia is not considered a reliable publisher of "research" or "evaluations" with medical implications. Neither is Journal of Global Drug Policy and Practice. You have been told this before. Steinberger (talk) 12:18, 16 May 2013 (UTC)
 * Nevertheless, the non-MEDRS-compliant Drug Free Australia pamphlet does provide URLs and partial citations to what may be considered reliable sources, both secondary and primary. Among the secondary source URLs that are still "live", the conclusions to be drawn are dramatically different from the impressions of the reports' conclusions as expressed in the Drug Free Australia pamphlet:
 * Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence
 * Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS among Injecting Drug Users
 * Stigmatella aurantiaca (talk) 13:08, 16 May 2013 (UTC)
 * I will reiterate what I stated in an earlier section of this talk page: Arguments for and Against needs contributions by editors capable of expressing in a fair and balanced fashion the legitimate concerns expressed by the opponents of NEPs. Your contribution did not constitute such an entry. Stigmatella aurantiaca (talk) 14:43, 16 May 2013 (UTC)
 * I am glad that DFA has been discredited as a reputable research body or evaluator as previous experience from countless people, regardless of whether it is in relation to Wikipedia or not, have encountered zealotry that is driven by moralism and ideology. In regard to the Research section, I have added an Expand template, as the extensive body of research that is in this field, as well as interlinked areas such as BBVs and public safety, needs to be represented in a balanced manner. Interested copyeditors will most likely need subscriptions to journals, libraries, etc, but any contributions will be beneficial; especially from those people who have access to hard copy material.--Soulparadox (talk) 14:45, 21 May 2013 (UTC)
 * Please remember that DFA is not a reliable source. Materials published by this group do not hesitate to misrepresent the scientific literature and to quote out of context to make their point. Not even the most fervent advocates of needle exchange programs has ever claimed that needle exchange programs can be the entire answer to the problem of transmitted disease among intravenous drug users, and there are legitimate questions of the effectiveness of such programs. But you weaken your case when you turn to such discredited sources as DFA for backup. Stigmatella aurantiaca (talk) 23:18, 21 May 2013 (UTC)
 * I have read the arguments of Stigmatella Aurantiaca, Soul Paradox and Steinberger above and have placed the full text I contributed on 9-10 May back on the Needle Exchange Programme page due to none of the objections being founded in fact. The text accurately reflects the science, which is the final arbiter of Wikipedia content. I shall take the objections in turn.
 * But first I should mention that when I first read Wikipedia’s pages on various illicit drug interventions some years ago I was appalled at the one-sided portrayal it gave of various harm reduction strategies. The pages were not anything approaching ‘balanced’ as the Needle Exchange Programme page presently amply exemplifies. It reads more like propaganda than an encyclopedia. And I believe that there are certain contributors who see themselves as harm reduction activists (if any one questions the concept see for example here who work to keep any contrary evidence off certain pages – just my belief. So in the interests of balance and factuality I have added the necessary balance to this page.
 * Taking the above objections . . . first, Stigmatella Aurantiaca has thought that “the conclusions to be drawn (from the US IOM report and the WHO report) are dramatically different from the impressions of the reports' conclusions as expressed in the Drug Free Australia pamphlet.”
 * A.	However, Drug Free Australia clearly states in their document here that the prestigious US Institute of Medicine found in their 2006 publication that the science on the effectiveness of needle exchange re transmission of HIV was ‘inconclusive’ and that there was no evidence it was effective with Hepatitis C (HCV). ‘
 * This is most definitely an accurate rendering of the actual text found in the US IOM document which specifically states on page 149 that, “Conclusion 3-5: Moderate evidence indicates that MULTICOMPONENT HIV PREVENTION PROGRAMS THAT INCLUDE NEEDLE AND SYRINGE EXCHANGE reduce intermediate HIV risk behavior. However, evidence regarding THE EFFECT OF NEEDLE AND SYRINGE EXCHANGE ON HIV INCIDENCE IS LIMITED AND INCONCLUSIVE.”
 * I believe that Stigmatella has failed to see that there are two quite separate findings in the one paragraph here. The first IOM finding very clearly addresses needle exchange programs studied AS PART OF multicomponent strategies which may include education, condom distribution and TV advertising campaigns. I remind readers that TV public awareness campaigns are not needle exchanges. Yet in Australia the famous mid-80’s TV ad titled ‘The Grim Reaper’ is credited with reducing much of Australia’s AIDS risk, maybe moreso than needle exchanges. Drug Free Australia cites this evidence in their document  and the fact that Australia’s needle exchange founder and WHO reviewer, Alex Wodak, has been currently calling for a new Grim Reaper ad in Australia to highlight that Hepatitis C is out of control despite plentiful needle exchange programs on offer – see Medical Journal of Australia article here is revealing. He says, ‘Until Australia embarks on a major national awareness-raising exercise, such as a "Grim Reaper"-style public education campaign, the band will continue to play on for hepatitis C as it once did for HIV.’ This is a clear admission that needle exchanges were not solely responsible for Australia’s low HIV, and to what extent they were is quite debatable.
 * So the first part of the IOM findings is that when NEP as a part of broader multicomponent approaches is considered, the broader program indicates ‘moderate evidence’ that risk behaviours are reduced. When NEPs are studied in isolation, the evidence is ‘inconclusive’ just as Drug Free Australia reports.
 * We must now ask, “Which of the two statements about a. multi-component programs and b. needle exchange programs in isolation of the multicomponent programs, are relevant to the Wikipedia Needle Exchange Programme page, titled ‘Needle Exchange Programme’ and not titled ‘Needle Exchange Programme and related education, TV campaigns and social interventions’? The interest of the US IOM, which has notably found in favour of needle exchange programs in all its previous deliberations and publications up until 2006 re the science, at which time they downgraded their conclusions on the science to ‘inconclusive’, is whether needle exchanges ALONE are responsible for reduced risk, or whether it is the broader spectrum of programming around and including NEPs which is causal. Their definite conclusion is that Needle Exchanges alone only have inconclusive evidence to back their causality, while multicomponent programs including needle exchanges have moderate evidence supporting their effectiveness. Stigmatella thought that Drug Free Australia was misrepresenting the US IOM but as can be seen, it is very correctly representing it.
 * Related to the above is the Drug Free Australia statement in their document on NEPs which directly quotes the US IOM, saying that “’ecological studies monitor populations rather than individuals, and therefore cannot establish causality’ for NSPs”. This direct quote from IOM document p 139 addresses particularly the four ecological studies the IOM examined, seen in the IOM list on p 146. All are positive for NEPs but again cannot isolate the effect of the NEPs from the other related interventions. These studies thereby contribute evidence regarding multicomponent programming where NEPs are included, but cannot rescue NEPs studied in isolation from the IOM verdict of an inconclusive science.
 * B.	On a related point, Steinberger has previously objected that the US IOM still supports the implementation of needle exchanges despite the evidence for their effectiveness being inconclusive. To that objection the following question becomes necessary . . . “Does their subjective support for the implementation of needle exchanges actually mean that their statement that the rigorous science being inconclusive is now changed to one that says that the science shows moderate, modest or wildly conclusive support for NEP effectiveness?” Certainly not. The onus of proof now lies on Steinberger to demonstrate that when the IOM gives subjective support for the continuation of NEPs that it really is reversing its view that the science of NEPs in isolation from the multicomponent programming is indeed inconclusive.


 * Second, moving to the effectiveness of NEPs in regards to Hepatitis C prevention, the US IOM says the following:
 * “Multiple studies show that NSEs do not reduce transmission of HCV, which has been attributed to the apparent failure of NSEs to provide enough ancillary injecting equipment such as sterile cotton, water, and alcohol wipes. While NSEs do reduce the frequency of reported needle and syringe sharing, they do not appear to reduce the sharing of other injecting equipment, such as cookers, cotton, rinse water, and drug solution (Hagan and Thiede, 2000; Sarkar et al., 2003; Taylor et al., 2000; Mansson et al., 2000).
 * Drug Free Australia’s statement here is that “multiple studies show that (Needle & Syringe Programs) do not reduce transmission of HCV (Hepatitis C).” This statement is again a direct quote from the US IOM report (p 149) and is not taking the IOM report out of context because the science on NEP and HCV is exactly that when transmission rates are compared worldwide in relation to presence or absence of NEPs. The Palmateer review of reviews agrees. In the absence of rigorous studies which directly address the issue of whether the provision of injection-related equipment will demonstrably reduce HCV transmission, the IOM goes on to say that the failure of NEP re HCV “has been attributed to the apparent failure of NSEs to provide enough ancillary injecting equipment such as sterile cotton, water, and alcohol wipes.” The IOM cites no weight of rigorous studies on this point, simply because there is too little to go on, and therefore does not make this part of Conclusion 3-6 (p 149) which is their finding on NEP and HCV. So there is no inaccuracy to the Drug Free Australia statement.


 * Thirdly, I move to Steinberger’s and Soul Paradox’s assertions that Drug Free Australia has been found to be an unreliable source via its citing Dr Kerstin Käll’s criticisms of the 2004 WHO review on the effectiveness of Needle Exchanges by Alex Wodak and Helen Cooney.
 * There was an extensive discussion on the Wikipedia conflict resolution forum RS/N here which discussed all these issues at length, with it noted that Kerstin Käll’s study from the Journal of Global Drug Policy and Practice was one of only four reviews rigorous enough to make the cull for the 2010 Palmateer EMCDDA review of reviews. 40 other reviews did not make the cull, so it is thereby a moot issue as to where Kerstin Käll published her study. She was one of only two reviewers called upon by the US IOM to report her review’s findings for their 2006 review discussed at length above (the other was Alex Wodak). And it is that self-same evidence given to the US IOM that is published in the JGDPP. So there is no question that Steinberger’s objections to Käll’s criticisms of the Wodak/Cooney review are fatuous.


 * Fourthly, the issue that Drug Free Australia is not a reliable MEDICAL source when it comes to commentary on NEPs is also not supported by fact. Drug Free Australia reports that its public statements and documents derive from its group of 24 Fellows. It says to a recent NSW Parliament Inquiry on p 24 here that, “we have 24 fellows who are dotted around the world but who are mostly within Australia. The majority of those are doctors mostly in addiction medicine, epidemiologists and those kinds of people, who contribute to our reports and who guide what we as Drug Free Australia publicly say.” Related to this is that Dr Kerstin Käll is one of those 24 Drug Free Australia Fellows so if her work is good enough for the Palmateer reviews to be cited as a core review for their work then the public statements of Drug Free Australia are well-guided. Dr Käll also, for example, contributes to this DFA report. She is among well-distinguished names which each are well-published as per this discussion on another Talk page some years back here where it says “Dr Joe Santamaria Epidemiologist, Former Head of St Vincents Hospital (Melbourne) Public Health Unit. Published in peer-reviewed journals such as ‘Drug Therapy’, ‘Patient Management’, ‘Australian Family Physician’, Australian Annals of Medicine, Medical Journal of Australia. These were in the 60’s and 70’s. Dr Stuart Reece Addiction Medicine Practitioner, Brisbane. Associate Professor, Uni of WA. Published in peer-reviewed journals Proceedings of the National Academy of Sciences of the USA, New England Journal of Medicine, British Medical Journal, Addiction Biology, British Dental Journal. Dr Greg Pike Director, Southern Cross Bioethics Institute and Surgeon. Published in peer-reviewed journals such as European Journal of Pharmacology, Journal of Physiology, Brain Research and seven others.” Also of relevance is that the Brian Watters giving testimony to the NSW Parliamentary Inquiry for Drug Free Australia, as one of its Board members here is none other than Australia’s own Drug Czar, Major Brian Watters, who was chief advisor to the Australian Federal Government for a decade and an architect of the UN recognised success of Australia’s Tough on Drugs approach implemented in 1998. He was also Australia’s representative to the UN International Narcotics Control Board for 5 years. There is simply no question that Drug Free Australia is a reliable source for Wikipedia.Minphie (talk) 02:54, 26 May 2013 (UTC)
 * I have reverted your edits. The purpose of this talk page is to hammer out a consensus in favour of certain edits to the article. When other editors dispute your view, it is not conducive to this process of consensus-building to say that your opponents' statements are not "founded in fact" and go on to imply that you are better suited than them to be the "final arbiter" of what the facts are. That's simply not the way that Wikipedia editing happens. This article needs to made less lopsided, I agree, but that stage can't be reached without finding agreement with the other editors here.


 * Furthermore, as numerous people have pointed out to you on several occasions (such as here), it simply isn't true that "There is simply no question that Drug Free Australia is a reliable source for Wikipedia". The fact that it's board includes specialists in this field doesn't make it a reliable source. For a controversial issue (like the purported effectiveness of needle-exchange programmes), reliable sources would ideally be those subject to peer-review and published in reputable journals (such as The Lancet or the New England Journal of Medicine), or in books published by respected university presses (such as, for example, Oxford University Press). As has been pointed out to you previously, Drug Free Australia and the Journal of Global Drug Policy and Practice don't measure up to this benchmark. Despite several years of trying, it doesn't seem as if you've been able to convince others of the opposite. Your attempts to cite them in articles are likely to be reverted in the future as well until you convince us of their accuracy and reliability. Gabbe (talk) 15:36, 26 May 2013 (UTC)

Link rot
The following cited links no longer appear to be valid. Some documents may have been moved to different servers. Others may just have evaporated. Could people here help in curing the link rot?
 * Safer Ottawa
 * Replaced dead link with


 * Replaced reference to preliminary report with cite doi reference to a full report by the same author:
 * Replaced reference to preliminary report with cite doi reference to a full report by the same author:
 * Replaced reference to preliminary report with cite doi reference to a full report by the same author:


 * Replaced with cite doi:
 * Replaced with cite doi:


 * Replaced dead link with alternative link to same paper:
 * Replaced dead link with alternative link to same paper:


 * 
 * Replaced dead link with alternative link to same paper:
 * Replaced dead link with alternative link to same paper:
 * Replaced dead link with alternative link to same paper:

Thanks, Stigmatella aurantiaca (talk) 23:42, 5 July 2013 (UTC)

Updates needed to Legal Aspects
Colorado is used as an example of a state where needle exchange programs must operate covertly. This has changed (depending on local jurisdiction). In 2010, Colorado lawmakers created an exemption in Colorado's drug paraphernalia law allowing counties to legally adopt syringe exchange programs through a local approval process. Stigmatella aurantiaca (talk) 11:52, 6 July 2013 (UTC)

Fixing this section should also fix two of the dead links that I have identified above. Stigmatella aurantiaca (talk) 11:53, 6 July 2013 (UTC)

Misrepresentation of the conclusions of PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS IN HIGH RISK COUNTRIES
I am removing material that misrepresented the conclusions of PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS IN HIGH RISK COUNTRIES, as evident in the Report Brief. Stigmatella aurantiaca (talk) 20:45, 5 July 2013 (UTC)

There appear to be multiple erroneous references to this same report in different contexts. I will see if I can get hold of the full report to see what it actually says, as opposed to the high level brief. Does anybody have access to the full report? Stigmatella aurantiaca (talk) 21:48, 5 July 2013 (UTC)

The complete text of the report is available online here for online reading or here as a free PDF download (with registration or as a guest). References to this report have been extensively misused in this article. Stigmatella aurantiaca (talk) 05:52, 7 July 2013 (UTC)

With this edit, I am removing misused references to the IOM report, including some that I had previously marked out with HTML comments. Stigmatella aurantiaca (talk) 06:08, 7 July 2013 (UTC)

See following section on selective quote mining. Stigmatella aurantiaca (talk) 12:14, 7 July 2013 (UTC)

Shall we try one of the dispute resolution channels?
Minphie, we are close to an edit war here, which is highly undesirable.

I agree that this article is somewhat lopsided, and that it needs more coverage of the legitimate concerns expressed by opponents of needle exchange programs. But I object strenuously to inclusion of material by an advocacy group that distorts and misuses the scientific literature, and I object to the misrepresentation through selective "quote mining" of the overall conclusions of a major meta-analysis of the scientific literature.

There are legitimate reasons for opposing needle exchange programs, including political and moral grounds. Concerns are often expressed that NSPs may encourage drug use, or may actually increase the number of dirty needles in the community. Another fear is that NSPs may draw drug activity into the communities in which they operate. It has also been argued that in fighting disease, needle exchanges take attention away from bigger drug problems, and that, contrary to saving lives, they actually contribute to drug-related deaths. In an era of limited resources and given the difficulty of evaluating the relative effectiveness of the different aspects of a multi-component attack on the problem of HIV spread among IDUs, it can legitimately be argued that the focus on NSPs may be drawing resources away from more effective channels.

All such concerns can be expressed without resort to distortion and misrepresentation of the scientific literature. &mdash; Stigmatella aurantiaca (talk) 02:43, 8 July 2013 (UTC)

Drug Free Australia and the Journal of Global Drug Policy and Practice (JGDPP) are advocacy groups
The consensus of multiple discussions has been that Drug Free Australia and the Journal of Global Drug Policy and Practice (JGDPP) are advocacy groups and are not reliable sources. Use of them as sources is not prohibited per se, but must be subject to considerations of "due weight".
 * Reliable sources/Noticeboard/Archive 66
 * Reliable sources/Noticeboard/Archive 66
 * Reliable sources/Noticeboard/Archive 68
 * Reliable sources/Noticeboard/Archive 91
 * Reliable sources/Noticeboard/Archive 98
 * Reliable sources/Noticeboard/Archive 99
 * Reliable sources/Noticeboard/Archive 121
 * Reliable sources/Noticeboard/Archive 151
 * Stigmatella aurantiaca (talk) 09:00, 5 July 2013 (UTC)

JGDPP has, on occasion, published citable material, and I look over references to JGDPP with this in mind. However, DFA makes no secret of being a lobbyist organization, and I have previously given examples of how DFA pamphlets and brochures misrepresent their source material. Stigmatella aurantiaca (talk) 09:43, 5 July 2013 (UTC)

Countering with an example where a DFA pamphlet did not misrepresent the source material, does not erase the multiple incidents where the pamphlet did misrepresent the source material. Stigmatella aurantiaca (talk) 11:37, 5 July 2013 (UTC)


 * Stigmatella, you have said that you believe that there is a consensus from the listed discussions above that Drug Free Australia is an unreliable source, so I will take each link provided in turn.
 * *Reliable sources/Noticeboard/Archive 66
 * This clearly states that DFA material should be included as a reliable source, but with attribution.
 * Reliable sources/Noticeboard/Archive 66
 * This very clearly is a question about using a DFA quote from a national peak body bulletin board which is password protected. It is not addressing the reliability of DFA as an organisation, but only where the citation is sourced.
 * Reliable sources/Noticeboard/Archive 91
 * I believe the JGDPP in relation to the Kall review of 2007 is a settled issue.
 * Reliable sources/Noticeboard/Archive 98
 * I believe the JGDPP in relation to the Kall review of 2007 is a settled issue.
 * Reliable sources/Noticeboard/Archive 99
 * I believe the JGDPP in relation to the Kall review of 2007 is a settled issue.
 * Reliable sources/Noticeboard/Archive 121.
 * This discussion has a lot of input from one of the Wikipedia contributors who was previously involved in the dispute over sourcing before it went to RS/N. This same contributor added a lot of material more than a week after the discussion appeared finishged which has unsubstantiated accusations about DFA being a Christian organisation (which it is not - it has had non-Christian Board members and Fellows involved since its inception), claims that Margaret Court, arguably Australia's greatest women's tennis player, as patron to the organisation is somehow compromised by the fact she is now a minister of religion, and claims that Dr Stuart Reece is a madman for saying that there has been a rise in STDs despite the free distribution of condoms and that therefore this harm reduction measure is open to question (despite OhioStandard totally misrepresenting what was said in his/her RS/N text and despite Dr Reece being published by dozens of medical journals on drug issues). I might mention that I had not seen this unsubstantiated text until today and it has obviously gone without reply from me. I make one note - DFA is said to be a fringe organisation in that RS/N discussion. Nothing can be further from the truth. It has on its Board the former Australian Drug Czar for the Australian Federal government, has a US former drug Czar amongst its 24 advisors who was also the founder and first President of the US National Institute on Drug Abuse (NIDA), and has Kerstin Kall as one of its 24 advisors, the very scientist whose JGDPP article opens Palmateer to question. DFA is cited frequently in Australian Parliaments and in Parliamentary Inquiry reports - I have addressed all this previously in Talk with full citation and it is not remotely fringe.
 * (2) I ask this question, to which I would like a reply. Should unsubstantiated claims in Wikipedia be the basis of rejection of anything? Is unsubstantiated anything the basis of Wikipedia decision making?
 * (3) Should gross inaccuracies in OhioStandard's long allegation which can be shown to be gross inaccuracies have any weight here?
 * Reliable sources/Noticeboard/Archive 151
 * This discussion came to a workable resolution where text was put on the Needle Exchange page, with no deletion of that text until a long time after by someone not part of the discussion - a deletion I was not aware of until just recently.
 * I believe what comes through clearly in all of these discussions is that Drug Free Australia is a valid source for Wikipedia so long as it is with attribution as per RS/N. Wikipedia does indeed accept advocacy organisations as a reliable source so long as they are notable and not fringe, and so long as it can be demonstrated that they have the expertise to comment reliably.


 * (4) You say you have concerns with Drug Free Australia's comment about the Palmateer study. I would like to know specifically how or why you think their observations about Palmateer statement I recorded are in error in any way. If not, I would want to know specifically why Wikipedia should keep its readers in the dark on such an important issue.
 * (5) You say that there are gross misrepresentations of the science by Drug Free Australia. I would like to know SPECIFICALLY what these are. I would like cited text, not unsubstantiated generalizations. I believe that unsubstantiated generalizations should not be a basis for deleting text from Wikipedia.Minphie (talk) 04:04, 8 July 2013 (UTC)
 * I have received advice from someone with expertise who has worked in the illicit drug sector for over two decades and he firmly believes that the contributions of Minphie are not those of someone with expertise in the field. I suggest that a resolution needs to be reached with the aid of people who actually hold expertise in regard to this subject. Regards,--Soulparadox (talk) 06:27, 8 July 2013 (UTC)

Selective quote mining used to distort the conclusions of the IOM report
By selective quote-mining, opponents of needle-exchange programs have attempted to make the IOM report sound as if its conclusions were the exact opposite of what they actually are. Proponents of NSPs understand that needle and syringe exchange can at best be viewed as only one component of a comprehensive strategy to address the problem of HIV transmission. Due to the complexity of the problem, it is not surprising that, as stated in the report, evidence regarding the effect of needle and syringe exchange alone on HIV incidence is "limited and inconclusive."

But let us look at somewhat larger excerpts from the report:

p. 149

 * Conclusion 3-4: Four ecological studies have associated implementation or expansion of HIV prevention programs that include needle and syringe exchange with reduced prevalence of HIV in cities over time and after considering the local prevalence of HIV at the time of program implementation or expansion—although a causal link cannot be made based on these studies. The evidence of the effectiveness of NSE in reducing HIV prevalence is considered modest, based on the weakness of these study designs.
 * Conclusion 3-5: Moderate evidence indicates that multicomponent HIV prevention programs that include needle and syringe exchange reduce intermediate HIV risk behavior. However, evidence regarding the effect of needle and syringe exchange on HIV incidence is limited and inconclusive.
 * Conclusion 3-6: Five studies provide moderate evidence that HIV prevention programs that include needle and syringe exchange have significantly less impact on transmission and acquisition of hepatitis C virus than on HIV, although one case-control study shows a dramatic decrease in HCV and HBV acquisition.

p. 173

 * Finally, studies show that multi-component prevention programs that include needle and syringe exchange are associated with reductions in drug-related HIV risk behavior. The Committee believes that multi-component programs that include NSE are likely to add value to a national HIV prevention program, but that existing research does not allow us to disentangle the specific contribution of each component. The individual components probably have different levels of effectiveness, and they may interact in ways that are not fully understood. A full understanding of each intervention component may highlight those that do not add substantial value in the presence of other interventions, and that are associated with unanticipated effects. In some cases the effects may be synergistic. This issue is important from a policy perspective because elements of these multi-component prevention programs can be resource intensive.

p. 175

 * CONCLUSION
 * For injecting drug users who cannot gain access to treatment or are not ready to consider it, multi-component HIV prevention programs that include sterile needle and syringe access reduce drug-related HIV risk behavior such as self-reported sharing of needles and syringes, unsafe injecting and disposal practices, and frequency of injection. Avenues of sterile needle and syringe access may include needle and syringe exchange; the legal sale of needles and syringes through pharmacies, voucher schemes, physician prescription programs, and vending machines; or supervised injecting facilities. Needle and syringe access is often part of a multi-component HIV prevention program. Other elements of multi-component programs may include outreach, education in risk reduction, HIV voluntary counseling and testing, condom distribution, bleach distribution and education on needle disinfection, and referrals to substance abuse treatment and other health and social services.


 * Participation in multi-component HIV prevention programs that include needle and syringe exchange is associated with a reduction in self-reported drug-related HIV risk behavior among IDUs. Such behavior includes self-reported sharing of needles and syringes, safer injecting and disposal practices, and frequency of injection. Sterile needle and syringe access is not primarily designed to address sex-related risk behavior, and this issue has not been well studied. The existing evidence is insufficient to determine the effectiveness of programs that include needle and syringe access in reducing sex-related risk. The Committee calls for more research to determine the impact of such programs on sex-related risk, and on integrating effective strategies for reducing sexual risk behavior and sexual transmission of HIV into multi-component programs that include sterile needle and syringe access.


 * The evaluation of strategies to eliminate criminal penalties for possessing needles and syringes—and enhance legal access via pharmacy sales, voucher schemes, and physician prescription programs—have focused on assessing the acceptability of such programs by drug users, pharmacists, and physicians. A few studies have examined the impact on drug-related HIV risk, and found suggestive evidence of a reduction. The evidence regarding supervised injecting facilities and vending machines—while encouraging—is insufficient for drawing conclusions on the effectiveness of these interventions in reducing drug-related HIV risks among IDUs.


 * As with drug treatment, a common concern is that sterile needle and syringe access may produce unintended results, including more new drug users, expanded networks of high-risk users, more frequent injection, and more discarded needles in the community. While few studies have specifically examined such outcomes, studies to date have not found evidence of negative effects. More research is needed on potential unintended consequences of HIV prevention programs that include needle and syringe access, and strategies to address such problems if they are found.


 * Undiluted bleach can inactivate HIV on injecting equipment in the laboratory, and in the field if used according to guidelines. However, in practice, injecting drug users do not use bleach correctly, so programs that distribute bleach should also educate drug users on proper techniques. In some countries, bleach is not available or acceptable, and it may be necessary to use other disinfectants. Drug users should rely on such methods only when they cannot stop injecting, or do not have access to new equipment. More research is needed to identify the simplest and most acceptable effective disinfection techniques using bleach and the best methods for educating IDUs on these techniques as well as the effectiveness of alternative disinfectants in field settings, particularly in countries where bleach is not available or acceptable.


 * Outreach-based efforts to prevent HIV transmission—which may direct drug users to needle and syringe exchange, for example—are associated with reductions in drug-related risk behavior, including injection frequency and sharing of injection equipment. Outreach is effective in linking hard-to-reach IDUs with drug treatment and other health and social services. The impact of outreach on sex-related HIV risk behavior is less clear and more research is needed to study this impact. More research is also needed to determine the best way to integrate effective strategies for reducing sexual risk behavior and sexual transmission of HIV among IDU into outreach and education programs.


 * Although questions remain about the contribution of individual elements of multi-component programs that include sterile needle and syringe access and outreach and education on risk behavior and actual HIV incidence, the report recommends that high-risk countries act now to implement such programs. These programs should include multiple access points and methods of delivery, focus on reducing sexual risks, actively refer drug users to other services, focus additional efforts on preventing hepatitis C, and incorporate strong program and component evaluations.

Stigmatella aurantiaca (talk) 12:03, 7 July 2013 (UTC)


 * Stigmatella, I will take your objections one at a time. And I will ask, respectfully, that I get answers to crucial questions which are raised by the deletion of text. These questions I have numbered thus (1), (2), etc in amongst the text of this section and another above.


 * Your immediate concern is that the IOM says there is modest evidence that MULTI-COMPONENT programs which include NEP have a 'modest' science supporting their effectiveness in preventing HIV, yet my statement is about the research of the effectiveness of NEP in preventing HIV IN ISOLATION FROM the other components of a multi-component prevention program. This Wikipedia page is titled 'Needle Exchange Programme', not 'Multi-component prevention programs to prevent HIV'. If it was the latter topic I would happily include the IOM statements about modest science etc etc - but the science on NEP effectiveness alone is indubitably 'inconclusive' as they say. I have not misquoted the IOM at all and I have made this point a number of times on this Talk page previously.
 * (1) Given that this is the case I would want to know why the paragraph at the beginning of the Wikipedia article which mentions the IOM and its inconclusive finding has been deleted when it is absolutely correct. I have no problem with anyone adding text to the effect that there is indeed a modest science supporting multi-component prevention programs and would not delete it, but arguably that belongs to a specialized page because it is a much larger topic, where indeed there is quite a discussion to be had about which components are in fact most effective.
 * I have read the questions you have enumerated re Drug Free Australia's right to question the Palmateer reviews. Please go up too that section on Talk and I will address those questions in turn.Minphie (talk) 02:18, 8 July 2013 (UTC)


 * Minphie, proponents of NSPs have long known that "needle exchange is not enough", which is part of the title of a 1997 paper which is much cited by opponents of NSPs. Most needle exchanges offer other services including counseling and programs aimed at getting people off drugs in the first place. As stated in the IOM report, "Nearly all programs included in our literature search combine needle and syringe exchange with other components such as outreach, risk reduction education, condom distribution, bleach distribution and education on needle disinfection, and referrals to substance abuse treatment and other health and social services." That is good, but it also makes it extremely difficult to evaluate what the relative effectiveness is of the various components of these programs. It is likely that these different aspects are synergistic. If nothing else, offering needle exchange may get an IDU to where he/she may talk with a social worker, who, with lots of luck, may convince an IDU to try to quit. Lots of maybes in that sequence, but that is the hope, anyway. Stigmatella aurantiaca (talk) 03:22, 8 July 2013 (UTC)


 * "Given that this is the case I would want to know why the paragraph at the beginning of the Wikipedia article which mentions the IOM and its inconclusive finding has been deleted when it is absolutely correct." &mdash; I deleted it for selective quote mining which completely misrepresented the major conclusions of the report. Stigmatella aurantiaca (talk) 10:13, 8 July 2013 (UTC)

Arguments "For" are going to need some upgrades as well
For the past year, I have been making the point that the "Against" section is very poorly written. Unfortunately, most of the contributions made in the last year "against" have been ones that I have had to fight against since they referenced lobbyist literature that used selective quote-mining and other such objectionable techniques to distort the conclusions expressed in the scientific literature.

Given the unsatisfactory nature of what has been offered, I decided to work on my own "Against" section. This is, of course, a rather peculiar thing for a strong supporter of these programs to be doing. But we cannot go around suppressing the moral, legal, and religious arguments that drive the opposition.

I am working on the "Against" arguments in one of my sandboxes here:. I am going to try get together with Minphe to put together something that we can both accept.

Unfortunately, as you can see looking at my sandbox, when this section is uploaded, the Arguments for and Against section will be, at least in terms of sheer verbiage, heavily biased in the "Against" direction. Perhaps some of you here could work on improving the "For" section in preparation for the day when I upload my work?

Thanks, Stigmatella aurantiaca (talk) 21:20, 15 July 2013 (UTC)
 * I have completed a revision of this section so that the tone is encylopedic, the scope is broadened beyond the U.S., and the content is clearer (for example, order of the information and grouping together points that belong under the same bullet point). However, I think the main issue at this stage is the U.S.-centric content; I have added one Australian reference, but this needs to be expanded upon.--Soulparadox (talk) 05:50, 16 July 2013 (UTC)


 * I added my expanded pro/con material, even though I never got a response from Minphe. Let's see if we can improve the sections that I added so that the debate is fair to both sides. Stigmatella aurantiaca (talk) 12:48, 20 July 2013 (UTC)