HIV in injecting drug users in Asian countries
http://www.100md.com
《英国医生杂志》
EDITOR—Reece concedes the critical importance of controlling the epidemic of HIV among and from injecting drug users, especially in Asia. This is a useful start. However, his subsequent comments are less than helpful.
Reece argues that the high incidence of hepatitis C indicates that harm minimisation is ineffective. A recent study estimated that needle syringe programmes between 1988 and 2000 avoided 25 000 cases of HIV and 21 000 cases of hepatitis C in injecting drug users in Australia.1 How does Reece explain the excellent control of HIV in injecting drug users achieved in Australia, which explicitly accepted harm minimisation and vigorously implemented harm minimisation programmes, whereas high rates of HIV infection occurred in the United States where harm reduction was explicitly rejected?
Reece claims that methadone treatment is unsafe: yet the risk of death is three to four times less for patients continuing in treatment than in those who discontinue treatment.2 His claim that harm minimisation lacks public support is irreconcilable with official survey data. A solid majority (59%) of respondents to the 2001 national drug strategy household survey supported needle syringe programmes,3 representing an 18% increase in support from the 1998 survey,4 whereas 58% of respondents in the 1998 survey supported or strongly supported methadone compared with 19% opposed or strongly opposed.4
Reece argues that naltrexone implants are effective and safe. It is conventional to assume that all new treatments are ineffective and unsafe until data are available from multiple, rigorous, randomised controlled trials with reasonable durations of follow up. No exception should be made for naltrexone implants.
Alex Wodak, director
Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia awodak@stvincents.com.au
Robert Ali, director of clinical policy and research
University of Adelaide robert.ali@adelaide.edu.au
M Farrell, senior lecturer in addictions
PO Box 48, National Addiction Centre, Institute of Psychiatry, London SE5 8AF m.farrell@iop.kcl.ac,uk
Competing interests: None declared.
References
Commonwealth Department of Health and Ageing. Return on investment in needle and syringe programs in Australia. 2002. www.drugpolicy.org/docUploads/ROIfinal.pdf (accessed 10 Nov 2004).
Bell J, Zador D. A risk-benefit analysis of methadone maintenance treatment. Drug Saf 2000;22: 179-90.
National drug strategy household survey: first results. Canberra: Australian Institute of Health and Welfare, 2001.
National drug strategy household survey: first results. Canberra; Australian Institute of Health and Welfare, 1998.
Reece argues that the high incidence of hepatitis C indicates that harm minimisation is ineffective. A recent study estimated that needle syringe programmes between 1988 and 2000 avoided 25 000 cases of HIV and 21 000 cases of hepatitis C in injecting drug users in Australia.1 How does Reece explain the excellent control of HIV in injecting drug users achieved in Australia, which explicitly accepted harm minimisation and vigorously implemented harm minimisation programmes, whereas high rates of HIV infection occurred in the United States where harm reduction was explicitly rejected?
Reece claims that methadone treatment is unsafe: yet the risk of death is three to four times less for patients continuing in treatment than in those who discontinue treatment.2 His claim that harm minimisation lacks public support is irreconcilable with official survey data. A solid majority (59%) of respondents to the 2001 national drug strategy household survey supported needle syringe programmes,3 representing an 18% increase in support from the 1998 survey,4 whereas 58% of respondents in the 1998 survey supported or strongly supported methadone compared with 19% opposed or strongly opposed.4
Reece argues that naltrexone implants are effective and safe. It is conventional to assume that all new treatments are ineffective and unsafe until data are available from multiple, rigorous, randomised controlled trials with reasonable durations of follow up. No exception should be made for naltrexone implants.
Alex Wodak, director
Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia awodak@stvincents.com.au
Robert Ali, director of clinical policy and research
University of Adelaide robert.ali@adelaide.edu.au
M Farrell, senior lecturer in addictions
PO Box 48, National Addiction Centre, Institute of Psychiatry, London SE5 8AF m.farrell@iop.kcl.ac,uk
Competing interests: None declared.
References
Commonwealth Department of Health and Ageing. Return on investment in needle and syringe programs in Australia. 2002. www.drugpolicy.org/docUploads/ROIfinal.pdf (accessed 10 Nov 2004).
Bell J, Zador D. A risk-benefit analysis of methadone maintenance treatment. Drug Saf 2000;22: 179-90.
National drug strategy household survey: first results. Canberra: Australian Institute of Health and Welfare, 2001.
National drug strategy household survey: first results. Canberra; Australian Institute of Health and Welfare, 1998.