As for the FP hospitals, we hope that they decide to take action towards making these types of service mandatory in the course of patient. How would you feel if you discovered that doctors were pushing flu vaccinations on patients just for financial reasons? In some hospitals flu vaccination funding for employees is out of the funding, and in some hospitals, will fire, or not hire, people if they have not, or refuse to receive a flu vaccination, wearing a mask is not even acceptable.
Seeing how strict and forceful some hospitals are about flu vaccines would make one think they act this way for a payout for the vaccine distributers.
Another way to look at this is how unethical mandatory vaccines are. In addition to being under constant surveillance—the state would register every prostitute, having police and doctors keep a close eye on each one—prostitutes faced compulsory medical examinations, which would then turn into compulsory hospitalization if found to have any venereal disease. According to the abolitionists, eliminating prostitution would not only significantly decrease the number of individuals with venereal diseases but also increase the moral standards of the nation as a whole.
In addition, people affected by the disease see a decrease on their living standards placing a burden in the whole family. Strategies to eradicate the disease implemented by the WHO have been effective. However, additional strategies are available to improve the eradication of the disease. Investment to improve housing and to conduct drug research for treatment would not only improve productivity, but will also improve the quality of life for people.
Lastly, countries affected by the disease should implement routine screening for Chagas in their blood banks in order to prevent further.
Prescription drugs are needed for the country to have a reliable healthcare system the fact that addiction plagues our hospital s true but with modern medicine and innovation comes change, with this improvement there should be a decline in opioid addiction cases, cheaper medicines and effective medication with a lower risk of addiction.
It is similar to welfare checks, how some states require drugs tests to make sure the people who are receiving financial government aid are actually using the money to bring themselves back into society. Our nation has other problems to focus on.
We can use this process by providing medical marijuana. Medical Marijuana can prevent from being given other drugs for pain. This is a possible solution to reduce the opioid prescriptions. That is, if there is a real connection between the introduction of the needle exchange program and the observed decline in new infections, then a series of conditions must be present in order to increase confidence in the conclusion that the program is at least partially responsible for the observed outcome.
The conclusion that the needle exchange program is plausibly connected to the decrease in new HIV infections is more credible if there is evidence that, as the putative causal agent, it was actually present in the community. This means that there must be an empirical pattern of evidence that, in effect, rules in its plausibility.
Programmatically, the pattern of evidence might include:. The argument that undergirds this approach is that programs have a structure and mechanisms that establish a logical pattern of expectations that can be tested empirically. To the extent that the empirical evidence supports these propositions, the plausibility that the needle exchange program was responsible for the observed change should increase.
That is, the plausibility increases through repeated assessments. As a simple example, if there is a reduction in HIV incidence but the needle exchange program failed to exchange a single needle, it is not reasonable to conclude that the needle exchange program was responsible for the decline, regardless of the strength of the design underlying the HIV incidence data. However, through multiple assessments, involving a logical network of evidence, it may be possible to derive a portrait of the plausibility that the needle exchange program is implicated in the change process.
Ruling in the plausibility that the needle exchange program is a causal agent, through empirical assessment, is only half the story. It is still possible that other features of the program or research process contain biases that affect the HIV incidence.
In traditional discussions of causal analysis, the notion of excluding or rendering implausible rival explanations has been the hallmark of competent experimental analysis. To the extent that repeated efforts to probe the results fail to disconfirm the plausibility that the intervention was at least partially responsible, its plausibility should be enhanced. Therefore, an assessment of the pattern of evidence not only entails ruling in the plausibility that the needle exchange program is a causal agent, but also requires ruling out plausible alternative explanations.
The panel analyzed the patterns of evidence from five sources: two evaluations of the research published before , the findings of studies published since , and two sets of studies that provide the best available detailed account of how needle exchange programs impact risk behaviors and viral infections—one on New Haven, the other on Tacoma.
The process of selecting studies for detailed examination involved a comprehensive analysis of the research findings of individual needle exchange and bleach distribution projects. The panel generated a list of published papers and presentations on needle exchange evaluation projects in the United States, Canada, and Europe.
A meeting was held to judge which reports included data that might be used in a review. The projects were subsequently grouped by city and divided among panel members so that each city project had two independent reviewers. The studies from each city were reviewed, annotated on a formal evaluation form, and then discussed with the full panel at a subsequent meeting.
Following this review, at a separate meeting, the panel decided to limit itself to studies conducted in the United States, because the legal and cultural environments of other countries are sufficiently different to raise questions about whether data are applicable to the United States.
Two U. Various criteria were used in deciding to pursue the New Haven and Tacoma sets of studies. Consistent with the logic of the patterns of evidence approach, the first criterion applied in selecting studies was that the site or project had to have been comprehensively studied.
That is, there had to be empirical evidence establishing that the needle exchange program was operational, that the mechanisms of the exchange process had been studied, and that there was an estimate of HIV incidence or, as in the case of New Haven, a proxy measure. The level of activity in the prevention environment can make it difficult to isolate the influence of the needle exchange program.
A second criterion was that, in the sites and projects selected, the needle exchange program had to be the predominant if not the only intervention ongoing at the time of the assessment. This criterion implies a selection process that focuses on high-contrast sites i. General Accounting Office carry out a review of the effectiveness of needle exchange programs. GAO researchers carried out an extensive review of the literature to identify empirical evaluation studies that had appeared in refereed or peer-reviewed journals.
Their review identified a total of 20 published studies and 21 abstracts on evaluations of needle exchange programs originating from nine distinct research projects, all but one of which the Tacoma study involved programs outside the United States. Among the nine research projects were one from Australia, one from Canada, two from the Netherlands, one from Sweden, and three from the United Kingdom. The GAO team developed a list of eight relevant outcome measures: 1 rate of needle sharing; 2 prevalence of injection drug use; 3 frequency of injection; 4 rate of new HIV infections; 5 rate of new entrants to injection drug use; 6 incidence rate of other blood-borne infections; 7 rate of other HIV risk behaviors; and 8 risk to the public's health.
They also identified three methodological criteria that had to be satisfied before findings could be considered: 1 the findings had to have been published in a scientific journal or government research monograph; 2 they had to have reached statistical significance ; and 3 the reported effects of the needle exchange program could not have been attributed by the authors to any other source. Of the eight listed outcome measures, only three outcomes met the methodological standard of evidence set by the GAO team: 1 rate of needle sharing, 2 prevalence of injection drug use, and 3 frequency of injection.
The GAO team summarized descriptive information, whenever it was available, on the ability of needle exchange programs to reach out to injection drug users and refer them to drug treatment and other health services.
Tables 7. Regarding the potential positive outcomes, of the nine research projects reviewed, two reported a reduction in needle sharing, and a third reported an increase. It should be noted that the increase in sharing by needle exchange participants resulted from their passing on more used injection equipment Klee et al. The earlier finding from that study appears to have been a transient effect that occurred before the needle exchange programs in the area reached full operation; that is, needle exchange participants were being used as a source of needles among their respective networks of injection drug users Klee and Morris, The researchers concluded, moreover, based on the data available from six of the nine projects, that the needle exchange programs were successful in reaching injection drug users and providing a link to drug treatment and other health services.
Regarding potential negative outcomes of needle exchange programs, all five projects that reported findings on injection drug use by program participants—four on frequency of injection and one on prevalence of use—found that use did not increase.
Note that three of these findings did not reach statistical significance. GAO reported that there was sufficient evidence to suggest that needle exchange programs "hold some promise as an AIDS prevention strategy" p. In summary, the GAO report, which was the first government report to evaluate needle exchange programs, concluded that such programs hold promise as interventions to limit HIV transmission.
The criteria for assessing the validity of the study findings and for including reports in the review were quite stringent. In particular, the criterion of statistical significance means that studies that showed no difference in the frequency of injection or needle sharing were excluded. Therefore, the argument that needle exchange programs cause no harm is not fully characterized because studies with high level of statistical power that showed no difference were excluded. This report consists of a summary volume with two supporting volumes and addresses a number of the questions that this panel was asked to address.
The University of California report was the work of a team of 12 individuals with expertise in clinical medicine, nursing, psychology, anthropology, sociology, cost-benefit modeling, and epidemiology. None of the team members was identified in published writings as either in favor of or opposed to needle exchange programs.
In a process that included discussions with an advisory committee, public health officials, needle exchange program staff members, researchers, experts in drug abuse treatment and injection drug use, and community leaders, a list of 14 research questions was generated: 1 How and why did needle exchange programs develop? The investigators conducted a formal review of existing research; made site visits and sent mail surveys to needle exchange programs; formed focus groups with injection drug users; and applied statistical modeling techniques.
Data collected from each approach were sorted into 1 of the 14 questions about impact of needle exchange programs. The aim of the literature review was to identify a maximum of written works relating to the effectiveness of needle exchange programs. Computer searches of AIDS line and Medline provided a first cut and were augmented by items from the bibliographies of articles found therein. In addition, the research team reviewed abstracts from the annual International Conference on AIDS from to and the annual meetings of the American Public Health Association from to To identify unpublished materials, needle exchange program staff were contacted about internal reports, and a search was made for newspaper and magazine clippings, government and institutional reports, and relevant book chapters.
From this effort, 1, data sources were identified, which included journal articles, conference abstracts, reports, unpublished materials, newspaper and magazine articles, 94 books or chapters, and personal communications or other sources. All materials were reviewed and coded according to which research question s they addressed.
Project members were assigned responsibility for synthesizing information for each of the 14 research questions. Each of the studies was assessed using a standardized format and ranked on a scale from 1 to The final ranking of an article was determined by agreement of at least two project members. Only studies ranked 3 or higher were used in the synthesis.
In addition to the review of existing research, the University of California team conducted site visits to 15 cities, 10 of which were in the United States, 3 in Canada, and 2 in Europe.
CDC was consulted during the selection process. At each site, the research team used multiple data collection methods with multiple iterations, consisting of interviews, focus groups, and observation using a formal qualitative research strategy. The methodology was codified in a manual. Standardized training of the research staff was provided. In the 15 cities, 33 needle exchange sites were visited and a total of interviews with needle exchange directors and staff, public health officials, injection drug use researchers, community leaders, program participants 11 focus groups , and injection drug users not enrolled in programs 7 focus groups were completed.
Observation guidelines were pretested at two sites and the results were compared qualitatively for interrater reliability before adopting the final guidelines. Of the nine outcomes and expectations for successful needle exchange programs listed in Table 7. That is, research findings concerning four of the five possible positive outcome domains were reviewed: reduction in drug-related and sexual risk behaviors, increase in referrals to drug abuse treatment, and reduction in HIV and other infection rates.
The report addressed all four possible negative outcomes: increases in 1 drug use by program participants; 2 new initiates to injection drug use; 3 drug use in the community in general; and 4 the number of contaminated needles discarded. The University of California report reviewed data on reported needle-sharing frequency in studies of needle exchange programs. Of the 26 evaluations addressing behavior change associated with the use of needle exchange programs that were identified, 16 were deemed of acceptable quality rating 3 or higher.
Of the 16 studies, 14 presented data on the frequency of needle sharing; 9 of these had comparison groups reported. As Table 7. Regarding sexual risk behavior change, the report concluded that the findings were neutral.
That is, four studies reported beneficial effects of needle exchange programs relating to sexual risk associated with number of partners and two reported mixed or neutral effects.
When reviewing studies that addressed risk associated with partner choice, three showed beneficial effects and two reported mixed or neutral effects. Finally, beneficial effects of needle exchange programs relating to condom use were observed in one study, mixed or neutral results in another, and adverse effects in three studies. The University of California report noted that 17 of 18 U.
Of 33 U. The extent to which referrals enter treatment and are retained was described—the 6 programs that collect data on referrals reported 2,—but was not studied. The report noted Lurie et al. This affects the likelihood that a needle exchange program will refer and that a referral will link a client with treatment. The University of California report identified 21 studies that were relevant to the issue of whether needle exchange programs impact rates of HIV infection: 2 case studies, 7 serial community cross-sectional studies, 6 serial needle exchange program cross-sectional studies, 1 case-control study, and 3 prospective studies.
The quality of studies was rated on a 5-point scale ranging from a low of 1 not valid to a high of 5 excellent and a mid-point of 3 acceptable.
Only two of the studies received a quality rating of 3 or higher, and two others were rated between 2 and 3. None of the studies showed increased prevalence or incidence of HIV infection among needle exchange participants. Given the quality rating of the studies, it is not surprising that the University of California report concluded that the studies available up to the time of the report Lurie et al.
However, needle exchange programs do not appear to be associated with increased rates of infection. It is intrinsically difficult to measure effects of intervention on the incidence of new infections of rare diseases, whose victims ordinarily do not show symptoms at the time of infection. Although most of the early studies used prevalent infection as the outcome measure, the more appropriate measure is incident or new infection. However, a further complication is that incidence is low in most locations, thereby requiring larger study populations to demonstrate program effects.
The University of California report noted Lurie et al. Well-conducted, sufficiently large case-control studies offer the best combination of scientific rigor and feasibility for assessing the effect of needle exchange programs on HIV rates. The University of California report noted that eight "acceptable" studies were identified that presented data on the issue of reported injection frequency. This last study also found reduced needle sharing reported among needle exchange participants.
This study noted that the apparent increase in injection could be attributed to several other factors, including the differential dropout of low-level injectors. The report also reviewed the methodological limitations of the studies, including the potential for socially acceptable responses by injection drug users.
On balance, because of methodological problems, the report drew no strong conclusions about levels of injection drug use. The University of California report reviewed a variety of studies and used focus groups to understand whether needle exchange programs could encourage persons to initiate injection drug use. In reviewing the demographic data from the programs, the report noted that the median age of participants across programs ranged from 33 to 41, and the median duration of injection drug use from 7 to 20 years.
This suggests that most participants initiated injection drug use prior to using the needle exchange program. A review of serial cross-sectional studies of injection drug users in San Francisco noted an increase in the mean age of the samples over time from 34 in to 40 in , suggesting that there was not an increase in young new injectors over time.
Researchers in Amsterdam used a capture-recapture method to estimate the number of injection drug users between and Despite initiation of a needle exchange program in , no change in the number of injection drug users was reported, and the average age of drug users increased over time. Furthermore, the number of drug users under age 22 decreased from 14 percent in to 3 percent in The authors concluded that there was no increase in the number of new initiates into injection drug use.
The report concluded, on the basis of evidence from surveys, that Lurie et al. Focus groups were consulted. Of 10 focus groups from needle exchange programs, comprising 65 injection drug users, 2 individuals thought needle exchange programs could encourage nonparenteral drug users to start injecting.
Among seven nonprogram focus groups comprising 47 injection drug users, 2 individuals thought needle exchange programs could encourage nonparenteral drug users to start injecting. The focus group data were viewed as corroborating evidence for the data available from surveys arguing against an effect of needle exchange programs on increasing the community levels of injection drug use.
The University of California report addressed the potential for increased drug use in the community by reviewing the studies noted in the previous section. Researchers searched for additional data by examining established data sets of drug abuse indicators and answers to additional questions asked of focus groups of injection drug users. The University of California researchers attempted to relate the presence or absence of needle exchange programs to ongoing statistical series like the Drug Abuse Warning Network DAWN , Drug Use Forecasting DUF , and Uniformed Crime Reports UCR , which might reflect altered patterns of drug-related events, such as drug cases in hospital emergency rooms, positive urine drug screens, and drug-related arrests, respectively.
The report noted wide variation in these drug-use indicators over time, which suggests inherent lack of precision and limits the manifestation of patterns—if any—relating to needle exchange.
The University of California report also noted that, because needle exchange programs are relatively new, changes in drug use might yet appear with longer follow-up. The report concluded that Lurie et al. The report also noted that the San Francisco and Amsterdam surveys described above provide Lurie et al.
The University of California report noted that adverse community responses to needle exchange programs are likely to be centered on the issue of discarded needles and the risk to the public of accidental needlestick injury. However, the report noted that one-for-one exchange rules cannot, in theory, increase the total number of discarded needles, although programs could affect the geographic distribution of discarded syringes.
Data on a surveillance project with the Portland, Oregon, needle exchange program noted a decrease in the prevalence of discarded syringes near the program Lurie et al. Passive surveillance of health or police department reports over time indicated either declines or small increases in needlestick injuries, with the trends due to changes in reporting patterns.
The University of California report concluded that needle exchange programs "have not increased the total number of discarded syringes" and, if structured as a one-for-one exchange with no starter needles, "they cannot increase the total number of discarded needles" Lurie et al. Using multiple data sources, the University of California reviewed a number of questions about needle exchange programs. As far as possible positive outcomes are concerned, the report concluded that the data available at the time of the report "do not … provide clear evidence that needle exchange programs decrease HIV infection rates," p.
The report goes on to state that there is no evidence that drug use among program participants increased, and there is no evidence of change in overall community levels of noninjection or injection drug use Lurie et al. This section is organized into topical areas that parallel the summaries of the GAO and University of California reports. Study findings are categorized according to the outcomes and expectations of program effects listed in Table 7.
Since the University of California report was issued, a number of studies on the impact of needle exchange programs have been presented or published. These studies utilize a variety of designs, including an ecological design; a comparison of prevalence rates between injection drug users who use and those who do not use needle exchange programs; HIV incidence rates among needle exchange program attenders; and, using data collected prospectively, a comparison of HIV incidence rates between injection drug users who attend and those who do not attend a needle exchange program.
Recent publications on needle exchange programs in San Francisco, New York City, and Portland, Oregon, have addressed the issue of the impact of the programs on HIV drug-use risk behaviors and sexual risk behaviors Watters et al. In an ecological study in San Francisco, Watters examined the trends in risk behaviors and HIV seroprevalence over a 6.
Interviews 5, were conducted with injectors in street settings and drug detoxification clinics. During that time period, multiple prevention efforts targeting injection drug users had been implemented including outreach, education, voluntary HIV testing and counseling, bleach and condom distribution, and needle exchange programs.
Among injection drug users who reported sharing needles, the proportion of those who reported ever using bleach increased from 3 percent in to 89 percent by and remained relatively constant at that level through fall Sexually active heterosexual male injectors also reported significant changes in condom use i.
However, Lewis and Watters found that a substantial proportion of sexually active male drug injectors, including heterosexuals, bisexuals, and homosexuals, reported frequently engaging in unprotected sex i. Several trends in drug-use risk behaviors were reported. In , for example, 65 percent of injection drug users reported having used shooting galleries in the preceding 2 years; in the to survey, only 3 percent reported injecting in shooting galleries in the preceding 6 months.
Substantial reductions in sharing behavior were also observed. Use of potentially contaminated needles declined from 51 to 7 percent of injections. Moreover, an increasing proportion of injection drug users entering the detoxification program reported using the needle exchange programs since they opened in For the to period, results also show that needle exchange participation was associated with a downward trend in the proportion of subjects reporting any injection with needles that had been used by someone else and a reduction in the percentage of study participants reporting having passed on used needles to others.
The extent to which the reductions in risk behaviors reported in the two surveys can be attributed to the needle exchange program itself is limited by the fact that the data are ecological trends. Other prevention efforts were occurring in New York City between the two time intervals. Therefore, although the results are consistent with an inference of reduction in risk behaviors following the introduction of a needle exchange program, the study design does not exclude the possibility of contributing or alternate explanations.
In the San Francisco needle exchange program evaluation, Watters compared frequent needle exchange participants with two comparison groups—injection drug users who used the exchange less frequently and a group who did not use it at all.
These researchers found a 47 percent decline from 66 to 35 percent in reported sharing behavior among injection drug user study participants between spring and spring More refined analyses revealed that frequent needle exchange participants i.
In contrast, over the 3-year study period, no change in reported rates of sharing behavior was observed among those not using the program. In New York City, Paone et al.
Participants reported a two-thirds decline in the proportion of time they injected with previously used needles 12 percent before participating in the needle exchange program, compared with 4 percent in the last 30 days while participating in the program.
Similar reductions in renting or buying used needles 73 percent decline were observed, and similar reductions in the number of participants who reported borrowing used needles were found 59 percent decline. The number of participants who reported using alcohol pads increased from 30 percent before participating in the needle exchange program to 80 percent in the most recent 30 days in the exchange.
Although the reduction in high-risk behaviors was based on self-reports of exchange users and no comparison of injection drug users not using the exchange was included in this report, this pattern of reduction in drug-use risk behaviors was found to be relatively stable in recent updates Des Jarlais et al. These authors also note in their recent updates that minimal changes in sexual risk behaviors were reported. Moreover alongside this program, inmates should be trained in disseminating clean needles.
The needle exchange programs in Moorhead, Milwaukee, and Scott County are working to lower the transmission rate and increase participation in treatment programs.
There are currently 35 states with known needle exchange programs in the United States. However, there is a large disparity of programs throughout the Midwest amfAR, This case study has revealed that there is a need for needle exchange programming in this portion of the country and the programs that do exist have.
The public should be advised of positive effects of needle exchange programs and warned of the risks of not supplying adequate syringes. This concept has been under research ever since. Harm reduction approaches for those who inject drugs, including the distribution of clean needles and syringes, are proven interventions. How well are the current policies working based on research data "The large indicator of success of these programs is the documented 75 percent reduction in HIV transmissions associated with injection drug use" said Anne Roach, spokeswoman for the Department of Public Health.
One of the major problems of our society nowadays is the rapid growth of drug addicts. This is because people misused and abused drugs, which can lead to addiction and dependent on drugs. In addition, the most abused drugs are psychotropic drugs such as cocaine and heroin, which can change the way people thinks, acts and feels. This condition is divided into versions A, B, C, D, and E- each which has its own method of spreading and which requires its own treatments.
Hepatitis B and C can be spread through sharing needles. Hepatitis B has a vaccine and medication to prevent and treat the condition, however, Hepatitis C has no means of prevention, besides not engaging in high-risk behavior, but has medication to treat it. Some patients with hepatitis will recover, but many spend their lives on medication and are continuously monitored for liver failure and cancer. Recreational drugs which are commonly injected include heroin, cocaine, methamphetamines, prescription stimulants, as well as opioids.
These drugs are injected into the bloodstream through a vein, either by the forearms or other discrete locations such as in between the toes. W hen i njecting many times throughout a period, the veins can become damaged or collapse as well as causing lesions and bruising. When this happens, injection drug users move on to other areas of the body including hands, face, neck, and even the groin.
Injection drug users also take methods to reduce the likelihood of the injection sites being seen through covering up with clothing and tattoos. Not only are the injected drugs addictive, but the needles themselves can also be too. An individual can present with needle fixation which is when they crave the act of injection itself. While the needle exchange program is aimed at reducing harm and providing a place of safe needle disposal, cannabis can be used to better address the issue of addiction.
Many people believe that cannabis is an addictive substance when in reality it can be an effective means of assisting with combating dependency and addiction. For example, cannabis can be used to prevent the development of addiction when consuming opioids for medicinal purposes, as well as offering an alternative to pain management without the risk of addiction.
Cannabis can also be used in harm reduction programs for those who have severe addictions and struggle with full abstinence. The aim of these programs is to use cannabis and other holistic alternatives for individuals suffering from a severe addiction to get over their addiction and to improve the chances of full abstinence.
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