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Letters

HIV in injecting drug users in Asian countries: Naltrexone implants are set to supersede harm minimisation

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7483.147 (Published 13 January 2005) Cite this as: BMJ 2005;330:147
  1. Albert S Reece, general practitioner (sreece{at}bigpond.net.au)
  1. Brisbane, QLD 4101, Australia

    EDITOR—Wodak et al draw attention to intravenous drug use as a source of HIV transmission.1 They make the case for harm minimisation strongly but omit to mention that this is consistent with ongoing and even increasing drug use.2 Harm minimisation remains a hypothesis that has never been shown to fulfil Hill's principles of causation3; neither have simultaneous confounding factors been controlled for.

    Such advocacy overlooks discordant data that include epidemic levels of the non-condompreventablehumanpapillomavirus (including the commonest tumour in the developing world, cervical cancer); epidemic levels of herpes and rising rates of chlamydia; holoendemic hepatitis C among drug users; the unpopularity of methadone both among patients who take it and who don't; the long term effects of methadone including mortality of 50%, and 590 deaths implicating it in Australia 1997-2001; severe erosive dental disease; osteoporosis and osteopenia rates of 87%4; the high prevalence of methadone use among major heroin dealers; and the failure rate of the “exchange” component of needle programmes with 10 times more needles given away annually than we have Australians. In three sub-Saharan nations HIV has decreased despite non-adherence to harm minimisation (J Museveni, address, Common Ground conference, Medical Institute of Sexual Health, Washington, DC, June 2004; www.medinstitute.org/Museveni.htm).

    Contrariwise naltrexone has been called “psychiatry's most effective drug.” Poor compliance has now been overcome by the development of long lasting subcutaneous depot preparations including that from Perth, Western Australia, which lasts up to 11 months.5 Surely the HIV dilemma necessitates regulatory fast tracking of this device, and the implant's emergent dissemination across the developing world?

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