Lynne Leonard, Emily DeRubeis, Linda Pelude, Emily Medd, Nick Birkett, Joyce Seto
30 April 2007
Among injection drug users (IDUs) in Ottawa, the capital of Canada, prevalence rates of HIV (20.6 percent) and hepatitis C HCV (75.8 percent) are among the highest in Canada. Recent research evidence suggests the potential for HCV and HIV transmission through the multi-person use of crack-smoking implements. On the basis of this scientific evidence, in April 2005, Ottawa's needle exchange programme (NEP) commenced distributing glass stems, rubber mouthpieces, brass screens, chopsticks, lip balm and chewing gum to reduce the harms associated with smoking crack.
This paper examined whether use of crack cocaine has become a risk factor for HIV infection. Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated.
Insite’s operators have twice applied for a federal health exemption to allow crack cocaine smokers to use the room – the request was rejected in 2006, ignored in 2009. Proponents say the room would allow health officials to reach a fast-growing segment of drug users, a group prone to viruses because of dirty crack pipes. Critics say scientific evidence for the benefits of supervised inhalation rooms is scant.
About two decades after the U.S. emerged from the worst of its own crack epidemic, Brazilian authorities are watching the cheap drug spread across this country of 190 million people. They have far fewer resources to deal with it, despite a booming economy that expanded 7.5 percent last year. Walter Maierovitch, a former drug czar, proposes programs that offer adults health services and a safe place to use drugs. "Insisting on programs that demand abstinence doesn't work," he said.
Drug users in France will soon have a state-sanctioned place where they can use heroin, crack and other intravenous drugs, after the government approved a pilot site in Paris. The City Council had already voted to allow a secure injection site to be opened in the city, a controversial measure, which social workers say should help to reduce the number of drug users in the streets.
For three years, the Vancouver Area Network of Drug Users’ (VANDU) operated an unsanctioned, peer-run “safer smoking room” for crack users in a small ventilated washroom in its Downtown Eastside facility. It protected crack users from violence, connected them with health care services, kept them away from public spaces and prevented the spread of disease from pipe-sharing, according to the authors of a recently-published study titled “We need somewhere to smoke crack.”
Prime Minister Stephen Harper’s statement about the failures of Canada's drug policy is mostly on point. It’s just the last bit he gets wrong: “I think what everyone believes and agrees with, and to be frank myself, is that the current approach is not working, but it is not clear what we should do.” He’s wrong, because we know what we should do: Supervised injection sites; prescription heroin; medical cannabis dispensaries; crack pipe distribution; drug testing kits; Naloxone for reversing opioid overdose.