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.
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.”
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.
Once crack was introduced about six years ago, Mandela and the surrounding complex of shantytowns became Rio's main outdoor drug market, a "cracolandia," or crackland, where users bought the rocks, smoked and lingered until the next hit. Hordes of addicts lived in cardboard shacks and filthy blankets, scrambling for cash and a fix. Dealers have stopped selling the drug in Mandela and nearby Jacarezinho in a move that traffickers and others say will spread citywide within the next two years. The drug bosses, often born and raised in the very slums they now lord over, say crack destabilizes their communities.
When you hear that your government is helping addicts shoot up or smoke crack, it's normal to wonder: how can this possibly be good? Until recently, Alberta Health Services did similar work, distributing free, clean crack pipes to Calgary addicts through the Safeworks Harm Reduction Program. But when local media publicized the existence of the pipe arrangement last month, things went sideways.
Louise Gallagher (Director, Public Relations, Volunteer Services, with the Calgary Drop In, Rehab Centre)
21 August 2011
In 2008, Safeworks, an outreach program of Alberta Health Services, began a harm reduction program aimed at mitigating the effects of sharing crack pipes with other addicts. Through the program, users had the opportunity to obtain a clean pipe. It helped cut down on transmittable diseases and it gave outreach workers an opportunity to build relationships and explore safer options with this at-risk population of crack users. It's disheartening that AHS decided last week to let this program go up in smoke because it became controversial.
A decision to stop a clean crack-pipe distribution program has disappointed those working to rehabilitate street addicts. Since 2008, Alberta Health Services had been giving out crack-pipe kits as part of the Safeworks program, an effort to reduce transmittable diseases. The kits contained a glass pipe, mouthpiece and cleaning tool and were handed out in an AHS van. More than 14,500 crack pipes were given out as of June 2011.
Vancouver health officials will distribute new crack pipes to non-injection drug users this fall as part of a pilot project aimed at engaging crack cocaine smokers and reducing the transmission of disease such as hepatitis C, HIV and even respiratory illnesses. The program, part of Vancouver's harm reduction strategy, is expected to start in October and run for six months to a year. The intent is to connect health care workers with crack cocaine smokers to evaluate how many of the drug users are in the city and what equipment they need to lower their risk of catching diseases. A kit with a clean, unused pipe, mouthpiece, filter and condoms will be handed out to the participants.
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.
Andrew Ivsins, Eric Roth, Nadine Nakamura, Mel Krajden, Benedikt Fischer
30 June 2011
Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUKs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada.
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.
Leslie A. Malchy, Vicky Bungay, Joy L. Johnson, Jane Buxton
30 April 2011
Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.
This fact sheet explains the Safer Crack Use Program of the Public Health Department of Toronto (Canada). In Toronto, a range of community-based, government and institutional agencies deliver harm reduction services. As with other harm reduction measures, there is no evidence that the distribution of safer crack use kits encourages drug use. Only people who are already using crack cocaine participate in the Safer Crack Use Program.
Brazil will soon have a special police task force targeting crack-cocaine. Meanwhile, the Brazilian state of Minas Gerais proposes its own drug fighting alternatives to address crack on the domestic front. Crack is a risk factor in urban violence, contributing to homicides and robberies in Brazilian cities. However, it is not the chemistry involved in crack, but the crack market that is increasing the crime and violence. How can rising crack use effectively be addressed, other than through mere suppression?
Jean-Paul Grund, Philip Coffin, Marie Jauffret-Roustide, Minke Dijkstra, Dick de Bruin, Peter Blanken
01 April 2010
Harm reduction programmes targeting stimulants like cocaine and (meth)amphetamines in several countries have shown positive results. However, these programmes are limited to Australia and North America. As the effectiveness of pharmacological and psychosocial interventions for stimulant users is limited, interventions to stabilise and minimise the negative consequences of ongoing methamphetamine use are of paramount importance. A wide range of health and social problems associated with stimulant use are largely unaddressed by current services.
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.
In 2004, a team comprised of researchers and service providers launched the Safer Crack Use, Outreach, Research and Education (SCORE) project in the Downtown Eastside of Vancouver, British Columbia, Canada. The project was aimed at developing a better understanding of the harms associated with crack cocaine smoking and determining the feasibility of introducing specific harm reduction strategies.
A number of public health departments and community organizations in Canada distribute safer crack use kits to people who use crack cocaine. The kits typically include mouthpieces, glass stems and screens, as well as condoms and referral information for other health and support services. This document outlines why such health programs are needed and answers a number of legal questions related to the distribution of safer crack use kits.
In the city of São Paulo, the culture of crack use has undergone considerable changes over these 11 years since it was first described. The sociodemographic profile of the users is practically the same and most use is still compulsive, with significant physical, moral and social impairment among them. Sole use of crack has overwhelmingly been replaced by associations between crack and other drugs, thus characterizing users in the city of São Paulo as multiple drug users.
The aim of this report is to provide key findings related to the SCORE project. It is our hope that the insights that we have gained may be of benefit to others engaged in similar initiatives and to ultimately improve the health of individuals who use crack. The SCORE project (Safer Crack Outreach, Research, and Education) grew out of the vision and hard work of the Safer Crack Use Coalition of Vancouver. Before the SCORE Project was funded, this coalition devoted much energy into raising awareness regarding the insufficient resources aimed at preventing the harms related to crack use.