Potential community and public health impacts of medically supervised safer smoking facilities for crack cocaine users

Kate Shannon,Mark W Tyndall,Arthur Bear,Robert Morgan,Megan Oleson,Tomiye Ishida,Thomas Kerr

doi:10.1186/1477-7517-3-1

Kate Shannon, Mark W Tyndall + Show 5 more

Open Access

https://doi.org/10.1186/1477-7517-3-1

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Abstract

There is growing evidence of the public health and community harms associated with crack cocaine smoking, particularly the risk of blood-borne transmission through non-parenteral routes. In response, community advocates and policy makers in Vancouver, Canada are calling for an exemption from Health Canada to pilot a medically supervised safer smoking facility (SSF) for non-injection drug users (NIDU). Current reluctance on the part of health authorities is likely due to the lack of existing evidence surrounding the extent of related harm and potential uptake of such a facility among NIDUs in this setting. In November 2004, a feasibility study was conducted among 437 crack cocaine smokers. Univariate analyses were conducted to determine associations with willingness to use a SSF and logistic regression was used to adjust for potentially confounding variables (p < 0.05). Variables found to be independently associated with willingness to use a SSF included recent injection drug use (OR = 1.72, 95% CI: 1.09–2.70), having equipment confiscated or broken by police (OR = 1.96, 95% CI: 1.24–2.85), crack bingeing (OR = 2.16, 95% CI: 1.39–3.12), smoking crack in public places (OR = 2.48, 95% CI: 1.65–3.27), borrowing crack pipes (OR = 2.50, 95% CI: 1.86–3.40), and burns/ inhaled brillo due to rushing smoke in public places (OR = 4.37, 95% CI: 2.71–8.64). The results suggest a strong potential for a SSF to reduce the health related harms and address concerns of public order and open drug use among crack cocaine smokers should a facility be implemented in this setting.

Highlights

Vancouver's Downtown Eastside (DTES) has been the site of an explosive HIV and HCV epidemic associated with a large open illicit drug use scene[1,2]
Vancouver is still contending with a open drug scene and issues of public order, among noninjection drug using (NIDU) crack cocaine smokers and crystal methamphetamine users [8]
Vancouver Area Network of Drug Users (VANDU) The Vancouver Area Network of Drug Users (VANDU) is a drug user organization that formed in 1997 in response to a growing HIV epidemic and health emergency in the Downtown Eastside of Vancouver associated with illicit drug use, and perceived government inaction

Summary

Introduction

Vancouver's Downtown Eastside (DTES) has been the site of an explosive HIV and HCV epidemic associated with a large open illicit drug use scene[1,2]. The objectives of a safer smoking facilities are similar to those of injection facilities including a safe environment that enables lowrisk, more hygienic drug consumption, reducing the health related risks of drug use and sharing of smoking paraphernalia, minimising the open drug use scene and associated public nuisance, and establishing contact with hard-to-reach drug user populations [18,19,20,21]. Advocates and policy makers in Vancouver, Canada are calling for a medically supervised safer smoking facility to smoke pre-obtained non-injection drugs, crack cocaine, and consideration is being given to applying for a federally-administered exemption from Health Canada (under exemption 56) to pilot a safe inhalation room [25,26]. A partnership between the Rock Users' Group of VANDU and CHASE, a communitybased research project, undertook an assessment of the willingness to use a safer smoking facility should one be made available

Methods

Results

17. Haemmig R

20. Stoever H

26. Howell M