Abstract
BackgroundDespite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking.MethodsData were derived from two prospective cohort studies of people who use illicit drugs in Vancouver, Canada between 2010 and 2014. Multivariable generalized estimating equations were used to identify the prevalence and correlates of public crack smoking and rushed public crack smoking.ResultsIn total, 1085 participants who had smoked crack in the prior six months were eligible for the analysis, of which 379 (34.9 %) reported always or usually smoking crack in public in the previous six months at some point during the study period. Factors positively and independently associated with public crack smoking included public injection drug use (adjusted odds ratio [AOR]: 5.42, 95 % confidence interval [CI]: 3.76-7.82), homelessness (AOR: 3.48, 95 % CI: 2.77-4.36), at least daily crack use (AOR: 2.69, 95 % CI: 2.19-3.31), crack pipe sharing (AOR: 1.98, 95 % CI: 1.60-2.46), drug dealing (AOR: 1.59, 95 % CI: 1.30-1.94), recent incarceration (AOR: 1.47, 95 % CI: 1.09-1.98), noticing police presence when buying or using drugs (AOR: 1.30, 95 % CI: 1.06-1.60), and younger age (AOR: 1.03, 95 % CI: 1.01-1.04). Rushed public crack smoking, which was reported by 216 (28.8 %) of 751 participants who had smoked crack in public at least once during the study period, was positively and independently associated with homelessness (AOR: 2.61, 95 % CI: 1.96-3.49), at least daily crack use (AOR: 1.48, 95 % CI: 1.11-1.98), crack pipe sharing (AOR: 1.44, 95 % CI: 1.10-1.89), drug dealing (AOR: 1.39, 95 % CI: 1.04-1.86), and younger age (AOR: 1.02, 95 % CI: 1.01-1.04).ConclusionsA high prevalence of public crack smoking and rushed public crack smoking was observed in this setting. These findings point to the need for implementing and evaluating evidence-based public health interventions, such as supervised inhalation facilities, to reduce the risks and harms associated with smoking crack in public.
Highlights
Despite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking
A recent multicriteria decision analysis performed by the Independent Scientific Committee on Drugs found that crack cocaine is among the top three illicit drugs that are most harmful to individual users and to others, due to its potential for causing substantial physical, psychological, and social harms [6]
This study found that individuals who were homeless had elevated odds of public crack use and rushed public crack use compared to individuals who were not homeless, which is consistent with other literature that has found that homelessness is one of the strongest predictors of using injection drugs in public [22, 33,34,35]
Summary
Despite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking. Individuals who use crack have been found to have elevated risk of HIV, hepatitis C virus (HCV), tuberculosis, herpes zoster, and other infectious pathogens secondary to sores, burns, or cuts, either from shared crack pipes or from increased prevalence of sexual risk behaviors [7,8,9,10,11,12,13,14]. Public injecting has been found to be associated with greater odds of injection-related risk behaviours (e.g., sharing used injection equipment, not cooking or filtering drugs prior to injecting), HIV and HCV transmission, and poor health and social status (e.g., more severe drug dependency, social isolation, and unstable lifestyles) [21,22,23]. Little is known about risks associated with the use of non-injection drugs in public settings— crack
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