Crack smoking rooms may cut HIV risk: study

By Terrapinzflyer · Oct 19, 2009 · ·
  1. Terrapinzflyer
    Crack smoking rooms may cut HIV risk: study

    People who smoke crack cocaine are at increased risk of becoming infected with HIV — a finding that highlights the need to adopt and to evaluate the use of safe inhalation rooms and safer crack kits, B.C. researchers say.

    Dr. Evan Wood of the B.C. Centre for Excellence in HIV/AIDS and his colleagues looked at 1,048 injection drug users in Vancouver for an average of nine years. During that time, 137 (or 13.1 per cent) became HIV positive, the team reported in Monday's issue of the Canadian Medical Association Journal.

    The researchers set out to study crack cocaine use given that in 2007 more than 20 per cent of new cases of HIV infection recorded in Canada were attributed to injection drug use, according to the Public Health Agency of Canada.

    The risk of contracting HIV among people who smoked crack cocaine daily increased over time, from 1.03 times higher in the first three-year period, 1.68 times during the second period, and 2.74 times higher during the third period, after adjusting for other factors, the researchers found.

    Mouth wounds such as burnt lips from crack pipes may make people more vulnerable to infection, the team speculated. Or people who smoke crack may be at increased likelihood of HIV infection through unsafe sex and needle sharing.

    The researchers were unable to assess these possible risk factors in the study.

    "Although highly controversial, innovative public health programs that address the unique needs of people who smoke crack cocaine and that contribute to HIV prevention efforts may include the distribution of safer crack kits and the provision of supervised inhalation rooms," the study's authors concluded.

    Safer crack kits include a glass stem with a mouth piece, metal screen, lip balm and hand wipes.

    Researchers also found that use of heroin decreased during the study period.

    Rooms successful in Europe studies

    Providing inhalation rooms have been used successfully in several European studies.

    "By bringing people out of the alleys and into the public health domain there's a whole host of opportunities that are made available to us," said Wood.

    Inhalation rooms and distributing safer crack kits give health workers an opportunity to engage with crack smokers to address their needs for health care, social assistance and referral for addiction treatment among "this often hidden population," the study's authors said.

    Both strategies need to be evaluated, they said.

    In a related journal commentary, Dr. David Celentano and Dr. Susan Sherman of Johns Hopkins Bloomberg School of Public Health in Boston agreed the controversial practice of handing out safer crack kits has the potential to reduce HIV transmission.

    The idea of a safe inhalation site has at least one high-profile proponent in Canada.

    "It's not a habit to be encouraged, certainly," said B.C.'s medical officer of health, Dr. Perry Kendall. "But it is a way with a demonstrated, evidence-based approach among other approaches to help reduce the risk of HIV transmission, hepatitis C transmission, sexual disease transmission and to get people into treatment."

    Kits containing pipes and mouthpieces have already been distributed in some Canadian cities, including Vancouver, Ottawa and Toronto.

    The researchers said the U.S. approach to drug use has been a dismal failure, and they're calling on Canadian officials to try a more pragmatic approach.

    The study did not include a random sample, but is thought to be represent injection drug users. It also relied on self reports.

    The study was funded by the U.S. National Institutes of Health and the Canadian Institutes of Health Research.

    CBC News

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  1. Terrapinzflyer
    and a related article:

    Increased Risk Of HIV Is Associated With Crack Cocaine Smoking
    A new study in the Canadian Medical Association Journal (CMAJ) reports that people who smoke crack cocaine are at increased risk of becoming HIV-infected. The study also indicates that smoking crack cocaine has considerably increased over the last several years.

    These findings are alarming and highlight the urgent need for innovative public-health programs focusing on crack cocaine smokers.

    Researcher examined a total of 1,048 injection drug users participating in the Vancouver Injection Drug Users Study in Vancouver, British Columbia. About 36 percent of participants were female, 26 percent self-identified as Aboriginal. At the start of the study the age average was 34 years. At enrolment the participants were HIV negative but by the end of the nine year study, 137 people contracted HIV.

    In addition, the proportion of people who smoked crack cocaine daily jumped from 11.6 percent in the first three and a half year period to 39.7 percent in the last period.

    Dr. Evan Wood of the BC Centre for Excellence in HIV/AIDS explains: "We have observed that use of crack cocaine has become one of the strongest risk factors for HIV seroconversion in Vancouver." According to the authors, this could be the result of mouth wounds caused from crack pipes making people more vulnerable to infection. In addition, relationship with more HIV-positive individuals could increase likelihood of HIV infection through sex and needle sharing. However, they were unable to evaluate these possible risk factors in the study.

    The authors support the careful evaluation and implementation of innovative harm reduction programs to help crack cocaine smokers. This includes the controversial distribution of safer crack kits and supply of safe inhalation rooms. These interventions would give opportunities for health workers to engage with crack smokers and help attend to their other health care needs.

    In an associated commentary, Dr. David Celentano and Dr. Susan Sherman of Johns Hopkins Bloomberg School of Public Health remark that "with the increasing proportion of injection drug users who are smoking crack cocaine, harm reduction programs need to address the unique needs of these people as part of a comprehensive HIV prevention strategy. Although controversial, the distribution of "crack kits" (glass stem with mouth piece, metal screen, lip balm and hand wipes) to this population has the potential to reduce HIV transmission."

    "Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs"
    Kora DeBeck MPP, Thomas Kerr PhD, Kathy Li PhD, Benedikt Fischer PhD, Jane Buxton MD, Julio Montaner MD, Evan Wood MD PhD
    CMAJ 2009. DOI:10.1503/cmaj.082054

    "The changing landscape of crack cocaine use and HIV infection"
    David Celentano ScD MHS, Susan G. Sherman PhD MPH
    CMAJ 2009. DOI:10.1503/cmaj.091574
    Canadian Medical Association Journal

    Written by Stephanie Brunner (B.A.)
  2. dyingtomorrow
    That would be real nice.

    SWIM just spent 2 days smoking off a broken ended glass crack pipe with 8 other semi-homeless people in a semi-abandoned building; wondering now if he got anything. He stopped by his brother's place and both his bro and his bro's gf got sick.

    Seems like heroin people get the best harm prevention.
  3. dyingtomorrow
    SWIM would add one more thing, which may sound small but is actually a big issue.

    A huge number of crack smokers in the ghetto don't have steady places to live. They go in weird places like abandoned buildings, bushes along bridges on the side of the highway, up on railroad tracks. Most of the places are littered with refuse, old needles, glass, etc. from all the people/homeless people who have hid out there to do drugs. This alone probably accounts for some amount of the spread of disease.

    Last weekend SWIM, for instance, was along the side of a bridge along a railroad track, sat down to smoke some crack and shoot up, and when he put his hand on the ground something slashed a 2+ inch, 1/4 inch deep gash in his palm (ironically, in terms of palm reading, right along his "life line"). It took 12 hours before it stopped dripping blood (which of course got all over a bunch of stuff) and still hurts SWIM like a bitch. SWIM thinks it was just glass, but there are a million things like that in drug use areas that could infect someone. SWIM also got some kind of deep puncture wound and huge bruise in his thigh likely from something in a garbage filled crack house he was at which he just found today in the shower, which he guesses healed enough for him not to notice while the heroin had him pain free. Who knows if he sat on someone elses old needle during that time too.

    Having sanitary crack smoking areas with clean equipment would undoubtedly help stop the spread of disease, injury amongst crack users, and hopefully stop the proliferation of bio-hazard drug waste.
  4. kailey_elise
    I can see the need for handing out safe crack smoking supplies (and in fact the exchange programs that I've been to have little kits with the supplies without the pipe), but I can't see safe crack smoking rooms being viable.

    I mean, when people inject opioids, it's sort of an in-and-out kind of thing, whereas crack smoking is something people tend to do for hours at a time (if they can afford it). So I see it becoming more of a huge hangout, as opposed to quick in, shoot up, leave like it currently is in regards to the safe injection rooms.

  5. Sniffin Sunshine
    heh this would so never happen in the US. well at least not in florida where swim is. we dont even have a needle exchange.. let alone a crack pipe exchange
    swim just gets the feeling that like swikailey said it would become a hangout spot and sooner or later dealers would hang out there as well, and i dont see the cops overlooking that and not trying to go in and just bust people

    swim does agree that having kits would be a good idea though as far as harm reduction.
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