Safe Crack Houses Urged

By chillinwill · Oct 21, 2009 · ·
  1. chillinwill
    B. C. Public Health Supports Strategy To Help Addicts

    Government authorities should allow medically supervised sites where crack-cocaine users can legally smoke their potent drug, researchers and B. C.'s top public-health doctor urged yesterday after a new study suggested crack addicts are particularly prone to contracting HIV.

    Sanctioned, safe crack houses would help curb the rampant transmission of dangerous infections among cocaine smokers, say proponents of the latest version of harm reduction, a controversial strategy that essentially condones an illegal activity to prevent an allegedly worse health problem. They also recommended that public-health officials be permitted to distribute "safe crack kits," including glass pipes designed to lessen the spread of viruses.

    "It's very unfortunate these things get politicized and made more controversial than they need be," said Dr. Evan Wood, who spearheaded the research. "But given the costs and challenges of HIV ... it's certainly in our interest to take a public-health approach to these infectious diseases that are already breaking free of their traditional boundaries."

    Dr. Wood is with the B. C. Centre for Excellence in HIV/ AIDS, which oversees Insite, a contentious facility where injection-drug users can shoot up while under medical supervision.

    Insite has been able to operate through an exemption to the Criminal Code's drug prohibitions granted by the federal government. The current Conservative administration has no plans to expand the concept, said Pamela Stephens, a spokeswoman for Rob Nicholson, the Attorney-General.

    " 'Harm reduction' sites and similar initiatives are inherently harmful to human health," she said in an email response to questions.

    "These programs not only cause physical harm, they also deepen and prolong the addictions and divert valuable dollars away from treatment."

    The debate stems from a paper published in the Canadian Medical Association Journal yesterday that found use of crack cocaine had soared between 1996 and 2005 to 40% from 12% among a 1,048-strong sample of injection-drug users in Vancouver.

    It also concluded that crack users, who typically heat blocks of cocaine in glass-bowled pipes and inhale the resulting smoke, were four times more likely to contract HIV than the other drug users.

    One theory is that the burns and open sores they often develop around their mouths provide an easy path for infection, said the CMAJ paper by Dr. Wood and colleagues with the B. C. Centre and the Urban Health Research Initiative.

    Another hypothesis is that users in the study got involved in unsafe sex or were even raped while on a crack binge, leading to virus transmission, the study suggested. Regardless of the reason, it is clear that crack-cocaine smokers are at greatly increased risk for a disease that is not only devastating to the individual, but costs the health-care system as much as $250,000 per case, Dr. Wood said.

    The paper suggested that crack sites and distribution of the kits be carried out initially on an experimental basis and studied scientifically.

    Dr. Perry Kendall, British Columbia's Provincial Health Officer, said he would support the idea, so long as the issue of second-hand smoke exposure for health-care workers in the safe sites was addressed.

    "Do you want people smoking crack outside in public, disruptively and spreading diseases, or would you rather have them doing it in an environment where it can be controlled?" asked Dr. Kendall. "In my mind it's a relatively simple equation."

    Critics, though, say safe crack sites would only encourage the addicts, and divert resources from what they really need: effective treatment.

    "What they should be doing is giving them a safe environment to get them off cocaine," said Larry Molyneaux, president of the Police Association of Ontario. "A harm-reduction program without a treatment program is a failure. Just feeding their habit isn't what is going to fix it."

    Dr. Wood said safe "inhalation sites" already exist in Switzerland, the Netherlands and Germany. Anecdotal reports indicate they have been successful in preventing disease, but no formal scientific studies have been conducted with any of those programs, he said.

    Dr. Wood also pointed to the evidence around Insite published in major medical journals, which suggests that its users are less likely to suffer overdose deaths and more likely to enter treatment.

    Tom Blackwell
    October 20, 2009
    National Post

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  1. chillinwill
    Ottawa Deaf to Pleas for B.C. Crack-Inhalation Site

    If B.C. hopes to set up a place where crack addicts smoke up legally, it will have to contend with the federal government.

    Health Canada has said any additions to InSite's supervised injection site would require another federal exemption under the Controlled Drugs and Substances Act - an exemption Ottawa refused to renew for InSite nearly two years ago.

    "All activities with narcotics such as cocaine and crack cocaine are prohibited under the CDSA unless authorized under the regulations," said Health Canada spokesman David Thomas. "If B.C. established such a site [without permission], this would become a matter for law enforcement."

    But the organizers behind North America's only sanctioned supervised-injection site say they've asked Ottawa for an inhalation-room exemption multiple times - and received no response. "We've done it a few times," said Mark Townsend, executive director of PHS Community Services, which runs Insite.

    Health Canada could not immediately confirm that it received such requests yesterday.

    B.C.'s chief health officer, Perry Kendall, came out in favour of the inhalation rooms this week after the publication of a Canadian Medical Association Journal article that found dramatically higher rates of HIV transmission in Vancouver's crack-user population.

    The study, Mr. Townsend said, "adds to the pressure that maybe a trial should take place, and so we are going to ask [Health Canada] again."

    The proposed facilities, which already exist in several European countries, would give addicts a designated place to smoke crack cocaine in the company of health professionals equipped with "crack kits."

    Ottawa is already embroiled in a protracted legal tug-of-war over who has final say over controversial harm-reduction strategies in the province. The case, part of an appeal over whether InSite's services are a constitutional right, was heard by the B.C. Court of Appeal in the summer, and parties are awaiting a verdict.

    Larry Campbell, the Liberal senator who helped spearhead InSite's creation in his role as Vancouver mayor, said an inhalation room, complete with necessary ventilation facilities, was built into InSite's Downtown Eastside facility when it was built in 2003. But organizers didn't want to push the envelope by asking for permission to set up a crack inhalation room in addition to a space where addicts can inject with the help of health-care professionals, so they let it go.

    "We said, 'Well, you know, let's get the supervised injection site up and running and go on,' because I didn't want it to be dragged on forever. ... I don't think we even applied for it. I think it was discussed and my feeling was that probably it was just adding a wrinkle in there that was going to hold up the whole process."

    Mr. Campbell said it's time Vancouver gets moving on the site - something he doesn't think it should need Ottawa's permission to do. "It would be the federal government messing in a provincial health-care matter."

    Dr. Kendall said he wants to pursue a supervised inhalation room, but there are no concrete plans to do so.

    Evan Wood, a researcher at the B.C. Centre for Excellence in HIV/AIDS and the senior researcher behind the CMAJ paper, says a clinical study could be under way as soon as the summer of 2010. He said he would have no problem asking the federal government for an exemption allowing the site to operate - as long as Ottawa does its due diligence and makes a decision based on the trial's scientific merit, which he said would be "groundbreaking" if it can help get high-risk drug-using populations off the streets.

    "You're using, basically, supervised injection sites and inhalation rooms as a strategy to recruit people into addiction treatment," he said.

    Anna Mehler Paperny and Wendy Stueck
    October 24, 2009
    The Globe and Mail
  2. jgarlopa
    Re: Ottawa Deaf to Pleas for B.C. Crack-Inhalation Site

    Cowboy lived in Vancouver for a short while, but it was more than long enough to notice that the city probably has the worst crack problem in North America. The situation is so bad up there that Cowboy doesn't see how anybody who has ever been to "Vansterdam" would not approve of this. The aim of creating an inhalation room for crack smokers has the same goals as that of the injection program, so why not?
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