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.
October 20, 2009