Crack Use As a Public Health Problem in Canada

Abstract

Oral crack use (smoking) is a relatively neglected public health problem in Canada, in comparison to injection drug use (IDU). There are indications that crack use in Canada may be increasing. Crack smoking involves particular risks and harms, including possible infectious disease transmission, which underline the need for targeted interventions. One pragmatic grassroots intervention that has only recently begun or been discussed in several Canadian cities is the distribution of 'safer crack use kits', which provide hardware for crack smoking devices along with harm reduction information. In addition to the direct benefits of using them, the kits may also bring previously 'hidden' marginalized crack smokers in contact with health and social services. There has been considerable controversy with regards to the distribution of the crack kits, within criminal justice, public health, and the general public; this resistance appears quite similar to that experienced when needle exchange programs (NEPs) were first being established. Systematic evaluation of the crack kits is urgently needed in order to produce definitive evidence of their health and other benefits, and to allow for evidence-based program and policy decisions in the interest of public health.La traduction du résumé se trouve à la fin de l'article.

Crack pipe sharing among street‐involved youth in a Canadian setting

“…Only 8% of all study observations indicated that participants in this study acquired their crack cocaine pipes from some type of health service, which is consistent with previous research that found a similar low rate of acquiring crack pipes through a health service and higher rates of acquiring pipes through corner stores among adults [14]. Although corner stores provide a means for crack users to acquire new pipes, these stores typically sell inexpensive low-quality pipes which have been found to facilitate health-related harms such as oral burns [28,29] and are more likely to fracture and consequently cut users with the shards; Pyrex pipes distributed by health programs are more durable and safer to use [30]. The absence of formal crack pipe distribution programs may contribute to youth continuing to use pipes that are more likely to lead to health-related harms and perpetuate the lack of availability of these pipes, which is particularly concerning as our results show a positive association between having difficulty obtaining crack pipes and sharing them.…”

A drug use survey among clients of harm reduction sites across British Columbia, Canada, 2012

“…There was more heroin use among respondents at sites closer to the major centre versus more morphine use at those further away. These finding are in keeping with evidence that prescription opioids diverted for illicit use is a growing problem in Canada [ 4 - 6 ]. Fischer et al found evidence that heroin has become an increasingly marginal drug used among illicit opioid users in Canada, particularly outside of major port cities thought to be heroin import points, such as Montreal and Vancouver [ 4 ].…”

“…Canadian cohort data has long indicated major increases in crack use over time and that crack is now the most prevalent drug used in many major metropolitan areas [ 6 , 21 ]. We also found that respondents from sites in or near the major centre had a higher prevalence of crack use.…”

“…In Canada, there is geographic variation in drug use often based on regional drug trafficking activities affecting drug availability [ 2 , 3 ]. In the past decade, there has been increasing prevalence of crack cocaine smoking and decreased use of heroin outside of major port cities with a concurrent increase in the use of diverted prescription opioids [ 4 - 6 ]. Changes in drug supply and method of use may put persons who use drugs (PWUD) at higher risk of overdose and other harms due to lack of familiarity with a new drug's potency and health risks [ 7 ].…”

Combining chain link sampling with a community-based participatory action study of people who smoke drugs in two cities in British Columbia, Canada

“…While these programs have been found to alleviate the harms associated with intravenous drug use, less attention and fewer resources have been allocated to people who smoke drugs (PWSD) (Boyd et. al., 2008;Bungay et al, 2010;Haydon and Fischer, 2005). PWSD who engage in unsafe drug practices are at increased risk of contracting bloodborne and pulmonary infections (Edlin et al, 1994).…”