Examination of Safe Crack Use Kit Distribution from a Public Health Perspective

Abstract

This paper examines the policy of safer crack use kit (SCUK) distribution within the city of Winnipeg, Canada. Publicly funded, SCUK distribution policy has been a contested topic throughout Canada, despite evidence that crack users represent some of the most marginalized members of society. Using the four pillars approach to drug policy as a guideline, the balance of allocation of resources for harm reduction is critiqued. Harms associated with crack use are broadly categorized as being associated with methods of use or social harms. The effectiveness of the current SCUK policy is examined according to the guiding principles of reduced harms and cost effectiveness. Research supports SCUK distribution based on the merits of increased health contacts and harm reductions. Data indicate the SCUK distribution policy supports efforts to reduce the transmission of communicable disease, notably Hepatitis C. A cost‐benefit analysis and assessment of the policy's effectiveness in reducing harms supports continuation of SCUK. Our conclusion advocates for the expansion of the current policy to emphasize further engagement and greater emphasis on working against associated social harms, but notes the need for further research on the topic. Benefits of peer‐based kit distribution are discussed and potential alternatives to the current SCUK policy are explored.

Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County

“…One practical example could be to enhance access to sterile injecting equipment among people who inject drugs in LAC, given previous research indicating inadequate syringe exchange program coverage in the region . The dissemination of ‘safe’ stimulant smoking kits could also facilitate less risky use patterns and referrals to appropriate professional support among sub‐populations such as MCSM .…”

HIV prevention and crack harm reduction using projection mapping in Mexico City

“…Specifically, crack-related harm reduction strategies have primarily been implemented in Canada (Fischer et al, 2016; Tapper et al, 2023), with the most widespread programmes promoting and distributing safer smoking supplies (e.g. pyrex pipes, mouthpieces) in ‘safer crack kits’ (Bergen-Cico and Lapple, 2015; Miskovic et al, 2018; Ivsins et al, 2011). Despite successful efforts there, crack intervention and prevention strategies are rare in Latin America (Domanico and Malta, 2012), although recently there has been an increasing presence of harm reduction programmes, including the use of virando (crack cocaine rock heated with boric acid to create a powder that can be snorted) in Brazil (Almeida et al, 2020).…”

Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal

“…The kits are provided by harm reduction programmes dedicated to people who use drugs. Following these new public health measures, studies reported decreases in sharing practices and increases in individual interventions with PWSC (Bergen-Cico & Lapple, 2015;Leonard et al, 2008). However, research has also pointed to persisting high prevalence of crack-smoking equipment sharing, even in areas where safer cracksmoking equipment was available (Fischer et al, 2010;Fischer, Cruz, Bastos, & Tyndall, 2013 ;Ti et al, 2011;Ivsins, Roth, Nakamura, Benoit, & Fischer, 2011;Leonard et al, 2008;Roy & Arruda, 2015).…”