Potential Uptake and Correlates of Willingness to Use a Supervised Smoking Facility for Noninjection Illicit Drug Use

Abstract

Many cities are experiencing infectious disease epidemics and substantial community harms as a result of illicit drug use. Although medically supervised smoking facilities (SSFs) remain untested in North America, local health officials in Vancouver are considering to prepare a submission to Health Canada for an exemption to open Canada's first SSF for evaluation. Reluctance of health policymakers to initiate a pilot study of SSFs may be due in part to outstanding questions regarding the potential uptake and community impacts of the intervention. This study was conducted to evaluate the prevalence and correlates of willingness to use an SSF among illicit drug smokers who are enrolled in the Vancouver Injection Drug Users Study. Participants who reported actively smoking cocaine, heroin, or methamphetamine who returned for follow-up between June 2002 and December 2002 were eligible for these analyses. Those who reported willingness to use an SSF were compared with those who were unwilling to use an SSF by using logistic regression analyses. Four hundred and forty-three participants were eligible for this study. Among respondents, 124 (27.99%) expressed willingness to attend an SSF. Variables that were independently associated with willingness to attend an SSF in multivariate analyses included sex-trade work (adjusted odds ratio [AOR]=1.85), crack pipe sharing (AOR=2.24), and residing in the city's HIV epicentre (AOR =1.64). We found that participants who demonstrated a willingness to attend an SSF were more likely to be involved in the sex trade and share crack pipes. Although the impact of SSFs in North America can only be quantified by scientific evaluation, these data indicate a potential for public health and community benefits if SSFs were to become available.

Public injecting among a cohort of injecting drug users in Vancouver, Canada

“…Furthermore, a high proportion of crack cocaine smokers in Vancouver’s Downtown Eastside also report engaging in injection drug use,44 45 and it is noteworthy that in the current study frequent crack use remained independently associated with recent frequent public injecting. It may be that injectors who smoke crack are deterred from using the supervised injection facility, as smoking is not permitted in the facility.…”

Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs

“…22 Feasibility studies in Vancouver showed a strong willingness among local smokers of crack cocaine to use such a facility. 20,23 Inhalation rooms and the distribution of safer crack kits also afford the opportunity for health workers to engage with people who smoke crack. Such encounters may be critical for initiating efforts to address some of the needs for health care, social assistance and referral for addiction treatment of this often hidden population.…”

Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies

“…A minority of DCFs (primarily in Europe) include facilities services targeting drug inhalers (e.g., crack smokers); these have been proposed but remain to be implemented elsewhere (e.g., in North/South America) (Hedrich, 2004;Hunt, 2006b;Kothner, Langer, & Klee, 2011;Shannon et al, 2006). A series of Canadian studies -conducted in Vancouver, Toronto and Ottawa -have found that largely majorities (ranging from 28% and 71%) of street-involved crack and other drug inhalers would use DCF services if offered, but did not measure any impacts of such interventions (Bayoumi et al, 2012;Collins et al, 2005;DeBeck et al, 2011;Shannon et al, 2006). Unfortunately, overall no rigorous evaluations on the discernable impacts of DCF programs targeting drug inhalers -including crack users -exist (Hedrich et al, 2010;Strathdee & Navarro, 2010).…”