Rationale to Evaluate Medically Supervised Safer Smoking Facilities for Non-injection Illicit Drug Users

Abstract

Many cities are experiencing ongoing infectious disease epidemics and substantial community harm as a result of illicit drug use. In an effort to reduce these public order and public health concerns, consideration has been given to the opening in Vancouver of a safer smoking facility (SSF). The present review was conducted to examine if there is a rationale to support the evaluation of a SSF in the Canadian context. Available evidence suggests that conventional drug control strategies are insufficient to address the health and community harms of non-injection drug use, and that the public order benefits of supervised injection facilities may be relevant to SSFs. In addition, there is persuasive evidence to suggest there is potential for blood-borne disease transmission through the sharing of smoking paraphernalia, and the potential for SSFs to address this concern is a pressing public health question. Also relevant to this topic are interventions to prevent transition into injection drug use, and SSFs may also be evaluated as a potential strategy to address this concern. MeSH terms: HIV; hepatitis C; substance abuse; intravenous La traduction du résumé se trouve à la fin de l'article.

Modelling crack cocaine use trends over 10 years in a Canadian setting

“…With respect to our study setting, it should be noted that drug use and associated high‐risk behaviours are deeply entrenched among IDU and other polydrug‐using subpopulations. Further, previous research in our study setting has demonstrated the limited ability of stand‐alone public health interventions to adequately modify high‐risk behaviours and we therefore conclude that a range of interventions may be required to successfully reduce the incidence of polydrug use and its related public health and public order harms [8,26,27].…”

CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian Guidelines for Management and Treatment of HIV/Hepatitis C Coinfection in Adults

“…Acquisition of HCV is rapid following initiation of IDU and of injecting paraphernalia (21,22). In addition, noninjection smoking paraphernalia has been implicated in HCV transmission (23). Given the risk of HCV morbidity and the high costs of treating HCV among injection drug users (see 'Economic impact'), evidence-based harmreduction strategies should be implemented (23)(24)(25)(26).…”

“…In addition, noninjection smoking paraphernalia has been implicated in HCV transmission (23). Given the risk of HCV morbidity and the high costs of treating HCV among injection drug users (see 'Economic impact'), evidence-based harmreduction strategies should be implemented (23)(24)(25)(26). Given the high rate of ongoing drug use during periods of incarceration, often associated with elevated risks of needle sharing, harm-reduction strategies for incarcerated individuals should also be considered (27)(28)(29).…”

Le Domaine des Co‐infections et des Maladies Concomitantes du Réseau Canadien pour les Essais VIH des IRSC : Lignes Directrices Canadiennes pour la Prise en Charge et le Traitement de la Co‐Infection par le VIH et l’Hépatite C chez les Adultes

“…L'acquisition du VHC est rapide chez les nouveaux UDI qui commencent à utiliser du matériel d'injection (21,22). De plus, des accessoires liés à l'inhalation qui ne sont pas utilisés pour les injections, ont déjà contribué à la transmission du VHC (23). Étant donné le risque de morbidité du VHC et le coût élevé des traitements du VHC chez les UDI (voir « L'impact sur l'économie de la santé », ci-dessous), il faudrait adopter des stratégies de réduction des méfaits fondées sur des données probantes (23)(24)(25)(26).…”

“…De plus, des accessoires liés à l'inhalation qui ne sont pas utilisés pour les injections, ont déjà contribué à la transmission du VHC (23). Étant donné le risque de morbidité du VHC et le coût élevé des traitements du VHC chez les UDI (voir « L'impact sur l'économie de la santé », ci-dessous), il faudrait adopter des stratégies de réduction des méfaits fondées sur des données probantes (23)(24)(25)(26). Compte tenu du taux élevé d'usage de drogues injectables qui se poursuit pendant les périodes d'incarcération, souvent associé à des risques élevés de partage d'aiguilles, il faudrait également adopter des stratégies de réduction des méfaits auprès des personnes incarcérées (27)(28)(29).…”