London, Ont., health agency supports distributing safe crack pipe kits

The controversial strategy of offering drug addicts free, clean crack smoking supplies has reached another Canadian city, and it may be just the latest step for the increasingly-common harm reduction tactic.

The "safer smoking supplies" strategy was recently supported by the Middlesex-London Board of Health, allowing health groups to pass out safe crack kits to drug users – a segment of the population harder hit by HIV and hepatitis C as a result of sharing dirty drug paraphernalia.

"While rates of crack- and cocaine-related emergency department visits, hospital admissions and admission to substance misuse and addictions programs are lower in Middlesex-London than Ontario rates, they cannot be ignored," reads a report submitted to London city council. "By providing safer smoking supplies, we will reduce the disparity in harm reduction efforts between those who inject drugs and those who smoke crack cocaine. We will be better positioned to reduce the harms associated with smoking crack cocaine, and expect to see benefits at both the individual and population level."

The London Free Press reported on Monday that Brian Lester, executive director of the Regional HIV/AIDS Connection, spoke out in favour of the move while a handful of local councillors expressed concern. Lester said the primary complaint – that providing free drug supplies would promote drug use – doesn't hold water.

“It does not enable drug use,” Lester told the newspaper. “The programming that we offer enables people who are caught up in the tight grip of addiction to be safer and prevent the spread of HIV and hepatitis C.”

Providing safe crack use kits as part of a harm reduction strategy is already prevalent in major Canadian cities. In Toronto, groups such as the Queen West Community Health Centre provide needle exchanges and crack kits to reduce the spread of diseases such as Hepatitis C and HIV.

Similar programs exist in Winnipeg, Montreal and Edmonton, among other cities.

In Vancouver, providing crack pipes as part of a harm reduction strategy is so prevalent that InSite recently started making them available through a vending machine.

But the strategy has also faced notable opposition. The federal government, for one, does not promote harm reduction strategies such as safe injection sites or providing clean crack kits.

When Vancouver's crack pipe vending machines were introduced, Federal Public Safety Minister Steven Blaney stated that the federal government supports "treatment that ends drug use," not doctors handing out heroin and needles, according to the Toronto Sun.

A pilot program introduced in Nanaimo, B.C., in 2007 was suspended after the community raised concerns about the system. The program was later reinstated and has since expanded. Ottawa city council also voted to end funding for that city's project in 2007, though the program found alternative funding and managed to survive.

And in 2011, Alberta Health Services stopped offering clean crack pipes to users in Calgary, ending a years-long policy of quiet assistance.

Regardless, the spread of safe crack use kits, which typically include stems, screens and clean mouthpieces, appears to be increasing, following in the footsteps of now-commonplace needle exchange programs.

A survey by the Ontario Harm Reduction Distribution Program found that 88 per cent of needle exchange programs operating in the province felt it would be beneficial to also distribute "safer smoking supplies."

The survey found that 36 per cent of those needle syringe programs were already in the process of implementing such projects.

As a result of the survey, the Ontario Harm Reduction Distribution Program, where needle-exchange programs get their supplies, announced it would begin offering smoking supplies to its clients.

The Canadian HIV/AIDS Legal Network has defended the legality of distributing safer crack use kits, stating that the rates of HIV and hepatitis C are much higher in people who use drugs than among the general population.

"Harm reduction programs represent a pragmatic public health response for people who are unable or unwilling to stop using drugs immediately," the group says. "First and foremost, harm reduction services seek to reduce the negative health consequences of drug use for these people, with blood-borne infections and overdose being the most serious and immediate harms."

The Canadian Drug Policy Coalition similarly supports the embrace of such harm reduction strategies. The Canadian Drug Policy Coalition notes that providing addicts with safe crack kits is more cost effective in both the short and long term. A recent study of a crack kit program in Winnipeg found that the average cost of kits were 59 cents per until, whereas the average cost of treating one HIV-positive patient for a year was $10,000.

Neither group maintains a list of where safe crack use kits are offered, though a recent report from the Canadian Drug Policy Coalition notes program are available in Newfoundland, New Brunswick, Ontario, Quebec, Manitoba, Alberta, and British Columbia.

"Programs throughout the country offer safer crack supplies as their budgets permit, though often the distribution of these supplies is done quietly because of public opposition," the report notes.

But the more commonplace such programs become, the less that opposition will matter. London may just be the latest city to see needle-exchange programs expand to offer safe smoking supplies.

Though one suspects it will still be some time before crack pipe vending machines make their way out east.