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Ottawa harm reduction program increasing crack smoking;
Up to 80% of drug users engage in "unprotected" sex

Two new harm reduction articles:

Crack program cut disease: study:  But free paraphernalia also increased drug use, AIDS conference told

By Chris Cobb, The Ottawa Citizen
Ottawa Citizen ( Canada ), August 18, 2006

TORONTO - The City of Ottawa 's controversial distribution of free drug paraphernalia to crack smokers is improving drug users' dangerous habits and preventing the spread of disease, says a new study released to the International AIDS Conference here yesterday.

The University of Ottawa study, funded by federal, provincial and city governments, says the crack-user program is radically reducing the sharing of drug paraphernalia, which is the main cause of disease, but is also increasing the amount of crack smoking.

"We definitely saw an increase in crack smoking," said University of Ottawa epidemiologist Lynne Leonard, "and it looked like a negative outcome of the program. We were rigorous and looking for negative and positive outcomes. But what we also saw was a huge, significant decrease in the use of injected drugs, which is far more risky than smoking."

The study results were released two days after Ottawa mayoral candidate Terry Kilrea said he'd scrap the city's needle-exchange and crack-pipe-equipment programs, as well as pesticide-education programs, in order to spend an additional $1 million on treatment programs.

Mr. Kilrea said the city shouldn't be enabling drug use by distributing needles and drug paraphernalia to addicts.

The city estimates between 3,300 and 5,000 injection drug users live in Ottawa and about 80 per cent of them are crack cocaine smokers. Between 75 and 80 per cent of injection drug users have hepatitis C and about 20 per cent are HIV-positive. Crack is a highly addictive stimulant and costs a quarter of regular cocaine.

The city program started in April 2005 despite huge opposition from some members of city council and from police Chief Vince Bevan.

Chief Bevan said at the time that the program would encourage drug use: "I am concerned that the message we are sending is that there's a safer way to do crack, that it's OK to try crack," he said shortly before the majority of council gave the program the go-ahead. "There is no hard evidence, no empirical studies that support the distribution of crack pipes."

Despite the increase in crack use, Ms. Leonard yesterday said there is now "significant scientific evidence" that shows the program is important in reducing the harms associated with crack smoking.

"It can be easily administered," said Ms. Leonard, who is the director of an HIV prevention research team. "If you provide it, people will come and take advantage of it. Once you've got those people you can work with them to further reduce harm."

The Ottawa program, unique in North America , provides crack users with a package that includes pipe stems, rubber mouth pieces and brass screens to prevent burns. The kits, which cost $2, but are free to addicts, also include condoms, lip balm, chewing gum, a pipe-disposal mechanism and information on drug use and prevention.

In its first year, the program has provided tens of thousands of pieces of smoking paraphernalia, including about 52,000 glass stems, to addicts.


Typically, crack smokers using the hot pipes develop open sores, cuts and blisters on their lips and when they share bloody smoking equipment they also run a high risk of sharing blood-borne disease. Studies also show crack smokers contract HIV and Hep C through oral sex.

Before the city program began, more than a third of the addicts who took part in the study said they used shared equipment every time they smoke crack. By April, when the study ended, 13 per cent said they continued to share.

Study examines drug users' sex lives

Kingston Whig-Standard ( Ontario ) August 18, 2006 Friday
BY Rob Tripp Whig-Standard Staff Writer

A Queen's University researcher has found a strikingly high rate of risky sexual conduct by injection drug users.

The finding from a pilot study of 60 users in Hamilton, Ont., suggests that a long-standing needle exchange program designed to combat the spread of infectious disease is undermined by other conduct of the drug users.


HIV, the virus that causes AIDS, can be transmitted when injection drug users share dirty needles. Many injection drug users also are active in the commercial sex trade, as prostitutes or in exchanging sex for drugs.

The use of clean needles by drug users is a barrier to the transmission of HIV, but if users continue to have unprotected sex, the disease still has a path to spread.

Dirty needle sharing and unprotected sex also are common transmission paths for hepatitis C and other diseases.

Prof. Ana Johnson-Masotti was quick to point out her sample of drug users was small and the 97 per cent figure includes all respondents who engaged in some unprotected sex, even if they also engaged in safe sex.

"This is just a preliminary finding just to show that the interviewing process works," said Johnson-Masotti, of the department of community health and epidemiology.

The research is a first step in determining whether needle exchange, condom distribution and education campaigns are cost- effective tools in controlling the spread of infectious diseases.

Johnson-Masotti said it is difficult to get material and information into the hands of the drug users, who shun contact with agencies and organizations.

"Once we reach them, programs seem very effective," she said.

Her pilot project, funded by a provincial granting agency, also involves sampling of drug users in Waterloo , Ont.

"In the future, we intend to expand the program across Ontario to include maybe five regions," she said.

Since 1992, a needle exchange program has operated in Hamilton from a van that visits different parts of the city.

Kingston has a needle exchange program that operates out of a storefront on Montreal Street near Brock Street .

The Hamilton survey found that 97 per cent of the respondents injected drugs with clean needles.

The bulk of the survey sample, 78 per cent, was male. Seventy per cent of the group was over the age of 40.

Seventy-five per cent of participants reported injecting 10 or more times in the previous 30 days, mainly using cocaine and crack.

Similar research in major Canadian and American cities reveals that many injection drug users engage in unprotected sex, although the rates typically range between 60 and 80 per cent of the sexually active respondents.

A national study in 2003 that tracked roughly 800 drug users in four Canadian cities, Regina , Sudbury , Toronto and Victoria , found that 60 per cent of male respondents never used a condom while having intercourse with regular female partners.


Johnson-Masottti's survey of drug users in Hamilton was conducted using face-to-face interviews between last October and January.