Canada: Crack Users Say Pipe Program Helps Them Stay Healthy

Nearly a year ago, the city of Ottawa augmented its needle-exchange program, which began in 1991, with a controversial safer-inhalation initiative to distribute clean pipe kits to crack cocaine users. Ottawa adopted the program based on a report that former medical officer of health, Dr. Robert Cushman, presented to the city.

Cushman advocated the distribution of crack pipes, tourniquets and other drug paraphernalia to Ottawa drug users to curb the spread of HIV and hepatitis C. The city estimates there are between 3,000-5,000 injection drug users in town, about 80 percent of whom have smoked crack cocaine. Roughly 75-80 percent of drug users have hepatitis C, and approximately 20 percent have HIV.

Ottawa has 12 partner agencies providing needle-exchange services, but not all health and community centers have joined the pipe-distribution effort. According to Cushman's report, "crack smokers are at increased risk for blood-borne infections and sexually transmitted diseases. Sharing of contaminated equipment increases risk of transmission" because hot pipes burn and split users' lips, allowing infected blood to be transferred when the next smoker uses the pipe.

Since April, the city has distributed about 1,500 pipe kits that include condoms, lip balm, chewing gum, a pipe-disposal mechanism and information on drug use and prevention. Dr. David Salisbury, Ottawa's current medical officer of health, said a Health Canada study showed users enrolled in needle-exchange programs are less likely to acquire HIV. A similar study is assessing the safer-inhalation program.

Ottawa's Site Program, based at the Sexuality Center at 179 Clarence St., dispenses clean needles and crack kits. The center also has a mobile van, which travels from 6 p.m.?midnight, and outreach workers who visit drop-in centers and patrol the Byward Market area. The safer-inhalation program has an estimated annual cost of $2,500 Canadian ($2,129 US), according to Cushman.

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