CRACKED!

Suggestions To Get Rid Of Crack Kits May Put Ottawa At Serious
Risk

The idea that two branches of our municipal government are at odds
with one another is hardly surprising. But an ongoing conflict between
the city's Department of Public Health and the Ottawa Police Service
is putting the health and well-being of Ottawa residents at risk.
Under fire is the city's two-year-old Safer Inhalation Program, which
handed out kits for making crack pipes to drug users. The kits serve
to reduce the risk of infection for drug users in Ottawa, a city with
the highest rate of HIV infection in the province and among the
highest rate of hepatitis C infection in the country.

Since the creation of the program, the HIV infection rate has fallen
from 39 a year to 12, according to Dr. David Salisbury, Ottawa's chief
medical officer of health.

Speaking at a January meeting of the community and protective services
committee, Dr. Salisbury accused the Ottawa police of confiscating
unused, city-issued crack kits. In addition, despite its meagre $2,500
a year operating budget, the program may face the chopping block
during this February's municipal budget process.

But these new developments are hardly surprising. The program has
always been unpopular with the police and certain city councillors.
Police Chief Vince Bevan lobbied hard against the program during the
epic city council debates that saw the program's creation in April
2005, and Mayor Larry O'Brien listed the cancellation of the crack kit
program as one of the key items he would like to accomplish early in
his term.

Caught in the middle of this debate are drug users, who suffer
significantly higher rates of HIV and hepatitis C infection than
non-drug users. This is, in part, due to a lack of access to safe,
clean crack pipes. Makeshift crack pipes, often made of metal cans or
piping, heat-up quickly, causing burns and splits in users' lips. This
allows blood-born infections to be transferred to the next user
smoking the pipe.

Ideally, the health of users and the communities they live in would be
the prime motivator of the city's drug policy. But Steve, a current
crack user, is very aware of what ultimately matters to many of the
powers that be: "They need to look at this issue in the only language
they understand: dollars and cents."

The total lifetime cost, both direct and indirect, of just one case of
HIV is roughly $750,000, according to the Public Health Agency of
Canada. If Dr. Salisbury's numbers are correct, a program costing only
$2,500 a year that can help reduce the rate of HIV infection in Ottawa
from 39 a year to just 12 is a pretty good deal.

Sadly, a recent report by the HIV/AIDS Policy and Law Review makes it
clear that successful initiatives like Ottawa's Safer Inhalation
Program are few and far between. The report, titled "Canada's 2003
Renewed Drug Strategy - an Evidenced-Based Review," criticizes
Canada's drug strategy for continuing to fund ineffective and
expensive programs.

In theory, Canada uses the "four pillars" approach for its drug
strategy, with funding and resources broken down between enforcement,
research, treatment and addiction prevention/harm reduction. In
reality, however, the vast majority of funding goes to enforcement -
more than 73 per cent of the $245-million budget. In contrast, harm
reduction programs like Ottawa's crack kit program received just 3 per
cent of the budget.

"The overwhelming emphasis continues to be on conventional
enforcement-based approaches which are costly and often exacerbate,
rather than reduce, drug-related harm," the study says.

The report also highlights that the vast majority of traditional drug
policies and practices have no hard data to indicate whether they are
working or not.

In contrast, data gathered by Lynne Leonard of the department of
epidemiology and community medicine at the University of Ottawa
indicate that the city's crack kit program has been very successful.

According to her data, in the six months prior to the launch of
program, 37 per cent of drug users said they shared equipment with
another person every time they smoked crack. Only 12 months after the
city began handing out kits, this number had fallen to 12 per cent.

The data also shows a significant drop in injection drug use, a
behaviour with much higher health risks, as users switched to pipes
instead of needles.

Perhaps most importantly, the success of the crack kit program means
that an often hidden population is now interacting regularly with
health care professionals who are able to provide information and
options on drug use and treatment.

In contrast to traditional enforcement approaches favoured by Police
Chief Bevan and Mayor Larry O'Brien, the city's crack kit program is a
cheap and effective way to reduce the social costs of drug use in our
communities and ensure drug users have access to necessary supports,
allowing them to make safer choices for themselves about what
activities they engage in.

Ultimately, cancelling the program won't help reduce the number of
drug users in the city. Rick, a user living in Ottawa who says he
spends about 48 hours each week high on crack, makes it clear how
terminating the program would affect him.

"If the program is cancelled, there will be a lot more cases of
diseases. I know it won't stop me from smoking crack. I'll just be
playing Russian roulette when it comes to sharing a pipe with a
stranger, or even someone I know. I'm an addict. It's a risk I would
take, even though I know it's putting my health in danger."

Next week, city council will hear presentations on the proposed
municipal budget. It is vital that individuals and groups concerned
with the health of their friends, families and neighbourhoods let
council know they support the Safer Inhalation Program.