CRACK PIPE PLAN FIGHTS ILLNESS

Handing out clean crack pipes seems to be having an effect in Ottawa.
Drug users are switching from injecting to smoking, and smokers are
sharing pipes less frequently.

Switching to crack-smoking might not seem like good news, but it is -
from a public-health perspective. There is a higher risk of
transmission of disease from sharing needles than from sharing pipes.
Pipe-sharing is still risky, though, because viruses can enter through
cuts and blisters on the lips. That's why the city started handing out
clean pipes with single-use mouthpieces.

At the International AIDS Conference, an epidemiologist from the
University of Ottawa presented the results of a study that showed the
two trends: the switch from shooting up to smoking and the tendency to
share pipes less often. Among those who shared pipes, more than a
third said they shared every time they smoked at the start of the
program. A year later, 13 per cent shared every time.

Ottawa's outgoing police chief, Vince Bevan, opposed the clean-pipe
program, arguing that it approves and enables illegal behaviour.

In practice, it seems unlikely that clean pipes will have any
immediate negative effect. If you were starving and you had before you
a rotten apple and a fresh apple, you'd take the fresh one first.
Similarly, an addict would choose a clean pipe. If there were no fresh
apple, only a rotten one, you'd eat that. A person who wasn't hungry
wouldn't eat either apple, and a person disinclined to do drugs won't
choose to smoke crack because clean equipment is available.

Ottawa does, however, need more research into the habits and attitudes
of drug users to learn whether the pipes are having unintended
consequences. Opponents of harm reduction say it will remove the
stigma that is one of the barriers to drug use. It's possible that
will prove true over the long term.

And we still don't know how many cases of HIV transmission the city's
clean-pipe program has prevented. The fact that crack-smokers tend to
have other HIV risk factors, including intravenous drug use, might
make it difficult to study crack-smoking in isolation.

The numbers so far do support the harm-reduction proponents. The
debate isn't over, though, because opposition to harm reduction isn't
about numbers. It isn't even about health. It's about principle. Harm
reduction is an admission that it is difficult and perhaps impossible
to eliminate drug use. Opponents fear that could evolve into societal
acceptance of drug use.

Harm reduction, though, is not only about reducing illness among drug
users. It's also about reducing the harm drug users do to society's
health. It's hard to find a moral principle that can compete with that
practical imperative.