HEP-C CALLED 'RUNAWAY' PROBLEM AMONG CITY'S ILLEGAL DRUG USERS

Medical Officer Defends Expanded Paraphernalia Plan

Ottawa's medical officer of health says hepatitis-C is a "runaway" problem
so severe among illegal drug users, it would be "stupid" not to implement
an expanded drug paraphernalia program.

Dr. Robert Cushman was responding yesterday to concerns about a new
initiative under which the city's 13-year-old needle exchange program was
expanded last month to include items such as stems for crack pipes,
tourniquets for intravenous drug users and aluminum caps used to cook
heroin and crack cocaine.

And police Chief Vince Bevan put up little resistance to the plan,
admitting that he doesn't know "what the health answer to that problem is."

Speaking of the city's health staff, Chief Bevan said: "I can certainly
understand their strategies for trying to prevent the spread of those
diseases."

Dr. Cushman said the incidence of hepatitis-C -- which can cause liver
cirrhosis and cancer -- has risen from 56 per cent two years ago, to 76 per
cent of tested drug users today. That is up from virtually zero 10 years
ago, he said.

The current needle exchange program does not adequately address this
epidemic, Dr. Cushman said, adding that the scientific community's
understanding of the disease makes it possible now to target solutions.

Hepatitis-C is considerably more communicable than HIV, he added.

Expanding the needle exchange program to include pipe stems for crack
cocaine smokers would help address the problem of hepatitis-C, Dr. Cushman
said. Crack pipes heat up during use, burning and cracking the user's lips,
and the blood then gets passed on to the next user. By passing out pipe
stems to users, those fluids would not be passed around.

Council's health and social services committee gave its support on Thursday
to the medical staff plan.

Because it requires no new spending and falls within the jurisdiction of
the committee, the matter will not be voted upon by council.

The estimated cost of the expanded program is $2,500 annually. Dr. Cushman
said the city would not hand out crack pipes, but rather the "stems" that
can be fitted on to pipes, through which users inhale. He said preventative
measures would save the health system money and free up resources for other
health problems.

Dr. Cushman said: "For me not to do this would be stupid," he said. "It's
so cheap, so cost-effective ... it would be unethical not to do it."

Some councillors expressed concerns that handing out the paraphernalia is
not the way to fight the drug problem.

"I'd like to see us put more money into getting drug users off drugs,"
rather than spend it on drug paraphernalia, said Cumberland Councillor Rob
Jellett.

"It's our responsibility as a society to help people help themselves, not
to help them use drugs," the councillor said.

Dr. Cushman's report to the committee cited studies by Health Canada and
Lynne Leonard of the University of Ottawa's department of epidemiology and
community medicine to back its argument that handing out drug paraphernalia
can reduce transmission of hepatitis-C and HIV.

The report said that there are between 3,500 and 5,000 intravenous drug
users in Ottawa. About one-third are reached by the city's programs for
hard drugs users. Of that sample, 21 per cent carry HIV. That rate, the
report said, may have been as high as 50 per cent in the past.

According to research carried out by city staff, there were 12 new HIV
cases reported among intravenous drug users in 2001, down from 39 in 1995.

The medical chief said similar programs had been initiated in Toronto,
Montreal, Winnipeg and Guelph, Ontario, where, he said, "there's evidence
that these programs are working in their areas."