SAFE CRACK HOUSES URGED

B. C. Public Health Supports Strategy To Help Addicts

Government authorities should allow medically supervised sites where
crack-cocaine users can legally smoke their potent drug, researchers
and B. C.'s top public-health doctor urged yesterday after a new study
suggested crack addicts are particularly prone to contracting HIV.

Sanctioned, safe crack houses would help curb the rampant transmission
of dangerous infections among cocaine smokers, say proponents of the
latest version of harm reduction, a controversial strategy that
essentially condones an illegal activity to prevent an allegedly worse
health problem. They also recommended that public-health officials be
permitted to distribute "safe crack kits," including glass pipes
designed to lessen the spread of viruses.

"It's very unfortunate these things get politicized and made more
controversial than they need be," said Dr. Evan Wood, who spearheaded
the research. "But given the costs and challenges of HIV ... it's
certainly in our interest to take a public-health approach to these
infectious diseases that are already breaking free of their
traditional boundaries."

Dr. Wood is with the B. C. Centre for Excellence in HIV/ AIDS, which
oversees Insite, a contentious facility where injection-drug users can
shoot up while under medical supervision.

Insite has been able to operate through an exemption to the Criminal
Code's drug prohibitions granted by the federal government. The
current Conservative administration has no plans to expand the
concept, said Pamela Stephens, a spokeswoman for Rob Nicholson, the
Attorney-General.

" 'Harm reduction' sites and similar initiatives are inherently
harmful to human health," she said in an email response to questions.

"These programs not only cause physical harm, they also deepen and
prolong the addictions and divert valuable dollars away from treatment."

The debate stems from a paper published in the Canadian Medical
Association Journal yesterday that found use of crack cocaine had
soared between 1996 and 2005 to 40% from 12% among a 1,048-strong
sample of injection-drug users in Vancouver.

It also concluded that crack users, who typically heat blocks of
cocaine in glass-bowled pipes and inhale the resulting smoke, were
four times more likely to contract HIV than the other drug users.

One theory is that the burns and open sores they often develop around
their mouths provide an easy path for infection, said the CMAJ paper
by Dr. Wood and colleagues with the B. C. Centre and the Urban Health
Research Initiative.

Another hypothesis is that users in the study got involved in unsafe
sex or were even raped while on a crack binge, leading to virus
transmission, the study suggested. Regardless of the reason, it is
clear that crack-cocaine smokers are at greatly increased risk for a
disease that is not only devastating to the individual, but costs the
health-care system as much as $250,000 per case, Dr. Wood said.

The paper suggested that crack sites and distribution of the kits be
carried out initially on an experimental basis and studied
scientifically.

Dr. Perry Kendall, British Columbia's Provincial Health Officer, said
he would support the idea, so long as the issue of second-hand smoke
exposure for health-care workers in the safe sites was addressed.

"Do you want people smoking crack outside in public, disruptively and
spreading diseases, or would you rather have them doing it in an
environment where it can be controlled?" asked Dr. Kendall. "In my
mind it's a relatively simple equation."

Critics, though, say safe crack sites would only encourage the
addicts, and divert resources from what they really need: effective
treatment.

"What they should be doing is giving them a safe environment to get
them off cocaine," said Larry Molyneaux, president of the Police
Association of Ontario. "A harm-reduction program without a treatment
program is a failure. Just feeding their habit isn't what is going to
fix it."

Dr. Wood said safe "inhalation sites" already exist in Switzerland,
the Netherlands and Germany. Anecdotal reports indicate they have been
successful in preventing disease, but no formal scientific studies
have been conducted with any of those programs, he said.

Dr. Wood also pointed to the evidence around Insite published in major
medical journals, which suggests that its users are less likely to
suffer overdose deaths and more likely to enter treatment.