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Crack Use As a Public Health Problem in Canada

Call for an Evaluation of ‘Safer Crack Use Kits’

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Abstract

Oral crack use (smoking) is a relatively neglected public health problem in Canada, in comparison to injection drug use (IDU). There are indications that crack use in Canada may be increasing. Crack smoking involves particular risks and harms, including possible infectious disease transmission, which underline the need for targeted interventions. One pragmatic grassroots intervention that has only recently begun or been discussed in several Canadian cities is the distribution of ‘safer crack use kits’, which provide hardware for crack smoking devices along with harm reduction information. In addition to the direct benefits of using them, the kits may also bring previously ‘hidden’ marginalized crack smokers in contact with health and social services. There has been considerable controversy with regards to the distribution of the crack kits, within criminal justice, public health, and the general public; this resistance appears quite similar to that experienced when needle exchange programs (NEPs) were first being established. Systematic evaluation of the crack kits is urgently needed in order to produce definitive evidence of their health and other benefits, and to allow for evidence-based program and policy decisions in the interest of public health.

Résmé

La consommation orale de crack (en le fumant) est un problème de santé publique qui reçoit peu d’attention au Canada en comparaison des drogues injectables. Or, il semble que la consommation de crack augmente au pays. Cette consommation a des risques et des effets particuliers, notamment la transmission des infections, qui donnent à penser qu’il faudrait élaborer des interventions ciblées. Une intervention pragmatique récemment amorcée ou envisagée dans certaines villes canadiennes est la distribution de « trousses de consommation de crack à risques réduits »; ces trousses contiennent des pipes à fumer du crack et des conseils pour réduire les méfaits de cette drogue. En plus de leurs avantages directs, les trousses peuvent mettre les services sociaux et de santé en contact avec des fumeurs de crack marginalisés dont on ne soupçonnait pas l’existence. La distribution des trousses suscite toute une polémique dans les milieux de la justice pénale et de la santé publique, ainsi que dans la population générale; la résistance est semblable à celle qui s’était manifestée lors de la mise en place des programmes d’échange de seringues. Une évaluation systématique des trousses de consommation de crack est essentielle et urgente pour établir la preuve absolue de leurs avantages et pour prendre des décisions conformes aux intérêts de la santé publique dans l’élaboration des politiques et des programmes.

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Authors and Affiliations

  1. University of Toronto, 33 Russell Street, Room 2035, Toronto, ON, M5S 2S1, Canada

    Emma Haydon BSc & Benedikt Fischer PhD

  2. Centre for Addiction and Mental Health, Toronto, Canada

    Emma Haydon BSc & Benedikt Fischer PhD

Authors
  1. Emma Haydon BSc
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  2. Benedikt Fischer PhD
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Correspondence to Emma Haydon BSc.

Additional information

Acknowledgements: Ms. Haydon acknowledges funding support from the Ontario Women’s Health Council; Dr. Fischer acknowledges funding support from the Canadian Institutes of Health Research (CIHR).

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Haydon, E., Fischer, B. Crack Use As a Public Health Problem in Canada. Can J Public Health 96, 185–188 (2005). https://doi.org/10.1007/BF03403687

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  • DOI: https://doi.org/10.1007/BF03403687

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