Pubdate: Thu, 22 Oct 2009 Source: Vancouver Sun (CN BC) Copyright: 2009 The Vancouver Sun Contact: http://www.canada.com/vancouversun/letters.html Website: http://www.canada.com/vancouversun/ Details: http://www.mapinc.org/media/477 Bookmark: http://www.mapinc.org/coke.htm (Cocaine) Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) Bookmark: http://www.mapinc.org/find?143 (Hepatitis) Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) RESEARCH NEEDED TO FIND WHY HIV HITS CRACK SMOKERS HARDER It's no secret that injecting drugs carries with it many dangers, not the least of which is the risk of infection with the HIV and hepatitis C viruses. Consequently, public health authorities have implemented many innovative and successful interventions, such as needle exchanges and Vancouver's supervised injection site, to reduce the risks of infection. What has been a secret, though, is the risks of infection associated with smoking crack cocaine. Although evidence from the U.S. as far back as the mid-1990s suggested that smoking crack is associated with HIV infection, the fact that the drug is smoked rather than injected led many people to believe that the risks were not significant. As a result, health authorities were not as quick to implement harm reduction measures for crack smokers as they were for injection drug users. But a study by researchers at the B.C. Centre for Excellence in HIV/AIDS, published this week in the Canadian Medical Association Journal, suggests that crack smokers face significant risks, and that we must therefore evaluate interventions that might reduce those risks. The researchers assessed the patterns of crack smoking among 1,048 injection drug users in Vancouver between May 1996 and December 2005, and discovered two things. First, the rate of crack smoking increased dramatically during the course of the study: Just 11.6 per cent of study participants were daily smokers during the first three years of the nine-year study, while 39.7 per cent were smoking crack daily during the last three years. It's not clear what drove this increase in crack use, though it's generally accepted that both economic and cultural factors play a role in the rates of use of crack and other drugs. The second finding was even more striking: Participants who smoked crack daily were more than four times more likely to become infected with HIV than injection drug users who smoked less often or not at all. It's also not clear why frequent crack smokers are at greater risk of infection, though the researchers offer several possibilities: Crack pipes are known to produce wounds in and around the mouth -- particularly when smoking is rushed to avoid detection -- which may make users more vulnerable to infection when sharing pipes or during oral sex. Alternatively, crack smokers may have more HIV-positive individuals in their social networks, which could lead to increased likelihood of infection, or users may have been unable to recall risky behaviours in which they engaged during crack binges. While the study can't therefore answer all questions, it does provide evidence that crack smoking is an independent risk factor for HIV infection. And that, combined with the fact that we don't have all the answers, makes it clear that we need further research to determine the best methods of reducing risks associated with crack smoking. The authors specifically suggest crack specific measures such as the distribution of safer crack kits -- which include pipes or mouthpieces and disinfectants -- and the provision of supervised inhalation rooms. While controversial, early research suggests that crack kits are associated with reduced sharing of smoking equipment. And while inhalation rooms are even more controversial, they have been successfully implemented in a number of European countries, including Germany, the Netherlands and Switzerland. Of course, like much else concerning crack cocaine, we don't really know what the impact of an inhalation room would be. But that, along with the very real risk of HIV infection, suggests that we must find out -- and we can do so by initiating a research project aimed at evaluating the impact of a supervised inhalation room. Several medical groups have expressed support for such a research project and for good reason, because the only thing we have to lose is our ignorance. - --- MAP posted-by: Jo-D