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. 
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MAP posted-by: Jo-D