Pubdate: Mon, 2 Nov 2009
Source: National Post (Canada)
Copyright: 2009 Canwest Publishing Inc.
Contact: http://drugsense.org/url/O3vnWIvC
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Evan Wood
Note: Evan Wood, MD PhD, is the director of the Urban Health Research 
Initiative at the B.C. Centre for Excellence in HIV/AIDS.
Referenced: The Canadian Medical Association Journal study 
http://www.cmaj.ca/cgi/reprint/181/9/585.pdf

THE PROMISE OF SAFER INHALATION

When Canadians think of crack cocaine, many remember disturbing 
television images seen in the late 1980's, when the drug first gained 
notoriety in the United States. More recently, crack has emerged as 
an enormous health and social problem in many Canadian cities.

Last month, a group of Vancouver researchers published a 10-year 
study from Vancouver's Downtown Eastside in the Canadian Medical 
Association Journal. The study, which I led, revealed a pair of 
significant findings: one, a massive increase in crack-cocaine use in 
recent years, and two, daily crack users have a four-fold higher rate 
of HIV infection. The study also made various recommendations to deal 
with rising crack-cocaine use and the corresponding increase in HIV.

When developing rational responses to rising crack use in Canada, it 
is useful to first reflect upon the long-term patterns of crack use 
in the United States. South of the border, the drug's use has 
remained persistently high despite an estimated $1-trillion spent on 
the "war on drugs." The failure of America's over-reliance on law 
enforcement is also demonstrated by increasing cocaine purity and 
falling cocaine prices over the last 10 years, as well as a 
ballooning prison population.

Primarily as a result of drug-law enforcement, one in eight 
African-American males in the age group 25 to 29 is incarcerated on 
any given day in the United States, despite the fact that ethnic 
minorities consume illicit drugs at comparable rates to other 
Americans. The economic forces of supply and demand have simply 
overwhelmed the vast police efforts, leading Nobel-Prize-winning 
economists such as Milton Friedman to recommend complete abandonment 
of the drug war.

It has famously been said that doing the same experiment over and 
over again and expecting different results is the very definition of 
insanity. There is overwhelming consensus in the scientific community 
that the U.S. approach to the control of crack cocaine has been a 
disaster. Therefore, Canadians must look elsewhere for more effective 
models, including Western Europe.

After successfully reducing public drug injecting, and recruiting 
intravenous drug addicts into treatment through the use of supervised 
injection facilities, several Western European countries have 
expanded these programs to include "inhalation facilities" for heroin 
and crack smokers. The philosophy is the same: Get addicts off the 
street and under the public health umbrella, where addiction 
treatment is available on demand.

It was in this context that we recommended an inhalation facility be 
considered for scientific evaluation in Vancouver.

A subsequent National Post editorial argued that HIV infections in 
Vancouver were likely due to needle-sharing and unsafe sex among 
crack users, and incorrectly implied that our recommendation was 
based solely on an unproven "oral-health hypothesis" whereby 
inhalation rooms would possibly prevent HIV transmissions due to the 
sharing of crack pipes.

First, our study clearly acknowledged that the link between HIV 
infection and crack smoking was likely due to a combination of 
factors. Second, with regard to needle-sharing and unsafe sex, 
evaluations of supervised injecting facilities have clearly 
demonstrated how these programs prevented needle-sharing and improve 
rates of condom use, which is why they have been proven cost-effective.

Finally, although studies from the United States have implied that 
the HIV virus may be transmitted by the sharing of crack pipes or 
oral sex among individuals with cuts and burns on their lips from 
crack smoking, we do not believe this is the primary reason an 
inhalation room should be evaluated. A study published in the New 
England Journal of Medicine demonstrated that the use of the Insite 
injecting facility in Vancouver enabled more rapid uptake of 
addiction treatment. A similar investigation should be the primary 
aim for any clinical trial of an inhalation facility.
- ---
MAP posted-by: Richard Lake