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Background
http://publications.gc.ca/collections/collection_2008/phac-aspc/HP40-4-1-2006E.pdf
https://www.vch.ca/media/safer-smoking-pilot-2013.pdf
https://www.vch.ca/media/safer-smoking-pilot-2013.pdf
The analysis focused on the period between December 2005 and November 2014, which was the most available follow-up period for the cohorts ACCESS and VIDUS. It included individuals who reported ever injecting drugs at the baseline interview and continued to report injecting drugs at the follow-up interviews.
Study variables
“During the previous six months, where did you obtain your crack pipes?” The study defined the question as reporting only health service locations (such as needle exchange programs, health clinics, and temporary shelters) compared to a combination of health service locations and other sources, or exclusively other sources (such as the street, homemade, or corner store). The main factor of interest was the source from which crack pipes were acquired in the preceding six months.
Statistical analysis
As a first step, we examined the baseline characteristics of the stratified sample by examining reports of health problems experienced from crack smoking. We used the GEE univariable models to examine the temporal trends of the independent variable, including the 6-month follow-up periods, the calendar dates, and the source acquisition of pipe crack. In the first analysis, we examined the temporal trends of health problems and the source acquisition of pipe crack using the GEE univariable models, respectively. We used the Fisher’s exact test when there were more than one cell containing expected values that were less than or equal to five. For continuous variables, we used the Wilcoxon Rank Sum test, and for binary variables, we used the Pearson’s chi-squared test.
Results
Large table.
Percentages of reporting health problems associated with crack smoking and crack pipe acquisition sources
Full size image
Large table.
Before December 2013, a total of 431 participants, whose last study visit was included in the sensitivity analysis, were considered. The results of the primary analyses were essentially the same as those of the participants in question. Both the declining trend for reporting health problems and the increasing trend for acquiring pipes solely through health service points were found to be significant at p < 0.001. In the multivariable GEE analysis, obtaining crack pipes solely through health service points remained significantly and negatively associated with reporting health problems (AOR = 0.74; 95% CI: 0.55-0.99). On the other hand, obtaining pipes through a combination of health service points and other sources was not significantly associated with reporting health problems (AOR = 0.85; 95% CI: 0.59-1.24).
Discussion
The program successfully accomplished its goal of decreasing health issues among individuals who smoke crack, most likely due to the recent expansion of distributing crack pipes in this particular setting. These findings indicate that exclusively obtaining pipes from health service points was strongly and negatively linked to reporting health problems from crack smoking, in comparison to obtaining crack pipes from other non-health service sources only, as shown in the comprehensive analysis. Following the implementation of the crack pipe distribution program, there was a significant decrease in the rates of reported health problems associated with crack smoking. Additionally, we observed a corresponding rise in the usage of crack pipes acquired solely through health service points, which aligned with the increase in crack pipe distribution services.
Acknowledgements
The writers convey their appreciation to the study participants for their valuable input to the investigation, as well as to the present and previous researchers and personnel.
Funding
The study was supported by the US National Institutes of Health (U01DA038886, R01DA021525), with funding provided by the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine. This funding supports Dr. Evan Wood (Director, Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS and Professor, Department of Medicine, University of British Columbia) in conducting the research. Dr. Kanna Hayashi receives support from the Canadian Institutes of Health Research New Investigator Award (MSH-141971). Additionally, Dr. Milloy receives support from the United States National Institutes of Health (R01DA021525), a New Investigator award from the Canadian Institutes of Health Research, and a Scholar Award from the Michael Smith Foundation for Health Research.
Availability of data and materials
Kindly reach out to the relevant author for additional details regarding the information, data, and materials utilized in this research. The data employed in this study is not accessible to the public.
Authors’ contributions
All authors have approved and read the final manuscript. AP has drafted the manuscript, incorporating suggestions from all co-authors. HD conducted the statistical analyses. AP and KH designed the present study. TK, MJM, and KH managed the cohorts during the study period. AP drafted the manuscript, incorporating suggestions from all co-authors. All authors made significant contributions to the conception of the analyses, interpretation of the data, and drafting of the manuscript.
Competing interests
The authors declare that they have no competing interests. The authors alone are responsible for the content and writing of this paper.
Consent for publication
Not applicable.
Ethics approval and consent to participate
All participants were provided with written informed consent for study participation. The research ethics boards of the University of British Columbia and Providence Health Research Ethics Board annually approved the studies conducted on the cohort. The Principal Investigators of the cohorts, Drs. Milloy, Hayashi, and Kerr, were granted permission to use the data for the present study, which was a part of the larger cohort study approved by the aforementioned research ethics boards.
Rights and permissions
Unless stated otherwise, this article applies to the waiver of the Dedication to the Public Domain and the Creative Commons license. If any changes were made, please provide a link to the Creative Commons license and give appropriate credit to the original author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.Org/licenses/by/4.0/), which permits unrestricted use, reproduction, and distribution in any medium. It is an Open Access article.
Reproductions and
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Abstract
Background
In Vancouver, Canada, we utilized long-running cohort studies to estimate the impact of crack pipe distribution services on the health rates associated with smoking crack. In the aftermath of recent expansion of crack pipe distribution services, there is little research and well-established programs targeting harm reduction for crack smoking users, despite the well-known potential for harm reduction programs to reduce health problems stemming from crack smoking. This is concerning, given the array of negative health consequences, including infectious diseases such as HIV, as well as burns and cuts from unsafe pipes, associated with smoking crack cocaine.
Methods
We utilized multivariable generalized estimating equations to investigate the correlation between sources of acquiring crack pipes and self-reported health issues linked to crack cocaine use (such as finger cuts or sores and coughing up blood) among individuals who were reported to smoke crack. The data used in the analysis were obtained from two prospective cohort studies involving individuals recruited from the community who engage in drug injection in Vancouver during the period from December 2005 to November 2014.
Results
In the analysis of multiple variables, individuals who obtained pipes exclusively from sources other than health service points (such as on the street or self-made) were much more likely to report health issues related to smoking crack, compared to those who obtained pipes solely from health service points (adjusted odds ratio: 0.82; 95% confidence interval: 0.73-0.93). Out of the 1718 eligible participants, the proportion of individuals who obtained crack pipes exclusively from health service points increased significantly from 7.2% in 2005 to 62.3% in 2014 (p < 0.001), while the rates of reporting health problems associated with crack smoking significantly decreased (p < 0.001).
Conclusions
These findings indicate that the growth of crack pipe distribution services has probably helped decrease health issues associated with smoking crack in this particular context. They offer proof that crack pipe distribution programs are beneficial in minimizing harm for crack smokers.
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Authors and Affiliations
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Urban Health Research Initiative, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Amy Prangnell, Huiru Dong, M. J. Milloy, Thomas Kerr & Kanna Hayashi
The University of British Columbia’s School of Population and Public Health, located at 206 E Mall in Vancouver, BC, V6T 1Z9, Canada.
Amy Prangnell & Huiru Dong
Vancouver Coastal Health, located at #800-601 West Broadway, Vancouver, BC, V5
Patricia Daly
The Medicine Department at the University of British Columbia, located at St. Paul’s Hospital on Burrard Street in Vancouver, BC, V6Z 1Y6,
M. J. Milloy & Thomas Kerr
The Health Sciences Department at Simon Fraser University, located in Blusson Hall at 8888 University Drive, Burnaby, BC, V5A
Kanna Hayashi
Corresponding author
Contact Kanna Hayashi.
Abbreviations
Downtown Eastside.
Human HIV.
Conclusion
During a phase of expansion in the distribution of crack pipes, there was a notable increase in the acquisition of crack pipes through health service locations. Simultaneously, there was a significant decrease in the occurrence of health issues related to smoking crack during this period. Obtaining pipes solely through health service points was found to have a significant and negative correlation with the reporting of health problems from crack smoking, in comparison to acquiring pipes solely through other means such as on the street or self-made. These findings support the idea of distributing safe crack smoking kits as an effective measure to reduce harm for crack smokers. However, it is important to note that this observational study does not allow us to establish causation. The availability of safe crack smoking equipment can potentially contribute to a decrease in health problems and save healthcare costs for communities facing high rates of crack cocaine smoking and its associated health issues.
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In 2017, during the expansion of the distribution pipe in Vancouver, Canada, there was a decline in health rates associated with smoking crack. This was observed in a study conducted by Daly et al.
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Date Received: November 2
Date of acceptance: 01
Date of publication: 03
DOI: https://doi.Org/10.1186/s12889-017-4099-9.