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Why Taxpayers Should Subsidize Crack Pipes

The goal's of the Vancouver Coastal Health's recently launched pilot project to provide free crack pipes to addicts are getting lost in the ideological debate about harm reduction and the public's opinion of whose health care needs should receive priority funding.
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Vancouver Coastal Health's (VCH) recent decision to launch a crack kit pilot study is not -- as some would say -- enabling drug use. Nor is it -- as Miranda Frum would lead readers to believe in her Huffpost blog entry on January 4 -- a monetary assault and slap in the face to smokers whose addiction is, albeit, a legal one.

Our recently launched pilot project is far from the waste of health care dollars that some factions have made it out to be. Instead, the pilot project will create linkages between people with addictions and the health care system as well as prevent unnecessary hospitalizations due to easily prevented infections and injuries. These goals, however, are getting lost in the ideological debate about harm reduction and the public's opinion of whose health care needs should receive priority funding.

The debate is indeed ideological, because the scientific evidence about the effectiveness of harm reduction has been proven. Harm reduction is an effective health care intervention for some of the most vulnerable people in our population.

In addition, this pilot project will provide VCH with much-needed information about crack

addiction in our community. Specifically, it will help VCH estimate the number of crack smokers

in Vancouver through the measurement of demand. The pilot project will also allow VCH to

determine if the distribution of crack kits is an effective way to engage users and, ultimately, track and evaluate the health outcomes arising from access to safe pipes and clean mouth pieces.

Currently crack pipes are sold in a makeshift manner by a number of agencies in the Downtown

Eastside, without the benefit of linkage to Vancouver Coastal Health. Through this pilot project,

VCH will evaluate whether or not we can use distribution of crack kits as an effective way to

engage people and help them access other health services including addiction treatment.

This turned out to be one of the major benefits of Insite, the supervised injection site.

At the street level, introduction of this pilot project will prevent the type of harms associated with makeshift crack pipes that are in use right now by people who can't afford to buy a suitable pipe, which frequently explode, leading to cuts, burns, and infections. Crack smokers

need to use brillo pads in these makeshift pipes as screens, which can break, be inhaled, and get stuck in the lungs prompting hospital visits.

And a few years ago, Vancouver experienced the largest ever reported community outbreak of invasive pneumococcal disease, which is a serious bacterial infection spread by saliva. The outbreak resulted in many admissions to our hospitals for people with blood infections and meningitis; one third of hospital admissions were to an intensive

care unit. The outbreak was largely among crack smokers and sharing pipes was likely an

important mode of transmission of the germ causing the outbreak.

Crack smokers develop sores, blisters, or cuts on their lips and mouth from contact with hot

smoke, hot glass, or metal pipe stems. These wounds may lead to increased susceptibility to

Hepatitis B and C, and potentially HIV through the sharing of pipes.

The fact that VCH spends 10 times more on treatment than it does on harm reduction means

it is not a question of one or the other. Both are required tools on the ongoing battle against

substance abuse and its negative impacts on people's health.

At VCH, we believe harm reduction and treatment are necessary components of any successful addictions strategy. Unfortunately, treatment for addiction is difficult and there are high rates of relapse, so harm reduction programs such as this one remain needed.

All debate aside, it is striking to me that getting lost in the vitriole about this pilot project are the people so adversely affected by addiction. They're our sons, daughters, mothers, and fathers.

VCH is committed to finding ways to keep these people alive and healthy through various harm

reduction initiatives while working to engage them in treatment for their addictions. For this most important goal we make no apologies.

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