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van Draanen J, Hamilton J, Morgan J, Maxwell S, Taylor T, Richardson L, Nolan S. Supervised smoking facility access, harm reduction practices, and substance use changes during the COVID-19 pandemic: a community-engaged cross-sectional study. Harm Reduct J 2023; 20:101. [PMID: 37525168 PMCID: PMC10388471 DOI: 10.1186/s12954-023-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.
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Affiliation(s)
- Jenna van Draanen
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Child, Family, and Population Health Nursing, Health Sciences Building, University of Washington, Box 357262, Seattle, WA, 98195-0005, USA.
| | - Jonah Hamilton
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jeffrey Morgan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott Maxwell
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
| | - Tara Taylor
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
- Spencer Creo Foundation, 500-610 Main St, Vancouver, BC, V6A 2V3, Canada
| | - Lindsey Richardson
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Sociology, Faculty of Arts, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Seonaid Nolan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Reid MC, Oliphant-Wells T, Moreno C, Ketchum J, Fitzpatrick T, McMahan VM, Glick SN. High levels of interest in access to free safer smoking equipment to reduce injection frequency among people who inject drugs in Seattle, Washington. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100163. [PMID: 37214756 PMCID: PMC10193167 DOI: 10.1016/j.dadr.2023.100163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
Background Drug use route transition interventions promote safer consumption by facilitating a switch from injection to safer routes such as smoking or oral consumption. Methods We performed a descriptive analysis using data from questions about "free, clean equipment for smoking" heroin, methamphetamine and/or crack from the Seattle 2018 National HIV Behavioral Surveillance survey of people who inject drugs (N = 555). We estimated the proportion of respondents with access to free safer smoking equipment, and among these participants, the proportion who reported that this access reduced their injection frequency. Among respondents without access to free safer smoking equipment, we described the proportion who were interested in getting access, and whether they thought this access would reduce their injection frequency. Results Among participants who reported prior year heroin (n = 495), methamphetamine (n = 372), or crack (n = 88) injection, 11%, 11% and 12% reported access to free safer smoking equipment, respectively. Of those with access, the proportion that reported that access reduced their injection frequency ranged from 12% to 44%. Among participants without access, 28% who used heroin, 45% who used methamphetamine, and 49% who used crack were interested in access. Of interested participants, a majority reported that they thought this access would reduce their frequency of injection. Conclusions Access to free safer smoking equipment was limited. Many participants were interested in getting free safer smoking equipment and reported that this access may reduce their injection frequency. Safer smoking equipment is a harm reduction strategy that should be available to reduce risks from opioid and stimulant injection.
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Affiliation(s)
- Molly C. Reid
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | - Jake Ketchum
- Public Health - Seattle & King County, Seattle, WA, USA
| | | | | | - Sara N. Glick
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
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Kryszajtys DT, Xavier J, Rudzinski K, Guta A, Chan Carusone S, Strike CJ. Stakeholder preferences for supervised consumption site design, staff, and ancillary services: A scoping review of feasibility studies. Drug Alcohol Depend 2022; 230:109179. [PMID: 34847503 DOI: 10.1016/j.drugalcdep.2021.109179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Supervised consumption services (SCS) prevent drug related harms for people who use drugs (PWUD) and often require a feasibility study before implementation. While there is a growing feasibility study literature, it has not been synthesized for use by researchers and SCS planners. We conducted a scoping review of feasibility studies reporting on preferred SCS design characteristics, staffing models and ancillary services. MATERIALS AND METHODS We searched academic databases and grey literature sources with key terms related to SCS and feasibility studies. Team members reviewed search results and included feasibility studies with findings relevant to SCS design, staff, or ancillary services. The research methods and findings from included studies regarding design elements were charted, collated, and reported. RESULTS The search yielded 1347 results; 26 met eligibility criteria for review. Most reported preferences for SCS location, hours and wait times. Few reported preferences for security, space allocation by type of drug use, and onsite opioid prescribing. PWUD generally preferred aligning design elements with the goal of harm reduction for clients while other stakeholders valued treatment as a goal. Specific considerations varied by implementation context. CONCLUSIONS These results can be used by SCS planners and researchers to help resolve implementation concerns and improve uptake among PWUD, which is critical during an overdose crisis. Future feasibility studies should ask about design preferences that may be significant to uptake but are not commonly covered in studies. These should also explore how context influences preferences to develop an evidence-based framework for context-specific design decisions.
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Affiliation(s)
- David T Kryszajtys
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
| | - Jessica Xavier
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
| | - Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON N9A 0C5, Canada.
| | - Soo Chan Carusone
- Casey House, 119 Isabella St, Toronto, ON M4Y 1P2, Canada; Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West 2C Area, Hamilton, ON L8S 4K, Canada.
| | - Carol J Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada.
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Speed KA, Gehring ND, Launier K, O'Brien D, Campbell S, Hyshka E. To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities. Harm Reduct J 2020; 17:72. [PMID: 33028363 PMCID: PMC7539556 DOI: 10.1186/s12954-020-00414-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. METHODS We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. RESULTS Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). CONCLUSIONS Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.
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Affiliation(s)
- Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Katherine Launier
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Daniel O'Brien
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Sandy Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
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Angulo-Arreola IA, Bastos FI, Strathdee SA. Substance Abuse and HIV/AIDS in the Caribbean. J Int Assoc Provid AIDS Care 2017; 16:56-74. [PMID: 21852689 DOI: 10.1177/1545109711417408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Caribbean and Central America represent a formidable challenge for researchers and policy makers in the HIV field, due to their pronounced heterogeneity in terms of social, economic, and cultural contexts and the different courses the HIV epidemic has followed in the region. Such contrasting contexts and epidemics can be exemplified by 2 countries that share the island of Hispaniola, the French Creole-speaking Haiti, and the Spanish-speaking Dominican Republic. Haiti has experienced the worst epidemics outside of sub-Saharan Africa. Following a protracted economic and social crisis, recently aggravated by a devastating earthquake, the local HIV epidemic could experience resurgence. The region, strategically located on the way between coca-producing countries and the profitable North American markets, has been a transshipment area for years. Notwithstanding, the impact of such routes on local drug scenes has been very heterogeneous and dynamic, depending on a combination of local mores, drug enforcement activities, and the broad social and political context. Injecting drug use remains rare in the region, but local drug scenes are dynamic under the influence of increasing mobility of people and goods to and from North and South America, growing tourism and commerce, and prostitution. The multiple impacts of the recent economic and social crisis, as well as the influence of drug-trafficking routes across the Caribbean and other Latin American countries require a sustained effort to track changes in the HIV risk environment to inform sound drug policies and initiatives to minimize drug-related harms in the region.
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Hull M, Shafran S, Wong A, Tseng A, Giguère P, Barrett L, Haider S, Conway B, Klein M, Cooper C. CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 Updated Canadian HIV/Hepatitis C Adult Guidelines for Management and Treatment. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2016; 2016:4385643. [PMID: 27471521 PMCID: PMC4947683 DOI: 10.1155/2016/4385643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2015] [Indexed: 12/13/2022]
Abstract
Background. Hepatitis C virus (HCV) coinfection occurs in 20-30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Purpose. To update national standards for management of HCV-HIV coinfected adults in the Canadian context with evolving evidence for and accessibility of effective and tolerable DAA therapies. The document addresses patient workup and treatment preparation, antiviral recommendations overall and in specific populations, and drug-drug interactions. Methods. A standing working group with HIV-HCV expertise was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published HCV antiviral data and update Canadian HIV-HCV Coinfection Guidelines. Results. The gap in sustained virologic response between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All coinfected individuals should be assessed for interferon-free, Direct Acting Antiviral HCV therapy. Regimens vary in content, duration, and success based largely on genotype. Reimbursement restrictions forcing the use of pegylated interferon is not acceptable if optimal patient care is to be provided. Discussion. Recommendations may not supersede individual clinical judgement. Treatment advances published since December 2015 are not considered in this document.
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Affiliation(s)
- Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | | | - Alex Wong
- Regina Qu'Appelle Health Region, Regina, SK, Canada S4P 1E2
| | - Alice Tseng
- Toronto General Hospital, Toronto, ON, Canada M5G 2C4
| | | | - Lisa Barrett
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada V6Z 2C7
| | | | - Curtis Cooper
- The Ottawa Hospital, General Campus, G12, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
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Strike C, Rotondi NK, Watson TM, Kolla G, Bayoumi AM. Public opinions about supervised smoking facilities for crack cocaine and other stimulants. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:8. [PMID: 26860540 PMCID: PMC4748465 DOI: 10.1186/s13011-016-0052-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/03/2016] [Indexed: 11/11/2022]
Abstract
Background The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada. Methods We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights. Results A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs. Conclusions Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Nooshin Khobzi Rotondi
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Gillian Kolla
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Ahmed M Bayoumi
- Centre for Research on Innercity Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. .,Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Canada. .,Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
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Hull M, Giguère P, Klein M, Shafran S, Tseng A, Côté P, Poliquin M, Cooper C. [Not Available]. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2014; 25:39-62. [PMID: 24634688 PMCID: PMC3950988 DOI: 10.1155/2014/921314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
HISTORIQUE : De 20 % à 30 % des Canadiens qui vivent avec le VIH sont co-infectés par le virus de l’hépatite C (VHC), lequel est responsable d’une morbidité et d’une mortalité importantes. La prise en charge du VIH et du VHC est plus complexe en raison de l’évolution accélérée de la maladie hépatique, du choix et des critères d’initiation de la thérapie antirétrovirale et du traitement anti-VHC, de la prise en charge de la santé mentale et des toxicomanies, des obstacles socioéconomiques et des interactions entre les nouvelles thérapies antivirales à action directe du VHC et les antirétroviraux OBJECTIF : Élaborer des normes nationales de prise en charge des adultes co-infectés par le VHC et le VIH dans le contexte canadien. MÉTHODOLOGIE : Le Réseau canadien pour les essais VIH des Instituts de recherche en santé du Canada a réuni un groupe d’experts possédant des compétences cliniques en co-infection par le VIH et le VHC pour réviser les publications à jour ainsi que les lignes directrices et les protocoles en place. Après une vaste sollicitation afin d’obtenir des points de vue, le groupe de travail a approuvé des recommandations consensuelles, qu’il a caractérisées au moyen d’une échelle de qualité des preuves fondée sur la classe (bienfaits par rapport aux préjudices) et sur la catégorie (degré de certitude). RÉSULTATS : Toutes les personnes co-infectées par le VIH et le VHC devraient subir une évaluation en vue de recevoir un traitement du VHC. Les personnes qui ne sont pas en mesure d’entreprendre un traitement du VHC devraient être soignées pour le VIH afin de ralentir l’évolution de la maladie hépatique. La norme de traitement du VHC de génotype 1 est un régime comprenant de l’interféron pégylé et de la ribavirine dosée en fonction du poids, associés à un inhibiteur de la protéase du VHC. Pour les génotypes 2 ou 3, une bithérapie classique est recommandée pendant 24 semaines s’il y a clairance virologique à la semaine 4 ou, pour les génotypes 2 à 6, à 48 semaines. On peut envisager de reporter le traitement chez les personnes ayant une maladie hépatique légère. Le VIH ne devrait pas être considéré comme un obstacle à la transplantation hépatique chez les patients co-infectés. EXPOSÉ : Les recommandations ne se substituent pas au jugement clinique personnel.
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Affiliation(s)
- Mark Hull
- Université de la Colombie-Britannique, British Columbia Centre for Excellence in VIH/AIDS, Vancouver (Colombie-Britannique)
| | - Pierre Giguère
- L’Institut de recherche de l’Hôpital d’Ottawa, Ottawa (Ontario)
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Watson TM, Strike C, Kolla G, Penn R, Jairam J, Hopkins S, Luce J, Degani N, Millson P, Bayoumi AM. Design considerations for supervised consumption facilities (SCFs): preferences for facilities where people can inject and smoke drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:156-63. [PMID: 23085257 DOI: 10.1016/j.drugpo.2012.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/05/2012] [Accepted: 09/01/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supervised consumption facilities (SCFs) aim to improve the health and well-being of people who use drugs by offering safer and more hygienic alternatives to the risk environments where people typically use drugs in the community. People who smoke crack cocaine may be willing to use supervised smoking facilities (SSFs), but their facility design preferences and the views of other stakeholders have not been previously investigated in detail. METHODS We consulted with people who use drugs and other stakeholders including police, fire and ambulance service personnel, other city employees and city officials, healthcare providers, residents, and business owners (N = 236) in two Canadian cities without SCFs and asked how facilities ought to be designed. All consultations were audio-recorded and transcribed. Thematic analyses were used to describe the knowledge and opinions of stakeholders. RESULTS People who use drugs see SSFs as offering public health and safety benefits, while other stakeholders were more sceptical about the need for SSFs. People who use drugs provided insights into how a facility might be designed to accommodate supervised injection and supervised smoking. Their strongest preference would allow both methods of drug use within the same facility with some form of physical separation between the two based on different highs, comfort regarding exposure to different methods of drug administration, and concerns about behaviours often associated with smoking crack cocaine. Other stakeholders raised a number of SSF implementation challenges worthy of consideration. CONCLUSION Decision-makers in cities considering SCF or SSF implementation should consider the opinions and preferences of potential clients to ensure that facilities will attract, retain, and engage people who use drugs.
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Affiliation(s)
- Tara Marie Watson
- Centre for Criminology and Sociolegal Studies, University of Toronto, 14 Queen's Park Crescent West, Toronto, Ontario, Canada M5S 3K9
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Werb D, Debeck K, Kerr T, Li K, Montaner J, Wood E. Modelling crack cocaine use trends over 10 years in a Canadian setting. Drug Alcohol Rev 2010; 29:271-7. [PMID: 20565519 DOI: 10.1111/j.1465-3362.2009.00145.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Crack cocaine use among illicit drug users is associated with a range of health and community harms. However, long-term epidemiological data documenting patterns and risk factors for crack use initiation remain limited especially among injection drug users. We investigated longitudinal patterns of crack cocaine use among polydrug users in Vancouver, Canada. DESIGN AND METHODS We examined the rate of crack use among injection drug users enrolled in a prospective cohort study in Vancouver, Canada between 1996 and 2005. We also used a Cox proportional hazards regression analysis to identify independent predictors of crack use initiation among this population. RESULTS In total, 1603 injection drug users were recruited between May 1996 and December 2005. At baseline, 7.4% of participants reported ever using crack and this rate increased to 42.6% by the end of the study period (Mantel trend test P < 0.001). Independent predictors of crack use initiation during the study period included frequent cocaine injection, crystal methamphetamine injection, residency in the city's drug using epicenter and involvement in the sex trade (all P < 0.05). DISCUSSION AND CONCLUSIONS These findings demonstrate a massive increase in crack use among injection drug users in a Canadian setting. Our findings also highlight the complex interactions that contribute to the initiation of crack use among injection drug users and suggest that evidence-based interventions are urgently needed to address crack use initiation and to address harms associated with its ongoing use.
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Affiliation(s)
- Dan Werb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Strathdee SA, Navarro JR. Commentary on Salmon et al. (2010): The case for safer inhalation facilities--waiting to inhale. Addiction 2010; 105:684-5. [PMID: 20403019 DOI: 10.1111/j.1360-0443.2010.02917.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Steffanie A Strathdee
- University of California San Diego, Division of Global Public Health, Department of Medicine, CA, USA.
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Shannon K, Ishida T, Morgan R, Bear A, Oleson M, Kerr T, Tyndall MW. Potential community and public health impacts of medically supervised safer smoking facilities for crack cocaine users. Harm Reduct J 2006; 3:1. [PMID: 16403229 PMCID: PMC1368973 DOI: 10.1186/1477-7517-3-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 01/10/2006] [Indexed: 11/21/2022] Open
Abstract
There is growing evidence of the public health and community harms associated with crack cocaine smoking, particularly the risk of blood-borne transmission through non-parenteral routes. In response, community advocates and policy makers in Vancouver, Canada are calling for an exemption from Health Canada to pilot a medically supervised safer smoking facility (SSF) for non-injection drug users (NIDU). Current reluctance on the part of health authorities is likely due to the lack of existing evidence surrounding the extent of related harm and potential uptake of such a facility among NIDUs in this setting. In November 2004, a feasibility study was conducted among 437 crack cocaine smokers. Univariate analyses were conducted to determine associations with willingness to use a SSF and logistic regression was used to adjust for potentially confounding variables (p < 0.05). Variables found to be independently associated with willingness to use a SSF included recent injection drug use (OR = 1.72, 95% CI: 1.09–2.70), having equipment confiscated or broken by police (OR = 1.96, 95% CI: 1.24–2.85), crack bingeing (OR = 2.16, 95% CI: 1.39–3.12), smoking crack in public places (OR = 2.48, 95% CI: 1.65–3.27), borrowing crack pipes (OR = 2.50, 95% CI: 1.86–3.40), and burns/ inhaled brillo due to rushing smoke in public places (OR = 4.37, 95% CI: 2.71–8.64). The results suggest a strong potential for a SSF to reduce the health related harms and address concerns of public order and open drug use among crack cocaine smokers should a facility be implemented in this setting.
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Affiliation(s)
- Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Tomiye Ishida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Morgan
- Rock User's Group (RUG) of Vancouver Area Network of Drug Users (VANDU), Vancouver, Canada
| | - Arthur Bear
- Rock User's Group (RUG) of Vancouver Area Network of Drug Users (VANDU), Vancouver, Canada
| | - Megan Oleson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Rock User's Group (RUG) of Vancouver Area Network of Drug Users (VANDU), Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark W Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
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