ottawa public health protecting you. promoting a healthy city. safer crack kits ottawa’s harm...

Ottawa Public HealthProtecting you. Promoting a healthy city.

Safer Crack KitsOttawa’s Harm Reduction Program

Safer Crack KitsOttawa’s Harm Reduction Program

6 Dec 2007

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Why is this program needed? (1)Why is this program needed? (1)

To prevent transmission of infectious disease among drug users and to prevent the spread to community-at-large

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Why is the program needed? (2)Why is the program needed? (2)To provide an outreach tool,

connecting marginalized street drug users with health professionals

Outreach services – absence of primary care – co-morbidity

Life-saving strategy A non-judgemental approach in

keeping with practice of medicine

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Why is this program needed? (3)Why is this program needed? (3)

To promote efficient use of taxpayer funds

Crack pipe distribution: $3,000 annually =

1 % of total Site program budget – no new money

Same cost as 3 nights in hospital 1 prevented HIV case pays for entire

Site budget Fiscally responsible approach given

health-care system pressures

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Drug Users and Infectious Disease Drug Users and Infectious Disease Public Health crisis - drug users

and infectious diseases - HIV, Hep C

Among drug users: 21 % HIV-positive (2nd highest

in Canada) 76 % Hep C – positive (higher

than Toronto, Montreal) Danger of other disease

outbreaks – TB, meningitis

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Number of Years Injecting

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Prevalence HCV Infection by Years of Injection Drug Use

Prevalence HCV Infection by Years of Injection Drug Use

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Ottawa’s Site ProgramOttawa’s Site Program

Fixed site, mobile service, partner agencies

Services offeredNeedle provision and disposalSafer injecting and disposal

counsellingHealth education/promotionCondoms and lubeFirst aid, including treatment of

abscessesAnonymous HIV testing

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Profile of crack smokersProfile of crack smokersCrack-smoking injection drug users

significantly more likely than non crack-smoking injection drug users to:

Be living on the street To engage in the sex trade To be infected with Hep C Many street drug users also

mentally ill – ‘self-medication hypothesis’

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How does disease spread?How does disease spread? Crack smokers – burned,

cracked, bleeding lips and mouth sores

Sharing unsafe equipment - cut-off pop cans, copper tubing – contaminated blood

Unprotected sexHep C 10-15 X more contagious

than HIVNeed to tailor interventions

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Scope of problemScope of problem Ottawa has 3,000-5,000 injection

drug users Most (80 %) also smoke crack Some (20 %) smoke crack only

Ottawa Public Health now addressing the ‘missing’ risk factor (IDU’s who smoke crack) and missed segment of drug users (who smoke crack only).

Providing needles only - a half-measure

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Scientific Evidence: Reduction in infection rates Scientific Evidence: Reduction in infection rates University of Ottawa study – 56%

reduction in HIV infection rate – long-term users of Site (2003)

Seattle study – non-use of needle exchange among users – 6 x Hep B risk/7 x Hep C risk (1995)

Montreal follow-up 1999 study – improved health outcomes with more needles, sites

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Scientific Evidence: Equipment sharingScientific Evidence: Equipment sharing Crack smokers more likely to

report oral sores & sores may facilitate HIV infection (Faruque et al, 1996)

Sharing non-injection equipment orally and intranasally risk factor for Hep C in NYC women (Tortu et al, 2004)

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Winnipeg FindingsWinnipeg Findings Reported frequency of pipe

sharing before and after program implementation =Decreased from 79% to 40%

Majority (62 %) reported fewer problems with burned, cracked lips

STREET CONNECTIONS NEW CLIENT AND TOTAL CLIENT ENCOUNTERS, JAN-SEP 2004

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INTRODUCTION OF SCUK IN AUG 2004

EVALUATION FINDINGS/BENEFITS(Winnipeg Regional Health Authority)EVALUATION FINDINGS/BENEFITS(Winnipeg Regional Health Authority)

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Harm Reduction Does Not Promote Drug Use Harm Reduction Does Not Promote Drug Use

“Our data did not support the hypothesis that a syringe exchange program would stimulate increased drug abuse in terms of frequency of injection or recruitment of new and/or younger users.” JAMA, 1994

“Where offered, legal use of sterile injection equipment has been popular with IDU’s and has not led to any increases in illicit drug use.” Lancet, 1996Crack pipe controversy similar to early

days of needle exchange programs

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Other Canadian Cities: Safer Crack Pipe Distribution Other Canadian Cities: Safer Crack Pipe Distribution

Winnipeg Vancouver Toronto Montreal Halifax Kingston Guelph Yukon Ottawa is not a leader on this

issue Practice becoming norm in

Canada

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It’s Legal (1)It’s Legal (1)

Ontario’s Health Promotion and Protection Act requires MOH’s and Boards of Health to control and prevent the spread of disease.

Ontario Ministry of Health mandates needle exchange programs – these are minimum standards.

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It’s Legal (2) It’s Legal (2) Criminal Code does not

prohibit instruments for preventing disease – safer crack kits are not ‘drug paraphernalia.’ (intent of law vs. ‘head shops.’)

Within the authority of MOH acting as statutory officer

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ConsultationConsultation Site Program Departmental

Consultative Group – Council-appointed community advisory group including Police Services representative

Legal Services extensively involved Fall 2004 report

– HRSS approval =Extensive media coverage

(Citizen, Sun, TheBody.com)=Ottawa Police Chief was not

opposed

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Program results to dateProgram results to date Since Apr. 1, more than 600 kits

distributed – vast majority of clients received counselling & several rehab/housing referrals

Clinical health service with trained professionals, not a depot

Average age: 37 (only 10 clients under 21)

Average duration of drug use: more than 8 years

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Ongoing Evaluation Ongoing Evaluation Pre and post-evaluation 300 in cohort studied before start

of program May, 2005 – 1st post-evaluation Evaluated every 6 months

afterward Measures: HIV and Hep C

incidence, sharing patterns of drug users

National surveillance – I-Track

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Support for Program includes:Support for Program includes:

10 local Site partners i.e. Anglican Social Services and Centretown/Sandy Hill CHC’s

Mayor of Vancouver & BC Ministry of Health Services

Winnipeg MOH & Winnipeg Regional Health Authority

Canadian AIDS Society& Can. HIV-AIDS Legal Network

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PostscriptPostscript After 2 years of successful

program No increase in drug use (but crack

has become the predominant street drug in Ottawa)

Decrease in crack injection Decrease in reported sharing

behaviour Hep C and HIV prevalence and

incidence all “trending” down

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Postscript 2 Postscript 2 Community engaged in a process to

develop and Integrated Drug and Addictions Strategy (IDAS)

IDAS report resulted in 17 recommendations for Ottawa, one of which was an “independent study of the safer inhalation program”

PP invoked by one opponent that because we were unsure of all of the effects of the program and wanted to study it, it should be cancelled and it was

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ConclusionsConclusions We have a disease epidemic We have a means to combat it More cost-effective to prevent

disease than to treat it

Context – Integrated Drug and Addictions Strategy for Ottawa

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ottawa public health protecting you. promoting a healthy city. safer crack kits ottawa’s harm...

Documents

ottawa public health

healthy city

meningitis slide

large slide

segment of drug users

smoke crack

marginalized street

women idus slide