Examination of Safe Crack Use Kit Distribution from a Public Health Perspective

• Author: Dessa Bergen‐Cico,Alicia Lapple
• DOI: http://doi.org/10.1002/wmh3.169
• Published date: 01 December 2015
• Date: 01 December 2015

Examination of Safe Crack Use Kit Distribution from a

Public Health Perspective

Dessa Bergen-Cico and Alicia Lapple

This paper examines the policy of safer crack use kit (SCUK) distribution within the city of

Winnipeg, Canada. Publicly funded, SCUK distribution policy has been a contested topic

throughout Canada, despite evidence that crack users represent some of the most marginalized

members of society. Using the four pillars approach to drug policy as a guideline, the balance of

allocation of resources for harm reduction is critiqued. Harms associated with crack use are broadly

categorized as being associated with methods of use or social harms. The effectiveness of the current

SCUK policy is examined according to the guiding principles of reduced harms and cost

effectiveness. Research supports SCUK distribution based on the merits of increased health contacts

and harm reductions. Data indicate the SCUK distribution policy supports efforts to reduce the

transmission of communicable disease, notably Hepatitis C. A cost-benef‌it analysis and assessment

of the policy’s effectiveness in reducing harms supports continuation of SCUK. Our conclusion

advocates for the expansion of the current policy to emphasize further engagement and greater

emphasis on working against associated social harms, but notes the need for further research on the

topic. Benef‌its of peer-based kit distribution are discussed and potential alternatives to the current

SCUK policy are explored.

KEY WORDS: crack cocaine, drug policy, harm reduction

Introduction

Canada’s drug policy has been developed from the four pillars strategy, which

is a multi-faceted approach grounded in public health principles. The four pillars

approach integrates prevention, treatment, enforcement, and harm reduction in a

complementary manner to address the health, safety, and societal factors

associated with drug use (Alexander, 2006; Canadian Drug Policy Coalition

[CDPC], 2013; Haden, 2006). This approach also acknowledges that drug

prohibition itself cultivates violence, crime, disease, and black markets that

present harms to drug users and the larger society (Haden, 2006). According to

the CDPC, current Canadian drug policy priorities include public safety and

access to services and supports for people with drug problems (Carter &

MacPherson, 2013). The policy priorities are in line with public health approaches

World Medical & Health Policy, Vol. 7, No. 4, 2015

349

1948-4682 #2015 Policy Studies Organization

Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

at the macro level while dually considering the broad base of factors that impact

health at the micro level of the drug users (Public Health Agency of Canada

[PHAC], 2011). Since 2007 there has been a shift in Canada’s national anti-drug

strategy that has eliminated “harm reduction” from its policies, restricting the

scope to three pillars: enforcement, prevention, and treatment (Government of

Canada, 2014). However, many provincial and municipal drug strategies are

based on a public health framework and continue to incorporate the four pillars

approach encompassing harm reduction. Within the public-health framework, the

philosophy and practice of harm reduction is considered a pragmatic approach to

drug use, which seeks to reduce drug-related harms to individuals and

communities.

Public health harm-reduction practices aim to foster connection with high-

risk populations in addition to providing access to condoms and clean drug use

paraphernalia to prevent the spread of disease (Cheung, 2000; Roe, 2005). Harm-

reduction strategies are not limited to injection drug use (IDU); in Canada they

apply to crack cocaine use, which is also associated with the spread of

communicable diseases, injuries resulting from drug use paraphernalia, and social

harms. Substantial research supports the distribution of clean injection drug use

paraphernalia for harm reduction (Degenhardt et al., 2010). However, safer

crack/safer smoking use kit distribution is a topic of much debate amongst both

professionals and the public, and the benef‌its are not well understood. To date

there have been few studies examining harm-reduction strategies involving the

distribution of safer crack use kits (SCUK). This article examines SCUK

distribution in Winnipeg, Canada and explores factors to consider for the

continuation of this public health policy based on existing SCUK research.

Although the CDPC prioritizes public health policies and support for people who

use drugs, current Canadian federal drug policies are often in opposition to

municipal and provincial health policies, thereby underscoring the divisions in

policies as they pertain to public health and drug use (Carter & MacPherson,

2013).

Concerns regarding crack cocaine use trends in the Canadian city of

Winnipeg led to the development and implementation of SCUK distribution in

2004 as part of the city’s harm-reduction services. Although SCUK distribution

occurred in other cities in Canada prior to this, the Winnipeg Regional Health

Authority (WRHA) program was the f‌irst publicly funded SCUK program led by

a regional public health authority in Canada (WRHA, 2015). The aims of

Winnipeg’s SCUK distribution program are to reduce the spread of sexually

transmitted and blood-borne infections (STBBIs) and reduce other drug-related

harms in Winnipeg (Back

e, Bailey, Heywood, Marshall, & Plourde, 2012; Ross,

2015). Concerns regarding the use of public tax dollars for SCUK’s have been

accompanied by questions about whether the distribution of clean drug use

paraphernalia provides any benef‌it or simply encourages and enables drug use

(Brodbeck, 2012). Such opposition serves to reinforce public opinion that people

who use drugs may be less deserving of health protection. Although this paper

specif‌ically examines harm-reduction policies associated with crack cocaine use in

350 World Medical & Health Policy, 7:4