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

AuthorDessa Bergen‐Cico,Alicia Lapple
Published date01 December 2015
Date01 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
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
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
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,
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

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