Potential community and public health impacts of medically supervised safer smoking facilities for crack cocaine users

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.