Harm Reduction Success as Needle Exchange Program

Distributes Safer Crack Smoking Resources

Lynne Leonard Emily Meadows, Linda Pelude

Joyce Seto, Nick Birkett, Emily Medd

HIV Prevention Research Team University of Ottawa

Ottawa, Canada

Harms Associated with Smoking Crack

Harms Associated with Smoking Crack

Safer Crack-Smoking InitiativeApril 2005

Safer Crack-Smoking Kit

Methods

•Personal structured interviews with 634 street-recruited active IDUs.

•550 reported smoking crack in previous 6 months. • Interviewed at four time points

6 months PRE 112 crack-smokers 1 month POST 114 crack-smokers 6 months POST 157 crack-smokers

12 months POST 167 crack-smokers•Provided saliva samples for HIV and HCV testing.•Compensated $10 CA.•Extraction NEP program data.

Results: Program Uptake

Immediate, high and sustained• Direct users

80 % 1 month POST

80 % 6 months POST

87 % 12 months POST

• Direct and indirect users

81 % 1 month POST

86 % 6 months POST

94 % 12 months POST p=.003

Results: Impact on Sharing Crack-Smoking Equipment

• Significant decline in sharing crack-smoking equipment

85 % 6 months PRE85 % 1 month POST80 % 6 months POST80 % 12 months POST

p<0.01

• Among “sharers”, significant decline in sharing every time

37 % 6 months PRE31 % 1 month POST12 % 6 months POST13 % 12 months POST

p=0.001

Results: Transitioning

Significant increase in smoking crack• Smoked crack in six months prior to interview

77 % 6 months PRE86 % 1 month POST89 % 6 months POST97% 12 months POST p ≤

0.001

• Frequency of smoking crack since availability of crack-smoking equipment

26 % “more” 6 months POST 29 % “more” 12 months POST

Results: Transitioning

Significant decrease in injecting drugs• Injected drugs in month prior to interview

96 % 6 months PRE84 % 1 month POST78 % 6 months POST78 % 12 months POST p ≤

0.001

• Frequency of injecting since availability of crack-smoking equipment

41 % “less” 6 months POST 40 % “less” 12 months POST

Scaling Up Harm Reduction

6 Months

PRE

1 Month

POST

6 Months

POST

Cumulative12 Months

IDU

ONLY 2,566 723 1,829 4,566

IDU and Smoke Crack

N/A 742 2,040 4,838

Smoke Crack ONLY

N/A 543 1,899 4,469

Conclusions

Significant and sustained community and individual level harm reduction impacts:

• Increased availability and accessibility of resources to reduce the harms associated with smoking crack.

• Decrease in the frequency of engagement in the multi-person use of crack-smoking implements.

• Transitioning to smoking crack – significant predictor of injection cessation.

• Contact with previously un-engaged population at risk of the harms associated with drug use.

• Evaluation findings suggest the urgent utility of replicating this initiative at all NEPs.

Acknowledgements

Research Team• Interviewers I-Track Project• Women and men in Ottawa who inject

drugsFunders

• Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada

• City of Ottawa Public Health• Institut National de Santé Publique,

Québec• Ontario HIV Treatment Network (OHTN)

ADDITIONAL SLIDES

Socio-demographic Profile

AgeAverage 37 years; range 16 – 63

GenderMale 77%

EthnicityCanadian 79% Aboriginal 11%

Highest education levelLess than high school 50%Some post secondary 23%

HousingUnstable housing 48%

Socio-demographic Profile

History HIV testing 87%

Positive HIV Lab result 11%

History HCV testing 85%

Positive HCV Lab result 55%

Socio-demographic Profile

Drugs injected most often in past 6 monthscocaine 35%crack 22%morphine 31%heroin 4%

Age first smoked crackmean 25 years range 7 – 54 years

Duration smoking crackmean 10 yearsrange 1 month – 49 years

Resource Costs

Cost

Glass stem 30 cents

Mouthpiece 4 cents

Screens 8 cents

Complete kit 2 dollars

Results: Distribution

One Month

Six Months

TwelveMonths

Crack kits 1,419 183 42

Glass stems 7,212 17,696 28,768

Screens 9,185 32,557 52,001

Mouthpieces 3,123 8,123 9,306

Results: Distribution

One Month

Six Months

Twelve Months

#s

Dist.

Crack Kits 90% 81% 30% 1,644

Glass Stems 52% 97% 97% 53,678

Screens 51% 88% 88% 93,745

Mouthpieces 34% 56% 52% 20,552