Ottawa Public Health Protecting you. Promoting a healthy city. Safer Crack Kits Ottawa’s Harm...
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Transcript of 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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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
0
10
20
30
40
50
60
70
80
90
0 to 1 2 to 3 4 to 5 6 to 10 11 to 15 16 to 20 21 ormore
Number of Years Injecting
Perc
ent
(%)
SurvIDUPOINT
Prevalence HCV Infection by Years of Injection Drug Use
Prevalence HCV Infection by Years of Injection Drug Use
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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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
0
200
400
600
800
1000
1200
1400
JAN FEB MAR APR MAY JUN JUL AUG SEP
NEW CLIENT TOTAL CLIENTS
INTRODUCTION OF SCUK IN AUG 2004
EVALUATION FINDINGS/BENEFITS(Winnipeg Regional Health Authority)EVALUATION FINDINGS/BENEFITS(Winnipeg Regional Health Authority)
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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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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Ottawa Public HealthProtecting you. Promoting a healthy city.
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 HealthProtecting you. Promoting a healthy city.