Thursday, August 26, 2004

Ban the evil weed, but hand out instructions with official crack pipes

Winnipeg makes crack smoking safer

By OLIVER MOORE
Globe and Mail Update

Social workers in Winnipeg have begun handing out “high-quality” crack pipes and instructions to addicts on the city's streets, part of a harm-reduction strategy put in place by local health officials.

The program is modelled on one in Toronto and comes decades after Winnipeg began giving injection-drug users clean needles in return for dirty ones. Although fully approved, the program was launched with no public notice and has only this week become widely known, said Dr. Margaret Fast, a medical officer of health who works for the city.

Dr. Fast told globeandmail.com Thursday that she had so far received only two phone calls from irate citizens, but she conceded that there may be more to come as the story gains wider circulation.

“The major concerns seem to be that this will encourage drug use ... but that's done elsewhere,” she said in a telephone interview from Winnipeg. “The process we use for providing [the pipe] is relatively rigorous, I think.”

The kits are not handed out to just anyone who asks, she stressed, but are given to crack cocaine users who have been assessed by trained social workers, who in many cases have had multiple interactions with those users.

Dr. Fast said that the program was launched because patrolling social workers with an outfit called Street Connections had noticed that some injection-drug users were switching to crack and that others were using the cocaine derivative in addition to their habitual drug. With that shift came a new slate of health concerns.

Using makeshift or poorly-made crack pipes can cause oral cuts or burns. If shared, these pipes can also help spread blood-borne diseases, particularly if the group includes drug users who also sell sex. The transmission of both hepatitis and HIV is a concern in such a situation, Dr. Fast said, describing the grim scenario of a pipe passing from mouth to mouth, repeatedly coming into contact with bleeding lips and cracked gums.

Winnipeg's new harm reduction strategy – dubbed the ‘safer crack use kit' – is designed to minimize these dangers. It is intended for use by a single person only and includes a good-quality glass pipe less likely to injure users. It also includes metal screens, alcohol swabs (for those users who do end up sharing), pipe cleaners, matches, lip balm, at least one condom and information about where addicts can get help. It also includes instructions on how to use the kit.

Dr. Fast said that it is too early to assess how well the program is working. Surveying will be done, she said, though success goes beyond the disease-reduction goals themselves. Such a kit has the corollary benefit of giving social workers an excuse to engage crack users in conversation, she said, and it gives the users a reason to co-operate with the social workers.

Globe and Mail © 2004

1 Comment:

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• The base is filled with water to the depth dictated by the bong. Water quality can include use of tap water, which may promote mineral buildup, or distilled water, which deposits less residue on the smoking equipment and is easier on lungs. Sometimes other liquids are used, e.g., lime water, giving the smoke a different taste. More rarely, liquids like Coca-Cola and herbal teas are used. However, such liquids can make cleaning difficult and time-consuming.
• The substance to be smoked is packed into the bowl and ignited. Cigarette lighters and matches are commonly used for ignition. Packing the bowl is a balance between filling it with enough substance to create a useful amount of smoke and leaving enough room for air to be sucked through the substance.

When inhaling, the volume of the lungs increases, causing the air in the lungs to decrease in pressure. The air in the lungs is then at a lower pressure than the air in the atmosphere. The pressure difference causes a flow of air from outside of the bong through the bowl picking up smoke from the burning substance. The smoke then bubbles through water and on into the chamber where it is temporarily held. Once the chamber is full to the smokers desired capacity, the hole above the water level is uncovered, either the bowl is pulled out of the stem, or, in bongs with an attached bowl a "carb" or "Shotgun" (a small hole that is covered by the thumb) is uncovered and the smoke is inhaled into the lungs. Once in the lungs, the active chemicals in the smoke are absorbed into the blood stream.
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