Transcript Ottawa`s Harm Reduction Program - Association of Local Public

Safer Crack Kits
Ottawa’s Harm Reduction Program
6 Dec 2007
Ottawa Public Health
Protecting you. Promoting a healthy city.
Why is this program needed? (1)
To prevent transmission of infectious
disease among drug users and to
prevent the spread to community-atlarge
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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
with practice of medicine
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Health
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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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Drug Users
and Infectious Disease
Public Health crisis - drug users and
infectious diseases - HIV, Hep C
Among drug users:
nd highest in
 21 % HIV-positive (2
Canada)
 76 % Hep C – positive (higher than
Toronto, Montreal)
Danger of other disease outbreaks –
TB, meningitis
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90
Prevalence HCV Infection by
Years of Injection Drug Use
80
Percent (%)
70
60
SurvIDU
POINT
50
40
30
20
10
0
0 to 1
2 to 3
4 to 5
6 to 10
11 to 15
16 to 20
Number of Years Injecting
21 or
more
Ottawa’s Site Program
Fixed site, mobile service, partner
agencies
 Services offered
Needle provision and disposal
Safer injecting and disposal
counselling
Health education/promotion
Condoms and lube
First aid, including treatment of
abscesses
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a healthy city.HIV testing
Anonymous

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Profile of crack smokers
Crack-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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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 sex
Hep C 10-15 X more contagious than
HIV
Need to tailor interventions

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Scope 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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Scientific Evidence: Reduction
in infection rates
University of Ottawa study – 56%
reduction in HIV infection rate – longterm 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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Scientific 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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Winnipeg 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
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EVALUATION FINDINGS/BENEFITS
(Winnipeg Regional Health Authority)
STREET CONNECTIONS
NEW CLIENT AND TOTAL CLIENT ENCOUNTERS, JAN-SEP 2004
1400
1200
1000
800
INTRODUCTION OF SCUK IN AUG 2004
600
400
200
0
JAN
FEB
MAR
APR
NEW CLIENT
MAY
JUN
TOTAL CLIENTS
JUL
AUG
SEP
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,
1996
Crack pipe controversy similar to early
days of needle exchange programs
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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
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Canada
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
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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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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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Consultation



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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Program results to date

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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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Ongoing Evaluation
Pre and post-evaluation
 300 in cohort studied before start of
program
st post-evaluation
 May, 2005 – 1
 Evaluated every 6 months
afterward
 Measures: HIV and Hep C
incidence, sharing patterns of drug
users
National
Ottawa Public
Health surveillance – I-Track

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Support for Program includes:

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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. HIVAIDS Legal Network
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Postscript
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
Ottawa Publicincidence
Health
all “trending” down
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Postscript 2

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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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Conclusions

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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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