Margot Kuo, Despina Tzemis, Ellison Richmond, Jane Buxton CPHA 2012 June 12, 2012 Edmonton, AB
Risks of smoking crack
Risks of smoking crack Risk factor for HIV among people who inject (DeBeck et al. 2008) Risk factor for HCV, found on shared pipes (Nyamathi et al. 2002, Fischer et al. 2008, Tortu et al. 2004) Levamisole in cocaine has caused neutropenia in BC (Knowles et al. 2009, Buchanan and Lavonas 2012)
Extent of crack cocaine smoking Crack cocaine neglected, harm reduction efforts rudimentary (Fischer and Coghlan 2007) BC highest past-year usage of crack (6.9%), highest lifetime use (11.7%) (CADUMS 2010) Among street-involved adults in Victoria and Vancouver: crack drug used most in past 30 days (83.8%) (CARBC 2011) Among cohort who inject: crack increased from 7.4% to 42.6%, 1996-2005 (Werb et al. 2005)
BC harm reduction strategies Vancouver: BC Centre for Disease Control and Vancouver Coastal Health Authority: some materials for free VCH has been piloting kits including pipes, often limited to one per day (Olivier 2011) Other sites in the province have been distributing materials including pipes 33% of sample reported difficulty accessing pipes (associated with sex work, sharing pipes, police, difficulty accessing services, health problems) (Ti et al. 2012)
Study purpose
Study purpose Learn from the expertise of people who use drugs What are the perceptions of people who smoke crack? Use, effects, risks Comparison to other modes of cocaine use, other drugs Social risk environments macro micro
Methods Partnered with local organizations Semi-structured, same-sex focus groups Explored drug use practices, perceptions of harms from smoking, suggestions for HR programming Recorded transcriptions were coded Risk environment framework
Results
Results 10 males and 21 females 27-64 years, median 48 years Four aspects of risk environment interact to lead to harms related to crack cocaine smoking Social risks largely micro peers, partners, friends, family, police, community services (or lack thereof)
Both supportive and harmful Social networks could be protective or harmful I definitely don t keep in touch with family that much. I don t really want to talk to my family that much cause I don t want them to-- I don t want to rub it in that I m, you know, down here. - male
Friends and partners Friends and partners implicated in initiation, continuation of use, preference of smoking I didn t-- well, I did crack twice before I got out here and it was just, like, a sex thing. But when I got out here, my ex-boyfriend, he was doing it all the time. And then I got into it and-- I didn t like it. I did it to keep him company - female
External stigmatization Perceived as perpetuating risks around drug problems But if you treat your people like crap, we re going to live-- be treated like crap, we re going to feel like crap. And the only way that we can feel better about ourselves, is something that can be relieved in smoke female
Internal stigmatization Within some people who use drugs, smoking crack seen as safer, better than injection do I think injecting a needle and, you know, opening my body up to infection, or whatever, same thing as smoking and sharing with a Hep C person? It s what I think in my mind is a safer upgrade. - female
Sharing drugs and pipes At times more important than perceived risks from sharing pipes to share the plastic and take it off, that s like a lot of procedure and us crackheads, hey, I want right now while it s hot. Ain t going to wait to cool it down and take off the plastic. You gotta have your own pipe and if you want to do the plastic that s your own plastic. if you want to share, well, you re [expletive] out of luck or you gotta wait for the person to do it and take the plastic off. That s the only way that it s going to happen. - female
Mixed preference for being alone Varying social preferences mean some smoke inside/outside, alone/with others it makes me paranoid being outside and being outside and around too many others. I get selfconscious about myself and my behaviours negatively, in a negative way. Because it makes me tweak out and, you know, behave differently noticeably. - male
Policing dangers More dangerous practice (rushed: more likely to share pipes, burn or cut selves) Confiscated pipes and drugs going to inject in an alleyway it s different. Cops are different-- ways of dealing with things. Some of them grab it, smash it and confiscate it. - male
Social benefits in services Peers and peer-driven networks seen as important And [organization] here is where I come because, like, my house is just up there and I have-- I could get a stroke or I could get a heart attack. I-- but I m still an addicted person and I use-- still use it for my pain. So I come to [organization] because I know these guys are all here for me, for us-- our clients to be safe. Yeah, we re actually family. I see everybody here as my family. - female
Discussion and recommendations
Discussion Limitations: convenience sample from particular population, difficult to get full picture of risk environments People who smoke crack aware of harms and benefits from micro social environments (and other aspects of environment) Social risk environment contributes to many experienced harms
Recommendations Particulars of practices and preferences must be understood for effective harm reduction programming Products Facilities and services Messaging Police policy Consideration given to how social interactions affect drug use and perceptions of harm reduction: drug use trajectory, internal stigma, etc.
Acknowledgments Thank you focus group participants and peer recruiters Thank you partner organizations in Vancouver Thank you for listening! Questions: www.towardtheheart.com
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