J Urban Health. Jun 2005; 82(2): 276–284.
© Oxford University Press on behalf of the New York Academy of Medicine 2005
Potential uptake and correlates of willingness to use a supervised smoking facility for noninjection illicit drug use
Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, V6Z 1Y6 Vancouver, British Columbia Canada
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia Canada
Canadian HIV/AIDS Legal Network, 417 Saint-Pierre Street, Suite 408, H2Y 2M4 Montréal, Québec
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
Many cities are experiencing infectious disease epidemics and substantial community harms as a result of illicit drug use. Although medically supervised smoking facilities (SSFs) remain untested in North America, local health officials in Vancouver are considering to prepare a submission to Health Canada for an exemption to open Canada’s first SSF for evaluation. Reluctance of health policymakers to initiate a pilot study of SSFs may be due in part to outstanding questions regarding the potential uptake and community impacts of the intervention. This study was conducted to evaluate the prevalence and correlates of willingness to use an SSF among illicit drug smokers who are enrolled in the Vancouver Injection Drug Users Study. Participants who reported actively smoking cocaine, heroin, or methamphetamine who returned for follow-up between June 2002 and December 2002 were eligible for these analyses. Those who reported willingness to use an SSF were compared with those who were unwilling to use an SSF by using logistic regression analyses. Four hundred and forty-three participants were eligible for this study. Among respondents, 124 (27,99%) expressed willingness to attend an SSF. Variables that were independently associated with willingness to attend an SSF in multivariate analyses included sex-trade work (adjusted odds ratio [AOR]=1.85), crack pipe sharing (AOR=2.24), and residing in the city’s HIV epicentre (AOR=1.64). We found that participants who demonstrated a willingness to attend an SSF were more likely to be involved in the sex trade and share crack pipes. Although the impact of SSFs in North America can only be quantified by scientific evaluation, these data indicate a potential for public health and community benefits if SSFs were to become available.
The Full Text of this article is available as a PDF
These references are in PubMed. This may not be the complete list of references from this article.
1. Strathdee SA, Galai N, Safaeian M, et al. Sex differences in risk factors for HIV seroconversion among injection drug users: a ten year perspective. Arch Intern Med. 2001;161:1281–1288. doi: 10.1001/archinte.161.10.1281. [PubMed] [Cross Ref] 2. Craib KJ, Spittal PM, Wood E, et al. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ. 2003;168:19–24. [PMC free article] [PubMed] 3. van Beek I, Dwyer R, Dore GJ, Luo K, Kaldor JM. Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study. BMJ. 1998;317:433–437. doi: 10.1136/bmj.317.7156.433. [PMC free article] [PubMed] [Cross Ref] 4. Thorpe LE, Oueller LJ, Levy JR, Williams IT, Monterroso ER. Hepatitis C virus infection: prevalence, risk factors, and prevention opportunities among young injection drug users in Chicago, 1997–99. J Infect Dis. 2000;182:1588–1594. doi: 10.1086/317607. [PubMed] [Cross Ref] 5. Thorpe LE, Oueller LJ, Hershow R, et al. Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment. Am J Epidemiol. 2002;155:645–653. doi: 10.1093/aje/155.7.645. [PubMed] [Cross Ref] 6. Selvey LA, Denton M, Plant AJ. Incidence and prevalence of hepatitis C among clients of a Brisbane methadone clinic: factors influencing hepatitis C serostatus. Aust N Z J Public Health. 1997;21:102–104. doi: 10.1111/j.1467-842X.1997.tb01664.x. [PubMed] [Cross Ref] 7. Hahn JA, Page-Shafer K, Lum PJ, Ochoa K, Moss AR. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco. Hepatology. 2001;34:180–187. doi: 10.1053/jhep.2001.25759. [PubMed] [Cross Ref] 8. Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander ER. Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health. 2001;91:42–46. doi: 10.2105/AJPH.91.9.1350. [PubMed] [Cross Ref] 9. Villano SA, Vlahov D, Nelson KE, Lyles CM, Cohn S, Thomas DL. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland. J Clin Microbiol. 1997;35:3274–3277. [PMC free article] [PubMed] 10. Tortu S, Neaigus A, McMahon J, Hagen D. Hepatitis C among noninjecting drug users: a report. Subst Use Misuse. 2001;36:523–534. doi: 10.1081/JA-100102640. [PubMed] [Cross Ref] 11. Flamm SL, Parker RA, Chopra S. Risk factors associated with chronic hepatitis C virus infection. Limited frequency of an unidentified source of transmission. Am J Gastroenterol. 1998;93:597–600. doi: 10.1111/j.1572-0241.1998.171_b.x. [PubMed] [Cross Ref] 12. Tortu S, McMahon JM, Pouget ER, Hamid R. Sharing of noninjection drug-use implements as a risk factor for hepatitis C. Subst Use Misuse. 2004;39:211–224. doi: 10.1081/JA-120028488. [PubMed] [Cross Ref] 13. Conry-Cantilena C, VanRaden M, Gibble J, et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med. 1996;334:1691–1696. doi: 10.1056/NEJM199606273342602. [PubMed] [Cross Ref] 14. Alter HJ, Conry-Cantilena C, Melpolder J, et al. Hepatitis C in asymptomatic blood donors. Hepatology. 1997;26:29S–33S. doi: 10.1002/hep.510260705. [PubMed] [Cross Ref] 15. Broadhead RS, van Hulst Y, Heckathorn DD. The impact of a needle exchange’s closure. Public Health Rep. 1999;114:439–447. doi: 10.1093/phr/114.5.439. [PMC free article] [PubMed] [Cross Ref]
16. Haemmig R. Beyond safe injecting rooms: next steps in hard reduction incl. safe smoking rooms. Paper presented at: International Conference on the Reduction of Drug Related Harm; April 20–24, 2004; Melbourne, Australia.
17. Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JS, Tyndall MW. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171(7):731–734. doi: 10.1503/cmaj.1040774. [PMC free article] [PubMed] [Cross Ref]
18. Kerr TH, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to explosive HIV epidemics driven by frequent cocaine injection: is there a role for safer injecting facilities? Journal of Drug Issues. In press.
19. Kerr T, Palepu A. Safe injection facilities in Canada: is it time? CMAJ. 2001;165:436–437. [PMC free article] [PubMed] 20. Wood E, Kerr T, Spittal PM, et al. The potential public health and community impacts of safer injecting facilities: evidence from a cohort of injection drug users. J Acquir Immune Defic Syndr. 2003;32:2–8. doi: 10.1097/00126334-200301010-00002. [PubMed] [Cross Ref] 21. Wood E, Spittal PM, Small W, et al. Displacement of Canada’s largest public illicit drug market in response to a police crackdown. CMAJ. 2004;170:1551–1556. doi: 10.1503/cmaj.1031928. [PMC free article] [PubMed] [Cross Ref]
22. Campbell L. Four Pillars—the Vancouver experience. Paper presented at: 15th International Conference on the Reduction of Drug Related Harms; April 22, 2004; Melbourne, Australia.
23. Wood E, Schechter MT, Tyndall MW, Montaner JS, O’Shaughnessy MV, Hogg RS. Antiretroviral medication use among injection drug users: two potential futures. AIDS. 2000;14:1229–1235. doi: 10.1097/00002030-200006160-00021. [PubMed] [Cross Ref] 24. Wood E, Tyndall MW, Spittal PM, et al. Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help? CMAJ. 2001;165:405–410. [PMC free article] [PubMed] 25. Spittal PM, Craib KJ, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166:894–899. [PMC free article] [PubMed] 26. Wood E, Tyndall MW, Spittal PM, et al. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS. 2002;16:941–943. doi: 10.1097/00002030-200204120-00021. [PubMed] [Cross Ref] 27. Miller CL, Johnston C, Spittal PM, et al. Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users. Hepatology. 2002;36:737–742. doi: 10.1053/jhep.2002.35065. [PubMed] [Cross Ref] 28. Spittal PM, Bruneau J, Craib KJ, et al. Surviving the sex trade: a comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs. AIDS Care. 2003;15:187–195. doi: 10.1080/0954012031000068335. [PubMed] [Cross Ref] 29. Sterk CE, Theall KP, Elifson KW. Who’s getting the message? Intervention response rates among women who inject drugs and/or smoke crack cocaine. Prev Med. 2003;37:119–128. doi: 10.1016/S0091-7435(03)00090-2. [PubMed] [Cross Ref] 30. Rosse RB, Collins JP, Jr, Fay-McCarthy M, Alim TN, Wyatt RJ, Deutsch SI. Phenomenologic comparison of the idiopathic psychosis of schizophrenia and drug-induced cocaine and phencyclidine psychoses: a retrospective study. Clin Neuropharmacol. 1994;17:359–369. doi: 10.1097/00002826-199408000-00008. [PubMed] [Cross Ref] 31. Colliver JD, Kopstein AN. Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Drug abuse warning network. Public Health Rep. 1991;106:59–68. [PMC free article] [PubMed]
32. Bailey I. Pickton accused in 4 more deaths: this is now the largest serial killer investigation in Canadian history. National Post. 2002;3:A1–A1.
33. Astemborski J, Vlahov D, Warren D, Solomon L, Nelson KE. The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. Am J Public Health. 1994;84:382–387. doi: 10.2105/AJPH.84.3.382. [PubMed] [Cross Ref] 34. Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–1401. doi: 10.1016/S0140-6736(00)04562-1. [PubMed] [Cross Ref] 35. Kilbourne AM, Herndon B, Andersen RM, Wenzel SL, Gelberg L. Psychiatric symptoms, health services, and HIV risk factors among homeless women. J Health Care Poor Underserved. 2002;13:49–65. [PubMed] 36. Faruque S, Edlin BR, McCoy CB, et al. Crack cocaine smoking and oral sores in three inner-city neighborhoods. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;13:87–92. doi: 10.1097/00042560-199609000-00012. [PubMed] [Cross Ref] 37. Mitchell-Lewis DA, Phelan JA, Kelly RB, Bradley JJ, Lamster IB. Identifying oral lesions associated with crack cocaine use. J Am Dent Assoc. 1994;125:1104–1108. [PubMed] 38. Porter J, Bonilla L. Crack users’ cracked lips: an additional HIV risk factor. Am J Public Health. 1993;83:1490–1491. doi: 10.2105/AJPH.83.10.1490-a. [PubMed] [Cross Ref]
39. Centers for Disease Control and Prevention. Top 11 most frequently asked questions about viral hepatitis. Available at: http://www.cdc.gov/ncidod/diseases/hepatitis/common_faqs.htm. Accessed June 15, 2004.
40. From the Centers for Disease Control and Prevention. 1993 revised classification system for HIV, infection and expanded surveillance case definition for AIDS, among adolescents and adults. JAMA. 1993;269:729–730.
41. Barr CE, Lopez MR, Rua-Dobles A, Miller LK, Mathur-Wagh U, Turgeon LR. HIV-associated oral lesions; immunologic, virologic and salivary parameters. J Oral Pathol Med. 1992;21:295–298. doi: 10.1111/j.1600-0714.1992.tb01014.x. [PubMed] [Cross Ref]