Ottawa City Council voted on July 11, 2007 to cease funding for Ottawa’s Safer Inhalation Program. The purpose of the Safer Inhalation Program is to reduce Hepatitis C and HIV transmission among crack users by providing them with free clean pipes. The program has been successful in several respects. The Green Party of Ontario in Ottawa Centre endorses the Safer Inhalation Program, in combination with more accessible drug treatment facilities and more community safety programs. The Safer Inhalation Program seems to be successful, and it is also cheap. Our party believes in preventative health care for everyone, and we believe in spending as little money as possible in the process. For more details on our endorsement of the Safer Inhalation Program, read the full article.

Ottawa’s Safer Inhalation Program provides clean glass pipes to crack users to prevent Hepatitis C and HIV transmission among users by reducing the sharing of dirty pipes. The program costs the city about $8000 each year, and is used by a large number of crack users in Ottawa.

On July 11 2007, Ottawa City Council voted to cease funding for the program. In general councillors representing the city core voted in favour of the program while the mayor and councillors representing suburban and rural wards voted against the program. The Green Party of Ontario in Ottawa Centre urges City Council to reconsider their decision for reasons outlined below. We are working with local organizations to find out how we can shape Green Party of Ontario policies to support programs like Ottawa’s Safer Inhalation Program. We believe every citizen has the right to be healthy, including those citizens judged ‘untouchable’ by too many politicians.

GREEN PARTY OF ONTARIO POLICY:

We advocate preventative health care. This means regulating chemicals in our foods and emissions in our air and water to prevent asthma, cancers, etc. We believe it is better to prevent a disease in the first place than to treat it (although treating diseases is obviously important once they have been acquired). We believe supporting Ottawa’s Safer Inhalation Program is an example of a local application of our party’s provincial preventative health care policy.

The Green Party of Ontario’s Health Advocate, Judy Greenwood-Speers, is the Director of Administration of a long-term drug rehabilitation facility. She has applied her experience well by creating Green Party policies that make harm reduction and drug rehabilitation a high priority. One of our provincial health policies is to establish five new residential drug rehabilitation centres that have research as a key feature, so we can not only help the people using these centres, but also determine what types of treatment work best for people of different ages, using different types of drugs, so we can help many more people in the future. As Judy says, “One size does not fit all when it comes to recovery.”

CRACK PIPE SAFETY:

Users often make crack pipes from whatever material they can find, including pop cans, asthma inhaler ‘puffers’, and pill bottles found in the trash. These crudely-designed pipes often create wounds on the mouth from the heat of the pipe. These mouth sores allow disease transmission from sharing pipes or from oral sex with people who have a disease. According to a scientific paper being published in the peer-reviewed International Journal of Drug Policy (reference at bottom), about 10% of Ottawa’s crack users test positive for HIV and about 55% test positive for Hepatitis C. The goal of the Safer Inhalation Program is to reduce Hepatitis C and HIV transmission by supplying clean pipes free of charge to crack users in order to discourage pipe sharing.

IS THE SAFER INHALATION PROGRAM WORKING?

A) Is the program reducing sharing of dirty pipes?

The rate of crack users reporting sharing pipes every time fell from 37% before the program to 13% after the program began. The goal of the program is to discourage the sharing of dirty pipes among crack users to reduce disease transmission, so this is very good news.

B) Is the program reducing disease transmission?

The rate of new HIV infections reported among Ottawa’s Injected Drug User population has dropped considerably during the program, but it is too early to tell whether this is due to the Safer Inhalation Program. As Dr. David Salisbury, Ottawa’s Chief Medical Officer, says only time would tell the effect of the program on disease transmission rates. Too bad City Council judged the program before waiting for its effectiveness to be tested with scientific rigour.

C) Is it true that crack use increased during the Safer Inhalation Program?

It is impossible to say whether crack use increased or decreased during the Safer Inhalation Program, but the ‘gut feeling’ of many community workers dealing directly with crack users is that the total number of serious drug users in Ottawa has remained fairly stable over the past few years. We do know, however, that during the program there was a shift among drug users from one type of drug to another, from injected drugs to smoking crack. While both types of drug are bad, injected drugs carry a greater risk of disease transmission than smoking crack. Also, discarded needles can be left in parks or other areas where children may pick them up and potentially get diseases from the needle. Smoking crack, especially using clean unshared pipes, carries less risk of disease transmission both among drug users and for the neighbourhood community. So although the proportion of crack use did increase during the Safer Inhalation Program, it seems to be because people were shifting from injected drugs. To quote one drug user “Now stems [i.e., clean crack pipes] are more accessible I have stopped my injection use.â€? (page 6 of paper published in International Journal of Drug Policy – see bottom).

COSTS OF SAFER INHALATION PROGRAM:

The City of Ottawa pays for about 25% of the program’s costs, which is about $8000 per year. The Ontario Ministry of Health pays for the remaining approximately 75%. By comparison, each Hepatitis C patient treated costs the provincial Ministry of Health $30,000, and each HIV patient costs the ministry $250,000 – $600,000 in treatment and care over their lifetime.

DRUG TREATMENT, COMMUNITY SAFETY:

The Safer Inhalation Program is not a drug treatment program. Its goal is to reduce Hepatitis C and HIV transmission among drug users. Neither the Green Party of Ontario nor the organizations involved in the Safer Inhalation Program believe this program will stop drug use. To be most effective, the Safer Inhalation Program must be combined with easier access to effective drug treatment programs so users who want to quit can get help. We also need better community safety programs to reduce rates of crack use in public places, and littering of old pipes in our neighbourhoods. The Green Party of Ontario advocates increased access to drug treatment programs (including the above-mentioned five new rehab centres we will build), and community safety initiatives that involve both community policing and initiatives among Safer Inhalation Program participants themselves. We don’t want to give out free crack pipes without also tackling the larger issue of drug addiction. Upon election, our party will work with drug users and experts alike to develop better treatment options in Ottawa.

WHY HELP CRACK ADDICTS?

A) Financial reasons

Putting aside all moral considerations, it makes financial sense to prevent disease transmission. If the Safer Inhalation Program succeeds in preventing two Hepatitis C infections each year, then its costs will have been offset by preventing the costs associated with patient care, treatment, and social costs that accompany infection. If the program prevents a single HIV infection (note, however, that Hepatitis C is the main target of the program as it is more easily transmitted than HIV), then it will have saved taxpayers several hundred thousand dollars. This is a cold, logical way of calculating the benefits of saving lives, but it truly does save taxpayer money. This is an example of fiscal conservativism aligning with social justice (the Green Party is neither left nor right, but forward).

B) Moral reasons

Crack addicts are citizens, and all citizens are equal. Most drug addicts eventually succeed in kicking their addiction and re-enter mainstream society. As you can imagine, it is much easier to kick an addiction and re-enter mainstream society if you don’t have HIV or other diseases. If we want crack users to kick their habit, then we should support programs that prevent them from acquiring diseases, and also support drug treatment programs to help them quit. These aren’t just ‘crackheads,’ they are people with names and families like the rest of us.

SUMMARY:

While the other political parties brag about how much more money they will throw at health care, the Green Party of Ontario is coming up with innovative ways to save money while helping prevent infections in the first place. We believe government programs should be judged based on reason and logic rather than rhetoric. We want every citizen to be healthy, and we want to spend as little money as possible in the process. We hope you agree that this is common sense.

FIND OUT MORE:

IF YOU HAVE ACCESS TO MEDICAL/SCIENTIFIC JOURNALS:

• Leonard L., DeRubeis E., Pelude L., Medd E., Birkett N., and J. Seto.  (In Press).  “I inject less as I have easier access to pipesâ€? Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking resources are distributed.  International Journal of Drug Policy.  www.elsevier.com/locate/drugpo
• McMahon J.M.  (2003).  A Potential hidden source of Hepatitis C infection among noninjecting drug users.  Journal of Psychoactive Drugs.  35:455-460.
• Hagan H., Thiede H., Weiss N.S., Hopkins S.G., Duchin J.S., and E.R. Alexander  (2001).  Sharing of drug preparation equipment as a risk factor for Hepatitis C.  American Journal of Public Health.  91(1):42-46. www.ajph.org/cgi/reprint/91/1/42
• Inciardi J.A.  (1995).  Crack, crack house sex, and HIV risk.  Archives of Sexual Behaviour.  24:249-269.

OTTAWA REPORTS AND PUBLIC HEALTH ORGANIZATIONS:

• Official evaluation report published by Dr. Lynne Leonard and others from the University of Ottawa’s Department of Epidemiology and Community Medicine: www.ohrdp.ca/Final%20Crack%20Report%20ES%20f.pdf
• Ottawa City Budget 2007 – Public Health section: www.ottawa.ca/city_hall/budget/budget_2007/images/final_op/public_health_en.pdf
• Aids Committee of Ottawa: www.aco-cso.ca

GREEN PARTY OF ONTARIO MAIN WEBSITE (to find out more about our party’s preventative health and harm reduction policies):

• www.gpo.ca

See our September 22, 2007 press release on this subject: www.ottawagreens.ca/ottawacentre/?p=195