Some suburban parents will allow their teens to have a party at home where underage drinking is allowed, and the parents can make sure no one gets hurt or leaves driving drunk. The concept is simple, you know they’re gonna drink as soon as they leave your sight, so you try to reduce the risk of harm by allowing it in the home. This is the spirit of what’s called “Harm Reduction” in a nutshell.
Our other parents, governments, have been trying to institute harm reduction as well. Needle exchange programs are a prime example. The hope is that by giving free clean needles to injection drug users, they will discourage needle sharing and thus the spread of blood-borne illnesses such as HIV and Hep-C.
Some countries have seriously upped the ante on needle exchanges, and now actually provide supervised injection sites, where users are allowed to openly inject their drugs, and even get a nurse to help them do it!
Now, Canada’s National Post is reporting a drastic left turn in harm reduction strategies that may cause some to wonder whether the purveyors of such services care more about harm reduction or retaining their jobs:
Vancouver Coastal Health, which funds the controversial InSite, North America’s only supervised drug injection clinic, said it was looking to launch a pilot project in the fall that would hand out free crack pipes to address a shift in the city’s drug culture away from drug injection and toward crack smoking, said medical health officer Dr. Réka Gustafson.
I almost thought there was some genius going on here the first time I read this – that they were providing crack paraphernalia as a means to lure people away from injectables. And while crack is probably far more dangerous than heroin, I could see how that would serve their goal of reducing disease transmission. I mean, how many people are catching blood-borne illnesses from pipes, right? Wrong. They’re not trying to cause a shift away from injection, they’re addressing it:
“People have assumed this is some sort of big philosophical change,” she said. “This is a practical change. If you’re going to provide harm-reduction services, then you want to make sure you’re addressing the harms that are occurring. It’s really just knowing that there’s been a shift toward crack cocaine smoking over the past decade in our population, and it doesn’t make sense to provide harm-reduction supplies for injections only.”
So in other words, they’re reacting to market demands. Crack-smoking is up relative to heroin injection, so they’re simply making a business decision to provide the paraphernalia that’s in demand. They’re justifying it on the same arguments used for free needles:
Supporters say it will protect addicts from overdose and diseases such as HIV and bring them into the health-care system.
Health officials also hope to stop the spread of diseases like hepatitis C among addicts who share their pipes.
Let’s remember that these diseases, HIV and Hep-C, are blood-borne – and that we’ve been through at least 25 years of lectures and browbeating to instill the idea that you can’t catch such diseases by sipping from the same glass, sitting on the same toilet seat, or touching the same doorknob as someone who has them. Seriously. So I don’t understand how we’re supposed to believe that there’s an epidemic of HIV and Hep-C being transmitted via crack pipes. Moreover, I can’t understand how anyone working in public health could ever bring themselves to make such a suggestion. In doing so, they’re spreading stigmatizing misinformation. This isn’t the black plague we’re talking about, these are blood-borne illnesses.
I defy anyone to show that crack pipes are a major (or even peripherally significant) method of transmission of blood-borne illnesses such as HIV or Hep-C. I was able to find some literature hypothesizing that since some crack users may burn their lips with hot pipes and end up with some bloody blisters or sores – that they could end up leaving infected blood on the end of the pipe, and then, if the other crack user sharing the pipe also had an open wound on their mouth, the blood might get in there and they might get infected. Yes, this is all a possibility, but a far-fetched one nonetheless. If we’re going to follow this logic and classify sharing a pipe as a major risk for blood borne illness transmission, then we may as well start being paranoid about drinking from the same bottle. And then, isn’t that just as likely – that two crack users in such bad condition that they both have bleeding burnt lips would probably share any food, utensils, bottles, straws or glasses they come across too?
In addition to providing free crack pipes, they’re also proposing to provide a safe inhalation site (i.e a clinical environment in which to smoke crack), an initiative which also poses several glaring practical problems. While a heroin user may be contented to sit around in such an environment and nod out, the kind of crack users they’re targeting (totally down and out street level users – we’re not talking about Charlie Sheen here), will seldom have enough crack at a time for an extended stay in one place while they smoke. Their lifestyle involves an around the clock process of hustling crack money – often buying one small rock at a time. It’d be hard to imagine them trooping back to the inhalation site upon buying each rock. Crack highs are short lived, and necessitate constant smoking in order to maintain the high. Plus, the level of paranoia that accompanies crack use would hardly make such an environment ideal, nor would the hyperactive behavior and sexual activity that often goes with such patterns of use fit in well at such an environment. I could go on and on here, but the point is simple – harm reduction strategies for heroin users are not directly applicable to crack users.
I don’t see any point in giving out free crack pipes – which brings me to my main point. Maybe I’m being pessimistic here, but I can’t help to think that this is simply a strategy to make sure that enough people are coming through the door to keep the agency in business and the government dollars flowing. I support some forms of harm reduction, but this one doesn’t seem to make sense to me.
