Harm Reduction Success as Needle Exchange Program Distributes Safer Crack Smoking Resources

1. Harm Reduction Success as Needle Exchange Program Distributes Safer Crack Smoking Resources Lynne Leonard Emily Meadows, Linda Pelude Joyce Seto, Nick Birkett, Emily Medd HIV Prevention Research Team University of Ottawa Ottawa, Canada

2. Harms Associated with Smoking Crack

3. Harms Associated with Smoking Crack

4. Safer Crack-Smoking InitiativeApril 2005

5. Safer Crack-Smoking Kit

6. Personal structured interviews with 634 street-recruited active IDUs. 550 reported smoking crack in previous 6 months. Interviewed at four time points 6 months PRE 112 crack-smokers 1 month POST 114 crack-smokers 6 monthsPOST 157 crack-smokers 12 months POST 167 crack-smokers Provided saliva samples for HIV and HCV testing. Compensated $10 CA. Extraction NEP program data. Methods

7. Immediate, high and sustained Direct users 80 % 1 month POST 80 % 6 months POST 87 % 12 months POST Direct and indirect users 81 % 1 month POST 86 % 6 months POST 94 % 12 months POST p=.003 Results: Program Uptake

8. Results: Impact on Sharing Crack-Smoking Equipment • Significant decline in sharing crack-smoking equipment 85 % 6 months PRE 85 % 1 month POST 80 % 6 months POST 80 % 12 months POST p<0.01 • Among “sharers”, significant decline in sharing every time 37 % 6 months PRE 31 % 1 month POST 12 % 6 months POST 13 % 12 months POST p=0.001

9. Results: Transitioning Significant increase in smoking crack • Smoked crack in six months prior to interview 77 % 6 months PRE 86 % 1 month POST 89 % 6 months POST 97% 12 months POST p ≤ 0.001 • Frequency of smoking crack since availability of crack-smoking equipment 26 % “more” 6 months POST 29 % “more” 12 months POST

10. Results: Transitioning Significant decrease in injecting drugs • Injected drugs in month prior to interview 96 % 6 months PRE 84 % 1 month POST 78 % 6 months POST 78 % 12 months POST p ≤ 0.001 • Frequency of injecting since availability of crack-smoking equipment 41 % “less” 6 months POST 40 % “less” 12 months POST

11. Scaling Up Harm Reduction

12. Conclusions Significant and sustained community and individual level harm reduction impacts: • Increased availability and accessibility of resources to reduce the harms associated with smoking crack. • Decrease in the frequency of engagement in the multi-person use of crack-smoking implements. • Transitioning to smoking crack – significant predictor of injection cessation. • Contact with previously un-engaged population at risk of the harms associated with drug use. • Evaluation findings suggest the urgent utility of replicating this initiative at all NEPs.

13. Acknowledgements Research Team • Interviewers I-Track Project • Women and men in Ottawa who inject drugs Funders • Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada • City of Ottawa Public Health • Institut National de Santé Publique, Québec • Ontario HIV Treatment Network (OHTN)

14. ADDITIONAL SLIDES

15. Socio-demographic Profile Age Average 37 years; range 16 – 63 Gender Male 77% Ethnicity Canadian 79% Aboriginal 11% Highest education level Less than high school 50% Some post secondary 23% Housing Unstable housing 48%

16. Socio-demographic Profile History HIV testing 87% Positive HIV Lab result 11% History HCV testing 85% Positive HCV Lab result 55%

17. Socio-demographic Profile Drugs injected most often in past 6 months cocaine 35% crack 22% morphine 31% heroin 4% Age first smoked crack mean 25 years range 7 – 54 years Duration smoking crack mean 10 years range 1 month – 49 years

18. Resource Costs

19. Results: Distribution

20. Results: Distribution