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Rationale to Evaluate Medically Supervised Safer Smoking Facilities for Non-injection Illicit Drug Users

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Abstract

Many cities are experiencing ongoing infectious disease epidemics and substantial community harm as a result of illicit drug use. In an effort to reduce these public order and public health concerns, consideration has been given to the opening in Vancouver of a safer smoking facility (SSF). The present review was conducted to examine if there is a rationale to support the evaluation of a SSF in the Canadian context. Available evidence suggests that conventional drug control strategies are insufficient to address the health and community harms of non-injection drug use, and that the public order benefits of supervised injection facilities may be relevant to SSFs. In addition, there is persuasive evidence to suggest there is potential for blood-borne disease transmission through the sharing of smoking paraphernalia, and the potential for SSFs to address this concern is a pressing public health question. Also relevant to this topic are interventions to prevent transition into injection drug use, and SSFs may also be evaluated as a potential strategy to address this concern.

Résumé

Plusieurs villes doivent composer avec des épidémies continues de maladies infectieuses et les dommages importants causés par l’utilisation de drogues illicites. Afin de réduire le nombre d’infractions à l’ordre public et d’apaiser les préoccupations en matière de santé publique, on a envisagé la création, à Vancouver, d’installations sécuritaires pour les fumeurs de drogues illicites (ISFDI). La présente évaluation avait pour but d’examiner s’il s’avérait justifié d’appuyer l’évaluation d’une ISFDI dans le contexte canadien. Les preuves disponibles révèlent que, d’une part, les stratégies antidrogues habituelles ne suffisent pas à contrer les effets sur la santé et la collectivité de l’utilisation des drogues non injectables et que, d’autre part, les effets positifs de la création de sites d’injection sur le maintien de l’ordre public peut justifier la création d’ISFDI. De plus, certaines données probantes convaincantes laissent supposer qu’il pourrait y avoir des répercussions positives sur la transmission de maladies à diffusion hématogène qui découlent du partage des articles des fumeurs et la possibilité que les ISFDI puissent remédier à cette situation constitue une question de santé publique prioritaire. Les interventions visant à prévenir le passage aux drogues à injection représentent un autre sujet pertinent à l’étude de la présente question; on pourrait également évaluer les ISFDI comme un moyen stratégique éventuel pour corriger cette situation.

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Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Courtney L. C. Collins BSc, Thomas Kerr PhD, Mark W. Tyndall MD, ScD, David C. Marsh MD, Patricia S. Kretz BSc, Julio S. Montaner MD &  Evan Wood PhD

  2. Canadian HIV/AIDS Legal Network., Canada

    Thomas Kerr PhD

  3. Department of Medicine, Faculty of Medicine, University of British Columbia, Vacncouver, Canada

    Mark W. Tyndall MD, ScD & Julio S. Montaner MD

  4. Department of Healthcare and Epidemiology, Faculty of Medicine, University of British Columbia, Canada

    David C. Marsh MD &  Evan Wood PhD

  5. Vancouver Coastal Health, Vancouver, Canada

    David C. Marsh MD

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  1. Courtney L. C. Collins BSc
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Correspondence to Evan Wood PhD.

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Collins, C.L.C., Kerr, T., Tyndall, M.W. et al. Rationale to Evaluate Medically Supervised Safer Smoking Facilities for Non-injection Illicit Drug Users. Can J Public Health 96, 344–347 (2005). https://doi.org/10.1007/BF03404029

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