Canadian Journal of Public Health

, Volume 102, Issue 3, pp 188–191 | Cite as

Do Crack Smoking Practices Change With the Introduction of Safer Crack Kits?

  • Leslie A. MalchyEmail author
  • Vicky Bungay
  • Joy L. Johnson
  • Jane Buxton
Quantitative Research



Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of “safer crack kits” on smoking practices.


Two cross-sectional surveys were conducted, the first prior to kit distribution and the second a year later. Participants were individuals who smoked crack and lived in Vancouver’s inner city. Crack smoking practices and use of items in the crack kit were documented.


The results of the second survey (i.e., following 12 months of kit distribution) showed an increase in availability and use of safer use items; mouthpieces and condoms provided in the kit were used by 79% and 59% of recipients, respectively. Unsafe practices were reported post distribution: although 42% used brass screens, the majority reported that they usually used Brillo®; over 40% of respondents reported using syringe plungers to scrape crack resin; and participants reported sharing crack-use paraphernalia.


While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.

Key words

Crack cocaine smoking safer use harm reduction 



La consommation de crack augmente à Vancouver malgré les dangers de cette pratique. Beaucoup de fumeurs de crack partagent leurs accessoires, ce qui accroît leur risque de contracter des maladies infectieuses. Nous avons voulu étudier les effets sur la consommation de crack de la distribution de « kits-crack » (trousses pour un usage plus sécuritaire du crack).


Nous avons mené deux enquêtes transversales, la première avant la distribution des trousses et la seconde un an plus tard. Les participants étaient des fumeurs de crack vivant dans les quartiers déshérités du centre-ville de Vancouver. Nous avons collecté des informations sur la consommation de crack et l’utilisation des accessoires de la trousse.


Les résultats de la seconde enquête (12 mois après la distribution des trousses) font état d’une hausse de la disponibilité et de l’utilisation d’accessoires de consommation à moindre risque; les embouts et les condoms contenus dans la trousse étaient utilisés par 79 % et 59 % des destinataires, respectivement. Des pratiques non sécuritaires ont été déclarées même après la distribution des trousses: bien que 42 % des usagers emploient une grille en cuivre, la majorité ont dit qu’ils se servaient habituellement d’un Brillo®; plus de 40 % des répondants ont dit utiliser des pistons de seringues pour gratter la résine de crack; et les participants ont dit partager leurs accessoires.


La distribution des trousses a facilité l’accès aux accessoires de consommation à moindre risque, mais elle n’a eu qu’un impact limité sur les pratiques de consommation à moindre risque. Nos constatations soulignent le besoin d’une distribution ciblée d’accessoires de consommation à moindre risque. Les études futures devraient explorer la dynamique des pratiques non sécuritaires de consommation de crack et les moyens de donner plus de poids aux messages sur la consommation à moindre risque.

Mots clés

crack tabagisme comportement de réduction des risques réduction des dangers 


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  1. 1.
    Haydon E, Fischer B. Crack use as a public health problem in Canada: Call for an evaluation of ‘safer crack kits’. Can J Public Health 2005;96:185–88.PubMedGoogle Scholar
  2. 2.
    Bungay V, Johnson J, Varcoe C, Boyd S. Women’s health and use of crack cocaine in context: Structural and ‘everyday’ violence. Int J Drug Policy 2010;21(4):321–29.CrossRefGoogle Scholar
  3. 3.
    Fischer B, Powis J, Cruz MF, Rudzinski K, Rehm J. Hepatitis C virus transmission among oral crack users: Viral detection on crack paraphernalia. Eur J Gastroenterol Hepatol 2008;20(1):29–32.CrossRefGoogle Scholar
  4. 4.
    DeBeck K, Kerr T, Li K, Fischer B, Buxton JA, Montaner J, Wood E. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ 2009;181:585–89.CrossRefGoogle Scholar
  5. 5.
    Buxton JA. Vancouver Drug Use Epidemiology, Vancouver site report for the Canadian Community Epidemiology Network on Drug Use (CCENDU), 2007. Available at: (Accessed January 20, 2010).Google Scholar
  6. 6.
    Gyarmathy VA, Neaigus A, Miller M, Friedman SR, Des Jarlais DC. Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users. J Acquire Immune Defic Syndr 2002;30(4):448–56.CrossRefGoogle Scholar
  7. 7.
    Leonard L, DeRubeis E, Pelude L, Medd E, Birkett N, Seto J. “I inject less as I have easier access to pipes”: Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking resources are distributed. Int J Drug Policy 2008;19:255–64.CrossRefGoogle Scholar
  8. 8.
    Porter J, Bonilla L. Crack users’ cracked lips: An additional HIV risk factor. Am J Public Health 1993;83(10):1490–91.CrossRefGoogle Scholar
  9. 9.
    Tortu S, Neaigus A, McMahon J, Hagen D. Hepatitis C among noninjecting drug users: A report. Substance Use & Misuse 2001;36(4):523–34.CrossRefGoogle Scholar
  10. 10.
    Tortu S, McMahon JM, Pouget ER, Hamid R. Sharing of noninjection drug-use implements as a risk factor for hepatitis C. Substance Use & Misuse 2004;39(2):211–24.CrossRefGoogle Scholar
  11. 11.
    Story A, Bothamley G, Hayward A. Crack cocaine and infectious tuberculosis. Emerg Infect Dis 2008;14(9):1466–69.CrossRefGoogle Scholar
  12. 12.
    Malchy L, Bungay V, Johnson J. Documenting practices and perceptions of ‘safer’ crack use: A Canadian pilot study. Int J Drug Policy 2008;19(4):339–41.CrossRefGoogle Scholar
  13. 13.
    Mateu-Gelabert P, Maslow C, Flom PL, Sandoval M, Bolyard M, Friedman SR. Keeping it together: Stigma, response, and perception of risk in relationships between drug injectors and crack smokers, and other community residents. AIDS Care 2005;17(7):802–13.CrossRefGoogle Scholar
  14. 14.
    Furst RT, Johnson BD, Dunlap E, Curtis R. The stigmatized image of the ‘’crack head”: A sociocultural exploration of a barrier to cocaine smoking among a cohort of youth in New York City. Deviant Behavior 1999;20(2):153–81.CrossRefGoogle Scholar
  15. 15.
    Butters J, Erickson PG. Meeting the health care needs of female crack users: A Canadian example. Women & Health 2003;37:1–17.CrossRefGoogle Scholar
  16. 16.
    Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute, 1993).Google Scholar
  17. 17.
    Bungay V, Johnson JL, Boyd S, Malchy L, Buxton J, Loudfoot J. Women’s stories/women’s lives: Creating safer crack kits. Women’s Health & Urban Life: An International & Interdisciplinary Journal 2009;8(1):28–41.Google Scholar
  18. 18.
    Fischer B, Rudzinski K, Ivsins A, Gallupe O, Patra J, Krajden M. Social, ealth and drug use characteristics of primary crack users in three mid-sized communities in British Columbia, Canada. Drug Education, Prevention and Policy 2010;17(4):333–55.CrossRefGoogle Scholar
  19. 19.
    Bruneau J, Lamothe F, Franco E, Lachance N, Desy M, Soto J, Vincelette J. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study. Am J Epidemiol 1997;146(12):994–1002.CrossRefGoogle Scholar
  20. 20.
    Strathdee SA, Patrick DM, Currie SL, Cornelisse PGA, Rekart ML, Montaner JSG, et al. Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. AIDS 1997;11(8):F59–F65.CrossRefGoogle Scholar
  21. 21.
    Shaw SY, Shah L, Jolly AM, Wylie JL. Determinants of injection drug user (IDU) syringe sharing: The relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada. Addiction 2007;102(10):1626–35.CrossRefGoogle Scholar
  22. 22.
    Wood E. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS 2002;16(6):941–43.CrossRefGoogle Scholar
  23. 23.
    Kerr T, Small W, Buchner C, Zhang R, Li K, Montaner J, Wood E. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Am J Public Health 2010;100(8):1449–53.CrossRefGoogle Scholar
  24. 24.
    Boyd SC, Johnson JL, Moffat B. Opportunities to learn and barriers to change: Crack cocaine use in the Downtown Eastside of Vancouver. Harm Reduction Journal 2009;5(34):1–12.Google Scholar
  25. 25.
    City of Vancouver. Downtown Eastside Community Monitoring Report, 2005–2006. Available at: (Accessed November 16, 2010).Google Scholar
  26. 26.
    Buxton JA, Preston E, Mak S, Harvard S, BC Harm Reduction Supply Services Committee. More than just needles: An evidence-informed approach to enhancing the distribution of provincial harm reduction supplies. Harm Reduction Journal 2008;5(37):1–7.Google Scholar
  27. 27.
    Malchy L, Buxton J. Learning from cross Canadian experience: Harm reduction in the context of crack cocaine smoking. Paper presented at the UBC NEXUS Spring Research Institute, Vancouver, BC, 2009).Google Scholar
  28. 28.
    Rhodes T. The ‘risk environment’: A framework for understanding and reducing drug-related harm. Int J Drug Policy 2002;13(2):85–94.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2011

Authors and Affiliations

  • Leslie A. Malchy
    • 1
    Email author
  • Vicky Bungay
    • 2
  • Joy L. Johnson
    • 2
  • Jane Buxton
    • 3
  1. 1.Nursing and Health Behaviour Research Unit, School of NursingUniversity of British ColumbiaVancouverCanada
  2. 2.School of Nursing, University of British ColumbiaVancouverCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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