DISTRIBUTION OF CRACK KITS IS GOOD POLICY

Consider this: The province decides to fund a cheap medical program
that could reduce the spread of a serious disease and, along with it,
could reduce health care costs significantly.

One would think such a program would be heartily endorsed by anyone
who's concerned about spiralling health care costs. Alas, the program
concerns drugs -- more specifically, crack cocaine, one of the most
harmful of the illicit drugs. And that means that many people will
reflexively oppose the program regardless of the benefits it may realize.

The pilot project involves distributing crack kits, including pipes,
mouthpieces, filters and condoms, to crack cocaine smokers. Although
it's not clear how many subjects will be involved, the project is
expected to run for six months to a year and to cost between $ 50,000
and $ 60,000.

That's a mere pittance compared to the project's potential savings.
Although the evidence is not conclusive on this point, there is reason
to believe that the sharing of crack pipes can lead to transmission of
a variety of blood-borne diseases, most notably hepatitis C ( HCV).

Indeed, just a few years ago Benedikt Fischer of the University of
Victoria's Centre for Addiction Research studied 51 crack smokers and
found HCV on one pipe.

This doesn't prove that HCV is transmitted via shared crack pipes, but
given that many crack smokers have burns and open sores on their lips,
it's certainly possible.

We know further that both HCV and pipe sharing are epidemic among
crack users. According to data from the ongoing B. C. Alcohol and
Other Drug Monitoring Project, which interviews samples of drug users
every six months, 70 per cent of crack smokers in Victoria and 60 per
cent in Vancouver reported sharing crack pipes.

It is, therefore, imperative that we do whatever we can to reduce the
risk of HCV transmission among crack users, not only to safeguard
their health but also to reduce health care costs.

The cost of treating HCV infection is estimated at $ 30,000 per person
per year, and given the number of HCV-infected drug users in Canada,
the estimate for treatment over the next 20 years runs into the
billions of dollars.

This itself is a crisis, in addition to the epidemic of HCV infection
among drug users.

And it means that if the pilot project prevents two people from
becoming HCV positive, it will have paid for itself for each year's
outlay.

But preventing HCV infection is, of course, not the only to reason to
endorse the project. Crack pipe sharing might also lead to HIV
transmission and to respiratory illnesses such as pneumonia.

And preventing disease isn't the only reason to endorse the
project.

The distribution of crack kits also acts as a form of outreach to
deeply marginalized drug users, a point of first contact with the
health care system.

As we have seen with Insite, Vancouver's supervised injection site,
the project could ultimately result in more users seeking treatment.

Of course, we don't know if the project will have this effect, or even
if it will reduce HCV infection. But that is precisely why it needs to
be tried and studied. Running such a project is the very epitome of
responsible health care policy-making.