A paradigm shift is taking place on harm reduction for smoking/inhaling stimulants (crack/paco or coca base paste). When sharing homemade pipes crack users get wounds on lips and gums and are susceptible to diseases such as herpes, tuberculoses, hepatitis and the HIV/AIDS virus. Crack use often implicates risky sexual behaviour in exchange for crack or to buy crack. At the local level in Brazil, Canada and the US ‘safer crack use kits’ are dispensed with condoms, pipes, pipe stems, tissues, vaseline and lip balm to counter infections and sexually transmitted diseases.

  • The interplay between drug-use behaviors, settings, and access to care

    A qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo, Brazil
    Noa Krawczyk, Carlos Linhares Veloso Filho and Francisco I. Bastos
    Harm Reduction Journal 2015, 12:24
    August 2015

    Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues.

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  • Cannabis to substitute crack

    A step by step rehabilitation
    Tom Blickman Amira Armenta
    Monday, April 22, 2013

    The mayor of Bogota has recently proposed a pilot scheme with crack cocaine addicts to explore the substitution of crack made of cocaine base paste (or bazuco as it is called in Colombia) by marijuana. The substitution treatment plan will include 15 problematic users from the marginalized Bronx area who are already receiving health assistance of the CAMAD operating in that sector of the city. The treatment will last approximately eight months, after which the results will be evaluated.

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  • Cannabis as a substitute for alcohol and other drugs

    A dispensary-based survey of substitution effect in Canadian medical cannabis patients
    Philippe Lucas, Amanda Reiman, Mitch Earleywine, Stephanie K. McGowan, Megan Oleson, Michael P. Coward & Brian Thomas
    Addiction Research & Theory
    November 20, 2012

    This article examines the subjective impact of medical cannabis on the use of both licit and illicit substances via self-report from 404 medical cannabis patients recruited from four dispensaries in British Columbia, Canada. The aim of this study is to examine a phenomenon called substitution effect, in which the use of one product or substance is influenced by the use or availability of another.

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  • Cocaine addiction treatments to improve control and reduce harm (CATCH)

    New pharmacological treatment options for crack-cocaine dependence in the Netherlands
    Mascha Nuijten, Peter Blanken, Wim van den Brink and Vincent Hendriks
    BMC Psychiatry 2011, 11:135
    August 2011

    Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population is not reached by the addiction treatment system.

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  • Uptake, benefits of and barriers to safer crack use kit (SCUK) distribution programmes in Victoria, Canada

    A qualitative exploration
    Andrew Ivsins, Eric Roth, Nadine Nakamura, Mel Krajden & Benedikt Fischer
    International Journal of Drug Policy 22(4):292-300
    July 2011

    Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUKs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada.

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  • Do crack smoking practices change with the introduction of safer crack kits?

    Leslie A. Malchy, Vicky Bungay, Joy L. Johnson & Jane Buxton
    Canadian Journal of Public Health 102(3):188-92.
    May-June 2011

    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. 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.

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  • The Safer Crack Use Program

    Fact sheet
    Toronto Public Health
    June 2010

    This fact sheet explains the Safer Crack Use Program of the Public Health Department of Toronto (Canada). In Toronto, a range of community-based, government and institutional agencies deliver harm reduction services. As with other harm reduction measures, there is no evidence that the distribution of safer crack use kits encourages drug use. Only people who are already using crack cocaine participate in the Safer Crack Use Program.

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  • The fast and the furious

    Cocaine, amphetamines and harm reduction
    Jean-Paul Grund, Philip Coffin, Marie Jauffret-Roustide, Minke Dijkstra, Dick de Bruin and Peter Blanken
    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
    April 2010

    Harm reduction programmes targeting stimulants like cocaine and (meth)amphetamines in several countries have shown positive results. However, these programmes are limited to Australia and North America. As the effectiveness of pharmacological and psycho­social interventions for stimulant users is limited, interventions to stabilise and mini­mise the negative consequences of ongoing meth­ampheta­mine use are of paramount importance. A wide range of health and social problems associated with stimulant use are largely unaddressed by current services.

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  • Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs

    Kora DeBeck et. al.
    Canadian Medical Association Journal (CMAJ)
    October 27, 2009

    This paper examined whether use of crack cocaine has become a risk factor for HIV infection. Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated.

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  • Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence

    Marie Longo, Wendy Wickes, Matthew Smout, Sonia Harrison, Sharon Cahill & Jason M. White
    Addiction 105, pp. 146–154
    June 2009

    This study tested the impact of a long-acting form of amphetamine as medication to help control dependent use of the closely allied stimulant, methamphetamine. Prescribed usually for the treatment of pathological sleepiness or attention deficit/hyperactivity disorder, effects of the amphetamine tablets prescribed in the study take several hours longer to emerge than normal amphetamine and last three to six hours longer, giving it a 'smoothing' profile similar to methadone for heroin users; non-rapid onset make it less intensely pleasurable, and longer duration suits it to once-daily administration.

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