anyone got any papers evidencing crack pipe provision?

I have been searching for weeks and despite Canada and France giving out pipes I can't find any papers looking at evidence which I will need if I am ever to write a proposal for a trial.

thanks

Hi - I could learn something here - can you tell me what the benefits will be of giving out crack pipes ? I'm feeling a bit thick ( well it is Sunday ) and I haven't done the crack training, though I know case workers have. Keeps this thread live too .....
thanks, Gill

Firstly it would encoutage people into drug projects earlier in much the same way needle provision brough injectors into projects before they got a DVT, building relationships, earlier interventions=better.

purely from a harm min perspective, sharing pipes increases the risk of disease transmission, there is evidence mmounting (mostly anecdotal at present) that hep can be transmitted this way, but as cocaine lowers the immune system and anti-biotic resistant starings of TB are about its makes sense.

plus burns to fingers and lips.

plus home made pipes = more risk.

Home made crack pipes certainly carry lots of risks..as described above, from burns to lips, face, eyes, lungs; also inhaling lumps of foil, ash, and other bits of the pipe, made worse by the anasthetic effect of the crack, and the drive to waste-not-want-not by sucking long and hard.

I have several examples of pipes made from little pill bottles. The bashed in coke tins ones are even worse, with bits of crack jumping off into your face, and various toxic fumes from the paint.

A nice safe glass pipe from the clinic might make someone more inclined to pipe it rather than inject, maybe, and i am sure it would bring in the custom. Maybe adding a few hard-to-reach groups. i think might be a good idea. While handing it out would certainly provide an opportunity to explain about risk of Hep C and TB etc from sharing pipes with people who have cracked numb lips.

I think they are quite expensive, arn't they? maybe we could make a profit by selling them! I'm pretty sure that would be even more heavily frowned upon, though it might be a nice little earner. ("Birmingham GP struck off for selling crack pipes"?)

Judith,
It's not just me then that has bashed in coke tins in my room at work. I retrieved some that patients used in our toilets at work. I found them in the toilet cistern ! how hygienic is that. We had to make a bracket to keep the lid on the toilet as obviously can't knowingly allow this to happen. I would imagine pipes to be expensive and seem to remember seeing them in a shop in Amsterdam but didn't notice the price.

Depends what you call expensive you can get them at this site for £2.99 http://www.everyonedoesit.co.uk/online_headshop/product...D=262&iLastCatID=254 - had a search when trying to convince my end-stage COPD crack smoker (central cyanosis, clubbing, difficulty in dressing herself) she needed to stop inhaling the plastic!

Well there's no argument they are too expensive then, we better whip ourselves into a frenzy and rant to some commissioners.

The pipes given out in Canada (and even the UNITED STATES!) are simpler than those in the link and are a plain straight tube, with a rubber mouth-piece to prevent burns, they are glass, simply because its cheap but also breaks (meaning people come back for more) but you can also see what you are doing.

In france pipes are slightly different in design and are given out in a kit with condoms etc.

In Germany there are room where you can go and smoke crack with drug-workers/nurses on hand (Drug consumption rooms) usually attatched to supervised Injection sites.


Horray for backward Britian once proud leadres in human rights for drug users and brave innovator now scared to even copy proven lifesaving evidence based practice.

I know it is little comfort but when you talk about evidence base think about this. The new GMS QOF was meant to be evidence based and yet the targets they set for cardiovascular risk management (i.e. cholesterol profiles and hypertension along with glycaemic control) are not evidence based. The targets are not aggresive enough. Substance use is not the only area being short changed by targets not being evidence-based. To achieve the CVD targets to evidence based targets will be VERY expensive and so GPs are being asked to 1/2 do the job. So the job will not be done properly presently. When QOF targets change then the job will be done better but the prescribing costs will soar. But I suspect other budgets (like substance use management budgets) may need to be cut as a result.

James,
I wonder if Substance use or misuse may come into the QOF ?
That might put the cat among the flying rats

I've not come across any evidence for (or for that matter against) crack pipes, so one could say good opportunity to do a trial. I'm not sure though about the legalities of giving out pipes, whether there'd need to be primary legislation, or whether one could have a situation akin to giving out injecting paraphernalia prior to the change in paraphernalia laws a couple of years ago i.e needle exchanges did give out clean water, filters etc in the interests of reducing risk, even though the Statute hadn't been changed. Re drug use and the QOF - I can't see it happening even though all of us working in the field would like it to.

"drug use and the QOF? - its here in Leeds! We have managed to persuade our PCT to help us write our own QOF ( a homeless practice) and included targets for crack users - eg harm reducn advice given (not your actual pipe though), alcohol intake recorded, safe sex advice etc. And I think the amount they give us will help to buy a couple of pipes...

A Scottish harm reductionist approach ?
http://news.scotsman.com/topics.cfm?tid=220&id=203832006

pleased to hear "drug use and the QOF" is around Sally, I just can't see it though for mainstream practices can you?

I cannot see the logic in this. Surely it isnt quite the same as providing free syringes which prevent untold infections. I would have thought money could have gone on more needed things.

Moreover, I cannot see the logic that condoms should be automaticaly given to drug users - isnt that being a little patronising, assuming that they are completely lacking any sense of responsibility at any level, if so, why would they come an ask for needles. Its those that dont ppl ought to be concerned for.

quote:

Originally posted by drew:
I cannot see the logic in this. Surely it isnt quite the same as providing free syringes which prevent untold infections. I would have thought money could have gone on more needed things.

there is evidence growing that sharing pipes does spread infections. Its hard to come by at the moment just like the evidence that giving out needles could help stop HIV was before anyone evidenced it (and the same protestations were voiced)

quote:

Moreover, I cannot see the logic that condoms should be automaticaly given to drug users - isnt that being a little patronising, assuming that they are completely lacking any sense of responsibility at any level,

heavy crack users don't have money to spend on condoms and do have sex (sometimes lots of sex with multiple partners and sex working crack users are more likely to have unprotected sex as well)

whats more important is that some stats I just got from France (horray for the internet) show they had 20% of new clients who had never been to drug services before by giving out pipes!

now if just 1 in twenty of those engaged and reduced/stopped their crack use, how much would that save society in terms of disease transmission, possible crime etc etc. how much is that worth?

remember every £1 on treatemtn saves (is it 7 or 16 pounds in healthcare and social costs?)

typically though we will fight a firefighting action and try to elastoplast the issue instead of progressive and innovative treatments unless theres a new expensive patented drug to push

Is this the time for a should we treat drinkers, smokers, overeaters debate?

mind you I think condoms should be free for everyone, its those that can least afford £5-6 a pack that most need sexual health protection, how those from deprived areas with poor parenting, education, housing and health are expected to spend the little money they have on a condom is beyond me, though we can always blame them for the high pregnancy rates in this country and not the condom companies that over-price essential items (don't even bother with they can come and get six free from a health center thats open certian hours, I remember doing that as a teenage boy and standing in a line with about 20 pregnant women before being interviewed in the open just to get a few.

when you add that cocaine and crack users might have sex for hours on end you can easily understand why its importnat we make it as easy as possible for people to minimise the risks thay take (and cocaine also lowers immunity)

I tip I picked up once is that miniature Martel bottles can easily have the glass base knocked out and make a "perfect" crack pipe - clean, glass - so that's waht I recommend to a user who is using coke cans or plastic bottles.

Martyn is that the VSOP or the Cordon Bleu or doesn't it matter ?

Cliff, i do see your point, but mouth - mouth spread of infection may turn out to be equally the same for ppl sharing joints, do they get free spliffs?

I just think the money could go on R&D for the cocaine equivillant to methadone/bupe, then perhaps the need for smoking could be reduced. Just my thoughts though.