VICTORIA - A new study is providing evidence to support fears that the highly infectious and potentially fatal hepatitis C virus can be passed among crack cocaine smokers sharing their pipes.
"We have some initial evidence that a hepatitis C-infected crack smoker can, under certain circumstances, pass on the virus on to the pipe,'' said Dr. Benedikt Fischer, leader of a study released Wednesday.
The director of the University of Victoria's Centre for Addictions Research said it affirms the risk that oral crack users can pass on hep C through risky crack use methods.
"(That's) one of several steps necessary to transmit hepatitis C from one crack smoker to another by way of crack-pipe sharing,'' he said.
The evidence comes from a new biological study of drug paraphernalia used by more than 50 inner city crack users in Toronto last year.
In the study, crack pipes were collected shortly after being used by 51 users, who were tested for hepatitis C virus antibodies.
The virus was detected on one of 22 pipes tested whose owners had tested antibody positive.
The study comes as public heat over the distribution of free, safe crack-pipe kits continues to inflame some Canadian communities. Political pressure at the municipal level saw Ottawa scrap its safe pipe program earlier this year, while a similar program in Nanaimo, B.C., was put on hold.
Fischer said he felt the study's results have implications and lessons for both scientists and public health officials.
"Primarily, that in order to prevent the spread of hepatitis C in the high-risk population of street drug users, you need to not only focus on injection drug users but also on crack smokers,'' he explained.
The results are being welcomed by some at the leading edge of drug-intervention programs.
British Columbia's provincial health officer said evidence of the virus on the stems of crack pipes clearly helps the argument that hep C can be transmitted between smokers of the concentrated cocaine concoction, sometimes known on the street as "rock.''
"This study adds further support for interventions that are aimed at trying to reduce the spread of infectious agents between crack users,'' said Dr. Perry Kendall.
"For quite some time we've been concerned about the potential spread of diseases like HIV, hepatitis C, tuberculosis and even syphilis, using shared crack pipes -- a bit like using shared drug-injection equipment can spread diseases.
"This study, which actually finds hepatitis C virus on the stems of crack pipes ... adds weight to the fact that this is a feasible way to spread diseases.''
Kendall said it's unfortunate the distribution of safer crack pipe kits has come under fire.
Safer crack kits most often include a glass stem, mouthpiece, metal screens, matches, Vaseline, condoms, lubricant, hand wipes and alcohol swabs. Some also include lip balm, chewing gum and information materials concerning safer crack use and treatment of oral sores and lesions.
Kendall rejected suggestions that some harm reduction programs promote drug abuse. He said studies show needle-exchange programs and supervised safe injection sites do not encourage anyone "to take up drug use or do more drugs than they would have done otherwise.''
Kendall expressed frustration that free pipes for street users, in particular, have come under fire.
"For some reason crack pipes have been a lightning rod for people who are opposed to harm reduction initiatives, who haven't been able to unseat established programs, such as needle and syringe exchanges,'' he said.
In Nanaimo, a five-month program to distribute free pipes was put on hold this summer, officially because of reports there were threats of violence against nurses handing out the kits. But the program was politically controversial.
It appears that situation may soon change, however.
Dr. Murray Fyfe, a medical health officer with the Vancouver Island Health Authority, said they have been given a go ahead to add crack pipe components under a change made last month to the provincial harm reduction supply and services policy.
"So this is a first for B.C.'' he said, adding that the start date begins April 1, 2008, the beginning of the next fiscal year.
"Although we may be able to get some of them, in smaller supply, before (that),'' he said.
Fyfe said the move will include Nanaimo, where he said the health authority is engaged with the city council on harm reduction initiatives.
He, too, welcomed the results of the UVic study, pointing out that much of the concern over the potential risk of transmitting hepatitis C through crack pipes has been speculation and based on anecdotal evidence.
"Having this first bit of really solid evidence really does help,'' he said.
Experts have concluded that more street-level drug users in Canada are infected by hepatitis C than HIV.
It's estimated that the consequences resulting from increased infection now cost Canadians $500 million to $1 billion each year.
