Crack use as a public health problem in Canada: call for an evaluation of 'safer crack use kits'

Oral crack use (smoking) is a relatively neglected public health problem in Canada, in comparison to injection drug use (IDU). There are indications that crack use in Canada may be increasing. Crack smoking involves particular risks and harms, including possible infectious disease transmission, which underline the need for targeted interventions. One pragmatic grassroots intervention that has only recently begun or been discussed in several Canadian cities is the distribution of 'safer crack use kits', which provide hardware for crack smoking devices along with harm reduction information. In addition to the direct benefits of using them, the kits may also bring previously 'hidden' marginalized crack smokers in contact with health and social services. There has been considerable controversy with regards to the distribution of the crack kits, within criminal justice, public health, and the general public; this resistance appears quite similar to that experienced when needle exchange programs (NEPs) were first being established. Systematic evaluation of the crack kits is urgently needed in order to produce definitive evidence of their health and other benefits, and to allow for evidence-based program and policy decisions in the interest of public health.