an urgent impetus for action safe inhalation interventions to reduce covid 19 transmission CORD-Papers-2022-06-02 (Version 1)

Title: An urgent impetus for action: safe inhalation interventions to reduce COVID-19 transmission and fatality risk among people who smoke crack cocaine in the United Kingdom
Abstract: Crack cocaine use is rising in the UK with smoking the primary form of administration. Provision of safe inhalation equipment for crack cocaine is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply exacerbating COVID-19 transmission and respiratory risk. This is of concern given high prevalence of respiratory health harms such as COPD among people who smoke illegal drugs. This commentary draws on scoping review and mixed method empirical evidence to argue for provision of safe crack inhalation equipment in the UK with commensurate legal reform. Review of crack inhalation interventions illustrates the health protective and service engagement benefits of smoking equipment supply. Survey data generated with 455 people who inject drugs in London illustrate high prevalence of current crack use (66% n=299). Qualitative accounts illustrate perceptions of relative smoking safety alongside accounts of severe respiratory-related health harms. To date injecting drug use has been of primary concern in relation to harm reduction initiatives. It is crucial that people who smoke illegal drugs are considered a vulnerable population in regard to COVID 19 transmission and fatality risk with innovative harm reduction measures scaled up in response.
Published: 2020-06-22
Journal: Int J Drug Policy
DOI: 10.1016/j.drugpo.2020.102829
DOI_URL: http://doi.org/10.1016/j.drugpo.2020.102829
Author Name: Harris Magdalena
Author link: https://covid19-data.nist.gov/pid/rest/local/author/harris_magdalena
sha: 8c1d4dc9aed4de68b3f16d797ccdf3bfb2a9e0bf
license: no-cc
license_url: [no creative commons license associated]
source_x: Elsevier; Medline; PMC
source_x_url: https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32595070
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32595070
pmcid: PMC7306748
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306748
url: https://api.elsevier.com/content/article/pii/S0955395920301705 https://www.sciencedirect.com/science/article/pii/S0955395920301705?v=s5 https://www.ncbi.nlm.nih.gov/pubmed/32595070/ https://doi.org/10.1016/j.drugpo.2020.102829
has_full_text: TRUE
Keywords Extracted from Text Content: UK COVID-19 cocaine people law Reino 180,748 DeBeck blood particles Pūras Inhaled cocaine pulmonary water soft tissue tobacco citric fibres Citric acid nose ... renal waterpipes lacuna Cocaine hepatitis C SSTI ( hydrochloride opiate Frankeberger inhaled Vardavas Haydon & raft hypodermic syringes lips OST sodium bicarbonate heroin lung COVID-19 lightbulbs self-isolate sores crack-specific people needles UK Women Fumes lungs lip skin tin cans Dorset Police Constabulary BBV Prangnell hepatitis ash stem Renal PWID citric acid participants Methadone NSP Shehab, 2014) . Covid-19 Talen Dan Ciccarone Niamh Eastwood
Extracted Text Content in Record: First 5000 Characters:Crack cocaine use is rising in the UK, with smoking the primary form of administration. Provision of safe inhalation equipment for crack cocaine is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, exacerbating COVID-19 transmission and respiratory risk. This is of concern, given high prevalence of respiratory health harms such as COPD among people who smoke illegal drugs. This commentary draws on scoping review and mixed method empirical evidence to argue for provision of safe crack inhalation equipment in the UK, with commensurate legal reform. Review of crack inhalation interventions illustrates the health protective and service engagement benefits of smoking equipment supply. Survey data generated with 455 people who inject drugs in London illustrate high prevalence of current crack use (66%, n=299). Qualitative accounts illustrate perceptions of relative smoking safety -alongside accounts of severe respiratory-related health harms. To date, injecting drug use has been of primary concern in relation to harm reduction initiatives. It is crucial that people who smoke illegal drugs are considered a vulnerable population in regard to COVID 19 transmission and fatality risk, with innovative harm reduction measures scaled up in response. A primary focus of harm reduction research and intervention is mitigation of injecting-related health harms. Understanding and working to reduce the health harms associated with drug inhalation has, in the United Kingdom (UK), been comparatively neglected. It is crucial to rectify this deficit, particularly in the current COVID-19 context and in relation to crack inhalation. In the UK very few treatment or harm reduction supports exist for the high and growing population of people who use crack. Although smoking is generally considered safer than injecting, legal provision is only available for injecting equipment distribution. As outlined in this article, this policy lacuna acts to heighten health harms and exacerbate COVID-19 vulnerability among an already very marginalised population. The UK has the highest prevalence of people who use crack in the European region (EMCDDA, 2019) . This is a growing population, with an 8.5% rise from 166,640 in 2012 to 180,748 in 2017 (Hay et al., 2019) highlighted as a matter of governmental concern (Public Health England and Home Office, 2019 ). An offical inquiry into this increase reports heightened availability, affordability and acceptability of crack, with expanded and 'aggressive' marketing also noted. While the majority of the increase in use is reported among people who inject drugs (PWID) and/or who are in receipt of opiate substitution therapy (OST), samples drawn from treatment and criminal justice services are subject to bias. Modelling data for 2017 estimate 52,677 people who use crack but not opiates (Hay et al., 2019) . Women appear over-represented in this population, one that is largely 'hidden' from service or research data capture (Hope, Hickman & Tilling, 2005) . Well evidenced is the effectiveness of OST and needle and syringe programmes (NSP) in attracting stigmatised populations to services and reducing blood-borne virus transmission (Larney et al., 2017; Platt et al., 2018) . The UK was an early adopter of this crucial harm reduction response, acting in 1986 to legalise needle and syringe provision to prevent an HIV epidemic among PWID. Commensurate action to protect the health and welfare of people who smoke crack is, however, stymied by legislative barriers. This commentary draws on mixed-method data from current research with PWID, coupled with review of the international academic and grey literature on crack smoking health impacts and interventions, to explore the case for review of UK policy pertaining to crack pipe supply. Just as the HIV epidemic provided a crucible for long needed legislative action regarding needle and syringe provision, the COVID-19 pandemic necessitates urgent action to expand and innovate harm reduction and drug treatment services for the benefit of people who smoke crack cocaine. Cocaine is one of the most widely used illegal drugs worldwide, with prevalence estimated at 0.4% (18.2 million) among people aged 15-64 (United Nations Office on Drugs and Crime, 2018). Global prevalence reports provide limited specificity regarding drug form, making it difficult to ascertain scale of crack cocaine versus powder (hydrochloride) cocaine use. National surveillance data specifying crack use are often stymied by sampling basis (recruitment services in the UK offering few crack-specific supports, for example) and thus likely to under-report prevalence, with seizure data subject to limitations due to the localised production of much crack product. Crack can, for example, be prepared in the home for personal use by heating powder cocaine with a base such as sodium bicarbonate (baking soda). Those with the economic and/or social capital to do so
Keywords Extracted from PMC Text: Women lungs Vardavas opiate sores ash lightbulbs raft Renal " citric self-isolate Fumes citric acid Covid-19 waterpipes London PWID participants blood particles hydrochloride lips water crack-specific hepatitis C participants nose DeBeck Pūras people Citric acid SSTI ( Reino OST Frankeberger hepatitis ... law pulmonary heroin lip inhaled needles COVID-19 sodium bicarbonate UK 180,748 NSP soft tissue cocaine PWID skin Prangnell Peat lacuna Inhaled Haydon & renal Methadone Voon Kirsty Cocaine I'm hypodermic syringes BBV Competing fibres Shehab, 2014). tobacco stem Dorset Police Constabulary tin cans lung Thatcher
Extracted PMC Text Content in Record: First 5000 Characters:A primary focus of harm reduction research and intervention is mitigation of injecting-related health harms. Understanding and working to reduce the health harms associated with drug inhalation has, in the United Kingdom (UK), been comparatively neglected. It is crucial to rectify this deficit, particularly in the current COVID-19 context and in relation to crack inhalation. In the UK very few treatment or harm reduction supports exist for the high and growing population of people who use crack. Although smoking is generally considered safer than injecting, legal provision is only available for injecting equipment distribution. As outlined in this article, this policy lacuna acts to heighten health harms and exacerbate COVID-19 vulnerability among an already very marginalised population. The UK has the highest prevalence of people who use crack in the European region (EMCDDA, 2019). This is a growing population, with an 8.5% rise from 166,640 in 2012 to 180,748 in 2017 (Hay et al., 2019) highlighted as a matter of governmental concern (Public Health England and Home Office, 2019). An offical inquiry into this increase reports heightened availability, affordability and acceptability of crack, with expanded and 'aggressive' marketing also noted. While the majority of the increase in use is reported among people who inject drugs (PWID) and/or who are in receipt of opiate substitution therapy (OST), samples drawn from treatment and criminal justice services are subject to bias. Modelling data for 2017 estimate 52,677 people who use crack but not opiates (Hay et al., 2019). Women appear over-represented in this population, one that is largely 'hidden' from service or research data capture (Hope, Hickman & Tilling, 2005). Well evidenced is the effectiveness of OST and needle and syringe programmes (NSP) in attracting stigmatised populations to services and reducing blood-borne virus transmission (Larney et al., 2017; Platt et al., 2018). The UK was an early adopter of this crucial harm reduction response, acting in 1986 to legalise needle and syringe provision to prevent an HIV epidemic among PWID. Commensurate action to protect the health and welfare of people who smoke crack is, however, stymied by legislative barriers. This commentary draws on mixed-method data from current research with PWID, coupled with review of the international academic and grey literature on crack smoking health impacts and interventions, to explore the case for review of UK policy pertaining to crack pipe supply. Just as the HIV epidemic provided a crucible for long needed legislative action regarding needle and syringe provision, the COVID-19 pandemic necessitates urgent action to expand and innovate harm reduction and drug treatment services for the benefit of people who smoke crack cocaine. Cocaine is one of the most widely used illegal drugs worldwide, with prevalence estimated at 0.4% (18.2 million) among people aged 15-64 (United Nations Office on Drugs and Crime, 2018). Global prevalence reports provide limited specificity regarding drug form, making it difficult to ascertain scale of crack cocaine versus powder (hydrochloride) cocaine use. National surveillance data specifying crack use are often stymied by sampling basis (recruitment services in the UK offering few crack-specific supports, for example) and thus likely to under-report prevalence, with seizure data subject to limitations due to the localised production of much crack product. Crack can, for example, be prepared in the home for personal use by heating powder cocaine with a base such as sodium bicarbonate (baking soda). Those with the economic and/or social capital to do so1 , are less likely to fall within the demographic commonly associated with crack use and/or come to the attention of drug treatment services. Limitations in the evidencing of crack use extend to mode of administration. Concurrent crack and heroin use are commonly reported among PWID in North American and UK research data, but mode of crack administration is not always specified. Given that crack can be injected (after conversion with an acid to a soluble hydrochloride) the assumption may be that this is the primary practice or, conversely, if focusing on injection-related health harms, crack smoking may not be of interest or disclosed. The 'Care & Prevent' study provides an example. Survey data, generated with 455 PWID in London, orientated around understanding injection practices but also associations between skin and soft tissue infection (SSTI) and the renal disease, AA amyloidosis (see Harris et al., for rationale and methods detail). Renal risk necessitated addition of smoking related questions. These highlighted a higher prevalence of current crack use (66%, n=299) than would have been captured by injecting specific questions alone (50%, n=228). Notably, mode of administration varied for many – with 71 exclusively smoking crack, 114 exclusively injecting and 114 combining crack smoking wit
PDF JSON Files: document_parses/pdf_json/8c1d4dc9aed4de68b3f16d797ccdf3bfb2a9e0bf.json
PMC JSON Files: document_parses/pmc_json/PMC7306748.xml.json
G_ID: an_urgent_impetus_for_action_safe_inhalation_interventions_to_reduce_covid_19_transmission