Using Surveillance With Near-Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019.

In 2019, Connecticut launched an opioid overdose-monitoring program to provide rapid intervention and limit opioid overdose-related harms. The Connecticut Statewide Opioid Response Directive (SWORD)-a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups-required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients' status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD's near-real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Craving in crack cocaine users according to individual and behavioral characteristics. / Craving em usuários de crack segundo características individuais e comportamentais.

OBJECTIVE: to analyze variation in craving levels according to individual and behavioral characteristics of crack cocaine users at two public treatment services in Pelotas, Rio Grande do Sul, Brazil. METHODS: this was a cross sectional study with a sample of 133 participants; the Cocaine Craving Questionnaire scale was used to verify craving levels. RESULTS: 86% of interviewees had moderate and severe craving levels; regarding individual factors, a higher level of severe craving was found in women (45%), those with brown skin color/"mestizos" (60%), low schooling (46%) and minor psychiatric disorders (59%); regarding behavioral factors, the level of severe craving was higher in users who divorced the last year (44%), those who had problems with the Law (61%), those who practiced violence acts (57%), those using more than four psychoactive substances (67%), and those with heavy crack consumption (57%). CONCLUSION: almost all crack users were found to have high craving levels; these were proportionally higher in some individual and behavioral variables.

For Women Living With HIV, A Trauma-Informed Approach To Care.

At a San Francisco primary care clinic, trauma is recognized as a root cause of many health challenges.

Evidence of hepatitis E virus infections among persons who use crack cocaine from the Midwest region of Brazil.

The current study aimed to determine the seroprevalence of hepatitis E virus (HEV) infection among persons who use crack from Midwest region of Brazil. Sera samples from 698 users of crack, collected from November 2013 to July 2015 were tested for anti-HEV immunoglobulin G (IgG) and immunoglobulin M (IgM) markers. Of the 698 serum samples, 99 (14.2%) were positive for anti-HEV IgG. Two samples were positive for anti-HEV IgM but both were negative for HEV RNA. The variables independently associated with anti-HEV positivity were increasing age and absence of stable partnership. This study showed high prevalence of past hepatitis E virus infection among persons who use crack.

Impairment of spatial working memory and oxidative stress induced by repeated crack cocaine inhalation in rats.

Crack cocaine is a highly toxic drug with great potential to induce addiction. It produces more intense effects than cocaine powder, with its use having grown worldwide. However, few studies have focused on the cognitive and biochemical consequences that result from crack cocaine inhalation. This study examined the effects of direct crack cocaine inhalation on spatial working memory and brain oxidative stress parameters in rats. Male adult Wistar rats, well-trained in an eight-arm radial maze (8-RM), underwent five sessions of crack cocaine inhalation (crack cocaine group) once a day or inhalation simulation (sham group), being tested in 1-h delayed tasks 24 h after the last inhalation. An additional inhalation session was carried out the following day, with the prefrontal cortex, hippocampus and striatum being removed five minutes afterwards in order to assess oxidative damage such as lipid peroxidation, thiobarbituric acid-reactive species (TBARS) levels, and advanced oxidation protein products (AOPP), as well as the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Animals from the crack cocaine group showed more errors (p <  0.01) in the 1-h post-delay performance in the 8-RM when compared to the sham group. The crack cocaine group showed decreased (p <  0.05) lipid peroxidation in the hippocampus and increased (p <  0.001) levels of AOPP and SOD activity (p < 0.05) in the striatum when compared to the sham group. Therefore, the repeated inhalation of crack cocaine impaired long-term spatial working memory and elicited oxidative stress in the hippocampus and striatum of rats.

The route of administration exacerbates prefrontal functional impairments in crack cocaine users.

Studies have evidenced more severe health consequences in individuals who smoked crack cocaine as compared to intranasal cocaine users. Differential neurocognitive deficits between the crack and intranasal cocaine-addicted patients, associated with prefrontal cortex functions, have never been tested using complex cognitive tasks in humans. In this study, we examined possible distinct neurocognitive deficits in 43 crack-addicted patients (CrD) compared with 36 intranasal cocaine-addicted patients (CD) and 32 controls. CrD and CD were evaluated after 2 weeks of supervised detoxification in two inpatient treatment programs. All the subjects were evaluated using an extensive battery of neurocognitive tasks, including the Trail Making Test, the Stroop Color-Word Test, the Digits Forward and Digits Backward tasks, the Controlled Oral Word Association Test, the Wechsler Adult Intelligence Scale, and the Frontal Assessment Battery. Differences in performance in the neurocognitive tests between the three groups were investigated controlling for age, IQ, psychiatric symptoms, and years of education. Both intranasal and crack users were impaired on a variety of cognitive measures relative to controls. Crack users performed worse than intranasal cocaine users in inhibitory control (p < .05) and general executive functioning (p < .01). Crack use seems to be more deleterious to neurocognitive functions associated with the prefrontal cortex. This may predispose crack-addicted patients to more severe negative clinical outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics.

Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18-68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.

Tuberculosis infection among cocaine crack users in Brazil.

BACKGROUND: WHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain. METHODS: A cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model. RESULTS: Among 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals. CONCLUSION: Given the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.

Maternal, fetal and neonatal consequences associated with the use of crack cocaine during the gestational period: a systematic review and meta-analysis.

OBJECTIVE: Crack cocaine consumption is one of the main public health challenges with a growing number of children intoxicated by crack cocaine during the gestational period. The primary goal is to evaluate the accumulating findings and to provide an updated perspective on this field of research. METHODS: Meta-analyses were performed using the random effects model, odds ratio (OR) for categorical variables and mean difference for continuous variables. Statistical heterogeneity was assessed using the I-squared statistic and risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Ten studies met eligibility criteria and were used for data extraction. RESULTS: The crack cocaine use during pregnancy was associated with significantly higher odds of preterm delivery [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.59-3.10], placental displacement (OR, 2.03; 95% CI 1.66-2.48), reduced head circumference (- 1.65 cm; 95% CI - 3.12 to - 0.19), small for gestational age (SGA) (OR, 4.00; 95% CI 1.74-9.18) and low birth weight (LBW) (OR, 2.80; 95% CI 2.39-3.27). CONCLUSION: This analysis provides clear evidence that crack cocaine contributes to adverse perinatal outcomes. The exposure of maternal or prenatal crack cocaine is pointedly linked to LBW, preterm delivery, placental displacement and smaller head circumference.

Willingness to use an in-hospital supervised inhalation room among people who smoke crack cocaine in Vancouver, Canada.

INTRODUCTION AND AIMS: People who use illicit drugs (PWUD) often engage in drug use during hospitalisation. Adverse outcomes may arise from efforts to conceal inpatient drug use, especially in hospital settings that rely on abstinence-based policies. Harm reduction interventions, including supervised drug consumption services, have not been well studied in hospital settings. This study examines factors associated with willingness to use an in-hospital supervised inhalation room (SIR) among people who smoke crack cocaine in Vancouver, Canada. DESIGN AND METHODS: Cross-sectional data from two open prospective cohorts of PWUD involving people who smoke crack cocaine were collected between June 2013 and May 2014. Multivariable logistic regression analyses were used to identify factors associated with willingness to use an in-hospital SIR. RESULTS: Among 539 participants, 320 (59.4%) reported willingness to use an in-hospital SIR. Independent factors positively associated with willingness included: ever used drugs in hospital [adjusted odds ratio (AOR) = 1.89], and daily non-injection crack use (AOR = 1.63). Difficulty accessing new crack pipes (AOR = 0.51) was negatively associated with willingness (all P < 0.05). The most commonly reported reasons for willingness were to: remain in hospital (50.6%), reduce drug-related risks (25.6%) and reduce the stress of hospital discharge for using drugs (24.7%). DISCUSSION AND CONCLUSIONS: A high proportion of people who smoke crack cocaine reported willingness to use an in-hospital SIR, and those willing were more likely to report heavy drug use and previous in-hospital use. These findings highlight the potential utility of SIRs to complement existing in-hospital services for PWUD.

Is Ayahuasca an Option for the Treatment of Crack Cocaine Dependence?

The low efficacy of crack cocaine addiction treatment available in Brazil has led Brazilian users to find alternatives to reduce drug consumption or even to reach abstinence. One of them is the use of entheogenic substances, like ayahuasca, an infusion obtained from two native plant species from the Amazon. The present report aimed to understand how crack cocaine users recover from drug addiction by consuming ayahuasca tea in a religious context. This is a qualitative study with a purposeful sample of 40 crack cocaine users, based on in-depth, semi-structured interviews. Participants reported that ayahuasca allowed them to access a consciousness dimension which enabled them to solve problems and traumas and reduce crack cocaine consumption. The religious ceremony increased the user's spirituality and the reception from the community gave them a sense of self-esteem, strengthening them in an emotional and social way. That positive experience has been incorporated into the daily routine of most participants. Findings indicate that ayahuasca, in a religious context, may have therapeutic value for crack cocaine dependence treatment.

Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil.

Crack cocaine (crack) dependence is a severe disorder associated with considerable morbidity and mortality, constituting a major public health problem in Brazil. The aim of this study was to improve understanding of the profile of treatment-seeking crack-dependent individuals. We recruited 65 crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil. Assessments, conducted between August 2012 and July 2014, focused on sociodemographic characteristics, the pattern/history of crack use, treatment history, concomitant substance use disorders, psychiatric symptomatology, and impulsivity. In the study sample, males predominated, as did unemployment, homelessness, and low levels of education. On average, the participants had smoked crack for 10 years. Most had previously been treated for crack dependence. Concomitant DSM-IV diagnoses of dependence on other substances were common, dependence on tobacco and alcohol being the most prevalent. Participants presented significant psychiatric symptomatology and impulsivity, with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms, and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic, and comorbid features of this disorder.

Patterns of Non-injection Drug Use Associated with Injection Cessation among Street-Involved Youth in Vancouver, Canada.

Although abstinence from drug use is often a key goal of youth substance use treatment, transitioning to less harmful routes and types of drug use is desirable from both a clinical and public health perspective. Despite this, little is known about the trajectories of youth who inject drugs including changes in patterns of non-injection drug use. The At-Risk Youth Study (ARYS) is a longitudinal cohort of street-involved youth who use drugs in Vancouver, Canada. We used linear growth curve modeling to compare changes in non-injection drug use among participants who ceased injecting drugs for at least one 6-month period between September 2005 and May 2015 to matched controls who continued injecting over the same period. Of 387 eligible participants, 173 (44.7%) reported ceasing drug injection at least once. Non-injection drug use occurred during 160 (79.6%) periods of injection cessation. In adjusted linear growth curve analyses, the only non-injection drug use pattern observed to decrease significantly more than controls following injection cessation was daily crack/cocaine use (p = 0.024). With the exception of frequent crack/cocaine use, transitions out of injection drug use did not appear to coincide with increased reductions in patterns of non-injection drug use. Our findings indicate that most (80%) of the observed injection cessation events occurred in the context of ongoing substance use. Given that transitioning out of drug injection represents a significant reduction in risk and harm, efforts supporting vulnerable youth to move away from injecting may benefit from approaches that allow for ongoing non-injection drug use.

Exposure to crack cocaine causes adverse effects on marine mussels Perna perna.

Our study aimed to evaluate crack cocaine effects in different life stages of the marine mussel Perna perna. For this purpose, fertilization rate, embryo-larval development, lysosomal membrane stability and DNA strand breaks were assessed. Effect concentrations in gametes and in larval development were found after 1h (IC50=23.53mg·L-1) and 48h (IC50=16.31mg·L-1), respectively. The highest tested concentration showing no acute toxicity (NOEC) was 10mg·L-1, while the lowest observed effect concentration (LOEC) was 20mg·L-1. NOEC concerning embryo-larval development was 0.625mg·L-1, while the LOEC was 1.25mg·L-1. Cyto-genotoxic effects were evidenced in mussels exposed to crack cocaine concentrations ranging from 5 to 500µg·L-1. Our results report the first data on effects of an illicit drug to marine organisms and should encourage further ecotoxicological studies of these contaminants of emerging concern in coastal ecosystems.

Differences in biomarkers of crack-cocaine adolescent users before/after abstinence.

AIMS: To measure the variation in Brain-Derived Neurotrophic Factor (BDNF), Thiobarbituric Acid Reactive Substances (TBARS) and interleukin (IL) levels in crack-cocaine dependent adolescents after 21days of abstinence, comparing to levels found in a group of healthy controls. DESIGN: Cross-sectional nested on a short follow-up study. SETTING: Two inpatient treatment units for adolescents, and a low-income neighborhood. PARTICIPANTS: 90 adolescents, of both genders, with diagnosis of crack cocaine dependence, and 81 healthy adolescents. MEASUREMENTS: Serum levels of IL-6, IL-10, TBARS and BDNF were assessed on admission and discharge. Drug addiction severity was assessed by the Addiction Severity Index - Teen Version (T-ASI) and Cocaine Craving Questionnaire - Brief version (CCQ-b). Psychiatric comorbidities were assessed by the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Generalized Estimating Equations (GEE) were used to estimate the IL-6, IL-10, TBARS and BDNF levels, adjusted for confounders. Hedges' g was used to estimate effect size. FINDINGS: TBARS (p=0.005, d=0.04), IL-6 (p=0.027, d=0.40) and IL-10 (p=0.025, d=0.41) were elevated and BDNF (p<0.001, d=0.62) was reduced (p<0.001), in patients, in comparison to controls, at admission time. Variation in those levels between admission and discharge were not significant. CONCLUSIONS: Crack-cocaine use seems to be associated with inflammatory and oxidative imbalances in adolescents.

Education and equipment for people who smoke crack cocaine in Canada: progress and limits.

BACKGROUND: People who smoke crack cocaine experience a wide variety of health-related issues. However, public health programming designed for this population is limited, particularly in comparison with programming for people who inject drugs. Canadian best practice recommendations encourage needle and syringe programs (NSPs) to provide education about safer crack cocaine smoking practices, distribute safer smoking equipment, and provide options for safer disposal of used equipment. METHODS: We conducted an online survey of NSP managers across Canada to estimate the proportions of NSPs that provide education and distribute safer smoking equipment to people who smoke crack cocaine. We also assessed change in pipe distribution practices between 2008 and 2015 in the province of Ontario. RESULTS: Analysis of data from 80 programs showed that the majority (0.76) provided education to clients on reducing risks associated with sharing crack cocaine smoking equipment and about when to replace smoking equipment (0.78). The majority (0.64) also distributed safer crack cocaine smoking equipment and over half of these programs (0.55) had done so for less than 5 years. Among programs that distributed pipes, 0.92 distributed the recommended heat-resistant Pyrex and/or borosilicate glass pipes. Only 0.50 of our full sample reported that their program provides clients with containers for safer disposal of used smoking equipment. The most common reasons for not distributing safer smoking equipment were not enough funding (0.32) and lack of client demand (0.25). Ontario-specific sub-analyses showed a significant increase in the proportion of programs distributing pipes in Ontario from 0.15 (2008) to 0.71 (2015). CONCLUSIONS: Our findings point to important efforts by Canadian NSPs to reduce harm among people who smoke crack cocaine through provision of education and equipment, but there are still limits that could be addressed. Our study can provide guidance for future cross-jurisdiction studies to describe relationships involving harm reduction programs and provision of safer crack cocaine smoking education and equipment.

Correlates of three-year outpatient medical care use among rural stimulant users.

Outpatient medical care (OMC) settings are a care context in which effective management of unhealthy substance use can occur. However, no studies have documented rates of OMC use and characteristics of OMC use among rural substance users. This study sought to examine the rates and frequency of OMC use in a sample of rural drug users over a three-year period. We also explored characteristics of participants associated with use of OMCs over time. Data were collected from June 2005 to September 2007 from a natural history study of 710 stimulant users living in rural communities. Participants were adults, not in drug treatment, and reporting recent methamphetamine, crack cocaine or powder cocaine use. Between 34 and 39% of participants reported any use of an OMC over the three-year follow-up period, with a mean average number of visits ranging from one to two at each follow-up. Having medical insurance, reporting any use of substance use disorder-related care (including formal substance use treatment or mutual-help groups), and higher Addiction Severity Index (ASI) medical and psychiatric composite scores were associated with greater odds of any OMC use and higher frequency of OMC use over time. Being male and having higher ASI alcohol and drug composite scores were associated with lower odds of any OMC use and lower frequency of OMC use. Our findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance, and the need for public health efforts to increase the use of OMCs among rural drug users not experiencing more severe medical or psychiatric health problems.

Effects of crack cocaine addiction and stress-related genes on peripheral BDNF levels.

This study examined the effects of glucocorticoid receptor (NR3C1), corticotropin-releasing hormone receptor 1 (CRHR1), and brain-derived neurotrophic factor (BDNF) genes on susceptibility to crack cocaine addiction and BDNF levels. Crack addicted patients who sought treatment (n = 280) and non-addicted individuals (n = 241) were assessed. Three SNPs in NR3C1 (rs6198, rs41423247, and rs10052957), three in CRHR1 (rs12944712, rs110402, and rs878886), and one in BDNF (rs6265) were genotyped. No significant effect was seen in the case-control analyses. Crack cocaine addicted patients showed significantly lower serum BDNF levels. Significant effects were observed for NR3C1 rs41423247 and rs10052957. These effects were restricted to non-addicted individuals and they were supported by significant gene-by-disease status interactions. For CRHR1, all SNPs were associated with BDNF levels. Although there were significant effects only in the analysis restricted to non-addicted individuals, the lack of significant results in the gene-by-disease status interaction analyses suggest a general effect on BDNF levels. The haplotype analyses presented the same effect seen in the single marker analyses. This study suggests that SNPs in the NR3C1 and CRHR1 genes may influence BDNF levels, but this effect is blunted in the context of crack cocaine addiction. Therefore, our data may be interpreted in light of several studies showing pronounced effects of crack cocaine on BDNF levels. Since peripheral BDNF is a biomarker for several psychiatric phenotypes, our results may be useful in interpreting previous associations between stress-related SNPs, drug addiction, and depression.

Asthma associated with the use of cocaine, heroin, and marijuana: A review of the evidence.

OBJECTIVE: A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana. DATA SOURCES: A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed. STUDY SELECTION: Due to the relatively small number of studies, we included all studies and cases. RESULTS: For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms. CONCLUSIONS: Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

Public opinions about supervised smoking facilities for crack cocaine and other stimulants.

BACKGROUND: The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada. METHODS: We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights. RESULTS: A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs. CONCLUSIONS: Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.