Ottawa's crack pipe program provides rubber-tipped glass tubes for smoking crack in the hopes of reducing the spread of HIV and hepatitis through pipe-sharing among drug users. (CBC)

People who smoke crack cocaine are at increased risk of becoming infected with HIV — a finding that highlights the need to adopt and to evaluate the use of safe inhalation rooms and safer crack kits, B.C. researchers say.

Dr. Evan Wood of the B.C. Centre for Excellence in HIV/AIDS and his colleagues looked at 1,048 injection drug users in Vancouver's Downtown Eastside for an average of nine years. During that time, 137 (or 13.1 per cent) became HIV positive, the team reported in Monday's issue of the Canadian Medical Association Journal.

The researchers set out to study crack cocaine use given that in 2007, more than 20 per cent of new cases of HIV infection recorded in Canada were attributed to injection drug use, according to the Public Health Agency of Canada.

The risk of contracting HIV among people who smoked crack cocaine daily increased over time, from 1.03 times higher than the general population in the first three-year period, 1.68 times during the second period, and 2.74 times higher during the third period, after adjusting for other factors, the researchers found.

Mouth wounds such as burnt lips from crack pipes may make people more vulnerable to infection, the team speculated. Or people who smoke crack may be at increased likelihood of HIV infection through unsafe sex and needle sharing.

The researchers were unable to assess these possible risk factors in the study.

"Although highly controversial, innovative public health programs that address the unique needs of people who smoke crack cocaine and that contribute to HIV prevention efforts may include the distribution of safer crack kits and the provision of supervised inhalation rooms," the study's authors concluded.

Safer crack kits include a glass stem with a mouth piece, metal screen, lip balm and hand wipes.

Researchers also found that use of heroin decreased during the study period.

Rooms successful in Europe studies

Providing inhalation rooms have been used successfully in several European studies.

"By bringing people out of the alleys and into the public health domain there's a whole host of opportunities that are made available to us," said Wood.

Inhalation rooms and distributing safer crack kits give health workers an opportunity to engage with crack smokers to address their needs for health care, social assistance and referral for addiction treatment among "this often hidden population," the study's authors said.

Both strategies need to be evaluated, they said.

In a related journal commentary, Dr. David Celentano and Dr. Susan Sherman of Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., agreed the controversial practice of handing out safer crack kits has the potential to reduce HIV transmission.

The idea of a safe inhalation site has at least one high-profile proponent in Canada.

"It's not a habit to be encouraged, certainly," said B.C.'s medical officer of health, Dr. Perry Kendall. "But it is a way with a demonstrated, evidence-based approach among other approaches to help reduce the risk of HIV transmission, hepatitis C transmission, sexual disease transmission and to get people into treatment."

Kits containing pipes and mouthpieces have already been distributed in some Canadian cities, including Vancouver, Ottawa and Toronto.

The researchers said the U.S. approach to drug use has been a dismal failure, and they're calling on Canadian officials to try a more pragmatic approach.

The study did not include a random sample, but is thought to be represent injection drug users. It also relied on self reports.

The study was funded by the U.S. National Institutes of Health and the Canadian Institutes of Health Research.