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Harm Reduction Research

Perceptions of People Who Smoke Crack

Background: Crack is the most commonly used drug among street-involved adults in Vancouver and Victoria, and BC has the highest rate of crack use of any province. Compared to safer injection, there is relatively little attention paid to the risks or harms from smoking crack.* 

Risks: Crack cocaine is perceived as being highly adulterated and more addicting than injecting or smoking cocaine. Many people are unaware that users can fatally overdose from smoking crack cocaine. Crack cocaine leads to tooth decay, damage to the mouth and throat, as well as the lungs.** Smoking crack is a risk factor for HIV/AIDS infection, as well as hepatitis C, which may be transmitted via shared equipment (crack pipes). While pipes are distributed by some harm reduction sites, many users report difficulty accessing them, as well as pressure to share pipes when smoking socially.* 

Crack smoking is a growing epidemic in BC

Findings: Users perceive smoking to be less harmful than injecting. Users report several risks associated with smoking in public, including fear of arrest or drug confiscation, shame, fear of violence, fear of being made to share drugs or equipment, and a reduced drug effect. Crack cocaine users prefer to smoke alone in a safe, personal space, and report a desire for a safe inhalation space where they can smoke in privacy or semi-privacy, receive support and help, and use safe equipment. Access to supportive, low-barrier housing is also recommended.

TTH eZine2 Participant Quote

* Richmond, Ellison et al. "Perceptions of People Who Smoke Crack Cocaine: Social Environments and Risks." Presented at the Canadian Public Health Association conference, 12 June 2012, Edmonton, Alberta.

** Kuo, Margot, et al. "Perceptions of Crack Cocaine Among Cocaine Users in Vancouver" Presented at the BCCDC research week 2011

Survey on Drug Use Among Harm Reduction Clients

Background: The Harm Reduction Strategies and Services (HRSS) Committee implemented a survey at harm reduction sites across BC to determine drug use trends outside of Vancouver and Victoria where there is little research.

Methods: A two-page survey tool was developed with extensive input from stakeholders and distributed to twenty-eight harm reduction sites in the five geographic health authorities. The sites administered the ten minute survey to their clients. Data was analyzed with a focus on frequency of type of drug use by region, poly-drug use, and comparing major centres with communities ≥ 50km from the major centre. 


  • 698 respondents reported using one drug or more in the prior seven day period.
  • Crack (50%), heroin (44%), morphine (30%) and cocaine (26%) were the most frequently reported drugs.
  • Crack use is most common in Vancouver Coastal, Vancouver Island, and Northern Health Authorities.
  • Heroin and morphine use are slightly higher than crack use in the Interior Health Authority.
  • Poly-substance use is common in all health authorities, and most common in Vancouver Island.
  • Major centres had clients with higher use of crack and heroin.
  • Non-major centre clients had higher use of cocaine and morphine.
  • 90% of those respondents disposing of needles reported a safe disposal method.

Learn about the survey tool developed by HRSS in the sidebar.

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An important part of conducting the Survey on Drug Use among Harm Reduction Clients was to develop a simple tool for the collection of basic indicators on drug use among harm reduction clients in BC.


  • Pilot sites report it is feasible to administer a survey once per year
  • The data collection process is acceptable to the site staff and peers
  • The data collected was valued by the sites for gaining knowledge and service planning
  • As a measure of client acceptability, refusal and non-completion rate was reported to be low (5%)
  • Some issues were identified for lower volume harm reduction sites (e.g. time of year and duration of data collection period)

Conclusion: Changes have been made with input from the evaluation to develop a more user friendly survey tool for next year.