Difficulty accessing crack pipes and crack pipe sharing among people who use drugs in Vancouver, Canada

Data for this study were derived from two prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS). Multivariate logistic regression was used to identify factors independently associated with crack pipe sharing. Among 503 crack users, 238 (47.3%) participants reported having shared a crack pipe in the previous six months. Having acquired a mouthpiece in the last six months (adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.31 - 2.79) and difficulty finding new pipes (AOR = 2.19; 95%CI: 1.42 - 3.37) were positively associated with pipe sharing. Binge drug use (AOR = 1.39; 95%CI: 0.96 - 2.02) was marginally associated with sharing pipes.There was a high prevalence of crack pipe sharing in a setting where crack pipes are distributed at low or no cost. Difficulty accessing crack pipes was independently and positively associated with this behavior. These findings suggest that additional efforts are needed to discourage crack pipe sharing as well as increase access to crack pipes.Crack cocaine use continues to be associated with various health-related harms. Injuries such as blisters, sores, and cuts on the lips and gums are common among people who smoke crack [1], and crack use has been associated with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection [2,3]. There is evidence suggesting that injuries to the oral mucosa promote the transmission of HCV when crack smoking paraphernalia are shared between individuals with oral lesions [4]. However, in the case of HIV, the transmission pathways have not been determined and may reflect elevated syringe sharing or unsafe sex among crack users [2,5]. Other studies have pointed to crack use as a potential mode for the transmission of other infectious diseases including tuberculosis [6,7]. However, increasing access to crack pipes may reduce the frequency of injecting and by extens