It’s a small, black plastic bag with a wooden chopstick sticking out of it. Inside are several items, collectively worth $1.66, that could save a life.

Syd Malchy empties the kit onto the table and pokes through items.

Malchy, who is a co-investigator on the SCORE (Safer Crack Use, Outreach, Research and Education) project explained that the project grew out of the Safer Crack Use Coalition.

SCORE lasted for two years, from March 2006-March 2008. “Basically we wanted to fund this program of assembling the crack kits and distributing them,” Malchy said. “We also wanted to evaluate the outreach as an initiative.”

Click here to visit the City of Vancouver Drug Policy Program’s podcast page and hear Syd Malchy describe the contents of a crack kit.

Malchy said the project recruited women to join kit-making circles. These brought together one or two representatives from the SCORE project and for each circle recruited four women from the Downtown Eastside. The 200 women who participated in the circles ranged in age from 20 to 60, were using or had used drugs, typically lived in extreme poverty, were experiencing unstable housing and, in many cases, were sex workers. They earned $20 for the one hour of work.

During the time they were working on the project, “They’re safer, making money and two-way education is happening,” Malchy said. While project organizers could use some of that time to educate the women about how to use the materials in the kit, the women educated the researchers about what it’s like on the street, and express safety and housing concerns, for example. The sessions took place four times a week in various Downtown Eastside locations for one year.

Malchy said they distributed the kits in various ways. One team was from the women’s group from VANDU (Vancouver Area Network of Drug Users). They also distributed them from the Washington Hotel’s needle exchange. Some were handed out on the street and others through a mobile program. Distributions happened both during the daytime and at night.

Malchy said the people distributing the kits were trained, so that they would chat with the crack user and explain how to use the different components of the kit and how each item made the process safer. “We did not want the kits to fall off a truck, we wanted to have an interaction.”

“We did not want the kits to fall off a truck, we wanted to have an interaction.” Syd Malchy, SCORE Project

Users soon got to know the SCORE team of four men and one women, all community peers. Researchers were pleased crack users were eager to get the kits, as that showed they understand the value of the harm-reduction tools, but they soon discovered that the kits had become a commodity in the neighbourhood. As crack users learned how the kit could help them use the drug in a safer way, they also realized they were valuable. “Basically, the biggest issue was the commodity factor,” Malchy said. “People are so desperate because there isn’t anything available for them.” In the report on the project, one of the outreach workers who distributed kits noted demand always outran the supply of kits: One of the outreach workers was quoted in the report saying, “You give one person one and they come running.”

In fact, a number of users asked if they could be supplied with just a glass tube or mouthpiece, rather than the whole kit, if they just required those pieces. Further, many users asked if the kits, or some components of the kits --glass stems in particular-- could be supplied by various agencies in the DTES, in conjunction with an outreach distribution. In distributing the kits, the outreach workers also tried, where possible, to show users how to use the screens that came with the kits and how to assemble the mouthpiece on the glass tube. They tried to talk to users about their drug-using habits, to give them harm reduction advice and explain why the sharing of pipes and mouthpieces was risky (because of the potential for disease sharing). The report notes that the three elements mentioned most frequently as essential to changing crack use practices were availability of clean materials, repeated messages and demonstrations. Of these, the key element to changing practices was availability of the kits.

The SCORE Project Report contains recommendations calling for:

• The integration of the provision of unlimited safer crack use supplies into existing harm reduction services, such as needle exchanges or community health clinics;
• A variety of approaches (e.g., peer-led outreach teams, mobile van outreach and nurse-led outreach) as part of a continuum of outreach distribution. These should be tailored to the unique needs and circumstances of particular contexts. Further, education efforts should include demonstrations on how to use paraphernalia correctly, particularly screens.
• Comprehensive educational outreach programming, to address gaps in knowledge about safer crack use.
• The involvement of current crack users in the development of programs.
• Concerted efforts to provide women who use crack with specialized services.
• Increased networking among individuals involved in harm reduction policy and programming, to share information and develop appropriate community and health programs.
• Public education about harm reduction and crack use.
• Research to determine the feasibility and effectiveness of harm reduction strategies to assist people to use more safely (i.e., safe inhalation sites, stimulant maintenance programs).
• The recognition by harm reduction programs that systemic factors such as poverty, homelessness, gendered violence, racism, inadequate health care, and punitive drug laws shape the lives of people who use crack and must be addressed.

While there are numerous ways for injection drug users to access clean needles, and hear the associated harm-reduction messages, there is no organization distributing safer crack kits in a large-scale way.

Over the two years, project members assembled and then distributed 14,000 kits. They discovered that a significant number of Vancouver drug users do not inject drugs but do smoke crack. While there are numerous ways for injection drug users to access clean needles, and hear the associated harm-reduction messages, there is no organization distributing safer crack kits in a large-scale way. That means many crack users also miss out on the harm-reduction messages. Malchy said the core Downtown Eastside should be flooded with kits, to lessen their commodification and make them available to all users who want them. “That’s really what needs to happen,” Malchy said. “They need to be everywhere.”

The crack kits, which were contained in a small, black plastic bag, included:

• plastic tubing (used as a mouthpiece, which helps to reduce disease transfer)
• a pyrex glass stem (used as a crack pipe, which prevents the glass from cracking, breaking or sharding)
• two sets of five pipe screens (to fold up and push into the glass pipe, to replace brillo pads, which are coated with a toxic substance crack users inhale and can also break off while extremely hot and enter the user’s throat or lungs)
• a wooden push stick
• two alcohol swabs
• a lighter
• two condoms
• two bandaids
• a resource card and a crack-use tips card