Transcript No Slide Title

National Working Meeting on Crack Cocaine and Hepatitis C
Cavalieri, W. 3 Déry L. 2 Dinner, K. 1 Donaldson, T. 1 Fischer, B. 3 Fontaine, J. 2 Kendall, P. 1Lacoursiere, A.J. 3 Lavoie, F. 2 Liepold, H. 2 Palmer, D. 3 Rothfuchs, S. 2 Steer, L. 3 Stewart, D. 3 Taylor, M. 3
1. Hepatitis C Prevention, Support and Research Program, Community Acquired Infections Division, CIDPC, Public Health Agency of Canada; 2. Canada’s Drug Strategy, Health Canada 3. National Steering Committee Members on Crack Cocaine and Hepatitis C
Issue and Background
Challenges
People who use drugs, non-governmental organizations (NGOs), researchers, and public health officials are concerned about
increased use of crack-cocaine across Canada. Some NGOs and public health units distribute safer crack use kits as a harm
reduction approach, yet not enough is known about the effectiveness of these kits or whether hepatitis C virus (HCV) or other bloodborne pathogen transmission is occurring when crack equipment is shared. Increasing prevalence of crack use among marginalized
drug-using populations may have implications for public health; much remains unknown. While the size of the population of crack
smokers is unknown in Canada, several recent studies of injection drug users show over half have also smoked crack: low-income,
street-involved, Aboriginal people, and people with mental illness are over-represented.
The driving assumption for this meeting was that there are a number of public health problems related to the use of crack cocaine, including
the potential transmission of the hepatitis C virus (HCV) and other infectious diseases.
The goal of the meeting was to generate and share knowledge on crack-use patterns and practices, research and interventions in order
to make recommendations on strategies to reduce the risk of transmission of HCV and other infectious diseases through the use of
crack cocaine.
The National Working Meeting on Crack Cocaine and Hepatitis C was held on March 10 and 11, 2005 in Ottawa, Ontario, Canada.
There were 59 participants attending, representing a number of disciplines and areas of expertise including people who use drugs,
service providers, researchers, national and regional offices of the federal, provincial and municipal governments, criminal justice, and
user groups. The meeting was hosted by members of the Public Health Agency of Canada’s (PHAC) Hepatitis C Program, and
Canada’s Drug Strategy (CDS) of the Healthy Environments and Consumer Safety Branch, Health Canada (national and regional
offices).
Creating A National Steering Committee
Community organizations, researchers, and other had been signalling to the federal government their concern about harms
associated with crack cocaine use. While crack use was a growing concern in many parts of the country, there had been few
opportunities to conduct in-depth research on crack issues, and to take stock of the expertise and experiences from across the
county. The government recognized the need to collaborate with other sectors.
Q: How can we foster collaboration between people who use drugs, law enforcement officials, public health, NGOs, researchers and
government?
A: The National Working Meeting on Crack Cocaine and Hepatitis C provides an example of collaboration in which the role of the
federal government was a FACILITATOR. While government cannot and should not speak on behalf of people who use drugs,
it
does have contacts, networks, and resources to facilitate the collaboration of multiple sectors towards planning an event and
maintaining an ongoing network. Having administrative staff and budget available to organize teleconference and to play a
secretariat role for the process - without LEADING the process - is a key collaborative role that government can play. While the
government lacked the resources (time, budget) to support longer-term research projects on crack cocaine, on the
recommendation of the steering committee a literature review was undertaken to compile the best available information and a
working meeting was convened to bring together leading experts in the country - community, researchers, health officials and
governments to discuss the issue discuss current knowledge, gaps, strategies, and next steps. The role of the Steering Committee
was to plan the event (establish a meeting design) and do follow-ups as required.
The Steering Committee’s vision was to hear the expertise of all parts of the country, reflecting Canada’s diversity including
Aboriginal people, both official languages, women and men, all provinces and territories, and all sectors. To determine
representation at the meeting, Steering Committee members drew upon their contacts in their respective sectors, for example,
regional offices identified key experts from their regionally funded projects. The outcome of this “recruitment process” was that
everybody in attendance at the meeting was both an expert and an active participant at the meeting. There were no “observers”:
all were active participants in presentations, small group discussions, and plenary sessions.
Consensus: Determining the desired objectives, outcomes and final
agenda of the meeting with such a diverse Steering Committee.
What did we want? Who would come? What issues should be
discussed?
Bureaucratic process:. Government process and multiple levels of approval
proved challenging for adhering to agreed upon deadlines (e.g. the
literature review) as well as for straight forward planning
requirements (e.g. travel, hospitality, etc.).
Bureaucratic Fiscal constraints: Advancing expenses for participants proved
difficult and was ultimately not successful. Representation and Authority:
Issues arose for some Steering Committee members about whom
they are representing. Personal viewpoints? NGO viewpoints?
Content: The agenda had to address different levels of knowledge
expertise.
Centrality: Who is this meeting for? Is there one beneficiary? Are there
multiple communities benefiting? What does it mean when “the
user” is at the centre?
Media: Should it be there? There was a desire by some to share the
meeting with members of the media. After some debate, it was
decided that media would not be present at this first national
meeting on crack cocaine and hepatitis C. In addition it was felt that
media presence may inhibit honest and comfortable sharing.
Legal concerns: Bringing together people who use illegal drugs if
government officials are hosting generated concerns. What if
someone brought an assembled crack pipe on the airplane? Are
there legal repercussions for participants who have disclosed
information?
Privacy: Since testimonials were to be provided by people who use
drugs, it was important that clear written/verbal permission was
obtained prior to publishing the results of the meeting. Such
testimonials will remain in the public domain indefinitely.
Lessons Learned
Flexibility: Modification of activities to adapt to the meeting
objectives was highly important. The facilitator made clear that if
people need to leave the room outside of scheduled break
periods they were free to do so. A “chill out room” was provided
as a space where people could reflect outside of the larger
meeting room, share resource materials, or meet informally.
Resourcefulness: Activities were carried out amidst some setbacks (e.g.
presentation of highlights of literature review rather than having a
document available in advance) to ensure knowledge transfer.
Concrete examples were given (e.g. safe crack kit demonstration
by people who user drugs).
Networking: Bringing together such a diverse group of people made
the meeting a networking success. The way the meeting was
designed, with plenary, presentations and small group
discussions, the Steering Committee really took into account the
importance of knowledge translation.
Trust: While at times challenging, Government had to trust both the
NGOs and community organizations involved, including users
and vice versa. Without trust, this event would not have come to
fruition.
Client centred: The meeting was planned and conducted while being
attentive and flexible to participants’ needs. A number of people
with current drug use experience participated in the planning and
a considerable number of them did presentations to the group.
Passion: The enthusiasm among government, NGOs, public health,
users, and the facilitator helped enable the planning,
coordinating, and execution of the meeting.
Facilitator: Community organizations recommended a facilitator. This
person was neutral, objective and had invaluable experience
with the drug using community.
Recommendations from the Working Meeting
Recommendations for Collaboration
 Develop a Government of Canada (GOC) policy on harm
reduction;
 Clarify legal issues concerning possession and
distribution of drug paraphernalia when the intent is to
prevent communicable diseases;
 Undertake rigorous evaluation of safer crack kit
distribution programs. Evaluation must examine the benefits
of outreach, linking drug users with health and social
services, etc. - i.e. not strictly measuring reduction in
infectious disease transmission, which is too narrow a
measure of success;
 PHAC should show leadership in bringing housing,
justice, mental health et al. to the table to address multisectoral aspects of infectious disease and drug use issues;
and
 Establish long term stable NGO and research funding for
drug use and infectious disease issues, and for the Hepatitis
C Program - Drug users are hard-to-reach. Often, the
momentum is just beginning when the funding ends;
Some bureaucratic processes can be challenged and
changed.
 Make use of contacts already established through regional
offices.
 Be able to modify and adapt activities to meet overall
objectives.
 Move beyond infectious disease and look at a more holistic
approach to this issue.
 Ensure Steering Committee members are clear about whom
they are representing and whom they have permission to
represent.
 Accommodate participants’ needs.
 Hire the right facilitator who is trusted and has experience
working with community as well as bureaucrats.
 Ensure that there are no legal or privacy concerns (e.g. that
no one is travelling with previously used drug paraphernalia, that
all participants understand that information shared at the meeting
is now in the public domain).
 Trust your partners.
 Maintain momentum and communication post-event.
CIDPC Public Health Agency of Canada
Hepatitis C Prevention, Support and Research Program, Community Acquired Infections Division
For more information, please contact: Annie J. Lacoursiere at [email protected]