In Toronto, harm reductionists distribute safer crack-smoking kits.
The kits are packed with Pyrex crack pipes, metal pipe screens, and mouthpieces. They also include lip balm, alcohol swabs, lighters, chewing gum, and condoms.
It's a compassionate response to crack addiction, the way clean needles and Narcan are to the opioid crisis. The kits reduce side effects and risks associated with smoking crack, including the transmission of hepatitis C.
Individuals who smoke crack often get sores, burns, and cuts on their lips and inside their mouths. They're also at high risk for developing respiratory problems, such as asthma, bronchitis, and pneumonia – issues worsened when they use plastic and copper pipes. Pipe sharing also puts them at risk for hepatitis C, so providing them with clean pipes and lighters decreases the chances that they'll share. And crack use often leads to unprotected sex, which puts them at risk for STDs like HIV – hence the condoms.
The distribution of these kits is often the only opportunity community outreach workers have to connect these individuals to harm reduction, health, and social services.
But whether Philadelphia will allow individuals to smoke or inhale other drugs in its proposed comprehensive user engagement sites (CUES) remains unclear.
During a community meeting hosted by Solomon Jones in North Philadelphia on Feb. 9, Roland Lamb, deputy commissioner of the Department of Behavioral Health and Intellectual disAbility Services, said that individuals who smoke crack would be welcome there. However, in a Feb. 14 commentary written by Mayor Kenney and District Attorney Larry Krasner, it sounded as if the site will only allow people to use drugs intravenously.
Allowing people to use certain illicit substances and not others is discrimination, and if city officials fail to include individuals who smoke crack in their plans for these sites, this response is as discriminatory as the height of the war on crack 30 years ago.
Black Americans are nine times as likely to be dependent on cocaine (which includes crack) within two years of first using it as whites, and weekly cocaine use among blacks increased by 138 percent between 2011 and 2015, presumably because cocaine is more available in black communities than it is in other places. Black Americans are also nearly six times as likely to be incarcerated on drug charges, even though whites equally sell and possess illegal drugs. If we don't provide them the space to use substances, this plan is racist.
Providing a safe space for individuals to use opioids is lifesaving for people of all complexions. In the last two years, Philadelphia has lost more black and brown individuals to overdose than to gun violence.
But creating this space will not atone for the war on crack and neither will allowing for only opioid use in CUES. Instead, it continues to discriminate against individuals based on the substances they use – just like the draconian crack-cocaine sentencing laws of the past.
If our government truly wants to right the wrongs caused by this country's racist drug war, this effort must first be tailored to our city's most marginalized – the poor, the black, and brown, and the Latino, non-English-speaking residents in Kensington who use or are affected by illicit drugs and their trade. The city must build this initiative around their needs, and the least marginalized and everyone else in between will benefit from that response. Not the other way around.
So what does this look like?
To start, individuals who use any drugs should be allowed to use them at CUES. In Toronto, people are allowed to smoke drugs outside in a smoking tent attached to a safe injection trailer. It provides them with a safe, warm, destigmatized space to smoke. Philadelphia's CUES should create and manage similar smoking spaces – not just in Kensington, but across the city in neighborhoods like Center City, Point Breeze, Mayfair, and Manayunk. No one neighborhood should bear the weight of all the city's drug use. And at those CUES, individuals should have access to safer crack smoking kits, in addition to clean needles.
And that's just the beginning. In the long run, we need pre-arrest diversion programs, investment in public schools, children, and substance-use prevention, and expungement for and investment in returning citizens with possession offenses who have been harmed most of all.
That's the vision for the future. Some may facetiously call it a leftist utopia; we call it slightly less racist drug policy. But for now, let's get tents and trailers up and running in neighborhoods across the city for people who use all illicit substances – not just opiates.
While overdose deaths are irreversible, many black and brown individuals incarcerated on drug charges have lost their lives, too.