title: Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting.
abstract: OBJECTIVE
  Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada.
  
  
  METHODS
  Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes.
  
  
  RESULTS
  Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%).
  
  
  CONCLUSIONS
  A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors.forename: Lianping
authors.initials: L
authors.lastname: Ti
authors.forename: Jane
authors.initials: J
authors.lastname: Buxton
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D016578:Crack Cocaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D040261:Harm Reduction; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012309:Risk-Taking
chemical_list: D016578:Crack Cocaine