ArticleHarm reduction journal2026
Innovation, respiration and drug paraphernalia policy: a mixed methods study of crack pipe practice and respiratory harm in England.
Article in Harm reduction journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
Funding
Abstract
backgroundProvision of equipment for the purpose of stimulant inhalation is prohibited under UK law. Crack cocaine use is prevalent and rising in England, where the SIPP (safer inhalation pipe provision) study piloted and evaluated a crack equipment and workforce training intervention. We report mixed method findings from the baseline component of the study, prior to intervention implementation. The aim of this paper is to situate quantitative findings regarding respiratory risk through qualitative exploration of crack inhalation practice in a context of stimulant equipment prohibition.
methodsIn this paper we report descriptive findings from baseline survey data (n = 727) with a focus on thematic analysis of interview data (n = 33). Participants were recruited through drug treatment services and peer networks in six geographical locations in England, with survey eligibility criteria including crack use (injecting or smoking) in the past 28 days.
findingsOf the 733 participants who completed the baseline questionnaire, 727 (99%) smoked crack in the past month and were included for further analysis. A minority reported crack injection (28%). Over half (55%) used crack daily in the past month. Many (60%) reported respiratory symptoms, with one third experiencing a respiratory-related hospitalisation. Qualitative data illustrate ingenuity of crack equipment practice, with participants fashioning pipes out of materials ranging from umbrella handles, through to tin cans and plastic inhaler cases. Ash and stainless-steel scourer were primarily used as suspension materials. Accounts of practice illustrate connections between materials used and respiratory harms, the latter exacerbated by poor living conditions and limited availability of supports.
conclusionWe evidence a high burden of respiratory harm among people who smoke crack in England. Stimulant inhalation equipment prohibition contributes to a constellation of respiratory risk, with use of unsafe materials and impoverished living environments exacerbating health harms among a highly marginalised population. There is a need to reorientate drug services to support safer crack inhalation practice and reduce respiratory risk. Legislative change can facilitate this process.
trial registrationISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454 .
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