ArticleHarm reduction journal2022
Heroin pipe distribution to reduce high-risk drug consumption behaviors among people who use heroin: a pilot quasi-experimental study.
Article in Harm reduction journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 28 citations in OpenAlex.
- A comprehensive review of state laws that govern the distribution and possession of drug use equipment in the United States.The International journal on drug policy · 2026Review
- Sociodemographic, behavioral, and geospatial factors associated with syringe services program use in San Francisco, California.Drug and alcohol dependence · 2026Article
- Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff.The International journal on drug policy · 2026Article
- Promises and pitfalls of safer smoking supply distribution in the United States: a thematic analysis of open-ended survey questions from harm reduction organizations.BMC public health · 2025Article
- Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison.The International journal on drug policy · 2025Article
- Responding to an evolving crisis: Meeting the needs of a growing population who smoke their unregulated substances.Canadian journal of public health = Revue canadienne de sante publique · 2025Article
- The emergence of fentanyl in a stimulant landscape: Un/intentional use, social relations, and developing communities of care.The International journal on drug policy · 2025Article
- Naloxone distribution amidst shifting drug use patterns: Insights from a needs-based syringe services program.Drug and alcohol dependence · 2025Article
- Implementation determinants of safer smoking supplies in U.S. syringe services programs.Implementation science communications · 2025Article
- Association of safer smoking supply distribution with participant encounters and naloxone distribution from syringe services programs: Findings from the National Survey of Syringe Services Programs in the United States.Drug and alcohol dependence reports · 2025Article
- A systematic review of macro-, meso, and micro-level harm reduction interventions addressing the U.S. opioid overdose epidemic.Drugs (Abingdon, England) · 2025Article
- Large decrease in syringe distribution following the introduction of fentanyl in King County, Washington.Drug and alcohol dependence reports · 2024Article
- Changes in injecting versus smoking heroin, fentanyl, and methamphetamine among people who inject drugs in San Diego, California, 2020-2023.Drug and alcohol dependence · 2024Article
- Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont.Harm reduction journal · 2024Article
- Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs - Baltimore, Maryland, 2014-2022.Drug and alcohol dependence · 2023Article
- Trends and correlates of abscess history among people who inject drugs in Massachusetts: A mixed methods exploration of experiences amidst a rapidly evolving drug supply.Drug and alcohol dependence reports · 2023Article
- High levels of interest in access to free safer smoking equipment to reduce injection frequency among people who inject drugs in Seattle, Washington.Drug and alcohol dependence reports · 2023Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundHeroin pipe distribution may encourage people who use heroin (PWUH) to transition from injecting to smoking heroin, reducing harms associated with injection drug use. A syringe services program (SSP) in Seattle, Washington, led by people who use drugs developed a heroin pipe distribution program.
methodsWe conducted a pretest-posttest quasi-experimental study to evaluate the impact of heroin pipe distribution on drug consumption behaviors among PWUH between March and December 2019. SSP clients were surveyed during three weeklong timepoints before and four weeklong timepoints after heroin pipe distribution. Primary outcomes were change in proportion of SSP clients who exclusively injected heroin, exclusively smoked heroin, and both injected and smoked heroin in the past seven days comparing the pre- and post-intervention periods.
resultsAcross the seven observation timepoints, 694 unique respondents completed 957 surveys. Multiple responses from a single respondent in a given period were collapsed, resulting in 360 pre-intervention and 430 post-intervention records. Heroin use was reported in over half of pre-intervention (56%, 201/360) and post-intervention records (58%, 251/430). Compared to pre-intervention behaviors, the proportion of respondents who exclusively injected heroin was lower after the start of heroin pipe distribution (32%, 80/251 vs 43%, 86/201, p = 0.02), while the proportion of respondents who both injected and smoked heroin was higher (45%, 113/251 vs 36%, 72/201, p = 0.048). Just under half (44%, 110/251) of respondents who used heroin during the post-intervention period used a heroin pipe obtained from the SSP, of which 34% (37/110) reported heroin pipe distribution had reduced their heroin injection frequency. Self-reported hospitalization for a pulmonary cause was not associated with using a heroin pipe.
conclusionsThe proportion of SSP clients who exclusively injected heroin was lower after implementation of heroin pipe distribution. Randomized studies with longer follow-up are needed to investigate whether heroin pipe distribution reduces heroin injection and improves health outcomes associated with drug use. Limited intervention exposure, loss to follow-up, and pipe availability from other sources pose methodological challenges to evaluations of route transition interventions in community settings. This pilot highlights the potential for organizations led by people who use drugs to develop, implement, and evaluate novel public health programming.
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