Safe Inhalation Pipe Provision (SIPP): Introducing an Intervention to Reduce Health Harms and Enhance Service Engagement Among People Who Use Crack Cocaine in England

Author: Magdalena Harris Jenny Scott Vivian Hope Mat Southwell Lee Collingham Mick Webb Andrew Preston Niamh Eastwood

Theme: Models of Care Year: 2022

Crack cocaine use is rising in the United Kingdom, with smoking the primary form of administration.
Provision of safe inhalation equipment for crack cocaine is prohibited under UK law. Pipes used for
crack smoking are often homemade and/or in short supply, exacerbating viral transmission and
respiratory risk. In this paper we introduce the novel NIHR-funded safe inhalation pipe provision
(SIPP) intervention, be delivered in collaboration with peer-networks and policing partners. Our goal
is to reduce health harms and increase service engagement among people who use crack (PWUC),
with evidence of impact to inform legislative review.
Description of model of care/intervention:
The SIPP intervention consists of a kit with heat-resistant glass pipe, risk reduction information, and
tailored training for service providers. This will be provided to PWUC through drug treatment
services and peer-led networks in three geographical areas reflecting different patterns of crack use
and service provision. We will train and support peers to conduct research with PWUC who don’t
access services and to ensure our methods and materials are acceptable.
We employ a mixed-methods quasi-experimental design. Our primary outcome measure is decrease
in crack pipe sharing in the past 28 days. Secondary outcomes include increased drug treatment
presentations; reduction in injecting frequency; current acute injuries; homemade pipe use; and
respiratory risk markers. We will conduct a pre and post intervention study with a non-equivalent
control group, enabling measurement of differences in primary and secondary outcomes among
PWUC following SIPP introduction. A nested qualitative process evaluation will assess SIPP fidelity
and acceptability.
Conclusion and next steps:
Systematic evaluation of safe inhalation interventions for PWUC is urgently needed in order to
produce definitive evidence of their health and other benefits, and to allow for evidence-based
program and policy decisions in the interest of public health. The SIPP intervention commences in
June 2022.
Disclosure of Interest Statement:
All authors are Investigators in the NIHR-funded SIPP project. Andrew Preston is ED of Exchange
Supplies, a social enterprise supplying harm reduction equipment. The authors have no other
disclosures of interest to declare.

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