A new report published in the Journal of Public Health Management & Practice (JPHMP) from the National Association of County and City Officials (NACCHO) explores national trends related to smoking and highlights the findings of a recent evaluation project of smoking supplies distribution. The report demonstrates the importance of offering smoking supplies as an outreach strategy to reach people who smoke, and ultimately to prevent overdose and infectious diseases.  

In recent years, smoking has increased while injection has decreased as a method for consuming opioids, stimulants, and other drugs. Consequently, the proportion of smoking-involved overdoses has increased while the proportion of injection-involved overdoses has decreased. Given these trends, it is more important than ever for Syringe Service Programs (SSPs) to reach people who smoke with overdose prevention and other health services—and offering the supplies they need is an effective way to reach this population. Safer smoking supplies include pipes or aluminum foil for smoking, mouthpieces to protect lips from burns, and tools like screens or push sticks for handling drugs. 

In 2023, NACCHO funded six SSPs to evaluate the effects of their existing smoking supplies distribution programs. Sites used mixed methods, combining retrospective program data, surveys, focus groups, and interviews.  

All six sites found that distributing smoking supplies enabled them to reach new and more diverse populations. All reported a substantial increase in participant encounters after initiating smoking supplies distribution, with one site reporting a 106% increase in annual visits. Most sites shared that they didn’t publicly promote their new offerings, but that the increase in clients occurred immediately, suggesting a significant, unmet need for smoking supplies, and the power of word-of-mouth among PWUD for communications and outreach. Sites were able to confirm the increase in visits was directly linked to the availability of smoking supplies. At one site, 40% of clients reported that they initially came to the SSP for these supplies, and another found that 91% of new clients accessed smoking supplies exclusively. Sites also shared that offering smoking supplies allowed them to diversify their reach and increase community engagement.

Five sites reported a reduction in syringe encounters since the inception of safer smoking supplies distribution—despite the overall increase in participant encounters. This suggests that participants may be transitioning from injection to smoking due to the availability of smoking supplies. Through interviews and focus groups, sites learned that participants wanted to switch to smoking due to the perception that it was safer in terms of HIV, hepatitis, and overdose risk and due to the perception that it is more convenient and less stigmatized. Notably, smoking poses lower risk for acquiring and transmitting HIV and hepatitis infections, and limited, but emerging, evidence suggests that smoking might pose lower risk for overdose, although further research is needed to understand this relationship.  One site surveyed participants to assess health benefits and found that 78% of participants who had transitioned from injection to smoking reported fewer soft tissue injuries and 59% reported fewer non-fatal overdoses. 

The findings of this project suggest that distributing smoking supplies allows SSPs to expand and diversify their reach, better reaching people who smoke which has become critically important as smoking and smoking-involved overdoses are on the rise. Distributing smoking supplies may also encourage or facilitate a transition from injection to smoking, which could combat the spread of HIV and viral hepatitis, and which may even reduce overdose risk. To learn more about these findings, check out the new report from NACCHO here.