Distributing Safer Smoking Pipes Increases Engagement with Harm Reduction Services in the United States: Findings from the National Survey of Syringe Services Programs

Abstract Background In response to the recent and growing shift from injecting opioids to smoking fentanyl, an increasing number of syringe services programs (SSPs) in the USA are distributing safer smoking supplies. A recent federal ban prevents SSPs from using federal funding to procure safer smoking supplies. There is a lack of research on safer smoking supply distribution and harm reduction outcomes. Therefore, we assessed the relationship between distribution of safer smoking supplies by SSPs and levels of participant engagement and naloxone distribution. Methods We used data from the 2023 National Survey of Syringe Services Programs (NSSSP) (N=429), which measured services delivered in 2022. SSPs reported whether they distributed safer smoking pipes (yes/no). We examined the relationship between safer smoking pipe distribution and two outcomes: the number of participant encounters and naloxone doses distributed. Results There were 187 SSPs (43.6%) that distributed pipes for smoking to participants. Compared to SSPs that did not distribute pipes, those that distributed pipes reported more participant encounters (aRR=1.49, 95% CI: 1.09-2.02) and naloxone dose distribution (aRR=1.21, 95% CI: 0.89-1.65), though this latter finding was not statistically significant. Conclusions Findings showed SSPs distributing safer smoking pipes had more participant engagement and naloxone distribution. To maximize their full individual and population-level health benefits, SSPs should be supported technically, legally, and financially to implement safer smoking supply distribution for their participants. Highlights In 2022, 44% of syringe services programs (SSPs) distributed safer smoking pipes. More community-based organizations distributed pipes than public health or health care programs. Distribution of safer smoking pipes was associated with more participant encounters.