"Using data from the 2023 NSSSP, the largest sample of U.S. SSPs collected to date, we found 44 % of SSPs reported distributing pipes for smoking. SSPs that offered pipes to their participants had a 62 % higher rate of participant encounters compared to SSPs that did not offer pipes. Given SSPs can reduce transmission of HIV and hepatitis C virus (Fernandes et al., 2017, Platt et al., 2017), reduce overdose fatalities (Lambdin et al., 2020), and improve entry into substance use disorder treatment or clinical care (Jakubowski et al., 2023), implementation of pipe distribution by SSPs represents a critical public health approach that could increase participant visits and reach a broader population of PWUD at risk for infectious disease or overdose, namely those who smoke and do not inject drugs. Our findings align with previous work showing that safer smoking supply distribution at SSPs was associated with increased participant volume by engaging with new populations (National Association of County and City Health Officials, 2023). In the same report, SSPs also described that providing safer smoking supplies deepened their engagement with PWUD, allowing them to reach participants that did not previously use their services. As SSPs are trusted by PWUD (MacNeil and Pauly, 2011), it follows that bringing more people to SSPs more often has the potential to improve population-level health benefits. This approach may be especially important in the era of fentanyl, as recent research suggests people who only smoked fentanyl experienced non-fatal overdoses, infectious diseases, and hospitalization less often than people who injected fentanyl (Megerian et al., 2024). SSPs offering pipes could help people adopt safer drug use practices by facilitating a transition from injection to smoking. To help inform the development and implementation of safer smoking supply distribution at SSPs, future studies should explore program challenges, such as neighborhood pushback, and adjustments, such as staffing needs or outreach efforts."
Esther O. Chung, Sheila V. Patel, Lynn D. Wenger, Jamie L. Humphrey, Amang Sukasih, Ricky N. Bluthenthal, Hansel E. Tookes, Don C. Des Jarlais, Sara N. Glick, Paul A. LaKosky, Stephanie Prohaska, Laura Guzman, Alex H. Kral, Barrot H. Lambdin, 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, Volume 14, 2025, 100317, ISSN 2772-7246, doi.org/10.1016/j.dadr.2024.100317.
