- Provide individual stems in the quantities requested by service users with no limit on the number of stems provided per service user, per visit
- Offer a new stem when the stem is scratched, chipped, or cracked, or has been used by someone else, as it is considered unsafe in this state
- Provide stems without requiring service users to return used equipment
- Provide pre-packaged safer inhalation kits (which should include stems, mouthpieces, screens, and push sticks) and also individual supplies, concurrently
- Provide other harm reduction products, such as condoms and lubricant, with no limit on the number provided
- Educate service users about safer use of equipment, safer smoking practices, the risks of sharing smoking supplies, and safer sex
- Dispose of used stems and other inhalation equipment in accordance with local regulation for biomedical waste
- Educate service users about the proper disposal of used safer smoking equipment
- Provide multiple, convenient locations for safe disposal of used equipment
* OHRDP acknowledges that best practice provides the highest standards of practice but that programs may be constraint by human and fiscal resources
Stems are used to funnel vapours to inhale smoke. They are used in combination with mouthpieces and screens.
The OHRDP recommends that sites maintain a stockpile (safety stock) of a minimum of one month’s supply of products at the site, at all times. This is to ensure there is a consistent supply of products available for service users.
It is best if sites have one designated person ordering supplies from the OHRDP, but a minimum of two people should be trained in case an alternate is needed. The person trained to order supplies should always rotate the product inventory at least once every three months to ensure that products that have an expiry date don’t expire.
Note: product distribution can fluctuate when sites first start supplying new products. It may take a few months for sites to understand the distribution patterns of new products. OHRDP will be working with sites to understand product needs in the province.
- There is evidence that HIV, HBV, HCV, pneumonia, and tuberculosis can be passed to others when inhalation equipment is shared (Boyd et al., 2008; Fischer et al., 2007; Malchy et al., 2011).
- There are two health risk behaviours among people who smoke drugs that may lead to the transmission of infection and/or injury: 1) Sharing inhalation equipment despite cuts, burns, sores or blisters in the mouth region; and 2) Using sharp and damaged equipment that can wound the user (Ivsins et al. 2011). By providing provincially funded safer inhalation equipment to people who smoke drugs, these two risk behaviours will decrease.
- A study conducted by Leonard et al. (2007) found that when people had access to safer inhalation equipment, injection drug use (a more harmful method of drug use) decreased.
- Crack cocaine smoking has been associated with an increased risk of sexually transmitted infections (STIs). Shannon et al. (2008) found woman who smoke crack have higher risks associated with STIs and HCV. Furthermore, women smoke crack experience increased exploitation, violence and vulnerability compared to their male counterparts. Offering gender-specific harm reduction initiatives is important and could include increased efforts to discuss STI protection among women who smoke crack.
- Some programs provide condoms with safer inhalation equipment. Malchy et al. (2011) noted that condoms provided in safer crack smoking kits were used by 59% of the survey respondents.
- Malchy et al. (2011) indicated that information cards listing local resources were useful. In a study conducted by Boyd et al. (2008) those who received information cards indicated that they either used them or gave them to a peer in need of the resources listed.
- Police interference was reported as an issue, primarily in accessing equipment (Ivsins et al., 2011; Ti et al., 2011). Participants in the Ivsins (2011) study discussed the fact that police often break or confiscate stems, and sometimes those who smoke crack cannot have equipment on them due to conditions of probation or parole. Capacity building with providers and authorities, and tackling general political resistance, will be an essential component of safer inhalation program success.
- Learning opportunities for those who smoke drugs were hindered when the service user exemplified rigid thinking with regards to learning something new about what they had been doing for years (e.g. using screens instead of brillo). The same thinking would apply if the participant felt it was disrespectful for those distributing the equipment to demonstrate how to load a stem (Boyd et al., 2008). Consideration in best ways to build rapport with service users will be an essential component of program success.
- With the introduction of safer inhalation products, it is recommended that educational resources are made available to service users. A Safer Smoking Pamphlet and a Service User’s Guide to the Safer Inhalation Supplies are provided by the OHRDP. Hard copies of these resources can be ordered by e-mailing firstname.lastname@example.org.