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Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff
Journal article   Open access   Peer reviewed

Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff

William H. Eger, Shelby L. Huffaker, Elana Forman, Jessica Smith, Chris F. Akiba, Rose Laurano, Sheila V. Patel, Barrot H. Lambdin, Alexis M. Roth and Angela R. Bazzi
The International journal of drug policy, v 147, p105106
09 Dec 2025
DOI: https://doi.org/10.1016/j.drugpo.2025.105106
PMID: 41371077
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.drugpo.2025.105106View
Published, Version of Record (VoR) Open

Abstract

Funding Harm reduction Implementation science Qualitative research Safer smoking Syringe services programs
•U.S. syringe services programs (SSPs) are increasingly implementing safer smoking equipment.•Adoption has been facilitated by fentanyl penetration and the COVID-19 pandemic.•Smoking equipment implementation may improve program reach into underserved communities.•Implementation barriers included limited scientific evidence on smoking equipment, stigma, and cost and funding restrictions.•Piloting smoking equipment, partnering with diverse funders, and adapting services may improve sustainability. Amidst population-level transitions from injecting to smoking unregulated drugs, US. syringe services programs (SSPs) are increasingly distributing safer smoking equipment. We conducted qualitative interviews with representatives of 27 geographically diverse U.S. SSPs from May 2023–March 2024. Guided by the Consolidated Framework for Implementation Research, we explored programs’ experiences distributing safer smoking equipment, including staff perceptions on challenges to implementation and sustainment. Thematic analysis identified key findings. We interviewed 41 SSP representatives, including leadership (63 %), frontline (22 %), and clinical and clinical support staff (15 %). Two critical incidents–fentanyl adulteration of unregulated drug supplies and the COVID-19 pandemic–drove the adoption of this intervention. Interviewees perceived that safer smoking equipment facilitated client engagement, expanded SSPs’ reach into previously underserved communities, and promoted individual health by reducing the adverse consequences of injecting drugs. Barriers to implementation and sustainment included program staff and leadership concerns about limited evidence on the public health benefits of safer smoking equipment, stigma and negative local attitudes, funding restrictions, and cost (particularly for glass pipes). Strategies to support implementation included incrementally piloting safer smoking equipment, partnering with diverse funders, and adapting services to navigate resource constraints. Nevertheless, limited funding and legal support hindered broader adoption, reach and sustainability. Implementation of safer smoking equipment represents a critical evolution in harm reduction programming that may engage underserved communities in the range of evidence-based prevention services offered by SSPs. Flexible funding and supportive implementation climates are needed to support SSPs in providing this impactful service.

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UN Sustainable Development Goals (SDGs)

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Collaboration types
Domestic collaboration
Web of Science research areas
Substance Abuse
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