Crack pipes distribution in people who use drugs attending a harm reduction service in Bologna, Northern Italy. Results of a cohort study (2025)

BACKGROUND: In Italy, little is known regarding the potential for harm reduction programs targeting crack cocaine smoking to reduce health problems from crack smoking. This study targeted people who use crack cocaine attending a harm reduction service in Northern Italy. Our aim was to evaluate the effects of the delivery of glass crack pipes in relation to the modification of consumption styles and of problems perceived as a consequence of crack use after 30 and 60 days from enrollment.
METHODS: Cohort study. Outreach workers recruited 40 people who use crack to participate in a study of the impact of crack pipe distribution, with outcomes measured at 30 and 60 days post-enrollment.
RESULTS: Sharing bottles for smoking crack decreased of 22% after 30 days and of 46% after 60 days. After 60 days the habit of sharing cans or mouthpieces has disappeared. After every follow-up, the percentage of individuals reporting any problem always decreased, mainly for perceived mental disorders (paranoia/feelings of persecution and irritability after 30 days), direct consequences of smoking crack-cocaine with improvised and dangerous tools (burns on the lips in both follow-ups) and indirect consequences of crack-cocaine smoking (breathing problems after 30 days).
CONCLUSION: The distribution of equipment suitable for inhalation use (pipes) seems to be an effective practice to reduce dangerous behaviors and health problems among people who use crack cocaine. [Author's abstract]