Why does providing crack pipes to people who smoke crack matter?

Imagine ordering your favourite alcoholic beverage at your favourite establishment and being served this beverage in a chipped, dirty, unwashed glass. Now imagine taking a sip, your lips brushing the jagged rim, oily fingerprints, an unusual taste. Is that a spot of blood on the glass rim? Or maybe just a bit of food, left there by the previous user? Thankfully, regulations and regular public health inspections prevent this kind of scenario by ensuring establishments provide customers with utensils that are clean and safe to use. 

This is a basic tenet of harm reduction. A simple measure of public health.           

Unfortunately, this public heath measure does not extend to all forms of psychoactive substance use. If consumption of the most widely used substance in Canada (i.e., alcohol) is regulated to ensure that we safely consume it, shouldn’t people who use other substances be offered the same basic health measures?

Although the continued establishment of programs like needle exchange and supervised injection sites is a sign that harm reduction principles are increasingly accepted, not all is fair and equal in the world of harm reduction. People who smoke crack cocaine, for example, are not accorded the same public health measures – like being given safer drug use equipment – as people who inject their drugs. One of the more controversial harm reduction programs recently implemented in just a few cities in Canada is the distribution of pipes to people who smoke crack.

I’m often asked: “But why would we want to give pipes to people who smoke crack?”

Here is why:

  • Without access to clean pipes, people smoke with unsafe objects, which can cause cuts and burns to their lips and mouth.
  • Without access to clean pipes, people tend to share these unsafe pipes.
  • Crucially, sharing pipes has been associated with the transmission of illness and disease like hepatitis C, pneumonia, and tuberculosis.

Providing clean pipes to people who smoke crack is the same as providing clean needles to people who inject drugs. Risk of disease transmission decreases. Outreach workers have increased contact with drug users. People start to believe we care about them, and stop thinking (and this is something I’ve heard numerous times), “I’m not as important because I’m a crack smoker.” Not providing pipes to people who smoke crack is kind of like saying, “Your experiences of inequality, while detrimental to your well being, are not as important because you don’t inject drugs.”

I’m also often asked: “Doesn’t handing out crack pipes encourage crack use?”

It was recently found in Vancouver that crack use declined once crack pipes started being distributed. Not only does providing pipes not encourage crack use, but now people are less frequently cutting and burning their lips/mouths, and pipe sharing has been reduced, thus reducing the risk of disease transmission (and subsequent costs of related medical visits and care).

I’m often told: “Alcohol is legal, crack is not.”

Legality of drugs is subjective. Health is not.


*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC


Author: Andrew Ivsins, PhD candidate in Sociology at the University of Victoria/Centre for Addictions Research of BC. 

5 Replies to “Why does providing crack pipes to people who smoke crack matter?”

  1. Good read, thank you for sharing your perspective. Perhaps negative comments come from a lack of understanding how the health of the society effects us all within it. As you pointed out distributing clean pipes results in reducing transmitted diseases, could it then also contribute to reducing strain on out healthcare for treating individuals with these diseases?

  2. I would think that a guy who is a PhD candidate in Sociology who studies, lives and breathes this stuff all-day, everyday, would be pretty well educated on the subject. Ad hominem attacks against the author will not further your argument. Additionally, he’s not calling for the legalization of crack use, but rather proposing simple public health interventions to minimize the harm of the drug use itself. A person who smokes crack is still subject to the risks and harms associated with criminalization and arrest, but if he/she gets clean pipes, the risk of transmission of HIV and HCV decreases and they come into contact with people who can offer other services and support, including drug treatment should the person be ready for it.

    Harm reduction benefits everyone in society: drug using and non-drug using alike. Check out the link on the reduction of crack use following the introduction of the pipe distribution. This has also been the experience of needle exchange programs and safe injection facilities across the globe (including Canada). I’m in the United States where the war on drugs rages and tearing families and communities apart while destroying the lives of countless numbers of people. Programs that reach out and engage are far superior in helping people when compared to the way we do it.
    –Andrew Reynolds

  3. Legality of drugs is not subjective anymore than murder, DUI, speeding in a car, or stealing from a store. Without laws for the common good, society turns into chaos eventually and a lawless society is NOT what is the best for Canada. It sounds like you need more education in what’s best for society, not what feels right for you.

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