Expanding Access Through Safer Smoking Supplies

Citation: Cioffi, C. C., Gau, J., Callaghan, I., Fernandes, L., Yada, T., McKlusky, A., & Yandel, R. (2025). Understanding demographic differences in the uptake of safer smoking supplies following the introduction of safer smoking supplies at syringe service programs in Oregon: A quasi-experimental study. Harm Reduction Journal.

Access to harm reduction supplies saves lives—but not everyone who uses drugs injects. This study looks at what happened when safer smoking supplies, such as pipes, were made available at syringe service programs across Oregon. The results show that offering smoking supplies can bring new people into services—especially people who may not have felt safe or seen in traditional harm reduction spaces.

What You’ll Learn in This Blog

• Who accessed safer smoking supplies

• How housing status, race and ethnicity, and gender influenced service use

• What the data says about naloxone and HIV and hepatitis C testing

• Actionable strategies to improve harm reduction outreach

Why Safer Smoking Supplies Matter

In the Northwestern United States, about 3 out of 4 people who inject drugs also smoke them. Historically, many harm reduction services have focused only on safer injection supplies. That leaves people who smoke, especially people who do not inject, out of the conversation and out of reach.

This study used two years of data from 26 syringe service sites across Oregon (May 2022 to March 2024) to explore who accessed smoking supplies, and what else they engaged with when they did.

What the Study Found

Safer Smoking Supplies Brought New People In

• 1 in 5 participants accessed services only for smoking supplies (pipes), not syringes

• People who identified as Hispanic or Latino were 2.1 times more likely than White participants to take only pipes

• People who were unhoused were 3.4 times more likely to access only pipes compared to people with permanent housing

• Women were less likely than men to access pipes only, possibly pointing to barriers in outreach or awareness

What About Naloxone and Testing?

• People who accessed only pipes were 73% less likely to take naloxone compared to people who took syringes

• HIV and hepatitis C testing remained low across all groups—less than 10%—with no major differences between them

Participants Were Open to Change

Among a group of returning participants:

• 60% started taking pipes when they became available

• People who took pipes were 2.4 times more likely to also take naloxone

This suggests that once offered, safer smoking supplies were accepted—and may influence how people engage with services and make choices about their health.

Practical Recommendations

1. Offer both injection and smoking supplies: Not everyone injects. Providing smoking equipment helped reach people who might otherwise go unserved.

2. Design services that reflect community needs: Hispanic and Latino participants and unhoused individuals were more likely to use pipe-only services. This shows the importance of culturally responsive, housing-informed outreach.

3. Support naloxone access for everyone: People who smoke may still face high overdose risks—but are less likely to take naloxone. New strategies are needed to close that gap.

4. Boost testing efforts: HIV and hepatitis C testing uptake was low overall. Offering it alongside other services—or with small incentives—could help.

5. Recognize the value of behavior shifts: When people have more choices, they engage differently. Expanding supplies may help people reduce risk and feel more respected in the process.

Moving Forward

This is the first Oregon-based study to explore the impact of offering safer smoking supplies across multiple service sites. The findings are clear: expanding what we offer makes it easier for more people to connect with life-saving resources.

Bringing in people who are often left out—especially people who are unhoused, Hispanic or Latino, or prefer smoking—requires building services around trust, access, and dignity.

This research was conducted by the University of Oregon in partnership with HIV Alliance and supported by the National Institute on Drug Abuse. Data were collected between May 2022 and March 2024 across 26 syringe service sites in Oregon.