Academic Journal
Provision of safer smoking equipment to reduce health harms and enhance service engagement among people who use crack: a realist informed review.
| Τίτλος: | Provision of safer smoking equipment to reduce health harms and enhance service engagement among people who use crack: a realist informed review. |
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| Συγγραφείς: | Piot A; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom. Electronic address: alexandre.piot.20@ucl.ac.uk., Sharpe C; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom., Vuckovic C; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom., McGaff C; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom., Scott J; Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom., Hope V; Public Health Institute and School of Public and Allied Health, Liverpool John Moores University, 3rd Floor Tithebarn Building, 79 Tithebarn Street, Liverpool, L2 2ER, United Kingdom., Platt L; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom., Harris M; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom. |
| Πηγή: | The International journal on drug policy [Int J Drug Policy] 2026 Aug; Vol. 154, pp. 105371. Date of Electronic Publication: 2026 Jun 05. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9014759 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4758 (Electronic) Linking ISSN: 09553959 NLM ISO Abbreviation: Int J Drug Policy Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1998- : Amsterdam ; New York : Elsevier Original Publication: Liverpool, England : International Journal on Drug Policy |
| Ιατρικοί όροι (MeSH): | Crack Cocaine*/administration & dosage , Crack Cocaine*/adverse effects , Cocaine-Related Disorders*/complications , Harm Reduction*, Humans |
| Περίληψη: | Background: Safer smoking equipment interventions for people who smoke crack cocaine have been unevenly implemented globally with most harm reduction policy and practice focused on preventing opioid and injecting related harms. There is a need to synthesise the international evidence on safer inhalation equipment provision for crack and understand how, why, for whom, and in what context can such interventions improve engagement with services, promote safer use practices, and reduce harm. Methods: Bibliographic databases (n = 8) and grey literature sources were searched for reports on the distribution of safer inhalation equipment among adults who use crack. Data synthesis was applied around a realist framework, focusing on contextual factors and mechanisms which influenced the interventions' outcomes. Results: Evidence from 16 peer reviewed and 6 grey literature studies was included. Overall, acceptability of safer inhalation interventions and uptake (≈ 90% in some studies) was high. Evidence pointed towards reduced pipe sharing, decreased injecting, and improved engagement with health and social services. However, implementation was frequently hindered by resource, political, and logistical constraints. Five context-mechanism-outcomes were developed covering service accessibility, integrated provision, tailored provision, peer-supported behaviour change, and organisational resilience against criminalisation and funding cuts. Service engagement and the adoption of safer crack use practices were greater when supportive contexts activate key mechanisms such as perceived safety, ease of access, perceived relevance, and peer-supported learning. Conclusion: Although political, legal and funding constraints can impede implementation and optimal delivery, this review highlights the role of accessible, integrated and peer supported delivery models that services and policymakers can deploy to effectively reduce crack-related health harms and foster engagement with services. (Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Crack cocaine; Crack pipe; Harm reduction; Intervention; Service engagement |
| Substance Nomenclature: | 0 (Crack Cocaine) |
| Entry Date(s): | Date Created: 20260605 Date Completed: 20260614 Latest Revision: 20260614 |
| Update Code: | 20260615 |
| DOI: | 10.1016/j.drugpo.2026.105371 |
| PMID: | 42248707 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-4758 |
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| DOI: | 10.1016/j.drugpo.2026.105371 |