, Boston, Massachusetts, USA.
Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA.
Harm Reduct J. 2023 Oct 27;20(1):160. doi: 10.1186/s12954-023-00875-x.
Providing sterile drug smoking materials to people who use drugs can prevent the acquisition of infectious diseases and reduce overdose risk. However, there is a lack of understanding of how these practices are being implemented and received by people who use drugs globally.
A systematic review of safer smoking practices was conducted by searching PubMed, PsycInfo, Embase for relevant peer-reviewed, English-language publications from inception or the availability of online manuscripts through December 2022.
Overall, 32 peer-reviewed papers from six countries were included. 30 studies exclusively included people who use drugs as participants (n = 11 people who use drugs; generally, n = 17 people who smoke drugs, n = 2 people who inject drugs). One study included program staff serving people who use drugs, and one study included staff and people who use drugs. Sharing smoking equipment (e.g., pipes) was reported in 25 studies. People who use drugs in several studies reported that pipe sharing occurred for multiple reasons, including wanting to accumulate crack resin and protect themselves from social harms, such as police harassment. Across studies, smoking drugs, as opposed to injecting drugs, were described as a crucial method to reduce the risk of overdose, disease acquisition, and societal harms such as police violence. Ten studies found that when people who use drugs were provided with safer smoking materials, they engaged in fewer risky drug use behaviors (e.g., pipe sharing, using broken pipes) and showed improved health outcomes. However, participants across 11 studies reported barriers to accessing safer smoking services. Solutions to overcoming safer smoking access barriers were described in 17 studies and included utilizing peer workers and providing safer smoking materials to those who asked.
This global review found that safer smoking practices are essential forms of harm reduction. International policies must be amended to help increase access to these essential tools. Additional research is also needed to evaluate the efficacy of and access to safer smoking services, particularly in the U.S. and other similar countries, where such practices are being implemented but have not been empirically studied in the literature.
为吸毒者提供无菌药物吸烟材料可以预防传染病的传播并降低用药过量的风险。然而，全球范围内，人们对于这些做法的实施情况和接受程度缺乏了解。
通过检索 PubMed、PsycInfo 和 Embase，对从创立之初或在线手稿可用之日起截至 2022 年 12 月的相关同行评议的英文出版物进行了安全性吸烟做法的系统评价。
共纳入来自 6 个国家的 32 篇同行评议论文。30 项研究仅纳入吸毒者作为参与者（n=11 名吸毒者；通常 n=17 名吸毒者，n=2 名注射吸毒者）。1 项研究纳入了为吸毒者服务的项目工作人员，1 项研究纳入了工作人员和吸毒者。25 项研究报告了共享吸烟设备（如烟斗）的情况。一些研究中的吸毒者报告说，出于多种原因，如想积累可卡因残渣，以及保护自己免受警察骚扰等社会危害，他们会共享烟斗。在多项研究中，吸毒者表示，与注射毒品相比，吸食毒品是减少用药过量、感染疾病和警察暴力等社会危害风险的关键方法。10 项研究发现，当为吸毒者提供更安全的吸烟材料时，他们会减少一些危险的药物使用行为（如共享烟斗、使用破损的烟斗），并改善健康结果。然而，11 项研究中的参与者报告了获得更安全的吸烟服务的障碍。17 项研究中描述了克服更安全的吸烟服务获取障碍的解决方案，包括利用同伴工作人员并向有需要的人提供更安全的吸烟材料。
本项全球综述发现，更安全的吸烟做法是减少伤害的重要形式。必须修改国际政策，以帮助增加获得这些基本工具的机会。还需要开展更多研究来评估更安全的吸烟服务的效果和获取途径，特别是在美国和其他类似国家，这些做法正在实施，但在文献中尚未进行实证研究。
