(77) People Who Inhale Stimulants At Risk for COVID-19 and Other Injury

Purpose:
The COVID-19 pandemic disproportionately impacts people who use drugs, yet the impact of COVID-19 on people who inhale stimulants has not been well documented. The purpose of the study was to assess how COVID-19 is impacting the practices of people who “smoke” methamphetamine and crack cocaine to guide future harm reduction efforts.

Methods:
Anonymous surveys were administered to respondents reporting inhalation of crack cocaine and/or methamphetamine in the past three months. Respondents were eligible if they sought services from an outreach team staffed by a municipal syringe service program (SSP) or if they were patients at a low threshold substance use disorder treatment program at Massachusetts General Hospital (MGH). The survey assessed smoking practices, access to safer smoking supplies, and the impact of COVID-19 on both. Respondents received a $15 gift card for their participation. The study was deemed exempt by the MGH Institutional Review Board.

Results:
The survey was administered to 68 unique respondents recruited in MGH’s Bridge Clinic (30%) and through outreach with a municipal SSP (70%). Fifty percent were white, 38% were Black, 2% were American Indian or Alaskan Native and 10% reported identifying as Hispanic or Latinx. Of the 68 people surveyed, 85% smoked crack cocaine (25% also reported injecting crack cocaine), 52% smoked methamphetamine (63% also reported injecting methamphetamine). Forty-six percent of respondents reported changing their rate of smoking stimulants during COVID-19 (15% decreasing and 31% increasing). Sixty-six percent of respondents reported sharing pipes in the last three months. Sixty-six percent of respondents also indicated they never sanitized their pipes with alcohol sabs prior to use. Many respondents reported smoking out of a broken pipe (69%) and/or using something other than a pipe to smoke out of (52%) in the past three months (most commonly bottles and foil). Half (49%) of respondents reported their smoking practices were unchanged due to COVID-19, but 35% reported increased frequency of safer practices, including using alcohol swabs and mouth pieces. Among the 46% of respondents surveyed who both smoked and injected stimulants, 61% of those respondents stated that they injected instead of smoked stimulants due to lack of access to pipes. Seventy-one percent of respondents indicated having access to new pipes would change their pipe sharing behavior. Most respondents (62%) agreed with the statement “I am more likely to go a doctor’s office if they provide pipes”.

Conclusion:
Inhalational practices that placed respondents at risk of injury and illness including COVID-19 were common. While COVID-19 did not appear to impact smoking practices for half of those surveyed, some respondents did report increased use of harm reduction practices amid COVID-19. This study was limited by its small sample size and use of non-validated items. Future studies should evaluate the ways in which providing safer smoking materials may promote health and engage patients in care. Racist policies drive the criminalization of inhalation drug use equipment and advocacy efforts should focus on reclassifying pipes from paraphernalia to harm reduction equipment.

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Diversity, Equity, and Inclusion: Currently there is limited access to new pipes for people who inhale substances. People who inhale substances, especially crack cocaine, are often minoritized individuals who are underserved by harm reduction and medical programs. Individuals who are less likely to access traditional medical settings are under studied. This study leverages community partnerships to recruit people of color who do not access Massachusetts General Hospital. Due in part to limited access to pipes, many individuals engage in risker practices including sharing pipes, using broken pipes, and/or injecting instead of smoking. Some of these practices are made even riskier due to COVID-19. This abstract will explore the potential health benefits of providing safer smoking supplies, especially during COVID-19. This research supports advocacy efforts to decriminalize smoking paraphernalia in order to help address health disparities and carceral disparities.