Pipes as an engagement tool: qualitative findings from a crack equipment and harm reduction training intervention in England

Background:
Crack cocaine use is increasingly prevalent in England, yet drug services are poorly equipped to support the needs of this population. Provision of stimulant inhalation equipment is prohibited, and workforce crack-related harm reduction knowledge is generally low. The Safe Inhalation Pipe Provision (SIPP) project piloted a crack inhalation equipment and training intervention in England. This paper explores how and in what way crack training and equipment provision influences engagement with drug service providers.

Methods:
SIPP is a mixed-method study, comprising a before-and-after survey, service monitoring data, qualitative interviews, focus groups, and observations. Here we report qualitative data generated with people who use crack and providers at three intervention and three comparison group sites. We conducted a thematic analysis and report themes specific to contact and engagement with drug services.

Results:
Prior to intervention implementation, little adequate crack-specific support was identified. SIPP equipment provision facilitated increased contact and/or disclosure of crack use with services. Workforce training enhanced communication and relationship-building opportunities, enabling disclosure of additional need and commensurate provision or linkage to health and social supports. The capacity for contact to facilitate engagement was impacted by organisational and structural constraints, and for some populations barriers to access remain entrenched.

Conclusions:
Provision of crack inhalation equipment can facilitate new contacts with services among a highly marginalised population. Complementary workforce training helps to enable relationship building and engagement opportunity. Additional methods of provision, including through peer networks, are required to support people for whom barriers to service access remain.

Trial registration: ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454