I Don't Want to Shoot up the Meth Anymore: Pipe Distribution as a Harm Reduction Service for People Who Use Methamphetamine.

Background: Methamphetamine use is disproportionately high in rural settings, with rates increasing during the COVID-19 pandemic. While syringe service programs reduce disease transmission among people who inject drugs, limited research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural methamphetamine use.

Methods: We conducted semi-structured interviews with people who use methamphetamine in rural southern Illinois. Inclusion criteria involved methamphetamine use in the past 30 days. Interview guides explored attitudes and behaviors regarding pipe use practices and pipe access. Interviews were recorded, transcribed, and coded. The data were analyzed for emergent themes using a sequential, deductive process.

Results: Nineteen participants, average age 37.1 (SD + 8.7), were interviewed. 53% were women, and 89% were white. All reported smoking methamphetamine, and 84% reported injecting. Participants reported engaging in smoking instead of injection to decrease wounds, pain, and infections. Smoking enabled some to use socially as opposed to alone, as was typically the case when they injected. Participants expressed interest in pipe distribution through a harm reduction agency. They shared that, were a harm reduction agency to distribute pipes, it would connect people to other services such as HIV testing, naloxone, and safer sex supplies.

Conclusions: Pipe distribution may function as a harm reduction strategy by decreasing injection and solitary drug use and linking patients to additional services. Given disproportionate methamphetamine use in rural regions, this intervention could specifically address drug-related harms that impact rural populations.