Safer smoking information: Crack cocaine
This fact sheet provides information for service providers on how to educate and support clients to smoke crack cocaine more safely. Crack cocaine is a stimulant. This means that it speeds the body up, which can increase heart rate, energy and alertness.
Smoking drugs can lead to a range of health issues, including cuts, burns, blisters and sores on the mouth, lips and gums, blood-borne infections such as hepatitis B and C and other infections like pneumonia. Smoking drugs also carries a risk of overdose or drug toxicity.
By using safer smoking supplies, not sharing supplies and following other safer smoking practices, people who smoke drugs can significantly reduce their risk of health issues. Providing access to harm reduction supplies and education helps support people to use drugs as safely as possible. It also opens the door to build relationships and provide referrals to other health and social services, including treatment services.
Safer smoking supplies
Using safer smoking supplies and not sharing supplies prevents transmission of infections like hepatitis B and C and can reduce harms like cuts and burns to the lips and mouth. All supplies are for personal use and should not be shared with others. Blood can remain on used supplies and can pass infections when shared, even if blood is not visible.
The following equipment is recommended to reduce risks and promote safer smoking practices:
- Alcohol swabs: Used to clean fingers and preparation surfaces
- Straight stem: Used to inhale drugs that produce vapour when heated
- Brass screens: Used in a straight stem to keep drugs in place and prevent hot pieces from being inhaled
- Wooden push stick: Used to prepare and position screens in a straight stem
- Mouthpiece: Placed on the mouth end of a pipe for safety
Safer smoking of crack cocaine
Service providers working with people who smoke drugs should offer education on how to smoke crack cocaine more safely. Here are some general safer smoking tips to reduce the risk of injury, infections and other health harms:
Hands and preparation surfaces should be cleaned with soap and water or alcohol swabs to reduce the risk of introducing germs into the body that can cause infections.
Using a straight stem from a harm reduction program reduces harms. Using other items as makeshift pipes can release harmful fumes or cause cuts and burns. Modifying a stem can compromise the glass and make it more likely to break or blow up.
Brass screens should be tightly packed into a straight stem and positioned 1 cm from the end using a wooden push stick. This will block small, hot particles of drug from being inhaled into the mouth and throat, which can cause burns. It is important to fold the brass screens properly to ensure they work. One way to do this is to stack one or more screens together and fold one side inward. The other side is pressed and folded so the stack of screens has a cone shape. The bottom of the cone can then be rolled up into the middle and everything pressed together tightly.
Steel wool (Brillo) should not be used in place of brass screens. Steel wool is coated in chemicals and hot pieces can break off, causing burns to the mouth and throat when inhaled.
A mouthpiece should be attached to the end of the stem opposite the screens. This will reduce the chance of burns, sores in the mouth and cuts to the lips. Mouthpieces should not be shared, to prevent passing infections.
The stem should be handled carefully to avoid burns, as it gets very hot.
The vapour should be exhaled immediately to prevent burning the lungs.
All smoking supplies should be replaced if they have been used by another person. A stem should be replaced when it is scratched, chipped, cracked or burnt. Placing it in a sharps container or hard plastic bottle and dropping it off at a harm reduction service ensures proper disposal.
Important info about safer crack smoking
Mixing different substances
There are risks with mixing drugs. Mixing different drugs can cause stronger or different effects than using either drug alone. Mixing crack cocaine with opioids like fentanyl or heroin increases the risk of heart attack, stroke and overdose. Different drugs also stay in the body for different amounts of time. It is important for people to always start with a small amount and use caution when using multiple doses or mixing drugs.
Safer sex
Crack cocaine use is associated with sex that has a higher risk of passing HIV and other sexually transmitted and blood-borne infections (STBBIs). Safer sex supplies such as condoms, gloves, barriers and lube should be offered to help reduce the chance of passing these infections. People can be referred to a healthcare provider who can prescribe PrEP (pre-exposure prophylaxis), which is a medication that is used to prevent getting HIV. PrEP does not prevent any other infections.
Stimulant overamping
Signs of overamping from stimulant use may include rapid heart rate or chest pain, rigid or jerking limbs, skin feeling hot or sweaty, anxiety, agitation and hallucinations. If someone is overamping, they may need support to calm down, cool down and rest. Emergency medical attention is required if someone has crushing chest pain or seizures, if they go unconscious or if they are not breathing. Naloxone works only on opioids and does not reverse stimulant overamping, but it is safe to use and may help if an opioid overdose is suspected.
Overdose (drug toxicity)
When someone is using drugs purchased from the illegal supply, there is a higher chance of overdose or toxicity. People can try to prevent or prepare for an overdose by:
using with other people or at a supervised consumption site
starting with a small amount and increasing slowly
getting their drugs tested, if possible
carrying naloxone and knowing how to use it
Naloxone temporarily reverses an opioid overdose. A person may be having an opioid overdose if they are unresponsive or unconscious, have slow or no breathing, are snoring or making choking or gurgling sounds, have cold or clammy skin, and/or have blue or grey lips and nails.
Resources
Responding to an opioid overdose, responding to stimulant overuse and overdose – CATIE, Toward the Heart BCCDC Harm Reduction Services
Harm Reduction Fundamentals: A toolkit for service providers – CATIE
Connecting: A guide to using harm reduction supplies as engagement tools – Ontario Harm Reduction Distribution Program
Best Practice Recommendations for Canadian Harm Reduction Programs – Working Group on Best Practice for Harm Reduction Programs in Canada
Acknowledgements
This resource is adapted from Connecting: A Guide to Using Harm Reduction Supplies as Engagement Tools by the Ontario Harm Reduction Distribution Program (OHRDP). CATIE also thanks the reviewers who contributed their expertise to this resource.