Safer smoking information: Smoking with foil

This fact sheet provides information for service providers on how to educate and support clients to more safely smoke drugs using foil. Foil is used as a surface to smoke drugs (sometimes known as “chasing the dragon”). Many different drugs are smoked with foil, including heroin, fentanyl, crack cocaine, crystal meth and some crushed pills. People use different supplies (such as straws, straight stems or foil tubes) to inhale the vapours.

For people who inject drugs, smoking drugs with foil is an effective way to lower the risk of many harms related to injecting drugs including vein damage, blood-borne infections such as hepatitis C and HIV, and other types of blood, skin and heart infections. However, smoking drugs with foil can lead to some harms, including 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 
• Foil sheets from a harm reduction organization: Used as a surface to smoke or vape drugs
• Straw, straight stem or foil rolled into a tube: Used to inhale the vapours

Providing education about safer smoking using foil

Using safer smoking supplies

Foil sheets from a harm reduction program are purpose-made for drug use. They are thicker than household aluminum foil or hairdressing foil, and they provide a more stable surface when heated, reducing the risk of burns. In addition, household foil and hairdressing foil have an oil coating that, when heated, can burn off and release chemicals that can be harmful to inhale.  

Mixing different substances

There are risks with mixing drugs. Mixing different drugs can cause stronger or different effects than using either drug alone. Mixing stimulants like crystal meth 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.

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:

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.

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.

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.