Download pdf
CATIE

Smoking crack cocaine with a straight stem: Steps to safer smoking

This resource provides information on safer smoking of crack cocaine. Crack cocaine is a stimulant. This means that it speeds the body up, which can increase heart rate, energy and alertness. When heated, a crack rock produces vapour that can be inhaled.

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 can also lead to overdose or drug poisoning.

Using safer smoking supplies, not sharing supplies and following other safer smoking practices helps to lower the chance of health issues. Providing education on safer use practices along with a range of free harm reduction supplies can support people to use their drugs as safely as possible.

Getting ready to smoke crack cocaine with a straight stem

Using new safer smoking supplies is the best way to reduce harms. All supplies are for personal use and should not be shared with others. This is because blood can remain on used supplies and can pass infections when shared, even if blood is not visible.

The following harm reduction supplies are recommended for smoking crack:

  • alcohol swabs
  • straight stem
  • brass screens
  • wooden push stick
  • mouthpiece
  • lighter

Safer practices for smoking crack cocaine with a straight stem

Service providers working with people who smoke drugs should offer education on how to smoke crack cocaine more safely by sharing the following steps and information.

How to smoke crack cocaine with a straight stem:

  • Wash hands and preparation surface with soap and water before handling harm reduction supplies. This can prevent infections caused by viruses and bacteria. Hand sanitizer or alcohol swabs can be used if soap and water are not available.
  • First, fold brass screens to pack them into a straight stem. There are many ways to fold screens. It is important that they are tightly packed in the stem. Here is one possible method:
    • Using one or more screens stacked together, fold one side inwards.
    • Press to fold in the other side so the stack of screens has a cone shape.
    • Roll the bottom of the cone into the middle with the folded sides facing inward. Press together tightly. The screens are now ready to pack into a stem.
  • Place the stem on a clean surface. Insert the folded screens and press them down with a wooden push stick so they are tightly packed.
  • Gently push the packed screens back, leaving about 1 cm of space at the end of the stem to allow room for the crack rock.
  • Attach a mouthpiece to the other end of the stem. A mouthpiece will reduce the chance of burns, sores in the mouth and cuts to the lips. Mouthpieces should not be shared.
  • Insert the crack rock into the stem. Place it in the gap between the screens and the end of the stem to hold it in place.
  • Apply heat to the end of the stem (with the rock).
  • Inhale slowly and exhale immediately. Holding the vapour in the lungs can cause burns and will not lead to a better high.
  • Handle the stem carefully as it will be very hot.

Important info about safer crack smoking

Using brass screens

Brass screens are used to keep the drug in place in the stem. Brass screens block small, hot particles of drug from being inhaled into the mouth and throat and causing burns. Brass screens are the safest option to use for this purpose. Some people prefer to use steel wool instead of brass screens. Steel wool is coated in chemicals and hot pieces can break off, causing burns to the mouth and throat when inhaled.

Using safer smoking supplies

Always use safer smoking supplies from a harm reduction program when possible. This can help prevent a range of harms including burns, blisters and cuts, which can increase the risk of infections. Modifying a straight stem can compromise the glass and make it more likely to break or blow up. Using other items as makeshift pipes can cause harms by releasing harmful fumes or causing cuts and burns.

Using personal smoking supplies and replacing them regularly

Smoking supplies are for personal use and should not be shared with other people. Replace all smoking supplies if they have been used by another person. Replace straight stems when they are scratched, chipped, cracked or burnt. Replace brass screens when they become loose. Dispose of safer smoking supplies in a sharps container or other hard plastic bottle. Drop it off at a local harm reduction organization for disposal.

Mixing different substances

There are risks with mixing drugs. Mixing different drugs can cause stronger or different effects than 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 to always start with a small amount, increase slowly 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 (or pre-exposure prophylaxis), which is a pill 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, try to help the person 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 only works 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 poisoning

When someone is using drugs purchased from the illegal or street supply, there is a higher risk of overdose or poisoning. 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 drugs tested, if possible
  • carrying naloxone and knowing how to use it

Naloxone 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

Safer substance use video series – CATIE

Safer crack smoking – CATIE

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

Acknowledgement

This resource is adapted from CATIE’s Safer Substance Use Video Series and Connecting: A Guide to Using Harm Reduction Supplies as Engagement Tools by the Ontario Harm Reduction Distribution Program (OHRDP). CATIE thanks the reviewers who contributed their expertise to this resource.