The distribution of sterile injection equipment to people who inject drugs via needle and syringe programs has been widely implemented across a number of countries in an effort to prevent HIV and hepatitis C infections, reduce needle sharing and re-use, and decrease the number of discarded needles and syringes in communities. 

Sterile injection equipment may be distributed through fixed sites, pharmacies, machines, outreach programs, or home visits. The effectiveness of the distribution of sterile injection equipment through needle exchange programs is well-established.363 A 2014 systematic review and meta-analysis reported a 34% reduction in risk of HIV transmission among individuals who participated in needle and syringe programs (pooled effect estimate 0.66, 95% CI: 0.43–1.01) compared to those who did not participate or who participated less frequently. 

In the same meta-analysis, a sensitivity analysis that included only studies assessed to be of high quality supported these findings and reached statistical significance (pooled effect estimate 0.43, 95% CI: 0.22–0.81).364 

In regards to hepatitis C infections, a 2011 meta-analysis found that receiving one or more sterile needles for each reported injection was associated with a 52% reduction (aOR 0.48, 95% CI: 0.25–0.93) in the odds of new hepatitis C infection when compared to receiving less than one sterile needle for each reported injection. When participants received one or more sterile needles for each reported injection in combination with OAT, the odds of new hepatitis C infection were further reduced by nearly 80% (aOR 0.21, 95% CI: 0.09–0.52) and there was a 48% reduction (aOR: 0.52, 95% CI: 0.32–0.83) in needle sharing practices compared to participants who received less than one sterile needle per reported injection and did not receive OAT,84 underscoring the importance of offering harm reduction supplied alongside OAT. 

Although there are currently no dedicated studies examining the impact of safer inhalation supplies distribution, there is a vital need for the expansion of this service across BC as an increasing portion of people who use drugs have reported that inhalation is their preferred mode of drug consumption. 

The BC Coroners Service reported evidence of smoking as a mode of drug consumption in 67% of BC residents who died of unregulated drug poisoning in 2023.365 The 2021 Harm Reduction Client Survey (n=537) conducted by the BC Centre for Disease Control also found that 64% of responding harm reduction service clients in 2021 identified smoking or inhalation as their preferred mode of drug consumption while 14% expressed a preference for injection.366 According to this report, 20% of respondents who smoked drugs in the past 6 months used a second-hand pipe and 6% injected drugs when they were unable to access unused smoking equipment. 366 

The use of second-hand or non-sterile smoking equipment exposes people who smoke drugs to infection and the development of pulmonary and respiratory problems.367,368 Given the risks affecting a significant portion of people who use drugs, the BCCDC includes safer smoking and inhalation equipment among its harm reduction services. This service is incorporated in an increasing number of supervised consumption and overdose prevention sites across BC. Guidance for ordering, distribution, and use of safer smoking supplies are available through the Toward the Heart website.