Safe inhalation pipe provision (SIPP): Evaluation of an intervention to enhance service engagement and reduce health harms among people who use crack cocaine in England

Research question: To what extent and how does safe inhalation pipe provision (SIPP) reduce health risks and enhance service engagement among people who use crack cocaine (PWUC)? Background: Drug treatment services have little to offer PWUC in England. No evidence-based pharmacotherapies are available and crack pipe provision is prohibited. Pipes used for crack smoking are often homemade and/or shared, exacerbating risk of infectious disease transmission and chronic respiratory conditions. Legislative review of crack pipe prohibition is needed but must be evidence informed. This study is supported by police force partners who view SIPP as a needed public health intervention to support drug treatment engagement among a high risk population. Objectives 1. Measure the effect and cost-effectiveness of SIPP on harms and risks associated with crack use (pipe sharing, presentation at drug services, using home-made pipes, cuts/burns, crack injecting) 2. Evaluate SIPP fidelity, reach and acceptability in diverse drug treatment and peer-network settings. 3. Explore the barriers and facilitators to SIPP uptake and service engagement among PWUC. 4. Explore the mechanisms through which SIPP facilitates changes in health risks and access to services, to inform implementation at scale. 5. Build peer-network research capacity and explore whether the quality and impact of their SIPP engagement with PWUC differs in comparison with SIPP engagement through drug treatment services. 6. Co-develop a scalable SIPP toolkit and harm reduction resources to enhance PWUC engagement with drug treatment services and facilitate crack-related risk reduction practices. 7. Translate evidence to policy and advocacy outputs, including to inform legislative review. Methods: Quasi-experimental design comprising a pre-post comparison study with a non-equivalent control group and a nested qualitative study to identify impacts and predictors of SIPP use to inform intervention scale up and an assessment of its cost-effectiveness. Timeline: Our 5 phase project will be delivered over 30 months. P1. Optimisation [M1-6]: Evidence review; peer training; co-production; P2 Baseline data generation [M7-9]: Cross sectional survey; stakeholder interviews; provider focus groups; P3 Implementation [M10-18]: SIPP delivery; PWUC interviews, observations; P4 Evaluation [M19-24]: Follow-up survey, interviews, focus groups; economic evaluation; P5 Dissemination [M25-30]: Scalable SIPP toolkit; harm reduction resources; policy and public health advocacy. Impact: Systematic evaluation of safe inhalation interventions for PWUC is urgently needed in order to produce definitive evidence of their health and other benefits, and to allow for evidence-based program and policy decisions in the interest of public health. Led by a team of multidisciplinary researchers, drug treatment providers and PWUC, this research will provide value for money by evidencing the impact of a low-cost intervention on health care outcomes and drug treatment engagement among PWUC. PPI: Formative work with PWUC, drug treatment providers, police and crime commissioners, police force, and the Hepatitis C Trust inform our proposal. This project is a community-academic partnership, addressing community-identified need and building peer researcher capacity, with meaningful peer and community stakeholder involvement throughout ensuring project accountability and output relevance.