Crack is a crystal form of cocaine. The solid crack (rock) is placed into a glass pipe or stem (straight shooter) or metal pipe, which is heated by a flame (usually from a cigarette lighter) to melt the crack and the vapour inhaled. The crack pipe mouthpiece is a length of clear vinyl tubing, which is attached to the glass pipe and put into the mouth. The mouthpiece can be taken off the glass pipe as necessary and used by an individual to avoid sharing.
Why do people who use crack get mouth sores and cuts?
Glass and metal pipes conduct heat from the flame. Oral lesions (blisters or sores) and cracked or burnt lips occur due to contact with the hot glass or metal. A glass crack pipe can fracture and break at the tip due to repeated overheating or scraping the resin inside the pipe. The jagged edges may be removed and the shorter pipe continued to be used. The sharp edges of a broken pipe may cause cuts, and without a mouthpiece the shorter pipe may be more likely to cause burns to the lips and fingers. 1-3
What diseases can sharing crack pipes spread?
- Sharing of equipment (e.g. glass pipes) especially when oral lesions are present can provide a route of transmission for hepatitis C, hepatitis B, HIV and other communicable diseases. 4-8
- The spread of TB has been found in a crack using populations.9,10 and sharing of crack cocaine paraphernalia may have been an efficient means of spreading pneumococcal pneumonia in an outbreak in Vancouver in 2006.11
Why does the BC Harm Reduction* Strategies & Services provide mouthpieces*?
The core components of harm reduction strategies & services include referrals, advocacy, education and supply distribution. These services are aimed at reducing harms from injection and other drug use. Harms include oral lesions and cuts and communicable disease transmission.
- Mouthpieces can reduce the risk of oral lesions as the tubing avoids direct contact of the mouth with hot crack pipes and broken glass stems.
- Having one’s own rubber mouthpiece allows individuals to protect themselves from the transmission of communicable diseases through sharing pipes.
- Providing supplies for people who do not inject drugs creates a further point of engagement for otherwise hard-to-reach / under serviced populations.
How can mouthpieces be ordered?
The harm reduction supply requisition form available online at the BCCDC website can be used to order the tubing. The form is then faxed to the BCCDC. The tubing comes in 3 different widths to fit most glass stems; each plastic bag contains 100-foot of tubing which can be cut at the distribution site with special cutters also provided by the harm reduction supply services.
More information on Canadian best practice recommendations for safer crack cocaine smoking equipment distribution can be found here.
*For a definition of harm reduction, please see Health file #102, Understanding Harm Reduction
1 Mitchell-Lewis, D.A., Phelan, J.A., Kelly R.B., Bradley, J.J. & Lamster, I.B. (1994). Identifying oral lesions associated with crack cocaine use. Journal of the American Dental Association, 125(8), 1104–1108.
2 Porter J, Bonilla L. (1993). Crack users’ cracked lips: An additional HIV risk factor. American Journal of Public Health, 83(10), 1490–1491.
3 Faruque S, Edlin BR, McCoy CB, et al. Crack cocaine smoking and oral sores in three inner-city neighborhoods. J Acquir Immune Defic Syndr Hum Retrovirol 1996;13(1):87-92.
4 Tortu, S., McMahon, J.M., Pouget, E.R. & Hamid, R. (2004). Sharing of noninjection drug-use implements as a risk factor for hepatitis C. Substance Use & Misuse, 39(2), 211–224.
5Tortu, S., Neaigus, A., McMahon, J. & Hagen, D. (2001). Hepatitis C among noninjecting drug users: A report. Substance Use & Misuse, 36(4), 523–534.
6 Gyarmathy, V.A., Neaigus, A., Miller, M., Friedman, S.R. & Des Jarlais, D.C. (2002). Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users. Journal of Acquired Immune Deficiency Syndromes, 30(4), 448-456.
7 Leonard, L., DeRubeis, E., Pelude, L., Medd, E., Birkett, N. & Seto, J. (in press). “I inject less as I have easier access to pipes”: Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking resources are distributed. International Journal of Drug Policy. doi:10.1016/j.drugpo.2007.02.008
8 Fischer, B., Rehm, J., Patra, J., Kalousek, K., Haydon, E., Tyndall, M., et al. (2006). Crack across Canada: Comparing crack users and crack non-users in a Canadian multicity cohort of illicit opioid users. Addiction, 101(12), 1760-1770.
9 McElroy PD, Rothenberg RB, Varghese R, et al. A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations. Int J Tuberc Lung Dis 2003;7(12 Suppl 3):S486-93.
10 TB outbreak tied to crack users. Caranci Julia, Alberni Valley Times October 2nd 2007
11 Buxton JA. Vancouver drug use epidemiology. Site report for the Canadian community epidemiology network on drug use. 2007