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Pipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed.
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Basically, you put your crystal into [the pipe] and you should keep the lighter about an inch below the bottom of the pipe. You let it melt into a liquid form and you wait a second until it re-crystalizes over, and then you heat it up until it puddles again. You keep it constantly moving while inhaling not as hard as you would with crack, but not slow, just like a normal sized breath
When asking about the process of smoking, the most common ways described involved the use of a store-bought ball pipes (a glass stem with a bowl attached) or using tin foil and straws, a method known as "chasing the dragon". With the exception of participants who were homeless/street-involved, few discussed the use of improvised equipment such light bulbs, soft drink cans and/or ginseng vials. For the homeless participants, improvised pipes were only used when ball pipes were not available. Some participants had used crack stems to smoke crystal methamphetamine or had heard of others doing so. Smoking with a crack stem was generally considered an unsuitable method because it does not have a bowl to collect the liquefied crystal methamphetamine that prevents this liquid from being inhaled and/or swallowed. During several groups, a technique called "hot-railing" was described. Hot railing involves heating a crack stem and then inhaling a line of vaporized crystal methamphetamine through the nose. Although uncommon, a few participants mentioned converting crack stems into ball-type pipes. Some had seen friends or acquaintances heat a crack stem and then 'blow' out a ball that would be used to collect and smoke liquefied crystal methamphetamine. After hearing about this technique, we asked other participants but few were familiar with it.
I've never seen it happen... I think the reason [why it happens with crack and not crystal] is, because with crack, the heat is right on the stem, where we heat the bowl, and you have to heat it a lot more with crack... Because you hold the stem partway down with crystal, it would never burn your lips cause you'd burn your fingers first. It just doesn't happen.
Injuries and burns were linked more to smoking crack cocaine or to the use of improvised pipes (e.g., light bulbs) for smoking crystal methamphetamine. Participants who had smoked crack cocaine said less heat was required to vaporize and inhale crystal methamphetamine than to burn crack cocaine to smoke. Reduced heating was linked with fewer burns to the hands, lips and mouth. The participants clarified further that crystal methamphetamine is vaporized, not burned, and that if you used the amount of heat applied to crack pipes with a crystal methamphetamine pipe you would burn the drug. In general, cuts and burns from smoking with any device was deemed to be an issue related more or less to personal skill.
While we obtained valuable information about the ideal contents of a harm reduction kit for crystal methamphetamine smoking, our data lead us to question if the kits might be used at all and/or used for the intended purpose of reducing sharing. With the exception of homeless/street-involved youth, many participants were hesitant to say that a safer crystal methamphetamine smoking kit would lead to changes in their behaviour. Crystal methamphetamine is often smoked in a group setting where sharing is a part of the culture of smoking and not the result of an inability to buy or access new and clean supplies. Questions about ease of purchase revealed that it is relatively easy to purchase a suitable pipe. Research team members had no difficulty purchasing pipes to show during the focus group discussions. Nevertheless, there were a minority of homeless/street-involved participants who lacked sufficient resources to purchase a pipe. Data from a 2009 Toronto study amongst street youth (n = 100) showed that 74% youth rated access to a safer crystal meth kit as high on their demands . Among youth in that study who smoked crystal methamphetamine, 83% used a glass pipe with a bowl, 40% used a homemade pipe made from a light bulb, 21% smoked it using tin foil, 19% used a crack pipe and 8% used a metal pipe. While our findings related to sharing behaviour lead us to question whether or not kits would decrease sharing amongst this population, access to kits might reduce the use of improvised equipment (e.g., light bulbs) said to be more likely to cause injury and burns. Amongst all participants, gay men were the least convinced that the kits would reduce sharing at parties because the social aspect of sharing a pipe was an important part of the experience and integral to the sexual transactions occurring in bathhouses. They also felt that the risk of disease transmission associated with pipe sharing was trivial in the context of the unprotected sex occurring in settings where crystal methamphetamine was used. Future studies targeting crystal methamphetamine smokers should examine more thoroughly whether harm reduction services could actually reduce pipe sharing.
An objectionably low-pressure transient event, arising for example from a power failure or from an intermittent/interrupted supply, has the potential to cause the harmful intrusion of untreated, possibly contaminated groundwater into pipes with leaky joints or cracks as the risk of backflow increases significantly with reduced pressure. This is especially important in systems with pipes below the water table. Pathogens or chemicals in close proximity to the pipe can become a potential contamination source. In the event of a large intrusion of pathogens, the chlorine residual normally sustained in drinking water distribution systems may be insufficient to disinfect contaminated water, which can lead to damaging health effects.