A rapid Health Impact Assessment of safer inhalation devices for crack cocaine use in Wales

Abstract Background Unsafe crack cocaine pipes cause serious health risks including infections and respiratory harm. Safer Inhalation Devices (SIDs), used globally, reduce harm, increase service engagement, and lower disease transmission. A unique Health Impact Assessment (HIA) was conducted to identify the potential wider impacts of a pilot of this intervention in Wales on health outcomes and equity across vulnerable groups. Methods A rapid HIA was conducted in 2024 by the Health Protection Division and facilitated by the Wales Health Impact Assessment Support Unit, Public Health Wales. Using a five-step process-screening, scoping, evidence appraisal, reporting, and evaluation-the HIA identified potential impacts, both positive and negative. A participatory workshop with 24 stakeholders, including former users and support workers, informed the findings where qualitative results were thematically analysed. The final report guided pilot development, aiming to maximise benefits and reduce harm. Results Potential positive impacts on health, well-being and equity were identified as encouraging safer use of inhalation devices, increased engagement with health services and potential to reduce stigma of engagement with services. The intervention could potentially benefit not only crack cocaine users, but family members and communities by promoting health, safety and trust. Potential challenges were identified as resource strain and accessibility of providing the kits. Key success factors were identified as tailored delivery, peer support and sustainable funding. Conclusions This innovative research has demonstrated how HIA has been instrumental in shaping a harm reduction service in Wales using SIDs as a vehicle, highlighting impacts which are transferable to different contexts. Recommendations have been implemented to ensure the wider health, well-being and equity impacts are addressed, with positive impacts being maximised, and mitigating for unintended negative impacts. Key messages • A Health Impact Assessment highlights the potential of Safer Inhalation Devices to reduce harm, increase engagement, and improve well-being, while addressing potential impacts on equity. • The Health Impact Assessment reveals potential benefits including safer drug use, and potential challenges such as resource strain, emphasising the need for tailored delivery and sustainable funding.