“Huge step backwards for recovery, it sucks!” was how one participant in a new study described the smoking ban in drug treatment programs in Philadelphia.
The exploratory study* was conducted by Dr. Casey Bohrman, a researcher at West Chester University, in partnership with Angels in Motion. It used both qualitative and quantitative methods to examine how the policy was impacting people with a substance use disorder (SUD) who also smoke. Over half, 56 percent, of people with SUD smoke cigarettes.
“Of those who left treatment prematurely, 85 percent said not being able to smoke was part of their reason.”
The sample included 112 people, 80 men and 32 women. Fifty-two percent of the participants were unhoused. Of those who provided opinions about the ban, Dr. Bohrman told Filter, “12 people expressed support for the ban, seven expressed mixed or neutral opinions, and 48 opposed the ban.”
The study also found that 46 percent of participants reported that the smoking ban was impacting their decision about whether or not to seek inpatient addiction treatment. Of the participants who had at some point entered inpatient treatment within the last two years, over half (55 percent) reported they left treatment prematurely (whether voluntarily, against medical advice or kicked out).
Most starkly, of those who left treatment prematurely, 85 percent said not being able to smoke was part of their reason for leaving.
The data clearly show that banning smoking has had a negative effect on treatment initiation and retention. Several comments from participants reflected this: “If I cannot smoke, I’m afraid I will leave AMA,” “Bad enough you have to stop fentanyl, then they want you to stop cigarettes,” and “The stress of quitting something else is holding me back.”
“Based on the study findings, I would suggest pausing the policy until further research can be completed.”
Dr. Bohrman had this recommendation for drug treatment providers: “While this study is exploratory, it indicates that the smoking ban is serving as a barrier to accessing and completing treatment for some people with substance use disorders … Given that we are in the midst of an overdose crisis, any barrier to accessing treatment is of concern. Based on the study findings, I would suggest pausing the policy until further research can be completed.”
The results of the study didn’t come as any surprise to Philly harm reductionist and social worker Brooke Feldman. She sounded the alarm in 2019 when the city’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) and the managed care organization, Community Behavioral Health (CBH) implemented the ban.
Vaping is also included in the ban, removing a key harm reduction option for smokers. The ban only applies to publicly funded inpatient detox and addiction treatment facilities. (The new research didn’t cover the types of treatment that the programs in question were offering.)
Feldman correctly predicted that drug users would either not enter treatment or would leave when they learned of the prohibition on smoking, even in outdoor spaces! In 2019, she wrote in Filter: “While Philadelphia’s decision to impose this ban is perhaps well-intentioned, it is likely to have several unintended negative consequences. It presents a treatment initiation barrier at a time when the illicit fentanyl-tainted street drug supply makes drug use in Philadelphia far riskier than ever before. At this time of unprecedented drug use-related deaths, the goal should be to eliminate all barriers to accessing treatment—not to erect new ones.”
Sure enough, prohibiting smoking is proving a deadly obstacle to drug treatment. In 2020, nurse and harm reductionist Bill Kinkle wrote for Filter about how his friend, Bobby, died of overdose after refusing treatment because of the ban.
* Data from the study were presented by Dr. Borhman and Brooke Feldman to DBHIdS Commissioner Dr. Jill Bowen and CBH CEO Dr. Faith Dyson-Washington at a meeting on July 23, 2021. After no action was taken, the data were submitted for the public record at the August 12 HHS Council hearing in Kensington. The study is currently being written prior to submission for publication.