Against the advice of health experts, the province of Saskatchewan, Canada, decided in early 2024 to stop distribution of safer smoking supplies for people who use drugs. Months later, people who work with drug users say the policy has predictably led to an increase in injecting and riskier drug-use behaviors.
The Saskatchewan government began a program in November 2018 to distribute smoking kits including sterile pipes, in an effort to prevent HIV and hepatitis C transmissions from people sharing injecting equipment. The kits could be distributed by existing syringe service programs, providing an option for people injecting drugs to switch to smoking.
But in January, the province announced it would stop distributing sterile pipes. It now prohibits independent providers from handing them out if they receive provincial funding. “Providing crack pipes and instructions on how to use illicit drugs sends the wrong message. It’s giving individuals the impression that using illicit drugs is somehow safe or condoned,” Saskatchewan Mental Health and Addictions Minister Tim McLeod told CBC in January.
Saskatchewan also implemented a a “one-to-one” restriction on syringe provision. This means that only one sterile syringe can be given out for each used syringe returned—falling far short of the recommended needs-based provision to maximize protection for people who inject.
Harm reduction providers blasted the province’s new policy. The Saskatchewan Union of Nurses also criticized the approach, saying it was “gravely concerned.” The union noted that provision of sterile smoking equipment is an evidence-based practice to reduce harms, and called one-to-one syringe distribution “an outdated and ineffective practice” that “puts communities at elevated risk.”
“The ban on the supplies makes it more difficult for those using drugs to choose to smoke instead of the alternative of injecting.”
The new policy also bans use of public funds to distribute educational materials about smoking drugs, in what one harm reduction worker called a “book burning.”
Advocates are deeply concerned that grave public health situations in the province are now worsening. Saskatchewan already had Canada’s highest rate of new HIV diagnoses, according to 2022 federal figures—about four times the national rate. Regarding overdose deaths, local outlet CJME reports that an estimated 174 people had fatally overdosed in 2024 as of May—more than one person per day, and putting the province on course for another record high.
“The ban on the supplies makes it more difficult for those using drugs to choose to smoke instead of the alternative of injecting,” Miranda Deck, engagement manager at Prairie Harm Reduction in Saskatoon, told Filter, noting that making this switch can reduce risks. “The ban also makes it more difficult for organizations like ours to provide all the services to the roughly 300 people a month that we see who access our services. Instead of having a program like this funded as it had been since 2018, we are now in the position to pay out-of-pocket for these supplies, which adds a cost of $24,000 a year.”
“After the free pipes were implemented in 2018—a process that took five years—our organization saw a huge increase in people coming in to access services and connect with case managers and the harm reduction group’s support team,” she continued.
“Safe smoking supplies [also] gives people accessing our site the opportunity to use our smoking room,” she added, and “doing so [ensures] people are using new equipment … whichever drug they are choosing to use.”
Others who work with people using drugs are also concerned. Angela Chernoff, a shelter coordinator for Bruno’s Place in Yorkton, told Filter that since this policy change, she has anecdotally observed a rise in injecting and risky practices, like reusing and sharing syringes, among clients.
“We’ve had two clients through here that had very scary foot infections, that posed a health risk,” she said. “We know that once you start running out of places to use you go for the veins in your feet. That puts a burden on acute care, and a demand on the health system.” Chernoff is additionally worried about the impact on her area’s high HIV rates.
“We have run specific fundraising highlighting the Pipe Prohibition to help us cover the cost of the supplies that we do not receive funding for anymore.”
While pulling away from harm reduction, the provincial government is simultaneously investing in what it calls its Recovery-Oriented System of Care model. It plans to spend nearly CA$50 million to provide 500 new substance use treatment beds and a central intake system allowing self-referrals. The province describes this as a “holistic, flexible, and individualized approach,” including detox, inpatient treatment and supportive living. Though mostly abstinence-based, the plan does include more access to medications for opioid use disorder, including for people in, or recently released from, prisons and jails.
Chernoff is cautiously optimistic about some elements of this—she said that some facilities have opened or expanded, though there’s been no direct financial impact for her shelter yet. “The missing link in all this is we don’t have good continuation of care in this province,” she said. “So I’m going to go to medical detox for seven days, then I’m out and I’m waiting on a referral to a treatment center,” a period when people are often very vulnerable.
Beleaguered harm reduction providers like Prairie Harm Reduction are meanwhile having to find ways to adapt in order to meet acute needs for people who use drugs.
“We as an organization are continuing to provide the supplies that we have always provided at our safe consumption site,” Deck said. “We have increased our fundraising initiatives to help cover some of the cost that these changes have forced us to make, and have run specific fundraising highlighting the Pipe Prohibition to help us cover the cost of the supplies that we do not receive funding for anymore.”
Photograph by Jlcoving via Wikimedia Commons/Creative Commons 3.0
