“If ye want tae live smoke foil”: Experiences of smoking heroin and its potential to reduce injecting-related harms

Objective: Explore the views and experiences of people who use drugs around the use of foil for smoking heroin, including its potential to reduce injecting-related harms.
Methodology: Qualitative, semi-structured interviews with 36 people who use drugs. Interviews were transcribed in full and a thematic analysis conducted. People with experience of heroin use, staff from harm reduction/recovery services, and academics formed the Research Advisory Group, and participated in an engagement workshop to develop recommendations from the findings. Ethics approval was granted by the NHS and the University of the West of Scotland.
Findings: Participants gave diverse rationales for the decision to smoke heroin in place of, or alongside, injecting drugs, with many engaging in complex patterns of polydrug (and ‘polymethod’) use. Many smoked in order to reduce or avoid injecting-related harms, such as overdose, blood-borne viruses, and skin and soft tissue infections. At times, accounts of smoking heroin highlighted pleasure, convenience, social context, and general preference above the reduction of risk, although avoiding harm was often viewed as a secondary benefit. Several participants described poor respiratory health, at times associated with heroin smoking. The study further highlighted several barriers and facilitators to the uptake of foil from Injecting Equipment Provision (IEP) services.
Conclusion: Findings provide innovative insight into the breadth and complexity of experiences of smoking heroin, including the place of foil in evolving patterns of substance use. The study underscores the importance and potential of foil in reducing injecting-related harms, alongside the need to broaden harm reduction responses. This includes, for example, offering more choice in foil types, improving the accessibility of IEP services for people who use heroin, and improving access to respiratory health checks.