As users turn toward smoking instead of injecting hard drugs, the number of glass pipes recovered on Ottawa’s streets has begun surpassing the number of needles.
Before the pandemic, needle hunters, city staff and the public reported finding a combined 4,704 glass pipes during all of 2019. During the first eight months of this year, they recovered more than six times that many, a total of 28,865.
The number of needles found across the city increased more slowly, and then remained fairly steady over the past three years. It reached 23,848 in the first eight months of 2024.
Harm reduction workers link the shift to the powerful but short-lasting effects of fentanyl.
Rob Boyd, CEO of Ottawa Inner City Health, said people turned to smoking stimulants like crack to balance out and lengthen the effects of fentanyl, which has increasingly taken the place of longer-acting opioid drugs like OxyContin.
That drove up the popularity of pipes. So did the shift to smoking fentanyl itself.
“Fentanyl clears the body more quickly than the other opioids. People had to dose more frequently in order to maintain the effect that they were looking for, so we saw people go from four to five injections a day to nine to 13,” he said.
Injecting so often causes veins to break down, he explained, and they become harder to find for the next hit.
“Smoking became a very convenient alternative,” Boyd said.
Louise Goodman, director of consumption treatment services at Sandy Hill Community Health Centre, said staff noticed an increasing trend toward smoking when the centre’s supervised consumption site temporarily closed.
“People moved to inhalation and then they just stayed,” she said.
In her view, the explanation is partly convenience and partly the toll that injecting takes on the body, including through collapsed veins.
Sandy Hill distributed 35 per cent more inhalation supplies in the first 11 months of 2024, compared to the same period in 2023. Goodman said they sometimes run out. By contrast, injection supplies are actually down 26 per cent, even as the number of people seeking services rises.
While crack users prefer a straight skinny pipe, fentanyl users generally opt for a “bubble pipe” with a bulb at the end. Goodman said that’s now “the most popular thing we give out.”
At Somerset West Community Health Centre, harm reduction workers distributed almost 40 per cent more bubble pipes this October than they did during the same month this year.
Derrick St John, interim manager of harm reduction at Somerset West, agreed that frequent fentanyl use could be part of the story. Pipes are also easier to use and reuse.
But misconceptions are also at work.
“There is some chatter among folks who use drugs that inhalation is safer,” St John said. “That is a little bit of a myth.”
‘Right into the blood, right away’
Despite the surge in pipes recovered on the street, the numbers pale in comparison to the amount of drug equipment safely left in drop-off boxes at the community health centres. There are similar boxes at fire stations, pharmacies, homeless shelters and even the Petro-Canada at Rideau Street and King Edward Avenue.
Together, they handled 3,692 kilograms of waste last year. There’s no way to know how much of that waste is pipes and how much is needles. The drop-off sites are figuratively and literally black boxes, and no one goes sorting through them to count.
But Ottawa Public Health figures about 1.3 million needles ended up in those drop-off boxes last year. Harm reduction facilities collected about 1.1 million more.
“Overall, these figures reflect a successful and comprehensive needle recovery strategy in Ottawa, supported by robust community and partner engagement,” OPH said in a statement.
The boxes might be a mystery, but the other legs of that strategy are not. Starting in November, OPH posted a new interactive map showing where city staff, needle hunters and the public are finding needles and pipes at the neighbourhood and intersection level.
It shows that the overwhelming majority of needles and pipes — 97 per cent — are showing up in just two wards, Rideau-Vanier and Somerset, with hotspots in Sandy Hill, Lowertown, Vanier, Centretown and Chinatown.
The epicentre is a handful of blocks near King Edward Avenue and Rideau Street. The data is reported at the nearest intersection, and needle hunters and city staff recovered more than 12,500 glass pipes at just nine intersections in that area from January to August this year.
Drug users there aren’t shy about explaining their choices.
“I like the immediate effect,” said a woman sitting on a piece of luggage at the corner of Nelson and Besserer streets, taking a hit from a skinny glass pipe. “Right into the blood, right away.”
“I don’t recommend needles,” she added.
Steps away on Nelson Street, another woman said she uses crack 50 times a day and fentanyl 10 to 15 times a day. She fears that injecting fentanyl so often could leave her with collapsed veins and bruises.
“Your veins end up disappearing,” she said. “It’s dangerous, because you get infections.”
And there’s another thing about needles.
“You can overdose way easier,” she said.
Workers call for safe inhalation site as smoking overdoses rise
Boyd agrees that smoking might be less likely to pass on infections, but is it really safer than injecting?
“I think that people also felt that maybe there was less of a risk for overdose, but that’s sadly not the case,” he said. “The risk of overdose is exactly the same.”
Overdose deaths involving inhalation have been trending up in Ontario over recent years, according to St John.
“Just because you’re smoking fentanyl doesn’t mean it is safer,” he said.
Boyd said part of the risk stems from the fact that there is no place for people to inhale drugs in a supervised environment. None of Ottawa’s supervised consumption sites allow smoking.
“We have asked many times for the province to allow us to do smoking in the sites as well, so that way we can monitor and respond more quickly to people,” he said.
“If there’s any delay in that, people are at high risk of injury and unfortunately also death.”
Goodman agrees that the need is “urgent.”
“We are responding to overdoses outside from inhalation,” she said. “It is happening. It’s going to happen more.”
Supervised injection sites also have the advantage of ensuring that needles are used — and disposed of — inside. Goodman suspects an inhalation site could have an impact for pipes, but Boyd said the story might be more complicated.
He said people like to hang onto their pipes for longer periods, especially since they build up drug residue that users scrape away and reuse when they’re dope sick.
“So I wouldn’t want to overpromise in terms of what that would do in terms of publicly discarded smoking equipment,” he said.
What are the dangers for the public?
Boyd said pipes don’t act as a blood reservoir in the same way as needles, so there isn’t the same level of risk of blood-borne illnesses like Hepatitis C. But he said it’s still safest to treat them as a biohazard if found on the street.
“It does carry risk,” St John explained. “Diseases can be transmitted through the saliva or blood from a pipe, so my advice would be to dispose of it safely.”
That means using tongs and, ideally, a sharps container, which harm reduction facilities like Somerset West will hand out to the public. Ottawa Public Health has a map showing where to find those across the city. Another option is calling 3-1-1.
Goodman said drug users have come to understand the importance of not leaving needles on the street, and there might be more education work to do to catch up on pipes.
“It’s just not as common to throw your needles away anymore,” she said. “We had to do education with needles, and now we have to do education with this.”
