‘I worked at a fantastically well-funded needle exchange, and we might see 100 to 150 people a day,’ says Smoke Works executive director Jim Duffy. ‘But we’d walk out the door through a crowd of 20 or more people smoking crack. These were people that we didn’t know – and it was our job to know people.’
The reason they weren’t coming through the door was because they didn’t think there was anything relevant for them at the exchange, he says – which meant they were missing out on all the add-on services it offered. ‘I myself never went into a needle exchange when I was using drugs heavily,’ he states. ‘I smoked, and had something brought me in I would’ve found free and anonymous HIV testing, I would’ve found bad coffee and good people, and all the things that make a welcoming environment – somewhere to bring problems that usually don’t get answered elsewhere.’
NO EASY ANSWERS
It was while working at Boston’s AHOPE exchange that he and co-founder Nate got the idea for Smoke Works, a harm reduction organisation that provides pipes and other smoking equipment, alongside training, technical assistance and advocacy. ‘With stimulant use at the time, it was almost like people were afraid of it,’ he says. ‘There was a perception that it was easier to work with people on opioids, whereas the presentation alone with stimulants made people nervous.’ There were also ‘no easy answers’, he adds – ‘no silver bullet in case of emergencies, like naloxone.’
Another disincentive to incorporating services for people who used stimulants was that it meant redefining job roles, he says. ‘We were serving people who use opioids, and that’s a specific demographic, but we needed to be serving the entire community of people who use drugs. That’s a challenge for a lot of folks. But obviously most of our people were already on more than one substance, and we just couldn’t address it with them – we didn’t have the tools.’
BUYER’S CLUBS
They began sourcing and distributing pipes on their time off from AHOPE, and in 2020 developed the first of their ‘buyer’s clubs’ where different harm reduction organisations would pool their resources to get more pipes for a lower outlay. As the demand continued to grow, they also began to channel the profits back to underfunded harm reduction groups to help them provide food, shelter and care to their clients.
‘In the early days, when there was less structure, if somebody that we worked with was trying to find housing for someone after an emergency, or a bail fund, abortion fund, or healthcare drive, we could just throw some money,’ he says. ‘And that was a cool thing to do, because all that was based on pipe sales.’
MUTUAL AID
This evolution from buyer’s clubs to a mutual aid model happened ‘really organically’ he says. ‘I can’t say enough that it’s at the behest of the community we serve.’ Previously, when AHOPE had obtained private funding to start distributing some pipes in 2020 his job had ‘got easier, because I had something to offer more people when I went out to meet them’, he says. ‘And we learned quickly that as much as we thought we knew everything, we didn’t realise that not everybody wants to inject. So the effect was immediate, and the effect was huge.’
In the first three months of pipe distribution at AHOPE, people brand new to the exchange were coming in ‘just for pipes – nothing else, no injection supplies’ and 50 per cent were leaving with naloxone, he states. ‘These were communities that we weren’t getting naloxone to, and this was during the period of fentanyl being found in stimulants.’
FENTANYL CONTAMINATION
When he’d started working in needle exchange two years previously it was ‘just at the point that fentanyl contamination in the local drug supply was becoming a major issue’, he says. ‘It was turning into saturation – arguably a safer place to be, because there was less mystery about what people were ingesting. But I saw the injection rates increase dramatically – from three to five times a day for heroin to 15 to 20 for fentanyl – and it seemed like we just weren’t addressing that. There were other, less risky, options than injection, but we weren’t offering them. And that seemed like a disservice to people, letting their needs go unmet.’
He and Nate began distributing pipes from a basement in evenings and on their days off from the exchange. ‘I’d take a personal day to take receipt of a pallet, and hopefully it would show up,’ he says. ‘We’d clock out of the needle exchange and start packing up pipes. And eventually the larger institutions started calling, because people had been talking about the need endlessly.’
HOSTILE ENVIRONMENTS
Before long they’d managed to find pipes ‘at the right price point, so that we could get them out to people for less’ he continues. ‘So when we started buyer’s clubs, we just got on Instagram and the people who responded were the folks doing this work in some of the most hostile environments, without any institutional funding.’ Many were working at full-time jobs to fund the distribution they did ‘out of the trunk of their car on the weekend’, he says. ‘Here we were at this well-funded exchange in Boston, and the inequity of services was just so stark.’ It was this that made him determined that ‘everything we built was to support those smaller groups’, he states. ‘It was one less thing that those folks with no money had to struggle to find.’
They partly achieved this through selling a range of Smoke Works merchandise – t-shirts, badges, even COVID masks – to cover the shipping costs, and eventually ‘stumbled into this system of prioritising those smaller, independent groups working where there’s no other services.’ The larger institutions would pay, allowing them to keep sending out free supplies to the smaller organisations. ‘That’s developed over the years, but it’s still the core mission,’ he explains. ‘To sell pipes so we can also give them away.’
By early 2022 he was able to quit the needle exchange – ‘a tough decision’ – and turn Smoke Works into a full-time operation. It has since moved fully beyond the earlier mutual aid model and concentrated its efforts exclusively on pipes, understanding that while there’s ‘no end to any need, we’re best if we stay in our avenue. So now everything we do is specific to free pipes.’
PUBLIC PERCEPTIONS
When it comes to public perceptions and media reporting – and obviously the two are very closely linked – it seems that while most people probably now regard traditional needle exchange as something beneficial and relatively uncontroversial, pipe distribution can seem a step too far. Why is that?
‘Sometimes I think that if we’d had pipe distribution for the last 30 years and were just now introducing syringes, it would be the same,’ he says. ‘But I’m going to point the finger towards ourselves. For decades we’ve been advancing access to harm reduction services in general, and we’ve gotten to people having at least a passive acceptance of the value of needle exchange by pointing to HIV prevention. That justifies the work they might not otherwise see the value in, and that’s completely valid – it’s the foundation of harm reduction internationally. But we failed to evolve the definition of harm reduction over time to really illustrate what’s offered in a needle exchange. If we had a more robust definition, people would see the value of safer smoking as well.’
Since pipe distribution can’t be as straightforwardly linked to HIV prevention – ‘you can, you just can’t do it as quickly’ – people won’t necessarily see the same tangible benefit. ‘But in reality when there’s a headline about needles in the park or an outcry over public injection, I just want to say “let’s get more pipes into the community!”. And when there’s a financial argument I want to say, “let’s get something that’s reusable, compared to an immediate biohazard, into the community”.’
Is he hopeful that it will all become less controversial in time? ‘Wouldn’t that be nice? But if ten, 15 years ago we were able to sit down and see the overdose numbers that we see now we’d also optimistically have said that access to services would rise as well – and it hasn’t necessarily. There’s been expansion based largely on naloxone distribution and incorporating that into existing frameworks, but there’s a backlash to everything too – where people see harm reduction as the enabling movement in a time when we should be pushing people towards recovery.’
UNDER THE RADAR
Their relationship with the city and state authorities has been mostly supportive, however, he points out. ‘Maybe we’re a little spoiled in Massachusetts. Our early goals at Smoke Works were to affect paraphernalia laws and be heavy into advocacy, but we realised there’s a quieter path that can have better results – because all of those avenues require House and Senate support, as well as headlines. What we got in Massachusetts was some passive state support and an allowance to spend money on injection alternatives.’
The value of that was more important than ‘changing the paraphernalia laws, that most people didn’t know how to interpret anyhow’, he says. ‘So those have been some of the larger wins for us – a handshake deal with a sheriff somewhere, or the board of health saying “we see the value”. The laws will always lag behind harm reduction, but Massachusetts has been really supportive. They see the effect – I just wish that were replicated everywhere.’
That’s not to say there haven’t been challenges, including being blocked by the company processing their payments and having $5,000 worth of equipment impounded by customs officials and never returned. He remains philosophical, however. ‘Some of what we’ve encountered is probably par for a small business. We’re pretty insulated overall – I just wish we could act in a way that would shield the programmes we work for, because they’re the ones who end up taking the majority of the heat.’
Smoke Works always ensures that it works closely with client organisations to equip them with the conversation points that help to illustrate the benefits, he says. ‘We try our best to make leading research available, and when we have a new customer one of my first questions is “who in your organisation is on board? Who isn’t? And would you like us to come in and talk about the larger picture?” Because if ten years ago you’d told me about pipe distribution I don’t know where I would have been on it.’
CRANK CALLS
While there’s been some inevitable negative press coverage, they’ve mostly ‘dodged it by a hair’, he says. ‘But that might not last forever, and we’re kind of prepared for that. A few years ago our URL was visible in a picture on the front page of the New York Post, but just ever so slightly obscured. We got some crank calls, but frankly they were funny. The brunt of it, unfortunately, is taken on the local level by the organisations doing the outreach and actually connecting with people.’
Is he worried that things could start to get very uncomfortable with the current administration? ‘We’re concerned, I can’t lie,’ he says. ‘We know this is on the radar of some folks in the administration, and it seems like things move very quickly from a local headline to Fox News to the president’s desk these days. That’s not lost on us, which is why we really value the silence around our work because it means we can move quicker.’
But that inevitably also presents a problem when it comes to advocacy, he points out. ‘If the New York Times called us tomorrow and said “we want do a cover story on how awesome pipe distribution is”, I’d think twice. Which is a really shitty place to be in, right? But the advocacy really comes down to the folks on the front lines. They’re doing the heaviest lifting.’
Jim Duffy spent several years working in outreach and syringe service programmes in the Boston area, before turning his focus to promoting novel harm reduction interventions through Smoke Works.
He is one of the speakers at this year’s DDN Conference in Birmingham on 10 July. For more information and to book your place visit drinkanddrugsnews.com/ddn-conference-2025/