BACKGROUND: People who smoke crack cocaine face significant health risks, including communicable diseases and damage to respiratory health, particularly when using shared or homemade equipment. Despite this, there are currently no targeted harm reduction interventions in Wales for this population. This unique study demonstrates how Health Impact Assessment (HIA) can be used as a process to highlight the wider impacts of a proposed harm reduction pilot of the provision of safer inhalation devices (SIDs) in Wales, and how it has informed future actions and implementation of the scheme.

METHODS: A participatory HIA was conducted using a structured process facilitated by the Wales Health Impact Assessment Support Unit (WHIASU). Stakeholder engagement included a workshop involving service providers, public health professionals, and individuals with lived experience of crack cocaine use. The process utilised HIA checklists to systematically assess the potential health, social, and economic impacts of implementing a SIDs pilot, as well as unintended consequences.

RESULTS: The HIA identified a range of positive impacts associated with SIDs, including reduced risk of infections, decreased use of unsafe inhalation equipment, and increased service engagement. Participants emphasised the intervention's potential to reduce stigma and enhance trust, particularly for women, parents, and individuals with a history of adverse childhood experiences. Challenges were also recognised, including potential service strain, funding sustainability, and access barriers for rural populations. Suggested mitigations included mobile outreach and home delivery models. The HIA also highlighted the importance of including lived and living experience to inform future monitoring and service design.

CONCLUSION: This HIA underscores the potential value of an SID pilot in Wales as a means of addressing a critical service gap and reducing health inequalities among people who smoke crack cocaine. It demonstrates the utility of HIA in identifying both potential positive and negative impacts, and in shaping harm reduction strategies that are inclusive, and evidence informed. The findings provide a foundation for pilot implementation and evaluation, as well as a model for integrating HIA into broader public health initiatives and holistic harm reduction services.