Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" from her crack pipe, a piece of Brillo pad the size of her fingertip. She complained of "burning" in her throat, a foreign body sensation, and change in her voice, but no dyspnea, dysphagia, or abdominal pain. On physical examination, she was afebrile with a pulse of 105 beats/min and respiratory rate of 24 breaths/min. She was tearful and spoke in a whisper. There were no visible oropharyngeal burns and the lungs were clear to auscultation, but she had intermittent inspiratory stridor. The O2 saturation was 96%, and the ethanol concentration was 100 mg/dl. No foreign body or burn was seen on indirect laryngoscopy. A lateral neck x-ray study showed a normal epiglottis and no foreign body. Chest x-ray studies were unremarkable. Fiberoptic laryngoscopy showed left posterior arytenoid edema and swelling. An abdominal x-ray study revealed a foreign body in the right lower quadrant consistent with the Brillo pad filter. The next morning, the patient was asymptomatic and was discharged, recovering without sequellae. While crack pipe screen aspiration is a rarely reported event, physicians should be aware of the potential for foreign body aspiration and ingestion by this mechanism.
Brass screens are considered an essential part of the safer drug smoking/inhalation supplies and are widely distributed by harm reduction programs in Canada. However, the use of commercially available steel wools as screens for smoking crack cocaine remains a common practice among people who smoke drugs in Canada. Use of these steel wool materials is associated with different adverse effects on health. This study aims to determine what changes folding and heating have on several filter materials, including brass screens and commercially available steel wool products, and examine the implications of these changes on health of people who smoke drugs.
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This study investigated the microscopic differences, studied by optical and scanning electron microscopy, between four screen and four steel wool filter materials used in a simulated drug consumption process. New materials were manipulated, compacted into its own Pyrex straight stem using a push stick and then heated with a butane lighter simulating a common method in preparing drugs for consumption. The materials were studied in the as-received (new), as-pressed (compressed and inserted into the stem tube but without heating) and as-heated (compressed and inserted into the stem tube and heated with a butane lighter) conditions.
A study by Boyd et al. [27] found that the most commonly reported factors associated with the preference for Brillo over brass screens among people who use drugs were: easier handling when in a rush, shorter time to insert Brillo in the stem and long-lasting habit of using Brillo. The same study found that the changes in drug smoking practices are less likely to occur if harm reduction equipment requires more time to use, is awkward to use, hinders consumption or leads to loss of the drug [27]. Hopkins et al. [21] attributed the continued use of metal wools such Brillo to its ease of use. The research highlights the importance of repeated messaging about safer crack use from peers and outreach workers and providing education to clients about advantages and preparation methods for brass screens in order to shift personal crack use practices [24, 27]. In order to maximize the use of safer smoking/inhalation supplies, the supplies should be designed to meet the needs of people who smoke drugs. Understanding and documenting the difficulties that people who smoke drugs experience when handling and using the supplies could inform the design of harm reduction supplies to maximize their adoptability and use [28].
Steel wool products are not designed to be used as screens for smoking drugs, and they are more likely to disintegrate faster when being handled and inserted into the stem and heated then brass screens, the latter which are distributed by harm reduction programs. When smoking drugs, these steel wool products may break apart into fragments which are then inhaled and can cause injuries to the oral cavity, larynx and lungs [7, 14,15,16,17,18, 29,30,31,32,33,34]. Several studies reported that negative health consequences associated with using Brillo for smoking drugs are common among people who use drugs and include: inhaling the whole Brillo screen, developing burns and cuts on lips, developing cuts on fingers when handling Brillo and breathing difficulties [17, 20, 24, 27, 33, 35]. In a study about structural inequities influencing the health of street-involved women who use illegal drugs in Vancouver, 51 (41.1%) women who smoked crack cocaine of total 126 participants reported inhaling Brillo in mouth, throat or lungs in the past year [20]. The black sputum (phlegm), that was reported by 75% of participants in a study of respiratory issues among people who smoke crack cocaine in Toronto, might be caused by the inhaled burnt steel wool fragments [36].
Brass screens distributed by harm reduction programs are less likely to break apart than steel wool or Brillo and are not coated with potentially toxic substance [24]. Some commercial steel wool products are coated with substances, such as soap and cleaning products that could be inhaled when the product is heated (e.g. Brillo and Chore Boy) [1]. Additional harms associated with steel wool use include inhaling toxic volatile organic carbons released when steel wool is burned [37]. Often, people who smoke drugs will heat the steel wool with a lighter to burn off the coating before using it as a screen for the first time. If a client is unwilling to use brass screens rather than steel wool, some harm reduction programs encourage their clients to place brass screens between the steel wool and the mouth or wrap steel wool in brass screens to act as a barrier for loose shards [37].
This study examines the effects of folding and heating on several types of brass screens that are distributed by harm reduction programs and potentially unsafe but commonly used screen alternatives like steel wool products. This study examined the behaviour of brass screens and steel wools when exposed to heat in the simulated process of smoking crack cocaine. The experiments were performed in the absence of drug because the focus was on how the behaviour of the equipment used for smoking crack cocaine during the drug preparation process (manipulation and heating of brass screens and steel wools) has implications on safer drug smoking practices. To our knowledge, no study has sought to characterize filter materials commonly used for smoking drugs and effects that folding and heating in a straight stem pipe have on these materials. The over-arching objective of this study is to identify what filter material characteristics might give people who smoke drugs the best and safest experience.
Eight filter materials and related supplies were procured by OHRDP for the investigation. The materials included four screen and four wool materials, new Pyrex stems, birch push sticks and BIC Mini butane lighters. The complete list of filter materials received for study is shown in Table 1 and is shown in their original packaging in Appendix A. All as-received filter materials were brand new, unused and clearly labelled, but without information about the original manufacturers.
The materials were studied in the following conditions: 1) as-received (in their unused and from the original packaging condition); 2) as-pressed (manipulated by hand and positioned in the stem using a push stick; the materials were positioned in the stem using a simulated screen preparation and positioning process and examined before heating the stem); and 3) as-heated (after heating the materials in the straight stem with a butane lighter during a simulated drug consumption process). All materials in all three experimental conditions were examined without drugs present.
The stainless steel pellet screen was the easiest material to manipulate and press into the Pyrex tube while the CleanZ ribbon was the most difficult. The steel wools broke into smaller wire fragments or debris during pressing into the tube, while the brass screen materials remained mostly intact after the deformation. The screen materials surfaces and wire shapes remained unchanged after 20 s of heating, but the Bull Dog, Rhodes American and S.O.S steel wool materials ignited and burned during heating leaving oxidized surfaces and brittle wires with resolidified ends that could easily tear off and be inhaled/ingested when smoking/inhaling drugs. The residues from steel wool screens remain on the inside wall of the Pyrex stem and are likely be scraped off in the process of recovering drug residues and could be then inhaled when drug residues are smoked.
Except for the stainless steel pellet screen, the other filter materials were developed for other applications in mind and are used ad hoc for drug consumption. It is highly recommended that filter materials be specifically designed for safer drug use by clearly defining the function of the filter and considering feedback from people who smoke drugs on its use.
A limitation of this study is that we were not able to investigate the effect of vapourizing an actual drug on the filter materials. Further research is needed to examine the chemical reaction of the specific drug vapour on the metal alloy screen during heating which should be investigated to confirm the stability of the filter materials and its effect on the drug. Another limitation of the study is an unknown effect in the presence of the drug vapour which is the possible condensation of the drug vapour on the filter wires on cooling. We hypothesize that, assuming constant wettability for metal surfaces, the amount of drug lost by coating the wires increases as the wire surface area to volume increases like for the steel wools with significant surface roughness. If this coating effect does occur, more of the drug would remain trapped in the screen and the intensity of drug effect would be decreased for the wools compared to the screen filter materials. In addition to this effect, once the crack cocaine has been smoked, the push stick is used to push the filter up the tube in order to partially recover the residual crack cocaine vapour condensation that has hardened on the inside wall of the Pyrex stem as the pipe cools. We hypothesize that drug condensate on the interior wire surfaces would not be recovered by this scraping action reducing the amount of drug that would be available to the user. be457b7860
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