A new statewide survey of people who visit needle exchange sites finds Washington is shifting away from injecting and toward smoking drugs, even as methamphetamine remains the most commonly used substance. Harm reduction workers and researchers say that shift is already reshaping outreach in shelters, outreach vans and downtown drop-in spaces.
The findings come from the University of Washington’s Addictions, Drug & Alcohol Institute’s 2025 WA State Syringe Services Program Health Survey, which collected 1,694 eligible surveys from clients at 24 programs across 24 counties between September and November 2025, according to the University of Washington’s Addictions, Drug & Alcohol Institute. The report found that 90% of respondents had smoked an opioid or stimulant in the past week, while 44% reported injecting a drug in the past week, and that methamphetamine was the most commonly used drug overall.
“Getting smoking supplies is why the majority of people are showing up at these sites today,” Caleb Banta-Green, a lead author on the survey, told KOMO News. Coverage of the report points to a sharp split in recent injection by program type: 35% at sites that offer safer smoking kits compared with 70% at sites that do not, a gap researchers described as an “extremely compelling” indicator that pipe distribution changes behavior.
Smoking supplies and harm reduction
Programs that add pipes, foil and heat-protective mouthpieces say the kits draw people in for naloxone, wound care and referrals, widening opportunities to connect clients with health services. A recent peer-reviewed analysis found that distribution of safer smoking supplies at syringe services programs was associated with increased participant encounters and greater naloxone distribution, lending national support to Washington’s local findings (PubMed Central). At the same time, the Washington State Legislature has moved to clarify protections for public health programs that distribute smoking equipment and drug-testing supplies, reducing legal uncertainty for providers (Washington State Legislature).
Housing and treatment demand
The survey also highlights how tightly substance use and housing insecurity are linked: 53% of respondents described themselves as homeless and another 23% reported temporary or unstable housing. Participants reported strong interest in services at programs, including 53% who wanted drug testing, 75% physical health care, 69% mental health care, 42% who indicated interest in methadone and 26% in buprenorphine, figures detailed by the University of Washington’s Addictions, Drug & Alcohol Institute.
Public health officials say the shifting patterns mean syringe services programs have to keep adapting. Safer smoking kits can lower injection-related infection risk and open doors to treatment, but smoking does not remove overdose risk. Local program reports and Public Health - Seattle & King County data indicate these distribution strategies increase service engagement while underscoring the need for drug-checking, naloxone, housing supports and low-barrier treatment alongside harm reduction supplies (Public Health - Seattle & King County).
