
By Erica C. Barnett
Earlier this month, King County Council budget chair Rod Dembowski quietly slipped an amendment into a nearly 400-page supplemental budget proposal that would prohibit the county from spending any money buying or distributing safer smoking supplies, such as pipes and foil, to drug users.
The county’s public health department only runs one needle exchange, where drug users can also access services and treatment medication, but the county distributes supplies to nonprofits that provide similar services, making the potential impact far more significant than the small amount—around $14,000— the county has spent so far this year on pipes and smoking supplies.
King County Public Health (KCPH) estimates that staff distribute safer smoking supplies at the downtown needle exchange for 15 to 20 hours a week, “translating to an estimated $83,000 annually for staff time,” according to KCPH spokeswoman Sharon Bogan. “During these interactions, staff are also connecting individuals with tools to prevent overdose, offering connections to treatment, and addressing client needs,” Bogan said.
King County hands out some of these supplies at its own needle exchange, downtown, and also distributes them to other organizations, including the Hepatitis Education Project and the People’s Harm Reducation Alliance.
Dembowski did not respond to several requests for an interview.
Opponents of harm-reduction approaches, such needle exchanges and the distribution of overdose reversal drugs, argue that making drug use safer merely “enables” drug users to stay addicted. The Trump administration has aggressively rejected harm reduction in favor of punitive approaches, including in recent policy guidance for federal shelter and housing funds.
King County, however, has long embraced harm reduction, which reduces the spread of infectious diseases like HIV and attracts drug users who would not otherwise come in contact with health care and treatment providers. The downtown needle exchange, for example, provides treatment referrals and “warm hand-offs” to the Pathways treatment clinic located in the same location; refers people to detox and medication-assisted treatment; provides case management and connections to housing, food and shelter; and hands out the overdose reversal drug Narcan, among other services.
“Distributing pipes and foil allows Public Health to build trust among people who use drugs. By building this trust, we can reduce preventable deaths, interrupt the spread of infectious diseases, and serve as a bridge to treatment and recovery,” Public Health’s Bogan said. “Discontinuing pipe and foil distribution means that we will lose our connections to people in our community who use smoking supplies and do not inject and who rely on our services.”

Caleb Banta-Green, a research professor at the University of Washington’s Addictions, Drugs, & Alcohol Institute (ADAI). said he “was saddened and surprised to see King County do something that appears to be following in the footsteps of the federal government’s really ill-informed approach.” When politicians actually visit harm reduction programs in person, he said, they often change their minds, “because it’s not just giving things to people. It is health promoting and it is literally about engagement and helping people.”
A survey ADAI conducted last year found that in 2025, opiate and meth users overwhelmingly switched from injecting drugs to smoking them, a change (compared to ADAI’s 2015 survey) that corresponded with a dramatic reduction in people showing up at sites that provided clean needles.
In King County, the reduction in injection drug consumption led to a reduction from 25,000 annual visits, or “encounters,” with the public needle exchange program to a low of 12,000 in 2022. After the county began handing out pipes and foil, that number rebounded, from 20,000 in 2023 to 60,000 in 2025, according to the county’s public health department.
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“There has been a dramatic shift in a decade from heroin to fentanyl, and from injecting to smokin—that is how people are consuming substances, and if we want to keep providing public health services for people who consume substances, we have to be adapting to that,” Banta-Green said.
Smoking from dirty or broken pipes, or using cheap, thin foil as a smoking surface, both pose their own safety risks, such as facial wounds and burns—making it a good idea for drug users to replace pipes and only use thick, high-quality foil. But coming in for safer supplies has another benefit, ADAI’s research found: It keeps people from injecting drugs, which is much riskier and can lead to abscesses, infections, and collapsed veins.
At needle exchange sites that didn’t offer smoking supplies, participants were far more likely to have injected drugs (70 percent) than at sites that offered smoking supplies (35 percent), according to the survey. At those same sites, 83 percent of participants said they would “like to get free, clean pipes or foils to smoke opioids, cocaine, or meth,” and 75 percent of the people who injected drugs but were interested safer smoking supplies said they would “inject less often” if smoking supplies were available.
“All of the evidence points to the same thing, which is when you make smoking supplies available, people will inject less, and if you take smoking supplies away, people will start injecting more,” Banta-Green said.
The county council is scheduled to vote on the full supplemental budget next Tuesday.





