Smoking Surpasses Injection as Leading Ingestion Method in Overdose Deaths


More Americans are overdosing and dying by smoking illegal drugs as opposed to injecting them.

Of the 109,000 recorded overdose deaths which occurred in 2022, almost 70 percent involved fentanyl and a recent study by the Centers for Disease Control and Prevention showed that fentanyl users are beginning to favor smoking as their preferred method of ingestion, surpassing those who favor injection. 

“From January–June 2020 to July–December 2022, the percentage of overdose deaths with evidence of smoking increased 73.7%, and the percentage with evidence of injection decreased 29.1%; similar changes were observed in all U.S. regions. Changes were most pronounced in deaths with [illegally manufactured fentanyls] detected, with or without stimulant detection,” the CDC study said.

The study was performed using CDC data taken from death certificates, postmortem toxicology testing, and medical examiner or coroner reports over 28 different police jurisdictions. This collection of data showed that as fentanyl has infiltrated the American drug supply, opiate users have made a distinct and notable transition from primarily injecting heroin to primarily smoking fentanyl. The method of ingestion was determined using information from police investigations, witness reports, and autopsy data.

This data collected from the CDC revealed notable trends. From January 2020 to December 2022, the 28 jurisdictions surveyed recorded 139,740 overdose deaths. Deaths increased 20.2%, from January–June 2020 to July–December 2022 with 21,046 deaths and 25,301 deaths respectively recorded. Deaths involving fentanyl increased by 8.4% over the same time periods from 71.4% to 77.4%. 

The kicker here is overdose deaths with evidence that the user smoked fentanyl increased 109.1% when comparing the two time periods with 2,794 deaths recorded in the first half of 2020 and 5,843 in the second half of 2022. Overdose deaths with evidence of fentanyl injection decreased by 14.6% with 4,780 recorded in the first half of 2020 and 4,080 in the second half of 2022.

“The leading route of use in drug overdose deaths changed from injection during January–June 2020 (22.7% of deaths) compared with ingestion (15.2%), snorting (13.6%), and smoking (13.3%) to smoking during July–December 2022 (23.1% of deaths) compared with snorting (16.2%), injection (16.1%), and ingestion (14.5%),” the CDC study said. “During July–December 2022, most deaths with evidence of smoking (79.7%), snorting (84.5%), or ingestion (86.5%) had no evidence of injection; among deaths with information on route of use, 81.9% had evidence of a noninjection route.”

Contrary to what most current or former drug users may believe from anecdotal data, smoking actually presents a greater addiction potential than injection for most drugs because of the way smoking delivers psychoactive compounds to the bloodstream and subsequently the brain. As such, it can also make it easier to overdose when smoking. As the following language from the University of Utah illustrates, the faster psychoactive compounds make it to the brain the more addictive they are and smoking is the fastest known method of ingestion.

“The fastest way to get a drug to the brain is by smoking it. When a drug like tobacco smoke is taken into the lungs, nicotine (the addictive chemical in tobacco) seeps into lung blood where it can quickly travel to the brain. This fast delivery is one reason smoking cigarettes is so addicting,” the University of Utah said.

The same information from the University of Utah went on to explain that injection is the second fastest way of delivering drugs to the brain, which could at least partially explain why fentanyl users have largely transitioned to smoking in lieu of injecting.

“Injecting a drug directly into a blood vessel is the second fastest way to get a drug to the brain, followed by snorting or sniffing it through the nose. A slow mode of delivery is ingestion, such as drinking alcohol. The effects of alcohol take many minutes rather than a few seconds to cause behavioral and biological changes in the brain,” the University of Utah said.

The CDC said that while injection poses many potential risks in terms of complications from improper injection techniques, infectious disease transmission from dirty needles etc, smoking fentanyl may present an increased risk for overdose. They stressed the nationwide need for education and harm reduction programs to help curb the dramatic increase in overdose deaths America has seen since fentanyl reared its ugly head. 



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