Smoking Surpasses Injection as Leading Ingestion Method in Overdose Deaths

A recent CDC study has shown that more people appear to be smoking fentanyl than injecting it, and it’s killing them.

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. 

1 comment
    I am stunned by the referenced page from the University of Utah for a number of reasons:
    (1) It provides absolutely no scientific references for its supposedly ‘factual’ statements about drug administration and activity.
    (2) It directly contradicts itself regarding one of those facts; showing an illustrations of someone smoking a drug labelled 1 next to its brief discussion about The Fastest Way to the Brain and someone snorting a drug labelled 2 !!!
    (3) It is simply not true that smoking is a faster route to the brain for drugs. IN FACT drugs that are injected intravenously (I.V.) follow a route straight to the heart & lungs and then straight to the brain. Thus there is almost no difference in delivery time (milliseconds) between those routes (the lungs surface actually slowing absorption rate compared to I.V.) and this has been demonstrated in many published human (& other animal) studies on the topic eg. see the The pharmacology of cocaine smoking in humans by Jones RT in the 1990 U.S. government Printing Office paper Research Findings on Smoking of Abused Substances. National Institute on Drug Abuse Research Monograpgh 99 Chiang CN, Hawks RL (editors) which found that for Cocaine (smoking freebase vs injecting HCl salt) “Time to peak is nearly as fast by smoking as by injection.” In other words injecting cocaine produces a faster peak blood concentration (& corresponding brain conc) than smoking it, not the other way around.
    (4) There are vast numbers of research and discussion papers published (as well as anecdotal reports in the regular media) regarding how many Heroin users started their habit by smoking the drug, but then progressed to I.V. usage because it gives a greater and more efficient ‘hit’. Smoking actually DESTROYS a significant proportion of ANY drug consumed by that method and is therefore much more wasteful, particularly if the user has a poor technique and/or has poor smoking apparatus. In this context what is often described as ‘smoking’ is actually a crude form of vaporising (which is not smoking), for example the common method of Heroin consumption referred to as ‘chasing the dragon’, where the user heats the drug on aluminum foil and ‘chases’ the vapor by inhaling from a straw (often missing/losing a substantial portion of the vapor).
    I would strongly suggest that people are smoking drugs simply because both it is much easier to obtain smoking paraphernalia (eg Al foil, glass light bulbs & glass tubes) than injection apparatus and there’s a stigma (partially deserved when you consider HIV & hepatitis) with sticking a needle in (usually) a persons arm.
    As to the illustration showing how different brain regions (which were unnamed) react to drugs differently via different administration routes; that’s also a substantial exaggeration/distortion of the truth and in the comparison of I.V. vs Smoking is basically not true, since they’re virtually identical.
    Smoking definitely kills users because its delivers a large ‘bolus’ of drug to the brain rapidly, but it is NOT FASTER than I.V. injection of the same drug (other injection routes such as subcutaneous & intramuscular are much slower).

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