The landscape of drug consumption in the United States is undergoing a significant transformation, as a growing number of users are opting to smoke opioids instead of injecting them. This change is particularly notable in the context of the ongoing fentanyl epidemic, which has had devastating effects on communities across the nation. In cities like Philadelphia, this shift has been observed since the onset of the COVID-19 pandemic, altering the way harm reduction services are delivered.
Megan Merrill, a recovery advocate from SOS Recovery in Rochester, New Hampshire, illustrates this trend as she distributes harm reduction supplies, including glass pipes, to individuals living in a nearby homeless encampment. “You’re going to see less vein damage, you’re not going to get abscesses on your arm or infections,” Merrill explains, emphasizing the health benefits of smoking over injecting. This perspective aligns with a broader understanding among harm reduction advocates that smoking can mitigate many of the health risks associated with intravenous drug use.
The preference for smoking opioids has emerged organically as users react to the changing drug supply. As heroin has largely disappeared from the market and fentanyl has become the dominant substance, users have adapted their consumption methods to avoid the severe health consequences linked with injection. The presence of xylazine, an animal tranquilizer that can cause severe skin lesions, has further motivated users to abandon needles.
According to Caty Simon of the National Survivors Union, this shift reflects a self-protective behavior among drug users. “One of the basic mottos of harm reduction is ‘any positive change,’” Simon says, pointing out that this behavioral shift is a testament to the desire for better health outcomes among those who use drugs.
Rising Popularity of Smoking Over Injection
Evidence suggests that smoking drugs may be associated with lower overdose rates compared to injection. Some studies indicate that individuals who smoke opioids could be as much as 30% less likely to experience an overdose compared to their injecting counterparts. This trend is particularly pronounced among younger users and those in regions where smoking is becoming the predominant method of administration.
Dan Ciccarone, a physician-researcher at the University of California San Francisco, notes that smoking fentanyl is more feasible than smoking heroin, as fentanyl’s composition allows for easier consumption. “The drug is cheap enough, and what’s more, it’s bioavailable enough,” Ciccarone states, illustrating how economic factors and drug characteristics influence user behavior.
While the shift towards smoking is viewed positively by many experts, it has also faced resistance. The distribution of “safer smoking kits,” which include pipes, has sparked controversy, particularly among conservative lawmakers. Despite this, organizations like Smoke Works in Massachusetts have successfully expanded their pipe distribution efforts, providing a vital resource for users seeking to minimize health risks.
Implications for Public Health and Policy
The increased prevalence of smoking as a method of drug consumption highlights a disconnect between public health strategies and the realities faced by users. While syringe exchanges are widely accepted, the distribution of smoking supplies often encounters pushback. The stigma associated with smoking, particularly in the context of past drug epidemics, complicates public perception and policy.
Jim Duffy, executive director of Smoke Works, observes that many individuals prefer smoking over injecting and that addressing this preference is crucial for effective harm reduction. “Not everybody wanted to inject,” Duffy explains, noting that many participants in their programs sought smoking supplies exclusively.
Despite the complexities surrounding smoking as a method of drug use, experts agree that it represents an opportunity for improved health outcomes. “If you’re smoking rather than injecting, you’re not going to be transmitting viral infections like HIV and hepatitis,” says Alex Kral, a researcher with RTI International.
As Merrill concludes her distribution rounds, she reflects on the dramatic changes in user behavior she has witnessed over the past few years. She has seen a significant decrease in the number of individuals injecting drugs, replaced instead by those seeking smoking supplies. “We call it safer because you’re not always going to be 100% safe in everything you do, but we can make it safer,” Merrill affirms, underscoring the need for ongoing support and resources for those navigating the challenges of addiction.
The ongoing shift from injecting to smoking opioids presents both challenges and opportunities for public health officials. As the landscape of drug use continues to evolve, understanding and addressing the preferences of users will be essential in shaping effective harm reduction strategies.
