by George Karandinos, MD, PhD1,2; Travis P. Baggett, MD, MPH1,2,3; Daniel Ciccarone, MD, MPH4 – March 16, 2026
The US is experiencing a historically unprecedented large-scale shift from opioid injecting to smoking. The US Centers for Disease Control and Prevention reports that more fatal drug overdoses now involve smoking than any other route of administration. Previously thought to be rare in the US, opioid smoking appears to be growing in nearly every US state. Its geographic spread, though, has been heterogeneous, initially increasing and reaching its highest prevalence in the Western US. Recent qualitative studies have explored the motivation for this trend. These studies report that many individuals who smoke opioids perceive that smoking instead of injecting reduces their risk of overdose, infections, and wounds, minimizes the frustration of repeated injection, and avoids injection-related stigma.
Source: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2846283