February 19, 2024
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A fast-growing number of fatal drug overdoses in the United States are caused by smoking fentanyl and other substances, according to a CDC report.
Drug overdoses claimed the lives of more than 109,000 people in the United States in 2022, the highest number on record and a stark indication of the toll taken by the nation's opioid epidemic.
Nearly 70% of the fatal overdoses that year involved the synthetic opioid fentanyl and its illegally manufactured versions, according to data from the U.S. Centers for Disease Control & Prevention. The drug has supplanted the less-potent heroin as the dominant opioid found in street drugs and is often mixed with stimulants and other substances, making it particularly dangerous when taken using any method.
But a new report from the CDC shows that that the number overdose deaths caused by smoking drugs has risen rapidly in recent years, overtaking injection as the leading cause of fatal overdoses. The trend has been most notable in cases involving fentanyl — with or without other drugs involved — as deaths caused by injecting drugs have declined.
The CDC examined data on overdose deaths during two time periods — from January to June 2020 and from July to December 2022 — in order to compare how people died and which drugs they took.
From the first time period to the second, there was a 73.7% increase in fatal overdoses linked to smoking drugs, and overall from July to December 2022, smoking drugs was blamed for 23.1% of all fatal overdoses. At the same time, deaths from injecting drugs dropped 29.1%, down to 16.1% of all overdoses during the 2022 time period.
These trends were observed throughout the United States, with the sharpest rise in smoking-related deaths found in the Northeast, the CDC report said. Overdose deaths from snorting drugs also slightly overtook injection nationally, driven by increases in the Northeast, Midwest and South. All regions saw declines in the percentage of fatal drug overdoses caused by injection.
Smoking is the quickest route for drugs to reach the brain, which makes doing so especially deadly when fentanyl is involved and mixed with stimulants that already are more commonly smoked. Heroin is most often injected, but the CDC said the rise in smoking overdose deaths may be partly driven by drug users transitioning to smoking fentanyl that's more powerful and widely available.
The CDC said the trend could reflect drug users trying to avoid problems associated with injections, such as abscesses that lead to infection. This is especially true in places where the animal sedative xylazine is commonly mixed with fentanyl. Xylazine is known to cause skin wounds that are difficult to treat.
It is also possible that drug users are looking for "more control" over how much drug they consume at once and that they want to reduce the damage to their veins caused by injecting frequently throughout the day, the report said.
The changing epidemiology around drug overdoses suggests there could be a need for harm reduction strategies that educate drug users about the specific dangers of smoking fentanyl. Many people who inject drugs choose to do so because existing public health efforts aim to ensure that people don't share syringes, which reduces the risk of blood-borne infections. As smoking-related deaths rise, there's now a greater need for programs that serve people who smoke.
"Some jurisdictions have adapted harm reduction services to provide safer smoking supplies or established health hubs to expand reach to persons using drugs through noninjection routes," the CDC report said.
The agency also emphasized the importance of expanding the availability of fentanyl test strips and naloxone to reduce the probability of fatal overdoses from all types of drugs and all methods used to take them.
