A recent analysis article published in Psychology Today and authored by Dr. Mark Gold examined the increasing numbers of overdose deaths by smoking rather than injection of illicit substances.

Moreover, a 2024 report from the Centers for Disease Control and Prevention (CDC) showed that many overdose deaths recorded in 2022 occurred due to smoking hard drugs rather than injecting them with needles, reflecting a significant change in drug use patterns. According to the report, the percentage of overdose deaths with evidence of injection decreased from 22.7% of deaths to 16.1%, while the percentage of overdose deaths with evidence of smoking increased from 13.3% to 23.1%.

“Most experts assume that injecting gets the drug to the brain fastest, but smoking is close and also accomplishes that goal. Also, crack cocaine (which is smoked) tends to be cheap and affects marginalized communities more frequently. In addition, with fentanyl being found in stimulants that are smoked, smoking drugs is very dangerous. The shift to smoking and the shift to speedballing by smoking are the most newsworthy and troubling changes in addiction today,” said  Brian Fuehrlein, M.D., Ph.D., associate professor of psychiatry at Yale and director of Psychiatric Emergency Room in his interview with Psychology Today.

According to Dr. Gold, this change in drug use patterns can be partially attributed to individuals switching from injecting heroin to smoking fentanyl analogs. Since smoking can be perceived as less invasive than injecting, some people may feel more comfortable using this method of drug administration. In addition, smoking can also be less costly and is associated with less stigma than injecting substances. Finally, since smoking is an easier route of administration than injection, it also allows more individuals to try illicit drugs and can even result in more frequent use, as well as rapid addiction and a higher risk of overdose.

There is also an increase in the use of vaping devices to smoke illicit drugs, such as methamphetamine, cocaine, and fentanyl. In particular, vaping fentanyl carries a high risk of lethal overdose, since even a small amount of the drug can be fatal and vaping can deliver a potent dose of fentanyl directly to the lungs and into the bloodstream.

“Increasing numbers of individuals are switching to or initiating drug use by smoking versus injecting drugs. Smoking may seem dramatically safer than injecting, but the ease of use, novel combinations, and use of the most dangerous and addictive drugs—methamphetamine, cocaine, fentanyl—make smoking extremely dangerous,” concluded Dr. Gold. “While the fear of injecting has served as a barrier for some, no such barrier attaches to vaping or smoking—and smoked drugs have similar effects on the brain as injected ones. All contribute to increased risks of overdose and death by smoking.”