3 hours ago
As drug use in the U.S. has shifted from injecting to smoking, public health experts have largely viewed this change positively. Smoking drugs like fentanyl instead of injecting can reduce infections, disease transmission, and potentially lower overdose rates.
However, a new study published this week introduces a significant concern: people who smoke drugs may face a higher risk of severe burns.
The study analyzed Medicaid claims data from Oregon between 2016 and 2024 and found that individuals who smoked drugs such as fentanyl or methamphetamine were about four times more likely than non-smokers of these drugs to require treatment at an acute burn care unit. While smoking marijuana was also linked to increased burn rates, the risk was most pronounced among those smoking opioids or stimulants.
"A headline is that half of emergency department visits and hospitalizations for burns in Oregon are among people who use smokable drugs," said Honora Englander, the study's lead author and an addiction specialist at Oregon Health and Science University. "That’s a striking finding: despite comprising about 15% of the population, 53% of burns occurred in this group."
Though the study focuses on Oregon, it reflects a nationwide trend where smoking has become more common than injecting. This shift is partly due to changes in the drug supply and harm reduction efforts encouraging smoking to reduce risks associated with injection, such as endocarditis, hepatitis, and skin wounds linked to xylazine.
Many burns resulted from the use of inexpensive butane torches, often purchased at hardware stores. Englander noted that a locking mechanism on these torches can produce a strong flame even when users remove their hands, contributing to severe burns.
Drug users often prefer these torches over softer flames, like those from Bic-style lighters, because torches are more powerful and less affected by wind.
The combination of powerful torches and the altered consciousness caused by substances like fentanyl can lead to devastating injuries. One patient interviewed reported a friend who "burned right through his hand" without waking up.
Englander and her colleagues initiated the study after Mark Thomas, an Oregon burn surgeon and co-author, observed numerous "devastating, serious, life-altering burns" linked to drug use.
In a separate interview, George Karandinos, a Harvard physician-researcher studying the shift from injecting to smoking, called the research a valuable addition to understanding drug use modes. However, he noted the difficulty in comparing burn risks directly with other health risks like overdose or HIV.
Karandinos also pointed out that overall burn rates did not increase during the roughly decade-long study period, despite the significant shift from injecting to smoking.
"Any particular way that people use drugs is going to have its own specific risks, so this research is really important," Karandinos said. "What we don’t know is relative risk: how does the number of burns compare to other health outcomes?"
Englander emphasized that the question is not whether smoking is safer, but how clinicians and harm reduction advocates can promote smoking methods that reduce the risk of severe burns.
"I tell people, essentially, that a soft flame and a lighter is safer than a torch," she said. "If people are going to use torches, I recommend not using them with the locks engaged and being aware of the risk when using sedating drugs like fentanyl."
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
