Severe burns from smoking opioids a new factor in harm reduction

In the United States, the trend in drug use is shifting from injection to smoking, a development that public health experts largely view as beneficial. They argue that smoking drugs like fentanyl instead of injecting them could lower rates of infections, disease transmission, and potentially even overdoses. 

However, a new study released this week introduces a notable complication to this perspective. The research indicates that individuals who transition to smoking drugs may face an increased risk of suffering severe burns. 

The study, which analyzed Medicaid claims data from Oregon spanning 2016 to 2024, found that people who smoked drugs like fentanyl or methamphetamine were approximately four times more likely to receive treatment at acute burn care units compared to those who did not use smokable drugs. Although smoking marijuana was also linked to elevated severe burn rates, the disparity was most significant among users of opioids or stimulants. 

“A key finding is that half of the emergency department visits and hospitalizations for burns in Oregon involve people who smoke drugs,” stated Honora Englander, the study’s lead author and an addiction specialist at Oregon Health and Science University. “This is remarkable considering that this group represents only about 15% of the population, yet accounts for 53% of burns.” 

While this research is specific to Oregon, it aligns with a broader shift in drug use patterns across the U.S., where smoking has become more prevalent than injection. This change is partly due to alterations in drug availability and efforts by harm reduction organizations to promote smoking as a safer alternative, reducing risks like endocarditis, hepatitis, and skin wounds associated with xylazine. 

The burns are often caused by the use of inexpensive but powerful butane torches, commonly available at hardware stores. Englander noted that a frequent cause of severe burns is a locking mechanism on these torches, which keeps the flame burning even when the user releases the lighter. 

Drug users tend to favor these torches over standard lighters because they produce a stronger flame and are less affected by wind, Englander explained. 

The combination of these intense flames and the altered state of consciousness experienced by users of substances like fentanyl can lead to catastrophic outcomes. A participant in the study mentioned a friend who “burned right through his hand” without waking up. 

Englander and her team initiated the study following observations by Mark Thomas, an Oregon surgeon and co-author of the paper, who had seen numerous severe burns seemingly linked to drug use. 

In a separate discussion, George Karandinos, a physician-researcher from Harvard who has examined the transition from injecting to smoking drugs, acknowledged the study as a significant addition to the understanding of drug use methods. However, he pointed out the difficulty in comparing the risks of burns with other health issues like overdose or HIV. 

Karandinos also observed that despite the notable shift from injecting to smoking drugs, overall burn rates did not rise during the study’s time frame. 

“Every method of drug use carries its own unique risks, so this research is crucial,” Karandinos stated. “What remains unclear is the relative risk: How do the numbers of burns compare to other health outcomes?” 

Englander emphasized that the focus should not be on whether smoking is inherently safer but on how medical professionals and harm reduction advocates can promote safer smoking practices to minimize severe burn risks.  

“I advise people that using a soft flame and a lighter is safer than a torch,” she said. “If they choose to use torches, I recommend avoiding the lock mechanism and being mindful of the risks associated with sedating drugs like fentanyl.”

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