ArticleDrug and alcohol dependence2024
Changes in injecting versus smoking heroin, fentanyl, and methamphetamine among people who inject drugs in San Diego, California, 2020-2023.
Article in Drug and alcohol dependence, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 35 citations in OpenAlex.
- Multilevel drivers and constraints of shifts from injecting to smoking opioids and stimulants: A qualitative study from the San Diego-Tijuana border region.Drug and alcohol dependence · 2026Article
- Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement.Addiction (Abingdon, England) · 2026Article
- County by county estimation of possible deaths averted, infections averted, and cost savings of overdose prevention centers in the United States from July 2019-June 2025.The International journal on drug policy · 2026Article
- What Dose of Methamphetamine Do Regular Consumers Use Daily? Estimating Oral Amphetamine Milligram Equivalents.Journal of addiction medicine · 2026Article
- Estimating the Daily Milligrams of Morphine Equivalent of Illicit Fentanyl Use in Los Angeles: Clinical and Epidemiological Implications.medRxiv : the preprint server for health sciences · 2026Article
- The changing contribution of fentanyl use to non-fatal overdose among a cohort of people who inject drugs in San Diego, California: A longitudinal assessment.Drug and alcohol dependence · 2026Article
- County by county estimation of possible deaths averted, infections averted, and cost savings of overdose prevention centers in the United States from July 2019-June 2025.medRxiv : the preprint server for health sciences · 2026Article
- Charting the Decline of the Fourth Wave: US Overdose Deaths by Race, Ethnicity, and Substance Involvement.medRxiv : the preprint server for health sciences · 2026Article
- Fentanyl use among people who inject drugs in two large Pacific Northwest metropolitan areas.Harm reduction journal · 2026Article
- A descriptive study of drug overdose epidemics, overdose prevention efforts, and opioid settlement fund distribution across six states.The International journal on drug policy · 2026Article
- Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff.The International journal on drug policy · 2026Article
- Early evidence of the effects of xylazine-adulterated fentanyl in Ohio.The International journal on drug policy · 2025Article
- Promises and pitfalls of safer smoking supply distribution in the United States: a thematic analysis of open-ended survey questions from harm reduction organizations.BMC public health · 2025Article
- A qualitative study exploring motives for the transition from injecting to smoking drugs in Vancouver, British Columbia.The International journal on drug policy · 2025Article
- Diagnostic performance of HIV risk assessment tools for identifying pre-exposure prophylaxis candidates: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison.The International journal on drug policy · 2025Article
- Xylazine prevalence and concentration in the Los Angeles fentanyl market, 2023-2025.Drug and alcohol dependence reports · 2025Article
- "I don't know how you can overdose smoking them:" Perceptions of overdose risks among persons who use illicit fentanyl-laced counterfeit pills.The International journal on drug policy · 2025Article
- Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of United States national treatment data.Addiction (Abingdon, England) · 2025Article
- Fentanyl Test Strip Use and Overdose Risk Reduction Behaviors Among People Who Use Drugs.JAMA network open · 2025Observational
Corrections and comments
- Update of
Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundAmidst an increasingly toxic drug supply in North America, people who inject drugs may be transitioning to smoking them. We aimed to assess changes in injecting and smoking opioids and methamphetamine among a cohort of people who inject drugs from San Diego, California.
methodsOver five six-month periods spanning October 2020-April 2023, we assessed prevalence of injecting and smoking opioids or methamphetamine and whether participants used these drugs more frequently by smoking than injecting. Multivariable Poisson regression via generalized estimating equations was used to examine time trends.
resultsOf 362 participants, median age was 40 years; a minority were female (29%), Hispanic/Latinx/Mexican (45%), and housed (33%). Among this cohort, of whom 100% injected (and 84% injected and smoked) in period one (October 2020-April 2021), by period five (November 2022-April 2023), 34% only smoked, 59% injected and smoked, and 7% only injected. By period five, the adjusted relative risk (aRR) of injecting opioids was 0.41 (95% Confidence Interval [CI]: 0.33, 0.51) and the aRR for injecting methamphetamine was 0.50 (95% CI: 0.39, 0.63) compared to period one. Risks for smoking fentanyl rose significantly during period three (aRR=1.44, 95% CI: 1.06, 1.94), four (aRR=1.65, 95% CI: 1.24, 2.20) and five (aRR=1.90, 95% CI: 1.43, 2.53) compared to period one. Risks for smoking heroin and methamphetamine more frequently than injecting these drugs increased across all periods.
conclusionsOpioid and methamphetamine injection declined precipitously, with notable increases in smoking these drugs. Research is needed to understand the health consequences of these trends.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.