ArticleDrug and alcohol dependence2024
Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000-2021.
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 28 papers.
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Who cites it
28 citing papers in PubMed.
- 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
- 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
- Trends in HCV Prevalence and Risk Factors Among People who Inject Drugs in Los Angeles County, 2012-2024.AIDS and behavior · 2026Article
- Hooked before the first injection: The role of prescription opioids in early injection drug use initiation in San Francisco.Addictive behaviors reports · 2026Article
- Amputation Rates Among Opioid-Related Hospitalizations in the United States, 2016 to 2022.Annals of internal medicine · 2026Article
- Failure to Treat Opioid Use Disorder and Opioid Withdrawal Associated with Patient-Directed Discharge in People with Injection-Related Infections.Journal of general internal medicine · 2026Article
- Understanding the Health Impacts of the Rapid Shift to Drug Smoking in the US.JAMA internal medicine · 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
- Fentanyl use among people who inject drugs in two large Pacific Northwest metropolitan areas.Harm reduction journal · 2026Article
- A Mobile Health Application to Support Reductions in Overdose Risk Behaviors: A Pilot Study.Substance use & addiction journal · 2026Article
- The Donovan Memorial Lecture: 'Fentanyl-Plus': A New Era of Fentanyl Polydrug Combinations in the North American Overdose Crisis.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Optimal buprenorphine exposure to treat patients with opioid use disorder in the era of fentanyl and polysubstance use.Frontiers in pharmacology · 2026Article
- Integration of safer smoking equipment in U.S. syringe services programs: Qualitative insights from program staff.The International journal on drug policy · 2026Article
- Stability or versatility: transitions in fentanyl routes of administration.Harm reduction journal · 2025Article
- Early evidence of the effects of xylazine-adulterated fentanyl in Ohio.The International journal on drug policy · 2025Article
- Use of Illegally Manufactured Fentanyl in the United States: Current Trends.Current addiction reports · 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
- Tranq burn: Exploring the etiology of xylazine-related soft tissue injuries.The International journal on drug policy · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundInjecting, smoking, and snorting heroin/synthetic opioids is each associated with unique health risks. It is unclear how route of administration (ROA) preferences have shifted during the opioid epidemic.
methodsUsing 2000-2021 admissions data from SAMHSA TEDS-A, we analyzed trends in heroin/synthetic opioid ROA preferences and factors associated with these preferences.
results7,881,318 heroin/synthetic opioid admissions reported injection, smoking, or snorting preference. Nationally, injection peaked in 2014 (69.9 %) and nadired in 2021(52.2 %), snorting nadired in 2014 (24.9 %) and peaked in 2021 (36.4 %), and smoking rose steadily from 2.5 % in 2005 to a peak of 11.4 % in 2021. From 2000-2021, the number of states with ≥10 % smoking rates grew from 2 to 27 (highest: 57.0 % in Arizona in 2021). In 2021, increased adjusted prevalence ratios (APR) of non-injection versus injection use were associated with older age at first opioid use (APR 1.52 [95 % CI: 1.51, 1.54] for those 30+ relative to ≤20), and all race/ethnicities relative to non-Latino White individuals (highest: Black individuals, APR 1.77 [1.75, 1.78]). Geography strongly predicted smoking versus snorting (Mountain APR 6.91 [6.64, 7.19], Pacific APR 6.61 [6.35, 6.88], reference: New England).
conclusionsROA preferences of heroin/synthetic opioids have changed substantially since 2000, with: 1) recent decreases in injection nationally; 2) increased smoking, particularly in the western US; and, 3) recent increased snorting in the eastern US. Smoking is now prevalent and growing. Public health implications include an increasing number of smoking-related fatal overdoses and the probable reduction of injection-specific morbidity and increase in smoking-specific morbidity.
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