ArticleAddiction (Abingdon, England)2025
Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of United States national treatment data.
Article in Addiction (Abingdon, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 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
- Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement.Addiction (Abingdon, England) · 2026Article
- Understanding the Health Impacts of the Rapid Shift to Drug Smoking in the US.JAMA internal medicine · 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
- Temporal and regional associations between fentanyl concentrations in the unregulated drug supply and drug-related mortality in British Columbia, Canada.The International journal on drug policy · 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
- 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
- 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
- Why have overdose deaths decreased? Widespread fentanyl saturation and decreased drug use among key drivers.Lancet regional health. Americas · 2025Review
- Decline in US Drug Overdose Deaths by Region, Substance, and Demographics.JAMA network open · 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
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
BACKGROUND AND
aimsOpioid smoking is becoming more common in the United States. The aim of this analysis was to estimate relative mortality risk among those who primarily smoke opioids compared with those who inject.
designRetrospective propensity score-matched cohort analysis.
setting2006-2021 US treatment episode data from SAMHSA TEDS-D.
participantsWe matched 287 481 individuals in a substance use treatment program reporting smoking opioids as their primary substance use to an equal weighted number of individuals in a substance use treatment program reporting injecting opioids as their primary substance use. The majority of individuals reporting smoking were male (62.6%), 21-29 years old (47.9%), white (65.7%), independently housed (54.3%) and in the West Census Region (70.3%). Cohort characteristics were closely balanced after matching. MEASUREMENTS: The outcome of interest was death during a treatment episode. Variables used for matching were year, opioid category, gender, race/ethnicity, age category, census region, housing status, employment status, number of prior treatment admissions, variables associated with opioid use severity (opioid use frequency, treatment setting intensity, age at first opioid use, use of medication-assisted treatment) and other reported substance use (methamphetamine, alcohol, benzodiazepines, cocaine).
findingsThe mortality rate was 6.5 [95% confidence interval (CI) = 5.9-7.1] per 1000 person-years in the smoking cohort and 9.7 (95% CI = 8.8-10.8) per 1000 person-years in the injection cohort, with a mortality rate ratio of 0.67 (95% CI = 0.58-0.77).
conclusionsAmong individuals in substance use treatment in the United States, those who usually smoke opioids appear to have a lower all-cause mortality risk than those who usually inject.
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