Smoking drugs, not injection, now most common way to overdose in U.S.: report

Fatal drug overdoses from smoking substances, rather than injection, has increased dramatically in the United States, a new report from the Centers for Disease Control and Prevention (CDC) has found.

Injection-related overdoses were previously the most commonly documented route for drug deaths in the country. However, a report published Thursday found that the rate decreased by 29.1 per cent between 2020 and 2022, falling from 22.7 per cent to 16.1 per cent.

Meanwhile, the percentage of overdose deaths with evidence of smoking increased by 73.7 per cent during the same timeframe, rising from 13.3 per cent to 23.1 per cent.

Researchers gathered information about routes of overdose deaths from witness reports, scene investigations and autopsy data, which was then categorized as either injection, smoking, snorting or ingesting.

The report compared data on routes of drug-related deaths from January to June 2020 with data from July to December 2022.

In a two-year span, smoking had become the most common route of drug overdose in the U.S.

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According to the report, more than 109,000 people died from drug overdose in the U.S. in 2022. Nearly 70 per cent of those deaths involved illegally manufactured fentanyls.

Growing reports of substance-related harms in Canada point to a similar crisis.

According to Health Canada, a total of 40,642 apparent opioid toxicity deaths occurred between January 2016 and June 2023. There was an average of 22 deaths per day.

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Between January and June 2023, 89 per cent of accidental apparent opioid overdose deaths in Canada occurred in B.C., Alberta and Ontario, the agency says.

Smoking has been the leading mode of drug overdose deaths in B.C. since 2017, according to a 2021 study published in BioMed Central.

“Little is known about people who smoke opioids, and factors underlying choice of mode of administration,” the study said.

Of the 369 people surveyed, 251 (68 per cent) reported smoking opioids in the three days before the study concluded.

Factors that were significantly found to be associated with smoking opioids included living in a small community, being a woman, using drugs alone and owning a take-home naloxone kit.

“These findings identify actions to better respond to the overdose crisis, such as targeted harm reduction approaches, educating on safer smoking, advocating for consumption sites where people can smoke drugs, and providing a regulated supply of opioids that can be smoked,” the study said.

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In Ontario, 33.7 per cent of opioid-related deaths had “evidence of pipe/foil for inhalation only” between March and December 2020, according to a 2021 report published by Public Health Ontario.

In Alberta, 23 per cent of opioid overdose victims died through smoking and snorting drugs in 2017, compared to 16 per cent who died via injection, a 2019 report published by the Government of Alberta found.

A review of substance-related deaths in Canada between 2016 and 2017 noted that, at the time, the most commonly reported route of consumption was oral, followed by injection, then smoking.

Data from across several jurisdictions in Canada and from the Public Health Agency of Canada (PHAC) showed a substantial increase in opioid-related harms and deaths since the start of the COVID-19 pandemic.

“The opioid overdose crisis continues to have significant impacts on people living in Canada, their families, and communities. It remains one of the most serious public health crises in Canada’s recent history,” the PHAC said in its most recent opioid-related harm report, published in December 2023.