Smoking fentanyl has become a very disturbing trend in the US

In recent years, the method of fentanyl consumption has shifted significantly. Smoking fentanyl has become more common than injecting it, and with this change comes an increased risk of fatal overdose.

A study by researchers has highlighted a critical new danger: the residue that accumulates in smoking equipment.

This residue can be shared unintentionally, raising the risk of overdose, especially among individuals who are not tolerant to opioids like fentanyl.

Overdose risks from fentanyl residue

Researchers at the University of California, San Francisco (UCSF), led by Dr. Daniel Ciccarone, have found that both the deliberate sharing and accidental consumption of fentanyl residue are contributing to this risk.

This is particularly dangerous for those who use the same equipment to smoke other drugs, such as methamphetamine, without realizing the potential for a lethal dose of fentanyl.

“The risk of overdose when sharing smoking devices with fentanyl resin is comparable to the risk of shared injection paraphernalia and HIV transmission,” said Dr. Ciccarone. “We need harm reduction-based and culturally attuned education campaigns to address this new risk.”

Overdose from fentanyl smoking

The study, published in PLOS ONE, is the first to examine fentanyl resin as a significant contributor to overdose.

It reveals a troubling trend: while fentanyl deaths in San Francisco reached an all-time high of 806 in 2023, with 653 attributed to fentanyl, nationwide deaths showed a slight decline but remained alarmingly high.

Additionally, fatal overdoses from psychostimulants like methamphetamine and cocaine are increasing.

Behavioral shifts and observations

The researchers conducted their study by observing individuals in their environments in 2022.

They interviewed 34 participants from syringe service programs, inquiring about their substance use progression, modes of use, overdose experiences, and changes in the local drug supply.

The study also included daily field notes, video recordings of smoking sessions, and photographs of drugs and equipment.

They found that fentanyl was extremely cheap, sometimes as low as $10 a gram, and most users smoked it using foil, although glass bubbles, bongs, and dabbing devices were also popular.

The quality of fentanyl varied widely, and users had no reliable method to determine potency. However, they could gauge it upon inhalation and had developed techniques to regulate their doses. Some participants reported using up to one or more grams daily.

Danger of shared equipment

The shift from injecting to smoking fentanyl was driven by the difficulty of injecting and the fear of overdose.

Smoking is more social, leading people to share equipment, drugs, and information. This sharing behavior introduces a significant risk, particularly for those with varying opioid tolerances.

The researchers observed interactions where individuals refused to share smoking devices to prevent unintentional overdoses.

One participant refused to lend a glass pipe used for fentanyl to someone who only used methamphetamine, highlighting the similarity in appearance between smoked fentanyl and methamphetamine residues and the potential for confusion.

“The overdose risk arises when there is a mismatch between the potency of the residual drug and the recipient’s tolerance,” Dr. Ciccarone explained.

Other dangers of fentanyl

Fentanyl’s extreme potency makes overdose easy, even with tiny amounts. It’s often mixed with drugs like heroin or cocaine, increasing accidental overdose risks. Users can’t gauge its strength, leading to unexpected, lethal doses.

Rapid effects can cause respiratory failure, resulting in death within minutes. Fentanyl in counterfeit pills poses a threat, as users may unknowingly consume it. High addiction potential and severe withdrawal symptoms complicate recovery.

Accidental exposure can harm first responders and bystanders. Fentanyl’s impact extends to public health systems, straining resources and increasing healthcare costs. The synthetic nature of fentanyl also makes it easier to produce and distribute illicitly.

Addressing the fentanyl smoking risks

Despite some participants taking precautions to prevent others from using their equipment, the shared smoking culture still poses increased risks due to high consumption rates.

Dr. Ciccarone emphasized the need for harm reduction education that is sensitive to the perceptions of opioid users.

“Pacing, increasing awareness of dosages consumed, and checking the tolerance of residue recipients are potential interventions that deserve further exploration,” he said.

The rise in fentanyl smoking presents a new, deadly risk for overdose. As the method of consumption shifts, so must the strategies for harm reduction.

Educating users about the dangers of shared equipment and developing interventions to manage dosages and tolerance can help mitigate these risks and save lives.

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