Experts say that smoking crack cocaine is becoming popular again. Many people believe that smoking potent drugs like heroin, fentanyl, methamphetamine, or cocaine is much safer than injecting them. After all, injecting drugs carries serious risks, such as severe skin infections and the chance of contracting diseases like HIV or hepatitis C when using shared needles.
However, there's some shocking news. According to a 2024 report from the Centers for Disease Control and Prevention (CDC), many heroin and other drug users who died from overdoses in 2022 smoked the drugs instead of injecting them, signaling a significant change in drug use patterns. The CDC reports that the percentage of overdose deaths with evidence of injection decreased from 22.7% to 16.1%, while the percentage of overdose deaths with evidence of smoking increased from 13.3% to 23.1%. This shows that smoking drugs is extremely dangerous, a fact that many people don't yet realize.
Brian Fuehrlein, M.D., Ph.D., an associate professor of psychiatry at Yale and director of the Psychiatric Emergency Room at the VA Connecticut Healthcare System, explains, "Most experts believe that injecting drugs delivers the substance to the brain the fastest, but smoking is almost as quick and achieves the same effect. Also, crack cocaine (which is smoked) tends to be cheap and affects marginalized communities more frequently. Moreover, with fentanyl being found in stimulants that are smoked, smoking drugs has become very dangerous. The rise in smoking and the growing trend of speedballing, where people mix stimulant and depressant drugs, are among the most concerning and dangerous changes in drug addiction today.
Why the Change in Drug Use Happened
The recent shift from injecting to smoking drugs and the increase in deaths from smoking may be partly driven by users switching from injecting heroin to smoking fentanyl analogs. Smoking is often seen as less invasive than injecting, so users may feel better about not injecting their drugs, unaware of the dangers. Smoking may also be cheaper and carries less stigma than injecting.
The ease of smoking also allows more people to try the drug and may lead to more frequent use, causing rapid addiction and a higher risk of overdose.
Addiction specialist James H. Berry, D.O., Professor and Chair of the Department of Behavioral Medicine and Psychiatry at the Rockefeller Neuroscience Institute at West Virginia University, agrees that smoking powerful drugs has become a major concern today. "In my experience treating patients in West Virginia for the past 20 years, there certainly has been a shift. Fewer patients starting treatment today report using needles compared to a few years ago. Many believe that smoking fentanyl is much safer than injecting, which explains part of the shift.
"However," Berry believes a major reason is the sharp increase in methamphetamine use, which is mostly smoked rather than injected. Methamphetamine has now surpassed opioids as the drug of choice for many in our area. Although speedballing is common, most patients report they prefer to use pure methamphetamine, though they find it difficult to obtain any that isn't mixed with fentanyl."
Berry also reports, "We are also seeing a noticeable increase in crack cocaine use this past year." Patients who use crack cocaine experience specific brain, gray matter, and volume deficits, new data suggests.
Vaping Speedballs and Other Drugs
Some people use vaping devices to smoke the most potent drugs, such as methamphetamine, cocaine, and various others. Some young people vape methamphetamine, cocaine, and fentanyl, even though it is a highly dangerous practice. The ability to vaporize these drugs has increased due to advancements in vaping technology and the availability of especially potent synthetic versions of these drugs.
Vaping Methamphetamine
Methamphetamine can be inhaled by heating it in a vaporizer or e-cigarette. The drug is usually dissolved in a liquid or used in its crystalline form, which is then heated to produce vapor. Vaped methamphetamine can have a quick onset of effects and carries a heightened risk of addiction and overdose due to the high potency of the drug delivered in this way.
Vaping Cocaine
While less common, cocaine can also be vaped. Like methamphetamine, cocaine is dissolved in a liquid that can be vaporized. The effects are similarly intense, with rapid absorption leading to increased risks, including severe cardiovascular events and addiction.
Vaping Fentanyl
Vaping fentanyl is especially dangerous due to the drug's extreme potency. Even small amounts of fentanyl can be fatal, and vaping can deliver a powerful dose directly to the lungs, leading to a quick and potentially deadly overdose. There are increasing reports of fentanyl being mixed with other substances in vape cartridges, either intentionally or accidentally, posing significant risks.
Vaping Marijuana
Some users of marijuana have already hacked or modified vape devices to smoke cannabis. Pharmacologically, as occurred when intravenous cocaine was replaced by crack cocaine, the effects of the drug when smoked are similar to those when injected.
A recent study by Yale researchers published online in Pediatrics showed that as many as four out of every ten teens and young adults who vape will modify the devices, allowing for discreet use of marijuana and potentially risking lung injury and burns. According to the study, 40.1% of 1,018 adolescents between the ages of 14 and 29 said they refilled devices not designed to be refilled, and 35.8% recharged the battery of vape pods intended to be discarded after one use. Others reported mixing nicotine and marijuana liquids in devices designed only for nicotine.
E-cigarette modification is significantly changing the marijuana risk profile as it delivers more THC to the brain more often in doses likely to have addiction potential.
Berry says, Our communities have many vape shops selling legal Delta-8 and Delta-10 THC. Along with high-potency Delta-9 THC concentrates shaped into 'illicit' nicotine vapes, this has contributed to an increase in people experiencing marijuana related mental health issues."
Conclusion
Increasing numbers of people are switching to or starting drug use by smoking rather than injecting drugs. Smoking may seem considerably safer than injecting, but the ease of use, new drug combinations, and the use of the most dangerous and addictive drugs methamphetamine, cocaine, fentanyl make smoking extremely hazardous. While the fear of injecting has served as a deterrent for many, no such deterrent attaches to vaping or smoking and smoked drugs have similar effects on the brain as injected ones. All contribute to increased risks of overdose and death from smoking. Unintentional speedballing adds to the risk if pipes are shared or if people are smoking multiple drugs in the same sessions.