According to a recent study by the government, smoking has overtaken injecting as the most prevalent method of drug use in cases of overdose in the United States.

The study published by the Centers for Disease Control and Prevention on Thursday is considered the largest investigation into how Americans consumed the drugs that ultimately caused their deaths.

The CDC decided to investigate the issue after receiving reports from California that indicated smoking fentanyl was becoming more prevalent than injecting it. Illicit and potent forms of this painkiller contribute to a higher number of overdose deaths in the United States compared to any other drug.

According to the study’s main author, Lauren Tanz, initial research has indicated that smoking fentanyl may be less fatal than injecting it, and any decrease in overdose deaths related to injection is a beneficial outcome.

However, both injecting and smoking come with a significant risk of overdose. It remains uncertain whether a shift towards smoking fentanyl would decrease overdose deaths in the U.S., according to Tanz, a CDC researcher specializing in overdose studies.

Illicit fentanyl is an infamously powerful drug that, in powder form, increasingly has been cut into heroin or other drugs. In recent years, it’s been a primary driver of the U.S. overdose epidemic. Drug overdose deaths in the U.S. went up slightly in 2022 after two big leaps during the pandemic, and provisional data for the first nine months of 2023 suggests it inched up last year.

In recent years, there has been a shift in the way fentanyl is consumed, with more drug users choosing to smoke it rather than inject it. According to Alex Kral, a researcher at RTI International who focuses on drug users in San Francisco, individuals will place the powder on tin foil or in a glass pipe, heat it from the bottom, and then inhale the resulting vapor.

According to Kral, the strength of smoked fentanyl is not as potent as that in a syringe. However, there are advantages to smoking for some drug users. These include reducing the likelihood of developing skin abscesses and contracting diseases like hepatitis, which are common among those who inject drugs.

Kral shared, “A person proudly displayed their arms to me and exclaimed, ‘Check out my arm! It looks fantastic! I can finally wear T-shirts and find employment without being judged for my track marks.'”

The CDC researchers analyzed the pattern by utilizing a comprehensive database compiled from death certificates, toxicology reports, as well as information from coroners and medical examiners.

Data was obtained from the District of Columbia and 27 states for the years 2020 to 2022. This information included details on drug usage in approximately 71,000 of the over 311,000 total overdose deaths in the U.S. during that time period, accounting for roughly 23%.

According to the study, there was a significant increase in the percentage of overdose deaths involving smoking from early 2020 to late 2022, rising by 74%. On the other hand, the percentage of deaths involving injection decreased by 29%. The study also found an increase in the number and percentage of deaths related to snorting, although it was not as significant as those involving smoking.

According to experts, determining the precise percentage of deaths caused by smoking, injecting, snorting, or swallowing drugs is a complex task. In certain instances, individuals may have used multiple drugs through various methods. In other situations, the specific method of drug consumption could not be determined.

In late 2022, a study revealed that for identified deaths, 23% were caused by smoking, 16% by injections, 16% by snorting, and 14.5% by swallowing.

According to Tanz, the data is representative of the entire nation. The data was collected from states in all regions of the country and showed a rise in smoking rates and a decline in injecting rates. The report stated that smoking was the predominant method in the West and Midwest, while it was roughly equal to injecting in the Northeast and South.

Kral stated that the study was “largely positive” but also acknowledged its constraints.

Understanding the circumstances and reasons behind a fatal drug overdose can be challenging, especially if there were no witnesses present. In cases where the drug was injected, it may be easier to determine due to visible injection marks on the body. However, if the drug was smoked, it may be more difficult to detect as it would require finding a pipe or foil at the scene and deciding whether to include that information in the report.

Kral also mentioned that numerous individuals who partake in fentanyl smoking often utilize a straw to breathe in the vapors produced by the ignited powder. It is plausible that the investigators mistook a straw for snorting.

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The Associated Press’ Health and Science Department is funded by the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all of its content.