Drug Smoking Linked to Severe Burns: New Study Raises Concerns

A Shift in Harm Reduction Faces Unexpected Risk: Severe Burns from Smoking Drugs

As strategies to reduce the harms associated with drug use evolve, a new concern has emerged: severe burns linked to smoking drugs like fentanyl and methamphetamine. Even as a move away from injection has been largely welcomed by public health experts as a way to reduce infections and overdose rates, recent research indicates that this shift isn’t without its own set of dangers. A study published this week in JAMA Internal Medicine highlights a significantly elevated risk of burn injuries among individuals who smoke drugs, particularly opioids and stimulants.

Burn Rates and Drug Use in Oregon

The study, led by Honora Englander of Oregon Health & Science University, analyzed Medicaid claims data from Oregon between 2016 and 2024. Researchers found that individuals who smoked drugs were roughly four times more likely to be treated in an acute burn care unit compared to those who did not consume smokable drugs. While smoking marijuana was also associated with increased burn rates, the correlation was most pronounced among those using opioids or stimulants. “A headline is that half of emergency department visits and hospitalizations for burns in Oregon are among people who use smokable drugs,” Englander stated. “That’s a striking finding: Despite comprising about 15% of the population, 53% of burns were in this group.” The full study provides detailed methodology and statistical analysis.

A National Trend, Local Data

This finding is particularly relevant given the broader national trend away from injecting drugs and toward smoking. This shift has been driven by changes in the drug supply, as well as intentional efforts by harm reduction organizations to promote smoking as a safer alternative to injection, reducing the risk of conditions like endocarditis, hepatitis and skin infections associated with xylazine. Stat News recently reported on this broader shift, detailing the reasons behind the move to smoking and its initial perceived benefits.

The Role of Butane Torches

Many of the severe burns observed in the study were linked to the use of inexpensive butane torches, commonly found in hardware stores. These torches are favored by some drug users over traditional lighters because they produce a more powerful and wind-resistant flame. A particularly dangerous feature of many of these torches is a locking mechanism that maintains the flame even when the user’s hand is removed. Englander explained that this feature, combined with the altered state of consciousness often experienced by individuals using drugs like fentanyl, can lead to devastating injuries. One patient recounted a friend sustaining a burn “right through his hand” without even realizing what had happened.

Evaluating Risk: Burns in Context

George Karandinos, a physician-researcher at Harvard who has studied the shift in drug use methods, emphasized the importance of this new research. However, he also cautioned against drawing simplistic conclusions about safety. “Any particular way that people use drugs is going to have its own specific risks, so this research is really essential,” Karandinos said. “What we don’t know is relative risk: How does the number of burns compare to other health outcomes?” Interestingly, the Oregon study found that overall burn rates did not significantly increase during the study period, despite the substantial shift in drug use behavior. This suggests that while smoking drugs is associated with a higher *risk* of burns, it hasn’t necessarily led to a surge in overall burn cases.

What Can Be Done to Mitigate the Risk?

Englander and her colleagues initiated the study after a local surgeon, Mark Thomas, noticed a concerning number of severe and life-altering burns appearing to be linked to drug use. Their findings underscore the need for clinicians and harm reduction advocates to address the specific risks associated with smoking drugs. Englander’s recommendation is straightforward: “I share people, essentially, that soft flame and a lighter is safer than a torch. If people are going to use torches, I recommend not using with the locks engaged, and being aware of the risk of the lock being engaged with sedating drugs like fentanyl.”

Broader Implications for Harm Reduction

The findings from Oregon raise important questions about the comprehensive assessment of harm reduction strategies. While reducing injection-related harms remains a critical goal, it’s clear that alternative methods of drug use are not without their own dangers. This necessitates a more nuanced approach to harm reduction, one that acknowledges and addresses the specific risks associated with each route of administration. Further research is needed to understand the prevalence of burn injuries in other regions and to develop targeted interventions to prevent them.

Looking Ahead: Refining Harm Reduction Guidance

The immediate next step involves disseminating these findings to harm reduction organizations and healthcare providers. This includes updating educational materials to specifically address the risks associated with butane torches and promoting the use of safer alternatives like soft-flame lighters. Ongoing surveillance of burn injuries in populations that use drugs will be crucial to monitor the effectiveness of these interventions and identify emerging trends. Further research is needed to explore the psychological and neurological factors that may contribute to burn injuries among individuals using substances like fentanyl, which can impair judgment and sensation.