A collaborative study just published in Drug and Alcohol Dependence led by Alex Kral at RTI found that there was a shift from injecting tar heroin to smoking fentanyl in San Francisco, California, from 2018 to 2020. The study was an observational cohort study of 395 people who inject drugs designed to assess changes in the frequency of injection, opioid injection, and fentanyl smoking. Quantitative and qualitative data were collected semi-annually.

Researchers found decreases in both the median number of past-month injections (from 72 to 19 from July-December 2018 to January-June 2020) and the rate of opioid injections (decreased by half). “Numerous participants who were interviewed by researchers said (among many other noteworthy things) that this drop corresponded with an increase in non-injected fentanyl use, predominantly by smoking it. Some participants said they switched from heroin to fentanyl entirely, citing reasons such as cost, health, or social stigma (e.g., reducing visible ‘track marks’ from injections that might preclude jobs). (Burns, Forbes, 9/7/21)” Researchers also make the point that “that smoking heroin or fentanyl seems to have been more common on the West Coast in recent decades than in other parts of the country” perhaps because tar heroin is not very potent and often contains additives that can tear up your veins if you inject it.

“‘Obviously a big point here is that if people reduce injection, they’re going to reduce injection-related diseases and blood-borne illness,’ Kral said. ‘Fentanyl overdose has also continued to exponentially grow in the San Francisco area, so it doesn’t seem like smoking fentanyl helps reduce overdose — we have no reason to think it’s worse for overdose rates, but no reason to think it’s better.’ (Burns, Forbes, 9/7/21)”

Officer Safety

The biggest threat with fentanyl contamination is inhalation, not transdermal absorption (skin contact). This is the same threat that most other drugs pose to criminal justice professionals. To ease any threat to officer safety, wear a respirator with a P100 filter and closed eye protection if you are encountering anyone smoking drugs. This goes for not just fentanyl, but all smokeable drugs. Whether it is fentanyl, methamphetamine or any other smokeable drug, walking into enclosed spaces with this smoke in the air is detrimental to your health. Personally, I like using the respirators listed below.