Research from the journal Drug and Alcohol Dependence helps medical, and addiction professionals focus on substance use trends and overdose patterns. For many years, the patterns revolving in these research areas stayed relatively the same, with some years with higher numbers across the board but no fundamental changes in which drugs were being used. That is, until fentanyl hit the streets, both as an additive to heroin and its own drug. In the past five years, there has been a dramatic increase in fentanyl use. But recently, Californian opioid users have taken to smoking fentanyl rather than shooting heroin.

Why Are People Smoking Fentanyl?

Smoking fentanyl (and heroin) is more common on the West Coast than in other regions. Experts point to problems in the drug supply that change the way they are consumed.

Anecdotally, people who “switch” from heroin to fentanyl are looking for a more potent drug. However, heroin can be expensive for long-term users, and California sees a lot of “tar heroin,” which is stickier and less powerful. It’s also more likely to give an intravenous drug user skin infections.

When people in California have switched from heroin to fentanyl, they have also cited what they perceive as harm reduction benefits. (When you’re smoking a drug, you won’t get any sores, but you may burn your fingers while you’re using it.) The absence of the physical ravages caused by IV drug use can help reduce the daily stigmas of heroin addiction. Without sores, an addicted person can also try to continue holding a job and carrying on with life with fewer barriers associated with the stigmas of addiction.

Smoking Fentanyl Doesn’t Prevent Overdoses

Fentanyl is the top cause of overdoses in the United States, and it often causes deadly overdoses. But, much of the time, it’s not even the drug people expect to be using. Most recently, several comedians in Los Angeles were unknowingly exposed to fentanyl in a “bad batch” of cocaine. As a result, three people died, and the fourth was left recovering in the hospital for over a week.

So even if fentanyl is being used more, it’s not stopping the trend of overdoses. Experts do see a bit of a silver living. Experienced, long-term opioid users often end up getting sick or spreading disease via dirty needles. When they switch to smoking, they’re no longer going to end up with hepatitis or HIV, but the potency of fentanyl and its analogs makes short or long-term use dangerous.

“Obviously, a big point here is that if people reduce injection, they’re going to reduce injection-related diseases and blood-borne illness,” Alex Kral, an epidemiologist at RTI International and the study’s lead author, said. “Fentanyl overdose has also continued to exponentially grow in San Francisco and [its] general area, so it doesn’t seem like this [trend of 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.”

Finding a way to help opioid users stay alive until they can cease their use, get treatment or start medication is one of the biggest challenges for the addiction profession. Harm reduction is a growing movement that aims to help addicted persons use safety tools like Narcan, an opioid overdose reversal drugs, to live to fight their addiction another day.