Americans Are Smoking Fentanyl More. Good News?

Why It Matters

By normalizing pipe distribution, harm‑reduction programs can curb injection‑related infections and deaths, yet they must also address the persistent overdose risk inherent to smoked fentanyl.

Key Takeaways

• Harm‑reduction groups distribute glass pipes to replace injection.
• Smoking fentanyl reduces infection risk and allows dose titration.
• Users report quicker, safer consumption and more social support.
• Medical experts warn smoking still carries high overdose danger.
• Increased pipe availability drives shift from IV to inhalation nationwide.

Summary

The video examines the growing trend of Americans smoking fentanyl instead of injecting it, and how harm‑reduction organizations are deliberately supplying glass pipes to facilitate that shift. Reporters Lev Facher and a STAT addiction reporter tour a distribution warehouse and accompany outreach worker Megan Merrill into New Hampshire’s homeless encampments, documenting the logistics of pipe kits and the rationale behind encouraging inhalation.

Key insights reveal that smoking fentanyl cuts exposure to bacterial infections, vein damage, and blood‑borne diseases while allowing users to titrate doses more precisely. Pipe kits—often called “boof” or “sniff” kits—are low‑cost, portable, and turn a 15‑minute risky public injection into a quick, discreet hit. Users also describe smoking as a more social activity, creating a peer safety net that can intervene during an overdose.

Jim Duffy of Smoke Works emphasizes that providing quality glass is not about forcing behavior but meeting demand; many users now return syringes for pipes. Megan Merrill reports a noticeable transition among unhoused populations, noting fewer abscesses and infections. Hospital medical director Sarah Wakeakeman cautions that while inhalation reduces injection‑related harms, fentanyl’s potency still makes overdose a serious risk, underscoring the need for universal precautions.

The shift has policy implications: expanding access to safer‑consumption supplies could lower healthcare costs tied to infections and overdoses, but public health messaging must balance harm‑reduction benefits with clear warnings about fentanyl’s lethality. As more jurisdictions adopt pipe distribution, the balance between reducing injection‑related morbidity and preventing inhalation overdoses will shape future drug‑policy strategies.

Original Description

After nearly two and a half decades of steadily increasing overdose rates in the U.S., there has been a dramatic decline in drug-related deaths over the last few years. There are many reasons for this change, not least of which is a marked decrease in the purity of fentanyl, the substance that has been largely driving the overdose epidemic. But other factors are at play, including a significant behavioral shift in fentanyl users — they are increasingly switching from injecting drugs to smoking them.

Outreach worker Megan Merrill sees it every day. “They're definitely smoking their drugs more than they're injecting it,” she said of the unhoused community she serves, “and I really think it has to do with the supply and like, their veins are just shot. And they just, you know, they need it.”

Harm reduction organizations simply making smoking supplies like pipes and foil more readily available is accelerating the shift to the safer practice of smoking, said Jim Duffy of Smoke Works Injection Alternatives. Duffy’s company supplies inexpensive glass pipes and other harm reduction products to organizations like New Hampshire’s SOS.

“People were using syringes because that's all that was offered. The demand for smoking supplies was there. But pipes were never on the table,” said Duffy. “It wasn't long into pipe distribution at the [syringe] exchange that we had people putting syringes back in our hands and saying, no, I'll just take the glass.”

In this week’s STATus Report, host Alex Hogan and STAT addiction reporter Lev Facher visit Duffy’s distribution warehouse in Braintree, Mass. They then ride along with SOS’s Merrill during her outreach work, including handing out glass pipes, at an encampment deep in the woods of New Hampshire.

Lev's new story: https://www.statnews.com/2026/02/12/fentanyl-harm-reduction-smoking-not-injecting/

0:00 Intro

0:52 What is Smoke Works?

2:02 QC on meth pipes

2:50 supporting people's preference for smoking

3:36 the right pipe for opioids

3:58 pros of smoking vs. injecting

5:23 intermission

5:36 Lev and Alex head to New Hampshire

6:24 Meeting Megan

7:23 The dangerous current supply

8:29 Harm reduction's role

9:16 Mass General's Sarah Wakeman's take

10:31 Outro

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