Smoking Drugs Is Now Leaving People With Lifelong Scars

When most people think about the dangers of illicit drug use, burns rarely come to mind. Yet a striking new study from the United States is putting severe burns from smoking drugs firmly on the public health agenda, revealing a pattern of catastrophic injury that has gone largely unnoticed until now.

Researchers at Oregon Health & Science University (OHSU) analysed nearly a decade of Oregon Medicaid data, from April 2016 to March 2024, and found that more than half of patients treated for burns in hospitals and emergency rooms had also used smokable drugs other than tobacco. It is a finding that experts describe as both alarming and long overdue.

A Shift in How People Are Using Drugs

The study, published in the journal JAMA Internal Medicine, comes at a time when the route of illicit drug use across the United States has changed significantly. Smoking has now surpassed injection as the most common route of fatal overdoses of illicit drugs nationwide.

Illicitly manufactured fentanyl and stimulants such as methamphetamine are increasingly being smoked rather than injected. Whilst this shift was partly driven by fears around needle-sharing and bloodborne disease, it has introduced a new and underappreciated danger: the risk of drug-related burn injuries.

“We have long recognised risks related to injection drug use,” said Dr Honora Englander, who leads an in-hospital addiction care team at OHSU and is the study’s lead author. “But the dangers associated with smoking drugs, particularly severe burns, have not previously been reported.”

Butane Torches: An Everyday Object With Deadly Consequences

Central to the research findings is the widespread use of butane torches, the kind typically designed for culinary use, among people who smoke illicit drugs. Unlike standard lighters, these devices often feature locking mechanisms that keep the flame active. For someone who loses consciousness or becomes sedated after inhaling fentanyl, that locked flame can cause catastrophic injury.

Englander and her colleagues interviewed 19 patients who smoke drugs, and those patients consistently described how easy it is to obtain these torches. What makes them particularly dangerous is the combination of a sustained, intense flame and the sedating effects of opioids such as fentanyl.

“This represents a different injury pathway than what we traditionally associate with substance use,” Dr Englander said. “Knowing the risk of severe burns from smoking drugs, it is so important to get the word out to the community.”

The Human Cost: Permanent Disability and Repeated Surgery

Burn injuries are not merely painful in the short term. For many patients, drug-related burn injuries result in permanent disability, multiple surgeries and lasting psychological trauma.

Dr Mark Thomas, a surgeon at the Oregon Burn Centre at Legacy Emanuel Medical Center in Portland and a co-author on the study, has witnessed the trend firsthand.

“We are seeing increasing numbers of patients with catastrophic burn injuries linked to drug use,” he said. “People can recover from addiction, but these burns often result in permanent disability, repeated surgeries, and lifelong physical and psychological consequences.”

The Oregon Burn Centre, one of the leading specialist facilities on the US West Coast, began noticing the rise in such cases in recent years, prompting the research team to investigate whether the pattern was reflected more broadly in population-level data. The Medicaid analysis confirmed it was.

A Public Health Crisis That Extends Beyond Overdose Deaths

Even as overdose deaths in the United States have edged slightly downward from a peak of roughly 100,000 deaths annually at the start of this decade, the OHSU findings serve as a reminder that the human cost of illicit drug use extends well beyond mortality statistics.

Severe burns from smoking drugs represent one of a growing number of non-fatal but life-altering harms that often go uncounted in national assessments of the overdose epidemic. For healthcare providers, outreach workers and policymakers alike, the research is a call to broaden the conversation.

Dr Englander now raises the issue directly with every patient she sees.

“I now talk with every patient about how they are smoking,” she said. “It is especially risky for people using these torches alone.”

Her message to frontline workers is clear: harm reduction conversations must include the risk of burns, and people who smoke drugs need to know that using a butane torch alone, particularly when using fentanyl, can have devastating consequences.

What Needs to Happen Next

The study underscores an urgent need for greater awareness among medical professionals, community health workers and people who use drugs themselves. Drug-related burn injuries are preventable, and targeted interventions, from safer equipment guidance to community outreach, could make a meaningful difference.

As smoking continues to rise as a route of illicit drug use, burn centres across the country may find themselves dealing with an increasing number of these cases. Recognising and responding to severe burns from smoking drugs as a distinct and growing public health risk is the first step toward addressing it.

Source: dbrecoveryresources