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Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000-2021.

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Summary

Route of administration (ROA) preferences for heroin and synthetic opioids have shifted, with declining injection use nationally and increasing smoking, especially in the western US. Snorting has also risen in the eastern US, indicating evolving public health risks.

Keywords:
Opioid epidemicOpioid injectingOpioid smokingOpioid use disorder (OUD)People who use drugsRoute of administration preferences

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Area of Science:

  • Public Health
  • Epidemiology
  • Substance Use Disorders

Background:

  • Heroin and synthetic opioid use is linked to unique health risks based on the route of administration (ROA).
  • Shifts in ROA preferences during the opioid epidemic remain unclear.

Purpose of the Study:

  • To analyze trends in heroin/synthetic opioid ROA preferences from 2000-2021.
  • To identify factors associated with changing ROA preferences.

Main Methods:

  • Utilized data from 7,881,318 admissions to SAMHSA TEDS-A from 2000-2021.
  • Analyzed trends in injection, smoking, and snorting preferences and associated demographic and geographic factors.

Main Results:

  • National injection use peaked in 2014 and declined to 52.2% by 2021.
  • Smoking rates rose steadily to 11.4% by 2021, with significant growth in western states.
  • Snorting use increased in eastern states, while older age at first opioid use and certain racial/ethnic groups showed higher non-injection ROA prevalence.

Conclusions:

  • Heroin/synthetic opioid ROA preferences have significantly changed since 2000.
  • Increased smoking prevalence, particularly in the western US, and rising snorting in the eastern US are key trends.
  • Public health strategies must address the growing risks of smoking-related overdoses and shifting morbidity patterns.