Study links smokable drug use to heightened incidence of severe burns

A new analysis in Oregon reveals a heightened incidence of severe burns requiring hospital-level care as illicit drug use has shifted nationwide from injection to smoking.

Researchers analyzed Oregon Medicaid data and found that over half of people treated for burns in hospitals and emergency rooms over nearly a decade also used smokable drugs other than tobacco.

"That's a striking and concerning finding," said lead author Honora Englander, M.D., who directs an in-hospital addiction care team at Oregon Health & Science University. "Serious burns are an under-recognized risk associated with smoking drugs. We hope that our study will increase awareness of this critical public health issue."

The study, published today in the journal JAMA Internal Medicine, analyzed Oregon Medicaid case data from April of 2016 to March of 2024.

Even as the number of overdose deaths in the United States has declined slightly from 100,000 deaths annually at the start of this decade, the new findings highlight a broader spectrum of injury and disability linked to substance use.

Smoking has surpassed injection as the most common route of fatal overdoses of illicit drugs nationwide, researchers said.

Researchers conducted the study after medical staff in Portland began noticing an increase in severe burns, especially at the Oregon Burn Center at Legacy Emanuel Medical Center. In addition to analyzing Medicaid data, Englander and co-authors conducted interviews with 19 patients who smoke drugs such as illicitly manufactured fentanyl and stimulants like methamphetamine.

She said patients described the widespread availability of butane torches designed for cooking.

Unlike common lighters, Englander noted that these devices typically include locking mechanisms that raise the risk among people who may become sedated or unconscious while inhaling fentanyl.

"This represents a different injury pathway than what we traditionally associate with substance use," Englander said. "We have long recognized risks related to injection drug use, but the dangers associated with smoking drugs, particularly severe burns, have not previously been reported."

Mark Thomas, M.D., a surgeon in the Oregon Burn Center at Legacy Emanuel in Portland, is a co-author on the study.

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

Englander, a hospital physician who specializes in addiction medicine, is encouraging outreach workers and medical providers to talk with clients about the hazard. It's especially risky for people using these torches alone.

"I now talk with every patient about how they are smoking," she said. "Knowing the risk of severe burn injuries, it's so important to get the word out to the community."

In addition to Englander and Thomas, co-authors include Stephanie Renfro, M.S., and Alisa Patten, M.A., of OHSU; Haven Wheelock, M.P.H., of Outside In; Syrrita Mason of The Peer Company; and Caroline Raymond-King, M.D., Ph.D., of Yale University.