The Dangers of Snorting, Injecting, and Smoking Opioids

Dangers of Smoking Opioids

Smoking opioids is a popular method of opioid use because it causes the drug to take effect almost immediately; it also does not have the stigma of “shooting” (injecting). Although smoking opioids is less risky than injecting opioids in terms of disease transmission and soft tissue infections, both injecting and smoking opioids carry an increased risk of overdose (vs. ingestion), and by 2022, smoking was the most common route of use among fatal overdoses.^8,9 Smoking or vaping opioids is also associated with rare but serious issues that are specific to this route of administration. These include:⁷

• Spongiform leukoencephalopathy, a neurological condition characterized by hyperflexia (hyperactive stretch reflexes), akinetic mutism (extreme apathy and indifference), spastic hemiplegia (a form of cerebral palsy), and potential death.
• Interstitial pneumonitis (irregular healing of the lungs).
• Bronchiectasis (widened lung airways leading to a buildup of mucus).
• Inflammation and scarring of the lungs.
• Early onset severe chronic obstructive pulmonary disease (COPD) with predominant emphysema.⁸

Dangers of Injecting Opioids

Like smoking opioids, injecting opioids leads to rapid drug absorption and thus carries an increased risk of overdose vs. ingestion. Potential health consequences of injecting opioids include:

• Skin and soft tissue infections and abscesses.^10,11
• Deep vein thrombosis (DVT)—a blood clot in the vein that can cause swelling, pain, and red/tender skin.^10,12
• Kidney disease that can lead to kidney failure.¹⁰
• Endocarditis (inflammation of the heart’s inner lining).¹¹
• Pulmonary complications, including hypertension, talc granulomatosis, septic pulmonary embolism, pneumothorax, emphysema, and needle embolization.¹³

Due to the practice of sharing needles, injecting opioids also carries a high risk of: 

• Viral hepatitis. The Centers for Disease Control and Prevention (CDC) recommends that people who inject drugs get vaccinated for Hepatitis A and B and get tested for Hepatitis B and C.¹⁴
• Human Immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).¹¹
• Other bloodborne or sexually transmitted infections (STIs).¹¹

Dangers of Snorting Opioids

Snorting an opioid means inhaling it through the nose where the drug is then absorbed into the bloodstream through the nasal membrane.¹⁵ People may snort opioids to avoid the stigma or risks of skin infections and disease transmission associated with injection.¹⁶

However, snorting opioids can cause small blood vessels in the nose to become irritated and rupture. This can lead to nasal pain, nosebleeds, and destruction of nasal cells or tissue that can result in holes in the nasal septum.^16,17 Sharing of tubes, straws and other nasal insufflation equipment can increase the risk of HIV and hepatitis C transmission. Fungal infections have also been associated with snorting opioids, particularly of opioid medication formulations that include acetaminophen.¹⁷ 

How to Help Someone Misusing Opioids

Opioid addiction, also known as opioid use disorder (OUD), is a treatable condition characterized by the compulsive, uncontrollable use of opioids despite it having negative impacts on a person’s life.¹⁸

If you or a loved one are exhibiting the signs of drug addiction, don’t lose hope. Evidence-based treatment interventions like psychotherapy, peer support, and medications for opioid use disorder (MOUD) have helped many people get sober and remain in recovery.¹⁹

Medications Used in Opioid Addiction Treatment

Research has found that medication treatment coupled with psychotherapy is effective for helping a person achieve and maintain abstinence from opioids.¹⁹

MOUDs like methadone, buprenorphine, and naltrexone have been shown to:²⁰

• Reduce cravings for opioids.
• Block the rewarding effects of opioids.
• Lower the risks of legal problems caused by opioid addiction.
• Reduce health problems associated with opioid use.
• Help people remain in treatment.

Behavioral Therapies Used in Treatment for Opioid Use Disorder

A few different types of behavioral therapies are commonly used in treating OUD. Some of these evidence-based therapeutic approaches include:¹⁹

• Cognitive-behavioral therapy (CBT) helps a person explore how their thought patterns contribute to their emotions and in turn affect their opioid use.  With the skills learned with CBT, the patient can change unhelpful core beliefs about themselves, others, and the world, stop their drug use, and mitigate many of the problems associated with addiction.
• Motivational interviewing is a therapy strategy that reduces a patient’s apathy toward change. The goal is to help the person weigh the costs and benefits of use and gradually help increase their motivation to reduce use.
• Contingency management, which involves providing rewards for each goal or milestone the person reaches, such as 30 days of abstinence.

Further, participation in peer-support groups like Narcotics Anonymous (NA) can bolster the skills, strategies, and self-esteem someone gains in treatment.¹⁹

Levels of Care and Treatment Settings

A few different treatment settings provide MOUD and behavioral therapies. The setting in which someone undergoes treatment may depend on the patient’s individual needs.¹⁹

Common levels of addiction treatment and treatment settings include:¹⁹

• Medical detoxification (detox), which is often the first step in treatment for someone who is physically dependent on opioids can be completed in an inpatient or outpatient setting. Withdrawal from opioids is rarely life threatening, but it can be extremely uncomfortable. Medical detox enables medical professionals to make this process much more tolerable for patients by monitoring and providing medications to mitigate withdrawal symptoms if necessary. It’s important that patients continue treatment after medical detox, as this step alone is seldom successful in helping someone maintain long-term sobriety.
• Inpatient/residential treatment, which involves living at the treatment facility 24/7 and receiving comprehensive services from a multidisciplinary staff including therapists, social workers, psychiatrists, and general practitioners.
• Outpatient treatment. Outpatient counseling involves visiting a facility and undergoing treatment several times a week. There are varying levels of intensity available for outpatient care. Partial hospitalization programs (PHPs) or intensive outpatient programs (IOPs) demand that patients visit more often and for longer session blocks, whereas standard outpatient care requires fewer treatment hours and affords more flexibility in scheduling.

There are many continuing care programs (also called aftercare) that patients can benefit from after attending formal treatment to set patients up for success and help prevent relapse. These can range from living in a sober living facility to attending 12-Step meetings.¹⁹

It is never too late to seek treatment and help is available. Please call American Addiction Centers (AAC) to begin the admissions process at one of our treatment centers or to learn more about the various options for addiction treatment. We are here 24/7 and happy to assist.