A new analysis published on Mar. 16 in JAMA Internal Medicine reports that more than half of people treated for severe burns in Oregon hospitals and emergency rooms over nearly a decade also used smokable drugs other than tobacco.
The findings highlight an under-recognized risk associated with the shift from injection to smoking as the primary method of illicit drug use nationwide. Researchers say this trend has led to a broader range of injuries and disabilities linked to substance use, beyond overdose deaths.
Lead author Honora Englander, M.D., who directs an in-hospital addiction care team at Oregon Health & Science University, said, "That's a striking and concerning finding. 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 analyzed Oregon Medicaid case data from April 2016 through March 2024 and included interviews with patients who smoke drugs such as illicitly manufactured fentanyl and methamphetamine.
Englander explained that many patients described using butane torches designed for cooking, which often have locking mechanisms that can increase burn risks if users 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 at the Oregon Burn Center at Legacy Emanuel Medical Center and co-author of the study, said, "We are seeing increasing numbers of patients with catastrophic burn injuries linked to drug use. People can recover from addiction, but these burns often result in permanent disability, repeated surgeries, and lifelong physical and psychological consequences."
Englander encourages outreach workers and medical providers to discuss these hazards with clients—especially those using torches alone—and now talks about safe practices with every patient she sees. "Knowing the risk of severe burn injuries, it's so important to get the word out to the community," she said.
Other co-authors include Stephanie Renfro, M.S., and Alisa Patten, M.A., both 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.
