Drug injection fades as smoking grows more common, marking sea change in U.S. fentanyl epidemic

Harm reduction experts applaud shift as safer, even as some officials reject pipe use
By Lev Facher, Feb. 12, 2026, STAT -Addiction ReporterROCHESTER, N.H. — Megan Merrill paused, mid-hike, as she surveyed the steep drop before her. She was standing on a five-foot snow drift, icy and brittle after 10 days of unrelenting New England cold, below which lay the railroad tracks that serve as a de facto border between the town behind her and the homeless encampment in front. 
She took the downward slope at a gallop, using her oversized backpack as a counterweight. The bag was made heavy with a stockpile of harm reduction supplies meant to help vulnerable drug users stay healthy and avoid disease, including sterile syringes, condoms, emergency blankets, and hand warmers.
The items Merrill was most eager to distribute, however, were glass pipes. Her reasoning was simple: Injection can lead to infections, diseases, skin abscesses, and potentially higher rates of fatal overdose. To Merrill and harm reduction workers like her, pipes are health care. 
“You’re going to see less vein damage, you’re not going to get abscesses on your arm or infections,” said Merrill, who works with a local community organization, SOS Recovery. “There’s less chance of you overdosing if you’re smoking than if you’re injecting. And infectious diseases: With injections, there are blood-borne illnesses, hepatitis C, HIV.” 
In the last decade, U.S. drug consumption behavior has shifted rapidly away from injecting and toward smoking. Once largely limited to the West Coast, a preference for smoking opioids has spread east since the Covid-19 pandemic, becoming especially pronounced in hard-hit cities like Philadelphia. 
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