Portland burn surgeons are sounding the alarm over a brutal side effect of the region’s shift toward smoked fentanyl: a spike in life-threatening burns that can go all the way down to muscle and bone. At the Oregon Burn Center, clinicians say they are treating patients who need repeated reconstructive surgeries, sometimes amputations, and at least one person recently died after falling asleep while smoking. The pattern has pushed doctors and public health researchers to ask whether inexpensive butane torches are creating a particularly dangerous path to permanent injury for people who smoke illicit drugs.
A mixed-methods paper in JAMA Internal Medicine looked at Oregon Medicaid claims from April 2016 through March 2024 and found that more than half of people treated for burns in hospital settings had used smokable drugs other than tobacco. Local reporting from OPB includes surgeons and study authors describing several catastrophic recent cases, including a patient who died after catching fire while smoking fentanyl.
How Butane Torches Raise Burn Risk
Researchers and burn surgeons say the danger often traces back to butane torches, handheld devices that produce a very hot, focused flame and often come with a lock that keeps the flame burning without pressure on the trigger. Dr. Honora Englander, the study’s lead author and director of the in-hospital addiction care team at OHSU, told OHSU News that the “softer flame” of a common lighter is a safer choice than a torch, especially when people are using sedating drugs such as fentanyl.
People interviewed for the study said they turn to torches because they vaporize drugs efficiently and keep working in the wind. Many also admitted using the lock while smoking, a small convenience that can become disastrous if someone nods off and leaves a live flame pressed against clothing, bedding or skin.
What The Numbers Show
The JAMA analysis paired Oregon Medicaid claims with interviews and found that people who smoke opioids or stimulants had burn treatment rates roughly four times higher than people who do not smoke illicit drugs, according to JAMA Internal Medicine. The mixed-methods approach, which combined state insurance data with interviews of 19 people who smoke substances, is described as the first effort to quantify burn risk tied to smokable drug use in an era when butane torches are widely available.
Harm-Reduction Tradeoffs
The shift from injecting to smoking does carry public health benefits, but it also creates a new set of hazards that are getting harder to ignore. The CDC has documented a national trend in which smoking surpassed injection as the most commonly documented route of drug use in overdose deaths by 2022, a change that makes Oregon’s findings relevant far beyond Portland…