More WA drug users are smoking rather than injecting, UW study finds

More illegal drug users in Washington state are smoking drugs rather than injecting them.

Results from the latest Syringe Services Program (SSP) Health Survey reveal that, since 2021, there has been a 49 percentage point decrease in respondents injecting drugs. In 2025, 90% of respondents reported smoking drugs the week prior, while only 44% had used a syringe.

The survey is conducted every two years by the Addictions, Drug & Alcohol Institute at the University of Washington, and asks SSP participants throughout Washington state about their health needs, drug use patterns, and interest in treatment services. Nearly 1,700 SSP participants across 24 counties participated in the survey in 2025.

SSPs are public health programs that provide resources to drug users so they can use safely, with the ultimate goal of saving lives and mitigating harm. There are about 40 of these programs in Washington state.

Resources the program provides include education on overdose prevention, naloxone, HIV and hepatitis C testing, treatment and housing referrals, and supplies to promote safe drug use, according to the Washington State Department of Health.

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The Addictions, Drug & Alcohol Institute uses the results from the survey to assess and help improve programs for people who use drugs.

For instance, as a result of the 2023 SSP survey, Washington funded health engagement hubs, where people can get physical care, harm reduction, mental health care, and substance use disorder treatment.

Alison Newman, a lead author on the report, attributes the increase in smoking to a change in the drug supply with fentanyl becoming more popular than heroin.

“Heroin… tended to have more black tar, which needed to be injected rather than smoked in order for people to use it,” Newman explained. “Fentanyl is more potent, people were able to get a similar effect from smoking it.”

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The survey also found that users were less likely to inject drugs at SSPs that provided smoking supplies.

“At sites with smoking supplies, 94% of people smoked, and at sites without smoking supplies, 78% of people smoke,” Newman said. “However, when you flip it and look at past week injections, twice as many people are injecting at sites without smoking supplies.”

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Because fentanyl is widespread, providing smoking supplies helps users smoke safely, Newman explained. While providing smoking supplies does not increase a user’s desire to smoke, it could cause them to inject less.

“We know that especially safe injection supplies help reduce the risk of HIV and hepatitis C,” Newman said, “and we think safer smoking supplies helps bring people in the door to engage in all these other really important services."

Other significant findings from the survey include:

• Methamphetamine remained the most frequently used drug (90%), followed by fentanyl (58%), cannabis (50%), alcohol (26%), crack or cocaine (26%), and heroin (9%).
• The majority of people surveyed wanted to stop using opioids or stimulants.
• Over half of the respondents were unhoused and around a quarter were in temporary or unstable housing.

Newman says the percentage of drug users who were unhoused was higher in 2025 than past years.

SSPs have adapted to meet the needs of the growing unhoused population amongst people who seek help from these programs. For example, Newman said they have started providing hygiene services, shower programs, and are helping connect people with food assistance..

SSPs are effective in improving public health in communities and connecting drug users with treatment, according to the state DOH. SSP participants are more than five times more likely to enter substance use treatment, and about three times more likely to report decreasing or stopping injecting drugs, the DOH reports.

More than half of participants in the survey said they’re interested in more services from SSPs, including drug testing, as well as physical and mental health care.

However, the DOH says SSPs still face "political challenges and stigma.”

“I know that sometimes smoking supplies are seen as controversial, but we know they're really helping to engage a group of people that can otherwise be really hard to reach,” Newman said. “We really want to help support their health, and provide support and referrals.”