The study examines trends in routes of drug use among drug overdose deaths in the United States from January 2020 to December 2022. Preliminary data indicate that over 109,000 drug overdose deaths occurred in 2022, with nearly 70% involving synthetic opioids, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). The CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) to describe these trends. Key findings include: - The percentage of overdose deaths with evidence of injection decreased by 29.1% from 22.7% to 16.1%, while the percentage with evidence of smoking increased by 73.7% from 13.3% to 23.1%. - The number of deaths with evidence of smoking increased by 109.1%, from 2,794 to 5,843. - Smoking became the most commonly documented route of use in overdose deaths by 2022. - Trends were consistent across all U.S. regions. - Among deaths with only IMFs detected, the percentage with evidence of injection decreased by 41.6%, and the percentage with evidence of smoking increased by 78.9%. The study suggests that strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other noninjection routes, could reduce drug overdose deaths. The findings highlight the importance of expanded messaging, continued support for syringe services programs, and enhanced outreach and harm reduction services for individuals using drugs through smoking and other routes.The study examines trends in routes of drug use among drug overdose deaths in the United States from January 2020 to December 2022. Preliminary data indicate that over 109,000 drug overdose deaths occurred in 2022, with nearly 70% involving synthetic opioids, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). The CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) to describe these trends. Key findings include: - The percentage of overdose deaths with evidence of injection decreased by 29.1% from 22.7% to 16.1%, while the percentage with evidence of smoking increased by 73.7% from 13.3% to 23.1%. - The number of deaths with evidence of smoking increased by 109.1%, from 2,794 to 5,843. - Smoking became the most commonly documented route of use in overdose deaths by 2022. - Trends were consistent across all U.S. regions. - Among deaths with only IMFs detected, the percentage with evidence of injection decreased by 41.6%, and the percentage with evidence of smoking increased by 78.9%. The study suggests that strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other noninjection routes, could reduce drug overdose deaths. The findings highlight the importance of expanded messaging, continued support for syringe services programs, and enhanced outreach and harm reduction services for individuals using drugs through smoking and other routes.