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Inhaled drug particles and aerosols are not confined to primary users.

Second-hand opioid smoke contaminates indoor air.

Non-using children, pregnant women and adults can test positive for drugs after second, third-hand exposures.

Some experts have mischaracterized smoking fentanyl as “safer” than injecting, seeking to reduce risks among users. Narrowly considered, the statement is accurate, as inhalation avoids needle-sharing, reducing risks for HIV, hepatitis C, bacteremia, abscess formation, and infective endocarditis among users. However, there’s no clinical-trial–level evidence (randomized trials with real patients) showing smoking illicit fentanyl is safer than injecting it. It isn’t, and that conclusion is unsupported by toxicology, environmental exposure science, or emerging data. Smoking fentanyl also may facilitate speedballing, as with methamphetamine plus fentanyl.

Smoking fentanyl is akin to injection without a needle, but in addition to this, smoking creates environmental contamination and major exposure risks. Evidence from tobacco, cannabis, methamphetamine, and household opioid-smoking indicates such risks exist, not only to users, but also to anyone living in or frequenting the same environment.

Secondhand tobacco smoke is firmly established as a cause of cardiovascular disease, lung cancer, asthma exacerbations, adverse pregnancy outcomes, and sudden infant death syndrome. More recently, “third-hand” smoke—residual nicotine and combustion byproducts persisting on walls, carpets, clothing, and dust—is recognized as an additional exposure pathway, particularly for infants and young children.

Cannabis research in controlled chamber studies has shown non-users in poorly-ventilated environments can absorb measurable Δ9-tetrahydrocannabinol (THC) after secondhand exposure, with detectable biomarkers in blood and urine. (THC is the intoxicating substance in cannabis.) Professor Adrian Bruinjzeel and colleagues have shown that cannabis dependence and withdrawal can then develop.

Second- and third-hand exposure to smoked methamphetamine poses documented risks in homes, apartments, cars, and short-term rentals where smoking occurs. When meth is heated and inhaled, airborne particles and vapors may settle onto walls, ceilings, carpets, furniture, HVAC systems, and personal belongings, creating persistent surface contamination. Studies from Colorado and California—which have established cleanup standards for former meth labs and contaminated properties—show residues can be re-emitted into indoor air or transferred through skin contact and dust ingestion. Infants and young children are at particular risk........

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