![]() Although the risk of overdose is lessened when heroin is inhaled, it is not eliminated. Dependence certainly occurs and (long term) heroin smoking is associated with respiratory health problems, although research has not yet adequately quantified these risks or distinguished them from confounding factors that are common among heroin users such as tobacco and cannabis smoking. Heroin smoking is not without its own harms. Additionally, there is suggestive evidence that severity of dependence is higher among people who inject however, the direction of causality here is less clear, as severity of dependence may also lead to injecting. When compared to inhaling/smoking heroin, the risk of overdose is far greater when people inject. ![]() Injecting also causes soft tissue injuries and often leads to long-term physical damage such as collapsed veins as a result of the repeated physical trauma that arises from repeated injecting. Poor injecting hygiene can also lead to a large number of local and systemic bacterial and fungal infections. The risk of acquiring blood-borne viral infections including HIV, hepatitis B and hepatitis C are all strongly associated with the sharing of injecting equipment through blood to blood transmission. When compared to other routes of heroin administration, injecting introduces many specific risks and simultaneously increases others. The risks of injecting versus smoking heroin
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