San Francisco researchers documented a notable shift among opioid users transitioning from injecting heroin to smoking fentanyl, driven by comparable drug effects but reduced health risks. The qualitative study of 32 participants found that fentanyl's potency allows users to achieve similar euphoric effects through inhalation as previously obtained through injection, eliminating many injection-related complications. This transition represents a significant departure from historical drug use patterns, where route changes typically escalated rather than de-escalated risk profiles. The shift appears motivated by practical health considerations including collapsed veins, infection risks, and overdose concerns, combined with market forces as fentanyl displaced heroin availability. From a harm reduction perspective, this represents a potentially positive development since smoking eliminates bloodborne infection risks, reduces overdose likelihood, and decreases injection site complications. However, the transition also reflects the broader opioid crisis evolution and fentanyl's market dominance. These findings suggest that user behavior adapts pragmatically to both drug characteristics and availability, indicating that harm reduction strategies should account for evolving consumption patterns rather than assuming static risk behaviors.