Fentanyl Smoking in San Francisco: Early Signs of a New Connoisseurship.

Heroin, once dominating the United States' opioid supply, has been supplanted by the more potent synthetic, fentanyl. In San Francisco, this has been accompanied by drastic changes in price and availability and the novel phenomenon of fentanyl smoking. Ethnographic research among people smoking fentanyl in San Francisco, often living houseless, suggests a process of knowledge reconstruction with the adaptation and discovery of consumption techniques. Equipment and techniques borrowed from more established cannabis consumption, some elaborate, are often used. An emerging appreciation of taste and the smoking process, rather than the achievement of intoxication alone, is transforming the potential for pleasure and connoisseurship among some of the city's most marginalized and stigmatized inhabitants. Given these signs of a new interest in fentanyl's taste and the smoking experience, there may be potential to encourage more deliberative, slow consumption to reduce the likelihood of overdose among those at risk.