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Prescription opioids replace heroin as drug of choice on street: study
TORONTO (CP) - Heroin is no longer the drug of choice among many substance abusers in Canada, with prescription narcotics such as morphine and OxyContin now taking its place, says a study of street users in seven cities across the country.
Researchers found that heroin remains the No. 1 illicit drug only in Vancouver and Montreal. In the five other cities - Edmonton, Toronto, Quebec City, Fredericton and Saint John, N.B. - more often than not, getting high means grinding up and injecting prescription opioids.
Furthermore, the switch to highly addictive prescription narcotics among street users likely represents just the tip of the iceberg, said lead author Benedikt Fischer, an addiction researcher at the University of Victoria. If the general population were factored in, he suspects the numbers would be much higher.
"We have to and will do research in Canada as to what is the shape and size of the iceberg below the tip that we've been showing with our little paper," he said Monday. "There are indications that it might be quite enormous."
"But its potential in terms of size and implications is of a nature that we better look at it and start thinking about what do we really need to do about it."
The study, published in Tuesday's issue of the Canadian Medical Association Journal, showed that heroin in 2005 wasn't even a factor among injection drug abusers in Fredericton, and it was barely noticeable in Edmonton and Quebec City.
"So that was quite a shocking finding for us," said Fischer, who also works at the Centre for Addiction and Mental Health in Toronto. "The dramatic changes are really what's happening around the opioids."
"This study for the first time systematically documents this for street-drug-use populations across Canada," he said of the research, which compares drug favourites among street users in 2001 and again in 2005. "This is the first research that shows this trend, or the real picture, across Canada."
The findings have several implications for Canada's health-care system, he suggested.
While heroin is produced in countries like Afghanistan and typically imported and distributed by organized crime organizations, which are subject to prosecution, "opioids come in some fashion directly or indirectly from a doctor's office, they're produced legitimately by pharmaceutical companies," he said.
"So we have very different problems here in terms of supply."
Supplying addicts with such narcotic painkillers as Demerol, Dilaudid, OxyContin and Percodan has given rise to break-ins at doctors' offices and pharmacies, double-doctoring (seeking prescriptions from different doctors) and more generalized theft to turn proceeds of crime into money for drugs.
"The main source is diversion," explained Fischer, so that drugs intended for legitimate use in people with severe pain, such as terminal cancer patients, are diverted to those merely seeking to get high.
Diversion is relatively easy in Canada, compared to many other countries, he noted. While most provinces have some sort of prescription-monitoring database so doctors and pharmacies can check an individual's drug purchases, most are incomplete or not equally accessible by health professionals. There is no national database.
As well, Canada "is a very prescription-happy society," Fischer said. "Canada is among the top consumers of prescription opioids."
But strictly controlling opioids or curtailing them completely to avoid illicit use is not the answer, he said, since many people suffering from pain have legitimate need of the drugs.
"So how to strike a balance - control better in terms of abuse potential while at the same time keeping it available to the people who need it - that's a very, very tricky and delicate issue."
Yet the growing problem of opioid abuse demands that the health-care system find an effective way to treat those addicted to prescription drugs, perhaps with a maintenance program similar to methadone for heroin addicts.
The problem, he said, is that research on methadone for pharmaceutical opioids is skimpy at best, and without that scientific evidence, doctors and even addiction experts don't know what works best to keep users off the drugs.
Gerald Thomas, a senior policy analyst at the Canadian Centre on Substance Abuse, called the study the best he has seen on the issue in Canada, where there has been little research tracking prescription opioid abuse.
"There generally isn't good data around this issue in Canada," Thomas said from Ottawa. "We can tell you how many (opioid prescriptions) are being sold, but that doesn't really give you an indication of how much they're being abused."