A new study conducted in seven Canadian cities reveals that prescription opioids, and not heroin, are the major form of illicit opioid use. These findings raise questions about the current focus of Canada's drug control policy and treatment programs.
A team led by Dr. Benedikt Fischer, a researcher funded by the Canadian Institutes of Health Research (CIHR) and based at the Centre for Addictions Research (CARBC) at the University of Victoria, published its findings in the November 21, 2006 issue of the Canadian Medical Association Journal.
Opioids are commonly prescribed as pain-killers (analgesics). Prescription opioids that are commonly prescribed in Canada include Oxycontin, morphine, Demerol, Percodan and Tylenol 3 or 4.
"Our study suggests that heroin use has become an increasingly marginal form of drug use among illicit opioid users in Canada, especially outside Vancouver and Montreal," says Dr. Fischer.
Heroin use was substantially prevalent only in Vancouver and Montreal. It was de facto absent in smaller cities like Edmonton, Quebec City or Fredericton. And, in all study sites, there was a significant decline of heroin use among participants between 2001 and 2005.
Dr. Fischer also highlights that in a large number of cases prescription opioids used by street drug users originate from the medical system and not from illicit production and distribution.
The secondary and reduced relevance of heroin compared to prescription opioids among illicit opioid users has implications for drug control policy and treatment programs, which primarily focus on heroin abuse and dependence.
"Our drug control policies ought to be targeting prescription opioid abuse more effectively," says Dr. Fischer. "But we also need to ensure we do not compromise legitimate access to and uses of prescription opioids."
Dr. Rémi Quirion, based in Montreal and Scientific Director of the CIHR Institute of Neurosciences, Mental Health and Addiction says, "although there have been reports on the increased levels of prescription opioid abuse in Canada and other jurisdictions, there has until now not been a systematic documentation of usage patterns among street drug users."
"This study, conducted by Dr. Fischer and his team provides us with the scientific evidence needed to improve public policy and treatment programs. Such research is key to ultimately improving the health of Canadians," adds. Dr. Quirion.
The multisite OPICAN cohort was established in 2001. The results reported in this study are based mainly on a follow-up sample of 585 participants from 7 Canadian cities (Vancouver, Edmonton,Toronto, Montreal, Quebec, Fredericton and St. John) who were assessed most recently in 2005.
The principal author of this study is also affiliated with the Centre for Addiction and Mental Health in Ontario, Canada's leading addiction and mental health teaching hospital, where the study was conducted.
The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.
The Centre for Addictions Research (CARBC) at the University of Victoria is a partnership between UVic and the University of British Columbia, Simon Fraser University, the University of Northern British Columbia, and Thompson Rivers University. Its mission is to facilitate research and knowledge exchange on substance use, harm reduction and addiction.
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