Pubdate: Wed, 22 Nov 2006 Source: Ottawa Citizen (CN ON) Copyright: 2006 The Ottawa Citizen Contact: http://www.canada.com/ottawa/ottawacitizen/ Details: http://www.mapinc.org/media/326 Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) CHANGING FACE OF ADDICTION Heroin is on its way out of fashion on Canadian streets. Addicts are turning to doctors and pharmacists rather than to dealers. This could be good news if governments react to the trend intelligently and quickly. In the latest issue of the Canadian Medical Association Journal, a group of researchers tracks changes in illicit use of opioids -- drugs such as morphine, codeine and heroin -- between 2001 and 2005. The sample of 585 users came from several Canadian cities. Most were white men, with an average age of 35. Half were "not stably housed." Along with the decrease in heroin use came an overall decrease in injection drug use, a risky behaviour that spreads HIV when users share needles. Prescription drugs are becoming the "predominant form of illicit opioid use," the researchers write. Prescription medication should be easier to control and regulate than illegal street drugs -- in theory, at least. The trend away from stigmatized drugs might also make it easier for Canadians to empathize with addicts on the streets. It would be unusual for a family to have no experience with prescription opioids such as Tylenol 3, morphine, Demerol, Percodan or OxyContin. These are drugs that threaten rich celebrities, the people around the table at Christmas dinner and the homeless guy down the street. The better the voters' understanding of drug addiction, the better Canada's drug policy will be. Nonetheless, the lack of stigma attached to pain pills could itself be a danger. These are the true gateway drugs: People can become addicted while using them to deal with pain, under prescriptions. The researchers suggest illicit opioid use could also be a form of self-medication for people with undiagnosed mental illness. As with all potentially harmful substances, from alcohol and cigarettes to crystal meth, controlling the supply will never entirely solve the problem. On its own, criminalizing any substance usually creates a black market or forces addicts to choose a new poison. Still, there are ways to make it harder for addicts and vulnerable people to abuse the health care system. Electronic health records can prevent doctors and pharmacists from prescribing to someone who already has a prescription or two, or at least help health care professionals recognize when it's time to inquire of a patient if he or she is developing a dependency. Governments can and should support treatment programs for opioid addicts. There's still a demand for methadone clinics -- especially in cities such as Montreal and Vancouver that have large numbers of heroin users. In the same issue of the CMAJ, a different group of researchers found that the safe-injection site in Vancouver "has been associated with an array of community and public health benefits without evidence of adverse impacts." Governments still need to make informed choices about injection drug use. But they also need to encourage treatment and prevention programs that specialize in the kind of drugs any Canadian might take at some point in his or her life. - --- MAP posted-by: Beth Wehrman