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.
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MAP posted-by: Beth Wehrman