Pubdate: Fri, 17 Aug 2012
Source: Toronto Star (CN ON)
Copyright: 2012 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Megan Ogilvie

OXYCONTIN REPLACED BY EXPLOSION OF SMALL-TOWN HEROIN USE

The dire predictions have panned out: Heroin has filled the void.

Almost six months after OxyContin was replaced with a harder-to-abuse 
pill, police services and addiction counselors say heroin has made a 
dramatic appearance on community streets, fueling crime and causing a 
rise in overdoses.

In many Ontario towns and cities, the potent drug is now cheaper and 
easier to access than OxyContin. Heroin is also surfacing in 
communities that have rarely or never had to deal with the dangerous 
narcotic. And some of those turning to heroin - often to stave off 
the horrors of opioid withdrawal - appear to cross all age groups and 
social and economic backgrounds.

Frontline police officers and addictions staff say the sudden arrival 
of heroin coincides with shrinking street supplies of OxyContin - an 
unintended, though perhaps not unexpected, consequence of making it 
harder for people to get the prescription painkiller.

"We went from 'hillbilly heroin,' as oxys were referred to, to heroin 
proper," said Murray Rodd, chief of the Peterborough Lakefield 
Community Police Service.

"It was a direct consequence of replacing the demand for OxyContin 
with actual heroin. And it happened in a very short period of time."

On Wednesday, Peterborough police took part in a major drug raid 
across the GTA, during which investigators seized, among other 
things, large quantities of cocaine, marijuana and heroin with a 
combined street value of more than $430,000.

The seven-month investigation, called Project Kingfisher, was led by 
the Durham Region police guns and gangs enforcement unit. Of the 28 
people arrested, 10 are Peterborough residents who together face a 
total of 60 charges.

Rodd said the number of charges and arrests linked to Peterborough 
residents "show the appetite and scope" of the heroin issue in the community.

Staff Sgt. Larry Charmley said Peterborough police - and those in the 
Durham force - were surprised by the amount of heroin coming into the 
Peterborough area.

"Until now, we never had a known heroin problem in Peterborough," 
Charmley said.

"We pretty much expected this might happen, and now it's verified."

On March 1, Purdue Pharma replaced OxyContin with OxyNeo, a new 
formulation of the oxycodone-based medication that the manufacturer 
says is more difficult to crush and therefore less likely to be 
abused through injecting or snorting.

At the same time, Ontario delisted OxyNeo from the province's drug 
benefit program, thereby tightening the rules under which it can be prescribed.

Both moves were made to curb the number of people who get addicted to 
OxyContin, a drug that is up to twice as strong as morphine.

OxyContin has fueled an addiction epidemic in Ontario. According to 
the province, each year between 300 and 400 people die from overdoses 
involving prescription opioids, primarily OxyContin.

Though the changes made earlier this year were generally welcomed as 
ways to prevent people from abusing the highly addictive drug, there 
were also worries that removing OxyContin from pharmacy shelves would 
create other problems.

People addicted to OxyContin could seek help when their supply ran 
out - which, while the ideal outcome, could stretch addiction and 
treatment programs beyond capacity, experts said.

Or users would turn to other, potentially more harmful drugs to 
satisfy their addiction. Police and addiction counselors pointed to 
heroin and fentanyl, another prescription opioid available as a skin 
patch, as prime replacements to OxyContin.

In Toronto, what some call the epicentre of the province's illicit 
drug trade, OxyContin is reportedly still easily found on the street.

Lynne Raskin, director of the South Riverdale Community Health 
Centre, said in general the community hasn't yet been affected by the 
discontinuation of OxyContin, and that reports suggest there has been 
no increase in the street costs of a pill.

She also said clients have reported that some people have found ways 
to abuse OxyNeo, that there is more heroin on Toronto streets and 
that it is "much cheaper and much more accessible."

A spokesperson for the Toronto Police Service said officers in the 
drug squad have not noticed a spike in heroin use.

It seems smaller communities in southern Ontario are the first to see 
the fallout from discontinuing OxyContin.

"What we are seeing now is a dramatic and sudden appearance and 
increase in use of heroin," said Det. Const. Michael Van Sickle, an 
officer in the vice branch of the Sarnia Police Service. "Six months 
ago, we were not hearing about heroin, nor were we seizing it."

Addiction counsellors in Hamilton and Durham Region told the Star 
that more clients have reported using heroin in the six months since 
OxyNeo replaced OxyContin. (Though in Hamilton opioids also continue 
to trend upwards.)

And, according to news reports, police and addiction workers in 
London, Ont., say they have seen users gravitate towards heroin, 
crystal meth and hydromorphone, a prescription narcotic similar to morphine.

Christina Colacicco, an outreach counsellor at the John Howard 
Society of Durham Region, said that while some clients have sought 
methadone treatment after finding it hard to get OxyContin, others 
are clearly using heroin as the alternative drug to get their needed high.

This switch means she and her colleagues have needed to ramp up 
overdose training for their clients by educating them about warning 
signs - blue lips, heavy breathing - that signal a potentially fatal 
drug overdose.

"We have to go on the defence," said Colacicco, who speaks with drug 
users at Project X-Change, a needle exchange program in the region.

Heroin comes with more risks than OxyContin because users do not know 
how much drug they are getting, or what substance has been used in 
the cutting process. Experts say the chance of overdose is much 
higher with heroin.

Debbie Bang, executive director of Womankind Addiction Services at 
St. Joseph's Healthcare Hamilton, said that prescription medications, 
such as OxyContin, are standardized and each pill provides an exact 
amount of drug.

"You ultimately know what's in that pill you are taking, while heroin 
is highly dependent on who is selling it to you," she said, adding 
that heroin could contain impurities that cause allergic reactions 
and is an unknown when it comes to purity.

"Is it purer than I'm used to, and therefore am I going to overdose? 
There is a whole unknown around that heroin product. And there's the risk."

Fentanyl - a drug that Sarnia police say has flooded the city's drug 
trade - is also a health concern.

People who abuse fentanyl cut the patch into pieces, scrape off the 
potent drug and inject it. This can lead to overdoses because users 
are not able to judge the dose they are getting.

Ontario's Ministry of Health has been monitoring the effects of 
discontinuing OxyContin since early March and is working with an 
Expert Working Group on Narcotic Addiction.

According to a ministry spokesperson, a weekly surveillance program 
that checks in with community addiction service organizations and 
needle exchange programs, via the Local Health Integration Networks 
and Public Health Units, has found "no significant changes in 
population health or health system utilization."

However, the surveys have found that changes in drug use behaviours 
appear to be happening more quickly in northern and rural communities 
where supply of OxyContin is lower, and that some organizations have 
reported clients substituting heroin for the prescription painkiller.

The ministry is also monitoring opioid-related emergency department 
visits and hospital admissions and opioid-related deaths. This data 
is not yet publicly available.

Theodore Cicero, a professor of psychology at the Washington 
University School of Medicine in St. Louis, said he is not surprised 
to hear the anecdotal evidence that heroin is replacing OxyContin in 
Ontario communities.

He co-authored a study, published in July in the New England Journal 
of Medicine, that found fewer people injected and snorted OxyContin 
after the harder-to-abuse version of the drug went on the market. In 
the U.S., the switch happened in August 2010.

However, the research also showed the abuse-deterrent formula caused 
the study's participants to turn to heroin, something Cicero said was 
an unanticipated outcome.

"We saw a doubling in heroin use," he said, noting his research 
suggests abuse-deterrent formulas of drugs are not the hoped-for 
"magic bullet."

"For this huge problem of substance abuse, simple fixes are not going 
to solve it. They will just steer the problem in different directions."
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MAP posted-by: Jay Bergstrom