ADDICTS KICKING HEROIN WITH PAINKILLERS

Prescription Drugs Flood Illicit Market: Study

Heroin is fast being replaced by legal pharmaceutical drugs such as
OxyContin and morphine among street users of opioids, suggests a
national survey of addicts that underscores the challenges and
opportunities of the changing drug trade.

Users of pharmaceutical opioids are less likely to inject their
narcotics, which is good for curbing infectious disease, but they are
also more likely to mix them dangerously with cocaine, crack and
other street drugs, the newly published study indicates.

Meanwhile, experts are struggling to understand a supply system that
includes retirees peddling painkiller prescriptions and
pharmaceutical company employees selling purloined stock. With Canada
one of the world's biggest medical consumers of opioids, which
provide users with an anesthetizing release, the abundance of legal
supplies has undoubtedly fed the illicit street market, researchers say.

There is an "urgent need" to more closely investigate and comprehend
the new opioid scene, says the study published this month in the
journal Drug and Alcohol Review by researchers in B.C. and Toronto.

"This is not a sideshow any more. In many communities, this is the
predominant form of opioid, if not overall street drug, use," said
Benedikt Fischer of the B.C. Centre for Addictions Research, the
study's lead author.

"These things are so abundantly available now, we are looking at
multiple supply routes feeding this consumption. And these routes are
a lot harder to define and grasp than heroin supply, which is very simple.

"I don't think our enforcement system has in any way caught up to
this or thought about how to cope with it properly."

Overall, such stimulants as cocaine, crack and crystal meth are still
considered the most common hard street drugs in Canada. The changes
tracked by Dr. Fischer's group are among the significant minority who
use opioids. Some of those users also take stimulants such as cocaine.

Called OPICAN, the research project looked at about 480 opioid users
in seven cities from Fredericton to Vancouver, in 2001 and 2005. They
found heroin use overall dropped 24% in that period, while
prescription opioid use jumped.

By 2005, heroin had all but disappeared in four cities, although it
was still common in Vancouver and Montreal, port towns with easier
access to the imported narcotic.

The paper published this month found that those using only
prescription opioids -- 62% of the total -- were much less likely
than heroin users to inject their drugs. About a third took the pills
orally, while the rest would crush them into a solution they could
feed into a hypodermic.

The greater oral use could be good news on two fronts, since
injection tends to increase the risk of overdose and, when needles
are shared, makes transmission of HIV and other serious infections
more likely, said Dr. Fischer.

The study also found, though, that the prescription-opioid users were
more likely to also use crack and other street drugs. The
unpredictability of such mixing tends to lead to more overdoses, Dr.
Fischer said.

Supply appears to come from a variety of sources, he said. Some users
obtain multiple prescriptions by visiting several physicians, a
tactic called chronic "doctor shopping." Others buy from ordinary
people who sell their prescriptions on the streets, including even
senior citizens reported to do business at some Toronto bars, Dr. Fischer said.

"No doctor would question a 70-year-old man who comes in [asking for
an opioid] and says 'Oh, my back.' "

But RaffiBalian, who runs the CounterFit harm-reduction program in
Toronto, said he believes the bulk of prescription opioids on his
city's streets are obtained through illegal means, such as thefts of
pharmacies, sometimes by insiders.

There is other evidence that the usual suspects are involved in the
prescription opioid market. Project Rip, a major investigation into a
Mafia-linked drug-trafficking ring in the Toronto area, prosecuted
three New Brunswick Hells Angels members and others for trafficking
in thousands of generic oxycodone and acetaminophen-codeine pills.

A wiretap captured Constantine "Big Gus" Alevizos, a Mafia-connected
dealer, discussing the purchase of one million Percocet-type tablets
from the employee of an unnamed pharmaceutical company.

Regardless of how users obtain the drugs, prescription opioids offer
them some advantages over heroin, experts say. They are cheaper, more
available and lack the unpredictability of heroin, which has sharply
varying levels of purity.

Rosemary Fayant, who was a heroin user in Edmonton almost two decades
ago and is now head of a provincial drug-users' network, agreed that
prescription pharmaceuticals have become the drug of choice for many addicts.

She noted that some users will take them orally because "they don't
have any [usable] veins left" after years of shooting up one drug or another.

Not everyone buys the theory, however, that pharmaceuticals are
pushing out heroin on Canadian streets, or that needle use is declining.

Mr. Balian said prescription opioids became popular in Toronto as a
way for users to soften the miserable crash following a stimulant
high. Opioid addictions developed, but in many cases users wanted to
move on to heroin, he said.

"Three, four years ago, there were only a handful of heroin dealers
here," said Mr. Balian. "Now, they're everywhere.... With opioids,
what we are seeing is the number of injection-drug users are increasing."

Nonetheless, Health Canada is concerned enough about abuse of opioids
and other prescription drugs that it recently commissioned an Ontario
expert to set up a system to monitor addiction to such medication.

A few months ago, the department ordered a study of an even grimmer
statistic -- the number of Canadians who overdose from prescription opioids.