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.