A LESSER EVIL FOR DRUG ADDICTS

There may be public health benefits for addicts of injection drugs
shifting from street drugs to the misuse of prescription medication,
according to a controversial paper.

Addicts who forge prescriptions or engage in so-called double-doctoring to
get prescription opioids such as dilaudid and Oxycontin are significantly
less likely to inject, which reduces the risk of blood-borne diseases such
as hepatitis C or HIV.

They're also less likely to overdose or become ill because the potency of
prescription drugs is known, unlike that of illicit drugs, according to
the advance electronic article in the medical journal Public Health.

"One crucial risk factor for harm related to injection drug use has
traditionally been the unknown, and often widely varying, potency ... of
street drugs," says the article.

The purity of heroin ranges from 10% to 70%, it notes, leading to overdose
risk.

While the non-medical use of prescription opioids, especially when
capsules are crushed and injected, bears health risks, there's still less
danger of overdosing, the authors write.

In addition, the misuse of prescription drugs cuts crime because addicts
aren't robbing people to get the funds to buy heroin, they suggest.

Forging prescriptions or double-doctoring "are clearly not desirable or
ideal ways to care for addicted populations" but potential reductions in
mortality, illness or crime can be seen as "superior objectives to justify
such behaviours," they write.

Unorthodox

"An unorthodox way of thinking about the increasing prevalence of
(prescription opioid) use among street drug users might be as an
unsanctioned or indirect form of medical opioid substitution," they
explain.

The authors see such behaviour as filling an unmet need because methadone
and other heroin substitution treatment is limited in Canada and the U.S.

In B.C., which has one of the higher per-capita methadone treatment rates,
there's only enough methadone for 50% of the people who are regularly
injecting opioids, says Dr. Perry Kendall, B.C.'s provincial health
officer and a co-author of the article.

Some medical issues are more likely to attract funding than others and
mental health and addiction are still so stigmatized that it's hard to
compete for health dollars, he says.

"At some point, (addicts) are going to want to quit and ... access to
treatment is not that available in a timely fashion."

In the paper, Kendall and his co-authors recommend that more research be
conducted comparing the mortality, illness and crime burden of heroin
users and prescription opioid users.

"If you're going to abuse opioids, it might be better from a public safety
.. perspective to be abusing diverted prescription ones than the stuff
that's manufactured in Mexico or Burma," Kendall said yesterday.

Co-author and Simon Fraser University public health specialist Benedikt
Fischer said the point of the paper was to open up the debate.

Shift away

"There's a shift away from heroin and increasing use of prescription
opioids and everyone seems to be panicking about it," he says.

"We're just trying to do a bit of constructive thought-provoking in the
interests of public health," he explained.

"We don't want anyone to be using drugs illicitly. It's not good for
public health. We're just saying, relative to the previous predominant
reality, (pharmaceutical substances) may not be all bad."

Adds Kendall: "We could look to (Barack) Obama who said now science has a
place in policy. I would hope that might sneak north of the border."