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The Potential Up Side of Street Opioids

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As our in-depth feature on Vancouver's legal heroin injection site suggests, Canadians seem to be open to creative ways of thinking about the problem of recreational drug usage.

So it's no surprise that it is four Canadian researchers who are asking the counterintuitive question: "Could the increasing misuse of prescription opioids among street drug users offer benefits for public health?"

That's the title of a provocative short paper just published in the journal Public Health. Lead author is Benedikt Fischer of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University in Vancouver.

Fischer and his colleagues note that both the legal and illegal use of prescription opioids has increased substantially over the past decade in North America. Some studies suggest these substances, which include OxyContin, morphine, Demerol and Percodan, “appear to have replaced heroin as the primary opiod drug of choice” among users seeking to get high.

While noting that opioid dependence of any sort is a serious problem, they argue that this shift could be a good thing for several reasons. Those who use prescription opioids to get high are less likely than heroin users to take the drug in the form of an injection. “Injecting is identified as a primary risk factor for both infectious disease transmission and overdose risks,” they note.

Furthermore, users tend to obtain prescription opioids by forging prescriptions or seeing several doctors at the same time and getting prescriptions from each. In contrast, heroin users usually buy their supply from street dealers, often obtaining the money they need by committing crimes.

“Recent studies comparing primary prescription opioid users with primary heroin users have suggested lower levels of illegal income generation or higher levels of paid work among prescription opioid users, potentially resulting in lessened impacts on public order and social costs,” they write.

The academics concede that their ideas as “speculative and interpretational” and add that “systematic and rigorous empirical investigation” will be required to confirm their hypothesis. In the meantime, they added, policymakers should be aware that the rise in non-medical use of prescription opioids may offer “some concealed public health benefits.”