“We did a feasibility study … and within several months we couldn't find any patients,” Dr. Rehm says. “We do not have people who are predominantly, or mainly, or even with a regular frequency injecting heroin as their main drug. … They don't exist.”
The picture is similar across the country: A 2006 study found that the only two places in Canada where heroin abuse outpaces that of prescription opiates are Vancouver and Montreal – port cities that are hubs of the global drug trade.
Everywhere else, pill popping (or grinding pills into a waxy powder, to inject for a better high) is the order of the day. An estimated 30 to 40 per cent of the 1,000 to 2,000 overdose deaths in Canada each year may be related to prescription opioids.
“How common is it?” says recovering addict Sean Winger, 29. “Really common. I was driving to the store the other day and there was a group of five kids. … I could hear, ‘Oh, those aren't Oxys.' ‘Well, what is it? How much do you take?' They don't know what they're taking.”
Mr. Winger got his first taste of prescription drugs at the age of 17, when he got his wisdom teeth out and was prescribed Percodan for the pain. The Kitchener, Ont., resident has been chasing that same high ever since: “My depression went away, it gave me energy, it made me sociable.”
A little while later, when his employer at a landscaping company was hard up for cash, she offered to pay him in the OxyContin pills she had been prescribed for chronic pain. “Was it responsible to pay an 18-year-old kid with OxyContin? Probably not,” Mr. Winger says, but he was only too happy to oblige.
When his employer's pills weren't enough, it was easy for Mr. Winger to find friends, or friends of friends, selling their own. As his craving grew, he looked up instructions online and filched needles from his diabetic grandmother to inject.
“Everybody starts swallowing and snorting … but it's just a matter of economy by then: You get so much higher with injecting that I couldn't afford to snort.”
He would get out of bed and mix his usual – one-and-a-half 80-milligram pills of OxyContin, ground up and injected into his left arm – and “that would be like my wake-up.”
In the five years Mr. Winger spent hooked on OxyContin, he held down a full-time job. He had a long-term girlfriend and a supportive extended family. He took classes at the University of Toronto. “I was a functional addict.”
But by the time he checked himself into a methadone clinic at the age of 23, Mr. Winger weighed 145 pounds, had collapsed a vein and added vomiting to his morning routine. He had broken up with his girlfriend, moved in with his grandmother and “was trying to decide if I had enough Oxy, if I injected it all, if it would be enough to kill me.”
In many ways, prescription drugs are less dangerous than other addictive substances: They're legal and their manufacture is regulated, so if you know what pills you're taking, you know what's in them. But because of their easy availability and that very lack of stigma, they are a far more insidious cause of addiction.
Such woes may be most common in smaller communities that are less likely to have the resources to cope. A University of British Columbia study has found that people in B.C.'s smaller towns are disproportionately dependent on prescription drugs.
Steve Morgan, one of the report's principal researchers, says painkiller use also seems to be higher in places – the B.C. Interior, Alberta's oil-sands region and Ontario's manufacturing heartland – with a higher number of workplace-related hazards.
“Could it be the case that occupational hazards lead to opiate addiction? … This is something we need to be studying.”
Approaches used with drugs such as heroin can be ineffective. Right now, methadone clinics are full of prescription-drug addicts who in many cases are not getting proper treatment.