The Changing Landscape of Illicit Opioid Use in Canada

Changing Trends in Illicit Opioid Use

While heroin use remains a concern, especially in larger urban centres, the face of illicit opioid use is changing. The use of legally prescribed opioids, obtained illegally, is rising. This shift necessitates a reassessment of prevention and intervention strategies, focusing on the regulation of prescription opioids.

Polydrug Use and Its Implications

The use of multiple drugs in conjunction with opioids is a significant issue. Users often combine opioids with substances like cocaine, crack, benzodiazepines, and alcohol. While users may seek the combined effects of these substances, these combinations can lead to severe health risks, including overdose and infectious disease transmission. Current treatment approaches, primarily methadone maintenance treatment (MMT), often fall short in addressing polydrug use, highlighting the need for more comprehensive interventions.

Health Impacts and the Role of Social Determinants

Illicit opioid use significantly impacts physical and mental health. Users face a higher risk of mortality, largely due to overdoses and complications from infectious diseases like HIV and HCV. Mental health issues, particularly depression, are also prevalent.

The interplay between mental health, social factors, and opioid use is complex. For instance, depression can be both a consequence and a precursor to opioid use. Furthermore, individuals experiencing depression may engage in riskier injection practices, increasing their susceptibility to infectious diseases.

Social determinants, such as unstable housing and involvement with the criminal justice system, significantly contribute to the negative consequences of opioid use. These factors heighten the risk of overdoses and infectious disease transmission.

Addressing the Crisis: A Call for Comprehensive Action

Effectively addressing the challenges of illicit opioid use requires a multifaceted approach. This includes:

Improved data collection: Gathering more specific data on illicit opioid use within both marginalised and general populations is crucial.
Addressing prescription opioid diversion: Stricter regulations are needed to prevent the flow of prescription opioids from legal medical channels to the illicit market.
Developing comprehensive interventions: Existing treatments need to evolve to address polydrug use more effectively.
Integrating mental health and addiction services: There is a dire need for readily accessible and comprehensive interventions that address both addiction and co-occurring mental health disorders among this population.
Addressing social determinants: Interventions must target the social factors that contribute to opioid use and its related harms, including unstable housing and lack of social support.