Non-medical use of prescription opioids and public health in Canada - An urgent call for research and interventions development

While the public health problem of psychoactive drug use is well recognized, the emerging phenomenon of non-medical use of prescription opioids has been largely ignored in Canada. Most evidence on this issue and related harms in North America to date come from the United States (US), where the prevalence of non-medical opioid use in key populations, as well as related morbidity and mortality, recently have risen substantially. Also, given the increases in the overall consumption of prescription opioids similar to those in the US, a substantial expansion of problems related to non-medical opioid use appears to be occurring in Canada. For example, recent major increases in the use of prescription opioids - rather than heroin - are documented for street drug users in Canadian cities. However, a comprehensive assessment of the problem of non-medical prescription opioid use is hindered by the spotty - or absent - nature of crucial indicators and data. We urge that the necessary efforts and resources for systematic assessment of the evolving phenomenon of non-medical opioid use and its key facets be established in Canada, and that policy-makers implement sensible intervention strategies targeting this problem within a public health framework, specifically avoiding unintended negative consequences (e.g., undermining access to pain treatment).