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Official websites use. Share sensitive information only on official, secure websites. For almost a century, heroin addiction has been a core element of the illicit drug use problem in Canada. There are many examples of these harms: the number of overdose-related deaths in British Columbia rose dramatically from 39 to between and ; 4 the majority of new cases of hepatitis C in Canada are related to illicit drug use; 5 and most heroin addicts are involved in regular criminal activity. Canadian law enforcement agencies direct substantial expenditures to prevent heroin importation and distribution — albeit with limited success. The multisite OPICAN cohort formed through community-supported outreach and snowball recruitment methods and comprising regular illicit opioid users who were not receiving treatment at the time of recruitment was established in with a baseline sample of participants to assess current opioid use patterns and related social and health indicators. John and were assessed most recently in The OPICAN study sites were chosen to produce a cross-section of existing profiles of illicit opioid use in large and midsized cities across Canada and were determined by local feasibility of the study protocol. Between and the assessment in , the longitudinal component of the study had a follow-up rate of Participants who were lost to follow-up were replaced with newly recruited participants to ensure large enough samples for hypothesis testing. Local samples of populations in Fredericton and St. John were added in All assessments of participants throughout the study were conducted by means of a standardized protocol, which included an interview, a clinical assessment e. Ethics approval for each component of the study was obtained from local institutions. The data reported here are based on a sample of participants from the follow-up and exclude those who were involved in methadone maintenance treatment before assessment to eliminate treatment effects. We obtained information on the following sociodemographic and drug-use characteristics of the participants: age, sex, ethnic background, housing situation permanent or nonpermanent , sources of income paid work , illegal sources of income sex work, drug dealing, other criminal activities , injection drug use in the 30 days before assessment, drug overdose and illicit use of opioids Demerol, Dilaudid, heroin, methadone from the street, morphine, OxyContin, Percocet, Percodan and Tylenol 3 or 4 in the 30 days before assessment. In the case of unequal variances, the Kruskal—Wallis and median tests were also performed on continuous data. All variables were considered statistically significant if p was less than 0. Participants were, on average, 35 years of age; most were male and white. Half were not stably housed, and about 2 in 5 had received income from illicit sources in the 30 days before assessment Table 1. Overall, one-third of the total sample reported using heroin during the 30 days before assessment. At 4 of the sites, heroin use was virtually absent. For the majority of participants in these cities, prescription opioids e. Moreover, the longitudinal analysis suggested that heroin use had significantly decreased in all sites since overall effect — Use of cocaine and crack cocaine was also very common across the sites and also decreased over time — Parallel to the above changes, key risk behaviours e. For example, injection drug use reported during the 30 days before assessment decreased significantly in the total sample between and , from Instead, the use of prescription opioids in varying forms has become the predominant form of illicit opioid use. Recent data from the United States have indicated similar patterns, including evidence that the rate of prescription opioid abuse has exceeded the rate of heroin use in American household survey populations in recent years. Our findings highlight several crucial points. First, prescription opioids used by street drug users originally come from the medical system rather than from illicit production and distribution as is the case for heroin. Our data on this are limited, but they do indicate that, although the vast majority of cohort participants reported buying their heroin from drug dealers, a substantial proportion of prescription opioids used were obtained directly or indirectly e. The problem of illicitly obtained prescription opioids from medical sources has been repeatedly documented and is currently receiving increased attention in the United States and Australia. However, Canada is the world's top per capita consumer of a number of opioids e. Many report their prescription opioid abuse as being related to previous exposure to pain treatment or report psychiatric symptoms that are undiagnosed or untreated e. Finally, the documented changes in illicit opioid use may require adjustments to opioid addiction treatment programs. Currently available or proposed treatment interventions e. Contributors: Benedikt Fischer designed the study, co-developed the analysis plan and data interpretation and was the principal author. Jayadeep Patra executed the data analysis plan and contributed to the data interpretation and drafting of the manuscript. Michelle Firestone contributed to the data interpretation and drafting of the manuscript. All of the authors approved the final version of the manuscript. Correspondence to: Dr. As a library, NLM provides access to scientific literature. Find articles by Benedikt Fischer. Find articles by Jayadeep Patra. Find articles by Michelle Firestone Cruz. Series information Research letter. Open in a new tab. This article has been peer reviewed. All of the authors approved the final version of the manuscript Competing interests: None declared. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.