Heroin use rises, spread feared

Until now, heroin abuse was virtually unheard of in Manitoba. The worrisome trend coincides with a rise in injection-drug use in Winnipeg's core -- a phenomenon that surfaced in the past few months and puts more drug users at higher risk of overdose and infectious diseases such as HIV and hepatitis C.

Dr. Lindy Lee, director of Health Sciences Centre's addiction unit, said heroin abuse was extremely rare in the city until last year, when about one-fifth of her patients in detox reported injecting it. Before, Lee said, anyone who told her they used the highly addictive drug shot up in other cities such as Vancouver or Montreal.

"At least 20 people last year told me they'd used heroin in the city, some regularly, some only intermittently," Lee said. "I think it's just starting to get a toehold in Winnipeg and we'd like to see it disappear. I've seen people (who say) that heroin was their drug of choice."

In the last two years, front-line addiction workers have seen an alarming rise in the number of Manitobans addicted to opiates, notably prescription painkillers like OxyContin. The abuse is propagated by "drug shoppers" who visit multiple physicians for prescriptions, and the illicit resale of the drugs.

While the initial jump in opiate abuse occurred among middle-class suburban youth who crushed and snorted the pills, Lee said the second wave has spread to the inner city, where more addicts are using needles to inject the drugs and get high.

Laura Goossen, Winnipeg director of the Addictions Foundation of Manitoba, said the rise in injection-drug use is a huge concern, since users are at higher risk of contracting diseases from sharing needles or accidental overdose. There aren't enough treatment spaces to meet the demand, Goossen said, and people who want to get on methadone treatment to kick their opiate addiction have between a three- and 12-month wait. Right now, there are 147 people on the wait list.

Goossen said heroin has never been a problem in Winnipeg and it's hard to explain why its use has suddenly become more prevalent, along with IV drug abuse.

"It's a huge concern," Goossen said.

"Sometimes what people are using is determined by what's available. If there's no OxyContin, that might create a market for more heroin use."

Abuse has "snowballed," Lee said, and more people are experimenting with extracting and injecting fentanyl from pain patches that contain that opiate, with devastating results. Lee said that she knows of at least eight of 13 deaths from opiates in 2009 that were due to fentanyl, including several people who were her former patients or close friends of patients she's treated.

There's also been a slight increase in the number of patients injecting the "poor man's speedball" of Talwin and Ritalin -- two prescription drugs that, when injected, can cause serious infections and progressive lung disease from its chalky residue.

Lee said she worries that people may turn to heroin if the health system cracks down on drug shoppers who prey on physicians to dole out the painkillers.

"More of them are injecting and sometimes you see husband, wife, adult children using together," Lee said.

"We've created an addictive market with opiates. If we even tighten up on the other prescription opiates, will people search out heroin?"

jen.skerritt@freepress.mb.ca

What is heroin?

Heroin is an opiate made from morphine, a naturally occurring substance that comes from the opium poppy plant. When it is injected into a vein, it takes only seconds to take effect. People addicted to heroin must inject the drug every six to 12 hours to avoid withdrawal symptoms.

Why are opiates so

addictive?

Part of the reason addicts can't stop craving opiates is the high wears off after frequent use. Users feel the need to keep taking the drug to ward off the severe symptoms of withdrawal, including vomiting, diarrhea, and leg cramps.

Patients have two options -- detox and abstain, or get on the wait list for methadone treatment.

What is methadone?

Methadone is a synthetic opiate that suppresses symptoms of withdrawal, but is tightly controlled. Addicts must drink their methadone in front of a clinician, and are subject to urine screens to ensure they're not using other drugs or alcohol.

Increased demand for methadone treatment in Manitoba has resulted in long waits for treatment -- more than 130 people are waiting to get into the Addictions Foundation of Manitoba's methadone intervention and needle exchange. Overall, there are between 650 and 700 Manitobans on methadone treatment for opiate addiction.

--Source: Health Canada/Addictions Foundation of Manitoba

Republished from the Winnipeg Free Press print edition January 11, 2010 B1