Is crackdown on Rx opioid diversion fuelling overdose crisis?

High rates of overdose linked street drugs laced with fentanyl are causing drug users to seek out diverted prescription opioids, says a new study.

The small study run in Vancouver, Canada, was based on interviews with people who use drugs (PWUDs) and are therefore at high risk of overdose if they buy street drugs or counterfeit medicines containing fentanyl – a dangerously powerful drug many times more potent than heroin.

The researchers – from the University of British Columbia and British Columbia Centre on Substance Use in Vancouver – found that PWUDs are trying to source diverted opioids to reduce their risk of harm, although access is challenging due to relatively high cost and limited availability.

Some PWUDs reported that they were forced to resort to street drugs – including potentially counterfeit pills – because of those access issues, as supply no longer meets demand.

The findings could help explain why some studies have shown that efforts to reduce diversion such as prescription drug monitoring programmes – while well intentioned – are not resulting in a reduction in negative health consequences associated with opioid use.

One PWUD polled said: "Obviously prescription drugs are measured exact, right? And you can count on it, right? You know exactly what you're getting."

"These findings emphasise the need for the continued implementation and evaluation of safer drug supply initiatives, including those providing access to a variety of drug types," write the scientists in the Journal of Substance Abuse Treatment.

"While North America continues to grapple with an opioid overdose epidemic driven by illicitly-manufactured fentanyl, this study demonstrates how [prescription opioids] are typically not only a safer alternative, but have the potential to help reduce overdose mortality and other drug-related harms," they conclude.

Opioid deaths have been rising dramatically in Canada, particularly in British Columbia where they reached historic highs during the pandemic last summer, taking the total for the province to around 1,700 in 2020.

The numbers have continued to climb this year, with projections currently estimating deaths of approximately 1,900 this year.