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Study provides insight into preference for heroin over other opioids

A study that asked people in British Columbia who use drugs about the substances they prefer is providing new insight to better inform safe supply programs.
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The BC Centre for Disease Control-led study surveyed 621 clients at harm reduction supply distribution sites in the province in October–December 2019. Of those who reported an opioid preference, 57.8% preferred heroin, 32.8% preferred fentanyl and 9.4% preferred prescription opioids.

"Even though most do not have access to heroin and consequently consume fentanyl, the study indicates that heroin is the most preferred drug of all opioids among the population of British Columbians who use drugs and access harm reduction sites," says Max Ferguson, lead author and BCCDC research epidemiologist.

More people in all age groups preferred heroin over fentanyl, even more so for respondents over the age of 50. Similarly, while there were regional differences noted, over half of participants in all health authorities preferred heroin.  

Safe supply programs are crucial, evidence-based public health interventions. However, accessing safer alternatives has been challenging in parts of B.C. and diacetylmorphine has not been widely available. 

“For whatever reason, many people are not in a place where they are willing or interested to go into treatment and stop using drugs,” explains Burmeister. “We need to keep people alive and healthy by meeting them where they are at by addressing their needs through a public health approach instead of relying on those who control the illicit market.”

“Understanding the preferences of people who use drugs and offering options such as diacetylmorphine should get more people to replace illicit opioids with safer alternatives and ultimately save more lives,” she says. 

The illicit drug toxicity (overdose) crisis continues to cause an unacceptable number of preventable deaths. It is the leading cause of death for people aged 19 to 39 years in B.C. and communities throughout the province feel its impacts. More than 6 people died each day in British Columbia last year from suspected illicit drug toxicity (overdose), according to the BC Coroner’s service. BC Emergency Health services also responded to more overdose calls in 2021 than ever before.

Multiple international studies have shown the effectiveness of injectable diacetylmorphine as a treatment for people who are dependent on opioid drugs. It helps clients and patients who live with opioid dependence improve their day-to-day functioning, find stability, and manage their withdrawal symptoms. Expanding safe supply options to include diacetylmorphine and fentanyl with known properties is expected to lower the risk of overdose as well as the other risks associated with injecting unknown contaminants.

The federal government has strongly encouraged the expansion of diacetylmorphine.  In April 2019, upon the recommendations of Canada's Chief Public Health Officer, Dr. Theresa Tam, diacetylmorphine (the pharmaceutical version of heroin) was added to the List of Drugs for an Urgent Public Health Need, making it possible for all provinces and territories to import this drug for the treatment of opioid use disorder.

Approximately 200 people in British Columbia are currently being treated with injectable diacetylmorphine at specialized clinics in Vancouver and Surrey.




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