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For example, a study of illicit opioid-dependent individuals attending a large Toronto Methadone Maintenance Treatment (MMT) program reported oxycodone (46.6%), codeine (45.5%), morphine (21.3%) and hydromorphone (17.4%) as the most prevalently used PO drugs. Although limited, recent studies have begun to characterize the use of POs among more marginalized populations. While Canada ranks as the 4th highest overall consumer (16,628), it is the world's top consumer of specific opioids (e.g., hydromorphone). According to International Narcotics Control Board (INCB) data, the United States is by far the world's largest consumer of POs on a per capita basis (37,565 defined daily doses of opioid per million population, 2004–06). In North America, increasing prevalence rates of PO misuse have been recently reported for general populations. In Canada, it has been estimated that there are between 90,000 and 125,000 injection drug users (IDUs), the vast majority of which are believed to use illicit opioids. The objective of this qualitative study was to gain a clearer understanding of this phenomenon, the associated drug use behaviours and preferences as well as the environmental and social context in which these drugs are obtained and administered among street drug users.

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As a result, in Toronto specifically, there is a clear emergence of two predominant drug groups in the street-based drug market: POs and crack cocaine. Simultaneously, recent studies have demonstrated a high prevalence of crack use among urban drug user populations across Canada. In Toronto, as in other North American cities, illegal drug markets have been shown to be undergoing a distinct evolution, as prescription opioid (PO) analgesics such as Ox圜ontin, Morphine and Dilaudid are being diverted from medical sources and becoming more widely available to street drug users. Street drug use is becoming increasingly diversified, both in terms of the types of drugs being used and in the ways in which they are being administered. Given the current profile of street-based drug market in Toronto and the emergence of crack and POs as two predominant illicit drug groups, understanding drug use patterns and socio-economic factors among younger and older users in this population has important implications for preventive and therapeutic interventions. In particular, the initiation of injection drug use and experimentation with POs among younger users was influenced by their experiences on the street, their peers and general curiosity. Distinct experiences were observed among younger users as compared to older users. Drug use preferences and behaviours were influenced by the availability of drugs, the desired effect, ease of administration and expectations around the purity of the drugs. There was consensus that Ox圜ontin and crack were the most commonly available drugs on the streets of Toronto. Resultsįive prominent themes emerged from the interviews: 1) Combination of crack and prescription opioids, 2) First injection experience and transition to prescription opioids, 3) Drug preferences and availability, 4) Housing and income and 5) Obtaining drugs. Content analysis was conducted to identify themes. Topics covered included drug use history, types of drugs used, how drugs were purchased and transitions to PO use. In-depth interviews were conducted with 25 PO injectors.

The purpose of this qualitative study was to describe drug use behaviours and preferences as well as the social and environmental context surrounding the use of these drugs among young and old street-based drug injection drug users (IDUs). There is evidence of a high prevalence of prescription opioid (PO) and crack use among street drug users in Toronto.

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