In Ontario, abuse of 'hillbilly heroin' being replaced by real thing

Heroin use is booming in the Canadian province, almost a year after the regional government tightened access to OxyContin, sometimes called 'hillbilly heroin,' to stem abuse.

Front-line drug-treatment workers and law enforcement officials in Ontario have been waiting for the other shoe to drop for nearly a year.

It was last March when the provincial government removed OxyContin, a prescription drug that had been the subject of reports of widespread abuse, from its drug benefit program. According to researchers at St. Michael’s Hospital in Toronto, there have been over 300 OxyContin-related deaths a year since the powerful painkiller was introduced into the Canadian market in 2000.

As hoped, delisting successfully limited access to the drug, often referred to as "Oxy" or "hillbilly heroin." Oxy prices shot up to as much as $20 a pill as supplies in the province dwindled.

But police and social workers have expected something would come and fill the void among the province's drug users. And now it looks like the substitute for "hillbilly heroin" is the real thing.

Small cities, big drug problems

Peterborough, Ontario, is a picturesque city of 80,000 in the central part of the province. Home to Trent University, Peterborough is not unlike other college towns with its pretty empire homes on quiet, tree-lined streets.

But it's also site of the same sort of heroin boom that's more traditionally associated with its big city counterparts in the Greater Toronto Area (GTA), says Dr. Clement Sun, who runs a network of private methadone clinics in a number of the hardest hit communities across Ontario, including Peterborough. One of Dr. Sun’s clinics sits in a former book store in Peterborough’s downtown.

“It’s definitely coming back,” says Sun.

Both Oxy and heroin are opiate-based, providing a rapid and powerful high – and are equally addictive. But OxyContin eclipsed the harder-to-get street drug, in part because there’s less of a stigma associated with prescription pill use: Oxy is prescribed, and unlike heroin, its quality is consistent. And before it was delisted, Oxy was also cheaper to obtain on the black market than traditional heroin.

Now, heroin seems to be making a comeback in a big way in communities where opiate addiction, primarily to OxyContin, has been rampant.

“What we’re predicting is the average person ... hiding their OxyContin use, they’re going to look for another source. We were watching for heroin, and sure enough the last six months we’ve seen more heroin then we’ve ever seen before.”

So just how much is “more"? Sun says that on average, in the last six months, his clinics are seeing one new case a week. Before that he might see a new patient seeking treatment for heroin once every 3 years.

Like Peterborough, the resurgence of heroin seems to be hitting hardest in some of Ontario’s midsize and larger cities, such as Hamilton, about two hours away from Peterborough and about an hour's drive from the provincial capital Toronto.

Hamilton, at the head of Lake Ontario, is home to just over half a million people. It's a steel town, and like other North American steel towns, Hamilton has been left scrambling in recent years to diversify its economy. The city’s hospitals are now the biggest employer, and while there are signs of rebound, the downtown struggles. Drugs have long been part of the equation – an equation that once again includes heroin.

One user, who asked that his name not be used, has struggled off-and-on with heroin and other opiate addictions for years in Hamilton. He says while crack is the king of street drugs, you could always find heroin if you wanted it. Only now, he says, “it’s everywhere.”

“The bigger cities, the trend is up higher – Hamilton is one of them,” adds Sun.

Fallout from Afghanistan?

“In the last few years, there’s been about a hundred kilos of heroin seized in the GTA at any given time,” says Dave Banham, tactical intelligence coordinator with the GTA drug section of the Royal Canadian Mounted Police (RCMP). Constable Banham stressed that this figure doesn’t include the regional police services, and reflects both the efforts of the Canadian Border Services Agency (CBSA) – which is responsible for Canada’s border security, including drug importation – and the RCMP.

Banham is quick to point out that this is the amount of heroin typically caught each year by the two agencies, and not necessarily what finds its way on the street. “The actual importation number, we don’t know,” Banham admits.

Though there is a slow recognition by municipalities and law enforcement that the street trade is changing, what isn’t being discussed is where the heroin currently flooding Canadian streets is coming from. That’s because the answer for Canadian policymakers is potentially an uncomfortable one.

After more than a decade of war, Afghanistan now supplies over 90 percent of the world’s opium, according to the United Nations Office on Drugs and Crime. Canadian Forces joined in the war effort shortly after their American counterparts in 2001.

“Typically, we’re seeing it come from Asia – so Pakistan, Afghanistan – it depends on how it’s routed, but the source of [heroin] would be that region,” says Banham.

An investigation in the Montreal Gazette found that from 2001, when the Afghan war began, to 2010 there was a 37-fold increase in opium production worldwide.

A follow-up investigation by the Canadian Centre for Investigative Reporting heard from a drug mule in Kandahar with knowledge of the heroin market. The mule alleged that heroin moved freely in and out of the Kandahar Airfield – home to coalition military forces and civilian contractors – sold to translators who would smuggle it onto the base. In addition, an unnamed district official claimed that heroin was smuggled out of the country via Afghanistan’s airports.

Constable Banham, with the Toronto RCMP, says that shipments seized here from the region were often found in cargo containers.

There have been 571 seizures of heroin by the CBSA since 2007 – the year heroin usage spiked before the recent delisting of OxyContin in Ontario. A spokesperson for CBSA emphasized though that "seizures" includes any amounts seized, whether large or small.

Twenty-two kilos of heroin, worth an estimated 8.8 million dollars on the street, were discovered last November by border officials in Toronto on a flight from Pakistan. Authorities called the seizure “significant.”

An uncertain outlook

Canada's heroin boom is further complicated by a decision last November by Health Canada, the government's health department, to open the Canadian market to generic versions of OxyContin.

Although the decision was rooted in intellectual property issues – OxyContin's patent had run out – it could easily reintroduce the drug to the streets in places like Peterborough and Hamilton. Indeed, frontline addictions workers, as well as Ontario’s health minister, urged Ottawa to not make the generic – and importantly, cheaper – version available so soon after OxyContin was delisted.

But it remains unclear whether heroin use will change now that generic OxyContin is back and so easily accessible. Oxy addiction is as bad, but with an important distinction: less social fallout than heroin. Heroin addicts are more prone to infectious disease, due to the risks of sharing needles.

One thing seems certain: The policymakers and police seem to be trailing the trends on the street. Dr. Sun says that while some local police forces have embraced his program, other communities would prefer to ignore the reasons his clinics are where they are.

Bilbo Poynter is executive director of the Canadian Centre for Investigative Reporting.