Abstract
In Australia, the USA, and Europe, 0·4%–0·8% of adults develop a dependence on illicit opioids. These people typically use opioids daily, despite being arrested, imprisoned, infected with blood-borne viruses, and having non-fatal drug overdoses. 1 Degenhardt L Hall WD Warner-Smith M Lynskey M Illicit drug use. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004: 1109-1175 Google Scholar Users of illicit opioids have generally been those who inject heroin, but, during the 1990s, many in Europe, North America, and parts of Asia reverted to older methods of use, including smoking and chasing of heroin—inhalation of the fumes released when heroin is heated. 1 Degenhardt L Hall WD Warner-Smith M Lynskey M Illicit drug use. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004: 1109-1175 Google Scholar Because of a substantial reduction in heroin supply in the early 21st century, users in Australia, Canada, and the USA have increasingly used pharmaceutical opioids. 2 Fischer B Rehm J Patra J Cruz MF Changes in illicit opioid use across Canada. CMAJ. 2006; 175: 1385-1387 Crossref PubMed Scopus (93) Google Scholar
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