Availability Of Illicit Drugs Research Articles

Essential/precursor chemical control research: Giommoni's review, understanding multi-replication interrupted time series analysis, and next steps

Controls on essential/precursor chemicals from commercial companies have been associated with many large downturns in illicit drug markets and attendant problems. My colleagues and I brought this to light in the studies that are the subject of Giommoni's review. McKetin et al. in an earlier review considered several of our studies on chemical controls for methamphetamine, all centered in North America. Giommoni discusses not only those studies but also our later work on chemical controls for cocaine and heroin. This later work evaluates US essential/precursor chemical policies targeting illicit drug producers outside of North America, and it examines impacts on illicit drug availability and use (the studies reviewed by McKetin et al. predominantly focused on outcomes such as drug-related hospitalizations, arrests, and treatment). Giommoni's review is a new resource that will help make the varied topics in essential/precursor chemical control research more accessible to many readers. After noting this, I discuss some common methodological misconceptions about our studies. For example, our studies generally used multi-replication interrupted time series analysis, a research design among the most powerful of all quasi-experimental designs. Authors, however, typically discuss the studies as if they used single-intervention interrupted time series analysis, a less powerful design. Multi-replication and single-intervention interrupted time series analyses also differ regarding likely confounders; awareness of this is critical to accurately assessing our findings and critiquing alternative explanations. Finally, I note that commercial chemical companies function as the silent, albeit usually unwitting, partners in the large-scale production of several illicit drugs, including fentanyl. And many governments are implementing essential/precursor chemical controls to help stymie this partnership. But they are doing so largely without evaluation and study—a poor policy practice. To remedy this, I suggest establishing multi-disciplinary applied research teams to help assess, guide and improve essential/precursor chemical control efforts.

NIDA on dramatic increase of mushroom seizures

From 2017 – 2022, law enforcement seizures across the United States of mushrooms containing psilocybin increased dramatically, according to a new study funded by the National Institute on Drug Abuse (NIDA). The number of law enforcement seizures increased from 402 seizures in 2017 to 1,396 in 2022. In addition, the total weight of psilocybin mushrooms seized by law enforcement increased from 226 kg (498 lbs.) seized in 2017 compared with 844 kg (1,861 lbs.) in 2022. This analysis, published in Drug and Alcohol Dependence, was led by researchers at New York University (NYU) Langone Health in New York City, and the University of Florida, Gainesville. The data used for the analysis were collected through the High Intensity Drug Trafficking Areas (HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy. Though law enforcement seizures do not necessarily reflect prevalence of use, they represent an indicator of the availability of illicit drugs. “We are in the middle of a rapidly evolving cultural, media, and legal landscape when it comes to psychedelics, and we need data to help shape informed and appropriate public health strategies,” said NIDA Director Nora D. Volkow, M.D., in announcing the research publication last week. “Moving forward, we must continue to track data on the availability of psychedelics, patterns in use, and associated health effects to guide efforts in promoting accurate education and reducing potential harms among people who do plan to use psychedelic drugs.” Adverse effects of psilocybin mushrooms, such as “bad trips,” are marked by “distorted thinking, perceptual changes, putting oneself in physical danger, and intense feelings of fear, anxiety, and confusion,” according to NIDA. “People who take psychedelic drugs like psilocybin may also experience short‐term side effects such as raised blood pressure and heart rate, agitation, confusion, vomiting, or nausea, which may be severe and require medical attention.” Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine, co‐investigator on the NIDA‐funded National Drug Early Warning System (NDEWS), and lead author on the paper, said “Research studies suggesting its effectiveness in treating mental health issues and extensive positive media coverage may lead some people to seek ‘shrooms’ outside of medical contexts. People who use psilocybin outside of medical supervision need to be educated about risks associated with use.”

‘There’s No Hope for Any Kind of Decent Life’: A Qualitative Study to Explore the Perspectives of People Experiencing Homelessness with a Recent Non-Fatal Overdose in Scotland

Abstract The past ten years has seen a marked increase in the numbers of people experiencing homelessness globally and an associated public health epidemic of drug-related deaths. Drawing from qualitative interviews as part of a wider pilot randomised controlled trial (RCT) conducted in Glasgow, Scotland with National Health Service pharmacists and third sector homeless outreach caseworkers, insights from those with living experience of both homelessness and a recent non-fatal drug overdose will be presented. Twenty people experiencing homelessness with at least one drug overdose in the past six months were interviewed in person, in a homelessness drop in centre or in emergency accommodation between November 2021 and January 2022. Findings from our study indicate that participants’ drug use and overdose risk were exacerbated during the Covid-19 pandemic due to the pervasive availability of illicit drugs for those placed in emergency accommodation, alongside reduced support and access to health and social care services. Additionally, multi-agency stressors such as a lack of autonomy and dehumanising experiences were reported, leading to a significant sense of powerlessness. Furthermore, the necessity of advocacy-based services as critical aspects of support was identified, with importance placed upon dedicated, homelessness staff and access to safe environments.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

Drug Overdose Deaths Among Persons Aged 10-19 Years - United States, July 2019-December 2021.

U.S. drug overdose deaths increased 30% from 2019 to 2020 and 15% in 2021, resulting in an estimated 108,000 deaths in 2021.* Among persons aged 14-18 years, overdose deaths increased 94% from 2019 to 2020 and 20% from 2020 to 2021 (1), although illicit drug use declined overall among surveyed middle and high school students during 2019-2020 (2). Widespread availability of illicitly manufactured fentanyls (IMFs),† proliferation of counterfeit pills resembling prescription drugs but containing IMFs or other illicit drugs,§ and ease of purchasing pills through social media¶ have increased fatal overdose risk among adolescents (1,3). Using CDC's State Unintentional Drug Overdose Reporting System (SUDORS), this report describes trends and characteristics of overdose deaths during July 2019-December 2021 among persons aged 10-19 years (hereafter referred to as adolescents). From July-December 2019 to July-December 2021, median monthly overdose deaths increased 109%, and deaths involving IMFs increased 182%. Approximately 90% of overdose deaths involved opioids, and 83.9% involved IMFs; however, only 35% of decedents had documented opioid use history. Counterfeit pill evidence was present in 24.5% of overdose deaths, and 40.9% of decedents had evidence of mental health conditions or treatment. To prevent overdose deaths among adolescents, urgent efforts are needed, including preventing substance use initiation, strengthening partnerships between public health and public safety to reduce availability of illicit drugs, expanding efforts focused on resilience and connectedness of adolescents to prevent substance misuse and related harms, increasing education regarding IMFs and counterfeit pills, expanding naloxone training and access, and ensuring access to treatment for substance use and mental health disorders.

THE ASSOCIATION BETWEEN SOCIAL CHARACTERISTICS AND PATTERNS OF SUBSTANCE USE DISORDER; A CROSS-SECTIONAL STUDY ON SUDANESE PATIENTS

Objective: This study aimed to examine the association between different social factors and patterns of substance use disorder in Sudan. Methods: Data were collected using a structured interviewer-rated questionnaire designed by the researchers, and distributed to the patients who have drug use disorder at the two main psychiatry teaching hospitals in Khartoum state, Sudan. Results: The total number of participants was 124 and the majority (95.2%) were males, and 54.8% were single. The onset is mostly before the age of 25 years. The most common substance was cannabis followed by alcohol. Only 61 participants (49.1%) had come to the hospital seeking treatment of their own free will, and 41.9% of participants had a family history of substance use which was significantly associated with early-onset. The majority of participants (69.4%) started using psychoactive substances at the age of 15–25 years. Half of the participants use drugs only in a group of friends. Bad relations between parents, and between participants and parents were perceived by participants to have a role in starting drug use. Conclusion: Substance use is more common among males with an early onset. A family history of substance use associates with an earlier onset. The study shed the light on the social aspects of substance use in Sudan and recommended more efforts to restrict the availability of illicit drugs in the country.

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons.

Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM). The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically. The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources. The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant. Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners' families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons. The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons. This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

Substance use and sociodemographic correlates among adolescents in a low-income sub Saharan setting.

:Background:The present study investigated the social and behavioral correlates of substance use, specifically bang or cocaine or similar drugs among a school-based sample of adolescents in a low-income urban setting.Methods:The study utilized data on 2,176 school-attending adolescents aged 11-16 years in Dar es Sa-laam (DES) to examine social and behavioral correlates for lifetime substance use. The correlates under investigation included, demographic - age and gender; social - poverty, parent-adolescent relationship; behavioral – truancy, aggressive behavior, injury risk; psychological- depression and suicide ideation. Bivariate and multivariate analyses were then carried out on several variables identified from the 2006 Tanzanian Global School-based Health Survey (GSHS) questionnaire. Results:Approximately seven percent of school-attending adolescents (n=144) reported having used an illicit substance at least once during their lifetime. After adding significantly associated covari-ates into a logistic regression model, we found that only truancy [OR= 2.29 (CI=1.07– 4.90)], suicide ideation [OR=4.36 (2.32 – 8.19)] and parents who had checked their adolescents' homework (OR=0.56 (CI=0.32 – 1.00)] were significantly associated with reported substance use. Conclusions:Our results suggest that health promotion programs should simultaneously target multiple factors associated with substance use behaviors among school-attending adolescents in Dar es Salaam. They should take into account the range of psychosocial characteristics of school-attending adolescents which may be impacted by or result from substance use.

Risk and protective factors for adolescents’ illicit drug use: A population-based study

Objective: The use of illicit drugs by adolescents is a widespread problem in Taiwan. The aim of this study was to identify risk and protective factors. Design: Web-based survey of high school students. Setting: Senior high schools and vocational high schools in northern Taiwan. Method: Survey data were collected from 15,754 students. Logistic regression analysis examined potential risk and protective factors in individual, family and peer/school domains for lifetime, past-year and past-month illicit drug use and the single and/or multiple use of ketamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and marijuana. Results: The prevalence rates of illicit drug use varied from 1.18% to 2.19% by frequency and type of illicit drug use. Perceived availability of illicit drugs, betel nut chewing, drug use by a family member, peer drug use, missing classes and type of school were significant risk factors in lifetime, past-year and past-month use. Sensation seeking, family member and peer drug use were common factors in ketamine, methamphetamine, MDMA and marijuana use. Drug use by a family member increased the risk of multiple drug use. Smoking was a risk factor for ketamine use. Drug-related knowledge was a protective factor. Conclusions: These findings support the idea that there exist multilevel risk and protective factors for drug use, especially in the family and peer/school domains. School-based interventions should be designed to integrate different levels of risk and protective factors.

Rational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain: Consensus Recommendations.

ObjectiveTo develop consensus recommendations on urine drug monitoring (UDM) in patients with chronic pain who are prescribed opioids.MethodsAn interdisciplinary group of clinicians with expertise in pain, substance use disorders, and primary care conducted virtual meetings to review relevant literature and existing guidelines and share their clinical experience in UDM before reaching consensus recommendations.ResultsDefinitive (e.g., chromatography-based) testing is recommended as most clinically appropriate for UDM because of its accuracy; however, institutional or payer policies may require initial use of presumptive testing (i.e., immunoassay). The rational choice of substances to analyze for UDM involves considerations that are specific to each patient and related to illicit drug availability. Appropriate opioid risk stratification is based on patient history (especially psychiatric conditions or history of opioid or substance use disorder), prescription drug monitoring program data, results from validated risk assessment tools, and previous UDM. Urine drug monitoring is suggested to be performed at baseline for most patients prescribed opioids for chronic pain and at least annually for those at low risk, two or more times per year for those at moderate risk, and three or more times per year for those at high risk. Additional UDM should be performed as needed on the basis of clinical judgment.ConclusionsAlthough evidence on the efficacy of UDM in preventing opioid use disorder, overdose, and diversion is limited, UDM is recommended by the panel as part of ongoing comprehensive risk monitoring in patients prescribed opioids for chronic pain.

Drug-related Mortality in Camden: Demographics and Substance Misuse Trends during the 2010 to 2013 Period

Background and Objectives: Mortality from substance misuse has a constantly changing pattern, with notable rising trends in certain regions of the country. In particular, Camden County, New Jersey has historically struggled with this problem. Because of its inclusion of Camden City, with its high poverty rate and high availability of illicit drugs, and the broader regional impact of the economic recession, analysis of substance misuse-related death in this population might facilitate understanding of these contributory factors in the development and maintenance of addiction and resulting mortality. Methods: Mortality and population data were obtained from public sources (N=516). Subjects’ demographic information and substance profile found at death were investigated for regression and trend analysis. Results: Across the study period, an overwhelming majority of subjects were white adult males. Opiate derivatives were the highest offending agent, occurring in 83.7% of deaths, followed by stimulants (50.3%) and benzodiazepines (38.4%). Furthermore, 24.4% of subjects were found to have 3 or more substances at death. No significant trends were found in mortality rates, but Camden County had significantly higher rates of drug mortality than the rest of New Jersey for the study period. Conclusions and Scientific Significance: This study highlights the opiate epidemic as a major player in Camden County, but also notes significant mortality contributions from stimulant drugs and benzodiazepines in the setting of polysubstance use elicited at the time of death. It is imperative to focus on basic needs (particularly housing) and outpatient long-term programs, rather than inpatient rehabilitation, especially in a population with high poverty rate.

Maternal cocaine abuse – An evidence review

In Australia, the use of illicit substances is on the rise, with as many as two in five people admitting to having ever used an illicit substance. As illicit drug availability is becoming ever more readily available, it has been argued that maternal substance use is increasing the demands of neonatal intensive care units and special care nurseries Australia wide. Cocaine causes miscarriage due to its vasoconstrictive effects on the blood supply of the developing foetus when used during the first trimester of pregnancy. Furthermore there is an increased risk of the foetus developing congenital anomalies and insufficient intracranial growth all due to the vasoconstrictive teratogenic effects of cocaine.Within this paper, common teratogenic effects of prenatal cocaine use are explored and further supplemented with the documented associated short and long term effects of such illicit drug use as reported in recent literature.The most common short term effect of maternal substance use on the neonate is neonatal abstinence syndrome (NAS) being one of the most common reasons and possibly unavoidable for admission to a neonatal intensive care unit (NICU). Such impacts upon NICUs are explored and discussed.

Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users

BackgroundThe epidemic of drug-related mortality continues to endure. The most common cause of death associated with drugs is overdose and opioids are consistently the substances most prominently involved. As well as efforts to control the availability of illicit drugs and increase engagement in treatment services, the use of naloxone for peer administration has increasingly been championed as a mechanism for addressing the DRD epidemic. Despite increasing adoption and use of take-home naloxone (THN) as a primary response to DRD internationally the evidence base remains limited. MethodsA systematic review and descriptive meta-analysis of the international THN literature was undertaken to determine an effect size for THN programmes. For each study, a proportion of use (PoU) was calculated using the number of ‘peer administered uses’ and the ‘total number of participant/clients’ trained and supplied with naloxone with a specific focus on people who use drugs (PWUD). This was constrained to a three month period as the lowest common denominator. As a percentage this gives the three month rate of use (per 100 participants). ResultsFrom twenty-five identified THN evaluations, nine studies allowed a PoU to be determined. Overall, the model shows a range of 5.2–13.1 (point estimate 9.2) naloxone uses every three months for every 100 PWUD trained. ConclusionOur model estimates that around 9% of naloxone kits distributed are likely to be used for peer administration within the first three months of supply for every 100 PWUD trained. Future evaluations should directly compare different training structures to test relative effectiveness and use a series of fixed time periods (3, 6 and 12 months) to determine whether time since training affects rate of naloxone use.

EPA-0861 – Patterns of drug misuse on guernsey, british channel islands

Introduction Guernsey is a British Protectorate island (population 65000) in the English Channel. Illicit drugs are difficult to import and expensive people look to alternative substances. Objectives To establish patterns of drug misuse among patients referred for treatment. Methods Case note audit of all referred patients in 2011, cross referenced with sudden unexpected death case review results. Results 198 patients were referred, 80 (40%) for mainly drug dependency. Reported patterns of use tended to follow local availability and polydrug misuse was common. Of the drugs clients, 96% reported misusing prescription only medicines (POMs) and over the counter (OTC) drugs, particularly opiates and benzodiazepines. Buprenorphine products were most commonly misused (26%), followed by benzodiazepines (25%), dihydrocodeine (22%), heroin (11%) and codeine (6%) (more than 1 drug may be reported so totals Conclusions High rates of pharmaceutical drug misuse on Guernsey may reflect the low availability of illicit drugs like heroin and cocaine. This increases demand for addictive POMs and OTCs. Prescribers in isolated communities need to be more cautious when prescribing addictive POMs, particularly fentanyl. Pharmacists may also need to monitor for OTC drug misuse, particularly of codeine-containing medications.

Increasing availability of illicit drugs among people who inject drugs in Bangkok, Thailand

BackgroundIn recent years, the Thai government has strengthened drug law enforcement as a strategy to address a continuing epidemic of illicit drug use. We sought to assess temporal trends in street-level availability of illicit drugs among injection drug users (IDUs) in Bangkok, Thailand. MethodsUsing univariate statistics and multivariate logistic regression, we assessed changes in the availability of five substances (heroin, methamphetamine, crystal methamphetamine, midazolam, and illicit methadone) between 2009 and 2011 and examined social, structural and individual factors influencing availability among community-recruited samples of IDUs in Bangkok. Availability was measured in three levels: immediate (available in ≤10min); moderate (available in 10–90min); and delayed (available in >90min; our reference category). ResultsThe analyses included 718 IDUs, including 165 (23.0%) women. Controlling for changes in participant characteristics between assessments, and in a period of constant nominal illicit drug prices, moderate availability of all substances increased significantly between 2009 and 2011, with adjusted odds ratios ranging between 2.36 (illicit methadone) and 4.61 (crystal methamphetamine) (all p<0.01). Immediate availability of all substances but heroin also increased (all p<0.01). More immediate availability of methamphetamine was also associated with a history of incarceration (p<0.05). ConclusionsDespite the Thai government's intensified drug suppression efforts, the availability of illicit drugs among IDUs in Bangkok increased significantly between 2009 and 2011. The findings raise concern about the overreliance on drug law enforcement-based approaches and point to the need for greater investment in evidence-based drug policies.

The Geography of Drug Abuse Epidemiology Among Probationers in Baltimore

Substance use is a pervasive health problem that contributes significantly to the recycling of offenders through the justice system. This study uses routine activities theory as a framework to determine whether the availability of illicit drugs in a probationer’s immediate residential environment is associated with their use of illegal substances. Combining narcotics-related calls for police service data, interviews with offenders, life history event calendars, and biological drug test results, a clustered-logit regression model of 250 drug-involved probationers indicates that the availability of drugs within the probationer’s immediate area is associated with a higher probability of testing positive for illicit substances. The results suggest a broader epidemiological framework to understand how environment affects drug use. Further research in this area will improve supervision practices of drug-involved individuals and interventions to reduce drug use.

Ready Access to Illicit Drugs among Youth and Adult Users

Current drug-control strategies in Canada focus funding and resources predominantly on drug law enforcement, often at the expense of preventive, treatment, and harm reduction efforts. This study aimed to examine the availability of the most commonly used substances in Vancouver, Canada after the implementation of such strategies. Using data from two large cohorts of drug-using youth and adults in Vancouver from the calendar year 2007, we assessed perceived availability of heroin, crack, cocaine, crystal methamphetamine, and marijuana. Compared to youth (n= 330), a greater proportion of adults (n= 1,160) reported immediate access (ie, within 10 minutes) to heroin (81.0% vs. 55.9%, p < .001), crack (90.4% vs. 69.3%, p < .001), and cocaine (83.7% vs. 61.1%, p < .001). Conversely, larger proportions of youth reported immediate access to crystal methamphetamine (62.8% vs. 39.4%, p < .001) and marijuana (88.4% vs. 73.2%, p < .001) compared to adult users. Regardless of differences in illicit drug availability by age, all drugs are readily accessed in Vancouver despite drug law enforcement efforts. This includes drugs that are frequently injected and place users at risk of human immunodeficiency virus (HIV) infection and transmission of other blood-borne disease.

Do Substance Use Norms and Perceived Drug Availability Mediate Sexual Orientation Differences in Patterns of Substance Use? Results from the California Quality of Life Survey II

Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in mediating the linkage between minority sexual orientation status and higher rates of prior-year substance use. We used data from the second California Quality of Life Survey (Cal-QOL II), a followback telephone survey in 2008-2009 of individuals first interviewed in the population-based 2007 California Health Interview Survey. The sample comprised 2,671 individuals, oversampled for minority sexual orientation. Respondents were administered a structured interview assessing past-year alcohol and illicit drug use, perceptions of perceived illicit drug availability, and injunctive norms concerning illicit drug and heavier alcohol use. We used structural equation modeling methods to test a mediational model linking sexual orientation and substance use behaviors via perceptions of drug availability and social norms pertaining to substance use. Compared with heterosexual individuals, sexual minorities reported higher levels of substance use, perceived drug availability, and tolerant social norms. A successfully fitting model suggests that much of the association between minority sexual orientation and substance use is mediated by these sexual orientation-related differences in drug availability perceptions and tolerant norms for substance use. Social environmental context, including subcultural norms and perceived drug availability, is an important factor influencing substance use among sexual minorities and should be addressed in community interventions.

Increases in the availability of prescribed opioids in a Canadian setting

BackgroundThe nonmedical use of prescribed opioids (POs) has increased across North America over the past decade. Our objective was to identify changes in the availability of POs and other illicit drugs among drug users in a Canadian setting. MethodsInformation on the availability of illicit drugs was collected in standardized interviews from a large observational research program involving illicit drug users in Vancouver, British Columbia from 2006 to 2010. The primary outcome was the perceived availability of a set of six POs (aspirin/oxycodone, hydromorphone, oxycodone, morphine, acetaminophen/codeine and methadone) among individuals reporting ever using POs. Availability was measured in three levels: not available, delayed availability (available ≥10min), and immediate availability (available <10min). Multivariate ordinal logistic regression models were executed to estimate the trend in PO availability, controlling for individual characteristics hypothesized to influence availability. Results1871 individuals were followed during the study period (2006–2010), including 583 (31.2%) women. The availability of POs increased over time, regardless of changes in the characteristics of cohort entrants. These increases were observed while the availability of traditional drugs of abuse (e.g., heroin and cocaine) remained constant. The adjusted odds of delayed availability vs. unavailability were between 34% (hydromorphone) and 71% (acetaminophen/codeine) greater in each calendar year. DiscussionThe availability of POs among drug users in a Canadian setting increased markedly over a relatively short timeframe, despite persistent and high availability of heroin and cocaine. Further study is required to determine the context of use of POs, associated harms, as well as policy responses to increasing availability.