Canada Survey of Pharmaceutical Diversion: Annual Report 2017

Cross National Survey of Pharmaceutical Diversion Canada Annual Report Period Covered: January 1, 2017-December 31, 2017 Synopsis of the Project Since 2014, data from the Canada Drug Diversion Project were collected as part of ongoing surveillance of the misuse, abuse, and diversion of prescription medications throughout Ontario. As reports of drug diversion, abuse and health consequences have increased, and the counterfeit pharmaceutical market emerged in both Canada and the United States, we are building on our successful Ontario-based pilot project to continue monitoring this problem on a larger scale. Our goal is to continue to expand our surveillance of these trends to include all provinces and territories in Canada. The purpose of the study is as follows: 1. To determine the rates of diversion of selected prescription drugs among a countrywide sample of law enforcement and regulatory agencies; and, 2. To identify diversion “signal sites” for specific drugs. The Canada Drug Diversion Project is the only apparent systematic countrywide examination of prescription drug diversion, providing surveillance data on the scope, magnitude, and ever-changing patterns of diversion. Such data are critical for law enforcement, regulatory agencies, and industry to develop appropriate prevention, risk management, treatment, policy, and enforcement initiatives. On a quarterly basis, diversion survey participants throughout Canada are sent a questionnaire requesting information on new diversion cases involving targeted prescription opioids, including buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tramadol, as well as prescription stimulants, benzodiazepines and other pharmaceutical medications of interest. Heroin and non- pharmaceutical fentanyl are also included in the survey. The Canada Street Price Questionnaire is also provided to capture street price information for target prescription products. Key Findings Note: The study expansion beyond Ontario was initiated in 2016. As a result, the data provided in this report are limited in geographic coverage, which continues to expand. Heat maps reflecting diversion activity by population are presented for each drug class. Benzodiazepines were mentioned most frequently, followed by hydromorphone and oxycodone products. We began collecting heroin and illicitly manufactured fentanyl case report data in 2Q16. Total illicitly manufactured fentanyl mentions steadily increased throughout 2017 in Ontario, and illicitly manufactured fentanyl had the highest number of mentions by population rate in Ontario and British Columbia. Heroin mentions increased steadily in British Columbia and Quebec, and the heroin mention by population rate was highest in British Columbia.