In Increasing the benefits and reducing the harms of prescription opioid analgesics [1], Hallinan and his co-authors present a welcome and overdue harm reduction perspective to the issue of non-sanctioned pharmaceutical opioid analgesics (POA) use, an issue that is generating increasing concern. In this commentary, the authors provide an overview to a recent policy paper on POA from the Royal Australasian College of Physicians [2], which is celebrated as a break-through application of harm reduction approaches to a traditional area of medicine. Clearly, the unsanctioned use of POA (i.e. use outside strict medical directions by the patient or another person) is an area where public health concerns about illicit opioid use intersect with medicine's more traditional role of alleviating physical suffering. Pharmacologically, illicit heroin and the opioids used in pain management all belong to the same family of drugs and act in the same manner. As the authors discuss, the illicit market for opioids is becoming a 'common market', increasing demand for diverted POAs.
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