That's a very tough question, and I wouldn't really use the word “recreational”. Much of the off-label use of opioids could be self-medication. There could be a whole range of reasons that people might be engaged in the non-official market for opioids.
Certainly, if you go from west to east in Canada, and I spend time in Prince Edward Island, almost 100% of prescription opioid use in the east, and in Vancouver, there is still a huge amount of heroin used. As we saw from the data from the U.S., people go back and forth depending on the circumstances. Markets for both illicit use of prescription drugs and illegal drugs use are very active, and there is very much a fluid interchange.
I guess I'm troubled by the term “recreational use”. I think even with the example of Ritalin there is a use; students are using it to sharpen their focus for exams, etc. It's part of the complexity of what we're looking at. It's difficult to come up with one solution. It has to be comprehensive. I do take a little bit of issue with what Dr. Selby said about harm reduction. Many harm reduction programs deal with people who are not in treatment. The Vancouver Police Department overdose response policy of not responding to routine overdose is to try to get people who use drugs to.... It's those sorts of things.
Very few people actually are in a form of addiction treatment. Most people who have addiction problems are not in treatment. There are lots of things we can do for those folks as well as people who are in a pain management who develop addictions as well.
I'm sure that didn't answer your question, but it's a very complicated issue.