In the last five years, prescription painkillers have dethroned crack cocaine as the main chemical fuel of petty crime in Hamilton.

Where robberies, break and enters and thefts were once most commonly linked to crack, now prescription opiates like oxycodone, fentanyl and morphine are the drugs driving addicts to crimes to support their habits.

While violent crime overall is trending down in the city, robberies targeting businesses and financial institutions increased by 11 per cent in 2012, and “most of these robberies are committed by drug users to satisfy their addictions,” according to a report presented to the police services board earlier this year.

It was like breathing. There was no option not to do it. - Rebecca, former opiate user

From 2011 to 2012, there was a 32 per cent rise in opioid-related arrests in the city — 127 of them in 2012, up from 96 the year before.

As it is with crack and other illegal drugs, the petty crime associated with painkiller addiction is a way to buy the drugs to feed the habit. But there's a new wrinkle for police to contend with in the opioid drug crime they face: Opiates are legal prescription medication, and so police are now also seeing robberies of pharmacies where addicts are trying to steal the actual drugs.

Hamilton Police vice and drugs Staff Sgt. Paul Downey is a three-decade Hamilton police veteran, and worked in the robbery unit for almost ten years before this stint in vice and drugs. Yes, crack is still smouldering in the background, he says. But prescription opiates just keep rising in prominence.

“When I was first in [the robbery unit], it was all crack. The fuel of crime was crack. It was the devil of them all,” Downey told CBC Hamilton.

“Then five years or so ago, the opiates get involved. Then you see the robberies, and they’re asking for fentanyl patches. They’re robbing for the opiates. Or doing [break and enters] for them.”

“When would you think there’d be a robbery where they specifically say ‘give me all your fentanyl patches?’”

2nd highest rates in the province

Killing Pain: Prescription drug abuse now Hamilton's biggest drug problem CBC Hamilton examines the city's growing opiates addiction problem in a three-part series. Tuesday: How prescription opiate abuse is taking over the city's drug scene and what medical and addiction specialists are doing about it.

How prescription opiate abuse is taking over the city's drug scene and what medical and addiction specialists are doing about it. Wednesday : The growing connection between crime and prescription drug abuse.

: The growing connection between crime and prescription drug abuse. Thursday: Stories of addiction and struggle. Three former addicts share their stories. Live chat Join CBC Hamilton Thursday at noon for a live chat with Dr. Norm Buckley, professor and chair in the Department of Anaesthesia at McMaster's Michael G DeGroote School of Medicine. Buckley will be speaking about Hamilton's prescription painkiller problem, and just how this stakeholder group is trying to fix it.

But the fact is, opioid use and abuse in Hamilton is on the rise. According to statistics obtained by CBC Hamilton from the Drug and Alcohol Treatment Information System, admission rates for local opioid withdrawal programs are now the second highest in the province, behind only northern Ontario.

In 2002, one in ten people who entered a withdrawal management program at St. Joseph’s Healthcare were opioid patients. By 2012, it was one in four.

Most opiates for sale on the street come from people diverting from their own prescriptions.

But the fact that local pharmacies are being held up for medication is a definite concern for Hamilton police, Downey says. “I wouldn’t say it’s rare. It happens more than we’d like,” he said.

Pharmacists have also taken note of the growing way prescription painkillers are being targeted, says Allan Malek, the senior vice president of professional affairs with the Ontario Pharmacists Association.

“Pharmacists aren’t complaining that this is a new phenomenon — but they are saying that this is an increasing phenomenon,” Malek said.

“The fact is, it’s all connected,” Downey said. “It’s the addiction that’s so strong, people will do whatever they have to do to get to it.”

'It was like breathing'

Rebecca knows all about that addiction.

The 23-year-old from Hamilton always told herself she’d never stick a needle in her arm.

Even though she’d used crack, coke and ecstasy, there was something about injecting drugs that terrified her. Until one day, a co-worker introduced her to shooting up the opiate hydromorphone. The feeling overtook the fear, and after a while, she was hooked.

“If I didn’t have it, I would be crying nonstop, nauseous nonstop, shivering nonstop — I’d basically curl up into a ball,” she told CBC Hamilton. She asked that her last name not be used.

When she was using, Rebecca burned through all the money she had – and so had to turn to theft to support her addiction.

“It was like breathing,” she said. “There was no option not to do it.”

Addicts will go to astounding lengths to get money for opiates, Rebecca says. She was the wheelman for meat robberies.

That’s right: meat robberies. Before getting clean earlier this year, Rebecca would drive a dealer around Hamilton who stole meat from grocery stores, and then sold it to bars on Barton Street. The money would then go towards buying prescription painkillers.

What are opioids? Opioids are prescription medications that relieve pain. To get high, people can simply take more than prescribed, or break them down to snort, smoke or inject them. Here are some of the opioids being used in Hamilton now: OxyContin : OxyContin is a time-released pain medication developed in 1995 for people who need around-the-clock pain relief. It was taken off the shelves in Ontario, but still exists on the street because of large stockpiles.

: OxyContin is a time-released pain medication developed in 1995 for people who need around-the-clock pain relief. It was taken off the shelves in Ontario, but still exists on the street because of large stockpiles. OxyNeo : OxyNeo is the new form of OxyContin that was brought in partially to curb abuse of the original drug. It can still be broken down and used to get high fairly easily. Purdue, the company that makes OxyNeo, maintains the product is harder to abuse.

: OxyNeo is the new form of OxyContin that was brought in partially to curb abuse of the original drug. It can still be broken down and used to get high fairly easily. Purdue, the company that makes OxyNeo, maintains the product is harder to abuse. Generic OxyCodone: Generic formulations of OxyCodone painkillers also exist on the market.

Generic formulations of OxyCodone painkillers also exist on the market. Percocet : Percocet is similar to OxyContin, but only lasts for about five hours as opposed to 12 hours. It contains Oxycodone and acetaminophen (the drug in Tylenol), which makes people sick if they take a lot of it.

: Percocet is similar to OxyContin, but only lasts for about five hours as opposed to 12 hours. It contains Oxycodone and acetaminophen (the drug in Tylenol), which makes people sick if they take a lot of it. Fentanyl : Fentanyl is most commonly available as a skin patch, but can also be seen as a lozenge, pills, shots and a film that dissolves in your mouth. It’s used for extreme pain situations, and often for cancer. In Hamilton, the patches are often chopped up and put inside the mouth, or smoked and injected.

: Fentanyl is most commonly available as a skin patch, but can also be seen as a lozenge, pills, shots and a film that dissolves in your mouth. It’s used for extreme pain situations, and often for cancer. In Hamilton, the patches are often chopped up and put inside the mouth, or smoked and injected. Morphine : Morphine is a common medium to strong painkiller, often used after surgery.

: Morphine is a common medium to strong painkiller, often used after surgery. Hydromorphone : Hydromorphone or Hydropmorphs are often used in Hamilton, and are more often abused because oxycodone is harder to obtain.

: Hydromorphone or Hydropmorphs are often used in Hamilton, and are more often abused because oxycodone is harder to obtain. Methadone: Methadone is usually used to wean people off other drugs, as it works on opioid receptors. It can still be abused for a kind of euphoria.

“He paid my gas and I got a percentage of what we made,” she said. “I never had to go into the stores though, thankfully.”

Jim is another Hamilton native who spent years fighting opiate addiction. He says drugs like OxyContin drive much of the petty crime in Hamilton. CBC Hamilton has not used his real name.

Jim once watched a girl set up her boyfriend — who was carrying close to $1,000 in marijuana — to get beaten and robbed so she could buy more prescription drugs.

“When people are addicted to it, and they’ll do anything they have to do to get it,” he said.

'We're finding pills'

Opiates move through the city in many ways, but the main starting point is patients who divert their own prescriptions and sell them at a profit.

“They’d have the smallest injuries or gotten hurt so many years ago and said that it kept hurting, so they’d still get the same amount of stuff, and they didn’t actually need it,” Rebecca said.

The results can be lucrative. OxyContin runs for $100-$140 per 80 milligram pill on Hamilton’s streets right now. A single Fentanyl patch goes for about the same.

If you “play it smart,” you don’t have to worry about being caught by police, Rebecca says. But many people don’t and deal out of their home — and that’s just asking to be caught, Jim says.

“I knew a guy who lived downtown who was selling the stuff. Every time I went there, there was a lineup out the door,” he said. Soon enough, police kicked in the door to arrest him.

“The bottom line is when we’re doing search warrants, we’re finding pills,” Downey said. But just finding the pills doesn’t mean an automatic trafficking charge. Now, police are facing a drug problem that's brought about a brand new issue: unlike drugs such as cocaine or heroin, which in all contexts are illegal, these drugs are legal and prescribed. That makes a trafficking charge much more difficult to land, Downey says.

“It’s harder because you have to catch them trafficking.” Just finding them with drugs on them isn’t enough. “You have to actually see them trafficking it to someone else.”

‘If the person has it legally, even if they’re trafficking it, you have to make sure. It’s more difficult, and that’s probably why it’s becoming a problem,” Downey said.

This rapid rise in illegal opioid use has driven doctors, police, pharmacists, the coroner’s office and addictions counsellors to form a special task force to find ways to better work together to combat the growing problem, and overhaul the way prescription opioids are handled and tracked through Hamilton.

The group brings together those who see the benefits of prescription painkillers when used properly and the people who deal with the consequences when they are not. They're trying to work through the needs of both: availability for the beneficial uses, as well as control and management to prevent abuse. The group is working to overcome lack of communication between those two sides, an issue that allows people slip through the cracks and makes the system easier to abuse.

“People have to get to know each other,” said Norm Buckley Director of Hamilton Health Science’s pain clinics, and co-ordinator of the group. “The police have to get to know the docs, who have to get to know the coroner. You have to figure out how to communicate."

An example of what needs to change is that right now, a prescribing doctor likely wouldn't find out from police or the courts if one of his patients was convicted of trafficking.

Using the internet to get high

On top of the existing hurdles, law enforcement agencies are facing a new hurdle: the internet. For years, “best practices” on how to get high were passed by word of mouth, and moved slowly. The internet changed all that.

The ease by which dealers and users cracked new oxycodone safeguards is proof of that. Since its introduction in the mid-90s, OxyContin was one of the most popular prescribed opiates in the province, until widespread addiction issues saw it pulled from shelves and replaced with OxyNeo – which was touted as a safer alternative that was much more difficult to break down and abuse.

But OxyNeo was released in the U.S. several months before it came to Canada. By the time it was released here, videos explaining how to get around the drug’s safeguards were already on YouTube.

“Street chemists very quickly learned how to break down this supposedly ‘tamper-proof’ formulation,” Malek said.

There are a wealth of forums and websites online dedicated to the best, safest, and most efficient ways to get high. They’re full of posts like this one:

“Would it be safer to snort half of a 80mg Purdue oxy or 1 full 40mg Purdue oxy? My gut says 40mg.”

Purdue Pharma, the company that makes OxyNeo, maintains that the product is harder to abuse.

"OxyNeo happens to be the first product of its kind available in Canada, and it represents evolving technology to address the misuse and abuse of the tablets," said Randall Steffan, the vice president of corporate affairs for Purdue Pharma Canada.

"In fact, evidence from a comprehensive series of surveillance studies in the U.S. suggest that OxyNeo is discouraging abusers."

In those studies of substance abuse treatment patients who reported using opiods, there was a 41 per cent decrease in overall abuse of OxyNeo and a 66 per cent decrease for abuse by injecting or snorting, Steffi says.

But there are also websites that act as online drug marketplaces, like BlackMarket and Silk Road. While it was running, Silk Road could only be accessed through a Tor browser, which allows for anonymous web browsing. Opiates could be ordered online from both sites using the virtual currency Bitcoin, and then shipped to your door by mail.

A lot of police in this city, if they catch you doing drugs, they’re not going to just throw you in jail. They’ll try to get you help first. I’ve seen that. - Jim, former opiate addict

The FBI shut down Silk Road last month before it was relaunched, while BlackMarket was down for a time before relaunching this fall.

“In the older days of the drug trade, it used to be word of mouth. Now people figure out how to abuse drugs online,” said Det. Chris Auger, who works with the OPP’s prescription drug diversion division.

“There are always going to be people that are little steps ahead of us, but it’s just a matter of time before we catch up,” he said.

Downey says he sees the growth the internet affords users on a local scale as well.

“Now with social networking you can Google all these things and it will tell you what you can do with them. That’s all out there,” he said. “As word travels, they get bigger and bigger and bigger.”

The problem is getting bigger, but police in Hamilton have a genuine want to help, Jim says.

“I know police that have walked down the street with seven addicts thanking them — thanking them for helping them. Making them do something,” he said.

“A lot of police in this city, if they catch you doing drugs, they’re not going to just throw you in jail. They’ll try to get you help first. I’ve seen that.”

The problems weigh on Downey, just like they would any cop, he says. “Anytime when something is being done illegally that’s hurting people it’s going to concern a cop,” he said.

“If we lived in a perfect world, you probably wouldn’t need drugs to get by.”

“But we don’t.”