GIVING JUNKIES A BETTER SHOT

A new program is offering addicts in Montreal and Vancouver free
heroin in an attempt to help them improve their lives; so why aren't
more of them signing up?

It's a chance to cut the chain that keeps addicts tied to a routine
of daily degradation as they find desperate ways to get the money to get high.

The North American Opiate Medication Initiative, known as NAOMI, is
offering hundreds of junkies haunting the slums of Montreal and
Vancouver the chance to join a research study that provides free heroin.

But they haven't been biting.

NAOMI needs 157 participants in each city. Nearly a year into
recruitment, only 85 have signed up and met the criteria for
participation, which critics say are too strict. This has pushed back
results by 10 months. Data will be released by the controversial
study a year after the last participant signs up.

Scientists want to know if hard-core addicts will be able to live
more healthy and productive lives with free, measured doses of
heroin, a drug that is not harmful to the body.

Heroin is addictive, and overdosing on it will kill brain cells
because of oxygen deprivation, but otherwise, the drug is safe, says
B.C.'s Medical Health Officer Perry Kendall.

"Heroin, if it's used on a maintenance basis, in pharmacological
doses without any risk of overdose or contamination, is actually a
very safe drug. About the only side effects that you find in the
literature, other than addiction, are chronic constipation,
diminution of sex drive, a very dry mouth, which can result in poor
oral hygiene."

He says heroin use doesn't knock years off people's lives.

"It doesn't harm the liver, doesn't harm the kidneys per se, and it
doesn't kill brain cells unless you overdose and run out of oxygen,"
Kendall said.

What kills, is the addiction and the all-out fight to get the illegal
drug. The lifestyle takes a frightening toll, says Mark Townsend,
director of the Portland Hotel Society, an organization that provides
low-income housing and is involved with a variety of harm reduction
strategies to help drug users.

He said the hard-core users NAOMI wants to work with are so
marginalized and abused that they can be impossible to reach.

The participants must be older than 25, have been hard-core users for
five years, have used every day for the past year, not be on
probation and, for the Vancouver participants, live within a
kilometre of the project's Downtown Eastside location.

The researchers running NAOMI thought it would be an easy choice for
addicts: Take free heroin and be involved in a study - offering a
break from crime - in exchange for the drugs their bodies are addicted to.

NAOMI was preparing for an onslaught of desperate callers when it
opened for applications. Hours of operation were limited to a few
hours a day. Few people came forward.

"It wasn't as explosive as we had expected," says David Marsh, a
scientist working on the study.

"We had to change our recruitment strategy. We opened the phone lines
for the whole day instead of the initial four hours a week. We had to
do outreach as well."

NAOMI researchers went to food banks and hotels spreading the word
about the project.

Townsend said NAOMI, like other projects, was designed with great
intentions but criteria for users that addicts simply can't meet.

"There's sometimes an imaginary version of what the target looks
like," he said.

"I think down here, the group they're trying to reach is very
marginalized, very abused. These people get very upset when they call
me and get my voice mail. They've waited in line for the phone,
people are yelling at them to get off, and they don't know when
they'll be able to call again. Life looks very different to them."

The addicts have to commit to interviews with doctors and follow a
routine for two years. They need to report daily for doses of heroin,
which they inject on site, and must submit to interviews with nurses.
NAOMI also makes available counselling and social workers.

Already, Marsh said, people who have gotten involved are making gains.

"It's still too early to draw hard conclusions, but so far, we're
seeing improvements among participants," Marsh said.

"People are getting into stable housing, reducing use of other drugs.
There are improvements in physical health, people are gaining weight
and engaging in counselling services."

Results of similar studies in Europe have been encouraging. Many
addicts have been able to lead stable lives while taking a regulated
dose of prescription heroin.

Some people who have signed up for the Vancouver study dropped out
early on to try abstinence, Marsh said.

The $8-million NAOMI project is one of many harm-reduction strategies
health agencies are using to deal with drugs and the health and
social problems they cause.

The treatment movement has been more in vogue than 12-step abstinence
programs that require people to quit drugs. Approaches that aim for
harm reduction accept that some people will never quit and strive to
minimize the health effects.

Governments backed the program on the west coast when users caught in
Vancouver's open drug market, the Downtown Eastside, sparked an
outbreak of HIV spread through dirty needles. Health officials backed
needle exchanges and, eventually, opened Insite, North America's
first safe injection site, and now the NAOMI project.

Insite is full to capacity and health officials have deemed it a
great success. A number of other Canadian cities, including Toronto,
are considering opening their own supervised spaces for addicts to get high.

Some people are angry about the public use of drugs outside the
injection room. Many of the 4,000 addicts in the Downtown Eastside
can't wait the five to seven minutes they might face to get a place
to shoot up. So they inject in the street.

Vancouver police announced a crackdown in December and began charging
people shooting up in public.

The Vancouver facility was set up in 2003 as a three-year experiment
exempt from Canadian drug laws. Since then, the clinic has run at
capacity with about 800 heroin injections daily.

Kendall said the clinic has achieved its goal to cut overdose deaths
and rates of hepatitis and HIV infection.

Its exemption from drug laws is due to expire in September 2006.
Kendall recently applied to Health Canada to make the facility a
permanent part of the medical service system.

With the federal election under way, a decision will likely take months.