A TOLERANCE FOR IV DRUG USERS

Vancouver Seeks To Protect Addicts, Not Punish Them

VANCOUVER, B.C. A woman squats on a stoop in an alley. She is holding an
orange syringe in her right hand. With her left, she is squeezing the air
as if trying to catch an insect that is not there. Half of the dose of
heroin she had been injecting is still in her needle. She is in junkie limbo.

"She has done a hit of heroin. She hasn't even finished it, it's so good,"
explains Mel Hennan, who is patrolling the back alleys of this city.

Next to the woman is a girl with pale skin and braids tied with green
rubber bands. She looks as if she could be the cashier at a fast food
restaurant. Yet she is scraping the alley with her black fingernails,
looking for rocks of cocaine. She is holding her syringe between her teeth
like a toothpick as she hunts.

A man two dumpsters down does not mind that someone is watching as he
unfolds a red pouch, pulls out a syringe and fills it with liquid. He
thumps it and pushes it into his collapsing veins.

This is heroin alley in Vancouver's Downtown Eastside, near the corner of
Main and West Hastings streets, the underworld scene of what police call
North America's largest open-air drug market. Here, some of the purest and
cheapest heroin and cocaine on the continent are bought and sold openly
along streets where tourists are warned to watch out for random needle
stickings.

City officials call Vancouver's drug problem an epidemic as incidents of
overdoses soar and addicts crowd some street corners. Last spring, Mayor
Philip Owen proposed a radical plan to set up "safe injection centers" or
"consumption rooms" where addicts could get clean syringes and inject their
drugs under the watch of trained health workers.

"These legally sanctioned facilities could provide a safe, secure
environment where drug users could inject under the care of health
professionals trained in safe injection techniques and overdose response
and away from the dirt and dangers of the street," the mayor said.

Vancouver, on Canada's west coast, is a major seaport and point of entry
for heroin and cocaine. Since the 1980s, the drug market in Vancouver's
Eastside has exploded as a result of concentrated poverty, lack of adequate
housing, high unemployment and easy access to inexpensive heroin and
cocaine in almost pure form. An estimated 12,000 intravenous drug users
roam the streets.

Since 1993, Vancouver has averaged 147 illegal drug overdose deaths per
year. As the death rate increases, so have cases of HIV and hepatitis C.
"In 1997, we had escalating HIV and AIDS cases among IV drug users," said
Heather Hay, regional network director for addiction services with the
health board for the Vancouver-Richmond area. "The Board of Health declared
a public health emergency. . . . The health board's position is safe
injection sites are a tool to prevent drug overdose deaths."

The plan for such sites has drawn praise, but also strong opposition from
business groups that say more needs to be done to enforce drug laws and
that drug injection sites will only lure more addicts into the area and
harm legitimate businesses.

"The only thing we are against is the location. The location is only a half
a block from our center," said Monty Jang, chairman of the Chinese Cultural
Center, who said he gives the mayor credit for the proposal.

"Our center is having a Chinese language school comprising somewhere around
1,500 students weekly," Jang said. "Let me put it this way: with that kind
of treatment, you may be attracting a lot of those drug addicts hanging
around, and maybe creating some prostitutes to make money and to buy drugs.
So that is the only reason why we're against it."

But Fred Bass, a Vancouver city council member, said he supports the
mayor's proposal. "We've had a drug scene that is out of control," he said.
"We have an epidemic of street drug use. It needs to be treated as an
epidemic. It is important to recognize how far behind North America is in
addressing a comprehensive approach to the drug epidemic."

While U.S. cities fight drugs principally with tougher law enforcement,
Canadian officials are using a different weapon. They call it harm
reduction, an approach that treats addiction as a disease rather than a
crime and attempts to keep as many users as possible alive and healthy.

"In Canada, the drug trade has the potential to generate criminal proceeds
in excess of $ 4 billion [Canadian] at the wholesale level and of $ 18
billion at the street level," Owen said in a report. "Expectations that
extra officers at the street level can significantly alter a problem of
this scale and complexity are unrealistic."

Owen said that increasing the number of officers on the streets only
displaces dealers and forces them to develop more sophisticated marketing
strategies. One that emerged recently was called "dial-a-dope." The mayor's
report quoted a middle-class cocaine user as saying: "You order a pizza.
I'll order cocaine. We'll see which one gets here quickest."

Other Canadian cities, such as Montreal, have studied the possibility of
providing safe injection centers. Canada's top drug enforcement officer,
Chief Superintendent Robert Lesser of the Royal Canadian Mounted Police,
has said that cities should explore safe injection sites to stop the spread
of HIV and hepatitis C. "I think it's something we have to look at," Lesser
said, according to news reports.

Cities in Germany and Switzerland set up injection sites several years ago,
allowing addicts to inject drugs under medical supervision. The clinics
provide clean needles, distilled water, filters and spoons and often allow
addicts 30 minutes to inject and feel the effects of their dope. More
recently, such cities as Sydney and Madrid have opened sites. Officials say
the centers have helped to dramatically reduce crime and disease.

Ann Livingston, project coordinator of the Vancouver Area Network of Drug
Users -- an advocacy group better known by its acronym, VANDU, that is made
up of intravenous drug users and former users -- argues that safe injection
centers would bring dignity to addicts. "At safe injection sites, the
building is designed where there is an entryway and a bathroom and an
actual place to shoot up further down," said Livingston, who is not a user.
"A place to get the 'rigs' and light a candle and an exit from the building."

Vancouver council member Bass said he prefers the term "clean injection sites."

"People think, 'Oh, my God, they want to legalize drug use in Canada. They
want to have safe injection sites.' They get very panicked," Bass said.
"But right now we have safe injection sites. They are in the parks, lanes,
cars and schools. The question is, are there better sites?"

Earl Crow, president of VANDU, is in his office talking to a church group
about the ravages of heroin and cocaine and his own struggle with
addiction. He works part time in the office, as do other users. In return
for light office work and alley patrols, they receive small, daily
stipends. Drug use or former drug use are the only requirements for work here.

"Only users can speak for users," Crow says. He has long, blond hair. He
was once a musician. Now he is an addict and president of an advocacy group
for addicts. He says he kicked heroin addiction but still smokes crack
cocaine. Each day he and other users from VANDU go out on the streets in
patrols to hand out clean "rigs" -- needles and other paraphernalia. "The
full works for a clean hit," Crow says. They also check users strung out on
the streets, in parks, at bus stops and in alleys to make sure they are not
overdosing and are feeling "healthy" -- as healthy as addicts can be.

"The quality of heroin is good in Vancouver. To try to withdraw is hell,"
Crow says, as he and Hennan walk down an Eastside street around noon. "I
can't describe the pain in your body. . . . When you are wired, it's very
hard to come down."

Crow stops at the entrance to an alley along West Hastings. A brown thick
liquid runs along the crevices in the brick pavement and into a drain. A
tall woman in a white miniskirt and torn stockings scratches at her leg,
then pokes in a needle. A man in a red sweat suit sits in the middle of the
alley. Crow nudges him. The man gets up and puts his head down on a
dumpster as if it were a pillow. "If they are just sleeping and breathing,
we don't disturb them. If they are not breathing, we know training for CPR."

Hennan is looking for any signs of an overdose. "People who OD on down
[heroin], look like they are going to sleep while walking," Hennan says. "I
OD'd about four times on heroin. One time, I paralyzed my leg. Four months
later, I got my feelings back."

The stench in the alley is like that of an overturned portable toilet.
Orange needle caps litter the alley like cobblestones. The junkies do not
move, or run, or hide. Instead they sit, some of them as if on their own
thrones, working with their intricate vials and packages and needles,
searching for veins.

"Can't you spare some money?" shouts a man who identifies himself as Scott.
"You don't understand, lady. I'm in a lot of pain. I need morphine in my
body." Up close, he has pink sores on his mouth and a thick, curly, black
mane. He is staggering. He has lost his shirt and is about to lose his
pants. There are scars on his bronze skin.

"This is like never-never land," Hennan says. A couple wearing shorts and
carrying maps and a camera walk through the crowd of addicts.

Crow stares at them. "Now that is stupid. They are crying out, 'Tourists!'
People up there have razor blades that will sever anything. They would cut
[the camera] off his neck. And he'll say, 'Why did they steal from me?'
They are so obvious when you go around with $ 2,000 worth of camera
equipment in a drug area. That's why."

"It's like some people just want to be accidental tourists," Hennan says.

Just then, Crow excuses himself. He says he needs to "score a down."

Hennan tells him to wait until they stop working. But Crow says, "We are
not working." Crow walks up to a man with dirty jeans. The man could be any
vendor. Crow makes his transaction, then slides into a store and reappears.

"I want to make this clear. I purchased this down for my girlfriend," Crow
says. "She is wired. She is sleeping, and when she wakes up she will be
very sick. I have to have some down in the house. When you are wired, you
might sleep three days straight. After a run, you are very hungry and very
tired."

He pulls his purchase from his pocket. It is a tiny envelope, no bigger
than a half-inch, the size of a fingernail. The envelope is made from the
orange paper used to wrap clean syringes. "It looks like baking soda," Crow
says. "It's wrapped down like an envelope. It's easy to unfold." This
"paper" cost him $ 10.

Hennan asks him to put it away. "It's triggering me," he says.