DOCTORS PAN MAYOR'S DRUG PLAN

Addicts May Risk Housing, Support Services If They Refuse To
Participate, Specialists Say

A group of B.C. addictions doctors has written an open letter to the
B.C. Medical Journal opposing the drug-substitution experiments
advocated by Vancouver Mayor Sam Sullivan, saying the experiments are
"not health care."

They say Sullivan's Chronic Addiction Substitution Treatment trials
also appear to tie needed housing, supports and counselling to an
addict's willingness to take substitute drugs.

However, other doctors involved in the trials say the critics have
misinterpreted basic information.

The open letter from the 14 doctors says : "We believe the CAST
initiative -- [experiments which aim to provide legal drug
substitutes for people currently addicted to stimulants such as
cocaine or crystal meth] -- is a poorly conceived strategy that has
negative consequences.

"We are concerned the provision of housing, counselling, or access to
a family doctor may be tied to participation in the CAST initiative,
and those same services denied to addicts who decline."

The doctors are also critical of the goal for the trial, which the
CAST website states is to reduce impacts on public disorder and
public health until more "durable" solutions can be found.

"This is not health care, nor is it likely that it represents the
goal of addicted patients."

Dr. Douglas Coleman, who sees thousands of patients a year for
addictions treatment with partner Dr. Donald Hedges, said people
signed the letter because they have a fundamentally different view of
what drug users need to improve their lives.

"We are clinicians and we just have different opinions," said Coleman.

He said the letter hasn't been sent to the mayor or people involved
with trying to start the CAST trials, such as Dr. David Marsh of
Vancouver Coastal Health or Dr. Michael Krausz, addiction research
chair at the University of B.C., because "those folks don't
particularly want to hear from us."

But Marsh, who has co-written a response with Krausz to the journal,
said the group's reaction is based entirely on misinformation.

"There is no indication people would have to participate in a trial
to get housing or counselling," he said. "And health benefits are the
main goals of any trial."

The CAST trials would operate in much the same way as another trial
now going on in Vancouver. The North American Opiate Medication
Initiative -- or NAOMI - provides heroin to long-term addicts, along
with intensive counselling and support.

The mayor's representative , David Hurford, also emphasized that city
staff have endorsed the idea of trying drug substitution as a
treatment method. As well, trials will ultimately be approved by the
Canadian Institute for Health Research, which has rigorous standards.

Coleman and some others on the list have expressed their opposition
in the past to many of the harm-reduction efforts in place for drug
users, particularly the supervised injection site. They would like to
see far more aggressive efforts for treatment.

Sullivan started advocating for a massive program of drug
substitution therapy for cocaine and crystal meth addicts shortly
after being elected in 2005. So far, there have been some small
experiments in the U.S., Finland and Australia.

He has claimed that the five trials now being proposed could enrol up
to 2,000 people and take $50 million a year out of the local drug
economy, which would in turn reduce gang violence on the streets.

While harm-reduction advocates locally support the idea of trying out
drug substitution for small groups of hard-core stimulant users, the
mayor's insistence on running a large-scale program and his claims
that it will dramatically reduce crime and drug-dealing have made them uneasy.