MEDICINAL HEROIN PROJECT WINDING DOWN

VICTORIA -- The opiates flowed from Europe, under heavy guard.
Shipped in powder form, they came in tidily packaged vials, 24 to a
box. In each vial were 10 grams of pure heroin - just add water.

Most of the shipments ended up in a nondescript building in
Vancouver's Downtown Eastside, stored in a vault behind bulletproof glass.

Throughout the day, a stream of hardcore heroin addicts would arrive
for their fixes. Each was allowed three visits a day.

Now the flow of clients has almost stopped. Only a handful remain in
the final weeks of North America's first medically prescribed heroin trial.

The program is coming to a close, just as the fate of Vancouver's
safe-injection facility, Insite, remains unclear. The Conservative
federal government has yet to decide whether to approve the
continuation of that facility's exemption from drug laws - whereby
addicts are allowed to bring and inject their own drugs - which
expires on June 30. Both programs are studying harm reduction, but
the $8-million North American Opiate Medication Initiative, funded by
the Canadian Institutes of Health Research with the approval of
Health Canada, offers heroin addicts a path away from the illicit drug trade.

At NAOMI, participants receive medically prescribed heroin or another
opiate, hydromorphone (Dilaudid), in a bid to keep them away from street drugs.

Each of the participants, drawn from Montreal and Vancouver, had been
addicted to heroin for many years.

Each had failed repeatedly to get off the drug using the best
existing treatment, methadone.

Martin Schechter of the University of B.C.'s faculty of medicine is
the lead investigator. While his subjects return to their lives, he
is working on a final report to be published later this year.

The preliminary findings are encouraging. Dr. Schechter noted that
the treatment proved extremely safe and created no security problems.
Eight-five per cent of the participants stuck with their year-long treatment.

Dr. Schechter's team is trying to determine whether there is an
economic case to be made for heroin therapy. Dutch and German studies
have found the treatment is more cost effective than paying the price
for health and criminal-justice services for those using street drugs.

In Canada, the estimated cost of an untreated heroin addiction
exceeds $45,000 a year. The Europeans found savings of roughly
$20,000 a year for those taking prescribed heroin.

"It's an argument that should appeal to the most hard-hearted fiscal
conservative," Dr. Schechter said.

There is also the human cost of heroin addiction.

"We had women coming up to the research team, thanking us because
they had been able to stop selling their bodies. We had a fellow who
decided to skip the midday session so that he could hold down some jobs.

"What was really common was that people would say that, for the first
time, they didn't wake up thinking about how to get their next fix."

That was the case for a participant known as Jazzman. When he was
accepted into the program in Vancouver, he had been on and off hard
drugs for more than four decades. He first stuck a needle into his
arm at age 15. He will be 58 this year and his body bears the
evidence of a harsh existence: liver damage, lung problems and
deteriorated discs.

Sometimes he kicked his habit. Sometimes he managed his addiction
while keeping a home and holding a job. But for the past eight years,
he has been on a downward spiral. Now he is living in the Downtown
Eastside, the poorest, roughest neighbourhood in Canada.

"I would have been dead if I hadn't hooked up with NAOMI," he said in
a recent interview.

"I was a basket case, totally emaciated, having to hustle and sell
everything I had to make it through one more day, one more fix. One
fix is $10 but I don't feel that ... I need $30 worth."

While he was in the program, Jazzman went through the secured,
frosted doors three times a day, seven days a week, for a year.

He would receive a loaded syringe from a nurse. He would sit at a
sterile, stainless-steel counter to inject. He would then sit in a
bland waiting room to recover from the drug's effects before heading out.

"There was this sense of relief. I wasn't going to go insane getting
what I needed. It was stopping the nightmare."

In between injections, he was eventually able to find some work. He
is now out of the program and, under the treatment of a doctor, takes
morphine. He says he will not even dabble in street drugs now.

Others he knows who were in the program have gone back to their
precarious street lives, but he believes that this time, he can stay
clean. "NAOMI did an awful lot of good. I was very determined to get
my life back."

As they prepare their report, the researchers will follow the
progress of Jazzman and the other participants. But that leaves in
limbo some troubled, vulnerable people who could benefit from
continued treatment.

Last November, doctors appealed on compassionate grounds to extend
the program on behalf of five participants. So far there has been no
agreement from either Health Canada or the regional health authority.

Infrastructure is also a problem. In June, the clinic in the Downtown
Eastside will shut its doors, unless the Vancouver Coastal Health
Authority finds the money to keep it open in some form.

Dr. Schechter's researchers knew from the outset that they would have
to let their subjects go after a year of treatment, even though it
meant watching them return to their high-risk lives on the street.

But it's still painful, he said. "You have people you can see with
the naked eye are benefiting tremendously; it feels terrible to deny
them the continuing benefit of that, knowing there is a strong chance
they could go back to using dirty needles and facing those risks."

Ann Livingstone, a co-ordinator for the Vancouver Area Network of
Drug Users, expects the final report to support the science of heroin
therapy, but she has little hope the federal government will accept
such findings.

"Of course it's a success," she said of the program, but adding that
the effort might have been for nothing. "And it's not fair to people
who become stable to have it discontinued because of the whim of
someone's politics. That's the horror of it all."