MAYOR SEEKS DRUG MAINTENANCE FOR COCAINE AND METH ADDICTS

Experimental Program Would Provide Substitute Drugs To Addicts

Vancouver needs an experimental drug program for cocaine and crystal
meth addicts that would give them substitute drugs to help them quit
or stabilize their habits, says Mayor Sam Sullivan.

While a medical experiment is already underway for heroin addicts
that provides some local addicts with daily doses of heroin, Sullivan
said he's confident it will eventually result in a heroin-maintenance program.

"It's just a matter of time. You've just got to work it through the
system. Now we've got to move into the next stage."

The next stage is what addiction experts say is the newest and
most-needed research, "stimulant maintenance" trials, which would
provide substitute drugs to cocaine and crystal-meth addicts.

Local researchers have frequently made the point that cocaine is much
more widely used in Vancouver than heroin, so a program for treating
cocaine would be of greater benefit.

"I want a stimulant maintenance trial going," said Sullivan. "I've
almost assumed [a heroin-maintenance program] is going to happen."

Sullivan said his primary focus is improving life for the city's
sex-trade workers. He noted that statistics indicate 88 per cent of
them are using stimulant drugs.

Sullivan has had a stream of advice and opinion on options for
Vancouver's drug problem since he told The Vancouver Sun in late
April that he wanted to see more heroin provided to city drug users,
that he was working with staff on what kind of program the city
should support, and that he had received substantial donations to
provide money for some kind of program.

He received visits from several groups, including researchers at the
local Centre for Excellence in HIV-AIDS, who within days of his April
statement e-mailed him a "brief draft proposal" marked confidential.

While neither Sullivan nor the Centre for Excellence would confirm
that the centre has made a proposal, Sullivan said a "very good
group" has come forward with a proposal for a stimulant trial.

Other international researchers who attended a harm-reduction
conference in Vancouver in April advised the mayor that stimulant
maintenance trials were more needed than heroin trials.

The mayor also has had at least three donors offer money for a
drug-maintenance program -- the type is unspecified. Two anonymous
donors have committed to $500,000 and $10,000 respectively, and MDS
Metro Laboratory Services founder Dr. Donald Rix has committed $50,000.

The mayor said he simply wants to act as a broker between potential
donors and any agency that wants to run a program, but he wants to
ensure something happens sooner rather than later.

"It's going to take too long through the government processes. We
need to push it forward."

Ron Morgan, a peer counsellor at the current supervised-injection
site Insite, said he thinks a stimulant-maintenance program would be
a great help.

"Crack cocaine is the most expensive way to do coke, so that means
people here are stealing from each other, fights are breaking out
over almost nothing. A stimulant-maintenance program would help
people stabilize their lives, stop them craving."

User Brian Alleyne also agreed it would be a benefit.

If Vancouver started a stimulant-maintenance trial, it would be a
first for Canada, but not for North America. Several research groups
have been experimenting with replacement drugs for cocaine and crystal meth.

One of the longer-term researchers is Dr. John Grabowski, a
psychiatry professor at the University of Texas and director of the
university's substance-abuse research centre.

Grabowski, in an hour-long interview from Houston Monday, said that
even in the more conservative American states, interest has been
growing in finding substitute drugs for stimulant users.

For many years, researchers tried to use anti-depressant-type drugs
to deal with cocaine or other stimulant addictions, but had very
little success.

He started his first trials in 1995 using a different approach.
Instead of anti-depressants or other calming-type drugs, he began
experimenting with replacement drugs that are also stimulants.

He began with Ritalin in 1995, used methamphetamine for some trials
before the "war against crystal meth" made it impossible to get, and
then moved on to trials with dextroamphetamine.

All of those showed signs of effectiveness, mostly with people who
are active and heavy cocaine users, as opposed to intermittent or binge users.

Effectiveness, in the drug-addiction-research world, means primarily
that people in the studies reduce their cocaine use.

Other clinical measurements also show they report fewer signs of
depression and behavioral disturbances.

Grabowski says his studies, unlike some European ones, don't claim to
provide evidence that drug substitutions reduce crime.

"Whether they continue to engage in criminal activity, we have no way
of measuring," said Grabowski. "Here's the problem -- people expect
too much of medications. If people walk in the door and their prime
way of getting money is to be a thief, treating them is not going to
change that."

What drug-maintenance programs can do is provide a chance for users
to attain some "biological and behavioural stability," he said.

That's in part because the drug is supplied, but also because it's
provided through a slow-release mechanism that allows users to
maintain a plateau, rather than going up and down with the euphoric
highs and subsequent crashes that characterize street use.

That evenness allows them to possibly get some order in their lives
and get more benefit from therapy and behaviour-control counselling.

Grabowski, who was contacted by city drug policy coordinator Don
MacPherson several months ago about a possible visit to Vancouver,
said he is convinced the current wave of stimulant-maintenance trials
will produce a drug combination that will prove effective in helping
cocaine and crystal-meth users who are trying to quit.

The trick then will be finding jurisdictions with the "clinical and
political will" to turn those experimental successes into health programs.

Other countries that have tried stimulant-maintenance programs
include Australia, Britain, the Netherlands, Switzerland, and Finland.

E-MAILS TO MAYOR BACK DRUG PROGRAM

A Vancouver Sun freedom-of-information request for all e-mails in the
nine days after Mayor Sam Sullivan said on April 21 that he was
trying to support and find funding for drug maintenance programs
indicated 21 of 30 comments were supportive.

"Your harm-reduction proposal deserves to be given a chance, even if
it is a temporary solution while we search for a long-term
resolution," said one, who offered $10,000 to support a Sullivan plan.

Another wrote: "I completely support your idea, and frankly, would
like to thank you for having the bravery to risk your career on
something so important."

On the other side, "I am appalled," said another. "I'm not saying
that what you have ahead of you is an easy task or there is a good
solution but giving drugs to drug addicts is not a good thing."

Another said "We CANNOT save everyone -- only those who want to be
saved from whatever ails them. . . . By making it 'easy' to get drugs
we are doing nothing but enabling people to remain on drugs."

And a third: "How dare you take from good hard-working people and let
others suck off that with nothing other than a worse habit to show for it."