VANCOUVER'S DRUG PROBLEM MORE VISIBLE, DOCTOR SAYS

Addiction I Toronto And Montreal Have Problems That Rival Or Surpass Ours,
New Physician Leader Says

A Toronto doctor who is moving to Vancouver to coordinate drug and alcohol
treatment programs here says Toronto has more heroin and cocaine users, but
Vancouver's drug problem is far more visible.

"I don't think Vancouver's problems are any worse than Toronto's or
Montreal's," Dr. David Marsh said in an interview Wednesday.

"They're different though, and one of those significant differences is the
visibility of the problems in the Downtown Eastside. Those aren't the only
problems in the city, but they are problems that everyone knows about.

"In Toronto, there are more heroin users and cocaine users and people than
there are in Vancouver. In proportion to the population, the prevalence of
problems is just as high in Toronto as it is in Vancouver, but the problem
isn't concentrated in one neighbourhood, and therefore isn't as visible,
and doesn't attract as much political attention."

Marsh, 37, works at the Toronto-based Centre for Addiction Medicine and
Mental Health, Canada's largest hospital for addiction treatment. He was
recently hired by the Vancouver Coastal Health Authority and Providence
Health Care and begins work here in January as the region's first physician
leader for addiction medicine.

Marsh refused to disclose how much he is being paid but did say he is
moving to B.C. because of government-funded initiatives such as InSite, the
new supervised drug injection centre near Hastings and Main.

"I'm excited about the opportunities here," said Marsh, who is here this
week for meetings and, with his wife, to look for a home.

"There's a political environment and funding situation here in Vancouver
that creates an opportunity to design a system that makes sense."

Marsh said he doesn't have authority over the budget spent on drug-related
issues by health authorities, but will help re-design existing services or
change their mandate.

Here are some of Marsh's comments on different drug problems:

- - On marijuana: "Speaking for myself and not any organization I'm
affiliated with," he said he favours decriminalization of small amounts of
marijuana, as the federal government has proposed. "The problem is that the
prohibition against possession has been demonstrated by research not to
decrease the prevalence of use. We make it illegal in hopes of preventing
young people from using it, but that doesn't work." He also said one of the
things young people consider when deciding whether to use a drug is their
perception of whether a drug is harmful. "As a prevention message, it's
very important for young people to realize that cannabis is not an
innocuous drug, that they can come to harm from using it, especially if
they smoke cannabis and try to drive a motor vehicle. And a small
proportion of cannabis users go on to develop a dependence, and their
cannabis use disrupts their social and psychological functions, and gets in
the way of them being good parents and good employees."

- - On cocaine: Marsh said cocaine use has declined slightly in North America
during the past decade, but noted that people who inject cocaine -- between
20 and 30 times a day, according to a study of users in Montreal and
Vancouver -- are more likely to get blood-borne diseases such as HIV, the
virus that leads to AIDS. Marsh conceded that crack cocaine users in
Vancouver are highly visible: The crack smokers in this study were
reporting 50 to 100 uses a day. They buy and use, buy and use ... They're
going to be cycling in and out of the street a lot."

What treatment programs for crack cocaine will he initiate here that have
not been tried before?

"I'm not sure we're hoping to try things that haven't been tried before. In
general, we hope to learn from other jurisdictions, and apply things that
might not have been tried here in Vancouver. Right now, the [Vancouver
Coastal] health authority is going through an addiction redesign project
and moving towards the end of the first phase, where they've been
introducing needle exchange, methadone, addiction counselling, and other
things. The next phase will be looking at the treatment part of the
continuum." [Drug experts often refer to a "continuum" of drug prevention
and treatment programs, including education, counselling, harm reduction,
detox and long-term treatment.]

- - On methamphetamines, which includes the "crystal meth" that many street
kids use: "Methamphetamine is an old drug that has been around for a long
time. Over the last 20 years, there's been a much higher prevalence of use
on the West Coast of the U.S. In Canada, unfortunately, we haven't had good
networks for tracking patterns of drug use, especially drugs used by small
portions of the population."

Marsh said there is no medication to treat people who abuse
methamphetamines, cocaine, ritalin and other psycho-stimulants, so "we're
mainly relying on counselling as the intervention. That said, there are
ways of trying to reach out and engage them in treatment, such as syringe
exchange programs."

- - On alcohol: "In Canada, the social costs of alcohol are greater than all
the illicit drugs combined, and the cost attributable to tobacco is even
greater than alcohol. In ways that are analogous to heroin and cocaine, we
need ways to reaching out to people with problems, and getting them
motivated to enter treatment. For instance, for an older person who is
isolated, living alone and continuing to drink as they develop liver
failure, we might have to educate community nurses or agencies that are in
a position to identify individuals with those problems and make treatment
referrals. Having alcohol and drug counsellors at community health centres
is a great opportunity for family physicians to identify alcohol problems,
or people who want to stop smoking."