ADDICTS TO GET FREE HEROIN

Gradual weaning. 150 to be recruited for Montreal portion of three-city study

The idea sounds like the farthest thing from drug rehabilitation: give
heroin addicts free shots of pharmaceutical-grade smack to help them kick
their habit.

Yet that's precisely what doctors in Montreal, Toronto and Vancouver hope
to do in a controlled study early next year.

Researchers plan to recruit about 150 heroin addicts for the Montreal
portion of the study. The addicts will be encouraged to shoot up in a
downtown clinic under the supervision of a nurse up to three times daily,
seven days a week.

Half of the addicts will be given heroin, and the other half methadone. No
one - not even the doctors - will know who has taken either drug until the
two-year study is concluded.

In Vancouver, news that a clinic might open a block away from a school and
day-care centre has some area residents worried.

In Montreal, researchers haven't found a location, although it will
probably be downtown.

Dr. Suzanne Brissette, who treats drug addicts at St. Luc Hospital, said
the study is being modelled after successful programs in Switzerland, the
Netherlands, Germany and Spain.

"The idea is to first stabilize addicts with the heroin," Brissette explained.

"These persons will be in contact with nurses, physicians and social
workers many, many times a day. At the same time, they might be given other
medications they need for infections, for HIV, for depression and other
psychiatric problems."

The goal of the research is to get addicts off the streets, where they
often use dirty needles to inject themselves with potentially fatal doses
of sub-par heroin.

Knowing that they have a steady supply of high-quality heroin, the addicts
would be less likely to resort to crime to pay for illicit drugs.

"When a heroin user shoots up on the street, his pusher doesn't care about
his health," Brissette said.

"The pusher cares only about making money and selling drugs. So this is
very different. It's done in a very therapeutic fashion."

Methadone, usually taken in the form of a syrup, is the standard treatment
to wean addicts off opiates.

However, up to 50 per cent of addicts don't respond to the treatment and
continue to shoot up.

The Canadian researchers are seeking to find out whether giving addicts
heroin in a supervised manner might be more effective.

Patients will be followed for two years. They will be allowed to take
heroin for one year, and then will be weaned off the drug during a
three-month period while undergoing counselling.

Brissette noted that under a Swiss study, none of the addicts overdosed and
some wound up taking less heroin than allowed.

That study revealed a decrease in the use of street heroin and cocaine, a
drop in crime among the addicts, and an increase in employment.

In addition, 30 per cent of the addicts later switched to methadone
treatment and abstinence-oriented programs.

Heroin addiction brings a high cost to society in drug-

related emergency room visits, loss of employment and incarceration for crimes.

A Toronto study has pegged the cost to society at $45,000 per heroin user.

Public-health authorities estimate there are up to 100,000 users of such
illicit opiates as crack cocaine and heroin in Canada.

In Montreal, the researchers set up an advisory committee in 1999 to lay
the groundwork for the study. Business representatives, community
activists, the RCMP, Montreal police, the Surete du Quebec, local
politicians and public-health officials were involved in the committee's
deliberations, Brissette said.

Jean-Luc Thibault, press attache to Saint-Jacques Councillor Robert
Laramee, sat in on some of those meetings.

"For Mr. Laramee, this project deserves to be studied," Thibault said,
noting that Saint-Jacques district has a high number of injection-drug users.

"The issue is how it should be established and where."

Brissette said she understands potential concerns by the public about the
project - dubbed NAOMI - but that people shouldn't get upset.

"It's out of the question that users will be allowed to take heroin home,"
she said. "The research protocol is very controlled and very strict."

To qualify for the study, each addict must undergo a physical and mental
assessment. Those with severe medical or psychiatric conditions will be
excluded, as will those on parole or probation for criminal activity.

Brissette said researchers must still obtain permission from many
regulatory bodies to let doctors prescribe heroin.

By the Numbers

Illicit heroin use in Canada

Estimated number of heroin users 60,000 to 100,000

Drug overdose deaths per year 500 to 1,000

HIV prevalence estimates among injected-drug users

9.5% in Toronto

17.9% in Montreal

25% in Vancouver

Hepatitis C in injected-drug users across Canada 60% to 95%

Source: Benedikt Fischer, Public Health Sciences and Criminology at the
University of Toronto

The Social Cost

Total cost of untreated heroin use

Average annual social cost per user (in Toronto sample) $45,000

(Hypothetical) social cost projections

115,000 heroin users in Toronto $675 million

50,000 to 90,000 heroin users in Canada $2.25 to $4.05 billion

The breakdown of major social cost

Crime victimization 44.5%

Law enforcement 42.3%

Productivity losses 7.0%

Health care costs 6.2%

Source: Benedikt Fischer, Public Health Sciences and Criminology at the
University of Toronto

The Signs

Characteristics of untreated heroin users

According to a Toronto-based study

Prevalence of the following signs (in last 30 days)

Regular alcohol use 70.2%

Crack/Cocaine use 57.9%

Benzodiazepine use 60.5%

Daily drug injection 84.2%

Serious acute health problems 54.4%

No permanent housing 51.8%

Illegal activities for income (avg. $1,432) 67.5%

Prevalence of the following signs (in last 12 months)

Needed medical help but did not seek any 41.1%

Multiple overdose experiences 50%

Drug-related ER visit (avg. 4.2 times) 62.3%

Arrested for drug or property offence 51.4%

In prison or jail 42.1%

Source: Benedikt Fischer, Public Health Sciences and Criminology at the
University of Toronto