WORLD 'NOT READY' FOR VANCOUVER COCAINE TREATMENT EXPERIMENT

If Vancouver started a program for prescribing cocaine to long-term
addicts, it would be a first in the world outside of some coca leaf and
coca tea trials in South America.

And although one local researcher believes it might be worth a try, the
director of epidemiology at Vancouver's Centre for Excellence in HIV/AIDS
Research says that he couldn't predict how it might work out, given that
cocaine addicts use their drug in a completely different way from heroin
addicts.

Heroin addicts who are on maintenance programs can exist quite comfortably
by getting a prescribed dose every day, but it's difficult to imagine what
cocaine users would do, says researcher Dr. Mark Tyndall.

"There are people who inject 40 times a day. If they are given an unlimited
pile, they will not know when to stop."

That was the response Thursday to news that Vancouver Mayor Larry Campbell
favours prescribing not just heroin, but also cocaine, to intractable,
long-time users. He made his preference public after visiting a Swiss
facility that provides prescription heroin to a small population of users
who have been unsuccessful at every other kind of treatment.

"It might be an interesting experiment, but in general the pattern of
cocaine is that it's not amenable to any kind of maintenance program," said
Tyndall, a lead researcher in a project tracking 1,400 drug users in
Vancouver for the last six years.

Tyndall is a strong proponent of harm-reduction measures like supervised
injection sites and heroin maintenance programs, which have shown measured
success in Europe, and which have achieved some level of public acceptance.

Locally, the Centre for Excellence is working on a proposal for a
heroin-maintenance experiment that would be conducted in conjunction with
other North America cities, modelled on the Swiss trials.

But, Tyndall said, "I don't think the world's ready to set up the first
cocaine experiment in Vancouver."

Tyndall said health researchers are anxious to find solutions for cocaine
users because they are the most at-risk for infection. He has recently
completed a study showing that frequent cocaine injectors are the people
most likely to contract HIV, with the likelihood of getting infected rising
directly in proportion to the number of times they inject each day.

But he still expresses doubts about a maintenance program.

"I don't think there's any precedent for that kind of program and it's
difficult for me to envision how it would work."

However, Simon Fraser University psychology professor Bruce Alexander, who
has studied British experiments in prescribing oral doses of amphetamines
and Ritalin to people addicted to those substances, argues that there may
be a case for trying a cocaine maintenance program.

In a paper he wrote with Jonathan Tsou for the journal Addiction Research
and Theory, it was proposed that "it might be time to evaluate the
prospects that cocaine itself, administered orally, might prove the best
drug for stimulant maintenance in Vancouver."

The paper acknowledges that "cocaine maintenance would be unprecedented
outside of South America," where some doctors in Bolivia and Peru have
experimented with giving addicts coca leaf or coca tea treatments.

Alexander believes it is something Vancouver should look at because the
city is unique for its high number of cocaine addicts.

"We're really a stimulant city more than a heroin city, so it's logical to
look at stimulant maintenance."

Tyndall agreed that Vancouver is unlike any other city in the world in the
high number of cocaine users it has.

"It's hard to find somebody who doesn't use it [among the addict
population]," he said. In the long-term Vancouver Intravenous Drug User
Study in which he has participated, more than 90 per cent of the original
1,400 people enrolled in the study used cocaine, half of them smoking and
half injecting.

The number of people who use heroin alone is very low. Tyndall said that
many people who are poor are reluctant to start using heroin because they
know that heroin is the kind of drug where they have to get a fix every
day, which isn't always possible when they are periodically broke. Cocaine
is preferred because addicts can do a lot when they have money but then go
without when they're broke without getting sick the way heroin users do.

But he said that cocaine is also the kind of drug where users will just
keep using as long as there is a supply.

Researchers have had little success finding a substitute for cocaine the
way methadone is used as a substitute for heroin.