A BETTER WAY?

It's late afternoon and stores around Victoria City Hall are starting to
close up for the night. The darkness turns the volume up on the drug-dealing.

In Centennial Square, clusters of teenagers suddenly converge, gathering
into a jostling, laughing crowd of 20 or so. Somebody lights a joint. Off
in the shadows, people huddle to conduct business.

Asked where the heroin is sold, the teenagers gesture to the other side of
City Hall, near the Douglas Hotel. One girl says the sellers in that area
can be heard calling out, "Up!" or "Down!" -- cocaine or heroin -- as
people walk by.

Not tonight, though, or at least not at this moment. The Douglas Hotel
security guard acknowledges that it's usually a busy corner, but says it's
been a little better lately since the policing got tougher. Not that it's
much of a win, he says; it just means that the dealing is happening on some
other corner now.

They're trying to clean this corner up and to a certain point, it's
working," says the guard. "But the people just go somewhere else. They
don't disappear."

A passerby who used to rent near Market Square says the dealing and drug
use downtown is so prevalent that she "wouldn't even let my kids come over"
to visit when she lived there.

"There would be people fixing up under my stairs," she says. "That's why
I'd be glad to see safe-injection sites. I'd be glad to point one out to my
kids and tell them that's where people who are addicted get help, instead
of stumbling across people under my stairs."

An estimated 1,500 to 2,000 habitual injection drug users live in the
capital region. They and their fellow users around the world buy enough
heroin, cocaine and other illicit drugs at street corners like this to
sustain an illicit drug trade estimated by the United Nations to be worth a
staggering $1 trillion a year.

That illicit injection drug use is tied to massive health and criminal
problems has been known for decades. In B.C., almost a quarter of all HIV
cases and two-thirds of the province's hepatitis-C infections are among
injection drug users. Prisons across the country are overflowing with drug
users; 60 to 70 per cent of inmates are addicts.

But it's the public face of drug use that is driving current demands for
change.

People are tired of finding discarded syringes in their parks and addicts
crouching under their stairs to inject. They're tired of losing whole
neighbourhoods to the social malaise that accompanies illicit drug use.
They know something has to give, and that it will probably have to be
Canada's laws around drug use.

The laws governing "hard" drugs like heroin and cocaine haven't changed in
almost a century. But attitudes have. A country that couldn't have imagined
10 years ago that it would ever tolerate drug use in its jails now
routinely makes bleach available to addicted prisoners to clean their
syringes. Needle exchanges operate in every major Canadian city.

Now, the federal government is on the brink of amending the law to allow
for safe-injection sites. Common in Europe since the mid-1980s, such sites
offer a clinical, hygienic setting for addicts to bring their drugs for
injection.

Outrageous, proclaimed the Canadian Police Association when the Senate
recommended such sites in a report this fall. The association declared them
"a back-to-school gift for drug pushers."

Most Canadians would once have vehemently agreed. But with jails and
hospitals bulging with addicts and neighbourhoods inundated with
trafficking and prostitution, they're no longer sure. Vancouver's new
mayor, Larry Campbell, won last month's civic election on a platform of
treating addiction as a health issue in the city's desperate Downtown Eastside.

"The election in Vancouver was clearly a recognition by people that you
can't bottle up this topic and pretend it's not there," says Roy Crowe,
executive director of the B.C. Association of Substance Abuse Programs.
"How can you keep supporting misguided policy when it so obviously doesn't
work?"

The drug trade has not yet consumed whole neighbourhoods on the Island as
it has in Vancouver. But it could. Quiet Fernwood suddenly has a
prostitution stroll near one of its parks, and discarded syringes are
turning up in people's yards. Complaints about trafficking and drug use are
on the increase downtown.

Victoria Police Chief Paul Battershill stresses that he would not support a
safe-injection site in Victoria unless it was introduced as a package with
other addiction services. And finding neighbours willing to have a site on
their street will also be a major challenge. But done right, Battershill
says, harm-reduction strategies really do make a difference.

"If people are thinking there isn't a drug problem here, they're wrong," he
says. "And if they think addicts don't deserve compassion, they're wrong
about that, too."

Addiction crosses all race, age and gender boundaries. Wealth is no
protection, nor is being from a "nice" home with supportive parents, as is
made heartbreakingly clear in the B.C. documentary From Grief to Action.

But while experimentation is common in Canada -- a quarter of the
population will use illicit drugs at some time in their lives -- the number
who end up addicted is mercifully small, less than half of one per cent of
the population. Drug use alone isn't enough to explain why people get hooked.

What are the risk factors? Being an adolescent is a major one. More than a
third of the 450 former heroin addicts being treated at Victoria's
methadone clinic in Fernwood started using heroin before they were 17.
Statistics from Canada and around the world show that all forms of illicit
drug use peak when people are teenagers, a worrying statistic in a time
when heroin is cheap and readily available on street corners.

Troubled youngsters are even more at risk. A U.S. study found that
adolescents were four times more likely to have used illicit drugs in the
previous month if they had serious emotional problems, and seven times more
likely if they had a history of behavioural problems. Those groups were
also nine times more likely to end up addicted.

Child abuse and emotional trauma are overrepresented among addicts. So are
mental illness and learning disorders.

"The addicts tell you they started at age 12," former B.C. chief coroner
Vince Cain said eight years ago when he wrote a provincial report on the
issue. "But it didn't. It started before they were born."

Addicted teenagers grow into troubled adults. They are more likely to be
unemployed, homeless, poorly educated and sick. They are more likely to
die: Overdose is the leading cause of death in B.C. for people ages 30 to 49.

Cocaine and heroin produce intense feeling of pleasure in users, and can
quickly become a form of self-medication for people struggling with pain
and trauma. They go looking for a "high" and find it in their body's own
brain chemicals, tricked by the drugs into releasing copious amounts of
endorphins.

But for those who become addicted, drug use quickly becomes less about
pleasure-seeking and more about escaping "dope sickness."

"It's like the worst kind of flu you could ever imagine," says local
methadone clinic director Brian Oswald. "Touch the ends of your hair and it
hurts. If you were feeling like that and knew that for $20 you could feel
better, what would you do?"

Getting straight isn't easy.

"The cure rate isn't too encouraging," acknowledges Crowe, whose
organization represents B.C. treatment programs offering everything from
abstinence to methadone maintenance.

"It's certainly less than 50 per cent for those trying drug rehabilitation
for the first time, and I think it's probably a lot lower than that. But
people who keep trying a number of times can get that rate up to 90 per
cent. Perseverance pays off."

In Canada, one of the earliest forms of harm reduction was the methadone
program, introduced in the early 1970s. Registered addicts replace heroin
with maintenance-level doses of methadone, a synthetic opiate consumed in
orange juice. Some stay on the drug indefinitely with no ill effects and
can work, drive and get on with a regular life.

Needle exchanges were the next wave in the 1980s, introduced to reduce the
risk of HIV and hepatitis-C through shared needles. AIDS Vancouver Island
now distributes 30,000 clean needles a month at its exchanges in Victoria
and Duncan.

The latest debate centres on safe-injection sites. There are 42 such sites
operating in countries including Australia, Switzerland and Germany. Health
officials will be converging in Ottawa later this month to discuss draft
guidelines to test such sites in Vancouver, Toronto and Montreal.

Safe-injection sites offer addicts clean conditions and someone to watch
over them, important in a province where a lethal overdose occurs almost
every day. There has never been an overdose death at any government-run
injection site, says UVic researcher Thomas Kerr, who visited 19 sites as
part of an international study he co-wrote. The sites also combat rampant
bacterial infections caused by users injecting in haste in unsanitary
conditions.

They're typically walk-in storefronts in neighbourhoods where addicts tend
to congregate -- the Downtown Eastside in Vancouver, for instance. In
Victoria, a likely location might be the needle-exchange site at the corner
of Blanshard and Cormorant streets, says AIDS Vancouver Island executive
director Miki Hansen.

Large cities often need more than one site to avoid a high concentration of
addicts in a single neighbourhood, says Kerr. Laws against trafficking
continue to be enforced outside of the clinics, but users are left alone.

The theory -- and by and large, the reality at long-standing facilities in
Europe -- is that safe-injection sites dramatically improve the health of
users, boost treatment rates, and clean up the street scene.

What a Canadian site will look like depends on which proposals are
eventually approved for exemption from drug laws by the federal government.
Provincial medical health officer Dr. Perry Kendall says facilities in
Europe range from a tiny one-room site to a converted warehouse with a
resident doctor.

The ideal sites have a needle exchange, a comfortable waiting room for
staff to make contact with users needing health care or treatment
referrals, and cubicles for nurse-supervised injecting.

Countries such as Switzerland are doing pilot projects with providing
heroin as well, but it's anticipated that Canadian sites will require
addicts to bring their own drugs.

Health officials view such sites as a rare opportunity to connect with a
notoriously elusive and shamed segment of the population, many of whom go
on to treatment. Almost 300 addicts sought referrals into treatment in the
first six months of operation last year of an Australian safe-injection site.

Communities have come on side after seeing the sites eliminate the open
drug scene. In many European cities, parks and downtown corners taken over
by drug-dealing and injection were restored to public use. Swiss citizens
were so impressed with a dramatic drop in petty crime after the startup of
the country's prescription-heroin pilot that they recently voted 70 per
cent in favour of extending it.

"I've seen no downside," says Kerr, a PhD candidate at UVic. "These sites
defy logic in a way, I know. But wherever they exist, the size of the open
drug scene decreases, and a huge number of referrals into treatment start
happening."

Logic would also seem to dictate that countries with more liberal attitudes
toward drugs would have higher use rates.

But statistics show a remarkable similarity in the incidence of heroin and
cocaine use in western countries. Regardless of a country's drug policies
- -- from the liberalized environs of Portugal, where use and minor
possession of any drug was decriminalized last year, to the zero-tolerance
U.S. -- around one per cent of the population will use heroin at some point
in their lives and about four per cent will try cocaine or amphetamines.

With the exception of a bulge in cocaine use in the mid-1980s, rates have
remained largely unchanged in North America for more than a decade. Overall
rates for illicit drug use have risen, however, primarily driven by an
increase in marijuana consumption. That rate in Canada is now 25 per cent.
In the U.S., with some of the toughest drug laws in the world, it's 39 per
cent.

'Drugs are illegal because drugs are harmful," the Canadian Police
Association said in its report last year to the Senate Special Committee on
Illegal Drugs.

"Canada must resist the seductive temptations being advanced by a
sophisticated drug lobby. While far from perfect, current strategies have
been effective in controlling the scope of illicit drug use in Canada."

However, the U.S. experience highlights the risks of zero tolerance. More
than three quarters of the country's HIV infections are drug-related.
Compare that to drug-tolerant Denmark, where the rate is four per cent. And
while the U.S. has fought its "war on drugs" for well over a decade, the
rate of illicit drug use is higher than ever.

"It's never been about the availability of drugs," says Hansen. "Addiction
is about how people feel about themselves."

Chief Battershill doesn't share the views of the national police
association. But neither is he ready to embrace safe-injection sites in
isolation.

"Simply opening a place where people can inject drugs won't accomplish
anything," he says. "We need a place where addicts can access health care,
detox, be referred into treatment. And I'd want absolute no-bullshit
measures of outcomes."

Whether a site is even the most pressing priority for the city just yet is
uncertain, says methadone clinic director Brian Oswald, who thinks the
bounds of methadone therapy have barely been tested. Methadone is a heroin
substitute, but more than half of Oswald's clients say it helped to curb
their desire for cocaine as well simply by reducing their overall
"dope-sickness."

Dr. Stanley de Vlaming, an addictions consultant at St. Paul's Hospital in
Vancouver, cautioned in a recent Vancouver Sun opinion piece that
safe-injection sites are just part of the puzzle, not the panacea. He'd
like to see more methadone and drug-free housing for recovering users, and
warns of the fine line between harm reduction and enabling.

Crowe would legalize all drugs for prescription use and maintain addicts on
heroin and cocaine if it was up to him. But a successful treatment
continuum offers something for everyone, he adds.

"I think abstinence has to be there as an alternative for some people," he
says. "And probably, they should try that first."

Victoria Mayor Alan Lowe isn't sure whether the city needs a site at this
point. Drug use is a hot topic given the current situation in Fernwood, he
says, but the solution isn't as easy as opening "a shooting gallery."

"We're not going to jump into this without having everything in place
first," says Lowe. "We'll just create more addicts if it isn't all in place."

Should a safe-injection site win public support in Victoria, the most
immediate problem will be where to locate it.

The sites have to be located close to where addicts live. Studies have
shown that most users won't walk more than a kilometre to use a site when
they're in the grips of dope-sickness.

That's an easy sell in Vancouver, where the drug scene is so pervasive in
the Downtown Eastside that most of the neighbours who might have complained
are long gone. But in Victoria, the largest group of addicts is currently
concentrated in Fernwood. Residents are already upset with the amount of
services for drug users there, and are not likely to warm to the idea of
hosting a safe-injection site as well.

Not many neighbourhoods will, acknowledges Battershill. "Location will be a
real problem."

Details can wait, says Hansen, but the time to start talking is now. Crowe
agrees: "Government has underestimated the importance of this topic and the
amount of misery that's brought about by leaving these problems to develop
and spread without intervention."

The truth of that is Vancouver's Downtown Eastside. Traffickers don't even
bother to hide their activities in the neighbourhood where some 10,000
addicts shop for drugs.

"It's such a cancer in the city to have an area filled with people doing
drugs," says Crowe. "Nobody's going to promise that we'll cure the problem
by doing things differently, but at least we could get it to where the
drugs weren't out there where every kid in the city can buy them."

Will there come a day when no one uses drugs? Not likely, says Kerr, the
UVic researcher. Substance abuse is as ubiquitous as human misery.

"It's a common social indicator of hard times," Kerr says. "That's why
you're seeing such an epidemic of drug use and HIV in the former Soviet
states. All that any of us can do is prevent what we can and treat the rest."

Oswald understands people's reluctance to provide addicts with a safe place
to use drugs.

But he says the alternative is disease, suffering, and an open drug trade.

"We need to keep people healthy even if they're still using," Oswald says.
"Because one of these days, they're going to stop. They're going to stop or
they're going to die."

Dope On Drugs

Heroin

What it is: A narcotic processed from morphine, which occurs naturally in
the seed pod of certain kinds of poppies.

How it's used: Sniffed, smoked or injected.

How it works: Instantly converts in the brain to morphine (named in 1811
for the Greek god of dreams, Morpheus) and binds to opiate receptors. That
tricks the body into releasing a flood of its own "pleasure" chemicals in
response, leaving users feeling euphoric and drowsy for several hours.

History in North America: Morphine was a popular choice for physicians
treating the wounded during the American Civil War, but the powerful
pain-killer left thousands addicted by war's end. The Germans invented a
version of morphine that they believed offered the same pain relief without
the addiction: Heroin.

Risks: Cardiac and respiratory function slow dramatically, sometimes to the
point of death. Addictive. High risk of bacterial infection if injecting in
less-than-sterile conditions. Shared needles spread HIV and hepatitis-C.

Cocaine

What it is: Chemical synthesis of the leaves of the coca plant.

How it's used: Sniffed, smoked or injected.

How it works: Triggers the release of the brain chemical dopamine while
blocking the body's ability to recycle it back into reserves. The
subsequent buildup of dopamine leads to an intense, short-lived "high"
marked by feelings of grandiosity and a sense of power.

History in North America: Cocaine was widely touted as a sexual tonic,
anti-depressant and soft-drink ingredient throughout the 1800s. Governments
began restricting its use around the turn of the century after seeing a
rise in the number of "dope fiends."

Risks: Highly addictive (lab rats addicted to cocaine will eventually
choose the drug over food or water). Tolerance develops quickly, leading
addicts to use as often as 25 to 50 times a day. Can cause cardiac arrest,
stroke, seizure and psychosis.

Methamphetamine

What it is: A pharmaceutical relative of amphetamine, but with a greater
impact on the central nervous system. Key ingredient is ephedrine, a common
nasal decongestant.

How it's used: Sniffed, injected or taken as a pill. Can be smoked in its
crystallized form, known as "ice" or "crystal meth."

How it works: Meth tricks the body into releasing all of its energy stores
at once, revving up the metabolism and leaving users feeling like "superman."

History in North America: First marketed in the 1930s as an ingredient in
Benzedrine, an over-the-counter decongestant. Other forms of amphetamines
became popular in the 1960s as a means of weight loss and staying awake.

Risks: A profound "crash" even after first-time use, causing such severe
depression that regular users binge on the drug for three to 15 days just
to avoid it. Long-term health problems due to chemical imbalance and sleep
deprivation. Tolerance develops quickly. Delayed withdrawal symptoms of as
long as three months after last use, leaving users unaware that they've
become addicted.