'THERE'S NO REHABILITATION SYSTEM AT ALL'

VANCOUVER -- After an 18-month cocaine and heroin binge, Karmalita Joe
was ready to get clean. She had tried and failed before at detox
centres around Vancouver, but the persistent urging of staff at InSite
- - the supervised-injection site where she says she went to shoot up
"repeatedly, daily, sadistically" - prevailed. On a Friday in early
July, she asked to be admitted to OnSite, the detox facility upstairs.

But the facility, which has been operating at capacity almost since it
opened a year ago, didn't have any spare beds. Come back Monday, she
was told.

In the intervening two days, she was on another trip.

"When you want to quit, you need to quit now," she said. "If you're
told you have to wait three or four days, that drive to quit ... it
just goes down, and addiction takes over."

Ms. Joe was lucky: She was back at OnSite the following Wednesday, got
a bed in its detox program and has graduated to its third-floor
stabilization room.

"I still, for the life of me, cannot believe I was able to stay
clean," she said.

But her predicament isn't unusual. The demand for detox and long-term
treatment beds far outstrips supply across Canada. Addicts who want to
kick their habit are often told to wait in line for treatment. Those
with the most entrenched addictions and the least support from family,
friends or the health-care system are the ones who can least afford to
wait a few days for a detox bed or several weeks for a space in a
long-term facility.

With the 2010 Winter Olympics approaching, the B.C. and Vancouver
governments are working feverishly to clean up the city's notorious
Downtown Eastside. This week, the judge of a new community court said
he hopes to sentence drug users to treatment to get them off the
street. But many of those users couldn't get into a detox bed if they
tried; there just isn't enough room.

B.C. has 176 detox beds and 326 longer-term stabilization beds, and
spends about 30 per cent more on treatment than it did eight years
ago. But an addict who wants to kick the habit has to wait four to
five days just to get into a detox bed in Vancouver, and several weeks
after detox to make it into a longer-term treatment program, according
to the Vancouver Coastal Health Authority.

Other provinces are in the same boat: In Ontario, people seeking
treatment in a Centre for Addiction and Mental Health facility could
get into detox in a day or two, but then wait as long as two weeks
after detox just to get an initial assessment appointment with a
counsellor, and as much as eight weeks after that before they can
enter a long-term treatment program.

It's been like this almost "forever," said Dennis James, clinical
director of addictions programming for Toronto-based CAMH. It's
difficult to tell just how large the gap is: Waiting lists aren't a
reliable indicator because many addicts just don't bother lining up,
Mr. James said. Almost all addicts who make it through detox have
tried to get into the system many times before.

Efforts are under way to remedy the shortage. B.C. is developing a
10-year plan to combat addiction, and the federal government is nearly
two years into a $121-million drug-treatment funding program. But
addiction doctors and researchers warn an injection of cash and even
an influx of new beds will do little unless they're part of a
comprehensive system that connects recovering addicts from one stage
of treatment to another, without letting them fall through the cracks
and back into the vicious cycle of substance abuse.

"There's no rehabilitation system at all," said Gabor Mate, a doctor
who works at OnSite. "There's a patchwork, which leaves a lot of
people without support."

Addiction treatment has been ignored for a long time, says Alan
Campbell, Vancouver Island Health Authority mental health and
addiction services director. In B.C., addiction was bounced around
from one government ministry to another for years, only falling under
the Health Ministry's umbrella in 2002.

Mr. Campbell says it's a challenge to convince people that addiction
is a disease. Although an influx of resources certainly helps, it will
take a long time for those increases to show results, he says.

Victoria is more than tripling its treatment beds by April, 2009, and
that will shorten the waiting list but won't eliminate the problem, he
says.

The federal government's drug treatment program, started in April,
plans to set up a $10-million abstinence-based treatment service that
will provide 20 addiction treatment beds for women dealing with mental
illness and addiction in Vancouver's Downtown Eastside. The beds are
set to open this fall.

Health Minister Tony Clement has criticized harm-reduction mechanisms
such as InSite, arguing they do nothing to get addicts off drugs but
instead help feed their habit. The federal government, in turn, has
come under criticism from doctors and researchers who support InSite
and say the government spends too much money on drug-law enforcement
and preventive advertising campaigns rather than treatment.

A Ticking Clock to Staying Clean

The noise of Hastings Street is muffled outside the brightly lit walls
of OnSite, where clients from the detox facility and third-floor
stabilization centre, clad in pyjamas and slippers, crowd around an
easel in the centre's common room.

OnSite, which opened last September and, like InSite, is run by the
Portland Hotel Society and Vancouver Coastal Health, has been full for
months. OnSite manager Liz Moss says she could fill four times the
beds she has now.

Portland Hotel Society executive director Liz Evans says OnSite's
clients come into the facility with a rapport already established with
staff from the supervised-injection site downstairs, so mistrust and
discomfort are less of a deterrent than they might be elsewhere. The
Portland Hotel Society now wants to create a long-term treatment
facility at a horse farm, using the animals to provide therapy for
recovering addicts.

Mr. Clement's spokeswoman, Laryssa Waler, wouldn't say whether the
government would support the proposal, but said Mr. Clement believes
in "treatment that leads to full recovery."

Ms. Moss says she prides herself on never discharging anyone from
detox onto the street. She makes sure they all head upstairs to
OnSite's stabilization facility, where they get another few weeks of
treatment.

If it's full upstairs, she may let them keep their bed on the detox
floor - which she admits sometimes gets her in trouble with staff
wanting to free up beds - or try to find them a space at another
recovery centre.

"It just gives those people a bit of extra support," she
said.

InSite supervisor Russell Maynard says the days following recovering
addicts' successful detoxification are critical to their recovery. "If
you have to wait, every single day, every six hours, the probability
of it not being successful is increasing," he said.

Because most detox facilities aren't directly connected to
stabilization centres, few recovering addicts have the luxury of a
smooth transition from one to the other. In Manitoba, detox and
treatment facilities are run by separate organizations, and the
province doesn't collect data on how long the wait is from one to another.

"You discharge them to the street, they're homeless - they go to a
shelter. What do they do? They shoot up," Ms. Moss said.

Although OnSite's location brings in people who otherwise would have
no contact with health care or treatment, Ms. Moss says, being smack
in the middle of the city's drug- and poverty-riddled Downtown
Eastside is a challenge. On welfare days, many OnSite clients who have
money in their pockets leave to buy the drugs they crave.

"It's a big thing if we can get people past welfare day," Ms. Moss
said, adding that she tries to get clients out of the Downtown
Eastside on those days. They often make day trips to the beach or the
Pacific National Exhibition. "It tends to get people's mind off of it.
. Sometimes we need to get people away from those triggers."

Susan King knows all too well what that feels like.

"I was a chronic addict; if I didn't have a crack pipe in my mouth, I
had a needle in my arm," she said.

Ms. King has been in and out of addiction treatment since 1994. She'll
celebrate 60 days clean on Monday after her second stint at OnSite.

She motions to a man lighting a crack pipe on Hastings Street just
outside the window of the cafe where she sits, coffee cup in hand.

"You have to get over the triggers. You have to be able to walk past
someone with a crack pipe in their mouth or a needle in their arm,"
she said. "It sparks something with you: 'What do you mean, I can't
get clean here?' You say, 'Of course I can.'"