CODEINE POSSIBLE LIFELINE FOR HEROIN ADDICTS

For John, getting off heroin the first time was heavy lifting. But the
cure hurt worse than the disease. John started shooting up in his
teens, running with a lowlife crowd on the West Coast and stealing
eight-track players to feed the habit (it was the 1970s, after all).

"Maybe it was peer pressure," he says now. "Being on heroin is like
being in a car in neutral. Apart from the drug and the jails, nothing
ever happens to you."

More than 10 years ago, hoping to quit the spike for good, he joined a
government-funded methadone program.

Methadone is a narcotic pain reliever used to take the edge off heroin
withdrawal.

Some addicts who go through the treatment manage to quit both heroin
and methadone for good.

Most, like John, fall short.

"It was horrible," he says. "Devastating. Going from heroin to
methadone was nothing. Going off methadone was painful. Shakes,
aching in all my joints.

"It took me four or five years to get off methadone. I started back on
heroin six years ago."

Now John's ready to try again. But not with methadone.

This time, he's hoping a novel drug-replacement program running in
Edmonton can help him get clean for good.

Dr. Peter Akai is an internal medicine specialist practising at the
non-profit Boyle-McCauley clinic.

In 1997, he started prescribing codeine in an effort to treat the
large number of street addicts piling up at his door.

"About 60% of our patients are drug addicts. Maybe half of those are
on opiates, heroin included," he says.

Akai's method operates on the same principle as a methadone program:
substitute one drug for another.

Unlike most methadone programs, however, Akai's program aims at
weaning the user off the drug for good.

"Methadone is a maintenance program," he says. "The idea is to switch
the user from a dangerous street drug to a safer (licensed) drug."

Akai prescribes codeine tablets in very short prescriptions and very
high doses.

Codeine has an opiate effect like heroin. An addict might consume a
quarter-gram a day of heroin, equal to 6,000 milligrams of codeine or
about 200 pills.

"Obviously I'm not going to start them with 200 pills," he says. "An
addict here might start with 30 pills daily, which would be enough to
kill you or me.

"In 10 days I'll drop that patient down to 27 pills, then to 24 in
another 10 days. In a few months he'll be down to zero."

Akai takes precautions. The prescription durations are short, to keep
the pills from being re-sold on the street - a common problem with any
drug-replacement program.

The codeine program is even being used to treat people with codeine
addictions.

Sam, one of Akai's patients, got hooked on prescription T-4s
(codeine-laced painkillers) after a hospital operation on her uterus
seven years ago.

"I didn't even know they were addictive," she says. "I kicked cold
turkey on a trip to Vegas a year ago, but it made me really sick. I
couldn't do that again.

"The codeine program lets me down slow. I can feel myself getting
better. My head's getting clearer, I can think straight. I can plan.

"Next step is to get right down to zero drugs and get back to work,
maybe go to the States."

What's missing from Akai's program so far is hard evidence that it
works.

He doesn't do the urine-testing mandatory in methadone programs, so he
depends on voluntary reporting from his clients to determine who's
clean and who isn't.

"About 100 people have gone through the program so far," he
says.

"Thirty-two have left as of December.

"Of the 32, 14 say they're completely off drugs. Six switched to
methadone, and 12 dropped out completely."

Since codeine-detox is still a fairly rare form of treatment, there
are no studies comparing its results to methadone programs.

Recently, Akai received a $20,000 provincial grant to study the costs
and benefits of the program over the next year and a half.

"We may end up doing drug tests to verify the results," he
says.

"If we can prove it works, I'd like to see it implemented across the
province."

That's Akai's long term.

John's long term involves hard years of white-knuckle abstinence. He
knows it won't be easy, no matter what pills he takes.

"But I'm motivated," he says.

"Once you know what the bottom of the bottom looks like, you get
motivated."