CONFERENCE SEEKS WAYS TO REDUCE HEROIN DEATHS

SEATTLE, Jan. 15 -- Larry W. Campbell, chief coroner of British Columbia,
where deaths from drug overdoses have risen tenfold in the last decade, to
407 last year, said he came to Seattle this week for one reason.

"There are ways to prevent these people from dying," Dr. Campbell said,
"and I'd like to learn more about them."

Dr. Campbell was attending an unusual conference here, "Preventing Heroin
Overdose: Pragmatic Approaches," which was billed by its sponsors as the
first international gathering of experts to center on the question of how
deaths among heroin users can be stopped.

The 400 people who attended gathered in a city that has a heroin problem of
its own: Seattle recorded a record number of heroin-related deaths, 144, in
1998 and has one of the highest per-capita rates of such deaths in the
United States.

The conference included scholars, researchers, doctors and other health
care providers, drug-treatment providers and a handful of police officials
who discussed strategies for dealing with heroin use.

Some strategies, including needle-exchange programs and informal pledges by
the authorities not to prosecute drug users who call 911 or who are taken
to emergency rooms by friends after an overdose, are already being employed
in some American cities. Other approaches are being gingerly experimented
with, including distribution to addicts of naloxone, a prescription drug
that can counteract the effects of an overdose.

But other strategies that health experts came from Europe to discuss seem
politically unimaginable here, including so-called "safe injection rooms."
In such places, drug users are allowed to shoot heroin under the
supervision of a trained staff, which can ensure that needles are sterile
or arrange for immediate medical treatment in the event of an overdose.

The conference here was co-sponsored by the University of Washington's
Alcohol and Drug Abuse Institute and by the Lindesmith Center, a New York
drug policy center that is financed by the billionaire George Soros and
advocates alternatives that are more liberal than the nation's drug policy.
The Seattle police and health departments were also listed as co-sponsors.

The meeting had extensive, and at times impassioned presentations that
generally favored an approach to drug abuse known in treatment circles as
"harm reduction." That approach is less focused on telling drug abusers
about the dangers of drugs than on getting them to use drugs more safely.

Advocates of the approach say that many drug abusers have heard the "just
say no" message countless times -- "They hear it every day of their lives,"
said Heather Meschery, director of a needle-exchange program in Santa Cruz,
Calif. -- but are determined to use drugs anyway. The effort, these
advocates say, should be on minimizing the harm they can do to themselves.

Urban Weber, director of an agency that runs two of the four safe-injection
rooms in Frankfurt, said that the approach had helped reduce overdose
deaths there from 147 in 1992, shortly before the injection program began,
to 26 in 1999.

"This is simply about keeping people alive," Dr. Weber said. "We say it's
safer to do it here than on the streets." And, like many of the advocates
here, he rejected the notion that such places encourage drug use,
especially among the uninitiated.

"It is by no means an attractive place to see," Dr. Weber said. "It is not
like going to a cafe and having a beer."

Several officials from American cities at the conference said the point was
not to adopt all such approaches now in use around the world, but to get
experts together to hear what was being tried.

"There is no one size fits all model to this problem," said Alonzo Plough,
the director of public health for Seattle and surrounding King County,
which operates one of the first and largest needle-exchange programs for
drug users, and is formulating plans for a broader initiative to combat
heroin-related deaths and H.I.V.

"It's very good to see the range of things that have worked in other
places," Dr. Plough said. "It's clear that not all those approaches will
work in any one place."

Ethan A. Nadelmann, director of the Lindesmith Center, whose critics say it
undermines drug control efforts, was less restrained in endorsing the ideas
presented here.

"We could cut heroin overdoses in half if the information from this
conference was widely disseminated," Mr. Nadelmann
said.