DRUGS FOR FREE?

Radical prescriptions to keep addicts healthy

No crack on-site. No drug dealing. No smoking of any kind. Medical
staff will provide clean syringes so you don't pass around AIDS. A
half-hour limit on your injecting, please. Staff will also provide
assistance if you O.D. While waiting your turn to spike or snort,
please help yourself to free coffee, snacks and used clothing, or take
a shower.

No, this is not Toronto. This was the scene in Zurich, Switzerland, at
the "shooting gallery" social worker Felix Munger worked at for 16
months in 1996-97. Such sites offer hard drug users a safe place to
use dope, medical supervision and referrals to detox, housing and
social services says Munger, who's currently employed at the Works,
Toronto's city-run needle exchange.

Safe injection sites have been proposed for Toronto -- along with more
radical measures such as heroin by prescription -- as politicians,
public health staff and AIDS activists re-evaluate the way Toronto
handles illicit drug use. Ironically, such proposals come just as the
Methadone Works, arguably Toronto's most progressive treatment
facility, is in danger of losing all funding.

Methadone Works, a subprogram of the Works, was launched in November,
1997, with a $91,000 grant from the city. Once that money ran out, the
program received a one-time grant of $40,000 from the Ontario Ministry
of Health. That funding will run out March 31 and neither the province
nor the city have expressed much interest in providing additional cash.

The cuts "have to be put in the context of budget pressure," explains
city councillor and board of health chair John Filion. "We want to
expand needle exchange across the city, we want to expand tuberculosis
programs, we want to expand dental programs."

Sitting in the Methadone Works offices, Anne Marie talks about the
parenting course she wants to take and how happy she's been in
treatment. The 38-year-old, originally from Nova Scotia, has been
taking crack cocaine "on and off" for eight years. She's also using
methadone, a opiate treatment drug, to wean herself from pain killers
prescribed after a cab smashed into her last year at Sherbourne and
Gerrard.

Asked what she'll do if MW closes shop, Anne Marie says she isn't
sure. But she does state, "I don't want to go to another program."

The Methadone Works offers a unique "low-threshold" approach to
treatment that blends a needle exchange with methadone therapy and a
decidedly open-minded approach to rehab.

"Success is a relative term for our clients," explains Works manager
Shaun Hopkins. "Success can mean not sharing needles any more, or
cutting back on drugs."

MW counsellor Jeff Ostofsky is a former roadie and heroin user who is
on methadone himself. "The motivation behind setting up a
low-threshold program is to take people where they are, without the
pie-in-the-sky, middle-class abstinence approach that wouldn't fly in
a million years," he says.

WHAT'S THE HARM?

A growing number of politicians, activists and health officials have
become converts to "harm reduction" -- an approach to drug use which
stresses treatment over incarceration.

Harm reduction was the model that inspired Canada's first "drug court"
which opened last December at Toronto's Old City Hall. As reported in
eye on Dec. 10, drug court aims to steer low-level coke and heroin
users away from jail and into rehab.

Buried in housing activist Anne Golden's report, Taking Responsibility
for Homelessness, which was issued this January, is a call for "a harm
reduction facility" -- a shooting gallery where street alcoholics and

addicts could use drugs on-site.

"What's the alternative?" asks George Panagapka. "Shooting up in an
alley, using dirty water and running if the cops come?"

Currently a student at George Brown College, Panagapka used coke,
heroin and speed for 25 years and was homeless as recently as 1997.
Polite yet outspoken, he now volunteers for the HIV-Harm Reduction
Network, an outfit which views safe-use rooms as a means of AIDS prevention.

According to a study by the Addiction Research Foundation (now part of
the Centre for Addiction and Mental Health), roughly 10 per cent of
Toronto's estimated 15,000 opiate addicts are HIV-positive (compared
to 25 per cent in Vancouver). Considering it costs roughly $100,000 to
treat one HIV-positive person, and that sharing dirty needles is an
excellent way to spread the disease, it makes sense to lure addicts
into the health system.

Some city councillors from wards with serious drug problems remain
reluctant to endorse shooting galleries.

"I don't have a problem with allowing alcoholics to have a drink in a
shelter," explains councillor Chris Korwin-Kuczynski, whose High Park
ward includes Parkdale. "Saying, 'You can come in here and sleep and
take drugs that the police would arrest you on the street for,' I
don't agree with that."

But downtown councillor Kyle Rae supports the idea, and would like to
see the city go even further. He says junkies should be allowed to
pick up heroin prescriptions like they do in parts of Europe.

"Throwing money at drug enforcement has not made a dint in the drug
fight," says Rae.

There's already one effort under way to make heroin available by
prescription. Dr. David Marsh, clinical director for addiction
medicine at the Centre for Addiction and Mental Health, is part of a
20-member North American Heroin Trial Working Group. The group has
been meeting since last year with the goal of setting up a smack
prescription system for major cities, including Toronto.

"Right now, we're drafting a study protocol to be ready at the end of
the academic year to submit to an ethics review to attract funding,"
he says.

To illustrate the benefits of prescribing heroin, Dr. Marsh points to
Switzerland, where, alongside injection rooms, doctors began offering
addicts legal heroin in the '90s. A 1997 University of Zurich report
found crime decreased by 60 per cent and employment doubled among some
1,146 junkies given legal smack.

Dr. Marsh says the regulatory barriers to a Canadian heroin trial
aren't that great -- it's already legal to prescribe heroin in hospitals.

The bigger problem will be finding widespread support for the idea. If
the Board of Health won't fund Methadone Works, why would the city
approve of injection rooms and smack scrips?