DOCTORING A CURE FOR EAST-SIDE DRUG CULTURE

Sensible. Thoughtful. Rational.

Descriptions like that may not bode well for Dr. Stan De Vlamming and his
proposals regarding Canada's war on drugs. Tacking on compliments from this
columnist may seal his fate, but I can't resist.

According to De Vlamming, the long-awaited shift from enforcement to
treatment need not include legalization of heroin or cocaine. Rather than
changing laws, the doctor insists we should change punishments. In place of
jail sentences, addicts should chose (sic) treatment options.

In harm reduction circles, rational thought has been drowned in emotion for
so long that sound advice stands out. While drug use itself rarely lands
addicts in court, the attendant life of crime does. Forcing them into
treatment just might work.

True, one must want to quit to have any chance of pulling it off. Yet
obligatory treatment would provide a critical break in the cycle --
otherwise, caught in the street's fix-to-fix frenzy, addicts spend very
little time lucid enough to ponder abstinence.

Most are addicted to heroin as well as cocaine. Stabilizing physical
withdrawal symptoms with methadone gives an addicted person a chance to
think more clearly about a world full of psychological snares.

Typically, that world is Vancouver's downtown east side. There, it's
difficult to walk more than a dozen metres without running into a mental
"trigger" for drug use. The sight of a paper flap changing hands, or a
crack pipe being stoked -- almost anything can crumble an addict's resolve.

Yet the treatment of choice, even for the dual-addicted, is a combination
of methadone and counselling, according to the good doctor. Although
methadone has no direct effect on the cocaine response, once established in
the program, disciplinary techniques can be used to wean addicts away from
coke.

Methadone does more than alleviate withdrawal. It blocks opiate receptor
sites in the brain -- which makes heroin overdose less likely -- and blocks
the ability to feel a heroin high, should one feel compelled to cheat.

While heroin requires constantly escalating dosage, methadone does not.
It's taken orally, which removes the threat of disease associated with
needle use. Methadone lasts 24 hours, heroin a mere four. Systematic visits
to a doctor prescribing methadone make binding a patient to a regimen of
HIV medications much more feasible.

Methadone is proved to decrease crime, normalize addicted lives and limit
the spread of HIV. I'm told the traditional complaint - - that methadone
builds up in bone marrow, which makes it more difficult to quit than heroin
- -- is simply urban legend.

It makes more sense to expand on something that already works than to
wander into the dark with legalized heroin. And I'd be remiss not to add
that legalized cocaine is ludicrous: Any level of use makes the subject a
psychotic liability to society.

De Vlamming does believe heroin may be useful in dealing with a small core
of patients who respond poorly to methadone. That means he won't have to do
without friends in the downtown east side, but I doubt he concedes the
point to ingratiate himself.

At any rate, I steer addicts toward De Vlamming's Gastown Medical Clinic
whenever they're open to making changes. The doctor does great work, but
budgetary restraints still force him to turn them away by the dozens. It
would be nice to see that change, regardless of where the rest of the
debate takes us.

Checked-by: Mike Gogulski