NAOMI'S END WILL JUNK LIVES

Dianne Tobin has been a heroin addict for 30 years and on Sunday she
got to tell her story at the 17th annual International Conference on
the Reduction of Drug Related Harm.

What captured the audience's attention was not so much the misery the
54-year-old Tobin faced as a petty thief and prostitute. It was about
her past four months on heroin maintenance. It has turned her life around.

If that was the end of the story, it would be heartwarming. But there
is a complication that could drive Tobin and 100 more like her back
on to the street.

Tobin is part of the NAOMI project, the North American Opiate
Medication Initiative. It is being carried out in Vancouver and
Montreal. The first recruits signed on just over a year ago. At its
centre is an ethical dilemma being much debated but unlikely to be
resolved in time to help the likes of Tobin.

A couple of times a day for the past four months, Tobin has checked
into a clinic set up for the project and injected herself with pure
heroin. The heroin was produced in a government-supervised lab.
Before it could be distributed, the people doing the study needed
permission from Health Canada.

The NAOMI project is the poster child of this international
conference. The lead scientist running the project is the highly
respected Dr. Martin Schechter. In his keynote address to the
conference on Sunday night he pointed out, while NAOMI is radical in
this part of the world, heroin maintenance trials have been going on
elsewhere for some time. The Swiss began their program in 1996. There
have also been similar studies in Germany and the Netherlands.

To qualify for the program, participants had to have a proven record
of two failures in methadone treatment, the standard drug treatment
substitute for heroin. Of those selected, 45 per cent get methadone,
45 per cent get heroin and 10 per cent shoot up an opiate called Dilaudid.

Now here's the catch and the ethical dilemma. No matter how well they
do on heroin, after 12 months the injections are reduced. After 15
months it is zero. In fact the first people who signed on are in
their final few weeks before they get cut off, which makes the
ethical debate even more pointed.

NAOMI spokeswoman Julie Schneiderman says to continue beyond the 15
months would be illegal.

But if the drug being tested was for breast cancer, for example, and
it was proving effective, under standard ethical medical protocols
all people involved in the study would be given the new drug. The
scientists would work at getting it approved for general use.

The three similar studies in Europe have shown that heroin
maintenance is effective and beneficial; the subjects' social,
economic and physical health improved and drug-related crime
declined. The Netherlands study concluded that when addicts were cut
off there was rapid deterioration in the lives of 82 per cent of
participants. Nonetheless, NAOMI participants will likely be offered
methadone, a treatment that had to fail them in order for them to
qualify for NAOMI.

NAOMI comes under attack for those reasons in a paper co-authored by
UBC research associate Dan Small. It's about to be published in the
international Harm Reduction Journal. Small works at the Portland
Hotel. Some of his clients are in NAOMI. He expects the worst.

Medical ethicist Dr. Tim Christie, with the B.C. Centre for
Excellence in HIV-AIDS, agrees with Small. He says if NAOMI adhered
to the usual ethics of research, the subjects would continue to get heroin.

And that's the point. This is about heroin and junkies, not our
sisters or mothers and breast cancer. Christie says NAOMI "is a study
to prove the obvious without a doubt."

It is about politics, not science or ethics for that matter.