ABOVE ALL, DO NO HARM

There was a point in Frank's life, after numerous rides on the
merry-goround of painful sports injuries, powerful pain killers and
gruelling withdrawal, that he was ready to surrender to his addiction.

Then four years ago he walked into the Toronto Public Health needle
exchange office known as "The Works" and made the connections that
helped him turn a new leaf. He tapered off OxyContin once and for all,
started working as a health outreach worker, and now carries the
latest "tool" in the city's drug strategy arsenal with him where ever he goes.

For about two months, public health has been handing out special kits
in eyeglass-like cases that contain two doses of naloxone, a drug that
can stop an opiate or opioid (one is natural, one is synthetic)
overdose because it knocks it off the brain receptors. So far, about
75 kits are in the hands of current or former drug users who have been
trained on how to identify an overdose from substances such as heroin,
OxyContin and morphine, and how to react.

"How would you feel if it was your brother, or your mother, or your
child, who had made a couple of wrong decisions in their life or had
taken more medication than they thought they needed to take and then
all of a sudden they collapsed on the street in respiratory arrest?"
asked Frank, a lanky healthcare worker, while seated in a modest
meeting room at The Works this week. "You got to keep the patient
alive before you can treat the disorder."

While proponents hail it as a life saver, critics group it in with
other harm reduction strategies they contend feed, rather than quash,
the addiction. Harm reduction is indeed a cornerstone of efforts to
deal with drug use in Toronto; public health has been handing out
clean needles to heroin users and pipes to crack addicts for years at
its glass-encased Works office at Victoria Street, north of Dundas,
and through 36 other agencies.

"We recognize some people are going to continue using drugs despite
all the prevention efforts, so we are providing them with the tools to
prevent disease transmission," said Shaun Hopkins, who runs the needle
exchange program at Toronto Public Health.

She says the naloxone kit has been well received, but another raucous
harm reduction debate may be just around the corner. Toronto
researchers will release a study next year that may suggest the city
consider opening a place where addicts can shoot heroin or smoke crack
under the supervision of trained staff, similar to Vancouver's
controversial Insite, in the Downtown Eastside neighbourhood.

Mayor Rob Ford has said publicly he does not support such approaches.
And others agree.

"We're in favour of helping [drug users], not killing them, to be
frank with you," said Gwen Landolt, president of the Drug Prevention
Network of Canada and vice-president of REAL Women, both groups that
advocate for an abstinence-based drug policy. DPNC wants more money to
be spent on treatment programs, not programs Ms. Landolt believes
exacerbate the dependence.

"It doesn't seem to solve any of the problems. If you're a
professional, an airline pi-lot, you'll get treatment. If you're a
poor drug addict shuffling along the street, they just push you in the
injection site to get more of the same," said Ms. Landolt, a lawyer
who is Toronto-based. She believes that drug courts, of which Toronto
has one, are the best way to deal with addicts. The addict is charged
and presented with an option: treatment or incarceration. "It does
open a window of opportunity," she said.

In 2008, while attending the XVII International AIDS Conference, then
health minister Tony Clement called Insite an "abomination," adding
that "allowing and or encouraging people to inject heroin into their
veins is not harm reduction ... we believe it is a form of harm
addition." The Supreme Court of Canada recently ruled that Insite
should remain open.

Holly Kramer, co-ordinator of the Toronto Harm Reduction Task Force,
sees a supervised injection site as another way of doing the same
thing that a needle exchange program offers. Just like crack pipe kits
are a way for health workers to reach marginalized folks, a centre
like Insite acts "like a carrot," hooking people up with services they
would not have otherwise sought, she argues.

But she recognizes the concept remains controversial, and is likely to
spur opposition from residents if it is ever proposed in Toronto. A
proposal to set up a methadone clinic in Cabbagetown was recently
scrapped after neighbours reportedly raised strong objections to a
project they feared could increase crime and decrease property values.

As for the anti-overdose kits, Edmonton has been offering them since
2005 and several cities in the United States also offer them, such as
New York, Boston and San Francisco.

In Toronto, the naloxone kits have stopped overdoses in four instances
so far, say officials.

Out in his west-end neighbourhood of Parkdale, Frank, who is limping
these days from an old cycling injury, is ready to plunge a syringe
with the antidote into a muscle if the situation calls for it. He
reasons that the health-care system saves money by helping a drug user
before the person makes it to the emergency room. Each naloxone kit
costs about $21. "I hope I never have to use it, but I'm quite
prepared to," he said. "Harm reduction is all about keeping people
alive, keeping them healthy, and then at some point hopefully they
will see that this is not working for them, that this is not a good
lifestyle choice."