SUCH A LONG JOURNEY

In an ongoing series, Star reporters Jessica Leeder and Kevin Donovan
have been examining some of the problems with methadone distribution
in Ontario. They've uncovered that doctors at a large chain of
addiction treatment centres run an unlicensed laboratory and have
questionable OHIP billing practices that Ontario Provincial Police
have been investigating.

But there's also little question that methadone can help put someone
addicted to heroin or other opiates on the path to stability. Scott
Simmie takes a look at one young woman who says methadone, and a
supportive social worker, saved her life.

Like many teens, "May" thought she'd experiment with drugs.

Unlike many teens, she went from popping the odd ecstasy tablet to
trying something else. At the age of 15, and with the encouragement
of her then-boyfriend, she smoked something that would change her
young life. She took heroin.

And then the heroin -- followed by crack, an abusive relationship and
a brief foray into the escort business -- nearly took her.

"I never thought I'd make it back alive," she says.

And she might not have, without something known as harm reduction.
It's one of the four components -- along with prevention, treatment
and enforcement -- that Toronto has adopted as its official drug
strategy. At its most basic level, harm reduction is a non-judgmental
approach geared toward reducing the harm associated with substance
use: Needle exchange programs decrease the spread of blood-borne
diseases; "wet" hostels that permit the controlled consumption of
alcohol can reduce the harm inflicted on (and by) chronic drinkers
who might otherwise chug mouthwash on the street.

Though some initiatives -- such as distributing safer crack pipes --
are very controversial, harm reduction programs share an underlying
philosophy: They do not -- indeed, acknowledge they cannot -- rigidly
impose abstinence. Harm reduction accepts people where they are,
helping to guide them along the road to recovery. And it was that
approach, says May, that ultimately saved her.

"They were really supportive. They would still talk to me even when I
was messed up," she says. "They were always giving me options."

May is 20 now, with a healthy glow and soft smile that hints at
justifiable pride in her accomplishments. After a very long journey,
she is clean. She credits the methadone program, and a very
supportive social worker, at the addiction medicine service of the
Centre for Addiction and Mental Health.

"I couldn't have done it on my own," she says.

May is one of some 300 clients who receive daily doses of the drug
through the centre's opiate clinic near College St. and Spadina Ave.
Under a pharmacist's watchful eye, a computer-controlled pump
dispenses the precise dose of methadone for each person. (The
methadone itself -- which can be injected in pure form -- is kept in
a locked, Plexiglas box well behind the dispensing window.)

The drug is then mixed with Tang, which clients making daily trips
drink on the spot. People who've been doing well in the program and
providing clean urine samples have "carry" privileges, meaning they
can take home nearly a week's supply at a time -- providing they keep
it safely stored and out of the reach of children. (In 1998, a
6-year-old Ontario boy died after drinking a dose improperly stored
in his father's fridge.)

Though not a "cure," it does allow those addicted to stabilize their
chaotic lives. Instead of constantly seeking drugs and engaging in
high-risk behaviour, a daily dose of methadone (though itself
addictive and potentially deadly -- especially for people who are not
opiate dependent) places users on a vastly more even keel.

And who are the typical users? Some of those walking through the
opiate clinic doors wear dress pants and shiny shoes and are en route
to the office; others do not and are not.

"There is no 'typical,'" explains Dennis James, deputy clinical
director of the addictions program at the Centre for Addiction and
Mental Health. "(Clients) range from people who are homeless, who are
really struggling in terms of basic necessities, to people who come
in wearing suits and ties and who are working in fairly high-powered
positions."

But clients do share a common sentiment. Most believe that without
the synthetic opiate they would probably be dead by now.

"I don't think I would be alive," says Michael, a well-dressed
45-year-old who had been addicted to prescription opiates or alcohol
more than half his life. "I think I would have died or perhaps been a suicide."

It seems everyone has a story about what led him or her to heroin or
prescription opiates -- and back off again. May's is particularly striking.

The daughter of Asian refugees, she talks with affection of a stable
upbringing and hardworking parents. You can tell she idolizes her
father, and that she's close to her extended family.

But even that love and stability could not prevent May from being
sexually abused by teenaged boys outside the family when she was only
7. The trauma haunted her. And, without knowing why, she later found
herself drawn to experimenting with drugs. (In fact, a high
proportion of women with substance dependence have experienced
childhood sexual abuse.)

"In a way, I had my own demons; I was molested as a child ... I was
just seeing whatever drug would work best for me to help me cope,"
she says. May was only 15 when she began making what she now calls
"bad choices."

It started with ecstasy. But then her boyfriend, who smoked heroin,
suggested she might like to try some. She did. And it made quite an impact.

"It was like: Wow. I've found something that will help me deal with
everything."

Soon she was smoking daily. In fact, after several months May found
she had to smoke daily to avoid debilitating withdrawal symptoms.
Once, those symptoms were so bad she confided to her father about her
drug use. After approaching some agencies she says were unhelpful
because of her age, May discovered this program at 17 and started on
daily doses of methadone. Her boyfriend joined, too. (They're no
longer together, but he remains clean to this day.)

In theory, May's story should end there. Sadly, it does not. Though
off heroin for about a year and still taking methadone, May had other
issues to deal with. Uncomfortable in her own skin, seeking approval
and a little excitement, she made another bad choice.

"When I turned 18, I decided to start (exotic) dancing. At first it
was so much fun. I didn't use any drugs and I only drank sometimes.
Then I got involved with the wrong people. I started dating this guy
who used crack cocaine," she says.

What began as very occasional use soon became habitual. Part of it
was the crack itself -- a drug more addictive than heroin that can
cut through methadone and still produce a high. The other factor was
that the relationship was an abusive one. May's self-esteem was
further eroding and the drug use provided a respite of sorts. A dark escape.

"I went very deep into my drugs. I started doing it more, started
thinking that I wasn't good enough for anyone, that I was ugly," she
says, speaking in an almost detached voice.

The slide continued, with May joining an escort service. She
believed, naively, that sex would not be part of the job. (There
were, in fact, dates where the person wanted only company. Most,
however, expected more -- sometimes much more. One of her clients
beat her severely. When she tried to defend herself, she says, he
told her that if she continued to block his assault he would only hit
her more. "So I stopped blocking him to get it over with.")

The one thing she craved more than drugs -- her boyfriend's love --
was dispensed infrequently and unpredictably. She says he alternated
between ordering her to take on more escort jobs to pay for crack and
then deriding her as a whore.

And, of course, if she worked that day she felt terrible about
herself -- leading again to the illusory respite of drugs.

"I used so much. If I worked that day, I'd use $200 a day," she says.
"It was like running around in circles. You know it's wrong, but yet
you go back to it. Every day you say 'no,' but yet you do it again. I
wanted to stop running around in circles -- I wanted to walk straight
and get out. But I kept on running in circles."

Even when she was at her worst -- beaten and bruised, sobbing,
defeated -- she continued to drop in to the clinic and take her doses
of methadone. It was, in fact, one of the few places where she could
actually talk to anyone about the plunging spiral her life had
become. Social worker Kate Tschakovsky continued to see May, to
listen to her, even during that time when she was so very lost.

'In a way, I had my own demons; I was molested as a child ... I was
just seeing whatever drug would work best for me to help me cope'

'May,' a methadone user

"I was amazed, week after week, that she wasn't dead," says
Tschakovsky. "She'd work all night, she'd come in here in the
morning, all loaded up, face pushed in -- you just do what you can.
That's the thing about harm reduction, we'll take you as you are."

And that acceptance -- even through the drugs and chaos -- made a
difference to May.

"Kate was always there for me, even if I was high. Even if you
weren't ready (to go clean), they'd be supportive and help you," she
says with gratitude.

That's a change in approach from the rigid rules that governed many
addictions programs in the past. It wasn't so long ago that someone
actively using would be turned away until they were ready to either
stop or enter detox. Harm reduction programs, however, will accept
people not yet ready to embrace abstinence.

"Addiction is one of those things where the system has traditionally
shunned people when they display most of their symptoms," says Dr.
Peter Selby, clinical director of the addictions program at the
Centre for Addiction and Mental Health. "When you're sickest, you get
the least help -- which makes no sense to me. You shouldn't be
disengaging them from the process."

And so Tschakovsky worked hard at maintaining a relationship with May.

"Some critics argue harm reduction is enabling," says Tschakovsky.
"But what would they suggest -- just abandon her?"

And May, who'd been running that endless marathon of circles, finally
got dizzy.

It wasn't long after the night when she says her boyfriend, after
wishing her "Happy Birthday" on her 19th, beat her. She says he even
deliberately crushed a glass crack pipe that she had hidden inside
her boot and left it there, causing her to badly slash one foot when
she put the boot on. Some months later, there was another beating --
one of the most severe.

Cliche or not, May had hit rock bottom. She entered detox.

"I'm lucky I made it out," she says with relief. "I saw how much I
was hurting my family. ... I woke up and realized what I did was wrong."

She comes to the clinic often these days. She meets with Tschakovsky,
knits with her regular group, makes plans for the future. She's also
attending a program that will allow her to complete high school. One
of her recent class projects was about domestic violence.

And there's a teacher there, a retired Toronto police officer, she
regards as a role model. She's talking about joining the force, or
maybe becoming a nurse. "I would love to help the community and
people in my situation," she says.

Slowly but surely, May's battered self-esteem is returning. And
sharing her story, she says, is part of that process. Not for
herself, but for others.

"I'm sure there are a lot of girls my age in that situation, involved
with older men who are physically and mentally and emotionally abusive.

"And if they both end up using ... you think that is all you've got.
You think no one else would love you because of what you did in the past.

"But that wasn't you. That was you when you were on drugs." Her
story, especially the hard part, is not unique.

"I've got 10 other clients like May," says Tschakovsky. "And not all
of them are doing as well."

May has been clean for a year and a half now. Which means her
journey, really, has only just begun.