DETOXIFYING VANCOUVER'S DRUG CULTURE

Waiting Times Drop, And More Addicts Seek Treatment In City Programs

VANCOUVER -- Six years ago, Vancouver drug addicts who decided to
break the habit had a six-week wait to enter a withdrawal program. By
the time services were available, many of them gave up. Today, the
wait is at most two days, and enrolment in so-called detox facilities
is growing.

Experts say long waiting times for detox were gradually eliminated
because the local Coastal Health Authority streamlined admissions
with a central registry in 2000.

It's an achievement in which the health authority should take some
pride, provincial health officer Perry Kendall said.

"I would be bragging about this if I had managed to do this," he
said.Last year, about 4,200 adults and youths were enrolled in
clinical or hospital withdrawal programs, said David Marsh, an
addictions specialist with the health authority. Some of the programs
are new, and enrolment in all is growing, he said.

Participation in long-term treatment has also increased, to 8,270
heroin addicts in methadone programs in 2004 from 1,000 in 1995.

But these changes have gone almost unnoticed in Vancouver's turbulent
drug scene. There are constant reports on the contribution of addicts
to the city's high property-crime rate and gang violence, in addition
to news stories about North America's only supervised heroin
injection site and clinical trials to give addicts free prescription heroin.

Vancouver's "Four Pillars" approach to drugs -- prevention,
treatment, harm reduction and enforcement -- became a federal
election issue after Stephen Harper said a Conservative government
would neither support the supervised injection site nor approve other
locations.

With Mr. Harper now the Prime Minister, B.C. health experts are
starting to lobby for support in Ottawa for the West Coast's
health-centred approach to treating drug addiction.

This week, Thomas Kerr, a Vancouver-based researcher on drug use and
HIV infection, will travel to Ottawa to present his recent research
to Health Canada and the RCMP.

Dr. Kerr and other researchers have had studies published in the
Lancet, the Canadian Medical Association Journal and the British
Medical Journal, with findings showing that the supervised heroin
injection site has reduced sharing of syringes by heroin users, led
to improved public order in the Downtown Eastside and had no negative
impact on Vancouver's drug use patterns.

Local agencies are asking Health Canada to allow Vancouver's
supervised heroin injection site to continue its operations. It is
operating under an exemption from controlled drugs and substances
legislation, which expires in September.

Mr. Kendall, who has made a formal, written request to Health Canada,
said an evaluation of the facility last fall was "all-round positive,
with no downsides."

But health experts say the progress is overshadowed by ongoing drug problems.

"Things are significantly better compared to 10 years ago," said Dr.
Marsh, who moved to Vancouver after eight years as clinical director
of addiction medicine at Toronto's Centre for Addiction and Mental
Health. "Overdose deaths are down by two-thirds to three-quarters.
New HIV infections among injection drug users are down.

"Infectious [heart disease linked to injection drug use] is down by
40 per cent. Total heroin seizures by police have fallen
substantially, and the number of people in treatment has gone up
eightfold," he said.

But the public perception, Dr. Marsh said, is that Vancouver's drug
scene is constantly worsening. He blames this partly on social
problems caused by the increased popularity of smoking crack as
opposed to injecting cocaine, and on the extreme psychotic and
violent behaviour of a relatively small numbers of crystal meth users.

Experts say the improvements are still not enough. The numbers are
hard to pin down, but experts estimate there are 5,000 injection drug
users in the Downtown Eastside neighbourhood alone.

And despite the studies on the supervised injection site, overall
information about what works and what doesn't, and on drug use in
general, is lacking, said Ann Livingston, spokesperson for the
Vancouver Area Network of Drug Users. There is little local
information on what happens to people after they complete a
withdrawal program and are discharged without drugs in their system.

According to Dr. Kerr, "If you compare the data on use of drugs in
the U.S. to Canada, it's a total embarrassment. In the U.S., they
really know what's happening."

Experts agree that improved detox programs and medical services are not enough.

"Our notion of prevention is very weak," Dr. Kerr said. "We do not
really acknowledge the social determinants of addiction such as
poverty, lack of housing and troubled early childhoods. . . . If we
want to get serious, we need to address the social conditions."