DRUG ADDICT HELP 'NOT EASY SELL'

Addiction isn't a problem that can be wiped out, say the people trying to
help addicts recover.

"The drugs are not going to go away. They're not," said Cindy MacIsaac,
program director at the Direction 180 methadone clinic on Gottingen Street
in Halifax.

If we were to stop the abuse of prescription drugs like OxyContin and
Dilaudid, heroin and other substances would fill the void, she said.

But the problem can't just be swept under the rug, either.

"It's got to be the disease with the most risks and it tends to be the
lowest on the totem pole for services," Ms. MacIsaac said. "It's not a sexy
topic. It's not an easy sell when you have sick children and you have
elderly folk and people with other chronic illnesses."

Ms. MacIsaac said stigma around addiction as a health issue might be due to
a perception that drug use is a choice. But when people are caught in the
grip of addiction, they don't have a choice, she said.

And however people fall into addiction's grasp, the public can't ignore the
risks to the community at large like the spread of hepatitis B and C and HIV.

The methadone clinic aims to minimize the risks faced by people with
addictions, both from using the drugs and from the things they do to obtain
them.

The health risks can include contracting diseases through shared needles
and abscesses from injecting. Addicts often end up putting themselves in
harm's way to maintain their drug habits, whether it be stealing from a
relative or entering the sex trade.

Although methadone, a synthetic opiate that's mixed with orange juice and
must be taken daily, is effective only for people addicted to opiates like
OxyContin, Dilaudid, morphine and heroin, Ms. MacIsaac said most people who
use the clinic are addicted to "pretty much everything."

Direction 180 gets $240,000 a year funding from the provincial Health
Department through the Capital district health authority. Ms. MacIsaac sees
the clinic as complementary to Capital Health's addiction services branch.

"One size doesn't fit all," she said. "It's important to have a variety of
service.

"This program was designed to meet them where they're at."

The clinic accepts that its clients - about 60 people come for methadone
every day - may not be able to keep strict schedules. They may have legal
troubles and are often abusing other drugs. They won't get kicked out for
being high or relapsing. And they won't get better right away.

"If it takes you 10 years to go into the woods, it takes you 10 years to
come out," Ms. MacIsaac said. "You've got to allow that time for them to
start to develop healthy social supports . . . links to community
organizations, look at work, education, dealing with outstanding court
charges they may have."

Some people will eventually be weaned off methadone - whose effects last a
whole day and smooth out the highs and crashes of injected opiates - but
it's not a goal.

Tom Payette, director of addiction services for Capital Health, said it can
in fact be a lifetime commitment.

At least one patient has been on the drug continuously since an early
addiction services methadone trial in 1979.

"Most addicts, when you get to a point that it's becoming problematic,
really just want to return to continue to use, but live a normal life," he
said. "That's chasing the dragon."

Direction 180 doesn't simply hand out methadone. Each client also receives
counselling, much of it by people who have lived through addiction
themselves, based on a thorough assessment of the client's physical and
mental health, lifestyle and living arrangements.

Ms. MacIsaac believes the clinic is successful, though success is sometimes
measured in small steps.

"You see somebody coming in and they've actually bathed or they're excited
because they've re-established contact with their children," she said.
"There's hope in their eyes. They're going to court as opposed to running
from court. They've got a smile on their face. They're grateful."

But there's a window of opportunity to help people that the clinic can't
always meet. People tend to arrive at the clinic at their very lowest point.

"When they come in, they're socially, emotionally, mentally, physically,
extremely distraught," she said. "They're bankrupt."

The will to get better may not last as long as the three-or four-month wait
to begin treatment. Ms. MacIsaac said she has seen people die of overdoses
after being placed on the waiting list, which now stands at 55. Others just
never return.

To help more people, she said, the clinic's needs are straightforward -
money and space.

Mr. Payette said family doctors can help identify addictions early on by
asking direct questions about their patients' ailments - What are you
using? Were you under the influence when you injured yourself?

"I don't believe physicians are asking those questions on a regular and
consistent basis," he said.

Dr. Connie LeBlanc, a Halifax emergency room physician, said she doesn't
pull any punches when she suspects a patient's condition is related to
substance abuse.

Alcohol is the drug that sends most people to emergency. Dr. LeBlanc said
she'll ask a patient who has had a car accident, a household mishap or a
fall while drunk if he thinks alcohol is a problem for him.

"I think it's part of looking after them," she said. "If they're open to
it, fine."

Dr. LeBlanc said she uses the same approach with other drug users.

"I have a little chat with them," she said. "The thing about taking street
drugs is that you don't really know what you're getting. These people are
in it for the money; they're not in it for your well-being. They'll dilute
with anything from urine to cornstarch."

For some, a bad experience will turn them off drugs, Dr. LeBlanc said.
Others will be more careful about their use but won't quit. Some will deny
they have a problem at all.

Those who need it and agree to it can be referred to detox and admitted
when a bed becomes available. But no one can be forced to clean up, she said.

"It's a problem that can't be solved unless somebody wants to solve it
themselves," she said.

To help people avoid addiction in the first place, we need to arm kids with
more information, Ms. MacIsaac said.

"We don't start early enough in the education system," she said.

The tendency is to shield children from such topics, as with the huge
controversy over the distribution of a sex education booklet in schools,
she said.

"It's happening," Ms. MacIsaac said. "Let them read it, give them the
resources. Talk to them about it, show them.

"Teach them to be safe."