GIVING ADDICTS A SHOT

A Controversial Program Will Supply Heroin To Heavy Users In Vancouver. Is
It A Cure Or Just A Fix?

It's a shooting gallery unlike anything a North American drug addict has
ever seen. Situated in a former Vancouver bank building, the warren of
rooms is decked out like a college lounge. There's mismatched furniture and
walls covered with old posters, including a trippy Salvador Dali--and
photos demonstrating how to shoot up safely. Drugs are to be delivered here
in an armored car and kept in one of the old vaults. Anyone in the
drug-addled Downtown Eastside who happened in might feel as if he or she
were hallucinating.

The actual plan for this space is as ethically risque as the setting is
unorthodox. A group of researchers this week is to begin a C$8.1 million
clinical trial that will provide pharmaceutical-grade heroin or methadone
to drug addicts. It will be the first study of its kind on the continent.
Within the year, similar trials will start in Montreal and Toronto as part
of the North American Opiate Medication Initiative, or naomi. The plan is
to focus on the country's most intractable cases--longtime users who have
failed methadone programs at least twice--and help them eliminate their
dependence on prostitution and crime to pay for drugs. "We hypothesize they
can stabilize their lives and get onto a better path," says Dr. Martin
Schechter, head of the Vancouver trial. The hope is they will eventually
wean themselves off heroin altogether.

There's certainly no more symbolic place in Canada to begin such a
controversial experiment than the Downtown Eastside, a 10-block grid of
boarded-up real estate that's home to 4,700 needle users, probably the
highest concentration of junkies in North America. One of them is Dianne
Tobin, 54, a 30-year addict who supports her C$200- to C$300-a-day habit by
drug dealing, shoplifting and prostitution. She told Time she wants to be
accepted to the program because under her current circumstances, "I don't
have time to have a long-term goal."

Others think the plan itself needs a fix. Stanley DeVlaming, a Vancouver
doctor who has worked with addicts, says a heroin-prescription program
sends a signal to users that the community has given up on them. "It's
almost palliative care," DeVlaming says, arguing that some new experimental
drugs have yet to be tried and that existing programs are underfunded.

Much louder table thumping has been heard from across the border. The White
House Office of National Drug Control Policy (ONDCP) was already rankled by
a safe-injection site opened in Vancouver last year--U.S. drug czar John
Walters labeled the program "state-sponsored personal suicide"--and by
Ottawa's plans to decriminalize small amounts of marijuana. Unsurprisingly,
the imminent heroin trials have appalled the ONDCP. Even proponents note
the ethical land mines. "I don't think anyone is arguing that heroin
maintenance is in itself a wonderful thing," says George Bigelow of Johns
Hopkins School of Medicine. "It's only good in relation to the options."

That's what spurred Switzerland, which in 1994 started its Heroin-Assisted
Treatment project. Public-health authorities credit the program--which has
since been expanded and extended--with reducing crime and HIV-infection
rates and improving participants' lives. Swiss authorities also say the
program is saving the country money because it spends less each year on
such things as prison and medical costs for addicts. The Netherlands, with
the second oldest ongoing program, is expanding its 300 treatment slots to
1,000. Trials are also under way in Germany and Britain.

The success of the European programs won't necessarily be repeated in
Canada, says Wim van den Brink, professor of psychiatry and addiction at
the Amsterdam Medical Center. "The drug scene is different from ours," he
says. "In Vancouver the scene is more concentrated, extreme, and many of
the addicts are in much worse condition." That describes the U.S. too,
which is why several American researchers are keeping watch. One of them is
the New York Academy of Medicine's David Vlahov, who helped develop naomi
during its early stages in the late 1990s. He calls the Canadian study
"state of the art" and expects it to "help refine clinical decision making
as well as public policy." And moral swamp or not, it may also save some
lives.