KICKING THE HABIT WITH FREE HEROIN

Vancouver Addicts Will Be Getting Government-Approved Fixes In A
Controversial Research Project

As well as helping addicts, advocates say it should reduce drug-related
crime, Daniel Girard reports

VANCOUVER--Phil Denbak will not yet allow himself to dream of a day when he
has broken the grip of heroin, his almost constant companion for more than
25 years.

But he is upbeat about the latest move intended to try to improve the lives
of hardcore addicts like him on Vancouver's downtown eastside: free heroin
injections. Denbak, 49, is hoping to participate in North America's first
prescription heroin trial, which begins here next month before expanding to
Toronto and Montreal this spring.

The idea behind the study, which got final approval from Health Canada this
week, is to find out if providing addicts with their average three daily
fixes will improve their quality of life by eliminating the need to pay for
drugs through theft, prostitution or other crimes.

If so, proponents say, then life will be better across the broader
community as well with safer and cleaner streets and fewer tax dollars
spent on hospitals, policing and the courts.

Similar studies in Europe found addicts' lives improved and crime rates
fell. Some users found jobs, many shot less heroin and others got into
treatment or quit the drug outright.

Denbak finds it hard to fathom getting clean, though he's tried numerous
times. Still, the former house painter, who spends most of his time
panhandling, collecting bottles and doing what he can to raise the $50 a
day he needs to feed his habit, thinks this could help.

"I'm not going to stop using," Denbak says matter-of-factly, his hollowed
cheeks, haggard look and glassy eyes stark testimony of his addiction. "But
if I don't have to spend all day getting money for my fix, then I might be
able to be more constructive.

"This is part of the solution, not part of the problem."

The North American Opiate Medication Initiative, or NAOMI, is an $8.1
million project funded by the Canadian Institutes of Health Research, a
federal agency. It will have 470 addicts at three sites; half of them will
get pharmaceutical-grade heroin made in Europe, the others methadone, a
drug taken orally to ease cravings and withdrawal.

Those taking heroin will get injections under medical supervision at
special clinics. They will get it for 12 months, then transfer over a
three-month period into methadone-maintenance or other treatment programs.
With recruitment and transition, the study will last up to two years.

"Right now, these people are injecting contaminated heroin using dirty
needles in unsanitary conditions and living a life where they have to
commit crime and prostitution to pay for their next fix," says Dr. Martin
Schechter of the University of British Columbia, the project's lead
researcher. "We're seeing if we can break that cycle."

Schechter stresses researchers will recruit for the study only "the most
severe cases of heroin addiction for whom there are no other treatment
options." Participants must be 25 or older, have been addicted to the drug
for at least five years, including the past 12 months, and have
unsuccessfully tried a methadone program at least twice before.

While Schechter admits the hard-core addicts who will qualify for the study
may represent less than one-quarter of the estimated 5,000 injection drug
users on Vancouver's downtown eastside, they account for a disproportionate
amount of crime and other problems associated with heroin addiction.

"This is an acknowledgment that some people are going to continue using
drugs whether we like it or not," he says. "The question is, do we treat
them as criminals or as people suffering from a medical condition and try
to work on getting them better."

The NAOMI project is the latest attempt at liberalizing drug policies in
the area, regarded as Canada's poorest neighbourhood. It's also the
location of North America's first supervised safe-injection site, which
opened in 2003, where addicts inject their own drugs under the watchful eye
of medical staff who monitor for overdoses.

In Vancouver, the police, mayor and some area business organizations are
supporting the study in the hope it will help reduce crime and better treat
those seen in the past as untreatable.

But critics say free heroin will mean addicts will take more of it or
increase their use of other drugs such as crack cocaine and crystal meth,
which many of them already abuse. The best way to address the problem is
with more detox beds and other treatments, they say.

Conservative MP Randy White (Abbotsford) calls the philosophy of the NAOMI
project "totally flawed."

"You can't stop crime by giving people the root cause of that crime," says
White, the Conservative critic on drug strategy. "It just doesn't make sense.

"Like it or not, to get off a drug you have to abstain from it."

White, who notes a United Nations report rejects the contention that there
were positive outcomes from a Swiss prescription heroin trial in the 1990s,
calls this "another shot in the dark" to fight the burgeoning drug problem.
Much better and more effective solutions would be to increase education,
advertising, rehabilitation and police enforcement, he says.

"We're off on this other tangent because we've thrown up our hands and said
we can't do anything with these people," he says. "So, we put them off to
the side and juice them up.

"That's wrong."

But Ann Livingston, project co-ordinator with the Vancouver Area Network of
Drug Users, says while more treatment facilities and programs are needed,
the prescription heroin scheme is another way "to treat addiction like an
illness, not like a crime."

With evidence in Europe that such programs have not only improved the lives
of addicts but cut down on crime, they should have wide appeal across the
community, she says.

"Canadians would be very wise to push for this kind of intervention for
addicts rather than what we currently do," Livingston says. "I'd venture
almost 90 per cent of addicts down here have been charged with a criminal
offence and it doesn't stop them using."

Dr. Stanley de Vlaming, who has treated addicts in the downtown eastside
for more than a decade, worries that the "high degree of anticipation and
hype" among neighbourhood users about NAOMI will skew results in favour of
prescribed heroin.

"Addicts are acutely aware that their behaviours and responses during the
study may also determine whether free heroin might be available after the
study," he says.

De Vlaming also calls the project "premature" because it focuses too much
time, money and energy on less than 5 per cent of addicts who don't benefit
from methadone. It could result in too many people being in very expensive
heroin maintenance programs when they, and many others, could be treated by
expanding methadone and other treatment, he says.

But Phil Denbak knows methadone isn't the answer for him. He's tried it
three times before and suffered from insomnia, constant chills and repeated
nausea.

So, for him, prescribed heroin is one of his only options.

"I'd like to try and get my life back together," he says. "And I think this
could help."