FREE HEROIN AT END OF LONG, WINDING BUREAUCRATIC ROAD

Eight years after researchers proposed free prescription heroin to
treat addicts, the project is close to reality.

Recruitment for the short-term scientific trial, known as the North
American Opiate Medication Initiative (NAOMI), will start this month,
with the first clients beginning treatment early in the new year.

Endless hurdles have delayed the study's startup. Not only did a site
have to be found that neighbours didn't object to, but several Health
Canada conditions had to be met. Researchers are waiting for an
exemption under the Narcotics Act to prescribe the drug. But the end
is in sight, which comes as a relief to clinical lead Dr. David Marsh.

Eight years ago, Marsh worked with the Addiction Research Foundation
in Toronto. At a meeting with other researchers to discuss treatment
options other than methadone, the idea for the heroin trial was born.

"After all this time and effort it's exciting to get if off the
ground," he said standing outside the study site at the corner of
Abbott and Hastings streets Thursday.

Renovations are almost finished on the property at 84 West Hastings,
which in past incarnations housed the Revival Centre church and a bank.

Surveillance cameras are fastened to the outside of the building.
Stringent security is in place even though little heroin will be kept
in the clinic.

Researchers are mainly concerned potential candidates will not realize
the study will involve a limited number of participants and will run
for only two years.

Marsh said expectations are high and some might be disappointed
considering officials estimate 4,000 addicts live in the city.

"It's a research study, not a permanent program," said Marsh, who is
certified by the Canadian Society of Addiction Medicine.

Only those living in a prescribed area in the Downtown Eastside are
eligible for the NAOMI trial. The criteria for acceptance is rigid.
Only 88 addicts will receive prescribed heroin, while 70 will get oral
methadone. Patients will be assigned to one of the two arms of the
trial at random.

Addicts will participate for a year and then be transferred to the
best available treatment they'll accept. After injecting, heroin
patients will be observed for 30 minutes before being allowed to leave
and will be asked if they need counselling.

The study hopes to determine whether prescribed heroin is better than
methadone for addicts who have failed at standard therapies, and
whether pharmaceutical heroin improves the health and quality of life
of injection drug users, reduces homelessness or reduces addicts'
contact with the criminal justice system.

"[The study] is important because dependence on injected opiates is a
devastating health problem," Marsh said. "We need as many options as
we can to prevent overdose deaths, the spread of HIV and other health
problems associated with drug use."

By study's end, researchers may simply discover good quality methadone
works better and is cheaper for treatment. "Maybe it'll be a vehicle
for advocating better quality methadone," Marsh said.

The study, which is also being conducted in Montreal and Toronto, is
expensive.

The Canadian Institute of Health Research is providing an $8 million
grant, while renovation and security measures at the study sites cost
$2 million.

Once researchers are ready to begin recruitment for the NAOMI trial, a
phone number will be posted around the Downtown Eastside and at
service agencies. Calls will only be taken at certain hours of the
day.

NAOMI trial spokesman Jim Boothroyd said not all participants will
begin at the same time. The study will also follow up on participants
who drop out.