THE FIX

Greg, a 37-year-old addict, has made five attempts in 10 years to kick the
heroin habit: "There's never enough drugs for the people down here. It
doesn't matter how much money you have, there's never enough. You always
want more." By Dan Toulgoet.

Twenty-eight-year-old Marcella stands in the rain on the corner of Jackson
and East Cordova streets. In one hand, she clutches a broken umbrella, its
body held together with a string. In the other hand hangs a bulky plastic
bag. The skin over her full cheekbones is soft, a result of her aboriginal
and Polish background.

Letting out an exaggerated yawn-she hasn't slept in 24 hours-she agrees to
be interviewed.

It turns out Marcella, who was born and raised on the East Side, has been
injecting cocaine into her brittle veins since she was 18. She lifts the
sleeves of her wool coat to reveal countless bumps and bruises on her arms
and wrists.

"This one's two years old," she says, pointing to a scar on her forearm that
has barely faded. The jugular veins in her neck are tender to the point that
they bleed when she touches them to demonstrate their sensitivity. "If I go
to sleep they'll heal up, but if I put a needle in there, they'll collapse."

Marcella, who doesn't want her last name used to protect her 10-year-old
son, is shooting up almost every hour of the day.

Although cocaine is her drug of choice, she uses heroin to keep herself warm
during the winter months and to mellow out her cocaine highs. For Marcella
to successfully support her drug habit, she needs to sell her body for $20
to $200 a trick.

During her 13 years as a sex-trade worker, Marcella has been beaten and
raped five times, but it hasn't been enough to make her stop.

Each time, she just wanted to find more drugs-as fast as possible. She's
wanted to quit, but that would mean leaving the Downtown Eastside, where all
her "friends" and connections are. This winter, she even looked into a detox
centre in northern B.C., but there was a three-week wait. Addicts like
Marcella don't plan that far in advance-their lives aren't just day-by-day,
they're moment-by-moment.

To give people like Marcella a chance at a better life, a group of
researchers is planning an experimental trial starting this summer that
would see a select group of Vancouver addicts given free, prescription
heroin. It's part of a national project involving 470 heroin addicts from
Toronto, Montreal and Vancouver. (Montreal and Toronto are moving ahead on
getting their university-based sites ready, but aren't allowed to begin
until Vancouver is ready.) Volunteers would be long-term addicts who live in
the Downtown Eastside and who have failed methadone treatment. Half the
subjects would be tested with methadone, the others with heroin.
Eighty-eight people would get prescription heroin and 70 would get
methadone.

The national clinical trial, which is funded by Health Canada, is called the
North American Opiate Maintenance Initiative or NAOMI, and it's based on
successful experiments in European countries like Switzerland, the
Netherlands and Germany. Switzerland, particularly, saw stunning results in
addicts who participated. According to the 1997 Swiss Heroin Prescription
Report, both the number of offenders and number of criminal offences
decreased by about 60 per cent during the first six months of prescription
heroin treatment, based on information obtained from the patients and from
police records. Income from illegal and semi-legal activities also dropped
to 10 per cent, down from 59 per cent originally.

The number of addicts with permanent employment more than doubled to 32 per
cent from 14 per cent, while the number of unemployed fell by more than
half, to 20 per cent from 44 per cent.

Users given heroin were found to have a better chance at stabilizing their
lives than those on methadone or abstinence-based programs.

Local researchers had hoped their own program would start a full year ago,
but have been stymied by red tape and difficulties finding a location. Now,
however, it looks like the trial won't begin until September.

It won't come a moment too soon for Greg, a 37-year-old addict who's made
five attempts in 10 years to kick the heroin habit. He's now on methadone, a
synthetic replacement for heroin. Methadone, an opiate-blocker, levels his
heroin cravings and prevents his body from getting ill. In early January, he
decided he'd had enough of waking up nauseous and bleaching out needles in a
desperate attempt to fix.

Unfortunately, he's on such a low dose-methadone is also addictive and
doctors don't want to overprescribe it-that he admits he can still feel the
effects of heroin and shoots up periodically. In the last week of February,
he had to have oxygen pumped into him after he collapsed at the safe
injection site on East Hastings.

Greg wonders why getting the prescription heroin trial off the ground has
taken so long. He's not alone. Rumours of free heroin have been spiraling
around Vancouver's Downtown Eastside for months. Every day, volunteers at
VANDU are asked about it.

"Everyone wants to know what they can do to get on it," Greg says.

Greg grew up in Burnaby, where he started snorting cocaine at parties on
weekends with a tough crew of teenagers almost 20 years ago. It wasn't until
he became reliant on a syringe to take the edge off his cocaine high that he
moved to the place where a short-term fix outweighs a long dreary reality.
"[The Downtown Eastside] is the last stop. When you're at the bottom,
something's going to change. You're either going to die, to jail, or you're
going to pull through."

In 1986, Greg started a marijuana grow-op with some friends he'd met while
working as a parking attendant during Expo. The profit from their grow-op
enabled them to buy $1,300-ounces of cocaine every three days. It was in
this grow house on 62nd and Fraser Street that Greg first shot up heroin.

"I was lying down on the bed and I had no worries and I was warm -it was so
great," Greg remembers. "I hate to say it, but that feeling that people are
first looking for when they do heroin-your whole body is warm and you have
no pain at all-that doesn't last forever. You start getting junk sick in the
morning or six to eight hours after because your body is addicted."

Just as his body changed, so did his financial luck.

Greg's grow house was busted. The $30,000 profit he'd saved was spent buying
ounces of coke and heroin and "partying with people." The money only lasted
four months and then he had to find other ways to support his habit.

"We were doing break and enters, mostly breaking into clothing stores and
stealing cars around the city," he says. At that time, computers were new on
the market and Greg and a small crew of addicts would smash into offices and
steal computers, pawning them to dealers in exchange for drugs. At his peak,
Greg was spending $400 a day on cocaine and a couple hundred on heroin.

"One person creates a lot of crime," he says now. "There are only a small
percentage of people doing the greatest percentage of crime in Vancouver.

"When I see kids first down here, I can see what's coming because I've seen
so many times how it starts. They come down here and they think they're
partying and stuff. They get together with the dealers and they're having a
good time making money and stuff. And then things change very quickly
because the drugs are so God-damned expensive. There's never enough drugs
for the people down here. It doesn't matter how much money you have, there's
never enough. You always want more."

A solid yellow line separates the emergency patient traffic down the narrow
hallway at St. Paul's Hospital. Two adjacent stalls accommodate a men's and
women's washroom near the Comox Street entrance. In bright green marker, the
words "I love heroin" are printed neatly over the faded beige paint in the
men's stall.

"Every minute of their time is spent trying to get drugs," says the national
coordinator of the NAOMI trial, Kathy Sayers, sitting in her small office
six floors up.

Sayers, who got involved in the project through her work with UBC's Centre
for Health Evaluation and Outcome Sciences at St. Paul's Hospital, is
impressed by the success of countries like Switzerland in reducing crime and
improving addicts' lives with free prescription heroin. But she's learned
the hard way that legally dispensing a hard drug that law enforcement
agencies have spent years trying to crush is an uphill fight.

Unlike in Switzerland, it's not the national government that's initiating
the prescription heroin experiment here and in the U.S. It's a group of
inquisitive clinicians and researchers dependent on government approval to
get the experiment going.

The U.S. government has continually refused to back the experiment. But
Canada's federal government provided $8.1 million for the project from the
Canadian Institutes of Health Research in February 2002. Since then, it's
been a bumpy road. Aside from dealing with political opposition from people
who think researchers would be better off promoting detox and rehabilitation
than so-called harm reduction, researchers have had to clear a series of
bureaucratic hurdles. Getting clinical trial approval from Health Canada was
the first challenge.

In her office at St. Paul's Hospital, Sayers points to a large binder on the
top shelf of her bookcase, with the initials CTA for clinical trial approval
written in black on its spine. "You've got to be very careful when you start
asking for human volunteers. There's lots of safeguards for them."

First, researchers had to find a formulation of heroin that Health Canada
would approve of. The first manufacturer they found was within budget, but
the formulation didn't meet Health Canada's standards, which stipulated that
the heroin must be pharmaceutical grade and could not be cut with other
drugs and the dispensing of the dosage has to be exact-unlike on the street.

The NAOMI team then found a European manufacturer that could produce the
exact formulation Health Canada would approve of, but the price was higher
than they'd budgeted. As the lesser of two evils, the NAOMI team opted to
buy the expensive heroin.

"Finding a manufacturer was difficult," Sayers says. "Health Canada tells us
what formulation they'll allow, so we have to find a manufacturer that could
do that exact formulation. As you can imagine, there aren't tons." The whole
process took six months.

After finally locating a manufacturer in Europe, the NAOMI team was hit with
yet another obstacle.

The United Nations' International Narcotics Control Body, an arm of the UN
Drug Control Program, requires that any manufacturer producing heroin must
not have a surplus. This meant the amount of heroin NAOMI imported into
Canada had to exactly balance how much the manufacturer made.

Almost two years after the proposal was initiated, in January 2002, the
project received clinical trial approval from Health Canada-a process that
normally takes six to eight weeks.

"These are all just regulatory hurdles," Sayers says. "They're not
roadblocks. They're mostly to protect the participants to make sure that
they're getting good drugs."

Ironically, what they're getting on the streets is anything but good drugs.
In the last few years, the Downtown Eastside has had an influx of dirty
drugs, infused with speed and toxic substances.

"That's a really bad turn for here, for speed to get into cocaine," Greg
says. "The amphetamines really damage people's brains."

Dealers are able to buy cheap chemicals and mix cocaine with impure
substances in their bathtubs, before selling it on the street for greater
profit. Desperate addicts then shoot the mix into their veins.

That's why for many addicts, getting onto heroin maintenance doesn't just
mean not having to work the corner or steal or rob people-it means getting
pure heroin, instead of these tainted products, says Greg.

Because heroin has never been tested as a pain reliever in North America,
Health Canada has to grant NAOMI an exemption from the Narcotics Act. That
meant the NAOMI team had to first find a site to dispense the heroin in the
Downtown Eastside that both the city and Health Canada would approve of. It
wasn't easy. In Montreal and Toronto, where the universities are central to
the drug problem, it wasn't difficult-the sites were simply based on campus.
But because the University of British Columbia is far from the heart of
Vancouver's drug problem, the Downtown Eastside is the only location
feasible for the experiment.

NAOMI first picked a site at 659 E. Hastings St. but withdrew its
application to the city last fall after neighbours complained the location
was too close to an elementary school and an abstinence-based recovery
house. The city also noted it was six or seven blocks outside the core of
the Downtown Eastside.

Tracking down a replacement wasn't easy, since, aside from the difficulty of
finding a willing landlord, the heroin site had to meet stringent physical
requirements. It had to be about 3,000 square feet with two separate
entrances to accommodate both the methadone and heroin clinics. It also had
to be renovated to meet high security standards under a certain budget.

After hearing that NAOMI researchers were having trouble locating a site,
Phil Bouvier, executive director for Central City Mission Foundation, a
charitable organization that offers low-income housing to Downtown Eastside
residents, invited the team to look at one of his empty rental spaces.

The first space didn't meet NAOMI's requirements, but another site owned by
the Mission did. That site is located at 84 West Hastings St., right in the
core of the Downtown Eastside. It had two separate entrances and sufficient
square footage. It was perfect except for one problem-it wasn't vacant.

Vera Ward is no stranger to drug addicts. She's been ministering to them at
her Downtown Eastside Revival Centre church at 84 West Hastings St. for 11
years, sometimes as many as 500 a week. At age 76, Ward would likely have
continued doing this for the rest of her life. But last January, she and her
husband Ron, both recovering alcoholics, learned they were being evicted so
Central City Mission could collect market value for the space, to help fund
the single-room-accommodation suites upstairs. The proposed tenant was the
NAOMI project. The Wards turned down an offer of another site across the
street, saying they're too old to move.

"I was heartsick," Ward said about the prospect of prescribing free heroin
to the drug addicts she works with. "If it was for anything else, if it was
going to benefit the community, I'd be glad to give up our church. But they
have no idea if it's going to work."

Ward, who took over the church after her brother, who had been running it
since 1948, passed away, said the move would only hurt addicts desperate to
be rid of heroin. "I love chocolate. Put me in a chocolate factory and I'd
die.

"Here we are trying to get them off the drug and they throw us out to put
them back on it."

Nonetheless, on March 15, the 84 West Hastings St. site was unanimously
approved by the city after 17 delegations spoke in favour of the heroin
trial. NAOMI now has full approval for the site, and is awaiting a building
permit, expected to come through shortly. Renovations should be complete
sometime in summer, at which point NAOMI will seek the Narcotics Act
exemption.

The trial is expected to begin in September, and last two years.

Martin Schechter, a UBC medical researcher who's heading the NAOMI trial in
Vancouver, has said testing free heroin on drug users will benefit all
Vancouverites.

"These 160 or so people, they will not have to engage in criminal activity
because they will know that their allotment of heroin is going to be
provided by a doctor," Schechter told the Vancouver Sun newspaper last year
(it was difficult for the Courier to get people to speak on the NAOMI
project because of the political sensitivity of the issue). "The whole idea
of the study is that if [drug addicts] don't have to go stand on the street
and sell sex or break into cars or burglarize your house, there may be a
window of opportunity where you could actually get them to break that cycle
and get them out of that spiral."

Jim Boothrayd, spokesman for NAOMI, anticipates that critics of harm
reduction will be watching the results of the trial particularly closely.
"Obviously, this is a highly innovative and controversial study. It's never
been tried in North America."

There's no chance the project would be expanded by NAOMI, since any major
changes must be approved by the funding body, Health Canada, says
Boothrayd-"This is a limited, short-term scientific trial"-although if it's
successful, the government could choose to establish prescription heroin
programs.

Back at the street corner, Marcella, who describes herself as a functioning
addict, says not having to track down her drug supply would give her a
chance at a regular life.

"If I were to know I had my dope there, I'd be able to sleep better and
concentrate on normal things because I wouldn't have to chase so much."