A RADICAL APPROACH TO AID DRUG ADDICTS

Vancouver Gambles On Injection Clinics To Reduce Health Risks

VANCOUVER -- With her matted hair and emaciated frame, Diane Boszak is
the perfect poster girl for a controversial clinic set to open next
week to help Vancouver's drug addicts.

At 32, Ms. Boszak is addicted to heroin and crack. She uses dirty
needles. She's sick with hepatitis C and admits she can't beat drugs.

On a sunny autumn afternoon, in an alley behind Vancouver's
drug-plagued East Hastings Street strip, the blond, tattooed woman sat
on a cement stoop and demonstrated her daily drug routine.

It was a disturbing sight, and health officials say it illustrates why
addicts need a haven to use intravenous drugs. The first clinic of its
kind in North America will open on Monday in Vancouver.

Ms. Boszak reached for a needle lying on the cement and prepared a
heroin fix. But when she tried to inject it into her hand, the dulled
needle missed the target. Blood poured from her wound. Undaunted, she
ran down the alley and returned with a clean syringe.

This time, she aimed the needle at her neck, a high-risk technique,
which, if done improperly, can cause a person to bleed to death. With
expert precision, Ms. Boszak pushed the needle into a vein near her
jugular. The heroin took effect at once. She grew quiet, shut her eyes
and dropped her head into her lap.

A few minutes later, she was lying face down on the
pavement.

It is this kind of open-air drug use that health officials hope to
halt with the opening of a so-called supervised injection site. There,
addicts can use drugs under medical supervision and without fear of
arrest.

The clinic is a gamble. Europe and Australia have injection clinics,
but they've never been tried in North America, which has traditionally
taken an abstinence-based, law-and-order approach to drug use.

Proponents argue that the clinic is needed to fight the epidemic of
drug-related infections and disease raging though Vancouver's skid
row.

Detractors -- and there are plenty -- say it condones drug use and
will speed the downward spiral of addicts.

Still others say the clinic's ground rules are too tough and might
scare away addicts.

Vancouver Mayor Larry Campbell, who promised the clinic in his mayoral
bid, is optimistic. He hopes it will save lives.

"So far this year, 37 people have died of overdose . . . in
Vancouver," Mr. Campbell said in an interview. "What I hope is that
it's going to prevent 37 people from dying."

Health Canada has granted the clinic an exemption from criminal
prosecution. There are rules: Users must sign in and agree not to
share drugs inside. Staff can't help a user inject a drug.

The clinic, which is a three-year pilot project, won't provide drugs,
but it has Ottawa's blessing to teach addicts how to inject safely. It
also has $1.5-million in federal funds to pay researchers to track the
progress of its addicted clients.

"This is incredibly precedent setting," said Ann Livingston, who has
worked with addicts in the Downtown Eastside.

"It's saying, you the user are a human being and deserve to be treated
like one, not just die in an alley."

The site will be open 18 hours a day and staffed by 40 medical
professionals. It is expecting about 800 visits a day.

It's estimated Vancouver has more than 8,000 intravenous drug users,
4,700 of them in the Downtown Eastside. In the past 10 years, more
than 1,200 people have died from drug overdoses in Vancouver.
Infections and disease linked to drug use are rampant, said Vivianna
Zanocco of the Vancouver Coastal Health Authority.

One-third of addicts in the Downtown Eastside have HIV or AIDS and 90
per cent have hepatitis C. "That's the epidemic levels," Ms. Zanocco
said.

After years of hand-wringing, Vancouverites finally embraced the idea
of a supervised injection site. But outside the city, there's more
skepticism.

A Canadian Medical Association Journal study published yesterday
suggested the stringent rules laid down by Health Canada might
dissuade addicts from using the site.

Researchers interviewed 458 addicts last spring in the Downtown
Eastside and while 92 per cent said they would use a supervised
injection site, support dropped to 32 per cent when told of the Health
Canada guidelines. Support dropped further, to 22 per cent, if police
were to conduct surveillance on the site.

Thomas Kerr, who co-authored the study, said addicts took exception to
Health Canada's prohibition against sharing drugs because users often
pool their money and split the spoils.

The rule against helping users inject drugs is also problematic, Dr.
Kerr said. Some addicts can't find veins; others never learned safe
injection techniques.

He suggested Health Canada relax its rules if turnout is
low.

U.S. reaction to the pilot project has been hostile.

John Walters, director of the White House Office of National Drug
Control Policy, called the project "state-sponsored personal suicide."

And David Murray, a policy analyst with the office, said last summer,
"Canada may be abetting the public health crisis more than treating
it."

Mr. Campbell shot back, saying the United States shouldn't point
fingers when it hasn't solved its own drug problems.

"All I'm trying to be is reasonable and practical," said Mr. Campbell,
a former coroner and narcotics officer.

"I'm not supplying drugs. I'm not condoning drugs. But what I am
saying is this is an illness. It's not something you either condone or
condemn."

The Vancouver police are also taking a wait-and-see
approach.

Constable Sarah Bloor said police signed on to the pilot project
because, like health officials, its members too have watched the
Downtown Eastside slide into chaos.

Still, police are concerned the site might attract traffickers. Next
week, they will have extra officers in the Downtown Eastside when the
site opens.

Police acknowledge they don't know what to expect. "This has never
been done in North America before," Constable Bloor said.

"If we see huge numbers or there becomes street disorder, then we'll
have to sit down. We don't want that community to go back to a chaotic
situation."

The supervised injection site is one segment of a four-part strategy
Mr. Campbell promised in his mayoral campaign. Its thrust is to treat
drug addiction as a health problem instead of a criminal matter.

But the strategy also calls for more treatment and prevention programs
and a tougher police approach to traffickers. Earlier this year,
Vancouver police dramatically increased the number of officers in the
Downtown Eastside.

In the alley behind East Hastings Street, Ms. Boszak said she might
"check it out," especially if staff can help her quit drugs.

"I'd love to get off of it," Ms. Boszak said. "But I just can't get up
and go and do that. I have no drive.

"I don't know what to do," she said, her voice trailing off. "I'm
lost."