WITH INJECTION SITES, CANADIAN DRUG POLICY SEEKS A FIX

VANCOUVER, B.C. -- Her fingers travel up and down her arm, feeling for a
good vein. Lori-Kim Veenstra opens a $7 bag of methamphetamine and pours
some of the crystals onto a clean spoon. She opens a tiny blue bottle of
sterile water and fills the spoon, waiting for the chemical to dissolve.
Sometimes junkies use water from puddles to break down their drugs,
sometimes soda pop or toilet water. Sometimes they use their own blood.

Not here. Veenstra, 40, is in a clinic at the Dr. Peter Centre, where
junkies who test positive for HIV can shoot up safely under supervision.
This is one of the first of what are called "safe injection sites" in North
America. Soon to be sanctioned by the provincial and federal governments,
it is an example of a new policy in Canada, known as harm reduction, to
address a pervasive drug problem plaguing Vancouver and other major cities.

In the past year, Canada has drastically shifted its approach to dealing
with drug users, going from punishing them to instituting the policy of
harm reduction. This program makes sure junkies are safe while they are
shooting up instead of sending them to jail.

"Before I knew about this room, I used to go outside and shoot in the back
alleys," Veenstra says. She ties a blue rubber tube around her left arm and
pulls it tight with her teeth. She takes a clean syringe and draws up the
liquefied drug, sucking it through sterile cotton, hoping the cotton will
capture the impurities in the addictive stimulant, made of substances she
is unsure of -- her crystal meth could be cut with drain cleaner, baby
laxatives or asbestos.

The syringe is full now. She steadies the needle and points it at her best
vein.

"The only thing I ask of you," she says, looking up, "is don't talk to me
and don't ask me if I'm okay. Okay?"

The needle punches her vein. There is a slight hissing sound, as if her
body is issuing a faint protest when the drug enters her system. She drops
the needle. But there is no hurry. She is not on the street. There is no
fear that another junkie might attack and stab her, then run off with her
drugs. There is no concern of an overdose. All the time, a registered nurse
is watching her, guiding her, making sure she uses sterile water and cotton
and a clean needle, and that she inserts the needle correctly, following
instructions.

"Go flush with the skin," a nurse, Patti Zettel, instructs. "Then up. Once
in the vein, release the tourniquet. Look, she has good blood flow." At
Odds With U.S. Approach

Throughout the country, officials are considering radical changes in
Canada's approach to drugs, rejecting the tendency in the United States to
push for law enforcement solutions. In so doing, officials are taking up
the stance of several other countries, including Germany, the Netherlands,
Switzerland and Australia, where there are various programs for
decriminalization, clean needles and free methadone clinics.

The Vancouver-based Harm Reduction Action Society, which advocates changes
in drug laws, reported that drug overdoses in Frankfurt, Germany, decreased
from 147 in 1991 to 26 in 1997 with the creation of safe injection sites.
In Switzerland, the organization said, drug overdoses also decreased, and
there was a marked increase in the number of people registering for
methadone and other treatment programs.

U.S. officials have angrily criticized the Canadian policy of harm reduction.

"The very name is a lie," John Walters, the White House drug policy
director, said in a telephone interview. "There are no safe injection
sites." Walter said the United States would continue to treat drug abuse as
a "deadly disease that shortens lives."

"It can't be made safe," Walters said. "We believe the only moral
responsibility is to treat drug users. It is reprehensible to allow people
and encourage people to continue suffering. That is why we don't make this
choice and we don't believe we ever will."

Canada also faced criticism from the United States in May when it proposed
decriminalizing possession of small amounts of marijuana.

Canadian officials said their approach is intended to combat HIV -- rampant
among drug users -- and to decrease overdoses. Officials in Canada's
largest cities, Toronto, Montreal and Vancouver, are also debating whether
supplying heroin to addicts will save lives and combat criminal behavior.

The Dr. Peter Centre, where Veenstra was using her crystal meth, does not
yet have legal sanction to run its safe injection program, but officials
and police are allowing it to operate without interference. The provincial
government has approved a three-year, $1.1 million pilot program, to be run
by the Vancouver Coastal Health Authority, for a safe injection clinic in
the city's drug-ridden Downtown Eastside district. This includes exemption
from prosecution under the Controlled Drugs and Substances Act.

Part of the pilot program involves gathering information on whether addicts
will be more likely to seek treatment, and whether the number of drug
overdoses and cases of infectious diseases decrease.

"Somebody said, 'Why are we helping addicts?' " said Viviana Zanocco, a
spokeswoman for the Vancouver Coastal Health Authority. "The question is:
Why shouldn't we? Are we only supposed to help heart patients?"

The program also makes good economic sense, Zanocco said. "When we get
somebody with HIV, it costs $150,000 Canadian [about $107,000] to treat
over a lifetime. Some people say you are enabling addicts, but you can
point also to the health care system. If we can prevent 10 people from
contracting HIV, the safe injection site pays for itself." 'No Nurse, No Fix'

Even before formal approval, the city of Vancouver is allowing operation of
a safe injection clinic in Downtown Eastside, where a public health
emergency was declared two years ago. Officials said poverty and cheap
heroin and cocaine prices combined to create the largest open-air drug
market in North America.

Junkies raced into the illegal clinic at a storefront building one recent
evening. Outside, some of the district's more than 12,000 intravenous drug
addicts were wandering about. Officials estimate that about 90 percent of
the addicts have hepatitis C and 30 percent are HIV positive. It is a zone
of intense poverty, minimal housing and high unemployment.

The addicts rushed past the coffee machine and into a back room. Beyond the
door were signs that read, "If you are not injecting or using the bathroom,
stay out," and, "No nurse, no fix."

"It's good to come here," said a drug addict who identified herself as
Corky. She was dressed in thigh-high boots, black fishnet stockings and a
tiny black dress. Corky had just finished taking a hit of heroin.

"Being a working girl, it's safe. You don't have to worry about guys
jacking you up for your dope," she said. "Maybe it allows for self-esteem,
maybe in the long run people will get off and you start to feel more normal
and get a semblance of respect."

All the while, Meagan Oleson watched the addicts. "This is a user-run safe
injection site," said Oleson, a nurse. "Users decide what goes on here. My
role is to supervise injections and to support them in doing that." The
site is run by volunteers; the space is donated.

"People die every day -- people shooting alone," Oleson said. "They don't
have access to sterile supplies. People are using water out of alleys to
mix dope with."

The official clinic is scheduled to open in September in another storefront
that will look no different from other businesses in the area. Addicts will
receive syringes and other gear for their fixes. "Then they would move into
a post-injection room to make sure they don't overdose or there are no
adverse reactions," Zanocco said.

Peer counseling and treatment options also will be available.

"They'll have to purchase the drugs on their own. They can possess drugs
and not be arrested inside," Zanocco said. She said police were still
trying to determine "how close they can be to make sure people don't stand
on the doorstep and sell drugs on the doorstep. That is something the
police will work out."

Constable Sarah Bloor of the Vancouver police department said, "The
Vancouver police is supportive of the effort to provide treatment and
health initiative in the community." Bloor said the drugs would still be
illegal but people using them inside supervised injection sites would be
exempt from being arrested for possession. Bloor said police tried to focus
most of their efforts on traffickers. "We don't currently go after users,"
Bloor said. "We believe users are individuals that require treatment. We
don't see them as criminals. They are individuals that have an addiction."

Courts in Vancouver generally do not prosecute users for simple possession,
which Bloor said was about "one point of a gram, or basically a hit.

"Basically someone with a flap of heroin or cocaine, a minimum amount, you
typically don't see the courts wanting to proceed to trial process for that
amount." 'Ethical Work'

Inside the Dr. Peter Centre, Zettel is watching Veenstra, the addict. "It's
the most ethical work I've ever done as a nurse and human being, because
addicts are Canadian citizens with a health problem," Zettel says. "We as a
society have reinforced their marginalization. They have a poor sense of
self-esteem and value. We have reinforced that. That to me is criminal.

"Lori is an IV drug user. If she wasn't here, she would be out there. Where
is it safe? Where is it better? In front of me or in an alley? . . . Doing
it here, I have the ability to teach and teach."

Clay Adams, of the Vancouver Coastal Health Authority, said the government
would provide medical liability coverage to employees working at the site.
"We understand the reality of the potential for overdoses," Adams said.
"The risk is there. We are not ignorant of the risks."

Currently, addicts must sign an agreement before using the injection room,
a small space much like a doctor's office in the clinic. The room has three
chairs, a sink, and a cabinet full of supplies. On a round table are clean
syringes, boxes of sterile water, cotton and rubber tubing. On the wall are
posters with photographs and text telling addicts how to achieve "The Safer
Fix."

Veenstra says her arms are healthier with the supervised injections,
although there are still deposits of crystal meth beneath her skin. She
says she is proud of the improvement. Veenstra also says she has started to
cut down on the amount of drug she uses each day, leaving a little more in
the needle after each fix.

This day, as she fixes her fix, she talks about how she ended up here.

"Most users are trying to hide the hurt," she says. Her mother, she says,
left when she was 6 months old. Reared by her father, she ran away at 10
and never looked back. She met a guy named Paul who asked if she was
hungry, and he took her back to his house.

"He was a heroin addict. He did a hit. He was all happy. He was nodding
out," Veenstra says. She wanted to be just like Paul. "I've been using
since I was 10. I lied to my first heroin dealer. I told him I already used."

Heroin was her mother for 30 years, she says, adding that she has no guilt
for being a junkie.

As Veenstra waits to shoot up, she sorts through her briefcase, which is
stuffed with pamphlets on treatment programs. She has stocked up on them;
nobody in the center pushes the information on her, she says.

Zettel says she wants to come across as nonjudgmental with addicts. "I
can't push my agenda. If Lori is interested in detox treatment, it is about
what Lori wants when she wants it," Zettel says.

Veenstra says Zettel has simply shown her the options. "She opened the
doors and windows," Veenstra says. "If I want to walk through that door, I
can." But not today, Veenstra says as she gathers her equipment for another
fix.