TIME FOR A NEW APPROACH TO HEROIN ADDICTION, VANCOUVER SAYS

When North America's first purpose-built, supervised site for using
heroin opened in Vancouver in early February, all that was missing
were the addicts.

InSite, near Hastings and Main streets at the gritty centre of the
city's Downtown East Side, offers 6 stalls for self-administered
injections. Clean needles, spoons, sterile water and lighters are laid
on steel counters. A raised nursing station oversees the stalls. The
bright utilitarian look is softened by potted palms and, on opening
day, thousands of tulips in memory of drug users who shot up in nearby
alleys and then died of overdose or disease.

But with addicts forced to mill about outside the site because of
legal barriers against drug use, the "opening" was actually a media
event -- part of the lobbying by health and community groups to hasten
federal approval of new and radical approaches to illegal drug use.

Proposed initiatives are based on a new-to-Canada premise of harm
reduction rather than law enforcement. Included are proposals for
clinical trials in 3 cities to introduce heroin-assisted treatment for
addicts, and for heroin consumption facilities for Vancouver.

Approval for these has been voiced in principle, says Liberal MP Paddy
Torsney, who chaired the 18-month investigation by the all-party
Special Committee on Non-Medical Use of Drugs. Its 39 recommendations
were released Dec. 9.

"Current policies are not serving us well," Torsney told CMAJ. "We
have to talk about [illegal drugs] as a health issue and not a moral
issue."

The committee's most daring recommendations fall under its call for
"removal of federal regulatory or legislative barriers" to testing
innovative methods of treatment. The committee called for consumption
sites and for a pilot project in Vancouver, Toronto and Montreal to
"test the effectiveness of heroin-assisted treatment for
drug-dependent individuals resistant to other forms of treatment."

Dr. Martin Schechter, professor of epidemiology at the University of
British Columbia, submitted a proposal to Health Canada in February
for the clinical heroin trials. He said they would attempt to
determine whether hard-core users who have unsuccessfully tried
methadone treatment at least twice can be treated using medically
prescribed heroin.

Recovery would be achieved by breaking the addicts' "cycle of crime
and other things they usually have to do to pay for their illicit
drugs. It would also put them in contact with the health care system."

Schechter said there are about 90 000 heroin addicts in Canada, and
20% to 30% of them would be candidates for the trials. During the
trials, which would be sponsored by the Canadian Institutes of Health
Research, physicians would administer diamorphine.

It's no surprise that support for the trials and consumption sites is
being led by Vancouver, which is plagued not only by problems of drug
use and disease but also by a crime wave attributed largely to addicts.

Last November, former coroner Larry Campbell became mayor after
promising to tackle drugs as a health rather than an enforcement
issue, and to open consumption sites. In April, a Vancouver group
opened a temporary, but illegal, supervised injection site.

Other examples of the sea change in opinion are found among people
such as Crown Prosecutor Rob Rattan, a spokesperson for From Grief to
Action, a group of middle-class parents whose children became heroin
addicts. The group contributed to the InSite facility.

Consumption facilities "can help protect heroin addicts from an
overdose and disease," said Rattan at the opening of InSite. His son
Gavin, now 21 and off heroin, had once overdosed in a nearby alley.