VANCOUVER TO TAKE NEW APPROACH WITH LEGAL INJECTION SITE FOR ADDICTS

VANCOUVER, B.C. -- The cops are outside the door, but a junkie named John
is in no hurry to get his fix.

The war on drugs is not waged in here, after midnight in a health clinic in
the city's freewheeling downtown Eastside slum. John patiently scours both
arms for one last good vein as he cracks jokes with a supervising nurse.

"For the liberal government of B.C., I'd like to thank you for this
opportunity," said John, and he drops the plunger on a needle full of
cocaine and heroin.

It's no wonder addicts are unafraid of arrest. Drug laws here, which are
already pliable by U.S. standards, are easing yet again, propelling Canada
toward European-style tolerance.

As the Canadian Parliament debates making possession of small amounts of
marijuana the equivalent of a traffic ticket, Vancouver, the vanguard of
Canadian cities, is taking the widely adopted idea of a needle exchange
even further. It plans to dispense prescription heroin to hundreds of
chronic addicts and to replace the clinic visited by John with a
state-of-the-art, federally sanctioned facility.

From the Canadian perspective, that John shot up with a clean needle, and
in a clinic where he can get information on treatment, is more important
than making an arrest.

But what Canada calls progressive, the Bush administration has called
"immoral," and has warned of slowdowns at the border should marijuana be
decriminalized. Without the threat of arrest, addicts won't seek treatment
and will only expand a drug market that spills across the border, U.S.
authorities say.

Vancouver is the nexus of the debate. The province is the namesake for
marijuana -- B.C. bud -- so potent and valuable it is traded with U.S.
smugglers kilo-for-kilo for cocaine. The city is so awash in heroin that a
100-kilogram seizure by police in 2000 didn't dent the street price. The
city also has one of the highest rates of HIV/AIDS infection in North
America. The unusually open drug market of the downtown Eastside, where
almost a third of the 16,000 residents are IV drug users, has helped make
overdoses the city's leading cause of death for men ages 30-49 for five
years running, according to research from the University of British Columbia.

The U.S. criticism rankles Vancouver, which just elected as mayor a former
drug cop campaigning for the injection site.

"There is no doubt the American drug problem is the biggest in the world,"
said Donald MacPherson, head of drug policy in Vancouver. "People here say,
'Go home and fix your own problems.' "

Following the Swiss

The day after Welfare Wednesday, when government checks arrive, ambulance
sirens scream out of the downtown Eastside neighborhood with overdose
cases. The $368,000 (U.S.) annual cost of such trips -- and the estimated
$100,000 (U.S.) spent annually on each new HIV case -- helped sway voters
toward a more liberal approach.

Canadians view drug addiction pragmatically, in part, because the
socialized medical system bears much of the cost, said Philip Handrick,
acting director of the Canadian Studies Centre at Michigan State University
in Lansing.

"Canadians tend to be very deferential to authority, and if the medical
authorities say this is the way we should approach it, there is a deference
to that opinion," he said.

There is consensus -- from the Canadian Senate to the Vancouver police
chief -- that arrests alone won't solve the problem. Instead, Canadians
have looked to Europe for cures to social ills. Vancouver, in particular,
latched onto a Swiss model called the "four pillars" that gives equal
weight to safe injection sites and incarceration.

In one study published in the British Medical Journal, Swiss heroin addicts
reported working more and relying far less on income from criminal activity
when prescribed heroin at government clinics.

A group of current and former drug addicts campaigned for Vancouver Mayor
Larry Campbell, and now are pressuring him to follow through on his pledge
of an injection site. An astonishingly high 15 percent of the city's IV
drug users have AIDS, compared with 1 percent in Pierce County, home to the
U.S.'s first needle-exchange program.

"This will go down in history as a time when we saw thousands and thousands
of people die" of HIV/AIDS and overdoses, said Anne Livingston, project
coordinator for the Vancouver Area Network of Drug Users, which operates
the site visited by John, who agreed to be interviewed if his last name was
withheld. The group is now frustrated that Campbell has been slower than
expected opening a site, even as rates of HIV/AIDS and other diseases
related to IV drug use hover at epidemic levels.

"The younger activists use the words like murder" to protest the delay,
Livingston said. "I want people to stop dying, not just to be right."

Decriminalization

As politicians and epidemiologists have looked to Europe for answers,
Canada's courts have gnawed at the foundation of marijuana-possession laws.

A judge in Ontario this year ruled the country's laws for personal
possession of marijuana were a violation of the country's version of the
Bill of Rights. B.C. courts, according to police, routinely give no jail
time -- and scant probation -- for possession arrests.

Acknowledging that police rarely make such arrests now, the Canadian
Parliament introduced a law last month that decriminalized possession of
the equivalent of 15 joints, while stiffening criminal penalties for big
pot growers and narcotics trafficking.

On the streets in Vancouver, Police Sgt. Bob Usui watches red-eyed tourists
drift out of the Amsterdam Cafe, one of the downtown Eastside clubs where
pot is bought and smoked openly.

Usui, who grew up nearby, is part of a beefed-up unit deployed last month
to clean up the neighborhood's open-air drug market. It's widely believed
that the show of force is linked to the city's bid for the 2010 Winter
Olympics.

Although marijuana is estimated to be one of the top three cash crops in
Western Canada, worth an estimated $2.8 billion (U.S.) in B.C. alone,
police are more concerned now about a burgeoning crack-cocaine market, Usui
said. While heroin addicts shoot up two or three times a day, crack addicts
can go through 30 needles daily, increasing risk of infection.

"Do you really want to ruin someone's life for a few joints? Usui said. "We
don't have the resources anyway, not like the Americans."

The U.S. rate of incarceration for all crimes is at least five times higher
than the rate in Canada, according to the Canadian National Parole Board.

Border slowdowns?

U.S. drug-policy officials critical of Canada's direction have used
Vancouver as a poster child for liberal drug laws. U.S. drug czar John
Walters called the downtown Eastside slum the worst he has ever seen during
a tour there earlier this year and said the country's direction on
marijuana may force more rigorous checks at the border.

"Nobody wants to punish Canada, but we have to take reasonable security
measures as the threat increases," he told The New York Times recently.

U.S. Border Patrol agents at the Blaine crossing have seen a 350 percent
increase in illicit drug seizures in the past three years. The trade goes
both ways, border agents say, with high-grade pot traded for cocaine to
fuel Vancouver's booming cocaine market.

Dave Murray, a researcher for Walters' office, said the Canadian approaches
are based on sketchy research. Looser laws would fertilize drug markets,
spilling even more pot into the United States, he said.

"The philosophy is that there's nothing wrong with what you're doing, so
where is the incentive to change behavior," Murray said. "If there is not a
criminal-justice sanction, as we've learned in the U.S., they won't go to
treatment."

Washington Gov. Gary Locke's criminal-justice adviser, however, said he
sees no reason to enhance border security to respond to the Canadian
proposals because a crackdown would hurt trade.

"I just don't understand the logic of that," said Dick Van Wagenen. "The
Canadians don't advise us about our own policy much, and we try to extend
that courtesy."

Treatment

The Vancouver Coastal Health Authority is expecting to get a federal waiver
from heroin-importation and -possession laws sometime this summer to open
an injection site in the downtown Eastside neighborhood and begin
prescribing heroin to 470 addicts. The neighborhood is home to an estimated
5,000 IV drug addicts. But two unauthorized clinics already are open,
including one at an HIV/AIDS treatment center connected to Vancouver's
largest hospital.

The Dr. Peter Centre debated supervising injections in 2001, after a
patient told a nurse he planned to use his own blood as a solution to mix
his drugs in and shoot up in the shrubs outside.

That put the nonprofit clinic in an ethical quandary, Executive Director
Maxine Davis said. The clinic's nurses live by the Hippocratic oath, but
they also didn't want to get arrested. Nor did the clinic want to lose
financial donors.

The clinic got the police's pledge to not raid it, and no donors canceled
checks after the injections were made public. About 15 patients a day shoot
up in a room plastered with appropriate injection technique and information
on treatment.

"This is the most ethical work I've ever done," nurse Patti Zettel said.
"It's simply unrealistic to think we can prosecute this away. It's
impossible to fund, and it's not working. And it's just not right."

But the clinic has had trouble getting addicts into treatment. Addicts must
call daily for eight to 10 days before getting into detoxification beds and
often wait a month for inpatient treatment.

Murray, of the U.S. drug czar's office, said the underfunded treatment is
perhaps the biggest problem with Canada's direction on drug policy.

"Without treatment, you have a kind of euthanasia by heroin injection," he
said.