ILLEGAL STREET DRUG USE PROGRAM UNDER REVIEW

A controversial new treatment program, currently under review from
Health Canada and seeking a health exemption, aims to provide possible
solutions to Vancouver's growing problem of illicit street drug use,
and the resulting social problems of poverty, crime, and
homelessness.

The program is part of Vancouver mayor Sam Sullivan's Project Civil
City, and proposes "drug substitution treatment" as an alternative to
the illegal consumption of street drugs by chronically addicted users.

The main goal of Chronic Addiction Substitute Treatment (CAST) is to
put chronic users in contact with doctors who would determine their
health issues and prescribe a legal oral substitute for illegal street
drugs. There is an estimated number of 2200 homeless people in
Vancouver alone, of which a significant percentage has mental health
disorders and addictions to street drugs such as heroine and
methamphetamines.

Lois Johnson, executive director of CAST, said, "We are working to
build some structure around some of the concepts that have come
forward and [to] acknowledge the need to deal with the drug problem on
the Downtown Eastside."

"[Project] Civil City objectives are to reduce by 2010 aggressive
panhandling, free market drug use on the streets of downtown
Vancouver, and [to] reduce crime in the city," she said.

This project aims to take injection drug users and put them through
the program and into contact with the courts system, the safe
injection site, Vancouver Coastal Health facilities, the police, or
NGOs.

There will be people monitoring the program, said Johnson, explaining
that people in the program would work with NGOs to provide things like
safe housing, counselling, and employment coaching.

Furthermore, this program will act as a clinical trial similar to a
crime statistic trial, said Johnson, who believes the program will
benefit the community by reducing crime in the city. The Vancouver
Police Department has identified chronic drug users who show up in the
system, she said, who commit crimes in the order of ten to 15 a day to
support their habit.

"There is a huge level of support for this among the corporate
community who are concerned about the increasing crime levels."

Johnson explained that as part of the initiative, a "community court"
would be established which would have the authority to put drug users
into treatment programs, in contrast to what is known as "catch and
release," where police arrest and jail users for a short period, and
then release them back out on the street "with no real treatment."

Overseeing the project's formation is David Holtzman, former executive
director of A Loving Spoonful, a charity that raises funds to provide
food for people living with HIV and AIDS. "I'm a concerned citizen,"
he said. "I live in that neighborhood, I know the community pretty
well."

"[CAST] encourages people living on the streets who are addicted to
street drugs to go through medical channels to find substitutes for
street drugs, which will be classified as 'legal medicines,'"
explained Holtzman.

"We're hoping we'll get a broad federal exemption for using existing
prescriptions," he said.

According to Holtzman, as a substitute treatment methadone has worked
well for some people who have been addicted to heroin but stimulants
have shown to be an increasing problem in Vancouver and globally.

"We've seen crack cocaine and crystal meth [use] going up in the city,
so we need to look globally for the best research that's being done on
maintenance programs it's all about harm reduction," he said.

Holtzman pointed out the success of global research trials, which show
that patients with long term addictions can be stabilised, and
stabilising chronic drug users is a factor which he believes will help
with issues like housing and health care.

"If someone is severely addicted often they will not be able to access
the services that homeless shelters provide. There isn't housing for
people who are severely addicted."

Holtzman explained that crystal meth is widely used on Vancouver's
streets, and usage has doubled in the past three years, due mainly to
the fact that the drug is cheap to produce and readily available.
Another attraction to the drug for people living on the streets is
that it keeps them alert.

"They're afraid to sleep through the night because of harm so they'd
rather be awake," he said. "It also gets rid of hunger pangs."

"Crystal meth is destructive in the sense that it has the tendency to
alter a mental health issue. It seems to be the worst drug [and] if
you're prone to any mental health disorders, it's certainly going to
bring that to the forefront," he added.

"Right now there's just a bunch of pamphlets saying "'don't use
crystal meth.'"

According to Holtzman, long-term, chronic addiction should be
classified as an illness, in the same category as having diabetes or
AIDS, and this program is a treatment option.

UBC Psychiatry Professor and Chair of Leading Edge Endowment Fund in
Addiction Research Michael Krausz supports the program.

"It's really a good initiative to do something [to make] treatment
more available," he said, adding that substitution and methadone is an
accepted and successful way of treating a drug addiction.

Krausz confirmed the success of similar trails worldwide such as the
NAOMI trial, (North American Opiate Medication Initiative), and he was
responsible for overseeing the Heroin Substitution Trial in Germany,
which had over 1000 patients. One of the goals of the substitution
treatment program is to reduce drug-related crime in the city, and
according to Krausz, "In the German Heroin Trial, there was an
enormous improvement [in crime] over the study period of two years.
[Crime] did go down, so it was effective."