Canada Offers Hard-Core Junkies Free Heroin In Study

by Am Johal

(IPS) VANCOUVER -- A year and a half after opening North America's first safe injection site, Vancouver will soon be the first city in the region to prescribe free heroin to about 158 addicts in carefully monitored clinical trials.

"This is more than establishing a standard of care, it's about establishing a standard of caring," said Dr. Dan Small of the PHS Community Services Society, a local non-profit advocacy group. "For the participants of this study who are suffering, this is not a pilot project, this could be a life-saving intervention."

Two other countries -- Switzerland and the Netherlands -- have already approved regular treatment with heroin maintenance as part of the continuum of care.

"Each research subject will be on either heroin or another approved treatment substitute such as methadone," explained Dr. David Marsh, a professor in the Department of Healthcare and Epidemiology of the University of British Columbia.

Marsh himself has worked for eight years to have the North American Opiate Medication Initiative (NAOMI) study approved, which required an exemption of Section 56 of the Controlled Drug and Substances Act.

The trial hopes to determine the most effective way to treat certain opiate-addicted people, especially those who have not responded to standard interventions.

But some addicts in the community are already criticizing parts of the study, which requires participants to give urine samples, and to reveal their medical history and criminal records, if they have one. They feel that there are too many barriers to enter the program and that it does not include enough participants.

The site location is in Vancouver's downtown eastside neighborhood, not far from where the Olympic Games will take place in 2010. It is located near the existing health board-managed safe injection site where users bring in their own drugs from the street.

The purity of heroin available on the street has been an issue in the past and was deemed to be a contributing factor in many overdose deaths.

The recruitment of participants will take place over the next year; each will be part of the study for one year. Due to the staggered time frame of entry, the study will take over two years to complete and will include Montreal in May and Toronto a few months later.

Initially, the study will take addicts with a documented case history of five years of heroin dependence. They must be 25 years of age or older, have tried methadone more than once, and live within a mile of the study site.

The study is being funded by the Canadian Institute of Health Research Studies and supported by the British Columbia Ministry of Health and Health Canada.

"Much of the criticism is limited to addiction specialists who question the ethics of the study," said Jim Boothroyd of the Center for Excellence in HIV/AIDS. "This study, however, has been reviewed by the ethical review boards at the University of British Columbia, McGill in Montreal and the Center for Addiction and Mental Health, which is affilliated with the University of Toronto."

Business groups and some resident associations are also unhappy with the expansion of drug treatment services in the neighborhood. Provincial cuts, including placing limits on the length of time an individual can collect social assistance, has increased homelessness in the area, where drugs are readily available.

Since 1990, over 2,000 overdose deaths have been recorded in the province. In 1997, Health Canada declared a public health emergency in the downtown eastside neighborhood, where the HIV/AIDS rate was almost 25 percent among drug users, and tuberculosis and hepatitis C rates were abnormally high.

This led to numerous turf wars that pitted competing neighborhood interests against one another.

Vancouver's former coroner, who handled many of the overdose deaths, was elected mayor in 2002 and says he supports the heroin study.

"For those who can't stop taking drugs, this is an attempt to stabilize their life," said Mayor Larry Campbell. "This program is designed to get to the most chronic users."

Dean Wilson, the former head of a health board-funded drug user group and the subject of a documentary on Vancouver's drug problem, also praises the initiative.

"If we truly believe that addiction is a medical condition, then we need to treat it as such -- we need to treat this as a medical issue, not a criminal issue," he said.

Wilson believes the research project is the appropriate action and should not have taken so long to get started. He says he is personally acquainted with the first subject to join the study, and has already noticed differences in the person he has known for over 25 years.

"He doesn't have to run around all day figuring out how he's going to get his next fix -- you can see the difference it makes to his self-esteem. I can notice the difference in him after one day."

Kim Kerr, executive director of the Downtown Eastside Residents Association, sees it this way: "We all make bad choices in life, and if the choice is made and someone becomes addicted, then we still have a responsibility to treat addiction as a health issue -- it's a common sense thing."