Pubdate: Mon, 13 Feb 2006
Source: Globe and Mail (Canada)
Copyright: 2006, The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Author: Deborah Jones
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

DETOXIFYING VANCOUVER'S DRUG CULTURE

Waiting Times Drop, And More Addicts Seek Treatment In City Programs

VANCOUVER -- Six years ago, Vancouver drug addicts who decided to 
break the habit had a six-week wait to enter a withdrawal program. By 
the time services were available, many of them gave up. Today, the 
wait is at most two days, and enrolment in so-called detox facilities 
is growing.

Experts say long waiting times for detox were gradually eliminated 
because the local Coastal Health Authority streamlined admissions 
with a central registry in 2000.

It's an achievement in which the health authority should take some 
pride, provincial health officer Perry Kendall said.

"I would be bragging about this if I had managed to do this," he 
said.Last year, about 4,200 adults and youths were enrolled in 
clinical or hospital withdrawal programs, said David Marsh, an 
addictions specialist with the health authority. Some of the programs 
are new, and enrolment in all is growing, he said.

Participation in long-term treatment has also increased, to 8,270 
heroin addicts in methadone programs in 2004 from 1,000 in 1995.

But these changes have gone almost unnoticed in Vancouver's turbulent 
drug scene. There are constant reports on the contribution of addicts 
to the city's high property-crime rate and gang violence, in addition 
to news stories about North America's only supervised heroin 
injection site and clinical trials to give addicts free prescription heroin.

Vancouver's "Four Pillars" approach to drugs -- prevention, 
treatment, harm reduction and enforcement -- became a federal 
election issue after Stephen Harper said a Conservative government 
would neither support the supervised injection site nor approve other 
locations.

With Mr. Harper now the Prime Minister, B.C. health experts are 
starting to lobby for support in Ottawa for the West Coast's 
health-centred approach to treating drug addiction.

This week, Thomas Kerr, a Vancouver-based researcher on drug use and 
HIV infection, will travel to Ottawa to present his recent research 
to Health Canada and the RCMP.

Dr. Kerr and other researchers have had studies published in the 
Lancet, the Canadian Medical Association Journal and the British 
Medical Journal, with findings showing that the supervised heroin 
injection site has reduced sharing of syringes by heroin users, led 
to improved public order in the Downtown Eastside and had no negative 
impact on Vancouver's drug use patterns.

Local agencies are asking Health Canada to allow Vancouver's 
supervised heroin injection site to continue its operations. It is 
operating under an exemption from controlled drugs and substances 
legislation, which expires in September.

Mr. Kendall, who has made a formal, written request to Health Canada, 
said an evaluation of the facility last fall was "all-round positive, 
with no downsides."

But health experts say the progress is overshadowed by ongoing drug problems.

"Things are significantly better compared to 10 years ago," said Dr. 
Marsh, who moved to Vancouver after eight years as clinical director 
of addiction medicine at Toronto's Centre for Addiction and Mental 
Health. "Overdose deaths are down by two-thirds to three-quarters. 
New HIV infections among injection drug users are down.

"Infectious [heart disease linked to injection drug use] is down by 
40 per cent. Total heroin seizures by police have fallen 
substantially, and the number of people in treatment has gone up 
eightfold," he said.

But the public perception, Dr. Marsh said, is that Vancouver's drug 
scene is constantly worsening. He blames this partly on social 
problems caused by the increased popularity of smoking crack as 
opposed to injecting cocaine, and on the extreme psychotic and 
violent behaviour of a relatively small numbers of crystal meth users.

Experts say the improvements are still not enough. The numbers are 
hard to pin down, but experts estimate there are 5,000 injection drug 
users in the Downtown Eastside neighbourhood alone.

And despite the studies on the supervised injection site, overall 
information about what works and what doesn't, and on drug use in 
general, is lacking, said Ann Livingston, spokesperson for the 
Vancouver Area Network of Drug Users. There is little local 
information on what happens to people after they complete a 
withdrawal program and are discharged without drugs in their system.

According to Dr. Kerr, "If you compare the data on use of drugs in 
the U.S. to Canada, it's a total embarrassment. In the U.S., they 
really know what's happening."

Experts agree that improved detox programs and medical services are not enough.

"Our notion of prevention is very weak," Dr. Kerr said. "We do not 
really acknowledge the social determinants of addiction such as 
poverty, lack of housing and troubled early childhoods. . . . If we 
want to get serious, we need to address the social conditions."
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MAP posted-by: Beth Wehrman