Pubdate: Fri, 19 May 2006
Source: Vancouver Courier (CN BC)
Copyright: 2006 Vancouver Courier
Contact:  http://www.vancourier.com/
Details: http://www.mapinc.org/media/474
Author: Jennifer Moreau, contributing writer
Bookmark: http://www.mapinc.org/decrim.htm (Decrim/Legalization)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)
Bookmark: http://www.mapinc.org/women.htm (Women)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

GRADUATION DAY

Gary Occhipinti is playing tour guide for the day. Leading a group of 
international visitors through the streets of Vancouver, he stops to 
point out buildings and explains the history behind them like any 
other guide. Except the men and women following him aren't 
tourists-they're social workers, researchers and nurses from the 17th 
International Conference on the Reduction of Drug Related Harm, and 
they're touring the Downtown Eastside to see how Vancouver is dealing 
with its drug problem.

As the tour progresses, addicts gather in stairwells and doorways in 
the early morning sunrise. Two toothless men pass by, one hobbling 
and pushing the other in a wheelchair. Police rifle through the 
pockets of a man backed against the wall outside Sheway, a health 
centre for pregnant addicts. Stops on the tour include the safe 
injection site, a drug users drop-in centre, and the corner of 
Dunlevy and Powell where Occhipinti says most of Vancouver's missing 
women were last seen. Tour members pose for photos in front of 
Oppenheimer Park, a site which Occhipinti notes has a long history as 
a drug market.

Occhipinti is a walking piece of history. A self-professed poster 
child for heroin maintenance, he's the first participant to graduate 
from Vancouver's controversial NAOMI trial-the North American Opiate 
Medication Initiative-which gives free heroin to addicts who failed 
to kick the habit through typical treatment such as methadone or abstinence.

Fifty-year-old Occhipinti doesn't look like your stereotypical heroin 
addict. At six-foot-three and 200 pounds he looks thin but has gained 
30 pounds since he started the trial. He has dark, deep-set eyes 
beneath bushy, downward sloping brows. His skin is pulled tight over 
high-set cheekbones and angular features.

Articulate and talkative, Occhipinti is the first of 137 participants 
in Canada to make it through the 12-month NAOMI trial, held both here 
and in Montreal. He's nearing the end of the "cooling down" period 
and has gradually reduced his dose for the last seven months. As the 
end of his supply of clean, prescription heroin approaches, questions 
about his future and the trial arise. Occhipinti is confident he'll do OK.

"I've gotten my habit shrunk down far enough that even if they close 
the doors on me tomorrow I would survive the withdrawal," he says.

After a year of free heroin, NAOMI participants have three months to 
scale down their dose and figure out what they're going to do next. 
But in order to qualify for the trial, candidates had to prove 
conventional treatment didn't work for them. Their post-trial options 
are abstinence, methadone or detox programs, the same approaches that 
didn't work before.

With the two largest populations of heroin addicts in Canada, 
Vancouver and Montreal were the cities chosen for the NAOMI trials. 
Vancouver's drug history is well known. It gained additional 
prominence in 1997 when Health Canada declared a public health 
emergency for the city after health officials discovered one out of 
four injection drug users had HIV. Hepatitis C and TB were out of 
control. In 1998, overdose deaths in B.C. hit a record high of 461, 
most in the Downtown Eastside, according to the Canadian Medical 
Association Journal.

Vancouver's NAOMI trial began enrolling people in February 2005 with 
the offer of a year's supply of free, prescription heroin in 
conjunction with a rigorous clinical trial. NAOMI proponents say 
taking addicts off the street and introducing them to the health care 
system reduces property crime. The idea is they won't need to steal 
to get money for their next fix and that they will have access to 
job-skills training, counselling and assistance in finding housing.

The NAOMI project operates on an $8.1-million budget, an amount 
researchers say is miniscule compared to the social costs of 
addiction. The Canadian Institute of Health Research approved the 
project and wrangled a grant from the federal government to pay its 
costs. NAOMI researchers say 60,000 to 90,000 addicts inject opiates 
in Canada, and each addict costs taxpayers $45,000 per year through 
the criminal justice, welfare and health care systems for a yearly 
cost estimated at from $2.7 to $4 billion.

The cost in lives also continues, with an estimated 1,000 overdose 
deaths in Canada each year. Occhipinti says he knows what overdosing 
means. He claims to have been "clinically dead" when he woke up in an 
ambulance, colder than he'd ever felt, after paramedics injected him 
with Narcan, a drug used to revive addicts. He was surprised he 
hadn't overdosed sooner and was grateful that a friend was brave 
enough to call 911. He says a lot of addicts don't call for help 
because they're afraid of problems with police.

Before NAOMI, Occhipinti got money any way he could. "It's almost 
impossible, unless you're very wealthy, to support your habit without 
stealing and dealing," he says. He sold heroin and prescription 
morphine and stole when necessary.

"I wasn't a very good thief because I'm too noticeable," he says. 
"I'm six-foot-three. It's kind of hard to slide through places and 
not be noticed."

How he's made his money during his time on NAOMI is unclear. He won't 
say what his current source of income is, but is looking for work in 
sales management now that he has more free time.

Born in Kitimat to Italian immigrants, Occhipinti moved to the U.S. 
with his parents when he was a toddler. He started using drugs-mostly 
pot, LSD and mushrooms-at age 14 while living in San Francisco. "It 
was the '60s, it was really exciting," he remembers, noting he never 
saw his own parents indulge in alcohol or drugs. "There was a 
revolution attached to it... there was a sense that the world was 
going to change for the better and people that took drugs in those 
days were not taking them to escape, but to expand."

When he was 16, a friend introduced him to heroin. The drug made him 
feel complete.

"[He] turned me on to something that his brothers were all addicted 
to, his older brothers were all heroin addicts. We thought we would 
try it and, no big deal, use it occasionally," he says. "We both 
liked it. The missing piece is in place and you feel a sense of ease 
and comfort. I'm not talking about being loaded and falling over, I'm 
talking about a sense of being in place that isn't possessed before 
you discover opiates. The problem is they're really addictive and 
very few of us escape that addiction, like myself."

Occhipinti joined the U.S. air force after high school but when drug 
testing became mandatory, he had to choose between honourable 
discharge or drug testing and a probable jail sentence. Occhipinti 
took the discharge. In 1979 he was caught breaking into a pharmacy to 
steal morphine. He was sent to San Quentin for less than a month 
during processing and relocated to another prison for 16 months. In 
1983 he got clean and started college two years later, and in 1988 he 
graduated and went to law school.

In 1991 he started "chipping," using drugs here and there after a 
doctor prescribed him painkillers for a back injury. He graduated 
later that year but a run-in with Nevada police ruined his hopes of 
becoming a lawyer. Police found seven ounces of marijuana and took 
Occhipinti to jail where forced testing showed traces of cocaine and 
heroin in his bloodstream. He was convicted of a felony and spent 22 
months in an Arizona prison.

Occhipinti is divorced with an 18-year old son who lives with his 
mother in Denver, Colorado. Neither his former partner nor his son 
knows about his role in NAOMI. "My son doesn't need to know. He knows 
that his dad has struggled with addiction," Occhipinti says.

Statistics on addiction recovery are hard to pin down. Dr. David 
Marsh, the clinical lead for the Vancouver trial, says putting a 
number to the opiate addicts who get clean is impossible. He says it 
depends on the extent of their addiction, the type of heroin they 
use, what it's cut with and the treatment addicts choose.

Some try methadone-an opiate derivative that blocks the craving for 
heroin and helps ward off the effects of withdrawal. It's as 
addictive as heroin, but a single dose lasts 24 hours whereas heroin 
usually requires three injections per day to avoid withdrawal 
sickness. Many users who transfer from heroin to methadone struggle 
with the powerful new addiction and withdrawal symptoms such as upset 
stomach, constant diarrhea, and muscle cramping, also known as "worms 
in the legs."

But methadone can be hard to get and harder to stay on. Despite a 
tenfold increase in availability over the past 10 years, demand for 
methadone outstrips supply, says Marsh. Spaces in methadone programs 
are limited by the number of well-trained doctors who are licensed to 
prescribe methadone and feel comfortable treating addiction. Only 15 
to 20 per cent of opiate addicts in Canada are on methadone and of 
those who get into a program, studies show, one-third drop out in the 
first year and another third drop out the following year.

Occhipinti is one of the dropouts. He tried methadone a few times but 
it didn't work. "For some people it's a great substitute," he says. 
"For me all it did was it guaranteed that I wouldn't wake up 'sick,' 
as we call it in withdrawal. But it doesn't give you any of the 
euphoria or the sense of well-being that heroin does."

The NAOMI trial's "harm reduction" approach is part of Vancouver's 
Four Pillars drug strategy-harm reduction, prevention, treatment and 
law enforcement. It's a European model championed by former mayor 
Philip Owen and adopted by his successor Larry Campbell and his 
COPE-dominated council. NAOMI researchers cite European studies that 
indicate improved health, a drop in illicit drug use, lower crime, 
and increased employment for addicts treated with heroin.

The NAOMI trial had 108 participants in Vancouver as of May 10. 
Forty-five per cent receive heroin, another 45 per cent methadone and 
10 per cent receive an opiate called Dilaudid, a possible third 
option for treating heroin addiction. Recruitment is ongoing and 
researchers hope to meet their target of 250 participants between the 
Montreal and Vancouver clinics by early 2007.

Not everyone can join. Potential candidates must be at least 25 years 
old with five years of drug use documented through their medical 
records or attendance in detox programs. Using those records, they 
must also prove they tried to kick heroin twice and failed. Anyone 
facing criminal charges is ineligible, because researchers don't want 
participants hauled off to jail in the middle of the research trial.

Participants must live close to the trial's clinic at Abbott and 
Hastings, so Occhipinti moved from Mount Pleasant into an SRO hotel 
in the Downtown Eastside to qualify. "To begin with I had to live in 
the Downtown Eastside area and it was a horrible experience: bedbugs, 
cockroaches, murders, stabbings, overdoses, poverty, despair, I mean, 
you talk about neglect, police brutality," Occhipinti says. "You live 
there every day for a while, and I thought, I've been to prison, San 
Quentin, I've done all that, but living down in one of those skid row 
hotels..."

Participants attend the clinic three times a day. A nurse gives out 
the drugs in clean, pre-filled needles. Participants shoot up under 
supervision at the clinic and stay for half an hour so their health 
can be monitored. The nurse keeps track of the heroin closely from 
behind a glass booth. Each syringe is labelled with a barcode that's 
scanned going out and scanned when it's returned empty. Participants 
can't leave the building until they return the needle. Security is 
tight and the place is rigged with surveillance cameras.

The results of the NAOMI trial won't be available until 2008. 
Speaking at the international conference on reducing drug-related 
harm, Marsh reminded conference-goers and journalists that 
researchers haven't finished the study. He says results might 
indicate the need for more and improved methadone programs, which 
would also be cheaper than prescribing heroin, but the data is still 
being collected on which treatment worked best with the trial's participants.

And as some of these addicts, including Occhipinti, approach the end 
of the trial, the ethics of the program have come under scrutiny. The 
key question: will the addicts, whose lives may or may not have been 
helped by a year's supply of prescription heroin, be allowed 
continued access to the drug once the trial is over?

Marsh told the conference he's discussed the possibility of 
continuing the program with "various levels of government" but 
because of mixed response he can't promise trial participants 
anything other than the original deal-one year of heroin and treatment.

Marsh pointed out that in most clinical trials, if the treatment is 
working, it's standard procedure to continue with the drug. But 
because heroin is illegal, he would be breaking the law if he 
continued to give out the drug, even if participants benefited from 
the treatment.

Bryan Alleyne, a worker at Vancouver's safe injection site and former 
president of VANDU, an advocacy group for drug users, originally 
thought the NAOMI project would get addicts out of crime and 
prostitution. But he has since changed his mind. "Now that we're 
coming to the end of the project, I really don't know what's going to 
happen," he says. "If people are going to revert back to crime, 
because they do have to feed their habit- their habits have become 
enormous since this here NAOMI project."

Alleyne says trial participants need help with job training or 
schooling to become productive members of society. He wants to see 
the program continue and says addicts will end up back where they 
started once the research is over. "If you cut people right off, 
people have to survive, they have to feed their habit. Because if 
you've been in this program for a year, you got more than a monkey on 
your back, you got King Kong on your back because they've been 
getting the best of dope."

The Dutch government conducted a similar trial to NAOMI in Holland. 
According to its results, 81 to 87 per cent of addicts returned to 
dysfunctional lifestyles after their free heroin was cut off.

NAOMI spokeswoman Julie Schneiderman notes that the trial is a 
research study, not a treatment program, and while the researchers 
are open to the idea of continuing heroin as treatment, they don't 
have the money to pay for it or the legal permission to do so. In 
2005 Health Canada issued an exemption under section 56 of the 
Controlled Drugs and Substances Act that allowed the trial to use 
heroin for research purposes only. Prescribing heroin beyond the 
original 15 months would be breaking the law.

Schneiderman says government policy makers will decide what to do 
after the trial. She hopes they base decisions on evidence, not 
emotion or morality.

Timothy Christie, a health care ethicist with the B.C. Centre for 
Excellence in HIV/AIDS, says the original point of the study was to 
see if heroin prescription helped chronic addicts. Christie says 
addicts could be healthier and kept off the streets if the federal 
government changed the drug laws. "That's part of the reason we're 
doing science is to give evidence to the government to change 
regulations," he says.

Extending the prescription heroin program would require approval from 
two divisions of Health Canada: the Office of Controlled Substances, 
which deals with illicit drugs, and the Therapeutic Products 
Directorate, which regulates pharmaceutical drugs. But federal Health 
Minister Tony Clement ultimately holds power over any exemption to 
the control of heroin.

Robin Walsh, spokesman for the minister, says Clement inherited the 
trial from the previous Liberal government but will honour the 
agreement. He says Clement wants to focus on prevention and treatment 
for drug addiction but couldn't offer any examples on what those 
might be. He says it would be inappropriate to speculate on extending 
heroin treatment until the final results are released. "We'll be 
watching carefully on the outcomes of the project," he says.

At 7:40 p.m. in early May, NAOMI participants shuffle out of the 
clinic on to Abbott Street after their evening injection. Two women 
stop to talk about their experience so far. Both think the program is 
great, one says she no longer has to sell her body and can sleep at 
night. The other has gained 40 pounds. Occhipinti steps out onto the 
sidewalk. Wearing a white dress shirt and dark sunglasses, he looks 
as if he just left a business meeting rather than a heroin clinic. 
Walking quickly down Hastings, he says he wants drugs decriminalized.

"It's like Sam Sullivan said- you know what, this isn't about fixing 
a problem that's a short term problem with an instant solution. This 
is something that you have to learn to live with. I thought he was 
very eloquent when he said the disabled as a group- realized they 
didn't want doctors controlling their lives. Assistance? Absolutely. 
Guidance? Sure, when it's needed. But control never. That's my stance 
on prohibition."

He's glad he joined the trial but fearful about facing the end. 
"Nothing like this has ever happened to anybody, this is a brand new 
thing for a Canadian."

Schneiderman says people coming off NAOMI heroin will get the best 
treatment available. But Occhipinti says he already knows methadone 
isn't an option for him. "The definition of insanity is repeating the 
same action over and over again and expecting different results," he 
says. "I refuse to do that. In other words, it never worked before 
over a 20-year period of sporadic attempts where one time I was on 
for a year and I was suicidal the whole time, slept 20 hours a day 
and never felt worse in my life."

Based on the Dutch research, there's a four out of five chance 
Occhipinti will end up back where he started before the trial. He 
says he has no choice but to face withdrawal. "I could continue to 
purchase street heroin but I don't want to go back to that life 
cycle. That was the whole purpose of the experiment to see if you 
could escape. For myself, I'm part of that big cohort of people who 
would like to be clean eventually, but making it illegal does not 
help me get clean."

Occhipinti says freedom was his biggest motivation for trying to 
quit. "Nobody wants to be tied to a substance or a problem. There's a 
part of most human spirits that wants freedom. [For] some of us it's 
huge, some of us it's tiny but I believe it's a part of almost everyone."
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MAP posted-by: Beth Wehrman