Pubdate: Mon, 26 May 2008
Source: Globe and Mail (Canada)
Copyright: 2008 The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Author: Justine Hunter
Cited: North American Opiate Medication Initiative http://www.naomistudy.ca/
Cited: Canadian Institutes of Health Research 
http://www.cihr-irsc.gc.ca/e/193.html
Cited: Vancouver Area Network of Drug Users http://www.vandu.org
Bookmark: 
http://www.mapinc.org/topic/North+American+Opiate+Medication+Initiative
Bookmark: http://www.mapinc.org/topic/Insite (Insite)

MEDICINAL HEROIN PROJECT WINDING DOWN

VICTORIA -- The opiates flowed from Europe, under heavy guard. 
Shipped in powder form, they came in tidily packaged vials, 24 to a 
box. In each vial were 10 grams of pure heroin - just add water.

Most of the shipments ended up in a nondescript building in 
Vancouver's Downtown Eastside, stored in a vault behind bulletproof glass.

Throughout the day, a stream of hardcore heroin addicts would arrive 
for their fixes. Each was allowed three visits a day.

Now the flow of clients has almost stopped. Only a handful remain in 
the final weeks of North America's first medically prescribed heroin trial.

The program is coming to a close, just as the fate of Vancouver's 
safe-injection facility, Insite, remains unclear. The Conservative 
federal government has yet to decide whether to approve the 
continuation of that facility's exemption from drug laws - whereby 
addicts are allowed to bring and inject their own drugs - which 
expires on June 30. Both programs are studying harm reduction, but 
the $8-million North American Opiate Medication Initiative, funded by 
the Canadian Institutes of Health Research with the approval of 
Health Canada, offers heroin addicts a path away from the illicit drug trade.

At NAOMI, participants receive medically prescribed heroin or another 
opiate, hydromorphone (Dilaudid), in a bid to keep them away from street drugs.

Each of the participants, drawn from Montreal and Vancouver, had been 
addicted to heroin for many years.

Each had failed repeatedly to get off the drug using the best 
existing treatment, methadone.

Martin Schechter of the University of B.C.'s faculty of medicine is 
the lead investigator. While his subjects return to their lives, he 
is working on a final report to be published later this year.

The preliminary findings are encouraging. Dr. Schechter noted that 
the treatment proved extremely safe and created no security problems. 
Eight-five per cent of the participants stuck with their year-long treatment.

Dr. Schechter's team is trying to determine whether there is an 
economic case to be made for heroin therapy. Dutch and German studies 
have found the treatment is more cost effective than paying the price 
for health and criminal-justice services for those using street drugs.

In Canada, the estimated cost of an untreated heroin addiction 
exceeds $45,000 a year. The Europeans found savings of roughly 
$20,000 a year for those taking prescribed heroin.

"It's an argument that should appeal to the most hard-hearted fiscal 
conservative," Dr. Schechter said.

There is also the human cost of heroin addiction.

"We had women coming up to the research team, thanking us because 
they had been able to stop selling their bodies. We had a fellow who 
decided to skip the midday session so that he could hold down some jobs.

"What was really common was that people would say that, for the first 
time, they didn't wake up thinking about how to get their next fix."

That was the case for a participant known as Jazzman. When he was 
accepted into the program in Vancouver, he had been on and off hard 
drugs for more than four decades. He first stuck a needle into his 
arm at age 15. He will be 58 this year and his body bears the 
evidence of a harsh existence: liver damage, lung problems and 
deteriorated discs.

Sometimes he kicked his habit. Sometimes he managed his addiction 
while keeping a home and holding a job. But for the past eight years, 
he has been on a downward spiral. Now he is living in the Downtown 
Eastside, the poorest, roughest neighbourhood in Canada.

"I would have been dead if I hadn't hooked up with NAOMI," he said in 
a recent interview.

"I was a basket case, totally emaciated, having to hustle and sell 
everything I had to make it through one more day, one more fix. One 
fix is $10 but I don't feel that ... I need $30 worth."

While he was in the program, Jazzman went through the secured, 
frosted doors three times a day, seven days a week, for a year.

He would receive a loaded syringe from a nurse. He would sit at a 
sterile, stainless-steel counter to inject. He would then sit in a 
bland waiting room to recover from the drug's effects before heading out.

"There was this sense of relief. I wasn't going to go insane getting 
what I needed. It was stopping the nightmare."

In between injections, he was eventually able to find some work. He 
is now out of the program and, under the treatment of a doctor, takes 
morphine. He says he will not even dabble in street drugs now.

Others he knows who were in the program have gone back to their 
precarious street lives, but he believes that this time, he can stay 
clean. "NAOMI did an awful lot of good. I was very determined to get 
my life back."

As they prepare their report, the researchers will follow the 
progress of Jazzman and the other participants. But that leaves in 
limbo some troubled, vulnerable people who could benefit from 
continued treatment.

Last November, doctors appealed on compassionate grounds to extend 
the program on behalf of five participants. So far there has been no 
agreement from either Health Canada or the regional health authority.

Infrastructure is also a problem. In June, the clinic in the Downtown 
Eastside will shut its doors, unless the Vancouver Coastal Health 
Authority finds the money to keep it open in some form.

Dr. Schechter's researchers knew from the outset that they would have 
to let their subjects go after a year of treatment, even though it 
meant watching them return to their high-risk lives on the street.

But it's still painful, he said. "You have people you can see with 
the naked eye are benefiting tremendously; it feels terrible to deny 
them the continuing benefit of that, knowing there is a strong chance 
they could go back to using dirty needles and facing those risks."

Ann Livingstone, a co-ordinator for the Vancouver Area Network of 
Drug Users, expects the final report to support the science of heroin 
therapy, but she has little hope the federal government will accept 
such findings.

"Of course it's a success," she said of the program, but adding that 
the effort might have been for nothing. "And it's not fair to people 
who become stable to have it discontinued because of the whim of 
someone's politics. That's the horror of it all." 
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MAP posted-by: Richard Lake