KICKING THE HABIT WITH FREE HEROIN
Vancouver Addicts Will Be Getting Government-Approved Fixes In A Controversial Research Project
As well as helping addicts, advocates say it should reduce drug-related crime, Daniel Girard reports
DANIEL GIRARD WESTERN CANADA BUREAU
VANCOUVER--Phil Denbak will not yet allow himself to dream of a day when he has broken the grip of heroin, his almost constant companion for more than
But he is upbeat about the latest move intended to try to improve the lives of hardcore addicts like him on Vancouver's downtown eastside: free heroin injections. Denbak, 49, is hoping to participate in North America's first prescription heroin trial, which begins here next month before expanding to Toronto and Montreal this spring.
The idea behind the study, which got final approval from Health Canada this week, is to find out if providing addicts with their average three daily fixes will improve their quality of life by eliminating the need to pay for drugs through theft, prostitution or other crimes.
If so, proponents say, then life will be better across the broader community as well with safer and cleaner streets and fewer tax dollars spent on hospitals, policing and the courts.
Similar studies in Europe found addicts' lives improved and crime rates fell. Some users found jobs, many shot less heroin and others got into treatment or quit the drug outright.
Denbak finds it hard to fathom getting clean, though he's tried numerous times. Still, the former house painter, who spends most of his time panhandling, collecting bottles and doing what he can to raise the $50 a day he needs to feed his habit, thinks this could help.
"I'm not going to stop using," Denbak says matter-of-factly, his hollowed cheeks, haggard look and glassy eyes stark testimony of his addiction. "But if I don't have to spend all day getting money for my fix, then I might be able to be more constructive.
"This is part of the solution, not part of the problem."
The North American Opiate Medication Initiative, or NAOMI, is an $8.1 million project funded by the Canadian Institutes of Health Research, a federal agency. It will have 470 addicts at three sites; half of them will get pharmaceutical-grade heroin made in Europe, the others methadone, a drug taken orally to ease cravings and withdrawal.
Those taking heroin will get injections under medical supervision at special clinics. They will get it for 12 months, then transfer over a three-month period into methadone-maintenance or other treatment programs.
With recruitment and transition, the study will last up to two years.
"Right now, these people are injecting contaminated heroin using dirty needles in unsanitary conditions and living a life where they have to commit crime and prostitution to pay for their next fix," says Dr. Martin Schechter of the University of British Columbia, the project's lead researcher. "We're seeing if we can break that cycle."
Schechter stresses researchers will recruit for the study only "the most severe cases of heroin addiction for whom there are no other treatment options." Participants must be 25 or older, have been addicted to the drug for at least five years, including the past 12 months, and have unsuccessfully tried a methadone program at least twice before.
While Schechter admits the hard-core addicts who will qualify for the study may represent less than one-quarter of the estimated 5,000 injection drug users on Vancouver's downtown eastside, they account for a disproportionate amount of crime and other problems associated with heroin addiction.
"This is an acknowledgment that some people are going to continue using drugs whether we like it or not," he says. "The question is, do we treat them as criminals or as people suffering from a medical condition and try to work on getting them better."
The NAOMI project is the latest attempt at liberalizing drug policies in the area, regarded as Canada's poorest neighbourhood. It's also the location of North America's first supervised safe-injection site, which opened in 2003, where addicts inject their own drugs under the watchful eye of medical staff who monitor for overdoses.
'This is part of the solution, not part of the problem'
Phil Denbak, heroin addict
In Vancouver, the police, mayor and some area business organizations are supporting the study in the hope it will help reduce crime and better treat those seen in the past as untreatable.
But critics say free heroin will mean addicts will take more of it or increase their use of other drugs such as crack cocaine and crystal meth, which many of them already abuse. The best way to address the problem is with more detox beds and other treatments, they say.
Conservative MP Randy White (Abbotsford) calls the philosophy of the NAOMI project "totally flawed."
"You can't stop crime by giving people the root cause of that crime," says White, the Conservative critic on drug strategy. "It just doesn't make sense.
"Like it or not, to get off a drug you have to abstain from it."
White, who notes a United Nations report rejects the contention that there were positive outcomes from a Swiss prescription heroin trial in the 1990s, calls this "another shot in the dark" to fight the burgeoning drug problem.
Much better and more effective solutions would be to increase education, advertising, rehabilitation and police enforcement, he says.
"We're off on this other tangent because we've thrown up our hands and said we can't do anything with these people," he says. "So, we put them off to the side and juice them up.
But Ann Livingston, project co-ordinator with the Vancouver Area Network of Drug Users, says while more treatment facilities and programs are needed, the prescription heroin scheme is another way "to treat addiction like an illness, not like a crime."
With evidence in Europe that such programs have not only improved the lives of addicts but cut down on crime, they should have wide appeal across the community, she says.
"Canadians would be very wise to push for this kind of intervention for addicts rather than what we currently do," Livingston says. "I'd venture almost 90 per cent of addicts down here have been charged with a criminal offence and it doesn't stop them using."
Dr. Stanley de Vlaming, who has treated addicts in the downtown eastside for more than a decade, worries that the "high degree of anticipation and hype" among neighbourhood users about NAOMI will skew results in favour of prescribed heroin.
"Addicts are acutely aware that their behaviours and responses during the study may also determine whether free heroin might be available after the study," he says.
De Vlaming also calls the project "premature" because it focuses too much time, money and energy on less than 5 per cent of addicts who don't benefit from methadone. It could result in too many people being in very expensive heroin maintenance programs when they, and many others, could be treated by expanding methadone and other treatment, he says.
But Phil Denbak knows methadone isn't the answer for him. He's tried it three times before and suffered from insomnia, constant chills and repeated nausea.
So, for him, prescribed heroin is one of his only options.
"I'd like to try and get my life back together," he says. "And I think this could help."