A Fix For Vancouver's Addicts

In February, Vancouver became the first city in North America to begin clinical trials for heroin prescription. This step, which required an exemption of Section 56 of the Controlled Drug and Substances Act, came a year and a half after Vancouver had opened North America's first safe injection site.

Dr. David Marsh, a University of British Columbia clinical associate professor in the Department of Healthcare and Epidemiology says, "Each research subject will be on either heroin or another approved treatment substitute such as methadone." According to Marsh, Switzerland and the Netherlands have already approved regular treatment with heroin maintenance as part of the continuum of care after over 20,000 patient years of research. Marsh himself has worked for eight years in Canada to have the North American Opiate Medication Initiative (NAOMI) study approved.

Some addicts in the community have criticized parts of the study, which require participants to give urine samples, reveal their medical history and a criminal record 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, in the downtown peninsula, 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 intake of participants for the study will happen over the next year and each participant 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, daily use for a year, 25 years of age and older, have tried methadone more than once and live within one mile of the study site. The project is funded through the Canadian Institute of Health Research Studies and supported by the B.C. Ministry of Health and Health Canada.

Jim Boothroyd, communications director for the B.C. Center for Excellence in HIV/AIDS, says," Much of the criticism is limited to addiction specialists who question the ethics of the study. 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."

There has been criticism of the expansion of health services in the downtown eastside neighborhood by business groups and some resident associations who feel that the expansion has only exacerbated the problems. Provincial cuts including placing limits on the length of time an individual can collect social assistance has increased homelessness in the neighhborhood where drugs are readily available.

Since 1990, there were over 2,000 overdose deaths in British Columbia and by 1997, Health Canada had declared a public health emergency in the downtown eastside neighborhood, where HIV/AID rates were reaching 25 percent of drug users and TB and Hepatitis C rates were abnormally high. This led to numerous planning and zoning turf wars that pitted competing neighborhood interests against one another.

Larry Campbell, the former coroner who had dealt with many of the overdose deaths, was elected mayor in 2002. Mayor Campbell says, "For those who can't stop taking drugs, this is an attempt to stabilize their life. This program is designed to get to the most chronic users."

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