Pubdate: Thu, 02 Mar 2000
Source: Globe and Mail (Canada)
Copyright: 2000, The Globe and Mail Company
Author: Rod Mickleburgh


B.C. Facing Worst Hepatitis C Epidemic In The Western World

Vancouver -- Faced with the worst hepatitis C epidemic among needle drug
users in the Western world and continuing high AIDS infection rates, health
experts here are pressing their call for North America's first sanctioned
site for the safe injection of illegal drugs.

"We have to stop looking at this as a criminal issue rather than a health
issue," Dr. Perry Kendall, the province's health officer, said yesterday.
"There is still a lot of resistance to the idea, but I think we're getting
there. I'm optimistic."

His comments followed the disclosure by a leading AIDS specialist that up
to 90 per cent of injection drug users in B.C. are infected with hepatitis

That is the highest reported rate in the Western world, according to Dr.
Michael O'Shaughnessy, director of the B.C. Centre for Excellence in

"The projected costs of this epidemic to the health-care system are
estimated to be in the millions of dollars," said Dr. O'Shaughnessy, noting
that treatment is complicated by the fact that more than 25 per cent of
infected drug users also have the AIDS virus.

"We need to wake up to the very real implications of hepatitis C on our
health-care, social-services and justice systems."

He based his findings on his centre's continuing study of 1,500 injection
drug users living on the city's drug-ravaged Downtown Eastside, where an
estimated 5,000 to 7,000 people inject drugs such as heroin and cocaine.

Dr. Kendall said he is disturbed by the high incidence of infection among
drug users.

Unless measures are taken soon to combat the spread of hepatitis C, the
province will be confronted with an inordinate demand for liver transplants
within the next five to 15 years, as the disease takes its toll, he warned.

Hepatitis C, which attacks the liver and can be fatal, is generally far
more acute among injection drug users because so many also suffer from
other serious health problems.

Dr. Kendall said anecdotal evidence is very strong that comprehensive, safe
injection programs in European cities such as Frankfurt have reduced the
spread of HIV infection and hepatitis C among drug users and dramatically
cut the number of deaths from drug overdoses.

He said authorities here should even consider a clinical trial into the
effects of providing prescription heroin to drug addicts, as is the
practice in several European countries.

Dr. Kendall said Canadians have shied away from the idea of providing safe
locations for injecting drugs because of proximity to the United States,
where the emphasis is on crime prevention instead of harm reduction.

"So, the result is that we have lots of unsafe shooting sites."

Diane Riley, the Toronto-based deputy director of the International Harm
Reduction Association, said she was ashamed of Canada's failure to try to
reduce the harmful effects of needle use by drug addicts through safe
injection sites.

"I have been to extremely poor countries where they do far more with less
than we do with all our resources. It's shameful," Ms. Riley said. "The
only barrier I can see is the political will."

She said very recent data from Australia, which has a strong harm-reduction
policy, indicate that the rate of hepatitis C infection among drug users
has been cut by 20 per cent, while the incidence among new users is down 40
per cent.

"We absolutely need to look at this here. We cannot not do it."

She said the Australian results are remarkable because the spread of
hepatitis C is harder to control than the AIDS virus, since there are more
methods of transmission.
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