Pubdate: Tue, 21 Oct 2003 Source: Montreal Gazette (CN QU) Copyright: 2003 The Gazette, a division of Southam Inc. Contact: http://www.canada.com/montreal/montrealgazette/ Details: http://www.mapinc.org/media/274 Author: Aaron Derfel, The Gazette Bookmark: http://www.mapinc.org/heroin.htm (Heroin) ADDICTS TO GET FREE HEROIN Gradual weaning. 150 to be recruited for Montreal portion of three-city study The idea sounds like the farthest thing from drug rehabilitation: give heroin addicts free shots of pharmaceutical-grade smack to help them kick their habit. Yet that's precisely what doctors in Montreal, Toronto and Vancouver hope to do in a controlled study early next year. Researchers plan to recruit about 150 heroin addicts for the Montreal portion of the study. The addicts will be encouraged to shoot up in a downtown clinic under the supervision of a nurse up to three times daily, seven days a week. Half of the addicts will be given heroin, and the other half methadone. No one - not even the doctors - will know who has taken either drug until the two-year study is concluded. In Vancouver, news that a clinic might open a block away from a school and day-care centre has some area residents worried. In Montreal, researchers haven't found a location, although it will probably be downtown. Dr. Suzanne Brissette, who treats drug addicts at St. Luc Hospital, said the study is being modelled after successful programs in Switzerland, the Netherlands, Germany and Spain. "The idea is to first stabilize addicts with the heroin," Brissette explained. "These persons will be in contact with nurses, physicians and social workers many, many times a day. At the same time, they might be given other medications they need for infections, for HIV, for depression and other psychiatric problems." The goal of the research is to get addicts off the streets, where they often use dirty needles to inject themselves with potentially fatal doses of sub-par heroin. Knowing that they have a steady supply of high-quality heroin, the addicts would be less likely to resort to crime to pay for illicit drugs. "When a heroin user shoots up on the street, his pusher doesn't care about his health," Brissette said. "The pusher cares only about making money and selling drugs. So this is very different. It's done in a very therapeutic fashion." Methadone, usually taken in the form of a syrup, is the standard treatment to wean addicts off opiates. However, up to 50 per cent of addicts don't respond to the treatment and continue to shoot up. The Canadian researchers are seeking to find out whether giving addicts heroin in a supervised manner might be more effective. Patients will be followed for two years. They will be allowed to take heroin for one year, and then will be weaned off the drug during a three-month period while undergoing counselling. Brissette noted that under a Swiss study, none of the addicts overdosed and some wound up taking less heroin than allowed. That study revealed a decrease in the use of street heroin and cocaine, a drop in crime among the addicts, and an increase in employment. In addition, 30 per cent of the addicts later switched to methadone treatment and abstinence-oriented programs. Heroin addiction brings a high cost to society in drug- related emergency room visits, loss of employment and incarceration for crimes. A Toronto study has pegged the cost to society at $45,000 per heroin user. Public-health authorities estimate there are up to 100,000 users of such illicit opiates as crack cocaine and heroin in Canada. In Montreal, the researchers set up an advisory committee in 1999 to lay the groundwork for the study. Business representatives, community activists, the RCMP, Montreal police, the Surete du Quebec, local politicians and public-health officials were involved in the committee's deliberations, Brissette said. Jean-Luc Thibault, press attache to Saint-Jacques Councillor Robert Laramee, sat in on some of those meetings. "For Mr. Laramee, this project deserves to be studied," Thibault said, noting that Saint-Jacques district has a high number of injection-drug users. "The issue is how it should be established and where." Brissette said she understands potential concerns by the public about the project - dubbed NAOMI - but that people shouldn't get upset. "It's out of the question that users will be allowed to take heroin home," she said. "The research protocol is very controlled and very strict." To qualify for the study, each addict must undergo a physical and mental assessment. Those with severe medical or psychiatric conditions will be excluded, as will those on parole or probation for criminal activity. Brissette said researchers must still obtain permission from many regulatory bodies to let doctors prescribe heroin. - - - - By the Numbers Illicit heroin use in Canada Estimated number of heroin users 60,000 to 100,000 Drug overdose deaths per year 500 to 1,000 HIV prevalence estimates among injected-drug users 9.5% in Toronto 17.9% in Montreal 25% in Vancouver Hepatitis C in injected-drug users across Canada 60% to 95% Source: Benedikt Fischer, Public Health Sciences and Criminology at the University of Toronto - - - - The Social Cost Total cost of untreated heroin use Average annual social cost per user (in Toronto sample) $45,000 (Hypothetical) social cost projections 115,000 heroin users in Toronto $675 million 50,000 to 90,000 heroin users in Canada $2.25 to $4.05 billion The breakdown of major social cost Crime victimization 44.5% Law enforcement 42.3% Productivity losses 7.0% Health care costs 6.2% Source: Benedikt Fischer, Public Health Sciences and Criminology at the University of Toronto - - - - The Signs Characteristics of untreated heroin users According to a Toronto-based study Prevalence of the following signs (in last 30 days) Regular alcohol use 70.2% Crack/Cocaine use 57.9% Benzodiazepine use 60.5% Daily drug injection 84.2% Serious acute health problems 54.4% No permanent housing 51.8% Illegal activities for income (avg. $1,432) 67.5% Prevalence of the following signs (in last 12 months) Needed medical help but did not seek any 41.1% Multiple overdose experiences 50% Drug-related ER visit (avg. 4.2 times) 62.3% Arrested for drug or property offence 51.4% In prison or jail 42.1% Source: Benedikt Fischer, Public Health Sciences and Criminology at the University of Toronto - --- MAP posted-by: Terry Liittschwager