Pubdate: Fri, 27 Jan 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Author: Camille Bains
Page: C1


Vancouver's medical-heroin program was modelled after treatment
started in Switzerland in 1990s

The smell of rubbing alcohol permeates a tiny room where chronic
heroin users inject a pharmaceutical-grade version of the drug three
times a day just to feel normal.

Justin Hall, 48, exits the freshly cleaned injection room at the
Crosstown Clinic in Vancouver's Downtown Eastside after his second
visit of the day. He plans to return in the evening for his third
"shift," the same routine he has followed for 2 1/2 years.

"A lot of people just muscle it, they don't bother with the veins,"
Hall says as the next group of people lines up outside the room
containing eight orange chairs in front of a counter and a mirrored

Nurses behind a glass wall slide doses of heroin through an opening,
dispensing an average of 200 mg of heroin. Patients must inject the
opioid and leave the room within seven minutes before it's cleaned for
the next group.

"It just levels me out," Hall says five minutes after the shot. "For
most addicts the use of getting high is a thing of the past. It's just
to keep a person level, just normal."

About 94 participants come into Crosstown two or three times a day,
rotating through a schedule starting at 7:30 a.m. and ending at 10:05
p.m. at the only clinic in North America that provides treatment with
supervised medicinal heroin, or diacetylmorphine.

"It's clean, it's safe, it's what I need to get through the day," Hall
says. "And I'm not being a burden to anybody else. I'm not committing
crimes or abusing anybody. I'm not hustling for money."

Hall says he began using marijuana, cocaine and other drugs at age 18
and then became addicted to heroin for 15 years before getting into
treatment at Crosstown.

"A lot of people would be dead if it wasn't for this place, that's
guaranteed, not just because of the fentanyl," the former construction
worker says of the potentially deadly painkiller that's often cut into

The B.C. Coroners Office says 914 people died of overdoses in British
Columbia in 2016, the highest number of annual fatalities in a
Canadian jurisdiction ever attributed to illicit drugs, including fentanyl.

Hall says that besides the pure heroin he receives at Crosstown,
support services at the clinic have allowed him to leave a single-room
occupancy hotel and move into stable housing so his four daughters can
visit him.

"There were quite a few years there when I didn't have much contact
with them. They see that my life has stabilized and I'm able to see
them when they come for visits."

Most people who chronically use heroin don't take it for the high but
to avoid becoming "dope sick" with withdrawal symptoms, such as
vomiting, sweating and diarrhea, Hall says.

"I definitely see myself having a job, working somewhere, making
money. I may still be going to the program, maybe not going three
times a day, maybe twice a day," he says, adding some Crosstown
patients go to work between injections.

Dr. Scott MacDonald, lead physician at Crosstown, says the program was
modelled after supervised heroin assistance treatment that started in
Switzerland in the 1990s.

"They are now closing clinics," he said of the successful outcomes in
that country. "They've solved their opioid problem. With adequate
treatment they basically have stopped recruiting new people into the

He says about 15 patients at Crosstown have transitioned to other less
intensive treatments, such as methadone or suboxone, as their lives

MacDonald says Crosstown clients tried and failed to quit an average
of 11 times with other treatments.

"This is not a lifelong treatment for everyone. Some people need an
intensified treatment option. They will get some order into their
lives, get healthier, get reconnected with their families, get back to

MacDonald, who testified before the U.S. Senate committee on homeland
security and government affairs in June as part of its research into
Vancouver's experience with addiction treatment, says officials from
Seattle have visited Crosstown, as has the mayor of Ithaca, New York.

He says the clinic's pharmaceutical heroin is brought in from
Switzerland but the lack of an import-export agreement involving
controlled substances between the two countries means multiple permits
are required as part of an onerous process that has the drug arriving
via Scotland.

The heroin could be made domestically if a drug company stepped up to
produce it and Health Canada provided it with a drug identification
number, MacDonald says, adding at least 500 more people in Vancouver
alone would be eligible for pure heroin treatment if the Crosstown
program were expanded.

He says the need is great across Canada. "What we need is the
provinces stepping up and saying there's a market. It's a safe,
effective, cost-saving approach."
- ---
MAP posted-by: Matt