HTTP/1.0 200 OK Content-Type: text/html Is Free Heroin Just a Quick Fix?
Pubdate: Mon, 31 Jan 2005
Source: Globe and Mail (Canada)
Page: A1 - Front Page
Copyright: 2005, The Globe and Mail Company
Author: Jane Armstrong
Cited: Centre for Addiction and Mental Health
Cited: Canadian Institutes of Health Research
Bookmark: (Heroin)
Bookmark: (Methadone)


VANCOUVER -- On a warm, rainy Saturday morning, Debbie Woelke stops pushing 
her shopping cart long enough to discuss the pros and cons of a plan to 
give free heroin to drug addicts in Canada's poorest neighbourhood.

The heroin trial is all the talk of Vancouver's Downtown Eastside and Ms. 
Woelke, 48, thinks it's a good idea. She might even apply, herself. "They 
should have done this a long time ago," she said leaning on her cart, which 
contains all her worldly belongings -- not groceries.

Like other addicts, Ms. Woelke lives in a bleak rented room in a 
residential hotel. Far better to be outside in the rain, even if it means 
wheeling around your clothes all day.

"Sometimes you need something just to relax and get your mind together, 
instead of always being in a state of panic. That's what's killing everyone 
down here," she said, pointing to the throngs of bedraggled souls shuffling 
along East Hastings Street. Like Ms. Woelke, they must hit the pavement 
every day to raise enough cash for their drugs. Most steal. Many women work 
as prostitutes.

"They have to do things they wouldn't normally do."

This is exactly what some of Canada's top addiction experts want to find 
out when they begin the first heroin prescription trial in North America.

If heroin addicts are freed of their daily chase for drugs, if it is given 
to them three times a day like medicine, can they change their lives for 
the better?

In a couple of weeks, the research team will begin taking applications here 
in Vancouver and later in Toronto and Montreal from addicts who want to be 
part of the study.

Researchers are looking for hard-core addicts, people who have tried and 
failed at least twice to get clean. In the three cities, there are spots 
for 428 addicts, roughly half of whom will receive heroin for a year; the 
other half will receive methadone, an artificial opiate that controls the 
cravings for heroin.

In Vancouver, the trials are causing a stir on the syringe-littered streets 
of the city's skid row, home to more than 4,000 drug users. Among those who 
deal first hand with these chaotic lives, there's a feeling that Canada is 
breaking new ground in how it treats the most intractable of drug addictions.

Similar studies in the Netherlands and Switzerland have shown positive 
results for addicts.

"What if you could say to an addict, 'For the next little while, you're not 
going to have to get your drugs from Al Capone. You can get your drugs from 
Marcus Welby,' " said Dr. Martin Schechter, the project's lead researcher.

"You don't have to worry about this afternoon and this evening. And 
therefore, you don't have to go and break in to cars or be a prostitute. 
You could actually come and talk to a counsellor or . . . get some skills 

It's a landmark study in North America, one that turns its back on 
abstinence as the goal.

But not everyone is thrilled with the prospect of free heroin for hard-core 
addicts. And even supporters have expressed concern about the ethics of 
offering heroin to addicts for a prescribed period of time. Is it fair to 
yank away their heroin at the end of the year?

Addiction experts in Canada have already expressed concerns about the risk 
of overdoses.

Last December, two staff physicians at Toronto's Centre for Addiction and 
Mental Health wrote scathing critiques to the ethics adviser of the 
Canadian Institutes of Health Research, the agency funding the study.

Vancouver physician Stanley deVlaming is worried the trials are designed to 
garner positive results. In Vancouver, 88 subjects are to receive heroin, 
while 70 will receive methadone, the heroin substitute.

"How meaningful will it be to compare the group of 88 elated subjects that 
win the heroin lottery to the group of 70 who were also desperately trying 
to get the free heroin, but lost the luck of the draw?" asked Dr. 
deVlaming, who has treated addicts in the Downtown Eastside for more than a 
dozen years.

"The first group would likely be very motivated to give the researchers 
positive results, while the second disappointed and disgruntled group 
randomized to methadone would be much less motivated."

As expected, the plan has rankled U.S. drug officials, specifically the 
office of White House drug czar John Walters, where an official called it 
an unethical and "inhumane medical experiment."

Offering free heroin to addicts when there are proven treatments for 
addiction can't be justified if the addict's desire is to get off drugs, 
policy analyst David Murray said.

"What you're doing is making it easier to be a heroin addict," he said from 
Washington. "These people won't get that much better in the long run. They 
will still be heroin addicts."

Washington's disapproval was expected and hasn't deterred Ottawa from 
funding the study. The Canadian Institutes of Health Research has committed 
$8.1-million for the trials.

In Vancouver, the plan has the support of top politicians and law 
enforcers, including the mayor and the police chief.

Mayor Larry Campbell, who was once a coroner and drug cop, said the trials 
are needed because current treatments aren't working for hard-core addicts.

"The critical thing is to accept this as a medical condition," Mr. Campbell 

"The side effects of this medical condition is that it forces you to . . . 
do things that you would never do, be it work as a sex-trade worker, be a B 
and E [break-and-enter] artist or a purse snatcher. So if I can mitigate 
that by putting you on heroin, imagine the changes you could have."

Right now, the trial is waiting for Health Canada to grant the necessary 
exemption form the Canadian Narcotics Act.

Ms. Woelke said she plans to tell her friends to apply. She would be 
content to get on the methadone program.

"Methadone, whatever," she said shrugging her shoulders. "I need something 
every day." 
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