DOWN AND OUT IN VANCOUVER

Potent heroin is killing addicts faster than the system can help them

Vancouver -- When Jane Martin turned 46 last week, she thought of the day
last month that she nearly added herself to Vancouver's growing tally of
heroin-overdose victims.

She had injected double her usual dose into her arm and lay dying on the
railway tracks, but paramedics got to her in time.

On her birthday she also thought of her former life as a nurse in Toronto.
How at 30, when she suddenly remembered being raped at age 7, it all
started to go bad. She became chronically depressed and the rest of the
memories just got worse: of her three daughters, now in the care of
relatives; of her split with a husband she says was abusive; of going on
welfare and moving to a ramshackle apartment in the Downtown Eastside.

The vermin-infested room stank, she never had enough money, hunger gnawed
at her, almost everyone around her was using heroin, she was still
depressed, and, four years ago, she pumped heroin from a needle into her
arm for the first time to escape her pain.

Too late, she realized that the drug only made things worse. Having tested
positive for hepatitis C and now living on the streets, she sells her body,
begs and steals to support her $40-a-day habit.

"It's not that I want to die," Ms. Martin said, "it's that I can't go on
living like this."

Whether or not they have a death wish, Vancouver's heroin addicts are dying
of overdoses at an increasing rate. For the first six months of this year,
heroin claimed 201 lives -- a 37-per-cent increase over the figure for the
same period last year.

For the doctors, street workers, police and other experts on the front
lines who are witness to this daily tragedy, it seems nothing is really
being done. And it's getting worse. Fiercer competition in what was already
the heroin capital of Canada has flooded the market with a cheaper drug of
greater potency. For $10, an addict can get one-10th of a gram of pure
heroin, enough to kill the inexperienced, overeager or suicidal user.

Cocaine and crack cocaine have also become cheaper, and the growing
popularity of taking cocaine or crack at the same time with heroin is
increasing the number of overdoses.

Cocaine is a stimulant that speeds up the heart rate and breathing rate.
Heroin is a depressant that slows down the system. Combining the two wreaks
havoc on the body.

It's a toxic recipe that has turned Vancouver's illicit drug users,
estimated at between 10,000 and 15,000, into sitting ducks.

If things keep going at this rate, 1998 will be much worse than 1993, the
year that a record 356 people overdosed on heroin and the province
appointed Vince Cain, who was then chief coroner, to head a task force to
examine the problem.

In the wake of the grim new tally, this past week Dr. Cain publicly
expressed disappointment that his recommendations -- including increasing
the number of detoxification places, taking care of addicts' social needs
and, the most controversial, decriminalizing heroin -- have been largely
ignored.

If an addict wants to kick the habit, the province provides 48 detox beds
for adults. And although the majority of overdose victims have been over 25
years old, the government plans to spend only on younger addicts. It has
pledged $5.3-million to add to the eight youth detox beds.

"It is all very well for people to call for these things and another thing
to find money to deal with them," said Lois Boone, B.C. Minister for
Children and Families, who has responsibility for addiction-related
programs. "I don't think anyone should expect a response overnight."

Ms. Boone's ministry places emphasis on prevention programs, to stem the
tide of people becoming addicted. The police have come to accept this
approach as crucial.

The RCMP recently took officers out of law enforcement to increase the
staff of their drug-awareness staff to 17 from three. Those officers give
lectures at schools, community groups and workplaces. The Vancouver Police
are doing the same.

But as they move into schools, police are discovering the battle is harder
than they thought.

"We're seeing heroin addicts in high schools who are smoking it," said
Detective Robert McLaren of the Vancouver Police drug squad. "They falsely
believe that smoking it is not addictive."

This is precisely how the tide of addicts continues to swell, with new
users not believing or unaware that they will end up like Jane Martin,
trapped in a nightmare where death seems the best option.

In a back alley in the Downtown Eastside last Thursday, Candy, a
38-year-old, HIV-positive, long-time addict, took her fix next to Sherry, a
teen-ager who looked out of place in her clean jeans and white lace shirt.

"She's 16, she's just run away from home, she's four months pregnant from a
. . . dealer and she just shot up heroin for the first time yesterday,"
Candy said. "I told her to go home and that if she ever shot up again I
would never talk to her again."

Sherry protested.

"It's not my first time," she said with a smile. "I was using some months
ago and then I stopped. I can stop again."

She said her social worker told her to return home and drop her new habit
or the welfare system would claim her baby.

"I told my boyfriend that if he didn't stop dealing I'm not going to see
him again, and if he doesn't stop I'll go back home," she said, weakly and
unconvincingly.

With prevention a long shot, and new money for social programs a pipe
dream, B.C.'s main response to the heroin-addiction epidemic is the
methadone-treatment program run by the College of Physicians and supported
by the Ministry of Health.

Methadone is a synthetic narcotic drug that, when taken orally, does not
produce a "high" but blocks the craving for heroin for about 24 hours. As
no needles are involved, the risk of the spread of HIV and hepatitis C,
rampant among the city's drug users, is reduced.

>From 1,100 addicts treated by 100 doctors three years ago, the program has
>grown to 5,000 addicts treated by 500 doctors. Last year, the province
>spent $5.5-million to supply addicts with methadone and $1.6-million to
>pay their doctors.

"Certainly it is our goal to expand the program," said Jeff Gaulin,
spokesman for the Health Ministry. "We have placed no limits on the
program, and what it boils down to is encouraging more doctors to sign up
so we can treat more people."

Many more seek methadone treatment than can be accommodated. And once an
addict enters treatment, what might seem like trivial barriers to a healthy
person loom as huge obstacles in an addict's struggle to become free and
clear. Some who enter treatment drop out because they say they can't handle
the control the doctors exercise over their lives, or they can't afford bus
fare for daily visits to pick up their methadone or the $65 fee (not
covered by the medical plan) that some clinics charge for overhead
expenses.

"You've got a population asking for exits and you have a system that's
ignoring that need," said John Turvey, executive director of the Downtown
Eastside Youth Activity Society, which last year gave out 2.5 million clean
needles in exchange for used ones. "When an addict says he wants help, you
can't turn him away because he may never reach that point again."

A growing number of experts, law-enforcement officials, criminologists and
doctors are convinced that it's time for Dr. Cain's radical solution: to
give heroin addicts controlled access to the drug they're addicted to.

The recent overdose statistics "underscore the urgency of getting on with
solutions to the problem," said Dr. Brian Emerson, head of the Health
Officers Council of B.C.

Inspired by a Swiss experiment, the council, an influential group of
doctors employed by the province, appealed last month to the provincial and
federal governments to consider a trial program of heroin maintenance for
addicts. Such a program would make it legal for doctors to prescribe
injectable heroin to keep addicts stable or wean them off the drug.

In the Swiss study, chronic heroin users for whom methadone treatment had
failed were given free heroin, which they injected under supervision.
One-third dropped out of the 18-month program and some of those who
remained continued to use illicit heroin and cocaine. But researchers
reported improved health and decreased criminal activity among those who
stayed, and a third of them were able to hold permanent jobs.

Of the 1,146 patients in the study, only 83 decided to give up heroin
completely.

Similar heroin-maintenance trials are being considered in the Netherlands,
Germany, Spain, Austria and Britain. Ontario's Addiction Research
Foundation is preparing a proposal for such a trial program.

Those who oppose such an experiment in Vancouver, such as Peter Hickey,
executive director of the province's methadone program, say it would be
premature at this time.

Although B.C. was the first jurisdiction in North America to use methadone
in the 1950s, the program was controlled from Ottawa. In 1995, B.C. became
the only province in Canada authorized to conduct its own methadone
treatment program. Pleased with results so far, Mr. Hickey argues that the
program needs to be given more time before other measures are resorted to.

Former addict Billy Weselowski, head of the abstinence-therapy program
Innervisions Recovery, thinks heroin treatment would be "community suicide.
You have to consider that when talking to an active addict, you are talking
to the drug, not to the person, and the drug is going to say `Give me
more.' " Mr. Weselowski said many addicts would "lie, cheat and manipulate
the system" instead of reforming themselves.

Indeed, with the methadone program, in which only the most trusted patients
are allowed to take supplies away from medical facilities, it nevertheless
is sold on the streets by addicts who want money for heroin.

Though powerful voices are joining the call for decriminalizing heroin, any
action soon is thought unlikely.

As the debate goes on, police are moving away from arresting users for
simple possession. Instead of going after addicts who traffic in small
quantities to support their habit, the police today concentrate on those
who traffic for profit.

"We're pretty tolerant and sympathetic to the plight of the addict," Det.
McLaren said. "You'd have to be blind not to see you're dealing with social
problems on the streets."

What is it that drives addicts to such self-destructive habits?

In many cases it is the sheer ugliness of life in Vancouver's Downtown
Eastside, Canada's poorest ghetto, said Ann Livingston, a non-user who acts
as co-ordinator for an addicts' lobby group, the Vancouver Area Network of
Drug Users, or VANDU.

One-fifth of the people who constitute the city's mental-health case load
live in this historically working-class neighbourhood. People from
everywhere else come to Vancouver to escape dire poverty, various types of
abuse or a life of crime or just because it's warm enough to live on the
street in the winter.

The Downtown Eastside is a neighbourhood that covers less than 6 per cent
of Vancouver's total area but has a third of its pubs. The streets are
strewn with garbage and reek of urine. Addicts, with ragged, dirty clothes
hanging on unwashed bodies, laze on street corners where drugs are sold
openly 24 hours a day. In the back alleys, at every hour, addicts are
smoking, snorting or injecting drugs.

Home, for those lucky to get one, is in a dank, crumbling residential
hotel. For $325 out of their welfare cheque, they get a room 10 feet by 12
feet that can hold little more than a bed, and in which the paint on walls
is peeling and the carpets have a galaxy of cigarette burns.

"There's a plentiful supply of drugs around and no hope," Ms. Livingston
said. "If addicts stopped using drugs, they would still be in those
circumstances with no promise of jobs."

And the terrible toll continues. One addict a day on average dies of an
overdose. For Jane Martin, who just missed her day last week, the renewed
debate offers little hope.

"I see three choices for me," Ms. Martin said. "I could kick the habit and
be a nonfunctioning, chronically depressed vegetable, or continue to be a
drug addict, or be dead."

She laughed. "Death seems the best option. It's the cheapest."

Checked-by: (Joel W. Johnson)