Detoxifying Vancouver's drug culture
Waiting times drop, and more addicts seek treatment in city programs
DEBORAH JONES

Special to The Globe and Mail

VANCOUVER -- Six years ago, Vancouver drug addicts who decided to break the
habit had a six-week wait to enter a withdrawal program. By the time
services were available, many of them gave up. Today, the wait is at most
two days, and enrolment in so-called detox facilities is growing.

Experts say long waiting times for detox were gradually eliminated because
the local Coastal Health Authority streamlined admissions with a central
registry in 2000.

It's an achievement in which the health authority should take some pride,
provincial health officer Perry Kendall said.

"I would be bragging about this if I had managed to do this," he said.Last
year, about 4,200 adults and youths were enrolled in clinical or hospital
withdrawal programs, said David Marsh, an addictions specialist with the
health authority. Some of the programs are new, and enrolment in all is
growing, he said.

Participation in long-term treatment has also increased, to 8,270 heroin
addicts in methadone programs in 2004 from 1,000 in 1995.

But these changes have gone almost unnoticed in Vancouver's turbulent drug
scene. There are constant reports on the contribution of addicts to the
city's high property-crime rate and gang violence, in addition to news
stories about North America's only supervised heroin injection site and
clinical trials to give addicts free prescription heroin.

Vancouver's "Four Pillars" approach to drugs -- prevention, treatment, harm
reduction and enforcement -- became a federal election issue after Stephen
Harper said a Conservative government would neither support the supervised
injection site nor approve other locations.

With Mr. Harper now the Prime Minister, B.C. health experts are starting to
lobby for support in Ottawa for the West Coast's health-centred approach to
treating drug addiction.

This week, Thomas Kerr, a Vancouver-based researcher on drug use and HIV
infection, will travel to Ottawa to present his recent research to Health
Canada and the RCMP.

Dr. Kerr and other researchers have had studies published in the Lancet,
the Canadian Medical Association Journal and the British Medical Journal,
with findings showing that the supervised heroin injection site has reduced
sharing of syringes by heroin users, led to improved public order in the
Downtown Eastside and had no negative impact on Vancouver's drug use
patterns.

Local agencies are asking Health Canada to allow Vancouver's supervised
heroin injection site to continue its operations. It is operating under an
exemption from controlled drugs and substances legislation, which expires
in September.

Mr. Kendall, who has made a formal, written request to Health Canada, said
an evaluation of the facility last fall was "all-round positive, with no
downsides."

But health experts say the progress is overshadowed by ongoing drug
problems.

"Things are significantly better compared to 10 years ago," said Dr. Marsh,
who moved to Vancouver after eight years as clinical director of addiction
medicine at Toronto's Centre for Addiction and Mental Health. "Overdose
deaths are down by two-thirds to three-quarters. New HIV infections among
injection drug users are down.

"Infectious [heart disease linked to injection drug use] is down by 40 per
cent. Total heroin seizures by police have fallen substantially, and the
number of people in treatment has gone up eightfold," he said.

But the public perception, Dr. Marsh said, is that Vancouver's drug scene
is constantly worsening. He blames this partly on social problems caused by
the increased popularity of smoking crack as opposed to injecting cocaine,
and on the extreme psychotic and violent behaviour of a relatively small
numbers of crystal meth users.

Experts say the improvements are still not enough. The numbers are hard to
pin down, but experts estimate there are 5,000 injection drug users in the
Downtown Eastside neighbourhood alone.

And despite the studies on the supervised injection site, overall
information about what works and what doesn't, and on drug use in general,
is lacking, said Ann Livingston, spokesperson for the Vancouver Area
Network of Drug Users. There is little local information on what happens to
people after they complete a withdrawal program and are discharged without
drugs in their system.

According to Dr. Kerr, "If you compare the data on use of drugs in the U.S.
to Canada, it's a total embarrassment. In the U.S., they really know what's
happening."

Experts agree that improved detox programs and medical services are not
enough.

"Our notion of prevention is very weak," Dr. Kerr said. "We do not really
acknowledge the social determinants of addiction such as poverty, lack of
housing and troubled early childhoods. . . . If we want to get serious, we
need to address the social conditions."

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