Hard-core heroin users began lining up this week in Vancouver to participate in a pioneering study where researchers will provide them with free heroin. The study, known as the North American Opiate Maintenance Project (NAOMI), won final approval Monday from Health Canada. Moving quickly, researchers this week began the process of selecting 158 participants, 88 who will receive free heroin and 70 -- the control group -- who will get methadone.

The NAOMI project is slated to expand to Toronto and Montreal later this year. In all, some 450 heroin users will participate in the one-year pilot project. At the end of the study period, the doses of heroin will tail off. The study is designed to see whether heroin is more effective than methadone in getting users who have proven resistant to other therapies to quit using. It will also examine whether providing free heroin will lead to decreases in criminality and homelessness among participants.

While similar projects have taken place in Switzerland and the Netherlands, the NAOMI project marks the first attempt to provide heroin maintenance therapy to drug users in North America. Led by Dr. Martin Schechter, head of the Department of Epidemiology and Public Health in the Faculty of Medicine at the University of British Columbia, study planners have spent years carefully building political support and wending their way through a typically Canadian maze of governmental approvals. The study moves ahead with the support of Vancouver police and elected officials, and now, the full support of the Canadian federal government.

The study site is at 404 Abbot Street (at the corner of Hastings) in Vancouver's Downtown East Side, the center of one of the largest hard drug scenes in North America. Already home to a safe injection site and some of the continent's best organized hard drug users, the community is behind the study, said Dr. Schechter. "People in the Downtown Eastside understand the terrible toll -- human, social and fiscal -- of chronic heroin addiction," he noted. "They also understand the need to test new treatments and innovative methods of reducing drug-related harm."

"This study has support right across the political spectrum in Canada," said NAOMI spokesman Jim Boothroyd. "In our community consultations, opposition to the study was not so much ideological as NIMBY-oriented," he told DRCNet. "People are afraid of bringing heroin addicts into their neighborhoods, but by working with the Downtown Eastside community, we have addressed those concerns."

"The city of Vancouver definitely supports the NAOMI study," said Theresa Beer of the city's drug policy office. "We were involved in gaining neighborhood approval and securing the site," she told DRCNet. "The Vancouver police are also fully aware of and support the study," she said.

A very cautious Boothroyd refused for months to speak on the record about the pending project, hoping a low profile would keep opposition from mounting. That approach caused some concern among advocates of the project, said Anne Livingston of the Vancouver Area Network of Drug Users, a group that has fought hard for such programs. "We were beginning to think they were taking the wrong approach, especially as this dragged on over the years," she told DRCNet, "but now, here we are with the final go-ahead. It's about time," she added.

With final approval granted by Health Canada, the project is moving fast, she said. "Approval came Monday, posters seeking applicants went up Tuesday, and the selection process began Thursday," she reported.

According to a NAOMI background paper, Canada has some 60,000 to 90,000 opiate addicts. While many hard drug users respond to methadone maintenance therapy, "some long-term, higher risk patients do not respond to or benefit from this standard treatment." Participants in the study will come from that group. According to program guidelines, candidates must be over 25, have been a heroin addict for more than five years, and previously have tried methadone maintenance. Persons on probation, facing criminal charges, or with severe mental illness will not be able to participate.

During the study, those selected to receive heroin will visit the clinic up to three times a day, seven days a week, where they will receive prescribed doses on heroin under a physician's supervision. Participants will be asked to remain at the clinic for a half hour after each injection. Available at the clinic will be social workers, drug and addiction counselors, and other social support staff, who will work with participants to achieve a more stable life-style and, ultimately, wean them from opiate addiction. At the study's end, participants will have a three-month transition period to wean them off heroin. They will then have the option of going into detox, going into methadone maintenance, or going back to the streets to feed their habits.

"Results from the European studies suggest that medically prescribed heroin could greatly help our most troubled heroin addicts -- those for whom we have no effective treatments," said Dr. Schechter. "But we won't know whether the same results hold true in the Canadian setting until we complete this carefully designed scientific study."

"Heroin addiction afflicts an estimated 60 to 90,000 Canadians and the costs associated with it -- in terms of human misery, public health, social problems and crime -- are staggering," said Dr. Alan Bernstein, President of Canadian Institute for Health Research. "Canada, and many other countries, therefore, need studies such as NAOMI to investigate new approaches to reducing the harm caused by heroin addiction."

And now it begins.

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