VANCOUVER — It's a chance to cut the chain that keeps addicts tied to a routine of daily degradation as they find desperate ways to get the money to get high.
The North American Opiate Medication Initiative, known as NAOMI, is offering hundreds of junkies haunting the slums of Vancouver and Montreal the chance to join a research study that provides free heroin.
But they haven't been biting.
NAOMI needs 157 participants in each city. Nearly a year into recruitment, only 85 have signed up and met the criteria for participation, which critics say is too strict. This has pushed back results by 10 months. Data will be released by the controversial study a year after the last participant signs up.
Scientists want to know if hard-core addicts will be able to live more healthy and productive lives with free, measured doses of heroin, a drug that is not harmful to the body.
Heroin is addictive, and overdosing on it will kill brain cells due to oxygen deprivation, but otherwise, the drug is safe, says B.C.'s Medical Health Officer Perry Kendall.
"Heroin, if it's used on a maintenance basis, in pharmacological doses without any risk of overdose or contamination, is actually a very safe drug. About the only side effects that you find in the literature, other than addiction, are chronic constipation, diminution of sex drive, a very dry mouth, which can result in poor oral hygiene."
He says heroin use doesn't knock years off people's lives.
"It doesn't harm the liver, doesn't harm the kidneys per se, and it doesn't kill brain cells unless you overdose and run out of oxygen," Kendall says.
What kills, is the addiction and the all out fight to get the illegal drug. The lifestyle takes a frightening toll, says Mark Townsend, director of the Portland Hotel Society, an organization that provides low income housing and is involved with a variety of harm reduction strategies to help drug users.
He says the hard core users NAOMI wants to work with are so marginalized and abused that they can be impossible to reach.
The participants must be older than 25, have been hard-core users for five years, have used every day for the past year, not be on probation and live within a kilometre of the project's Downtown Eastside location.
The researchers running NAOMI thought it would be an easy choice for addicts: Take free heroin and be involved in a study -- offering a break from crime -- in exchange for the drugs their bodies are addicted to.
NAOMI was preparing for an onslaught of desperate callers when it opened for applications. Hours of operation were limited to a few hours a day. Few people came forward.
"It wasn't as explosive as we had expected," says Dr. David Marsh, a scientist working on the study.
"We had to change our recruitment strategy. We opened the phone lines for the whole day instead of the initial four hours a week. We had to do outreach as well."
NAOMI researchers went to food banks and hotels spreading the word about the project.
Townsend says NAOMI, like other projects, was designed with great intentions but set criteria for users that addicts simply can't meet.
There's sometimes an imaginary version of what the target looks like," he said.
"I think down here the group they're trying to reach is very marginalized, very abused. These people get very upset when they call me and get my voice mail. They've waited in line for the phone, people are yelling at them to get off, and they don't know when they'll be able to call again. Life looks very different to them."
The addicts have to commit to interviews with doctors and follow a routine for two years. They need to report daily for doses of heroin, which they inject on site, and must submit to interviews with nurses. NAOMI also makes available counselling and social workers.
Already, said Marsh, people who have gotten involved are making gains.
"It's still too early to draw hard conclusions, but so far we're seeing improvements among participants," says Marsh.
"People are getting into stable housing, reducing use of other drugs. There are improvements in physical health, people are gaining weight and engaging in counselling services."
Results of similar studies in Europe have been encouraging. Many addicts have been able to lead stable lives taking a regulated dose of prescription heroin.
Some people who have signed up for the Vancouver study dropped out early on to try abstinence, Marsh says.
The $8 million NAOMI project is one of many harm reduction strategies health agencies are using to deal with drugs and the health and social problems they cause.
The treatment movement has been more in vogue than 12-step abstinence programs that require people to quit drugs.
Approaches that aim for harm reduction accept that some people will never quit and strive to minimize the health effects.
Governments backed the program on the West Coast when users caught in Vancouver's open drug market, the Downtown Eastside, sparked an outbreak of HIV spread through dirty needles. Health officials backed needle exchanges and eventually opened Insite, North America's first safe injection site, and now the NAOMI project.
Insite is full to capacity and health officials have deemed it a great success. A number of other Canadian cities, including Toronto, are considering opening their own supervised spaces for addicts to get high.
Some people are angry about the public use of drugs outside the injection room. Many of the 4,000 addicts in the Downtown Eastside can't wait the five to seven minutes they might face to get a place to shoot up. So they inject in street.
Vancouver police announced a crackdown in December and began charging people shooting up in public.
The Vancouver facility was set up in 2003 as a three-year experiment exempt from Canadian drug laws.
Since then the clinic has run at capacity with some 800 heroin injections daily.
Kendall said the clinic has achieved its goal to cut overdose deaths and rates of hepatitis and HIV infection.
Its exemption from drug laws is due to expire in September 2006. Kendall recently applied to Health Canada to make the facility a permanent part of the medical service system.
With the federal election underway, a decision will likely take months.
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