Pubdate: Tue, 20 Feb 2018
Source: Globe and Mail (Canada)
Copyright: 2018 The Globe and Mail Company
Author: Andre Picard
Page: A13


Every morning, Kevin Thompson takes a short stroll from his apartment
to the Crosstown Clinic, where he signs in, gets his prescription
medicine, then sits in a small room and injects it before heading off
to work.

He follows this routine up to three times a day and has done so
virtually every day for more than a dozen years.

The medicine is diacetylmorphine, the medical term for prescription

"It saved my life. No question, it saved my life," Mr. Thompson, 47,
says emphatically.

Mr. Thompson has been a heavy user of street drugs such as cocaine and
heroin since his early 20s. He was in college, studying hairdressing,
when he was robbed and lost all his money, and ended up homeless. To
get by, he started selling drugs, and soon became his own best customer.

"I'm not sure exactly how I got into drugs, but I sure did get into
them," Mr. Thompson says with a laugh.

He became addicted not only to drugs, but to the "hustle" - the
high-octane, high-risk lifestyle of dealing, stealing, and shooting up
over and over again.

In 2005, Mr. Thompson was recruited to participate in an academic
study known as the North American Opiate Medication Initiative
(NAOMI), which tried to determine if diacetylmorphine worked better
than methadone. NAOMI morphed into SALOME (Study to Access Longer-term
Opioid Medication Effectiveness) and eventually into a special access
program run out of the Crosstown Clinic.

Along the way, the former Conservative government tried to shut down
the initiative, resulting in lengthy court battles, but a small
program remains.

Mr. Thompson is one of 91 people prescribed diacetylmorphine, while
another 24 get hydromorphone, and a couple of dozen others have
transitioned to oral drugs such as methadone, Suboxone and
slow-release liquid morphine.

The philosophy behind the program is simple: It reduces harm - to drug
users and to the community.

Heroin substitution is designed for intractable users who have failed
repeatedly at rehab and other harm-reduction measures such as methadone.

Mr. Thompson, who was getting up to 400 milligrams of diacetylmorphine
three times daily - "enough to kill a horse," in his words - has never
overdosed, nor has he had complications that are common with street

He also gave up the hustle, meaning he long ago stopped shoplifting,
breaking into cars and other things he did to afford his next hit.

"I went to jail a lot, but I haven't been to jail in eight years," he

Nor does he make regular visits to the emergency room, which were
common when he lived on the streets and suffered routinely from
violence, infectious disease and other health problems that accompany

"I've got my own place. I've got a scooter. I've got a full-time job.
I even have a five-year relationship," Mr. Thompson says.

"If I was your neighbour, you wouldn't know I was on

The "dope" he takes now is a prescription drug supplied by the state.
It costs approximately $25,000 a year a person - $10,000 for the drug
itself and $14,750 for the operation.

It's expensive for Crosstown Clinic to operate because the rules are
onerous. Diacetylmorphine is imported from Switzerland and
prescribing, dispensing and storing it requires elaborate paperwork
and tighter security than some banks. Prescription heroin users must
come at specific times, receive a precise dose, inject in the
supervised facility, and the unused product is destroyed.

That cost would be a fraction if we were more pragmatic and treated
heroin like other prescription drugs and expanded the program,
allowing economies of scale.

It is estimated that about 500 people in Vancouver alone could benefit
from heroin substi-tution.

The research that has been carried out over the years shows this
harm-reduction approach saves money because long-time drug users such
as Mr. Thompson previously used an average of $48,000 annually in
health-care and criminal-justice services.

Those base economic calculations don't take into account that people
are kept alive and lead productive lives.

Mr. Thompson, for example, oversees an overdose-prevention site on
Vancouver's Downtown East Side. Working at the coal-face of the
opioids crises, he has lost track of how many people he has had to
revive with naloxone and how many friends he has lost because they
used contaminated street drugs.

"I kind of feel guilty sometimes because I'm getting help and others
aren't. It makes me sick to know we could be saving lives and we're
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