As we exit through the front room for a quick walk to the corner store, Oleson notes that the rules at 327 -- no fighting, no dealing, no unsupervised fixing -- are set by the users themselves. "There's nothing better than people determining their own health needs, right?" she asks. Looking around at all the nodding faces tinged with easiness and pain -- many of them Asian, black or indigenous, most of them impoverished -- it's a tough question to answer.

Since 1993, greater Vancouver has seen an awful share of the needle and the damage done: an average of 147 overdose deaths annually among an estimated 12,000 injection users of heroin and cocaine. At first, the long-term drug crisis is hard to fathom amid the picturesque landscape: a prosperous city ringed by lapping bays, green forests and mountains; home to a vibrant, polyglot community of almost 2 million still riding the rush of a successful bid for the 2010 Winter Olympics.

But detour into the roughly 10 blocks of the notorious downtown Eastside and the lush environs give way to the stench of urine, piles of trash, and discarded needles. The neighborhood's boarded-up storefronts, few dingy bars and numerous flophouses give no clue that the tourist-friendly Gastown and Chinatown districts are close by. Infectious disease has swept through a desperate populace of back-alley users commonly preparing fixes with dirty needles and puddle water -- more than 30 percent have HIV and 90 percent hepatitis C. Fearful of law enforcement and street thugs, some hurried addicts use their own blood to dissolve powdered narcotics for injection. The concentration of poverty scattered around the open drug scene's epicenter at Main and Hastings -- known locally as "pain and wasting" -- was recognized by the 1996 Canadian census as the poorest neighborhood in the nation. By 1997, with hundreds of deaths on the downtown streets, city officials had declared an epidemic.

According to Dr. Evan Wood, an epidemiologist at University of British Columbia, an abundance of cheap drugs and acute poverty underwrite the ghetto of despair. Displacement due to law-enforcement patterns and "ridiculously underfunded" addiction treatment exacerbate the problem.

"The only really effective way to deal with the drug crisis is to get at the demand side," says Wood, who also conducts leading HIV/AIDS research at St. Paul Hospital in Vancouver. "But there's a five-day waiting list to get into detox, and you have to phone every morning to keep yourself on that list." It's a striking state of affairs, given Canada's reputation for providing a vast social safety net. With nowhere to turn, most addicts choose to inject -- the fastest and cheapest way to get high -- regardless of the health dangers.

The first of its kind on the North American continent, Vancouver's official safe-injection site will be a proving ground for the city's ambitious "Four Pillars" drug policy. The strategy also calls for greater treatment and prevention programs, and vigorous law enforcement targeting dealers -- but not addicts, whom the policy says should be treated as a health problem. At an annual cost of about $2 million (Canadian), the site will offer 12 injection stations, a medical emergency room, counseling offices, and a "chill-out" room where users can socialize or simply relax after their latest fix, according to Viviana Zanocco, a spokesperson for the Vancouver Coastal Health Authority.

Although illicit-drug use inside the site will be permitted by special federal exemption, defining a boundary for street enforcement may remain tricky. "One Catch-22 is that people will still have to purchase their illicit drugs from somebody," says Zanocco. "How does the site work if people are too scared to go in because they're afraid the police will be standing outside the door? It's a struggle, I admit it. We're working with the police department on a strategy."

"This is a health problem, not a criminal problem," says Vancouver Mayor Larry Campbell. Like many other Canadian officials, Campbell appears unfazed by Washington's rhetoric. "We have conservatives in Canada, too, and they won't look at fact or reason either," he says flatly. "I've been to Zurich [Switzerland] where they had a problem way worse than ours, and I've seen the results." The harm-reduction component of the widely endorsed plan -- Mayor Campbell was voted into office in 2002 promising to implement it -- is modeled after programs in Europe and Australia, which have dramatically reduced overdose deaths and the spread of disease.

Though Canada is tagged a firebrand of progressive social policy next to the U.S., it, too, has long fought a supply-side war on drugs. Almost 95 percent of the roughly $500 million spent annually on Canada's drug strategy goes toward efforts to reduce the illicit drug supply. But that paradigm may be cracking now, due in part to the dire situation in Vancouver, and some leading-edge research at University of British Columbia.

With an in-depth study of the city's injection drug users already in progress, Evan Wood and his colleague Dr. Martin Schechter, head of UBC's epidemiology department, were able to measure the impact in late 2000 of a seizure of 220 pounds of heroin -- the single largest drug-enforcement win in Canada's history. Following more than 120 addicts during the months before and after, the researchers reported that "the massive seizure appeared to have no impact on injection users or on the perceived availability of heroin." In fact, the study found that the median price of heroin in Vancouver dropped 20 percent following the seizure, with no change in purity, suggesting an even more saturated supply. Separate research showed the number of fatal overdoses actually ticked higher in the following months.

Wood and Schechter also cite a 2001 United Nations report indicating that only 5 percent of the global illegal drug flow is successfully thwarted by law enforcement. Still, the problem isn't on the enforcement front lines. "The responsibility lies with the politicians and policymakers who continue to direct the overwhelming majority of resources into failing supply-reduction strategies, despite the wealth of scientific evidence demonstrating their ineffectiveness," they write. "Our strong consensus [is] that curbing HIV and overdose epidemics requires a shift toward prevention, treatment and harm reduction."

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