The clinic is ready and the government-supplied heroin is waiting to be injected, but researchers undertaking the first drug study of its kind in North America are having trouble finding enough addicts.
In Vancouver, a city with one of the worst illicit drug problems in the world, that wasn't expected to be an issue.
But Jim Boothroyd, spokesman for the North American Opiate Medication Initiative, which started recruiting in February, said researchers have experienced some difficulty in signing up its target of 157 addicts.
A little over two months into the Vancouver project, only 21 addicts have been recruited. Similar trials will follow in Montreal and Toronto this year.
"The study has experienced slower than expected recruitment," Mr. Boothroyd said yesterday.
He said researchers are confident they will eventually get all the addicts that are needed, but it will take a little more effort than anticipated.
"The recruitment strategy was initially planned around phone lines. We thought there would be a heavy volume of calls and the people who wanted to participate would be phoning us. That didn't materialize. So we very early on changed our strategy to doing more outreach."
Recruitment has started to pick up now that more effort is being made to find addicts instead of letting them call in, Mr. Boothroyd said.
Approximately 40 more addicts recently were accepted into a screening phase and he hopes they will soon join the small number already approved.
The situation is not a crisis, he added.
"The recruitment period is six to nine months. Investigators planned to bring people in very gradually. So while recruitment at the outset has been less than anticipated, we have a very wide window and we are very confidant we will recruit our target," he said.
Mr. Boothroyd described the setback as a "hiccup" and said the failure of the phone-in approach isn't surprising, considering that researchers are dealing with hard-core heroin addicts.
"This is a very, very marginalized group," he said. "These are people who've tried methadone more than once, who have been chronically addicted for more than five years, who have been needle-injecting daily for the last year and they tend to be beyond the pale anyway.
"This is the population for whom there is no treatment right now. How do you reach them? That's the question. And what we've learned is that you don't reach them by telephone."
The people the study is designed to help are in the throes of severe heroin addiction and experience all of the problems that implies, Mr. Boothroyd said.
"One of the working hypothesis of the study is that heroin maintenance therapy will allow them to stabilize their addictions and bring them into the realm of social services and health services which they are unable to access right now because of their chaotic lives. I think our enrolment strategy has run up against the chaos of those lives," he said.
Those who are accepted into the study are randomly divided into three groups.
The main study group is provided with heroin obtained under government supervision from pharmaceutical sources in Europe, where a number of heroin-maintenance programs have been established. The addicts come in three times a day to shoot up under the supervision of clinical staff.
A second group receives methadone so researchers can measure heroin maintenance against "the gold standard" of current heroin addiction treatment methods.
A third group is given a drug that mimics heroin but which has different chemical markers so researchers can determine, through urine testing, whether subjects are using street drugs outside the clinic.
The objective of the study is to determine whether drug users can regain control of their lives through heroin maintenance, and eventually break their addictions.
Mr. Boothroyd said similar programs have worked in Switzerland and Holland and are currently under study in Spain, Germany and Britain.
The research in Vancouver, Montreal and Toronto will provide the first North American data.
"At the end of this, we hope to have sufficient statistical power, in a North American population, to be able to say whether or not heroin- maintenance therapy could be another piece in the puzzle," he said.
"We are looking for a way of dealing with severe heroin addiction which obviously is a scourge right across this continent and around the world. Right now we don't know what to do. We don't have adequate treatment for these very marginalized people for whom methadone has not worked."
Mark Hume