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The opiates flowed from Europe, under heavy guard. Shipped in powder form, they came in tidily packaged vials, 24 to a box. In each vial were 10 grams of pure heroin - just add water.

Most of the shipments ended up in a nondescript building in Vancouver's Downtown Eastside, stored in a vault behind bulletproof glass.

Throughout the day, a stream of hardcore heroin addicts would arrive for their fixes. Each was allowed three visits a day.

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Now the flow of clients has almost stopped. Only a handful remain in the final weeks of North America's first medically prescribed heroin trial.

The program is coming to a close, just as the fate of Vancouver's safe-injection facility, Insite, remains unclear. The Conservative federal government has yet to decide whether to approve the continuation of that facility's exemption from drug laws - whereby addicts are allowed to bring and inject their own drugs - which expires on June 30. Both programs are studying harm reduction, but the $8-million North American Opiate Medication Initiative, funded by the Canadian Institutes of Health Research with the approval of Health Canada, offers heroin addicts a path away from the illicit drug trade.

At NAOMI, participants receive medically prescribed heroin or another opiate, hydromorphone (Dilaudid), in a bid to keep them away from street drugs.

Each of the participants, drawn from Montreal and Vancouver, had been addicted to heroin for many years.

Each had failed repeatedly to get off the drug using the best existing treatment, methadone.

Martin Schechter of the University of B.C.'s faculty of medicine is the lead investigator. While his subjects return to their lives, he is working on a final report to be published later this year.

The preliminary findings are encouraging. Dr. Schechter noted that the treatment proved extremely safe and created no security problems. Eight-five per cent of the participants stuck with their year-long treatment.

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Dr. Schechter's team is trying to determine whether there is an economic case to be made for heroin therapy. Dutch and German studies have found the treatment is more cost effective than paying the price for health and criminal-justice services for those using street drugs.

In Canada, the estimated cost of an untreated heroin addiction exceeds $45,000 a year. The Europeans found savings of roughly $20,000 a year for those taking prescribed heroin.

"It's an argument that should appeal to the most hard-hearted fiscal conservative," Dr. Schechter said.

There is also the human cost of heroin addiction.

"We had women coming up to the research team, thanking us because they had been able to stop selling their bodies. We had a fellow who decided to skip the midday session so that he could hold down some jobs.

"What was really common was that people would say that, for the first time, they didn't wake up thinking about how to get their next fix."

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That was the case for a participant known as Jazzman. When he was accepted into the program in Vancouver, he had been on and off hard drugs for more than four decades. He first stuck a needle into his arm at age 15. He will be 58 this year and his body bears the evidence of a harsh existence: liver damage, lung problems and deteriorated discs.

Sometimes he kicked his habit. Sometimes he managed his addiction while keeping a home and holding a job. But for the past eight years, he has been on a downward spiral. Now he is living in the Downtown Eastside, the poorest, roughest neighbourhood in Canada.

"I would have been dead if I hadn't hooked up with NAOMI," he said in a recent interview.

"I was a basket case, totally emaciated, having to hustle and sell everything I had to make it through one more day, one more fix. One fix is $10 but I don't feel that ... I need $30 worth."

While he was in the program, Jazzman went through the secured, frosted doors three times a day, seven days a week, for a year.

He would receive a loaded syringe from a nurse. He would sit at a sterile, stainless-steel counter to inject. He would then sit in a bland waiting room to recover from the drug's effects before heading out.

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"There was this sense of relief. I wasn't going to go insane getting what I needed. It was stopping the nightmare."

In between injections, he was eventually able to find some work. He is now out of the program and, under the treatment of a doctor, takes morphine. He says he will not even dabble in street drugs now.

Others he knows who were in the program have gone back to their precarious street lives, but he believes that this time, he can stay clean. "NAOMI did an awful lot of good. I was very determined to get my life back."

As they prepare their report, the researchers will follow the progress of Jazzman and the other participants. But that leaves in limbo some troubled, vulnerable people who could benefit from continued treatment.

Last November, doctors appealed on compassionate grounds to extend the program on behalf of five participants. So far there has been no agreement from either Health Canada or the regional health authority.

Infrastructure is also a problem. In June, the clinic in the Downtown Eastside will shut its doors, unless the Vancouver Coastal Health Authority finds the money to keep it open in some form.

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Dr. Schechter's researchers knew from the outset that they would have to let their subjects go after a year of treatment, even though it meant watching them return to their high-risk lives on the street.

But it's still painful, he said. "You have people you can see with the naked eye are benefiting tremendously; it feels terrible to deny them the continuing benefit of that, knowing there is a strong chance they could go back to using dirty needles and facing those risks."

Ann Livingstone, a co-ordinator for the Vancouver Area Network of Drug Users, expects the final report to support the science of heroin therapy, but she has little hope the federal government will accept such findings.

"Of course it's a success," she said of the program, but adding that the effort might have been for nothing. "And it's not fair to people who become stable to have it discontinued because of the whim of someone's politics. That's the horror of it all."

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