September 2006

Ask Gary Occhipinti to name the first step on the path he took to daily heroin use and he doesn't miss a beat. "Cigarettes."

Occhipinti believes that the first rush he got from smoking a cigarette set him up for the rush he sought from other drugs he tried through his teens.

The 50-year-old's first experience with cigarettes may have been years ago but the taste for them lingers, as his golden-stained fingers illustrate. Heroin has also lasted, although it has been years since he attained a sense of euphoria from taking it. "When you're an addict, what wakes you up in the morning is the first vestiges of the withdrawal process." At that stage, he shot heroin just to stop feeling sick.

This day he's clean, if shaky, after graduating from the North American Opiate Medication Initiative (NAOMI) and then going through detox. He's feeling sick and knows he should be in bed but he's determined to tell his story, in order to support the NAOMI trials and, he hopes, the eventual establishment of a heroin maintenance program.

Occhipinti lived in BC until he was five, when his Italian immigrant family moved to California. At 14, he tried heroin for the first time. Over the next 10 years, he used it with slowly increasing frequency until he was arrested for breaking into a pharmacy, attempting to steal morphine. He spent almost two years in jail for that crime.

After his release, he got clean and earned a degree at the University of Colorado. He followed up with a law degree from the University of Arizona. He was preparing to write his bar exams when drugs changed the course of his life. He was caught with marijuana.

"The bag of pot I bought cost me $11. It ruined my life." He spent 22 months in jail and was told he couldn't write the bar exams for five years. Fearing that he would do something that could land him in jail for a third conviction that, under California law, could wind up costing him life in jail, he left for Canada.

Here, he ran a computer company with a friend and stayed drug free for five years until, after a car accident, he accepted an opiate painkiller. "It kicked my addiction right back in again." From 2003 on, he was injecting heroin daily.

Occhipinti said he would shoot up anywhere from one to six times a day, depending on the purity of the heroin he bought. It cost about $25 a dose, an expense he covered with money from committing crimes. Occhipinti won't discuss precisely what crimes he committed, but repeats several times that he didn't commit any violence against "civilians". He admits to having sold drugs. He said some heroin users steal bank card PIN numbers or get involved in credit card fraud. He knows heroin users who feed their habit by breaking into cars and stealing CDs, DVDs and cigarettes. He said if they're arrested, they're usually out by the next day, starting the cycle over again.

But the need to commit crimes to feed his heroin habit ended for Occhipinti when he was accepted into the NAOMI program. NAOMI is a clinical trail that started in February 2005 in Vancouver and June 2005 in Montreal. Those accepted into the program must be 25 or older, addicted to heroin for at least five years and must have injected heroin daily for at least one year. They must also have attempted at least two episodes of methadone treatment for 30 or more consecutive days.

Participants are randomly assigned to oral methadone treatment or the injection group, which receives either heroin or hydromorphone, which is pharmacologically similar to heroin. (Neither the participants nor the study staff will know who is receiving which injectable medication.)

The treatments continue for 12 months, followed by a three-month period during which participants still being treated with injection drugs go through a transition to conventional therapies, such as methadone.

The trial's findings will be announced in 2008.

Occhipinti said on his first day of the program, he walked out of the building and realized how crippling it had been to be completely focused every single day on getting enough money to buy drugs. "The weight that lifted off my shoulders, it was something I didn't even know was there."

At first, he injected at each of the three sessions offered daily. After a while, he started to skip the middle one because, he said, "I didn't want to be loaded." Knowing the consistent purity of the heroin meant that he could get by with less.

With six months remaining, he started to work with clinical staff on decreasing the amount of heroin in his injections. By the time he graduated, he was down to 10 per cent of the amount he'd been injecting at the beginning. A few weeks later, he entered detox.

Now, he's still detoxing and trying to find work. He's living on welfare and has moved from the Downtown Eastside to a room in the centre of the city. But it's a struggle. He's clearly upset and angry he hasn't been able to convince an employer to hire him. And he said it's impossible to live on welfare and have enough money for food, after paying rent each month.

In terms of options, he sees three clear choices for himself: get a job, commit suicide or go back on heroin. At this point, he's still struggling to find a job.