VANCOUVER, British Columbia — Dave Napio started doing heroin over four decades ago, at 11 years old. Like many addicts these days, he heads to Vancouver's gritty Downtown Eastside neighborhood when he needs a fix.
But instead of seeking out a dealer in a dark alley, Mr. Napio, 55, gets his three daily doses from a nurse at the Crosstown Clinic, the only medical facility in North America permitted to prescribe the narcotic at the center of an epidemic raging across the continent.
And instead of robbing banks and jewelry stores to support his habit, Mr. Napio is spending time making gold and silver jewelry, hoping to soon turn his hobby into a profession.
"My whole life is straightening out," Mr. Napio, who spent 22 of his 55 years in prison, said during a recent interview in the clinic's mirror-lined injection room. "I'm becoming the guy next door."
Mr. Napio is one of 110 chronic addicts with prescriptions for diacetylmorphine hydrochloride, the active ingredient in heroin, which he injects three times a day at Crosstown as part of a treatment known as heroin maintenance. The program has been so successful at keeping addicts out of jail and away from emergency rooms that its supporters are seeking to expand it across Canada. But they have been hindered by a tangle of red tape and a yearslong court battle reflecting a conflict between medicine and politics on how to address drug addiction.
The clinic's prescription program began as a clinical trial more than a decade ago. But it has garnered more interest recently as a plague of illicit heroin use and fatal overdoses of legal painkillers has swept across the United States, fueling frustration over ideological and legal obstacles to forms of treatment that studies show halt the spread of disease through needles and prevent deaths.