Epidemiology: Forging the Future: Tracking the Addicts

Each morning Dr. Jane Buxton, 49, bicycles through the manicured West Side of Vancouver, Canada, to wage an unconventional war on drugs. Just two miles north and a world apart from Buxton's office is a 10-square-block area known as Downtown Eastside, where a shifting population of some 5,000 addicts huddle together, drawn to Vancouver for its relatively mild climate, generous social services and easy access to street drugs. The area also boasts the highest concentration of HIV and hepatitis-C cases in North America; more than 80% of its drug users test positive for hepatitis C and 25% for HIV.

What makes Vancouver's approach so unusual in North America is that as well as cracking down on drug use, the city treats it as a disease--providing free prescription-grade heroin in a research trial and running a medically supervised injection site--while carefully gathering data on the effects of city policies. At the heart of this experiment is Buxton, a physician-epidemiologist affiliated with the University of British Columbia medical school, who monitors the situation firsthand and meets several times a year with a committee of police, health workers, charities and support groups to collate their reports. "We're looking at the numbers of people affected, hospital utilization, deaths related to drug use and where interventions are needed," she says.

The program is not without its critics, especially within U.S. drug agencies. But Buxton is convinced that the only way to answer the critics is with hard evidence. Her mission, she says, is to help policymakers and the public understand that drug use "is a health and social issue and that persons affected should be treated ethically, with respect and dignity." Her no-nonsense annual report has become a valued source of well-documented evidence and has served as an early-warning system for emerging issues, such as the burgeoning use of crystal meth. "We interpret the data epidemiologically," says Buxton, "and we alert the key players."