The proposed research trial named CAST -- for chronic addiction substitution treatment -- has reignited a debate about how to deal with Vancouver's drug problem. And a big problem it is.

Studies indicate more than 33,000 British Columbians are dependent on illicit drugs. Property thefts, assaults, street prostitution, aggressive panhandling, dumpster diving, shoplifting and homelessness are, in many cases, directly related to people with chronic addictions desperately trying to find money to buy illegal drugs.

More than 140,000 property crimes were reported in Greater Vancouver during 2005. Drug offences have increased by 63 percent. There are 800 chronic offenders who are arrested more than five times per year. Many of these admit to committing between five to 15 crimes per day to fund their drug addiction.

In Vancouver's Downtown Eastside, the impact of addictive drug use is plain to see. The area has the highest HIV infection rate in North America, affecting almost 30 per cent of the local population, mainly women.

Use of drugs like cocaine, crack cocaine and methamphetamine has long been recognized as a driver of the HIV epidemic. These drugs are also associated with heightened violence, crime and public disorder.

On Feb. 26, Vancouver Mayor Sam Sullivan and an impressive group of doctors, concerned parents, ex-drug users, enforcement officers, residents, business people from the Downtown Eastside and politicians from across the political spectrum came together to launch Inner Change, the non-profit society that will drive the CAST research trial.

CAST would work with addicted people to substitute their use of illegal street drugs with legally available, orally administered prescription medications. The CAST trial rejects the use of needles and illegal drugs. The short-term goal is to help addicted people stabilize their lives, identify any underlying mental health issues, remove the need for criminal activity to finance their drug habits and reduce their impact on the surrounding community. The eventual goal is to get them off drugs completely -- abstinence.

Some people believe we should simply crack down on the problem with more enforcement.

The truth is we already spend 73 per cent of federal drug strategy money on enforcement, despite a lack of any scientific evidence to support this approach and little evaluation of the effects of this investment.

Another 14 per cent is spent on treatment, almost exclusively abstinence-based. In spite of the impression created by all the media discussion, only three per cent of federal drug strategy money goes to harm-reduction programs.

Some people argue the only way to help addicted people is to get them into abstinence-based programs. Again, the facts suggest otherwise.

Approximately 75 per cent of addicted people do not respond in the long term to abstinence-based treatment. Only about 15 per cent manage to stay clean for the long-term after-treatment. The other 10 per cent manage to become abstinent all on their own.

While many of us simply want the crime and the open drug market to go away, Phoenix Beck reminds us of what is really at stake. Phoenix is a young woman, now 25, who spoke at the Inner Change launch with disarming honesty and frankness. She told us she was 15 when she first tried smoking crystal meth -- she had no idea what it was. She lived on the edge of the Downtown Eastside for the next five years, spiraling down into a bleak life.

But Phoenix is a survivor. She decided to change and found a friend who gave her Adderall, a prescription stimulant. It is ironic that Phoenix had to get Adderall "illegally" to get off street drugs. She took the Adderall for just one week while her body adjusted to coming off the street drugs. Phoenix has made it back.

We as a society don't seem to have a problem with substitution treatment for people with decent homes and stable lives who are trying to deal with an addiction: Smokers can use a patch for nicotine replacement. Yet we expect people addicted to street drugs, often homeless with no stable source of income, to be able to quit hard drugs without medication.

Inner Change is young, and CAST is still in the planning stage. There are many details to work out. We need to put our heads down and work with the talented and knowledgeable group of professionals who have come together to drive this concept to reality.

As Dr. John Blatherwick said at a recent workshop: "There are many questions yet to be answered, but Mayor Sullivan has given us a huge opportunity here to create a program that could profoundly impact both addicted people and the communities they live in."

Getting people off illegal drugs is still the goal; CAST is another option, another tool to help addicted people get there.