Mr Kam, who declines to give his full name, blames the area's decline on the government's leniency towards illicit drug use. 'It looks like the government allows addicts to do that,' he says. 'They use drugs on the street because the policy is so slack, they think it is legal. This doesn't happen in Hong Kong, but here...' He shakes his head.

Although some, like Mr Kam, disapprove, others believe the government's progressive drug policy is saving lives here on skid row. Using public funding, health centres and outreach workers distribute free needles, alcohol swabs and sterile water vials to the neighbourhood's drug users to control the spread of disease. Now the provincial government is planning to add free crack-pipe mouthpieces to the list.

British Columbia's Ministry of Health plans to offer sterile mouthpieces - small, detachable pieces of plastic tubing that fit at the end of a glass crack pipe - to curb the transmission of HIV, hepatitis C and tuberculosis (TB) among crack users who share pipes. Those who smoke crack, the crystalline form of cocaine, often develop burns, blisters and sores around their lips from hot pipes.

'The distribution of [mouthpieces] can help prevent illness and save lives, resulting in lower health care costs and reduced risks to the health of the community,' the ministry says.

Ministry officials say they have not yet determined the cost of the programme. The government began making the mouthpieces available to at least one of the province's five regional health authorities this month. The decision on whether to use the programme will be left to the authorities themselves, officials say.

But at the price of about a penny each, the mouthpieces could potentially save millions of tax dollars in treating infectious diseases.

'It's a real no-brainer,' says Ann Livingston, executive programme director at the Vancouver Area Network of Drug Users (Vandu), a non-profit organisation that represents cocaine and heroin users in the Downtown Eastside.

Those who are addicted to crack cocaine are not deterred from smoking the drug when they lack pipes and mouthpieces, Ms Livingston says. Instead, they resort to using whatever materials are available, including aluminium cans or burnable syringe tubes, to construct dangerous makeshift apparatuses.

Her organisation has been distributing free crack-pipe mouthpieces for about five years, relying on donor money to purchase them. She hopes the ministry programme will alleviate the cost.

'As a health issue, it's timely and it's way overdue,' Ms Livingston says. 'We've had a lot of people die from pneumonia last year, and TB is still an epidemic in this neighbourhood.'

But while health workers, community groups and drug users alike applaud the ministry's plan, it has reignited a long-standing debate over drug use. Over the years, harm reduction has become the issue among policymakers, who have come to regard drug use as a public health rather than criminal matter.

Aside from its free needle exchange programme, established in 1989, the Downtown Eastside is also home to North America's first legal supervised injection site, Insite, which opened in 2003.

Meanwhile, researchers down the street are conducting an C$8.1 million (HK$61.7 million) study, launched in 2005, that provides addicts with daily doses of prescription heroin.

Critics say the mouthpiece distribution programme is yet another initiative that merely enables drug abuse.

'It's more about the message than the money,' columnist Joey Thompson writes in The Province, Vancouver's daily newspaper. 'The cynics - and I'll admit I'm one - view this recent addition to the harm-reduction distribution list as just another prop to keep the user using.'

Thompson argues that money and effort spent on harm-reduction programmes should instead be used to 'invest in treatment programmes that reward addicts who got clean'.

Getting clean, however, is easier said than done, says Vandu president Richard Utendale, who has been battling crack addiction for a decade. Mr Utendale says he first tried crack cocaine in 1983. But his use of the drug did not become a problem for him until 1997, around the time he believes crack cocaine became the drug of choice in the Downtown Eastside.

It was also around the mid-1990s that the neighbourhood descended into the cluster of derelict, low-income rooming houses and pawnshops that it is today, he says.

Mr Utendale says using crack cocaine made him feel better than almost anything. 'It felt like I was out of my body and looking down on myself,' he says. 'You have no cares, no concerns. Everything's warm and fuzzy.'

But once the feeling of bliss disappears, he says, users tend to go through a five- to 30-minute period when they are desperate to get their hands on more of the drug.

Mr Utendale says he has been through drug rehabilitation treatment more than half a dozen times. Recovery is the ultimate goal of harm reduction, he says. But, until they can recover, harm-reduction initiatives aim to keep drug users as safe and healthy as possible, he says.

Today, according to Vandu's statistics, close to 14,000, or 88 per cent, of the 16,000 people who live in the Downtown Eastside are users of illicit drugs, such as crack cocaine, methamphetamine and heroin.

Yet Mr Utendale says evidence shows that harm-reduction tactics are working.

Before the Insite safe injection site opened, Vandu recorded more than 400 deaths per year from drug overdose. Since 2003, the number has dropped to fewer than 50, he says.

Back at his shop, Mr Kam says that despite his disapproval of the government's stance on drugs, he sympathises with the addicts and often talks to them about their problems.

'They know it's no good for them,' Mr Kam says, but they tell him they can't break their addictions due to the widespread availability of drugs in the area.

Rampant drug use is no good for his business, either, he says. 'My customers don't come to Chinatown any more because they figure it's unsafe,' he says. 'That's a big problem for me.'