Pubdate: Mon, 29 Dec 2008
Source: Globe and Mail (Canada)
Copyright: 2008 The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Author: Justine Hunter
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

Ten to Watch in 2009: Dirty Needles

SHARING NEEDLES AND THE DAMAGE DONE

In the Past Six Months, Addicts on Victoria Streets Have Found Access 
to Clean Needles Increasingly Difficult, Leaving Outreach Workers to 
Desperately Search for Ways to Prevent the Spread of Disease and 
Death. The Fifth in a Series of 10 Remarkable People, Places or Things

VICTORIA -- In the past six months, drug addicts in Victoria have 
misplaced more than 60,000 needles, proving the city's needle 
exchange program is, increasingly, a misnomer. Since public pressure 
led to the closing of a long-time storefront exchange site in May, 
AIDS Vancouver Island has tried to fill the gap with a mobile 
service, where outreach workers on foot and on bicycles roam the 
streets trying to find addicts in need of clean gear.

At a time when those addicts are turning to more dangerous drug 
habits - police and health workers report an increase in the use of 
crack cocaine - it is more challenging for them to get clean needles.

"It's really hard to go out there, doing this work, when it's so 
futile," said outreach worker Erin Gibson, back from her rounds of 
searching the city's grittiest spots for clients.

A report from the University of Victoria's School of Nursing confirms 
what Ms. Gibson already knows: The mobile service isn't as effective 
as a fixed site. There are fewer clean needles reaching the addicts, 
and even fewer dirty needles being safely returned.

In October, Ms. Gibson's crew from AIDS Vancouver Island handed out 
just over 22,000 new syringes. They recovered fewer than 8,000. In 
2006, the agency was seeing a return rate on used needles of 99.8 per cent.

Where are those missing needles? No one is really sure.

"It's a concern," said Shannon Turner, the director of public health 
for the Vancouver Island Health Authority. Civic officials installed 
five drop boxes downtown in May, when they shut the Cormorant Street 
storefront site. It's helped - a bit. They are collecting about 750 
needles a month.

Her goal is to find at least one fixed location where addicts can 
exchange their old needles for new ones. But the challenge is finding 
a place where this crowd would be welcome. Police records show public 
complaints around the old exchange have dropped - but the problems of 
violence, drug dealing and loitering simply dispersed to other 
locations in the small downtown core.

The dilemma of the needles is a worry, but Ms. Turner is more alarmed 
by another trend: There seems to be a shift in preferences among 
street-drug users from injecting heroin to smoking crack cocaine.

"Most people don't survive [crack] very long," she said. "We have 
less time to save them."

Constable Connor King is the Victoria Police Department's expert on 
cocaine and heroin. He agrees there is a shift: "Five years ago, you 
saw someone huddled in a doorway, they were smoking marijuana. Now, 
they are smoking crack."

But heroin is still accessible and some prefer to inject cocaine, he 
added. Addicts use them interchangeably, depending on what's cheap 
and available.

Six months ago, outreach worker Ms. Gibson worked at the busy 
Cormorant Street needle exchange, which offered a warm meeting place 
where staff could dispense medical care or other needed assistance. A 
majority of their clients were either homeless or in unstable 
housing, with limited access to food and health care.

Now Ms. Gibson's day involves hours on the street, carrying a bright 
orange shoulder bag stocked with syringes, condoms and other 
harm-limiting paraphernalia.

On a recent day where the wind was blowing a freezing rain sideways, 
Ms. Gibson found a young woman huddled in a doorway, wrapped in a 
thin sheet. The girl needed more than a clean needle: Ms. Gibson 
tried to get her to a warm shelter.

"She said, 'I can't walk two blocks, I've been without shoes or socks 
for three hours.' "

There is a clear crossover between drug addicts and the homeless: 
There are an estimated 1,000 homeless people in Victoria, and about 
one-third of them have acute addiction or mental-health issues.

Karen Bahrey is a front-line health worker who is trying to save 
addicts by getting them off the street. To call her work ambitious 
would be an understatement.

In a city with near-zero vacancy rates, Ms. Bahrey's team spends a 
huge part of its time trying to find landlords willing to accept drug 
addicts who are accustomed to living out of a shopping cart.

The $3.5-million housing initiative, launched last year, has found 
housing for about 100 of the most challenging tenants Victoria's 
street population could offer.

Ms. Bahrey calls it "sheer luck" but in fact, it takes 
round-the-clock support, often with twice-daily visits to help them 
adapt to life off the street. Her team, which includes police and 
parole officers, enforces a "no visitors" rule to ensure that their 
clients don't bring the street home with them.

Once they are housed, they can start to deal with other problems, 
such as detox, education and dental care. Her caseload now includes 
people who are going to school, who are clean for the first time in 
10 years. One, an "entrenched" street person who gave birth to a 
drug-addicted baby, is now housed, clean and trying to get her baby 
back. "She looks like a different girl," Ms. Bahrey remarked.

Kelly Reid, who heads the initiative for the Vancouver Island Health 
Authority, expects to triple the caseload in the coming year.

"By the end of 2009," he predicted, "I expect people to come up and 
say 'I can see a change on the street.' "

[sidebar]

MOBILE SITE NOT AS EFFECTIVE, UVIC STUDY SAYS

Joan MacNeil and Bernadette Pauly, of the University of Victoria's 
School of Nursing, were studying needle-exchange programs on 
Vancouver Island last year when the ground shifted under them: 
Victoria's main exchange site was shut down.

The fixed site was replaced with mobile needle-exchange services 
only. And it provided an opportunity to evaluate the effectiveness of 
the two models.

Not surprisingly, the study concluded that when you make it difficult 
for drug addicts to get clean needles, they are more likely to reuse 
what they have, increasing the risk of infection and the spread of 
diseases such as HIV and hepatitis C. In November, close to one in 
five users reported reusing a syringe in Victoria, while the practice 
was unheard-of in the other communities they surveyed with fixes sites.

The researchers followed a group of 33 addicts between May and 
September. Here are some of the things their subjects told them:

"Do you think someone is going to walk all the way across town to 
find out they are not even here for a needle? ... They're going to 
find the easiest way."

"Most people are willing to share the rigs that they have. Most 
people are turning a dollar for a clean rig. Well, not going around 
selling, but if you ask them for one, they ask you for a buck."

"Oh, I sure liked it a lot better when it was in a fixed site. Yeah, 
of course it's great that we can get new needles ... but it is really 
hard cause my HIV has affected my nerves and it is hard for me to walk."

"I don't know where [the mobile outreach teams] are half of the time. 
Not like at the needle exchange."

[sidebar]

ONE TO WATCH

Thing

Dirty Needles

Why to Watch

A storefront needle exchange service shut down in Victoria last May 
because of public complaints about illegal drug activity. As a 
result, drug addicts are taking more risks to feed their habit. 
Health workers hope 2009 will be the year a new site is found - 
before the use of dirty needles takes its toll. 
- ---
MAP posted-by: Richard Lake