Pubdate: Tue, 04 Aug 2015
Source: Montreal Gazette (CN QU)
Copyright: 2015 Postmedia Network Inc.
Author: Charlie Fidelman
Page: A1


Canadian study explored local scene and its link to high-risk

"There was so much crack in the neighbourhood that users and outreach
workers nicknamed the area Rochelaga."

When anthropologist Nelson Arruda explored an east-end Montreal
neighbourhood, he expected to find shooting galleries - dark,
clandestine places where people inject drugs - and sex slaves addicted
to the next high.

What he found in Hochelaga-Maisonneuve were crack houses - located
every three blocks, and concentrated on a stretch spanning 20 streets
- - governed according to strict rules that included a ban on injecting
and prostitutes who on the surface operated independently.

To get inside, users had to be known to the house "gatekeeper" or
seller. Arruda, who was already working closely with community street
workers involved in harm reduction programs for four years in downtown
Montreal, got introduced to the east-end "Rochelaga" scene.

In a first Canadian study of its kind led by Dr. Elise Roy, professor
at the faculty of medicine and health sciences at the Universite de
Sherbrooke and research chair on addiction, Arruda spent a year on the
trail of high-risk behaviours at the intersection of illicit cocaine
use. Starting July 2011, Arruda observed and interviewed crack cocaine
users inside crack houses that are commonly called "piaules" in
French, or tiny apartments. What Arruda found underscores the
importance of the environment in public health approaches to
addiction, drug abuse and health risks.


Roy's team was already running a larger study called Interface on the
risks and harmful effects of drug use when outreach workers warned
that crack was flooding Montreal's downtown streets. Unlike powder
cocaine that's sniffed or injected, crack cocaine, which is powder
that's been hardened into rocks or crystals, is heated and smoked.
Crack users say it produces an intense high that's as good or better
than injecting, Roy explained, but it only lasts about 10 minutes.
Hooked users tend to binge smoke, looking for one high after another.

"They are continuously looking for more and more and that makes them
vulnerable," Roy said.

Roy was curious: Some studies coming out of the United States
described crack houses as places of high risk behaviour, "as sexual
slavery for women drug users." Arruda was already researching the
subject as an ethnographer on Montreal streets for several years, she
said, "but we were not able to capture good information on sex risk in
(the) context of crack availability." CHEAP, DESPERATE SEX

The sex trade is the pillar of crack houses. But Arruda did not find
sex slaves in Hochelaga-Maisonneuve crack houses, Roy said.
Neighbourhood sex workers paid a fee to use a room with a mattress in
the back, usually a bedroom. Still, there was not a lot of sex going
on in the crack houses. Most of the "johns" looking for sex only were
middle-class men, not regular drug users. And they were uncomfortable
in the "piaule" milieu - dirty, cramped and lacking in intimacy.

Also, many of the prostitutes were freelance, independent workers.
They didn't have pimps and they didn't "belong to the house." Still,
the gatekeeper or seller had a complicated relationship with the sex
workers that Roy called "subtle pimping." Crack is linked to binge use
and the seller supplied the women with free crack early in the day to
get the binge cycle going, she said.

One participant told Arruda that the piaules would close without the
sex workers. The piaules needed the prostitutes who needed clients to
feed their crack addiction. When desperate, some agreed to sex without
protection, Arruda said, and their prices dropped as the crack
cravings increased. "When they start on a binge they'll do it for five
dollars," Arruda said. "You can see the distress in their faces - on
the corner, waiting for a client."


Drug dens or piaules existed in the neighbourhood long before crack
became available. But not on the same corner. They had to be two to
three blocks apart. "It was not someone's house. The piaules we're
talking about are like shopping malls ... official big ones controlled
by criminal organizations," Arruda said. These underground businesses
are open 24/7 because "addicts are addicts 24 hours a day. We don't
sleep, right!" as one participant told Arruda. Gatekeepers work
12-hour shifts managing the operations as on-site employees of
organized crime that administer the piaules. Gatekeepers have two
roles: sell crack and maintain rules and order.

Each piaule had rooms reserved for selling, smoking and sex. Smoking
was usually done in the living room, while sex services were provided
in the bedroom. Piaules are short of furniture and cleanliness and
many are infested with bedbugs. Arruda describes one place as "full of
garbage and really filthy ... There is a stove but no fridge, three
old stained couches full of holes ... The walls are smeared with dirt,
graffiti and even blood."


Crack is the only form of cocaine that is available, and no other
drugs are allowed. Go in, spend a minimum of $20, leave within 20
minutes - unless you buy more crack. No harassing the seller to front
the drug on credit. No stealing. Smoking on site is permitted, but not

"You should know that those who smoke crack also inject. Heroin or
prescription opioids are a real problem in this population," Roy said.

Arruda said he was shocked to find crack dens were injection free

"I was surprised to see people kicked out and shouted at and banned,"
Arruda said. One seller confided that he was fed up with messy, bloody
syringes and police raids. But another hypothesis, Arruda said, is
that the high it produces is different. An injection can last as long
as half an hour and crack's high dissipates in about 10 minutes. "So
it's rock after rock and maybe the women go back to work faster
because she has another craving."


Injection drug use declined sharply as crack flooded the streets. The
shift in the cocaine market had a profound impact on street drug use.
One reason injection drug use declined, Roy said, is because crack is
smoked more and more on the street, not just in the piaules. "The
piaules are not the reason for the decline, it's the availability of
crack," she said.

According to recent public health estimates, Montreal had about 4,000
drug injection users in 2009, down from the 1998 estimates of 12,000.

"That's good news if injection is declining in terms of epidemics,"
Roy said, as needles and the spread of blood-borne diseases such as
HIV and hepatitis C are clearly linked. Two thirds of injection drug
users are infected with hepatitis C and one fifth have HIV.

But the piaule as a micro-setting where crack cocaine is used, is also
a threat to prevention, she said. "The fact that it makes users go on
the street to inject adds risk," she said. "And distributing clean
injection material to users (in piaules) is forbidden. Many need to
inject on a regular basis and when they have to go on the street
that's a threat to prevention."


Needle exchanges, drug treatment and other harm reduction programs
have helped reduce HIV infections around the world, "and it has shown
that public health has a role to play even if we're dealing with
crime," Roy said.

Outreach workers involved in harm reduction programs have established
relationships with piaules and their clients. They can go in, but they
can't distribute clean needles. But outreach workers are also there to
maintain contact with drug users and sex workers, to gain trust and
develop relationships.

"We are there for them when they need us," Roy said. "Prevention has
to work with environmental conditions to be efficient."

Researchers note that the portrait of crack houses described in their
2011-2012 study, which was recently published, may have changed in the
last two years. Crack cocaine may be on the decline in favour of new
synthetic "bath salts" drugs now being reported on the streets. The
next step is to continue to study drug pattern uses for their impact
on risky behaviour.

This study was funded by the Canadian Institutes of Health Research.
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