CRACK USERS SAY PIPE PROGRAM HELPS THEM STAY HEALTHY

A controversial decision by the City of Ottawa to distribute clean needles
and crack pipes to drug users is being credited with saving junkies from
disease, Raina Delisle reports.

Richard Grabell admits he's a "quasi-life junkie," but insists he's still a
healthy minded drug user.

No matter how desperately he needs a fix, Mr. Grabell, 35, never uses dirty
needles or second-hand pipes. He never shares his gear with other addicts.
And he's pretty sure he'll never catch HIV or hepatitis C.

He attributes his pros-pects for continued good health, at least in part,
to the City of Ottawa's program for distributing needles and crack pipes to
drug users.

Mr. Grabell, who studied politics at the University of Ottawa in the early
1990s, says most users would grab discarded needles and pipes from garbage
cans if they couldn't find clean tools. But thanks to the city's
publicly-funded Site Program, which provides sterile needles for injection
drug shooters and clean-pipe kits for crack cocaine smokers, there are
thousands of Ottawa drug users who are disease-free and determined to stay
that way.

Indeed, Mr. Grabell warns that a lack of such programming and resources for
drug addicts harms even those who don't use drugs. "Bitter, pissed-off HIV
drug users who can't get what they need to use" often retaliate by dropping
infected needles and pipes in public places. "If you want to turn your back
on that suicidal subculture, I think you're being pretty ignorant."

A year ago tomorrow, the City of Ottawa introduced its controversial
safer-inhalation initiative to help crack users get clean pipes. The city's
needle-exchange program has been around since 1991.

The crack-pipe program was approved based on a report presented to a city
council committee by Dr. Robert Cushman, the city's former medical officer
of health.

His research suggested the expansion of the needle-exchange program to
include the distribution of crack pipes, tourniquets and other drug
paraphernalia would curb the spread of HIV and hepatitis C among Ottawa
drug users.

The city estimates between 3,000 and 5,000 injection drug users live in
Ottawa and about 80 per cent of them have smoked crack cocaine. Between 75
and 80 per cent of drug users have hepatitis C and about 20 per cent are
HIV-positive.

Because of public concern, intense debate among city councillors and Ottawa
police Chief Vince Bevan's vocal opposition to the program -- which he said
will encourage drug use -- the pipe-kit distribution only got under way in
April.

For the dozens of homeless people who loiter around Mr. Grabell's temporary
home at the Shepherds of Good Hope shelter on Murray Street, the program
couldn't come quickly enough.

Earlier this week, a trio of users outside Shepherds' soup kitchen said
smoking crack is part of their daily routine and they depend on the city's
program for clean pipes.

However, even if the program didn't exist, they would still get high. To
save some cash, they would share pipes and be at higher risk for diseases.

One man said he's infected with hepatitis C. Although he's not sure how he
contracted the virus, which is a leading cause of cancer, he blames his
"lifestyle of using and abusing" and says the city's program for clean
equipment saves hundreds of his fellow junkies from a similar fate.

The city's Site Program is based at the Health Sexuality Centre at 179
Clarence St. Clean needles and crack kits are also available from the
mobile van, which travels to different locations in the city from 6 p.m. to
midnight, and from outreach workers who visit drop-in centres and patrol
the Byward Market area.

The program's success depends on wide distribution channels, according to
Dr. David Salisbury, the city's medical officer of health. Ottawa has 12
partner agencies providing needle exchange services; however, when the
health and community centres were asked to add crack kits to their
inventory, not all were eager to get on board.

"Research supports the needle-exchange program," said Rob Eady, senior
manager of public relations and fundraising for Shepherds of Good Hope.

"Evaluating the pipe program is on our agenda, but we need more proof it
actually works before we'll participate."

The health risk of reusing pipes is not as obvious as that of injecting
drugs with dirty needles.

But according to Dr. Cushman's report, "crack smokers are at increased risk
for blood-borne infections and sexually transmitted diseases. Sharing of
contaminated equipment increases risk of transmission." This is because hot
crack pipes burn and split users' lips and infected blood can then be
transferred when the next smoker takes a hit.

For now, Shepherds' residents will have to walk a few blocks to the Site to
collect their pipes.

"It's a needed facility," Mr. Grabell said. "A lot of people were
'MacGyvering' (rigging) their own kind of paraphernalia to smoke with and
it was really dangerous and unhealthy."

Since April, about 1,500 pipe kits -- which include condoms, lip balm,
chewing gum, a pipe-disposal mechanism and information on drug use and
prevention -- have been distributed. Individual pipe stems are also given
out. With the city recovering over 100,000 needles each year, the number of
pipe handouts will likely grow with awareness of the program.

"We haven't got to the whole population that we want to protect," said Dr.
Salisbury. "It's not a bad start, but it's certainly not where we want to be."

Dr. Salisbury cited a Health Canada study that showed users enrolled in
needle-exchange programs are less likely to acquire HIV. A similar study is
already in the works for the safer-inhalation program.

Mr. Grabell has a message for anyone who opposes the project: "For the
difference between 90 per cent and 10 per cent of users being hep C and HIV
positive, it's worth the extra money."

Last year, Dr. Cushman said it's so cost-effective, it would be unethical
not to implement the safer-inhalation program, which has an estimated
annual cost of $2,500.