DRUG PROGRAM AIMS TO GET ADDICTS `OFF THE NEEDLE'

The Works Is A Pilot Project For Heroin Users. The Program Began Late
Last Year After Toronto Approved A $91,000 Grant

When Sigrid Knorr arrived at her office near Dundas and Yonge Sts. one
chilly morning last month, she found a thin, wiry man huddled up asleep by
the door.

Knorr recognized him immediately and brought him in from the cold.

It was Richard R., a 34-year-old former junkie and methadone patient and a
client. Richard has been trying to rebuild his life and get off drugs. He
has been on a methadone program at The Works, a downtown clinic, for six
months.

``I started on Dec. 16,'' he says during an early morning interview. He is
sleepy and his speech is slurred.

``It was my birthday.''

His body shakes gently as he talks. He takes a shot from a bottle of cola
and apologizes for his state and demeanour. He needs his medication, he
explains. Once he takes it, he'll feel better and make more sense.

He has nothing but praise for the help he has received at The Works.

``My life now is still a bit hectic, but my choices are becoming more real.
I still have this little chaotic voice saying: `Use, use, use.'

``But there's another part of me saying: `You don't need that. Look at you.
You can do it. You don't need it.' ''

Richard is one of 24 patients who regularly come to The Works as part of a
pilot project for heroin users. The program began late last year after
Toronto city council approved a $91,000 grant for it.

``My basic goal is to get off the needle and get my life back to
productivity,'' he says.

Then he smiles and says: ``Or get some, since I never really had any.''

The Works, run by Toronto's public health department and Breakaway Youth
and Family Services, is a lifeline for Richard and other addicts and street
people.

It provides a wide variety of services for injection drug users and
prostitutes, including methadone access, a needle exchange, condom
distribution, TB testing, anonymous HIV testing, counselling and hepatitis
B and C testing.

Richard comes daily to The Works to get a prescription that he then fills
at a local pharmacy.

But he also gets counselling and support. Support from people like Knorr
and Jeff Ostofsky, a resources and development worker.

Ostofsky has been there himself. The one time heroin addict got on a
methadone program five years ago and has never looked back. In fact,
Ostofsky was instrumental in developing the program at The Works.

``When we started talking about it, it was a pipe dream, a fantasy. But now
we're doing stuff here that's never been done before. We are looking after
people who were turfed out of places.

``There is a real need for low-barrier clinics. We are seeing people who
are so hurting and so broken, even for me, coming from an addiction
perspective, even I didn't experience that and it breaks my heart.''

Indeed, it's been a tough road for clients like Richard, who moved here
from California three years ago.

``I love drugs,'' he explains. ``I've been doing drugs since I was 8. By
age 10 I was snorting speed and cocaine. I was taking whites and bennies.''

But no more. Slowly but surely Richard has made real progress, says Knorr,
a nurse who has worked with him over the last six months.

``When I first went on the program, I was really a mess,'' Richard admits.

Now, however all that is changing and Richard is making plans for his future.

``I would like to become some kind of outreach worker for people who are in
distress or in need, who are in trouble,'' he says.

``I like to help people. It makes me feel good to feel like I'm helping.''

That's music to the ears of Shaun Hopkins, manager of The Works.

``Many of our clients couldn't get into a (methadone ) program because of
waiting lists or they had difficulty meeting rules and regulations at other
programs,'' she explains.

``So we came up with a harm reduction methadone program.''

That translates into a fairly loose program for clients, says Hopkins.

``The idea isn't to end the dependency necessarily, but to bring people in
and to get them not to inject on a particular day.

``With the ultimate goal to prevent the spread of communicable diseases in
that population, both AIDS and hep C.''

So when the guidelines for use of methadone were relaxed by the province in
1996, The Works decided to come up with a new program to help addicts like
Richard R.

Up until two years ago, Canadian addicts had to wait years before receiving
methadone treatment. But now they can walk into a doctor's office and get a
prescription.

There are an estimated 10,000 to 20,000 heroin users in Toronto, experts
say. And many of them are forced to steal up to $500 a day to support their
habit.

Hopkins says methadone programs have clearly demonstrated benefits for
clients. They help reduce illegal drug use, reduce criminal behaviour,
improve employment, enhance social and family relationships and reduce
incidence of HIV.

``We don't have a lot of criteria for people to come here,'' she says.

``We try to assess what people need when they come to us. We'll do
everything we can to get them hooked up (to appropriate help).

``And often clients don't want to see traditional medical care. They feel
they have been abused by the traditional medical community because they are
drug addicts.

``If clients want to get clean, we help them do that,'' Hopkins says.
``It's a self-directed program. We ask them: `Do you want to stop using
everything or do you want to use other drugs while on methadone.'

``For some people, it's not a conscious choice.''

The program is now being reviewed for more funding and she hopes she'll get
another grant to continue it.

But things are tight in the public health department and she's not sure
whether the funding will come through.

In the meantime, she and others - like Richard - believe the program is
working well.

``We've seen some people who were very desperate here,'' she says. ``Being
on methadone is not the answer entirely. It takes the edge off and gives
people time and energy to think a lot about other things.''

That includes, Hopkins says, doing battles with the demons that may have
started them doing drugs in the first place.

For the clients here, life can be tiring, she says. The clinic ``gives them
an opportunity to come in and have regular contact with people, in an
informal way.''

If they need food or housing or even a long talk, The Works provides it.

``It's made a difference for a lot of people,'' she says. ``It's decreased
drug use and injection behaviour and also criminal behaviour.

``For us, the benefit is in the faces of the people we see. Some people
say: `If it was not for The Works, I'd be dead.'

``We're their only family. We're very non-judgmental. A lot of our clients
have burned their bridges both with family and medical community. Here, we
try to not close the door on anybody.''

What's more, if The Works is able to save even 24 people from contracting
HIV through the methadone access program, then Hopkins believes that's also
a very good thing indeed.