CRACK USERS MINE A WHOLE NEW VEIN

"Once I found out about needles I wouldn't smoke anymore. You're in seventh
heaven. It's a different high -- stronger and it lasts longer."

There's a glint of pleasure in Ted's grey-green eyes when he talks about
injecting crack, and a slow smile spreads over his weathered face.

Even though the habit he abandoned nine months ago drove him on to the
street and made him do things and keep company with people he can scarcely
talk about, the memory of the awesome pleasure remains -- and makes him smile.

And that's the problem.

Crack, which users claim is the most addictive and most debilitating of all
illegal drugs, has moved into another, more dangerous space. For the last
year or so at The Works, the needle exchange at Dundas and Victoria Sts.,
counsellor Leah Boelhouwer has been seeing vein abscesses and other grim
evidence that a new, more dangerous method of getting high is gaining ground.

Shooting crack is an instant high. Touch your finger to the spot of blood
the injection draws and then touch it to your tongue, a two-second process,
and you're there, in seventh heaven, blissing out, indifferent to pain,
trouble, the future, the past, even the present.

And for many street people without much else going on in their lives, it's
way too seductive to resist. At least at first.

But, as Ted found, once you start injecting it doesn't take long for the
health problems to catch up with you.

VINEGAR IN HIS VEINS

One of the big problems is the liquid used to dilute the crack. Vinegar was
Ted's choice. He'd take a $20 rock of crack, crush it with the end of his
syringe and then heat it in a spoon with a bit of vinegar. One of the
vinegar pouches from Harvey's would be enough for four or five syringes if
friends are sharing. (One Ottawa researcher believes HIV can be spread
through sharing the liquid and the spoon, but Ted never worried about that.)

He didn't like to see the occasional fizzing in the spoon. That meant too
much cut, too much baking soda.

Some users dilute with lemon juice but for Ted that wasn't an option. The
high wasn't as good. "I never used anything but vinegar," he says with a
certain macabre pride.

He knows vinegar in the veins is a nasty business. He's had the abcesses,
and seen the veins in his hands blacken after an injection. And now that
he's volunteering a bit at The Works, he knows the staff are worried enough
about it to have bought a big supply of ascorbic acid to offer as an
alternative for those addicts now using vinegar.

"Besides the vinegar there are so many chemicals in crack," says
Boelhouwer. "It's very, very hard on the veins. For us this a hot issue
right now -- and that's without even mentioning the health issues with
needles."

But in other Canadian cities those "health issues with needles" are causing
concern bordering on panic.

In Vancouver, in a recent study, the rate of new HIV infection among
injection drug users is the highest in the world, says Nate Hendley of
Addiction Research Foundation.

"Injection drug use is now driving the train of infection," says Michael
O'Shaughnessy of the B.C. Centre for Excellence in HIV/AIDS. "We went from
a prevalence rate of 5% in '94 to 40% in '97."

The 1,300 injection junkies they followed in their study may be more
high-risk users than the average among the 10,000 injection drug users in
the city, but nobody knows for sure.

At any rate the explosive numbers in the study got the folks in B.C. into a
tizzy and there now seems to be political will to try to stop the spread of
HIV in the drug culture.

"This phenomenon has been seen before in other cities," says Martin
Schecter, the lead investigator in the Vancouver study. "The virus can stay
a low level for a while, creep up slowly and then explode."

In Vancouver and cities such as New York and Edinburgh, the point at which
the momentum suddenly explodes has arrived when about 10% of the drug users
become HIV positive. While "there is nothing magic about 10%," says Toronto
researcher Dr. Peggy Millson, that does seem to be the spot of critical
risk on the graph.

While not all of the data from Millson's most recent study has been
analysed, the research suggests that 9.5% of Toronto injection drug users
are already infected with HIV/AIDS.

In Ottawa, the situation is already "unstable" says University of Toronto
epidemiologist Rob Remis. "It's the highest anywhere in Ontario."

Lynne Leonard, the social science researcher who conducted the
Ottawa-Carleton study, points out a number of worrying highlights:

* The prevalence rate nearly doubled from 10% to 19.2% between '93 and '97.

* The age at which the user got infected was younger.

* All of this happened despite a very active needle exchange with no caps
on the number of needles, unlike Vancouver and Montreal.

* In Ottawa there is no concentration of low-rent flophouse hotels as there
is in Vancouver's downtown east side.

The numbers in Montreal are very similar to Ottawa's -- 18% to 20% of the
injection drug users are HIV positive.

So why is the number so much lower in Toronto? And more importantly, how
can we keep it low?

Part of the reason seems to lie in the difference between the drug culture
here and elsewhere in the country. But it's a difference, as Ted's story
shows us, that could be changing.

In Toronto -- alone among the major Canadian cities -- the drug of choice
for injection is heroin, not cocaine.

Although Millson's work showed 70% of those attending the needle exchange
and followed had injected coke in the past six months, only 34% listed it
as the drug of choice. Injecting crack is so new the question wasn't even
asked.

In Vancouver the drug of choice for 80% of the people surveyed was cocaine.
In Ottawa cocaine was preferred by 82% and in Montreal 70%.

MARKET MANIPULATION

In Vancouver, experts believe the trigger that touched off the HIV epidemic
among injection drug users was the switch in preference to cocaine from
heroin. Why that happened is a complex question, but Shechter believes
market manipulation by drug dealers had something to do with it.

If pure cocaine were suddenly available in Toronto at a very reasonable
price, the drug of choice might quickly change here too -- with similarly
devastating consequences.

The most vulnerable people on the drug chain are those like Ted who,
through illness or poverty, have come to rely on crack as a reality assist.

As Toronto's associate medical officer of health, Richard Gould says: "We
have a fair amount of crack use here ... A lot of the people who get more
heavily dependent don't have a lot to lose. For those people feeling good
with crack is a rational choice."

Ted's story begins -- as many injection drug users do -- with medical
problems.

He broke his neck and his back in three places in a fall at a horse farm.
At the time he was a 49-year-old workaholic who managed a farm for one of
the country's wealthiest race horse operations. Drugs were the farthest
thing from his mind except when one of his grooms messed up. In fact, in an
irony that now makes him laugh, he was one of the few tough bosses who
banned drugs from the shedrow.

The successful spot Ted was sitting in at 49 had been a tough climb for a
little boy who had been given up by his mother at seven and raised (and
abused) by the Christian Brothers at St. John's Training School.

At 12 he started to work and after an adolescence full of beatings and
abuse, he began to make his mark at the track.

"I was a workaholic and celibate because of all the things that had
happened to me," he says. His work and his success were his greatest
interest and his proudest accomplishment. But that ended in '92 with his
fall from the hay mow.

"I was finished and I knew it," he says.

Throughout the recuperation period he was using barbituates to cope with
the physical pain. He was also avoiding the track in order to deal with the
mental anguish of losing his foothold in life.

In '94, living alone in Parkdale, he attempted suicide. For his family and
especially his nephew, this was a wake-up call. "My nephew saved my life
and helped me in a major way. My life was just shutting down."

But it was also through his nephew that he started using drugs. He had his
first toke of crack at Christmas '94 and it was "as if a new world had
opened up. No more pain. No more depression. I even called my boss at 4
a.m. and said I was coming into work."

For Ted, the toking and the occasional moderate use led, within a month, to
the "unbelievable buzz" of injection. This is far from the usual
progression, but Ted was using under the careful supervision of his nephew,
an experienced junkie. In early '95 shooting crack was a novel practice in
Toronto.

The anecdotal evidence from the street is that it's still not widespread,
but it's becoming attractive to street-level users because it allows a
cheaper, longer and more intense high.

It also, of course, has a very significant downside.

Injecting either cocaine or crack promotes recklessness. A heroin addict
uses a couple of needles a day. If you're injecting cocaine or crack, you
might need 30, even 40 needles in a run.

"It impairs judgment way more than heroin," explains O'Shaughnessy. "When
they're injecting coke they may start with their own needles, but as they
go on they might not even be aware they're sharing.

"Are they going to walk to the needle exchange in the middle of a coke run
to get the needles they need?"Schecter asks. "Highly unlikely. Through our
misguided public policy we set the table for the epidemic in Vancouver."

He urges other cities that have yet to experience the huge jump in
infection rates to take the Vancouver experience to heart.

He believes some of the factors that caused "the massive increase in
infection" are cuts to social housing so the addicts ended up concentrated
in the downtown east side in residential hotels that charged a monthly rate
as well as $10 for every re-entry at night.

(The policy allows the hotels to make money from the prostitution trade.)

What happened was the junkies couldn't afford to go out for clean needles,
and the hotels became huge "shooting galleries." Then the Vancouver needle
exchange put a cap on the number of needles each user could exchange. Those
public policies "created a powder keg," Schechter says.

It's a powder keg we don't want to recreate in Toronto where there are an
estimated 13,000 injection drug users (3,000 more than Vancouver),
Associate MOH Gould says. "We could see it here too. There is a fair
amount of crack in Toronto -- if they switch to injectible, then you
greatly increase the risk of HIV."

He also points out that the most vulnerable members of society, such as
injection drug users, are the most likely to end up on the street as a
result of recent government policy changes including the elimination of
rent controls.

LIVED IN BUS SHELTER

(Those changes affected Ted and his nephew very quickly. They were evicted
and lived with their dog in an unused bus shelter at Bay and Gerrard for
21/2 months in the winter of '96-97. At that point Ted stopped injecting
for a while. "It's hard to get your veins up when you're cold," he says.)

"Recent cutbacks may put us closer to the Vancouver situation," says
Millson. "It's impossible to expect safe injection when they have no clean
water, no place to keep clean needles. Even if they're trying, it's
incredibly difficult."

But even with political will to stave off the epidemic, there are those
such as medical epidemiologist Remis who say the information on Toronto is
falsely reassuring. We don't know what the rate of spread is here, he says.

"This is already a huge problem in Ottawa and we don't really know what the
situation is in Toronto."

Checked-by: Richard Lake