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.' "

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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.