ON THE FRONT LINE OF THE CRACK EPIDEMIC

Rob Boyd gets up close and personal with 'clients' as he provides
injection-drug users and crack smokers with materials to help them
avoid disease, writes Matthew Pearson.

A man in his 40s hands over a small piece of red paper. It's his
ticket to the needle exchange, which offers much more than needles.

The man tells the worker he's been smoking crack for more than four
years. He asks for five glass tubes, each the approximate length and
width of a king-size cigarette.

The man will use the tubes to make crack pipes. He says very little,
despite the worker's attempts to strike up a conversation, and leaves
quietly with a brown paper bag.

The exchange lasts less than five minutes.

Rob Boyd has done this hundreds of times. Mr. Boyd is the director of
Oasis, a social services program run out of the Sandy Hill Community
Health Centre. Oasis provides myriad services for drug users,
sex-trade workers, the homeless and people living with HIV or
hepatitis C.

Mr. Boyd says traffic increased dramatically after the City of Ottawa
voted to quit funding a crack-pipe program in July 2007. The program
was introduced in 2005 after a city-commissioned study found drug
users preferred to smoke the drug rather than inject it.

"Smoking cocaine is a far less risky behaviour than injecting cocaine,
from a disease-prevention point of view," Mr. Boyd says.

Fearing the city's decision would have dire consequences on crack
users, Oasis and a number of other social service providers banded
together to keep clean crack pipes accessible.

In the 16 months since, Mr. Boyd says, visits to the needle exchange
at Oasis have increased from 30 per month to 30 per day. But, as he
explains, the needle exchange doesn't operate an "exchange" in the
classic sense of the word.

"Most people's concept when you talk about an exchange is that you
bring one, you get one. Ottawa has not operated on an exchange basis
for a significant number of years as a result of the fact that we have
a cocaine use epidemic and that a one-for-one exchange doesn't provide
sufficient needle coverage," he says.

Earlier this year, the Shepherds of Good Hope, a downtown homeless
shelter, decided its needle exchange would only hand out a clean
needle if the user turned in a dirty one. City council explored the
issue and decided against a one-for-one approach.

Considering the crack-pipe decision of the year prior, Mr. Boyd admits
he was fearful.

"When they said 'no' to the crack pipes, the community stepped up and
said 'yes' to the crack pipes. We don't know what would have happened
if (the needles) went one-for-one, whether the community would have
done the same thing," he says.

There are "reasonable limits" placed on the number of items a client
can get each visit. However, because of the link between the
street-drug and sex trades, there is no limit on condoms.

Oasis is blocks away from the ByWard Market and Lowertown
neighbourhoods, the centre of the city's street-drug problem. The
needle exchange is located in a booth in a corner, beside the
elevator. A white noise machine buzzes overhead to increase client
privacy. The walls are plastered with posters. One urges
injection-drug users to dispose of needles responsibly, and not to
leave their "toys" around.

Workers ask each client a series of questions designed to gather data
about how many people are using the facility. Mr. Boyd says 91 per
cent of clients willingly provide the information requested, including
such things as the last two numbers in their years of birth, first two
letters of their mothers' names and how many years they have been
using drugs.

Oasis has been gathering this information from clients for the last
six months. Mr. Boyd says it will help create an overall picture of
crack use in the city, and gauge the number of people who smoke crack
versus the number of people who inject it.

The needle exchange provides injection-drug users with a variety of
supplies, including syringes, sterilized water packets and
tourniquets, while smokers can get glass tubes, screens, push sticks
and mouthpieces in order to build crack pipes.

Mr. Boyd explains the glass tubes heat up and can burn the user's
lips, causing open sores that can then expose them to diseases such as
HIV and hepatitis C if they share their crack pipes. Despite this,
most people pass when offered the rubber mouthpieces.

A young woman is next in line.

She has long brown hair and bangs that hang down her face like
curtains across her eyes. She speaks softly, shifting her weight from
foot to foot.

She is 24. She tells Mr. Boyd she has been using drugs half her life.
If that shocks him, he doesn't show it.

Most of the people who visit Oasis are homeless. In addition, Mr. Boyd
estimates that between 60 and 80 per cent struggle with a mental
illness, such as clinical anxiety, child abuse, post-traumatic stress
disorder, depression or active psychoses.

Cocaine has been the drug of choice in Ottawa for at least two
decades, Mr. Boyd says. The drug is expensive in its purest form, but
it's often mixed with chemicals to create a rock. And those rocks,
known as crack, sometimes go for as little as $3.

The high lasts for about 15 minutes, which means users must re-dose
many times throughout the day. By comparison, Mr. Boyd says the high
from a drug such as heroin can last up to six hours.

Mr. Boyd has worked at Oasis for almost five years. He says the time
he spends in the needle exchange is a rewarding part of the job.

"Most of the time we're trying to manage resources or negotiate with
clients about what it is we can offer, whereas this is such a pure
customer service interaction," he says. "There are very few
opportunities in this field to exactly meet the needs of clients as
they are presenting them."