WHAT HAS FOUR WHEELS AND RUNS ON HOPE?

The Somerset Street West Community Health Centre's Crack Van Is An
Innovative Program That Delivers

Michael started to use crack when he was 16. Eleven years of
on-and-off addiction have cost him dearly in every way.

"I grew up with it," he says. His mother was an addict and a dealer.
Now she's in treatment.

These days, Michael spends a couple of hundred dollars a week on
drugs. At one time, he'd spend $1,000. He's desperate to quit.

Michael stopped studying in Grade 9. He's never held a steady job. He
has served jail time -- in Ottawa and New Brunswick -- for the
chronic petty theft that finances his habit.

"I was clean for two-and-a-half years and fell back off last year,"
he says. "My girlfriend left me and that was it."

Asked why a crack user always wants more, he stops to think. "It
catches you by the balls," he says finally. "It makes me feel good --
for a few seconds -- then all my problems come back."

Michael -- not his real name -- is on probation. He's not allowed to
be around drugs or its paraphernalia. As thousands of addicts know
too well, jail may satisfy society's need to punish, but it does
nothing to unhook an addict.

Michael is an intravenous drug user, so it would only be news if he
had yet to contract hepatitis C.

His almost toothless smile speaks to the effects of drug abuse on oral health.

Less obvious, but just as common with users, is the drug-induced
psychosis and the mood and anxiety disorders. What crack has done to
his heart -- aside from broken it -- is yet to be seen.

About a year ago, a fellow user told him about a white van that roams
Ottawa streets dispensing needles and other free stuff. Michael
flagged it down one night in a move that just may have saved his life.

The Somerset Street West Community Health Centre operates the van --
one of two in Ottawa. They call it NESI -- Needle Exchange Safe
Inhalation Program.

Anne Christie-Teeter, acting director of Community and Social
Services at the centre, says harm-reduction programs work to reduce
the health and social harms associated with illegal drug use.

"We provide information and tools to reduce risky behaviours," she
says. "We help people engage with the health system."

The centre's harm-reduction van has been running for two years. It
employs four outreach workers, one co-ordinator and four part-time
relief staff. The staff has a variety of skills, including psychology
and social work. The van's $10,000 annual operating cost is financed
by the Ontario Ministry of Health through the Ottawa AIDS Bureau.

The van runs six evenings a week in concert with the Ottawa Public
Health outreach van, which is on the road nightly. The vans
complement fixed treatment sites and serve between five and 30 people
each evening.

The health centre's van, emblazoned with the words "Everyone
Matters," travels through the ByWard Market, into Vanier and the Bell
Street area. It also responds to calls and makes regular trips to
middle-class enclaves in Barrhaven, Orleans and Kanata.

It might meet addicts in a shopping centre or coffee shop parking
lot. Occasionally, when requested, it delivers to an addict's door.

"When we think of crack, we think of the streets and of alleys," says
former Harm Reduction program co-ordinator Catharine Vandelinde.
"Crack is Ottawa's drug of choice."

It's everywhere, she says.

"We go to people's homes in nice neighbourhoods with double-car
garages. Lots of people who use drugs aren't part of the street
culture. We go to the people wherever they are at and get them
sterile equipment -- so at least they're working with safer supplies."

The drug culture burrows deep. Women who use almost inevitably end up
as prostitutes controlled by "sugar daddies," addicts who use the
women to do the drug shopping. "It's a power-and-control thing," says
Vandelinde, who recently left the program and is now a consultant.
"Some people don't want to be part of the drug scene.

"It's also very common for women not to do their own injections. The
men do it for them."

It isn't uncommon for police in the Market to monitor the van and
then arrest its clients for being in possession of drug paraphernalia
if it contravenes a probation order.

Police Chief Vern White says police don't target users, but if people
are trafficking or contravening court orders, "there is no safe haven."

The vans have won over addicts with their easy access and their
softly-softly approach that reduces potential harm while offering a
potential entry point to treatment.

"We don't ask questions," says Vandelinde, "and we don't judge."

Still, she says, there are those who are slow to trust. "It can start
with someone saying, 'I'm using this many times a day, I would like
to use this many times. How do I get from there to here? Or how do I
get from injecting to smoking.' Maybe one day we can get them into
medical treatment."

Those they do get to know have often suffered sexual or other abuse
as children and young adults, says Vandelinde, and the street once
seemed like a haven from domestic misery.

The Somerset Street van carries needles, condoms, filters and mouth
pieces that keep lips away from the glass stem and prevent lip burns
- -- and ultimately infections.

They offer soluble vitamin C as an alternative to other junk that is
often part of the crack cocktail. Chopsticks, condoms and glass tubes
- -- the so-called pipes -- are all part of the paraphernalia
associated with crack use.

Bridgehead and Starbucks coffee shops donate food to provide some
regular sustenance.

The Ottawa Public Health van does not carry pipes since Mayor Larry
O'Brien led a charge against the program during the last municipal
elections. However, it has had enormous success with its
needle-exchange program -- handing out 500,000 sterile needle
syringes last year and getting back 676,000 used -- the disparity
explained by the fact that users get their sterile needles from
several sources.

O'Brien is a huge supporter of the needle-exchange program, but is
opposed to the pipe program.

Vera Etches, associate medical officer of health and manager of
clinical programs, says if users come to the Ottawa Health facilities
asking for clean pipes, they are directed to the Somerset West centre.

"Our job is to reduce the spread of HIV, hep C and B in the community
and prevent sharing," she says.

To travel on the van is to enter a world populated by characters who
have fallen far -- many never stood a chance. Some grab their stuff
and disappear. Others stick around to chat.

"Is that Pitmans?" a voice asks.

I'm in the passenger seat scribbling in my notebook -- my own version
of shorthand -- during a stop near the Shepherds of Good Hope.

A fortysomething woman presses her face to the window. She's holding
a scratch-and-win lottery ticket and is at the van to collect
supplies. Her hair is newly washed and her makeup is fresh, but there
is no hiding that she's an addict. "I went to Browns secretarial
college," she explains. "My sister and I. My mother insisted."

When she couldn't find work as a secretary, she became a bunny-suited
waitress at the old Riverside Hotel. Then she tried nursing. There
was a car accident, followed by prescriptions for heavy painkillers.
Next addiction. And now crack and the shelters.

"Good luck with the lottery," I say.

She smiles, collects her paraphernalia and leaves.

"There is so much more to people than their drug addiction," says
Vandelinde. "They've had families and careers. They often ask, 'Why
do you do this, why do you care?' It breaks your heart that somebody
caring for them is such a rare occurrence."

Michael is happy to endorse the van. "They don't judge."

Even still, he guesses that only about half the addicts he knows make
use of it. "It's either stupidity or laziness," he says. "Perhaps
some of them go straight to the (health) centres. But I'm more than
happy to praise this van. It's saving lives."

Driving around Ottawa in the dead of night to commune with messed-up
addicts might not be everyone's dream job, says Vandelinde, but for
some it's a mission.

"Everyone matters," she says. "If I could sum up why we do what we
do, that would be it."

Thursday: A full and frank discussion with Ottawa Police Chief Vern White.