STIGMA LEAVES CRACK ADDICTS OUT IN THE COLD

Unwelcome In Many Shelters Due To Their Erratic Behaviour, Crack
Users With Limited Access To Services Have Found An Advocate

TORONTO -- If substance abuse is a route to rock bottom, crack
cocaine can be a devastatingly effective shortcut.

In her 14 years of work at the Meeting Place Adult Drop-In in
Toronto, Leslie Saunders has come to know this particularly well in
the past two or three years, as the cheap and highly addictive drug
has proliferated on the sidewalks.

"That bottom is the same no matter what you're using," Ms. Saunders
points out, "but the progression is so much faster with crack ... it
shreds people's lives so much faster."

Stitching those shreds back together is especially difficult for the
49 per cent of Toronto's homeless people who described themselves as
regular crack users in a recent health survey, according to those who
are trying to help them.

A stigma that makes so-called crackheads the lowest of the low among
street addicts, due to the erratic behaviour and desperation the drug
can induce, means users are "very unwelcome in many places, including
some services for the homeless," said Erika Khandor, a researcher who
helped produce the survey for the Street Health agency. "There is a
real lack of supports and services for them, and they do feel
isolated even from existing services for homeless people."

Street Health launched one of the few crack-specific programs, called
the Crack Users Project, at the Regent Park Community Health Centre
in the downtown east end almost two years ago. The project, funded by
Health Canada, includes a drop-in for crack users and an outreach
program in which former users are trained as "crackologists" and sent
out to help others still struggling with addiction.

The program "has actually led to phenomenal results" by linking users
to workers who help them get health care, housing and addiction
counselling, Ms. Khandor said. "With that support, people have
decreased their use [of crack] and a lot of people have been able to
stabilize their lives."

Still, with an estimated 5,000 homeless people sleeping in shelters
and in public places on any given night, "there could definitely be
more done" to get adequate help to those who use crack, she said.

Rules barring intoxication and substance use keep many addicts out of
Toronto's 60-plus homeless shelters, where they might otherwise be
able to get referrals to services to help them. The Street Health
report calls for a more flexible shelter system to accept users.

Cocaine Anonymous, which operates on the same principle as Alcoholics
Anonymous, offers a helpline to link crack users to support-group
meetings attended by others trying to kick addictions.

Withdrawal treatment, however, has been more difficult for the
homeless to obtain since the Ontario government began to shift money
away from residential detoxification centres and into "daytox"
programs, in which addicts are treated at home. Street Health pegged
the number of detox beds in Toronto at 90 to 100 for men and 30 to 35
for women, the lowest per capita supply among Canadian cities.

Toronto's shelter, support and housing administration cited the lack
of detox beds among 10 major gaps in services for homeless people in
a 2005 report on its Streets to Homes initiative.

"Accessing detox has never been easy for people who are homeless or
the people who provide them with outreach services ... the challenges
of connecting clients to withdrawal management are intensifying," the
report said.

Those who manage to obtain a detox bed often wind up using again when
they are discharged back into the same street environment.

This helps to explain why Streets to Homes - a city program that
moves homeless people into their own apartments, where they receive
follow-up visits from support workers - can claim significant success
in reducing drug use and associated health problems among the 1,200
people it has housed over the past two years.

In a recent survey of 88 of those people, 70 per cent said their
health had improved and, among drug users, 74 per cent said their use
had decreased and 33 per cent reported having quit entirely.

"Housing is medicine; housing is harm reduction," Phil Brown, the
city's general manager of shelter, support and housing, said
yesterday. "Just by getting them into housing, and the follow-up
supports, you can see the effects of stability on the consumption of
drugs and alcohol."

And simply having a home, away from other users on the street, helped
to prevent relapses, the report said.

Crack-use kits are another tool, albeit a controversial one, that
health workers have been using to make contact with crack users and offer help.

In December, 2005, the Toronto Public Health Department took over
distribution of the kits from the Safer Crack Use Coalition, which
formed in 2001 to push for improved health and social services.

While some citizens groups complained the kits would only encourage
further drug abuse, advocates successfully made the case that clean
pipes would help stem the spread of disease, and give outreach
workers a chance to connect with the most marginalized drug users.

In fact, the two-year-old Crack Users Project conducted by Street
Health sprang directly from a survey conducted by workers handing out
the crack kits, said Paula Tookey, who oversees the CUP.

"The general sort of attitude from a lot of service agencies is that
crack users are difficult - their behaviour is uncontrollable, they
are distrustful," Ms. Tookey said. "So we figured ... what would
happen if we opened our door and welcomed crack users in?"

The project has since trained 20 crack users as outreach workers, 10
of whom are still working and four of whom have landed paying jobs
doing similar work, Ms. Tookey said.

Hundreds of users have attended the three-times-weekly drop-ins at
the health centre, where they can get help.

Despite all of this, it still comes down to whether a drug user
really wants to be helped, said Bonnie, a 38-year-old Toronto woman
who has used crack, off and on, for the past 10 years.

"If you really want the help, the help is there for you," she said in
an interview last week at the Meeting Place, at Queen and Bathurst
Streets. "They're not going to hold your hand, though. You've got to
want to do it.

"I don't blame anyone for where I am," Bonnie said. "I'm here because
of my own problems, and when I'm ready to quit, I'm ready."