SHOOTING UP THE RIGHT WAY

How Could a Clean, Safe Place Be So Controversial?

NIMBYism is alive and kicking today in Montreal. CACTUS, a needle
exchange clinic operating on rue St-Hubert, is garnering negative
attention for providing clean syringes, condoms, water and bleach to
injecting drug users. From the outside, the building does not announce
the organization's purpose; a single address on the door, and a row of
cactus plants in the window are the only link to the program's name.
Credited with offering support and materials to an estimated six
thousand heroin users in Montreal, the Centre d'action communautaire
aupres des toxicomanes utilisateurs de seringues (CACTUS) aims to
reduce the number of injecting drug users using contaminated needles
in an effort to lower the transmission rates of HIV, Hepatitis B and
skin infections within the city. According to the Canadian National
Task Force on HIV, AIDS and Injection Drug Use, approximately 20 per
cent of injection drug users in Montreal are HIV positive, and 70 per
cent have Hepatitis C.

CACTUS, however, concentrates less on numbers and more on aiding the
individual. Employing ex-users as staff, CACTUS aims to make
conditions more humane for the organization's clientele. "The idea is
to help them help themselves," says Darlene Palmer, an ex-heroin
addict and current employee of CACTUS. Since July 1989, clients have
been able to come in from the streets seven nights a week to exchange
their used needles for clean ones. Previously operating on a needle
quota system, the clinic now distributes more than 400,000 syringes a
year to addicts who might otherwise consider sharing needles out of
desperation or indifference. As needle exchange pilot programs in
Merseyside, England, have shown, a service like CACTUS can actually
help decrease crime rates, and ensure a better chance of survival for
those injecting drugs.

However, not everyone agrees with CACTUS's mission.

"[Needle exchange] programs in large metropolitan areas may be serving
to foster new social networks. Ultimately, we cannot rely on these
programs alone to stem the HIV tide: they must be integrated with a
wide range of additional services that emphasize treatment and rehab
over a punitive approach," writes Catherine Hankins, an adjunct
professor from the department of epidemiology and biostatistics and
associate director of the McGill AIDS Centre, in her editorial,
"Needle exchange: panacea or problem?."

In Montreal, the problem of infection has been worsened by the general
shift from heroin to cheaper drugs like cocaine. As CACTUS employees
confirm, because the cocaine high doesn't last as long as the effects
of harder drugs, abusers end up injecting 20 times a day to achieve
the same result, each time requiring sterile equipment that is not
readily available on the street.

The need for prevention is all the more emphasized by the fact that a
single HIV infection costs health services $100,000 in care. Yet
CACTUS alone cannot make a difference.

"In its report of May 1997, the National Task Force on HIV and
Injection Drug Use recommended proposals for improved needle exchange
programs," explains Hankins. But the programs alone are not
sufficient, as Hankins further explains: "The task force also
advocates the integration of needle exchange programs with a wide
range of additional health services, including detoxification,
treatment and rehabilitation programs, health promotion and
nutritional counselling, self-esteem training and advice on safe
injection practices."

The problem of drug-related disease is very real in Montreal.

"A lot of repression has sort of pushed everyone all over the place,"
says Palmer. "It is inhumane in the winter time to ask people to shoot
[up] outside. I think they're entitled to have places where they can
just do it differently."

As for the critics, they should be encouraged to see the human face of
addiction, instead of condemning what they don't necessarily understand.

CACTUS is located at 1626 rue St-Hubert. For more information, call
847-0067.