SYRINGES SOUTH BY SOUTHWEST

After a lengthy delay, a Verdun needle exchange site has finally
opened its doors. Others, however, may soon be closing theirs

It's been a long, Sisyphian struggle for Anita Cugliandro, but she
finally got the needle exchange site she's been fighting for. TRAC
(Travail de rue/action communautaire) opened to little fanfare eight
weeks ago in Verdun, despite a host of monkeywrenches involving
bureaucratic hurdles, nervous landlords and money worries. Cugliandro,
TRAC's 34-year-old clinical coordinator, sits in her office looking
both relieved and exasperated. She was TRAC's driving force and now
presides over the first needle exchange site to open in Montreal in
years. TRAC, she says, hasn't opened a moment too soon.

"The situation in Verdun has become so unmanageable," she says.
"L'Anonyme [a roving bus offering services to street people and drug
addicts] would come here once a week and stay for 45 minutes, and they
told me that they do more needle-exchanges in Verdun than anywhere
else in the city. There's an enormous demand."

Cugliandro believes the demand in Verdun is so high because, unlike
downtown where there are all-night needle exchanges that addicts can
go to every night, there were none in the city's southwest. "In
2002-03, L'Anonyme reported 1,100 visits from people from Verdun," she
says. "The first time I walked into a Verdun shooting gallery, I
dropped off 1,000 syringes and that lasted about four days. I'd show
up later with garbage bags full of supplies. And because I had a
pager, users would be calling me up at all hours, telling me what
equipment they needed. And they needed them like, now. It became so it
was like I was taking down grocery lists of supplies for them."

Most Verdun users, she says, are shooting cocaine and not heroin. A
coke rush lasts much shorter than heroin and consequently, some users
go through dozens of syringes a day. If they don't have clean ones,
Cugliandro says, they will, out of desperation, use a dirty one,
regardless of the risk of contacting HIV or hepatitis.

NIMBY fears

Cugliandro says that when she first approached the Direction de la
sante publique de Montreal (DSP), the reaction she got was extremely
positive. "They said it was a great idea and about time and that
they've known about the problem for years." Based on data and
statistics supplied by L'Anonyme, the DSP were enthusiastic about
setting up a needle exchange to serve the problematic southwest.
"Verdun had been in the line of fire for a while," Cugliandro says.
"Their criteria required that we had to work in partnership with the
local CLSC."

To carry out a needle-exchange program, however, CLSCs have to train
their staff properly, which took some time. And while the staff was
willing, Cugliandro says, "The problem was with the board of
directors. We had a couple of years of dialogue, but when the time for
the nitty-gritty came, the board had an extremely difficult time
convincing themselves that this was a good idea."

The worries were familiar ones: crime would go up, more users would
come to the area, needles would be strewn about and so on. "Nobody
likes junkies," Cugliandro admits. "It's like a visceral reaction."

But, last November, after a series of presentations, meetings,
consultations and the like, the board finally agreed to sanction a
needle-exchange site in Verdun. Not that Verdun residents knew much
about it. "The DSP said we didn't need public consultation because
this is a public health issue. We knew very well what the public would
say, which is, 'Not in my back yard.'" (Those worries haven't abated.
Cugliandro requested that the Mirror not publish their address,
fearing an army of angry picketers outside her office.)

But with the official go-ahead in place, all that was left was to find
a location. After being turned down cold by several landlords,
Cugliandro found a spot on de l'Eglise that would have proved ideal.
The landlord was open to the idea, as were the building's tenants -
the only problem was Verdun city hall. Due to zoning restrictions,
Cugliandro was told, there was no way they would be moving in.

"I freaked," says Cugliandro, half-smiling. "It was mid-December, I
had two counsellors who were slated to start work on January 12, and I
had to start from scratch." After a frantic search, they settled on
their present location in a less residential but not entirely
industrial area. The CLSC had to co-sign the permit for TRAC to open,
something Cugliandro says she would have contested but at that point
she was "just so fed up and exhausted. It irks me that they wouldn't
just give us the permit. It's the principle of it."

Nevertheless, with officialdom satisfied, an easy-going landlord, a
staff, office equipment and a clear mandate from the DSP, TRAC was
ready to go. So they thought.

Crushing premiums

"The last thing we were thinking about was insurance," says
Cugliandro. "We took it for granted. We had a public health mandate
and we honestly didn't think insurance would be a problem."

It was. Cugliandro says that a week before they opened two months ago,
they were told that the insurance company they were dealing with
wouldn't cover them - not for fires, not for theft and - the big one -
not for personal injury. Cugliandro believes, but was never told, that
insurers feared what might happen if a syringe-waving junkie decided
to run amok in the office.

Close to panic, TRAC's brass began calling other needle exchange sites
in Montreal to find out what was going on. "We found out that we
weren't the only ones," she says.

Marianne Tonnelier, the director of Cactus, told her that they didn't
have insurance coverage either. At the end of 2001, Tonnelier had
signed an agreement with the Association des hopitaux du Quebec (AHQ)
that would cover Cactus and 70 other community organizations
province-wide, including groups that do street work, like Spectre de
rue, and shelters for battered women. The agreement expired on March
31 this year. On March 10, Tonnelier says, she received a letter from
the AHQ to the effect that they would no longer be covering insurance
for Cactus - or any other community group. "They said it was a
directive from the Ministry [of Health and Social Services - MSSS],"
says Tonnelier. "There was no reason given." She suspects, however,
that community groups like hers are victims of the Charest
administration's re-engineering plans.

The AHQ says it had no say in the matter. "We don't know why the
ministry didn't renew the insurance. We're just intermediaries," says
the AHQ's communications chief Lisa Massicotte. Dominique Breton, a
spokesperson for the MSSS, didn't offer a reason why they decided to
end their coverage, but did say that, "We are looking for alternatives
in the private sector to ensure that these groups can continue to
provide their services. We want them to keep going but we are looking
at which way is the most appropriate."

Caught off-guard, Tonnelier managed to wrangle out an extension until
the end of May. She says she has received offers from other insurers,
but at prohibitive costs. "There is the possibility of combining with
the other organizations as a kind of grouping to get coverage,"
Tonnelier says. "But that doesn't mean it's going to happen."

And if it doesn't? "Cactus will have to close its doors," she says.
That would mean there wouldn't be any needle exchange services open
all night, "when demand is the highest. These are night people, after
all," says Tonnelier. She is expected to make an announcement May 31.

Problem recognition

Cactus' closing, Cugliandro says, would be disastrous. "Cactus is the
needle-exchange site, they do more business than anyone in the
province," she says. "Everybody looks to Cactus."

For the moment, TRAC is insured, but at three times the amount they
were hoping to pay. They do, however, have the support of city brass,
like Verdun borough mayor and executive committee member Georges
Bosse. "There is a drug problem in Verdun, like in other parts of the
city," he says. "Maybe it is worse here than in other sectors. But if
we want to solve the problem, we have to recognize that it exists.
It's not that visible, but we know it exists."

He says he personally hasn't heard any complaints about TRAC opening,
but knows that some of his constituency may be less than thrilled
about it. "We can't prevent people from worrying," he says. "We have
to show in practical terms that [needle exchanges] are a good solution."

Cugliandro knows she isn't out of the woods yet. "My worry is, can we
sustain this?" she says. "We're okay for a year but we have to find
the money to keep going. It's a concern."

TRAC can be reached at 514-798-1200