CRACK FLAK

Front Line Workers Worry About The Spread Of Hepatitis C As City Refuses To
Fund Safe Crack Kits

It's just a pipe - and some vaseline and a few metal screens. But harm
reduction workers can't believe their safe crack kits run afoul of the law
while the city doles out needles to heroin addicts and prepares for safe
injection sites. This curious situation, created by the selective
intervention of Toronto police, merely shows that officials do not realize
the extent of crack addiction in Toronto, say street workers.

"Everybody who's doing front-line harm reduction work has 10 times as many
crack smokers than injection drug users," says Lorie Steer, team leader for
Street Health and a member of the Safer Crack Use Coalition (SCUC).

Steer says this unfair favouring of one addiction over another means the
SCUC has been forced to seek private funding for the safer crack kits it's
distributing to stem the spread of diseases like hepatitis C, which are
reaching disturbing proportions.

The exact size of Toronto's crack-smoking population is unknown, but
one-third of drug users seeking treatment in Toronto identify crack as a
problem. In 1999, the last time a study was done, 31 per cent of street
youth said they'd used crack.

It's unsafe crack pipes, like tiny ginseng bottles and pop cans, that act as
conduits for diseases. Steer says that many crack users pass blood through
sores on their lips, which they often get when using unsafe crack pipes that
either overheat or are made from broken glass.

Of 108 crack users surveyed by the SCUC last year, 33 per cent said they
were infected with hepatitis C. Most of those infected said they shared
crack pipes.

SCUC's safer crack kits include, among other things, a clean glass stem or
pipe, Vaseline for lip care and literature on safer use.

Raffi Balian, coordinator of the COUNTERFit Program and a long-time harm
reduction worker with crack users, says they are transient, often in and out
of hospitals, and that if one of them contracted SARS, public health would
be in serious trouble.

But this issue has many layers. Funding a program like the safer crack kit
could land Toronto public health in some legal hot water.

Detective Court Booth, a drug enforcement officer, says programs that
distribute safer crack kits are clear violations of section 462 of the
Criminal Code, which says it's an offence to offer anyone an "instrument for
illicit drug use."

The city's needle exchange program managed to dodge the same obstacle in the
late 1980s by defining syringes as "devices" that when used for "treatment,
mitigation or prevention of a disease" technically become perfectly legal to
distribute.

But why, then, has the safer crack pipe program been largely overlooked by
Toronto police for the past three years?

"When the initiative commenced, the form that (the pipes) were in appeared
to be in contravention of the criminal code," Booth says. "You couldn't
distribute the pipes in the original format. Now I've heard there's some
assembly required.

"We don't want to frustrate people and keep them from thinking of new
ideas," Booth continues. "But we're the police. We're accountable for public
safety and making sure laws are enforced."

SCUC goes through about 2,000 glass pipes a month at 25 cents (from private
funding) per kit, and Steer estimates they could give out up to five times
as many per day. That's easy to believe on the day I drop by Street Health
at Dundas and Jarvis, one of 11 agencies now distributing the kits in the
city. The cramped reception area is abuzz with activity.

But despite the city's stated commitment to harm reduction, Liz Jansen,
regional director of Toronto public health, says: "The studies are very
complicated. People have a lot of other behaviours. They may be injecting
drugs, using dirty needles or having unsafe sex. What we don't know is
whether crack pipes are major vessels of disease."

Janzen's position seems to be at odds with board of health chair and city
councillor Joe Mihevc.

"Whether you're a prostitute selling to get crack, we have an obligation to
take care of each other. We all know people who've been there and come back,
and it's always been a nurturing community that's brought them along," say
Mihevc.

Lorraine Barnaby, a harm-reduction educator at the Queen West Community
Health Centre and a member of SCUC, says that without the kit, they would
never have known about the extent of the problem. "The kit brought users to
us. It was then that we realized we had thousands and thousands of drug
users that we had no contact with."