NEEDLE CITY

There Are No Quick Fixes For Victoria's Growing Heroin Habit

Every used needle left under a bush or in a back alley stairwell tells a
story, and Garth Greatheart is usually the one who listens. In the parking
lot of a small downtown office building, she finds a 7-Eleven serviette,
the wrapper from a syringe, and the blue cap from an empty sterile water
tube. The pile of trash tells a simple story: someone had something to eat,
and a fix of heroin.

In the back of another Blanshard Street building, there is a plastic bag
crumpled underneath a recycling container. Inside are 10 unused needles
wrapped together with a plastic band, some alcohol swabs and a lighter.
It's likely someone hid the stash there to use later, or simply forgot it.

Four times a day, Greatheart does her 20-minute "rig dig," touring along
Cormorant and Amelia streets and picking up used condoms, syringes (rigs),
needle wrappers and general trash, which is sometimes mixed in with urine
and feces. Greatheart, program manager for AIDS Vancouver Island, is among
a handful of AVI volunteers who make daily trips around the neighbourhood
cleaning up rigs and wrappers. It's a dirty job. Rubber gloves are
mandatory, and tongs are recommended.

In another alleyway between two buildings, there is a bloody tissue lying
on the ground.

"This tells me that someone stood here and had a fix," says Greatheart.
"There's no needle here. That's good."

In a back alley stairwell, she picks up two used needles with caps on them.
"Whoever it was that used this has a conscience. I see a story everytime I
see a wrapper or a rig. This isn't about the addiction. [They hide because
of] the shame of using drugs."

Her keen eye scans parking lots, corners of buildings and underneath rows
of bushes. She combs the greenery and walkways in between a restaurant and
several lawyers' offices on Amelia Street. Today, there are wrappers
scattered along Greatheart's route, but few needles. That's good news. It
means more people are using the needle exchange program, run by AVI's
Street Outreach Services (SOS)--the oldest such program in the country.

Greatheart returns to the AVI office and finds three men sitting outside.
She knows what is about to happen. One of the men starts to pull something
from his pocket. "Not here," she says, and the men immediately get up and
walk down the street. She doesn't get involved in any "say no to drugs"
debate, doesn't make moralistic comment. She just tells them to move along,
which means they'll probably end up at the parking lot of the building down
the street for their fix.

"We're not here to fix the problem," says Greatheart. "It's not that
simple." However, many area residents and businesses see a different story.
"A lot of people see it as terrible junkies whacked out of their minds."

Many people cling to the stereotype that drug users are always homeless and
poor. Some blame the needle exchange for condoning drug use. Others phone
the needle exchange, angry about the used needles on their property.

"They think it's our fault because we give [needles] out," says Greatheart.

Watch Where You Step

The simple fact that businesses and residents are finding needles points to
a greater problem: There are more needles on the ground. In the last two
months, residents and AVI employees have found an increasing number of rigs
in the downtown neighbourhood, more so than in previous years. Greatheart
doesn't know the reason for it, but says the increase is seasonal. In
summer, drug users from the mainland often come to Victoria for a "rest."
Not from the drugs, but from the violence and other hardships that come
with living in a larger urban centre like Vancouver.

Two weeks ago, AVI staff met with residents and business owners from
downtown, North Park and Fernwood. They were concerned about the increasing
number of rigs, particularly in and around parks and schools. The meeting
concluded with the formation of a community working group, which will meet
regularly to find a solution to the increased number of needles in the
community.

"Having the community come together for this, it wasn't a tar and feather
kind of meeting," says Miki Hansen, AVI's executive director. "We wanted to
find a solution to something that is pretty scary."

Dyan Dunsmoor-Farley says part of finding a solution to the needle problem
is not to waste time placing blame.

"The bottom line is there are places we won't tolerate [drug use]," says
Dunsmoor-Farley, chair of the North Park Neighbourhood Association.
"Especially in our parks. People have to feel safe when they go there.
Families and children need to feel safe in these areas."

Last October, residents called the police department about increases in the
number of drug users at Central Park, behind Crystal Pool. An officer was
temporarily assigned to that area and neighbours said drug use there went
down to almost nothing within two days. But the assignment wasn't
permanent. And that's the problem, say residents. They want to see more
police presence in their neighbourhoods, particularly in areas where drug
use and dealing are known to happen.

One of these places is the Fernwood Square, adjacent to the Belfry Theatre.
Another is Central Park.

"[Policing] is not very routine," says Dunsmoor-Farley. "We find ourselves
in between two community police offices. And as soon as the downtown area
starts to take their efforts away, we don't see any [cops] around here."

There has been an increase in the number of police patrolling downtown, and
beat cops regularly patrol well-known drug areas, but Sargent Keith Lewis
says "we can't be everywhere. If we had the numbers we would be out in all
these areas, but we can't."

Lewis adds that the police have not noticed any significant increase in
used syringes on the streets.

However, city workers are finding more used syringes in Victoria,
especially around Centennial Square and the adjacent parkade. Some of the
precautionary measures the city has taken to reduce the danger of used
needles on the streets includes needle disposal units in the Centennial
Square public bathrooms, and hard plastic garbage bin liners that are meant
to prevent punctures. City outdoor workers are also trained to properly
dispose of used syringes, and to never dig into garbage bins. They're also
given "dirty pay," an additional 25 percent of their salary for time spent
picking up needles and feces from city property. Private property owners
figure out their own solutions--many downtown businesses now restrict the
use of their washrooms, for example, in an effort to keep people from
shooting up there.

No Quick Fix

One of the solutions discussed at the community meeting was a safe
injection site, where people can go to shoot up. Such sites, which would
provide bathrooms, safe disposal of old needles, and access to new ones,
are used in Europe and are attracting more interest from people who are
realizing there is no quick fix for the city's drug problems.

The mere fact that the community was in favour of such an idea surprised
Greatheart. Six months ago, it would have been difficult to get people to
stop criticizing drug users, much less agree on an alternative drug use zone.

"People's attitudes are starting to change because they're seeing we can't
just make these people stop using drugs," says Greatheart.

In addition, heroin is crossing social boundaries. It's accessible and
cheap, about $20 a fix. The needles, alcohol swabs and sterile water are
available from agencies like Streetlink and AVI, or can be purchased from
any pharmacy.

"We're starting to see all kinds of people getting involved with drugs,"
says Kulli Meyer, executive director of the Dallas Society, which provides
counseling for drug and alcohol addiction. "We're seeing kids having
problems with it, it crosses the broader spectrum of society. There are
drug users in Uplands. It's becoming more public. People are talking about it."

There are now an estimated 1,500-2,000 current injection drug users in the
capital region, and the Victoria needle exchange program distributes 1.6
million needles annually. They get a 100 percent return rate. Some months,
the return rate exceeds the number of needles given out.

Either way, it's a significant increase from 1989, the program's first
year, when a mere 98,000 needles were handed out.

The new needles are provided by the Ministry of Health and disposed of by a
Vancouver bio-tech firm. The Vancouver company ships the used needles to
centres in Calgary and Washington State, where they're incinerated.

Exchanging Troubles

No one wants used needles lying on streets, or in garbage containers, where
someone might risk getting pricked. But despite the service that the needle
exchange offers, not everyone is in favour of it. Critics say providing
clean needles promotes drug use, and often cite a study by two Canadian
researchers who found higher HIV infection rates in those using needle
exchange programs versus those who did not.

However, the researchers, Julie Bruneau, an assistant professor of
psychiatry at the University of Montreal, and Martin T. Schechter, a
professor of epidemiology at the University of British Columbia, say their
study has been misinterpreted. In an April, 1998, op-ed piece in the New
York Times, Bruneau and Schechter wrote that their results were "not
surprising. Because these programs are in inner-city neighbourhoods, they
serve users who are at greatest risk of infection. Those who didn't accept
free needles often didn't need them since they could afford to buy syringes
in drugstores. They also were less likely to engage in the riskiest
activities."

The critics were quieted down when The Lancet, a respected British medical
journal, published a study last year in favour of needle exchange programs.
It found that in 29 cities worldwide where such programs are in place, HIV
infection dropped by an average of 5.8 percent each year among drug users.
In 51 cities that had no needle exchange or comparable facility,
drug-related infection rose by 5.9 percent a year. In addition, a study of
medical literature released last year by University of California-Davis
researchers found that most published studies about needle exchanges
indicated that they significantly reduced the risk of HIV transmission.

Treating injection drug use as a neighbourhood nuisance or blaming needle
exchanges for the increasing the number of rigs on the streets won't solve
the long-term problem. Communities are starting to accept the need to spend
money on prevention and finding solutions rather than lobbying for tougher
criminal and drug laws.

Prevention and treatment is also likely to be less of a financial burden on
taxpayers. A 1998 report by former provincial health officer, John Millar,
concluded that putting more money into harm reduction services, such as
needle exchanges and methadone clinics, which supply heroin users with an
alternative, less-harmful drug, will reduce future costs, particularly in
policing and healthcare. There are an estimated 15,000 injection drug users
in the province, twice as many as there were 10 years ago. Of these, 25
percent are HIV-positive and 88 percent have hepatitis C. Millar said
investing $6 million in expanding methadone availability alone could save
the province $30 million annually in the long run.

The Never-Ending Story

In 1993, deaths from heroin overdoses mushroomed to 331, an eight- fold
increase over six years. This prompted a report by then B.C. chief coroner
Vince Cain. The report found that heroin was present in 90 percent of
drug-related deaths. In 1999, illicit drug-related deaths claimed 385
people in B.C.--more than motor vehicle accidents. Each year, more people
die from overdoses than from breast or prostate cancer, but government
funding and community fundraisers to find solutions to these problems are
nowhere in sight. And the reason is likely because drug users are
considered the lowest of society, says Greatheart.

About two months ago, a man who overdosed on heroin managed to get himself
to the AVI office. He could barely speak. The staff called an ambulance and
he was sent to the hospital. Had he gone straight to the hospital on his
own, Greatheart says he probably wouldn't have received immediate attention.

"Drug users are seen as people who made a choice to do it, so they're not a
big priority," says Greatheart. "You have that attitude even in the
hospitals. That's why when someone goes to the hospital for treatment, we
often send a staff member with them. Someone to speak for them."

Two weeks ago, a staff member from the Fernwood Community Association found
a man lying on the ground outside the FCA office, with a needle still in
his hand. When he didn't wake up, the staff thought he had overdosed. They
called the police, who managed to wake the man up, and then sent him home.

Incidents like that can't be ignored, and are forcing communities to find
solutions.

"And this isn't just a Fernwood problem or a North Park problem," says
Meyer. "Every community has to find a solution to this problem, including
all levels of government, schools, parents, everyone needs to be part of
the solution."