Pubdate: Thu, 27 May 2004 Source: Mirror (CN QU) Copyright: 2004 Communications Gratte-Ciel Ltee Contact: http://www.montrealmirror.com/ Details: http://www.mapinc.org/media/267 Author: Patrick Lejtenyi Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) 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 - --- MAP posted-by: Larry Seguin