Pubdate: Thu, 27 Sep 2007
Source: Globe and Mail (Canada)
Copyright: 2007, The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Author: Anthony Reinhart

STIGMA LEAVES CRACK ADDICTS OUT IN THE COLD

Unwelcome In Many Shelters Due To Their Erratic Behaviour, Crack 
Users With Limited Access To Services Have Found An Advocate

TORONTO -- If substance abuse is a route to rock bottom, crack 
cocaine can be a devastatingly effective shortcut.

In her 14 years of work at the Meeting Place Adult Drop-In in 
Toronto, Leslie Saunders has come to know this particularly well in 
the past two or three years, as the cheap and highly addictive drug 
has proliferated on the sidewalks.

"That bottom is the same no matter what you're using," Ms. Saunders 
points out, "but the progression is so much faster with crack ... it 
shreds people's lives so much faster."

Stitching those shreds back together is especially difficult for the 
49 per cent of Toronto's homeless people who described themselves as 
regular crack users in a recent health survey, according to those who 
are trying to help them.

A stigma that makes so-called crackheads the lowest of the low among 
street addicts, due to the erratic behaviour and desperation the drug 
can induce, means users are "very unwelcome in many places, including 
some services for the homeless," said Erika Khandor, a researcher who 
helped produce the survey for the Street Health agency. "There is a 
real lack of supports and services for them, and they do feel 
isolated even from existing services for homeless people."

Street Health launched one of the few crack-specific programs, called 
the Crack Users Project, at the Regent Park Community Health Centre 
in the downtown east end almost two years ago. The project, funded by 
Health Canada, includes a drop-in for crack users and an outreach 
program in which former users are trained as "crackologists" and sent 
out to help others still struggling with addiction.

The program "has actually led to phenomenal results" by linking users 
to workers who help them get health care, housing and addiction 
counselling, Ms. Khandor said. "With that support, people have 
decreased their use [of crack] and a lot of people have been able to 
stabilize their lives."

Still, with an estimated 5,000 homeless people sleeping in shelters 
and in public places on any given night, "there could definitely be 
more done" to get adequate help to those who use crack, she said.

Rules barring intoxication and substance use keep many addicts out of 
Toronto's 60-plus homeless shelters, where they might otherwise be 
able to get referrals to services to help them. The Street Health 
report calls for a more flexible shelter system to accept users.

Cocaine Anonymous, which operates on the same principle as Alcoholics 
Anonymous, offers a helpline to link crack users to support-group 
meetings attended by others trying to kick addictions.

Withdrawal treatment, however, has been more difficult for the 
homeless to obtain since the Ontario government began to shift money 
away from residential detoxification centres and into "daytox" 
programs, in which addicts are treated at home. Street Health pegged 
the number of detox beds in Toronto at 90 to 100 for men and 30 to 35 
for women, the lowest per capita supply among Canadian cities.

Toronto's shelter, support and housing administration cited the lack 
of detox beds among 10 major gaps in services for homeless people in 
a 2005 report on its Streets to Homes initiative.

"Accessing detox has never been easy for people who are homeless or 
the people who provide them with outreach services ... the challenges 
of connecting clients to withdrawal management are intensifying," the 
report said.

Those who manage to obtain a detox bed often wind up using again when 
they are discharged back into the same street environment.

This helps to explain why Streets to Homes - a city program that 
moves homeless people into their own apartments, where they receive 
follow-up visits from support workers - can claim significant success 
in reducing drug use and associated health problems among the 1,200 
people it has housed over the past two years.

In a recent survey of 88 of those people, 70 per cent said their 
health had improved and, among drug users, 74 per cent said their use 
had decreased and 33 per cent reported having quit entirely.

"Housing is medicine; housing is harm reduction," Phil Brown, the 
city's general manager of shelter, support and housing, said 
yesterday. "Just by getting them into housing, and the follow-up 
supports, you can see the effects of stability on the consumption of 
drugs and alcohol."

And simply having a home, away from other users on the street, helped 
to prevent relapses, the report said.

Crack-use kits are another tool, albeit a controversial one, that 
health workers have been using to make contact with crack users and offer help.

In December, 2005, the Toronto Public Health Department took over 
distribution of the kits from the Safer Crack Use Coalition, which 
formed in 2001 to push for improved health and social services.

While some citizens groups complained the kits would only encourage 
further drug abuse, advocates successfully made the case that clean 
pipes would help stem the spread of disease, and give outreach 
workers a chance to connect with the most marginalized drug users.

In fact, the two-year-old Crack Users Project conducted by Street 
Health sprang directly from a survey conducted by workers handing out 
the crack kits, said Paula Tookey, who oversees the CUP.

"The general sort of attitude from a lot of service agencies is that 
crack users are difficult - their behaviour is uncontrollable, they 
are distrustful," Ms. Tookey said. "So we figured ... what would 
happen if we opened our door and welcomed crack users in?"

The project has since trained 20 crack users as outreach workers, 10 
of whom are still working and four of whom have landed paying jobs 
doing similar work, Ms. Tookey said.

Hundreds of users have attended the three-times-weekly drop-ins at 
the health centre, where they can get help.

Despite all of this, it still comes down to whether a drug user 
really wants to be helped, said Bonnie, a 38-year-old Toronto woman 
who has used crack, off and on, for the past 10 years.

"If you really want the help, the help is there for you," she said in 
an interview last week at the Meeting Place, at Queen and Bathurst 
Streets. "They're not going to hold your hand, though. You've got to 
want to do it.

"I don't blame anyone for where I am," Bonnie said. "I'm here because 
of my own problems, and when I'm ready to quit, I'm ready."
- ---
MAP posted-by: Keith Brilhart