It's not enough to buy crack. You need a pipe to smoke it. And since drugstores don't sell crack pipes, self-confessed addict Tony Smith has gone into a lot of dirty places in this Vancouver Island city to find pieces to craft pipes.
The 40-year-old Thunder Bay native, who has lived in Nanaimo for more than half his life, says he has made pipes from pieces of washing machines, steel wool, reused glass tubing from old neon signs, and glass broken from eyedroppers. There was a time, he says, when he would have had 10 to 15 pipes to show a visitor to his room in the Balmoral Hotel, a residence for people with addictions and mental illness. But Mr. Smith says he is using crack less these days, so has only one crack pipe to display - a homemade creation of yellowing plastic.
Within weeks, however, Mr. Smith will likely be able to pick up a clean pipe, provided with the city's blessing as part of a plan by the Vancouver Island Health Authority to distribute so-called crack kits to addicts in this coastal town of about 80,000.
"I think it will be a better product because, you know, it's sterile, it's clean," said Mr. Smith, a gaunt, haggard figure who is nonetheless lucid and reflective about his situation. "Certainly I will [get a kit]and use it. I imagine other people will do the same."
Homemade kits are thought to cause more harm than the crack itself due to chemicals they contain from past uses, as well as inevitable burns and cuts to the mouth, linked to shoddy design, that can leave users open to HIV and hepatitis C. If all users have a clean kit, they are less likely to use the kits of others - another practice that raises the risk of infection.
For Nanaimo, the proposal - which awaits city council approval - marks an interesting transition in harm reduction. "It's kind of funny coming from a community where, three years ago, a lot of people thought it was a bad idea," said Benedikt Fischer, research chair in applied public health at Simon Fraser University. "It's a bit of a mystery to me."
In 2007, a local uproar forced the Vancouver Island Health Authority to retreat from a similar program after three months. The mayor of the day was "disgusted" that the city was not consulted over authority nurses distributing crack pipes. Council passed a motion to compel the authority CEO to come to a council meeting to explain who started the program and why. Residents questioned harm reduction.
Jonnie Tunnell, who co-ordinates a mental-health crisis team for the island health authority, says there was nothing amusing about the situation. "It was horrible, actually. There was a lot of reaction against it," she said, recalling it became "stressful" for nurses to be targeted on the street by residents complaining about the program.
Current Nanaimo Mayor John Ruttan, elected in 2008, agrees things did not go well the previous year. "They came along, literally peddling crack kits out of the back of trucks, so they would drive down the street, and some wags have said it literally reminded them of an ice-cream truck. The only thing is they didn't have a bell on it," said the long-time Nanaimo businessman, who was chairman of the city's port authority before becoming mayor. "It just didn't seem to be a very professional approach."
But now consultation has taken place, and Mr. Ruttan supports bringing crack kits to the city. Murray Fyfe, medical health officer for the island health authority, says there has been a new approach to working out the issue with the city, and the eventual hope is to provide kits across the island.
"We have, most appropriately, taken the time to talk with communities about this, talk with local government representatives about what this is about," he said. "People are going to use drugs whether or not they have access to clean supplies. It's really about providing them with something to keep them healthy in the short term, and then engage with them and bring them into the health-care system for treatment and counselling."
Drug-related disorder has been eased from a half-dozen years ago. "You could walk down a key number of streets and it would resemble a small-scale Downtown Vancouver Eastside," said Corporal Dave LaBerge of the city's six-man bike squad. "There would be dozens of homeless, addicted, mentally ill people wandering around, doing drug deals, open prostitution."
Improved police tactics, programs to provide supportive housing and other measures have eased the situation, but enough issues remain to make the kits useful. The RCMP backed the tactic in the past, and does so now. "If they can give [addicts]a few items that will reduce the risk to their health, how can that be a bad thing?" Cpl. LaBerge asked.
Mr. Ruttan expects council will shortly give final approval to the distribution.
"Addiction is what it is," the mayor said. "It's an illness, and treatment is the solution. … I know the detractors will say, 'Why are we even doing this? We're just encouraging drug use.' Others will say, 'If these people are so heavily committed to drugs, how do you know they will even understand the difference between a crack kit and a new one or do they even care?' Well … all you can do is provide it for them and hope they will have the sense to use it."
The issue deserves wider attention, says Prof. Fischer, who has a particular understanding of the Nanaimo situation. He was lead researcher on a study, released last month, of crack use in three mid-sized B.C. communities - Nanaimo, Campbell River and Prince George. It included data culled from detailed, hour-long interviews with 70 Nanaimo crack addicts. The study found that four out of five participants reported that they had shared their crack pipes in the past 30 days, and 44 per cent had done so on more than 20 occasions. Nearly half made their kits from such makeshift items as pop cans, glass bottles or inhalers.
Prof. Fischer says there has not been much research on the impact of crack kits, which have been handed out in various communities, including Prince George. There, noted Prof. Fischer's study, addicts said the availability of crack kits reduced their need to share paraphernalia and gave them access to safer materials.
The professor says he will be interested in how the Nanaimo intervention affects rates of hepatitis C and HIV, and possible shifts in drug-use behaviours. "We essentially need to understand: Does this intervention really improve public health in any way. The other thing we want to know is what is the community response like. What's the response politically? Will the police support it?"
At Harris House, which operates a needle exchange and provides various health services, a nurse displays a demonstration kit. It includes a plastic disposable mouthpiece, glass tubing, pieces of chewing gum to help users moisten their mouth, and tiny screens to stop crack residue.
One former addict, interviewed on condition his name not be used, picked up the bag of items and said they would be better than the status quo.
"The glass is going to be better than taking apart metal lampshades, right," he said. "There's a lot of toxins associated with the metals that people use. Addicts are going to want these pipes."
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