Jo-Anne Kirk

On the walls, there are posters about treatment services, bad dates and steps to injecting safely. In the counter, there's a metal plate drug users push open to dispose of used needles. On the counter, this rainy day just before Christmas, there is a metal bowl offering mandarin oranges and candy canes. Welcome to North Community Health Centre Addiction Services' needle exchange.

  Jo-Anne Kirk, Clinical Supervisor at North Community Health Centre Addiction Services explains that the presence of drug-and-alcohol addiction services in partnership with the North Community Health Centre, which is located just across the hall, is still a relatively new concept. Previously, staff worked for the Ministry of Health, until services were devolved to Vancouver Coastal Health (VCH).

 Kirk has worked in both systems. Under the Ministry, she said, there were a lot of dedicated people working with a lack of access to resources. The approach with drug users was to aim for abstinence. Further, there were limited treatment options.

The devolution of services to VCH meant that addiction services have become a more integrated part of the healthcare continuum, offered at eight healthcare centres in Vancouver . Now, addiction services are presented from within the health and wellness model. At North Health -as at all the Community Health Centres (CHC)- the services include counselling, prevention for youth, needle exchange, opiate replacement therapy (methadone) and withdrawal management, including home detox. The nurse, part-time doctor and all of the counsellors are trained to deal specifically with addiction issues.

Kirk said there is less staff burnout, because they can celebrate clients' small steps forward rather than consider anything less than abstinence a failure. Over time, Kirk hopes that by offering the services within CHC's will make addiction less stigmatizing.

A good example of the difference its makes for clients to have addiction services integrated within CHCs is a new program North CHC started this month, to assist clients. The pilot "Urban Hepatitis C Treatment Program will reach out to those who are contemplating, entering or in treatment for Hepatitis C. (The vast majority of injection drug users have contracted Hepatitis C.) "It's a group that will provide support and answer questions around the treatment protocol," Kirk said.

Kirk explained that, depending on the kind of Hep C they've contracted, clients will be in treatment for 6-12 months. It can have very difficult side effects, including depression. Without treatment, however, clients will die of the disease. Kirk said the idea behind the program is to offer clients support, to help them get through the treatment, when they may not have many or any other supportive people in their lives. "It's something we can offer that's really hopeful."

Another program addiction services offers is acupuncture. Standing outside the group room, where several people with needles sticking out of their ears are reclining in chairs and listening to soft music in the dimly lit room, Craig Webb, a doctor of traditional Chinese medicine also sports needles out of his ears and in the space between his eyes. He offers his program for three, half days each week.

Webb says acupuncture offers clients a way to achieve balance again. Webb said drug use tricks the user's body into thinking it needs drugs to achieve balance. But taking drugs only allows users a temporary feeling of balance. Acupuncture, he said, helps those with addiction to de-stress and overcome sleep disturbances. "Essentially it's hitting a reset button."

He said that when somebody is in severe withdrawal, he suggests they do acupuncture three to five times a week, for about three weeks. Then, they can do it as needed, to stay in balance.

  The tiny needle exchange room with its own entry is another part of the addiction services' office. But it's an important entry point for many who come to the office for addiction services. Staffed by addiction services' staff, who pop behind the counter through an entrance off the main office cluster, it takes about 10 seconds to walk out the public needle exchange door, down the public hall and into the main door to the addiction services office. But it can take drug users months or even years to make that journey.

The needle exchange is another way addiction services can reach out to clients to offer them healthcare and addiction services. "We are in the business of making relationships with people," Kirk says, explaining that all staff in the office are also trained to handle needle-exchange requests. When a client enters the small needle exchange room, one of the addiction services staff pops behind the counter to serve them. Staff try to engage needle exchange clients in conversation, to let them know about things like a pneumonia vaccination program, offer to get them immediate medical help for a bad cough or open wound or just offer a friendly word or two.

That relationship-building works. Kirk recounts the story of a man who used the needle exchange and got to know the staff. One day, he decided to entre detox. That led treatment. Now, he's attending school and working as an addictions services peer to encourage drug users to consider other choices. This man's new path opened up to him because somebody at the needle exchange was friendly to him. "That was the first time somebody had treated him as a human being in ages; it was life changing."

  Kirk explains that if somebody walks through the door willing to discuss making a change, all staff are trained to talk with them about their array of potential choices. Some will start to make changes and then disappear, only to return a few weeks or months later, ready to re-engage in the process. Others get on the path to treatment and follow it through, right away. Kirk said that point is that staff form relationships with clients so that they can understand what clients need or want and support them in those choices. "They can make those decisions, as opposed to us imposing them on them," Kirk said.

  If a client wants to talk, a staff person will sit down and talk to them. If they want to get into detox, a staff person will make the call or arrange with the on-site nurse to set up the client with home detox. If they're hungry, they'll give the client food.

  One of the biggest challenges facing clients is the lack of housing. "How can you expect somebody to deal an addiction if they don't have housing or a safe place?" Kirk asked. She said getting stoned is a way some homeless deal with the discomfort of living on the street.

  Another issue is the wait for counselling. While youth, pregnant women and those who are suicidal are seen immediately, there can be a months-long wait for counselling.

  Corrine Logan is the Youth Addiction Counsellor at North Health and sees her 13-25-year-old clients at the office or at their schools. (Another counsellor connected to the North CHC handles youth education and prevention programs.) She said that, by far, the two drugs most teens she sees are taking are alcohol and marijuana.

  If there's one gap she'd like to see filled in the treatment continuum it's a daytox program for youth, women in particular.