“There was so much crack in the neighbourhood that users and outreach workers nicknamed the area Rochelaga.”
When anthropologist Nelson Arruda explored an east-end Montreal neighbourhood, he expected to find shooting galleries — dark, clandestine places where people inject drugs — and sex slaves addicted to the next high.
What he found in Hochelaga-Maisonneuve were crack houses — located every three blocks, and concentrated on a stretch spanning 20 streets — governed according to strict rules that included a ban on injecting and prostitutes who on the surface operated independently. To get inside, users had to be known to the house “gatekeeper” or seller. Arruda, who was already working closely with community street workers involved in harm-reduction programs for four years in downtown Montreal, got introduced to the east-end “Rocklaga” scene.
In a first Canadian study of its kind led by Dr. Élise Roy, professor at the faculty of medicine and health sciences at the Université de Sherbrooke and research chair on addiction, Arruda spent a year on the trail of high-risk behaviours at the intersection of illicit cocaine use. Starting July 2011, Arruda observed and interviewed crack cocaine users inside crack houses that are commonly called “piaules” in French, or tiny apartments. What Arruda found underscores the importance of the environment in public health approaches to addiction, drug abuse and health risks.
Roy’s team was already running a larger study called Interface on the risks and harmful effects of drug use when outreach workers warned that crack was flooding Montreal’s downtown streets. Unlike powder cocaine that’s sniffed or injected, crack cocaine, which is powder that’s been hardened into rocks or crystals, is heated and smoked. Crack users say it produces an intense high that’s as good or better than injecting, Roy explained, but it only lasts about 10 minutes.
Hooked users tend to binge smoke, looking for one high after another.
“They are continuously looking for more and more and that makes them vulnerable,” Roy said.
Roy was curious: Some studies coming out of the United States described crack houses as places of high risk behaviour, “as sexual slavery for women drug users.” Arruda was already researching the subject as an ethnographer on Montreal streets for several years, she said, “but we were not able to capture good information on sex risk in (the) context of crack availability.”
The sex trade is the pillar of crack houses. But Arruda did not find sex slaves in Hochelaga-Maisonneuve crack houses, Roy said. Neighbourhood sex workers paid a fee to use a room with a mattress in the back, usually a bedroom.
So it’s rock after rock and maybe the women go back to work faster because she has another craving.
Still, there was not a lot of sex going on in the crack houses. Most of the “johns” looking for sex only were middle-class men, not regular drug users. And they were uncomfortable in the “piaule” milieu — dirty, cramped and lacking in intimacy.
Also, many of the prostitutes were freelance, independent workers. They didn’t have pimps and they didn’t “belong to the house.” Still, the gatekeeper or seller had a complicated relationship with the sex workers that Roy called “subtle pimping.”
Crack is linked to binge use and the seller supplied the women with free crack early in the day to get the binge cycle going, she said.
One participant told Arruda that the piaules would close without the sex workers. The piaules needed the prostitutes who needed clients to feed their crack addiction. When desperate, some agreed to sex without protection, Arruda said, and their prices dropped as the crack cravings increased. “When they start on a binge they’ll do it for five dollars,” Arruda said. “You can see the distress in their faces — on the corner, waiting for a client.”
Drug dens or piaules existed in the neighbourhood long before crack became available. But not on the same corner. They had to be two to three blocks apart. “It was not someone’s house. The piaules we’re talking about are like shopping malls … official big ones controlled by criminal organizations,” Arruda said. These underground businesses are open 24/7 because “addicts are addicts 24 hours a day. We don’t sleep, right!” as one participant told Arruda. Gatekeepers work 12-hour shifts managing the operations as on-site employees of organized crime that administer the piaules. Gatekeepers have two roles: sell crack and maintain rules and order.
Each piaule had rooms reserved for selling, smoking and sex. Smoking was usually done in the living room, while sex services were provided in the bedroom. Piaules are short of furniture and cleanliness and many are infested with bedbugs. Arruda describes one place as “full of garbage and really filthy … There is a stove but no fridge, three old stained couches full of holes … The walls are smeared with dirt, graffiti and even blood.”
When they start on a binge they’ll do it for five dollars
Crack is the only form of cocaine that is available, and no other drugs are allowed. Go in, spend a minimum of $20, leave within 20 minutes — unless you buy more crack. No harassing the seller to front the drug on credit. No stealing. Smoking on site is permitted, but not injecting.
“You should know that those who smoke crack also inject. Heroin or prescription opioids are a real problem in this population,” Roy said.
“I was surprised to see people kicked out and shouted at and banned,” Arruda said. One seller confided that he was fed up with messy, bloody syringes and police raids. But another hypothesis, Arruda said, is that the high it produces is different. An injection can last as long as half an hour and crack’s high dissipates in about 10 minutes. “So it’s rock after rock and maybe the women go back to work faster because she has another craving.”
Injection drug use declined sharply as crack flooded the streets. The shift in the cocaine market had a profound impact on street drug use. One reason injection drug use declined, Roy said, is because crack is smoked more and more on the street, not just in the piaules. “The piaules are not the reason for the decline, it’s the availability of crack,” she said.
According to recent public health estimates, Montreal had about 4,000 drug injection users in 2009, down from the 1998 estimates of 12,000.
There is a stove but no fridge, three old stained couches full of holes … The walls are smeared with dirt, graffiti and even blood
“That’s good news if injection is declining in terms of epidemics,” Roy said, as needles and the spread of blood-borne diseases such as HIV and hepatitis C are clearly linked. Two thirds of injection drug users are infected with hepatitis C and one fifth have HIV.
But the piaule as a micro-setting where crack cocaine is used, is also a threat to prevention, she said. “The fact that it makes users go on the street to inject adds risk,” she said. “And distributing clean injection material to users (in piaules) is forbidden. Many need to inject on a regular basis and when they have to go on the street that’s a threat to prevention.”
Needle exchanges, drug treatment and other harm reduction programs have helped reduce HIV infections around the world, “and it has shown that public health has a role to play even if we’re dealing with crime,” Roy said.
Outreach workers involved in harm reduction programs have established relationships with piaules and their clients. They can go in, but they can’t distribute clean needles. But outreach workers are also there to maintain contact with drug users and sex workers, to gain trust and develop relationships.
“We are there for them when they need us,” Roy said. “Prevention has to work with environmental conditions to be efficient.”
Researchers note that the portrait of crack houses described in their 2011-2012 study, which was recently published, may have changed in the last two years. Crack cocaine may be on the decline in favour of new synthetic “bath salts” drugs now being reported on the streets. The next step is to continue to study drug pattern uses for their impact on risky behaviour.
This study was funded by the Canadian Institutes of Health Research.