Harm Reduction with a human face

Gus stretched out on the tracks in front of the streetcar. In his drug-induced stupor, it was the only way he could think of to ask for help.

It had been a long journey from his life as a professional chef in New Jersey to the streetcar tracks in Toronto. Now he was pleading - begging - for someone to help him.

And Gus needed a lot of help. He was suffering from bipolar disorder, hepatitis C, chronic hip pain from a botched hip replacement, and hyperthyroidism. He was addicted to pain killers, benzodiazepines, heroin and cocaine.

Although he was born in Canada, Gus's family had moved to New Jersey when he was a child. Later, Gus became a chef in a fast paced restaurant, frying up to six skillets at a time. His family remembers him as an excellent chef.

Then drugs took a hold of Gus's life. He was able to keep his job or a few years but he eventually turned to crime and selling drugs to support his addictions. His illegal activities forced him to flee to Toronto in 2002.

Without a plan and with no support, Gus quickly fell into old patterns of drug abuse. He was able to obtain prescriptions from a number of different doctors and was also taking methadone - a combination that contributed to an almost lethal case of over sedation.

Gus lived on the street, in park gazebos, under bridges and in shelters. He weighed only 140 lbs., drooled constantly, fell asleep while being spoken to and walked into walls, trees and street signs. Despite his disoriented and precarious state, he was making efforts to save himself. He would check himself into detox centers and emergency rooms.

Gus wanted and needed help. He would find it in the Annex Program.

The Annex is a 124-bed harm reduction program for men with addictions. It is in Seaton House, Canada's largest men's hostel. The program deals with the realities of severe addictions and focuses more on reducing the harm associated with substance abuse and less on a policy of abstinence.

It is a City of Toronto run program that provides a tolerant and low-demand environment; an atmosphere of safety, protected by house rules and front line staff. Counseling is provided and staff members make use of all necessary community care, health, housing and employment & social services to help the men in the program.

When Gus was first brought to The Annex he was so sedated he was unable to communicate in a meaningful way except the odd word that indicated he wanted help. The staff, including the counselor and the in-house doctor and nurse, worked with him for weeks. As the sedation wore off, they were able to piece together his history and identity.

A year after Gus first came to Seaton House he is a different man. He weighs 200 lbs., is medically stable, and has been clean of prescription and street drugs for almost six months. He no longer takes methadone, and has been approved for the Ontario Disability Support Program. He has also been able to find a new home through Ecuhome, a non-profit housing corporation created and maintained by seven faith groups in Toronto.

Gus also received help with other health and legal issues. For example, since his teeth were rotten, they have been pulled and replaced with a set of dentures. He received help through Seaton House's legal aid clinic and will likely have his outstanding charges dismissed because of the recovery he has made.

Just as important, Gus is no longer alone. He is now in regular contact with his family in New Jersey and is planning to attend his sister's upcoming wedding. He will be supported by the Annex team, including his family physician and psychiatrist, until he is stable in his new place.

Like his descent into addictions and mental illness, Gus's journey back from the brink has been grueling, but made possible, thanks in no small way, to the people at Seaton House's Annex Program.