Hooked on recovery

Cars speed past a marginalized area on the outskirts of Rome, Italy’s capital city. The tightly-packed high-rises dwarf the camper van stationed every day from noon to 19:00 on a narrow piece of land past the fast-food outlet and down the hill from the school. People wander up intermittently to the window of the van — some calm, others jittery — to pick up a couple of syringes, deposit used needles in the prominently positioned black bins and move on to shoot a dose of heroin. Some stay to talk.

“When we first started coming, certain people accused us of encouraging an open-air shooting gallery,” explains Marcello, an outreach social worker with one of the two street units that belong to the Italian Red Cross’s Villa Maraini programme. “They now understand that we are here to help, to reduce the harm that drug users do to themselves and to the community.”

The results take time, but they are tangible. A needle exchange programme reduces the risk of HIV transmission. Used needles are no longer scattered on the ground next to the school. Important information on health matters and drug rehabilitation is imparted in a remarkably relaxed and non-threatening atmosphere to the estimated 300 drug users who turn up here every day. And lives are saved. In 2007 alone, the street unit at Tor Bella Monaca intervened on average ten times a month in cases of heroin overdose, administering injections of the life-saving antidote, Naloxone. Since 1992, more than 1,500 people have been saved from overdoses.

“You keep people alive; you give them a chance to heal,” says Gino, another social worker, many of whom are also Italian Red Cross volunteers — and all of whom are ex-drug users. More than most, they understand that what is needed is compassion rather than condemnation.

Humanity

Their main focus is building trust with drug users: to catch them in times of need or when they are ready to be helped. Their commitment is palpable and passionate, as they listen patiently to often incoherent stories or trudge off to check on those unspeakably grim locations where junkies are known to hide. Their work brings them into contact with some of society’s most marginalized and stigmatized — including the 30 per cent of drug users ignored by other agencies because they are illegal immigrants. In fighting discrimination against drug users, they embody the Red Cross Red Crescent’s principle of humanity.

“The emblem provides us with protection in the streets,” adds Marcello. “Users do not see us as being on the side of the authorities; at the same time, it gives us credibility vis-à-vis the police and other agencies.”

Everyone’s story is unique. Giancarlo grew up in the shanty towns of Rome, one of seven children, scrounging to meet basic needs. He turned to petty crime and drugs at the age of 14, rotating in and out of jail in a never-ending cycle. His sister died of AIDS, one of his brothers of an overdose. In prison, he met the Villa’s outreach workers. “I never thought I could have a normal life. They helped me understand that if I wanted to, I could find a way out.” He entered the Villa’s therapeutic community. “It wasn’t easy, but they stood by me, respecting the time I needed without pressing me.” Today, Giancarlo is in charge of Villa Maraini’s drop-in centre and its overnight shelter. “For every 30 people who come to the centre every day, there are 30 paths to recovery,” he explains.

Active outreach, peer education and a flexible approach to treatment are fundamental to the Villa’s unique ethos. Approximately half of its 80 staff are ex-users. In the brightly lit corridors, people give each other friendly taps on the shoulder or stop for a chat. It is impossible to tell clients from staff. Someone could just as easily be a doctor as one of the 300 people coming for their daily dose of methadone.

Police mistrust

“Each person is different from the next, and each differs according to where they find themselves in life,” explains Massimo Barra, a medical specialist, the Villa’s founder, a life-long Red Cross volunteer, president of the Italian Red Cross and vice-chair of the Movement’s Standing Commission. “For this reason, the therapy must adapt to the needs of the individual, and not the individual to the constraints of a particular therapy.”

Philippe, the soft-spoken son of professionals, refers to his Jekyll and Hyde existence before the vicious circle of drugs began closing in on him. “I was convinced for many years that I could continue to lead a double life. I had a job, an apartment, a fiancée. Even if a part of you knows that you are spiralling towards hell, the minute you have your fix, you no longer think of this. Then one day, suddenly, you realize that at the bottom of the pit, there is only jail or death.”

Even though each case is unique, most speak of a ‘click’ — that moment when the burden of drug use becomes too heavy to bear. Villa Maraini aims to be there when this occurs, with a cup of tea, a place to stay, psychological counselling, whatever is required.

When he was eventually arrested, Philippe met Anna, a volunteer with the Italian Red Cross’s 24-hour emergency unit. The police initially viewed the unit with distrust. They now call on it whenever they arrest heroin users. Villa Maraini provides methadone to ease the otherwise violent withdrawal; this, in turn, enables due process to occur in a more orderly manner. For Philippe, the ‘click’ occurred a few months later. “On 15 August, I found myself in a parking lot in Rome, syringe at the ready. I suddenly saw how low I had sunk. I remembered Anna, took out the card she had given me and called.” He is now half way through Villa Maraini’s 20-month programme.

From its beginnings in a room where a group of professionals provided counselling to five drug users a few times a week, the Villa has blossomed into a semi-residential community, set amid the gardens of the Italian Red Cross compound. It provides a wide range of services to more than 700 people a day, including a 24-hour walk-in clinic, a night shelter, a prison outreach programme, a three-level treatment programme, a family support group and a work cooperative (run independently). These services have developed in response to need and now assist more than 3,000 users and their families each year. “Villa Maraini is the only structure of its kind in Italy which changes according to drug users’ needs,” explains Giancarlo.

New generation of users

This has brought its own challenges, including that of funding, and has meant that those involved have often found themselves at the forefront of advocacy, fighting alongside the Italian Red Cross to reduce the stigma and discrimination associated with drug use. The Red Cross has played a leading role at international level in promoting a humanitarian approach to drug policy. It is the driving force behind the Rome Consensus, which promotes humanitarian drug policies and counts 106 National Societies as signatories. In 2004, Villa Maraini and the Italian Red Cross began hosting training sessions for sister National Societies — ten so far. As a result, several have initiated programmes to address the problems of drug users, estimated to number 200 million worldwide. For example, the Red Crescent Society of the Islamic Republic of Iran has established mobile units in Tehran, while the Uruguayan Red Cross has set up a hotline to reinforce its street units.

Sadly, the problem is not going away. If anything, it may be getting worse. Social workers are concerned at young people’s blasé attitude to recreational drugs. All agree that this is an area the Villa must focus on next.

On a wet and rainy night at Rome’s Termini Station, bedraggled figures loom up out of the dark, glad for the hot tea on offer. It is time to make the rounds and check for possible cases of overdose in the most likely spots, people sprawled between parked cars or slumped in the photo booth.

“Kids are getting involved younger,” says Fabrizio sadly, as he peers out at the lonely individuals huddled outside. In the distance, the impersonal lights of the station glint like shards of glass. “It is a terrible thing to be 20 and have no hope,” he adds quietly.

Then he pulls up the collar of his jacket and ducks back out into the damp night.

At Rome’s Termini train station, Villa Maraini RedCross volunteers and a doctor help two drug users who have overdosed.
©VILLA MARAINI

Street unit worker Gino picks up used needles.
©VILLA MARAINI