Jeff has been using crack and heroin for twenty years. He has been on the methadone maintenance program for the last nine years and credits it for keeping him from going back to jail. When it works, methadone reduces the craving for heroin. Over coffee on Vancouver’s Downtown Eastside, I asked Jeff what could improve health among those in addiction. “Stability,” he said simply. “The chaos of the life is deadly.”
For Jeff, what really messes up the lives of those in deep addiction has more to do with the organization of society than the chemical composition of the drugs. Bad housing and lack of health resources combined with alienation from friends and family as well as ostracization by society ruins the lives of people in addiction.
Just saying “no” may work for a few people, but addiction remains a pernicious social problem in modern societies. For Bruce K. Alexander, a researcher specializing in the psychology of addiction at Simon Fraser University, the dislocation created by industrial society directly contributes to the growing levels of global addiction. Alienated and atomized, “people adapt to this dislocation by concocting the best substitutes that they can for a sustaining social, cultural and spiritual wholeness, and addiction provides this substitute for more and more of us,” says Alexander.
The criminalization of drug use has serious consequences. The strength of illicit drugs varies wildly, leading to overdoses and death. Having to hide or use alone means that many overdoses go unnoticed. A lack of clean syringes or crack pipes encourages the spread of infectious diseases like Hepatitis C and HIV. The scarcity of detox facilities, treatment services or access to methadone and other opiate substitution regimes makes it much harder to get clean.
In Vancouver, I work with a community of people in addiction who have not only stabilized their lives but have gone on to help organize their community, deliver services, testify in court, and build a better world.
For a century, the most common policy response to substance abuse has been a War on Drugs. It is expensive and it doesn’t work. In fact, drug addiction has only increased. Harm reduction, on the other hand, is an evidence-based approach that seeks better health and social outcomes for drug users and the community, but accepts that some drug use may continue. Community activists and drug users are taking some specific steps to re-imagine a more healthy approach tor addiction. There is no single answer, but rather a political, community and personal process of incremental wins.
Ceasefire in the War on Drugs
Vancouver, British Columbia has long been on the front lines in the War on Drugs. One of the first recorded opiate overdose deaths in the city was in 1887– the same year anti-Chinese riots swept the young city.
An anti-Asian moral panic blossomed around the manufacture and use of opium in the early 1900’s. The federal government became concerned that the “habit of opium smoking was making headway, not only among white men and boys, but also among women and girls.” By 1909, Canada enacted its first drug prohibition laws.
Vancouver historian Lani Russwurm explains that harm reduction proposals go back to the 1950s in the city. Policy recommendations backed by the mainstream press included: “rehab centers, educational campaigns, and stiffer penalties for traffickers. But what really stirred debate,” Russwurm writes, “was [a] proposal for clinics that would provide maintenance-level doses of heroin to addicts.” The implementation of these ideas continues to be a work-in-progress.
A Safe Place
By the 1990s, death was a nearly daily occurrence in Vancouver’s Downtown Eastside, a densely populated community nestled in the business hub of downtown, also the tourist-destination of the city’s oldest neighborhood Gastown, and the end of the Canadian Railroad. The tiny neighborhood boasted the highest HIV transmission rate in the industrialized world. In response, users began to organize and demanded a safe injection site.
Dean Wilson has used heroin since he was 12. He is a harm reduction advocate who works at the Drug Users Resource Centre. In 2001, Wilson told a special Parliamentary committee, “Every day we wait, we lose one more person.”
In 2003, drug users and activists pressured and embarrassed authorities into launching a pilot facility—an experiment that became what is now North America’s only supervised-injection site equipped with medical staff and detox facilities. A decade later, Insite is a hotbed of research and legal battles. Thousands of lives have been saved and Insite is here to stay. Even the Vancouver police publically encourage drug users to go to Insite.
But it’s not enough. With 700-800 visits each day and long line-ups, many users are turned away. The current federal government, which has opposed many harm reduction initiatives, is now considering legislation that would make it much harder to establish additional supervised injection sites.
Narcan: Back from the Dead
Involving, empowering and educating users and community members increases health outcomes and saves lives. This means giving people the tools to help themselves. After a recent rash of overdoses on the Downtown Eastside, the Drug Users Resource Centre rushed to put on a Narcan course. If administered quickly Narcan, or Nalaxone, is a medication that can reverse the effects of an opiate overdose. During an August heat wave, about forty of us packed into a hot, airless room for a training session. The cranky crowd shouted down anyone who dared interrupt nurse Kirsten Locher. We were sweating and a fight nearly broke out, but everyone was also keenly aware of the stakes. Most people in the crowd knew someone who died of a drug overdose.
“This training empowers people to take care of themselves and others in the community,” Locher told me. “We have an amazing community. Instead of just walking by someone who is passed out, they are checking on them.”
Locher objects to the limited availability of Narcan. Currently, only active and former drug users can obtain the harmless, non-narcotic product by prescription. “It’s a tool, like a pocket map. We need to increase accessibility,” she says. “I hope that Canada will make it available over the counter, as it is in other countries…available to all, not just active and past users, but friends, family – non-users, good Samaritans.”
The Canadian Drug Policy Coalition agrees, lamenting in a recent report that “the tragedy is that many of [overdose] deaths could have been prevented with measures such as training, [and] increased availability of [Narcan] naloxone.”
Dean Wilson supports Insite and Narcan, but based on his own experience, he is clear about the limitations: “Until we win prescription heroin, you’re still gonna have people dying.” Wilson is a plaintiff in a Canadian Supreme Court case seeking to make prescription heroin legal. For 15% of the addicted population, nothing else works – not abstinence, not 12 step programs, not jail, not methadone.
“This isn’t a way to put heroin on the street,” said Wilson’s lawyer, Adrienne Smith of PIVOT Legal. “This is a treatment for a small group of people who don’t react well to traditional treatment.” Smith sees policies opposing harm reduction as “needlessly punitive to drug users. Punishing people for trying to be well is not a way of moving forward.”
Professor Martin Schechter, the founding Director of the School of Population and Public Health at the University of British Columbia says, “[prescription heroin] is not simply the administration of a drug, but the opportunity for patients to benefit from up to thrice daily contact with doctors, nurses and counselors; the breaking of their cycle of criminality, sex work, jails and hospitalizations, and the stabilization of their previously chaotic lives.”
Activism and Community Building
More people becoming active in searching for and creating innovative solutions for themselves and their community reduces the dangerous dislocation and isolation of individuals within the community. Sharon S. explained that between organizing and attending meetings focused on the needs and rights of drug users, her drug use has decreased, “I don’t really want to [use] as much [because] working on this stuff is really satisfying.”
Laura Shaver has had a similar experience. Shaver is on the board of the Vancouver Area Network of Drug Users (VANDU), a peer-run organization that provides services and a voice for those in addiction. She is a champion of the harm reduction approach, crediting it with helping her get control of her heroin habit and becoming active in the community. Working with VANDU helped Shaver develop computer, public speaking, media communication and meeting facilitation skills.
Rethinking Health in Addiction
Addiction is a massive problem for most Western countries. And addiction rates have only increased during the long decades of the War on Drugs. To reduce the harm that addiction inflicts on society and increase the health outcomes for users, knee-jerk law and order policy responses must be abandoned.
In order to reduce the impacts on the social, economic, cultural, spiritual and physical health of people in addiction, the War on Drugs needs to be abandoned. People in addiction need supervised injection sites, methadone programs, prescription heroin and Narcan, safe housing, and an end to the type of stigmatization that forces addiction underground.
Fear-fueled, political opposition to needle programs, detox facilities and safe injection sites does nothing to stop drug use, but it harms drug users and society.
Garth Mullins is a writer, award-winning broadcaster and policy analyst living in East Vancouver, Canada. Follow him @garthmullins