Today marks the National Day of Mourning for workers killed or injured on the job. CDPC’s executive director Donald MacPherson participated in a memorial ceremony in Vancouver, B.C. to honour those who have died or have suffered injury or illness due to a work-related tragedy.
The Day of Mourning is a stark reminder of the urgent need for a safe supply of drugs in B.C. and across Canada, and increased access to harm reduction measures in the workforce.
A memorial wreath is placed at a ceremony in Vancouver, B.C. on April 28, 2022, honouring workers killed or injured on the job.
In British Columbia, the majority of employed people in the province who died of toxic drug poisoning from 2017 to 2021 were employed in the trades, transport, and equipment operator industries.
The impact of the drug poisoning crisis on those in the trades, construction, and transport industries can be attributed to factors such as managing physical pain, mental health, and a culture of substance use within the industry. 1
On this National Day of Mourning for workers killed or injured on the job, the Canadian Drug Policy Coalition is renewing its calls for an immediate, robust scale up of safe supply alternatives to the toxic illegal drug market and federal government action to decriminalize simple possession of drugs in Canada to reduce stigma and engage workers who may be at risk of drug toxicity deaths.
“It is common for people in these types of jobs to experience work-related injuries, stress and pain. They may not have or know where to find the resources they need to take care of these issues. This could lead to using pain medications and other substances more often to cope.” 3
In January 2022, the province announced new funding for the Vancouver Island Construction Association (VICA) to expand its Tailgate Toolkit project – a program aimed at harm reduction and prevention of toxic drug poisoning in B.C.’s construction industry. According to the province, the project will raise awareness of pain management and reduce stigma associated with drug use.4
A group of workers attend a memorial ceremony in Vancouver, B.C. on April 28, 2022, to honour those who have died or suffered injury or illness due to work-related tragedies.
April 28 is the national Day of Mourning for workers killed or injured while on the job.
A group of workers attend a memorial ceremony in Vancouver, B.C. on April 28, 2022.
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The Honourable Carolyn Bennett, M.D., P.C., M.P. Minister of Mental Health and Addictions and Associate Minister of Health
The Honourable Jean-Yves Duclos Minister of Health cc: Hon. Sheila Malcolmson, B.C. Minister of Mental Health and Addictions
Dear Ministers Bennett and Duclos:
Re: Proposed cumulative threshold of 4.5 grams in BC
We write as a coalition of over 20 civil society organizations in Canada, comprising people who use drugs and their families, Indigenous and racialized groups, service providers, legal organizations, research groups, and drug policy advocates. Our mission includes abolishing criminal and other laws, policies, and practices that control, stigmatize, pathologize, and punish people who use drugs.
We understand Health Canada is considering British Columbia’s request for an exemption from the Controlled Drugs and Substances Act to decriminalize simple possession up to a cumulative threshold quantity of 2.5 grams. As you know, this is far lower than the cumulative threshold of 4.5 grams requested by the province — already an exceedingly low cumulative threshold for many people who use drugs and near-unanimously rejected by BC’s Core Planning Table on Decriminalization.
Ministers: there is no legal or evidentiary basis for a cumulative threshold of 2.5 grams. Per the recommendation of our 2021 platform, we urge you to reject this quantity and dispense with threshold quantities altogether.1
As we’ve routinely communicated to you, there are significant risks of “net-widening” in defining a threshold that does not reflect real-world patterns of use. Drug markets will adjust to a low threshold, including via changes to the potency and amounts of drugs held or sold, potentially increasing overdose risk. Other harms resulting from a 2.5 grams threshold may include the incentivization of interactions with the unregulated market as people try to avoid criminalization by frequently purchasing smaller amounts.2 Those who will be most profoundly harmed by a low threshold will be Black, Indigenous, and other racialized, marginalized, and low-income communities, who are profiled and disproportionately arrested and incarcerated for drug offences.
A 2.5 grams threshold flies in the face of your governments’ commitment to evidence-based drug policy, anti-racism, and reconciliation with Indigenous communities. It sets a dangerous precedent for other municipalities across Canada seeking an exemption. It disregards the recommendations put forward by BC’s Core Planning Table and caters to the unsubstantiated, stigma-based requests of police. We know Health Canada has met with police as part of its decision-making process, while requests from drug user-led groups like the Vancouver Area Network of Drug Users (VANDU) have been ignored entirely.
Decriminalization must be done right. You have a moral, legal, and ethical responsibility to uphold the human rights of people who use drugs; this requires you to centre their expertise. A 2.5 grams threshold will continue to inflict grave harms on our communities and must be abandoned.
We ask that you therefore:
1) provide us with the rationale and evidence for a 2.5 grams threshold; and 2) meet with us this month to ensure that the perspectives of people who use drugs are prioritized and the recommendations of the BC Core Planning Table are ultimately adopted.
Signed,
Avenue B Harm Reduction AVI Health and Community Services BC Association of Aboriginal Friendship Centres Blood Ties Four Directions British Columbia Centre on Substance Use British Columbia Civil Liberties Association CACTUS Montreal Canadian Association of People who Use Drugs (CAPUD) Canadian Drug Policy Coalition Canadian Students for Sensible Drug Policy Centre d’intervention et de prévention en toxicomanie de l’Outaouais (CIPTO) Centre on Drug Policy Evaluation Drug Users Advocacy League Drug User Liberation Front ENSEMBLE Services Greater-Grand Moncton Gilbert Centre HIV Legal Network Indigenous Harm Reduction Network Moms Stop the Harm Multidisciplinary Association for Psychedelic Studies Canada Ottawa Inner City Health Pivot Legal Society South Riverdale Community Health Centre Vancouver Area Network of Drug Users (VANDU)
Additional signatures (added April 21, 2022 onwards)
Association des intervenants en dépendance du Québec (AIDQ) Sandy Hill Community Health Centre EACH+EVERY: Businesses for Harm Reduction Sandy Hill Community Health Centre PAN Student Overdose Prevention and Education Network (SOPEN) Gilbert Centre
2 A. Greer et al, “The details of decriminalization: Designing a non-criminal response to the possession of drugs for personal use,” International Journal of Drug Policy 102 (2022) 103605.
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I never made it to college or university. As a matter of fact, I never even completed high school. So the idea that I could one day be a skilled and experienced mixed-methods researcher, get paid for my knowledge and respected when I spoke, and co-author published papers and articles far exceeded my modest dreams. I had participated in research in the past as an interviewee—giving my perspective on a variety of subjects—but never from the investigative side. As you can imagine, when I was offered the opportunity to train and work as a qualitative researcher I was thrilled and jumped at the chance, particularly as the subject was one I was personally and professionally invested in: safe(r) supply.
“This project laid a path for me. Now all I have to do is walk it!”
~ Phoenix Beck McGreevy
Imagine Safer Supply is a massive undertaking—a multi-provincial qualitative research project seeking to explore the attitudes and perceptions people have about safer supply. We spoke to both people who identify as substance users and people who were primarily involved in frontline service provision to drug users. We found that there is less of a hard line dividing these two groups than we had expected.
I started with the project as a member of the Community Advisory Committee (CAC) in the summer of 2020. The team consists of the principal investigators, research associate, research assistants, and our community advisory team—the group with which I did most of my work on the project. Our committee had members with lived and living experience of drug use and/or the provision of frontline services for people who use drugs, as these were the two groups upon which our qualitative research was focused. Amongst our team, we found a similar level of crossover between the user/service provider camps as we did among the participants.
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We started from a blank slate, learning each step of research: developing interview questions, ethics review, leading interviews, and finally on to data analysis and knowledge translation. Unfortunately, as a result of the COVID-19 pandemic, which was in its first year, we were unable to do any of our work in person despite being dispersed across the country from British Columbia to Quebec. The team met frequently on Zoom and co-conducted qualitative interviews by phone or Zoom.
Safe supply rally; Vancouver; 2021
The research itself tested my newly minted but fierce qualitative interview skills. At first, I relied heavily upon the interview guides, asking each question in order and going through the prompts dutifully. I kept an eye on the time, shepherding participants along through the questions, neglecting to probe worthwhile digressions for the sake of following the guide in front of me. As each interview progressed and I debriefed with my colleagues—accepting constructive criticism—I became more comfortable with the art of interviewing. I began to sense where the really interesting stuff was and how to tease it out of each participant.
Our project has the word “imagine” in its title for a reason. We are asking people to envision their ideal safe supply program, from the available substances to the staff and the setting. We soon found that getting people to imagine something that doesn’t yet exist is very difficult and takes finesse to avoid influencing people’s responses. So many of the people we spoke to brought up ideas and then shot them down, saying things like, “Oh, well that would never work here because…” Many participants found their concepts limited by existing societal and governmental structures. However, we encouraged people to really dream, to imagine models of safe supply that could be possible outside prohibition or medical models, and even capitalism and criminalization. When people ventured outside the realm of what’s currently possible, that was where the really beautiful data lived.
Safe supply rally; Vancouver; 2021
For some participants, the primary focus of their ideal safe supply program was about the effect it would have on their lives. People dreamed of the life they could lead without having to hustle or do crime to feel normal. For others, it was about the physical, brick-and-mortar site of such a program. They laid out plans for community centres that welcomed people who use drugs and offered a sense of belonging and kinship where they could find wellness, however that felt for them.
We encouraged people to really dream, to imagine models of safe supply that could be possible outside prohibition or medical models, and even capitalism and criminalization. When people ventured outside the realm of what’s currently possible, that was where the really beautiful data lived.
Once the data collection phase was completed, we began data analysis. Spirited Zoom calls ensued as we developed our code book, combing transcripts and thinking critically about what each quote meant and how to categorize it. Each of us had different skills and interests that were shaped and honed further, bringing value to our analysis. Once our code book was fully developed and captured all the rich information our participants offered, we began to analyze the data in earnest. Currently, the team is working on analysis of the themes presented within the transcripts before we move on to knowledge translation. We plan to bring the project full circle by presenting the findings to our own communities, wider harm reduction and drug policy audiences, and drug user organizing groups, to inform their work moving forward.
On this project, I discovered a passion and aptitude for research that I didn’t know I possessed. Each new skill I learned was exciting and I burned to know more. The idea of taking things that the community knows and transmuting it into the hallowed form of “evidence” was thrilling to me. Creating data that could be used to make change and speak truth to power—I never dreamed it would be something I could do.
This project enabled me to imagine more than just safer supply programs: it led me to imagine a place for myself in academia and a career in research. This project laid a path for me. Now all I have to do is walk it!
“It’s simple, hun—you have the disease.”Bill says this as he hands me a wooden chip inscribed with the serenity prayer:
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
An biker who somehow landed in Westbank, Kelowna, Tom is paternal. I’ve never been told that I have a disease, but his words incite relief. I cannot stop drinking, and illness is better than badness. I have done horrible things.
I accept a tattered copy of the Big Book and devour it, highlighting, underlining, and earmarking earnestly until I have it memorized. I meet others who do the same. We form unexpected kinships, our lives irrevocably intertwined through a singular, obstinate pursuit of wellness. I repent. They hold me. I have never felt such intimacy.
When I leave 28 days later, we promise to stay in touch. I never speak to them again.
I am 18 years old.
I have been sober for 45 days, and something is very wrong. My legs have stopped working, and when I try to articulate how physically enervated I am—how utterly incapacitated—my councillors tell me to pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
I am drowning in a vast, violent emptiness. Anhedonia. Near-catatonia. The obsessions, the compulsions, the counting, the rituals; these I must relinquish to a Higher Power (though without them, I’m not sure who I am).
“Stop thinking so much.”
“You need humility.”
I eat 1175 calories a day—no more, no less. Identical meals at breakfast, lunch, and dinner. To deviate would trigger a binge. Pleasure is not safe. I attend group sessions and while other women weep, I try to stay awake.
Am I a sociopath?
All I want is chocolate.
I am 19 years old.
I arrive with a black eye and hematoma on my chin. It obscures my jawline and deforms my cheekbones, my reflection as grotesque as the memories I suppress. I don’t know how it (I) got there.
“Third time’s the charm.”
I am too tired to have hope. After nearly three years of homelessness, I am also too tired not to. Alcohol and bulimia have been replaced by crack cocaine. I no longer feel human. The things I did at 18 pale by way of comparison.
“Your brain is broken.”
I am hostile. My mind is a rabid animal, and I don’t trust this place—these people—to tame it. One month becomes two. Two becomes three, then six, then seven. Something shifts. I listen in a way I never have before. I believe in a way I never have before. The obsessions, rituals, counting, compulsions; they haven’t left, but they have transmogrified into something like spirituality.
“I could drink.”
I stop what I am doing.
Fall to my knees.
Pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Once. Twice. Three times.
Six if the thought returns. Nine times. Twelve. Fifteen.
I am terrified of myself.
“Every moment you spend in treatment, your disease is outside doing push-ups in the parking lot. It gets stronger as you do. It will never go away.”
In my sixth month I enrol in two university courses. One of them is introductory sociology. I am intrigued.
The councillors become trusted confidantes. They convince me I can leave. They expect to see me regularly.
I move into a basement apartment two blocks away. I visit the councillors every day, sometimes once, sometimes twice or more. I relay my academic successes.
“Don’t let it go to your head. Recovery must come first.”
I am 22 years old.
“Fuck you!”
The voice is not my own. A new woman has just arrived, and she is detoxing—hard. I am five months sober, and I have entered treatment voluntarily. I may return to my PhD, but I know I’m not prepared. I was promised that staff were trauma-informed.
That was bullshit.
Publicly funded, there are two councillors for thirty patients. Most have been street-entrenched for years or decades. We are told not to discuss drug use. Or violence. Or sex work. Or poverty.
“If you get triggered, we don’t have the tools to contain you.”
Twelve-step meetings are optional. AA members come bi-weekly to share their experience, strength, and hope. When they do, I look away.
“God, grant me the serenity.” —
I walk past the door, my fists clenched tightly. Bile rises in my throat.
I see myself in them. I will see myself in them when a month, two months, a year, from now they use again. They will hate themselves. It will not be their fault.
“This place is a joke!”
This time the voice is mine. I am with the psychiatrist. I denigrate her profession.
“I do not consent to being pathologized.”
She raises her eyebrows; takes notes; says nothing.
I leave early. In addition to bipolar disorder, obsessive compulsive disorder, borderline personality disorder, possible dissociative identity disorder, complex post-traumatic-stress disorder, somatoform pain disorder, possible autism, and, of course, severe alcohol and stimulant use disorders, my discharge summary notes that I present as rather angry.
I am 30 years old.
As I write this, I am 31 years old. I have been abstinent from alcohol and illicit drugs for nearly two years. Before my last relapse, I had been abstinent for eleven months. Prior to that (and prior to the two-year bender that was my Masters’ degree), I hadn’t touched drugs or alcohol for well over five years.
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My adult life has been shaped by substance use (or lack thereof): freneticism during periods of active use; temporal boundaries demarcated by surges of euphoria and devastating loss; rigidity and suffocation while sober; crystalline awareness that despite my Herculean efforts to think, look, and act normal, the best I’ll do is pass.
Panic, regardless. I fully expect to use again. Perhaps not immediately but eventually, definitely.
I am still recovering.
Only now, I don’t say that I’m recovering from addiction. Alcohol and drug use were never the problems. In a society that was built on oppression, though (that is, in a society that wouldn’t exist without the ongoing displacement, dispossession, and disappearance of Indigenous peoples; that has been designed to control, regulate, and disadvantage Black communities; that approaches disability as a fatal character flaw; that produces enormous wealth disparities and prohibits anyone who can’t or won’t conform to White, cis-hetero patriarchal standards of productivity from access to power or resources), alcohol and drugs are convenient red herrings.
I am still recovering.
Rather than focus on recovering from a “hopeless state of mind and body,” however, I have turned my efforts outward.
For someone who once espoused the merits of sobriety (and who viewed sobriety as the pinnacle of addict achievement), to now be unbothered by the idea of substance use (mine and anyone else’s) is a radical departure.
How did I get here?
During my third round of addiction treatment, I found sociology. I had very few expectations, but “the systematic study of society” seemed interesting, and it also fit my schedule. I still lived in extended care at treatment centre three, so I took the bus to campus between morning check-in, individual and group therapy sessions, and my daily chore routine. I wrote my first essays in the communal kitchen I shared with 120 other patients, and I asked staff to proofread my work because I didn’t own a computer (not that I would have been permitted to use one even if I had).
At first, education was jarring. After four years immersed in twelve-step programs, to be introduced to the social determinants of health (that is, the socio-cultural, economic, and political conditions that positively or negatively influence one’s health status) was de-stabilizing. Specifically, the insight that exclusion on the bases of income, race, sex, gender, and disability, among other facets of one’s identity, is correlated with outcomes such as substance use confounded me. I had been taught that addiction was solely my responsibility. It was the product of a malignant mind, nothing more, and so extraneous conditions such as homelessness were consequences of one’s usage, not causes.
The more I reflected, however, the more sociology made sense. I developed an “awareness of the relationship between personal experience and the wider society,”1 and was able to understand patterned behavior responses among social groups as they pertained to rates of addiction.
Indigenous peoples, for example, report much higher rates of alcohol and illicit drug addiction than other ethnic groups. Why? Because White frontiersmen introduced alcohol as a tool of colonization. Not only was it a profitable trade good, but authorities knew it would distract from the violence they enacted.3 The attempted genocide that followed included confining Indigenous peoples to reserves, apprehending and abusing generations of children through the residential school system and, in Canada, the “60’s Scoop,” prohibiting cultural engagement, non-consensual medical experimentation, and legislation that continues to disproportionately inflate Indigenous rates of poverty, homelessness, unemployment, and murder. Furthermore, mainstream addiction treatment approaches substance use through a Western world-view, erasing traditional knowledge systems and perpetuating colonial disruption.
Is it any wonder, then, that Indigenous people are more “prone” to substance use?
This is not to say that personal stories aren’t unique, or that individual trajectories won’t be informed by multiple, intersecting forces throughout the life course. We can’t accurately predict behavioural outcomes based on one or two bits of demographic information, but we can (we must) analyze trends (addiction-related and otherwise) within their historical contexts.
This is hard to see. I was a member of the New Westminster “recovery community” circa 2007/8. I was 19 y/o and in my 2 (of 5) abstinence based treatment centres.
Initially, I was fascinated by this information but didn’t think that it applied to me. I was raised in a wealthy suburb. I’m White. I had been sexually harassed, sure (and raped multiple times while homeless), but every AA sponsor I’d had told me this was further evidence of my powerlessness over substance use. “We put ourselves in vulnerable positions while using—when you stay sober, you’ll stop being taken advantage of.” My life chances hadn’t been constrained by systemic oppression (other than ableism, but I did not yet identify as neurodivergent), just my own bad choices, so I remained convinced that while addiction is beyond some, less privileged, people’s control, the origins of my own usage still lay firmly within me.
Then I learned about trauma. My professors introduced me to the implications of interpersonal trauma, and they demonstrated that prolonged developmental trauma, regardless of perceived severity, fundamentally alters one’s nervous system.2 I won’t disclose intimate details of my childhood, but I will say that one needn’t be raised in poverty or contend with racism to regularly feel afraid. This can have enormous physiological consequences in childhood, as being in “fight or flight” mode can lead to mood disturbances4, emotional dysregulation5, and loss of connection6—all potential roots of addiction.
Over time, it became evident that personal traumas are inextricable from broader (“macro-level”) structures such as the economic system. Our “micro-level” communication is shaped by the norms and expectations of society, so values such as individualism, a product of capitalism, invariably affect our actions. AA itself is hyper-individualized: It treats addiction as a “spiritual malady,” and in so doing it mars one’s ability to interrogate how social inequalities (and the maladaptation they evoke) make substance use desirable—and sometimes very necessary.
With this, I questioned everything.
“What if I had been raised differently because my parents had been raised differently? If my Grandparents hadn’t been impoverished immigrants, would we all have been a bit more inclined toward tenderness? Would I still have developed an eating disorder?”
“What if I developed an eating disorder, but the response to it had been less informed by a lineage of poverty? Rather than see bulimia as indulgent, would my parents have had the skills to inquire about the feelings underneath? Would I still have started drinking?”
What if, when I started drinking, I hadn’t been sent to addiction treatment that taught me that sickness was innate? Would I still have blamed myself for all that had happened, prompting an endless cycle of institutionalization, homelessness, self-flagellation via health-negating behaviours, subsequent institutionalization, and even fiercer destruction each time it didn’t have the desired result?
On and on and on. But, most importantly:
“Wait. Why is high-intensity alcohol and illicit drug even considered bad in the first place?”
I specialized in the medicalization of deviance (“abnormality”) as a mechanism of social control.7 In so doing, I catapulted head-first into a voyage of unlearning everything I knew about addiction. I was enabled in part by research, yes, but mostly grew from a) leaving AA and figuring out who the hell I was beneath the meetings and the chanting; and b) connecting with drug user activists. They, more-so than any text, instilled in me that the war on drugs, not drugs themselves, is a threat to our survival.
The history of alcohol and drug prohibition has been thoroughly documented elsewhere, so I needn’t repeat it here. Suffice to say that some substances are illegal not due to their chemical properties, but because they used to afford racialized immigrants and descendants of slavery economic and festive alternatives to wage labour. This threatened colonial nation-building projects, so state officials criminalized anything that might undermine their access to a compliant, exploitable workforce. Substance use also triggered fears of racial mixing (a major no-no among White European settlers obsessed with racial purity), and it threatened Victorian-era morality because ultimately, getting high feels really fucking good.
We must understand what is at stake: the alternatives to abstinence and “the program,” we are told, are jails, institutions, and death. Many arrive at treatment having already experienced a sort of social death. We are excluded from our families, the economy, housing, etc.
Today, the “disease model of addiction” has been naturalized in common discourse. That frequent, high-intensity substance use is a “chronic, relapsing condition” is a taken-for-granted assumption, with few publicly questioning why so many of us get and stay afflicted.
But, when we closely examine the most damaging outcomes of addiction—unemployment, incarceration, lack of access to medical treatment, homelessness, fatal overdose, suicide—we see that most are derived from the stigma, discrimination, and legislation surrounding use, not the actual act of using.
If, for example, heroin were to be publicly available, regulated, and normalized, people wouldn’t have to use in secret. They would know exactly what and how much they were getting instead of being poisoned by a toxic drug supply, and this would substantially reduce one’s risk of overdose. Beyond this, not getting fired or acquiring a criminal record by using would enhance employment options, and homelessness due to “unemployability” would thus be less prevalent.
Additionally, sustained illicit use necessarily propels one into a nefarious shadow world, one in which using becomes priority and social norms are suspended in favour of acquiring one’s next fix. How much of deviance is the result of not caring to participate in society, and how much is learning to not care after being treated like a degenerate? We internalize the labels ascribed to us, and we begin to act accordingly.
So where does this leave me?
Ultimately, I have come to see my own alcohol and crack-fueled binges, which now happen roughly once every 12 – 18 months, as the culmination of economic, political, legislative, institutional, and inter-personal failures. When I have tried to prevent benders by seeking help for post-traumatic stress (and the terrifying dissociative and somatic symptoms that accompany it), my first option is a sterile psychiatric ward, where I exist behind locked doors, am medicated beyond recognition, and am released with an appointment slip reminding me that a month later I am to meet with a harried psychiatrist who will review my medical records, tell me to consider permanent institutionalization, and prescribe me sufficient doses of antipsychotic and mood-stabilizing drugs to kill myself should I opt to (which I always seriously consider).
Mid-bender, trying to seek support looks like presenting at an emergency room, waiting for hours while hallucinating or in severe withdrawal, being given hefty doses of diazapam with the instruction not to ingest while drinking (ha!), and continuing to use. My roommates don’t know how to cope, I invariably lose my housing and employment, and those I should be able to call for help have been told by well-intentioned but misguided acquaintances that offering shelter, food, and safety is “enabling” my addiction (for the record, it is not).
To counter this, we need political education. Incorporating this is tough, because disease models of addiction actively de-politicize it. But there are inroads we can make.
I am left to fend for myself, and after four or so weeks of this I am so depleted and ashamed that I crawl into detox (after a bed becomes available, which can easily take weeks). Afterward, I’m still broke, alienated, and I have nowhere to go.
When I went to addiction treatment for the final time, I thought that perhaps my experience would be different. I was going of my own volition, I hadn’t just been scraped off the street, and I was optimistic that I might receive the trauma care that I still desperately need. Instead, I watched horrifically abused women be blamed for their condition, and as I felt myself deteriorate, I got the hell out of dodge.
I am not broken. The system is.
In some ways, medical sociology ruined me. I can no longer cope with the cognitive dissonance of sitting in twelve-step meetings while people discuss their “selfishness” and “self-centeredness” (the true etiology of addiction, according to the Big Book) while all I see are oppression and bad policy. I’ve tried many times over the years, and each meeting I attend reinforces that these are not, nor have they ever been, my people.
I also no longer pray to accept the thing I cannot change. I work (even as I oft question whether doing so is useful) to change that which I cannot—will not—accept. The former was easier, but given what I know, being passive in the face of injustice is not a viable option
I am still recovering.
By working with other user-activists on drug policy reform, I am recovering from loneliness and despair.
By writing, I am recovering from years of capitalist-induced performativity and my realities being denied.
According to AA, I am delusional. I most certainly will die soon. To this I say, maybe, but at least I’ll have died not hating myself.
I also refuse to invite people into my life whose love for me is conditional, so when (not if—when) I use again, I will not be alone. This fills me with great comfort, and it is now more important than a sobriety date ever was.
I dare call it spirituality.
Notes
Please note that I’m not claiming that trauma is the sole cause of addiction, which would be as reductive and deterministic as the program I malign. I broadly define trauma as structural violence, symbolic violence, and the more obvious interpersonal troubles it induces. With a background in medical sociology, I have been trained to minimize biological contributions to addiction; but severe, sustained use (which is more prevalent in marginalized groups), leads to physiological adaptations that make reducing or stopping one’s use more difficult.
I fully believe that some people (most people, actually) can transition away from problematic use and learn to use moderately. I am not one of those people.
I don’t wish to dispute that sustained substance use can have deleterious mental and physical health outcomes. As someone who narrowly evades death semi-regularly, it absolutely can. Still, I maintain that this is mostly a result of policy and stigma.
References
Mills, C. W. (1961). The sociological imagination. New York, NY: Grove Press
2. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. (pp. 99)New York, NY: US: Viking
Frank, J. W., Moore, R. S., & Ames, G. M. (2000). Historical and cultural roots of drinking problems among American Indians. American Journal of Public Health, 90(3), 344–351.
Lanius, R., & Olff, M. (2017). The neurobiology of PTSD. European Journal of Psychotraumatology, 8(1), 1314165
Hopper, J. W., Frewen, P. A., Kolk, B. A. V. D., & Lanius, R. A. (2007). Neural correlates of reexperiencing avoidance, and dissociation in PTSD: Symptom dimension and emotion dysregulation in response to script-driven trauma imagery. Journal of Traumatic Stress, 20(5), 713 — 725. doi: 10.1002/jts.20284
Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience, 13(3), 263 — 278.
Conrad, P. (1992). Medicalization and social control. Annual Review of Sociology, 18(1), 209–232. doi: 10.1146/annurev.so.18.080192.00123
supervised consumption service lawsuit in Alberta supervised consumption service lawsuit in Alberta
The Government of Alberta is threatening the health and safety of people who use drugs by rolling back reforms introduced by the federal Liberals in 2017 and imposing additional barriers to accessing supervised consumption services. The Liberal reforms in 2017 made it easier to set up harm reduction services in the province. The Government of Alberta has now introduced onerous requirements to service providers and service users that will make it more difficult to access and provide life-saving care.
These requirements include the following:
Providing a name and personal identifying information to access service
Good Neighbourhood agreements that far exceed current consultation requirements that make it virtually impossible to open any new harm reduction sites or renew existing ones
Standards for staff qualification and training that will exclude many people with lived and living experience
Onerous reporting requirements that are impossible for grassroots organizations, often operating out of a tent, to operate
High fines for non-compliance that will bankrupt small agencies
In response, Moms Stop the Harm and the Lethbridge Overdose Prevention Society (LOPS) have commenced legal action against the Government of Alberta to ensure that no additional barriers to access and provision of life-saving supervised consumption services are introduced.
“We know that our children would not have died had their overdoses taken place at a consumption site. This option was not available to them at the time. We also know how stigma and shame made them hide their use. We strongly oppose the new provincial guidelines as they will create barriers that will keep people from life-saving services. We know how hard it is to grieve someone you love and every overdose reversed is a family that does not need to arrange a funeral. This is why we launched this lawsuit together with LOPS—to save lives and to give people hope for the future.”
Both organizations argue that these changes—introduced in “Guidelines” by the Government of Alberta—conflict with the federal government’s goal of improving access to harm reduction services in 2017. They also allege that the Guidelines breach sections 2(a), 2(b), 7, 8, 12, and 15 of the Charter of Rights and Freedoms.
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This past week laid bare the dark history of Canada’s colonial past: 215 bodies of Indigenous children were uncovered on the grounds of a former residential school in Kamloops, British Columbia, on the territory of the Tk’emlúps te Secwépemc peoples. The horrific realities seized even the attention of the international media and government flags have been lowered to mark the tragic discovery.
We take pause in our work on drug policy in Canada to once again remember that our current drug policies have colonial and racist roots and that our work ahead is to stand with and support Indigenous Peoples and work together to create policies that end the discrimination, oppression and other devastating consequences so many experience.
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The discovery of these unmarked graves makes clear what Canadians must acknowledge: that Canada is founded on and continues to operate through colonial, systemically racist systems that continue to cause significant harm to Indigenous communities. Make no mistake, this was genocide. Grand Chief Stewart Phillip, of the Union of British Columbia Indian Chiefs, said to the media,
“This is the reality of the genocide that was, and is, inflicted upon us as Indigenous Peoples by the colonial state. Today we honour the lives of those children, and hold prayers that they, and their families may finally be at peace.”
The memory of this atrocity and commitment to reconciliation must not fade with the passage of time; and governments must step up and fully commit to justice for and self-determination of Indigenous communities. As a coalition committed to transforming Canada’s drug policies to those that support and empower Indigenous Peoples, we are committed to working with Indigenous organizations to dismantle a drug policy framework that has had such devastating impacts.
At this time, we encourage you to support Indigenous organizations working towards transformation and healing for the survivors of residential schools and ask you to consider donating to the Indian Residential School Survivor Society, an organization that has been providing support for survivors for over 20 years in British Columbia.
Memorial on the steps of the BC Legislature; Victoria; 2021
Along with voicing support and outrage on social media, we can write to our Members of Parliament and show our commitment by supporting Indigenous-led organizations who are best positioned to provide healing during this traumatic time.
Let this not be a flashpoint moment that dims with the next “big news story,” and let us become even more committed to having difficult conversations with our friends and families about what it means to truly seek reconciliation. Silence and apathy must end here as we move towards justice for and reconciliation with Indigenous communities across Canada.
On January 1, 2021, I hopped on my bicycle and rode from Saskatoon to Vancouver on a project called Cycle to Stop the Harm, to raise awareness around the drug poisoning crisis, drug policy reform, and mental health. Along with awareness and outreach, I raised money for Moms Stop The Harm and the Canadian Drug Policy Coalition—two amazing groups among many working at the leading edge of drug policy reform, outreach, and education. Full of determination, I left with a fundraising goal of $20,000 and a bicycle packed with everything I needed to survive winter camping and cycling from the prairies, through the mountains, and to the west coast. After 29 days and roughly 1670 kilometres, I successfully arrived in Vancouver with all my toes and fingers on January 29, 2021 with a total of $25,450 raised. Above all, this meant a voice for tens of thousands of people who are otherwise unheard and a chance to raise awareness around the current drug poisoning epidemic.
Iliajah Pidskalny; 2021
During that month, I received many questions: Why bicycle? Why winter? Why during a pandemic? What did you eat? Why peanut butter? What motivated you when it was most challenging? What was your training like? What will you do afterwards? Is there a personal connection to this issue? And the most common and most important question: what harm are you referring to?
The simple response to the latter is the harm done by our current drug policies, which have been a failed model for decades. The “war on drugs” is a useful term as it emphasizes the aggression of our current approach which, like war, costs a lot of money and many lives. After decades of failure, this model contradicts evidence, logic and human rights. The drug poisoning crisis is a manifestation of the harm caused by the war on drugs and is a serious epidemic taking the lives of thousands of people.
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Is there a personal connection?
No, I do not have a personal connection to overdose nor fentanyl poisoning. However, I am a human, and so I have a personal connection to other humans. I am embarrassed about this pitiful and devastating “war on drugs,” the policies of which are illogical and unjust. The policies have been justified by miseducation around drugs, drug use, and mental health, which has created a culture of stigma and accepted marginalization. Canada should take this issue more seriously before every Canadian has lost a loved one to fentanyl poisoning or overdose. There is no “us and them.” Taking a more empathetic and human rights approach to drug policies will not only expose systemic inequalities—whether socioeconomical, cultural, racial, or gender-based—it will also help us better understand mental health.
So when asked, “What harm are you referring to?”
I was ultimately referring to the harm caused by our own mind. Whether we’ve lost a loved one or are genetically prone to depression, our mind is at the root of so much suffering. Cycle to Stop the Harm was about mental health. Drug policy reform is the perfect place to increase research, understanding, and compassion regarding mental health and to decrease stigma (not to mention save tens of thousands of lives). Whether it’s depression, loneliness, anxiety, addiction, greed, hatred, or jealousy, we are all susceptible to mental and emotional ailments. That is the essence of why I began Cycle to Stop the Harm. That is why I was so motivated to bring awareness to this issue even if it meant the constant threat of hypothermia and frostbite for 29 days. I was riding for every boy and girl lost to fentanyl poisoning and for every mother and father who now suffers from their loss. I was riding for impoverished communities in Canada, Ghana, Mexico and every other country. I was riding for the rich and the poor, the religious and the atheist, the young and the old. Each day on that bicycle, I rode for every individual human.
Why bicycle?
I knew that I could bicycle and camp in the winter. I knew that a crazy journey like this could get some attention. I knew that I could give a voice to so many people who don’t have the opportunity/resources to speak up (or be heard).
Saskatchewan highway; 2021
Why winter?
I got the idea mid-December and I was not willing to wait. People say I’m impatient, but I call it enthusiastic. I also knew my journey would gain much more attention in winter than in summer. Furthermore, riding and camping in the winter highlights some (and only some) of the challenges experienced by Canadians who are homeless. After witnessing homelessness during another six-week winter bicycle journey in eastern Canada (October 23 – December 3, 2020), I wanted people to rethink the challenges of homelessness. I often wondered why people would call me adventurous or brave, yet rarely said anything like that (or anything at all) to people who live on the streets. Living outside in the winter sucks, even if you have good gear and do it by choice. I can’t imagine what it’s like involuntarily living without shelter and struggling with other barriers, including severe mental illness and stigma.
Why during a pandemic?
Although the world’s in the grips of a tragic pandemic, homelessness, addiction, depression, suicide, mental illnesses, and social inequalities don’t stop. In fact, overdose and suicide have only gone up in many communities during this time. For me personally, I wasn’t going to wait until the pandemic was “over” until I cared about these issues. I followed all pandemic protocols and was willing to take the extra challenges involved, which meant living/cycling for two weeks in a tent by myself until I could be hosted in a home. That totalled two warm homes in the month of January, and not nearly enough showering…
As for the journey itself, I’ll try to summarize some of the challenges.
Thanks to good gear, I was never cold during the night. However, every morning I had to crawl out of my warm sleeping bag and put on frozen socks, frozen boots, and frozen mitts. Overnight, my breath would precipitate as snow on the inside walls of my tent. This meant that any sudden movement, it would be snowing in my tent. I had spare dry socks, but my boots were wet (frozen), so I saved them for emergency (which was never, thankfully). Day after day, everything got more wet and more frozen.
Camping along Cycle to Stop the Harm route; 2021
After I put my frozen socks and mitts on, I would then pack up camp in the dark so that I could ride at dawn. Since I had limited daylight (especially in the beginning), I would cycle from dawn to dusk. It took a lot of time and energy to make and pack up a good winter camp everyday. I had to bicycle at least 80 km a day for it to be worthwhile. Riding 80 km was tough against prairie headwinds (consistently 50 km/hr and sometimes gusting up to 90 km/hr), but in the mountains I started averaging 120 km a day.
Once camp was packed up and the bike was ready to go, one of the hardest parts was next: shedding some layers before cycling. That always sucked. Singing and talking hysterically seemed to help. It was just a matter of cycling hard until my body would generate enough heat such that the involuntary and lifesaving shivers would stop. But, before that moment, the bitter cold seemed to desperately draw physical and mental energy out of me… day after day. Once I was fully warmed up, I cycled with only a long sleeve shirt, thin polyester leggings, and swimming trunks. Then to the next hardest part: stopping for a break. If I stopped, I would get extremely cold, shivering and teeth chattering within a few minutes (or sometimes seconds). Standing in middle-of-nowhere Canada with a shiver like that is a quick trip to severe hypothermia. My only source of heat was my body via exercise. So, I would rarely stop and only briefly. A quick sip of water (which had to be stored in a thermos) and a quick handful of as many calories as possible before cycling again. I noticed that bicycling with a mouthful of food, trying not to choke and wearing a face mask all at once was a quick way to warm up after a break.
What did I eat?
Each morning and evening I ate rice noodles with peanut butter. But to sustain me for the rest of the day, I would make energy bars from dates, chocolate, peanut butter and tortilla chips. After cycling all day, I would always get a nasty chill when I finally stopped riding in the evening. The only way to shake the chill was to set up camp as fast as I could (which worked surprisingly well every time). Then I would cook my rice noodles for dinner, often with vegetable juice or canned tomatoes and of course, peanut butter. I ate other things along the journey, especially candy in Saskatchewan and potato chips in Alberta. But, once I learned that the combination of dates, chocolate, peanut butter, and tortilla chips made me feel invincible, I never looked back. And so it was, for 29 days.
Eating a meal during Cycle to Stop the Harm; 2021
Why peanut butter?
For those who had followed the journey on social media, they noticed a consistent theme of peanut butter. It was in part a joke, but also the majority of my caloric intake. This is because it is cheap, but also because I have some serious gut health issues (IBS). My health issues have almost convinced me to stop travelling and doing adventures like this, but I’ve decided instead to adjust my lifestyle (diet) in a way that allows me to do the things that I love most. Of course, I’ve had to redefine what it is that I love most; but that, combined with peanut butter allows me to push on. (I share this to help remind people that I’m human, and to not over-romanticize my character qualities).
What motivated me when it was most challenging?
I met many people along the journey and everyone had a story—whether it was losing a friend to fentanyl poisoning or their own story about alcoholism, using heroin, or addictive shopping. Everyday, I would be reminded about who and what I was riding for: everyone and their mental health. When my toes were numb or the headwinds were gusting 90 km/hr, I just had to remind myself, “This isn’t about you, Iliajah. This is about everyone, including you.” I would look up at the mountains and think, “Be patient like the mountains, strong like the wind, and humble like the dust.”
During the month, I rarely thought about my final destination. Instead, I focused on one day at a time. Cycling and camping in the cold requires a lot of focus, and there was little time for me to celebrate or relax. Every minute was highly calculated, as I constantly danced with the threat of hypothermia and frostbite. However, when I left Manning Park at -20C one morning and arrived in Agassiz at +8C the same afternoon, I felt an overwhelming sense of relief. At that moment, I knew that I had successfully completed the journey and that I would safely arrive to Vancouver in only a few more days. By the time I arrived at my official final destination, Jack Poole Plaza (at the Olympic Flame) in Vancouver, I only felt an inexplicable exhaustion from my journey and an excitement for what lay next.
Jack Poole Plaza; Vancouver; 2021
What was my training like?
I spent the last six years without a vehicle, which meant many winters and many long distance bicycle rides. My first journey was from Saskatoon to Vancouver (in the summertime when I was 18 and with a buddy), and I fell in love with long distance cycling. Since then, I’ve done long hauls in Indonesia, Cambodia, Spain, and others in Canada. My legs were ready for Cycle to Stop the Harm. However, winter is a different beast and so this time my training was focused on my mind. I’ve been lucky enough to have the time, energy, and resources (books, wifi, people) to have stumbled upon and practiced meditation. This was the key to the empathy and compassion that motivated me to embark on a bicycle journey in the dead of winter for no one in particular, yet every particular person.
What did I do afterwards?
I went to Vancouver Island and continued to bicycle for Cycle to Stop the Harm. I had closed the fundraiser and decided to focus on conversation and reducing stigma. I thought it would be a more relaxed version of my month in January, but I was very wrong. It was another month full of numb hands and feet, with wet shivering and teeth chattering battles against hypothermia. It was far more challenging than the first month because there was no endpoint. Less people were paying attention, and so my life threatening efforts felt pointless. Alas, I rode another ~500 km from Nanaimo to Campbell River, then south to Victoria, and then finally back to Nanaimo. The project ‘Cycle to Stop the Harm’ has since been put to rest, while I take some time to heal and stop harming my aching body. But, as the days get warmer and the sun shines longer, I can smell ideas blooming in my mind. The next project awaits, and will blossom when the time is right.
canadian drug policy coalition 2021 canadian drug policy coalition 2021
There’s no denying that 2020 was a disaster. The human toll can be expressed in numbers, but the impact and actual loss is incalculable. Friends, family, lovers and co-workers died—many alone, and most from failed drug policy.
Though many of us understandably want to forget about this past year, we must not overlook the courage, ingenuity, and determination that helped move the dial on public health, harm reduction, and drug policy. COVID-19 helped the public see and understand the dire health inequities plaguing Canadian society. Supervised consumption, decriminalization of drugs, and safe supply entered public discourse and consciousness in a way they hadn’t in the past. This was due to the work of frontline advocates and communities affected by the harms of prohibition.
International Overdose Awareness Day; Vancouver; 2020
Not only did the overdose epidemic continue to rage in 2020, but the addition of the COVID-19 pandemic meant that Canadians were isolated from their regular supports. COVID-19 may have finally brought some folks shelter, but it also came with an increased risk of overdose because these individuals were now living alone.
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Looking forward, there is an enormous amount of work to be done in 2021. The illegal drug market is still tainted with poisoned drugs. Stigma and discrimination still push people into the shadows. Municipal and provincial governments continue to deny the evidence of harm reduction and its positive impacts. We must keep the pressure on as we endeavor to change the minds of our elected leaders and convince them to support progressive drug policy.
In 2021, the Canadian Drug Policy Coalition will train its focus on decriminalization and the legal regulation of drugs to help end the harms of the toxic drug market. We will do this through a range of major projects, each with its own audience and goal to push Canada towards a future free from drug policy-related harm.
Rally in support of Lethbridge Overdose Prevention Site; Lethbridge, AB; 2020
At the frontend of our efforts is, Getting to Tomorrow: Ending the Overdose Crisis, a national public health dialogue project aimed at helping Canadians realize that we all share the same goals: a safe and secure society free from the harms of a toxic drug supply. The project will bring together community leaders across Canada to identify shared values, goals, and a collective vision for change so that Canadians can work together towards solutions. Getting to Tomorrow aims to bridge the divide within communities that so often stands in the way of life-saving progress and build a broad base of public support that will help animate our other major initiatives and efforts.
Broken Drug Policies is a similar project focused in British Columbia hoping to leverage the gains in drug policy, already introduced at a provincial level, to accelerate drug policy reform. Broken Drug Policies will help the public understand how interconnected systems (health care, criminal justice, social services, employment) drive substance use and the power they as citizens have in influencing those systems to create change.
The Regulation Project will do a deeper dive into what a system of legal regulation of drugs could look like. Ultimately, it is only through a safer and regulated supply of drugs that the scourge of overdose deaths can end, and envisioning this future free from harm is a vital first step. As part of the project, CDPC will be consulting key stakeholders—principle among them people who use drugs—on what factors would ensure that a system of legal regulation would succeed. How would people access safer drugs? Who would have access to them? When and where could they these substances be obtained? All these questions will be explored to lay the blueprint for life-saving change.
Vancouver Area Network of Drug Users Memorial March; Vancouver; 2020
Working alongside this effort is Imagine Safe Supply, which seeks to clearly articulate the concept of “safe supply” and what it means for those most directly impacted by the harms of our current drug policy: people who use drugs. Having a clear and accurate understanding of this concept is the necessary foundation for transformative policy.
With the rollout of COVID-19 vaccines we are happy to begin planning of Stimulus 2022: Drugs, Policy and Practice in Canada, the country’s largest harm reduction and drug policy conference that will bring together harm reductionists, people who use drugs, government, community leaders, advocates and academics to share knowledge and build community and capacity to better respond to the worst overdose crisis in Canadian history.
As we look to 2021, we look with hope. We need to come together now more than ever as we walk this tremendous path to change failed drug policies and save lives. We hope that you’ll walk alongside us.
ARCHES closes on international overdose awareness day, ARCHES closes on international overdose awareness day
International Overdose Awareness Day began in Australia in 2001 as a bold and public call to combat stigma around drug use, honour the lives that have been lost to overdose, and educate society on the life-saving value of harm reduction. It has grown every year, with a record 874 global events and participation from 39 countries, including Canada, in 2019. These are all encouraging signs that society is waking up to (and communities are mobilizing around) the truth that drug prohibition has failed and a new human rights- and public health-based approach to drug policy is desperately needed.
(Interactive)
But it’s hard to sense this shift from the actions of the Alberta government, which recently cut funding to Canada’s busiest supervised consumption site, ARCHES, which forced its closure. The doors close today, International Overdose Awareness Day—a time when we should be moving towards progress through compassionate, evidence-based drug policy by embracing more harm reduction, not less. Instead, Alberta, in darkly ironic fashion, is sliding backwards—a regress that erodes the public health and safety of one of Canada’s hardest hit provinces when it comes to overdoses.
Since opening in March of 2018, ARCHES, located in Lethbridge, Alberta, saw an average 663 visits per day. “That’s more daily visits than the busiest sites in Toronto—a city of more than two million, and Vancouver—where Canada’s first supervised consumption site was founded in 2003,” according to the Star Edmonton. The number of lives saved and positive impact to the greater community is immeasurable, so it is both baffling and dangerous to shut the doors on such a vital health service. Research from chief coroners across Canada makes it clear that using drugs alone is extremely risky at a time when the drug market is so toxic. People will likely die without the supervised consumption services ARCHES provides and the supportive environment it affords.
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In the first quarter of 2020, there were 127 fatal overdoses related to fentanyl in Alberta, an increase from the previous quarter where there were 105. 85% of the deaths this year occurred in larger urban centres like Edmonton, Calgary, Red Deer, and yes, Lethbridge1.
In such a climate of death and human suffering, governments should be expanding harm reduction, not scaling it back. Alberta’s provincial government decided to pull funding after a financial audit found suspected financial irregularities around spending and expenses. But this is no reason to punish the marginalized clients who use the facility daily—whose very lives depend on its services and the community of care that has formed around them.
The Government of Alberta announced a mobile site will replace the services lost with the closure of ARCHES. But advocates warn that this can in no way replace the scale of services and community building a site like ARCHES provided. They’ve done the math, and the numbers are a cause for deep concern.
Let’s do some math! @archesleth SCS sees 800 people a day. They have 13 booths for injecting, snorting or consuming drugs from the unregulated market.
The 2 inhalation spaces (6-8 people total) have been closed because of #Covid19AB so lets put that aside for the moment. 1/4 pic.twitter.com/yufJ4eoNkW
(Vancouver Area Network of Drug Users memorial march; Vancouver; August 15, 2015)
And in British Columbia, two consecutive months of record-breaking overdose deaths have both shattered and enraged the spirits of affected communities. This May there were 171 fatal overdoses; in June, 177; and in July, 175. Across Canada, grief, fatigue, and rage surface in equal measure as frontline communities fighting two public health crises (COVID-19 and overdoses) also battle hostile local governments threatening their ability to save lives.
Now more than ever, International Overdose Awareness Day is needed to affirm the value of harm reduction and the policy changes needed to stem the tide of fatal overdoses: decriminalization and a safe supply of drugs. At a federal level, there is slow and incremental progress. It is not nearly good enough, but better than the backwards direction we’re seeing from a provincial government that seems driven by ideology and out of touch with the science and evidence supporting harm reduction.
Though drug policy is a federal matter, provincial governments have the power to alleviate some of the harm created by prohibition—which is fuelling overdose death—by, for example, deprioritizing police enforcement of certain drug laws (de facto decriminalization) and choosing where to spend money. Their funding decisions can also create serious harm for affected communities, as will likely be the case in Lethbridge.
