Tag: safe supply

Michael Nurse is a harm reduction practitioner, activist, and advocate. He resides in the city of Toronto where he has worked for the past 20 years delivering harm reduction-based street outreach from a lived experience perspective.

Frank Crichlow is the Board President of the Canadian Association of People Who Use Drugs and President of the Toronto Drug Users Union. He works at the South Riverdale Community Health Centre in Toronto as a Community Health Worker and is a community advocate with multiple organizations for people who are unhoused and who use drugs within African, Caribbean, Black, and racialized communities.

Frank Crichlow: The Imagine Safe Supply research looked at the meaning of drug user participation in safe supply. It found that the community values of people who use drugs would be central to the development and role out of effective safe supply. What is safe supply to you? And what kind of value-based considerations are there for safe supply within the African, Caribbean, and Black (ACB) community?

Michael Nurse: I see safe supply as a concept that offers transformation, that reshapes the way that people access drugs which are now deemed illicit or that are not regulated. But for me it’s problematic. At this time safe supply doesn’t really address all illicit drugs in use. It’s a particular focus on opioids. If you look at people who use crack cocaine, which in my home city of Toronto is predominantly people of African descent, even with crack cocaine people are experiencing overdoses from opiates which they never intended to use. So, to just have a focus on people who use opiates, to me it’s a very narrow focus. And it doesn’t really address the whole idea for me of safe supply, which is to transform the way that people access drugs which are currently illicit or not regulated. Yes, ACB people do use opiates intentionally, but I find we mostly use stimulants. And safe supply doesn’t address that use. 

What I would like to see is a focus on safer supply. For me that would be saying OK we are intending quality assurance when people access drugs that are now deemed illicit. Until I see that approach, I don’t really see safe supply as a concept that is working in a broad and meaningful way for people of African descent.

Frank Crichlow: It’s important that those drugs should be included. Crack is a drug that Black people use, and we only have 2 or 3 safe consumption sites in Canada where people could go and smoke these drugs. Personally, as an ACB person, I would feel a lot better knowing that we have a safe place to go, and we feel safe in do

Michael Nurse: I agree.

Frank Crichlow: The research found that while there is a broad need for more representative leadership from the Black community within frontline care, there may be specific considerations around the leadership of Black women in safe supply. Black families and communities are often matriarchal, and we heard that it would be important to involve mothers, grandmothers, and extended family members in these discussions. This leadership was also seen as important to address the increased risk that Black women face within drug use communities due to targeting and harassment. What are your thoughts on the importance of Black women in leadership around safe supply?

Michael Nurse: Yes, I see a need for developing the presence, leadership skills and knowledge of women of African descent in safe supply. And indeed, this applies to most marginalized and racialized women. In the context of African People’s communities, it should be known that women are pretty much the anchors in homes. Most homes are held together and are led by women. So, I mean, it would be a fundamental flaw in any design for a community service that does not take into account the role women play in maintaining spaces for people. Remember, if we’re talking about this being a project that is being led by people with truly lived experience, women have a tremendous amount to offer from their lived experience. So that alone should say yes, women need to be factored in in  a very high priority way. Because women carry that burden already, they play those roles already.

Frank Crichlow: But when you look at most organizations, Black women are seen mostly in frontline worker roles. There is just one community health centre I know of where we have a Black woman in an executive leadership position. To me, there is a need for women of ACB communities to be in higher positions. They are skillful and knowledgeable enough to be in those positions. 

Michael Nurse: You also bring up another point Frank. In most cases women in the ACB community are the trusted figures. They are the ones we go to for care, for advice, for intimacy, in these areas they are the trusted figures. When we look at the mistrust that we as People of African descent have in institutions, in organizations, you can see clearly why there is a need for more Black women within those fields. Just to heal that image, just to break down distrust between us and the service entity as we seek access to care and support. And also for the institutions that already exist to offer services in response to our real needs or desires.

Frank Crichlow: Where is that distrust coming from? 

Michael Nurse: That distrust is coming from the histories of this type of engagement.

Frank Crichlow: Of whiteness?

Michael Nurse: Not necessarily from whiteness. I would say it comes from the system, the institution, the whole capitalization of how people live, you know. It’s about business, it’s all about money, it’s all about funding. Organizations will dump you in a moment, dump programs in a moment, if it means that they can get a better handle on their money. So, the distrust doesn’t just come from whiteness, even though you could make that connection due to the high incidence of white privilege in the field and our society in general. But It comes from the way that money is prioritized in our society, with people being secondary.

Frank Crichlow: Yeah, but we have to remember, many Black women haven’t gotten over how they’ve been treated within these organizations. All that people report to is White people. How many people report to Black women in leadership roles?

Michael Nurse: I don’t know if I agree with you there, Frank. Because to me the treatment of Black people, women, or men in general, from organizations they need to trust isn’t just a fact of race. For example, I strongly believe that some of the most demeaning treatment a person of African descent can get from a police officer, is from a Black police officer. 

Frank Crichlow: Yea, that’s true.

Michael Nurse: If it is within the culture of society – be it black, white, yellow, green, brown, pink – we all buy into it because it is a system that controls how we access services. If we don’t really allow the people who are experiencing this to drive it, then we end up with the same model that we’ve always had. And I wouldn’t just pin this on White people. I would pin this on the cultural system we live in. It is still White people who are visible in representing the system, but we are also represented in there.

Frank Crichlow: It was just a point that I was raising about how some of us feel because of whiteness and how they look at us as weak people.

Michael Nurse: I don’t think you can package everything into whiteness. Because you know the Franz Fanon book “Black Skin White Mask”? I think some of it speaks to this experience. Once we have to exist within the system, we make choices based on the system and what it allows us. So, to me this is a struggle not against people but against the system. That’s where I see it.

Frank Crichlow: Okay, I could accept that. But I still believe that one of the main struggles is how we have been treated. 

Michael Nurse: Fair enough. But let’s say nothing changes within the way that safe supply is being developed and administered and the focus continues to be on opiates, after People of African descent are hired on to promote and help drive this work. As Black people, wouldn’t we be perpetuating the same kind of mal treatment that was always there before?

Frank Crichlow: I would say no. 

Michael Nurse: What would change? Would we have the ability to make changes on the spot as we work, as people? 

Frank Crichlow: Exactly, see that’s the challenge. That is where we have to challenge the system to make those changes.

Michael Nurse: So, the action is still against the system?

Frank Crichlow: Yes.

Michael Nurse: Yeah, so that to me it is where we meet. And for me, the key is for people to collaborate to change the system. We need to point out challenges, but also encourage people of all types to join in and fight to change the system and culture that seeks to dictate how people live and how they access safety and care. Yeah, that is where I see it. There definitely is a need for change and we need collaboration among all people to bring about this change.

Frank Crichlow: The Imagine Safe Supply research team heard that discrimination around gender and sexuality for Black LGBTQIA+ people leads to increased mental health risks and associated drug use. Do you see this as a problem in terms of LGBTQIA+ discrimination within ACB communities? How do you think we can provide a safe space for the Black LGBTQIA+ community with safe supply?

Michael Nurse: Of course, any kind of racism or oppression has a lasting effect on mental health. For me, that goes without saying. There are definite barriers against LGBTQIA+ people, against queer people, and this is compounded for LGBTQIA+ people who use drugs. It appears to me that discrimination expands according to how different you are from the mainstream, from the status quo. I remember when Black people I knew began to inject. It took a long time for that to be talked about with service providers or even in the community. People resisted telling other people within the community that they were injecting drugs because it was frowned upon. Injecting with needles was seen as much less desirable than smoking crack. Add now being LGBTQIA+, then you step into a whole new set of discrimination. 

And remember that most ACB communities are grounded in the Church. That’s where many black people seek spiritual and social guidance, connection with each other, social organizing. Predominantly, most of that comes through the church. And the church says sexual activity or love exchange between same sex genders is sinful. So, starting with that, the Church is actively subscribing to the social alienation and oppression of LGBTQIA+ people. How then do you expect LGBTQIA+ people to access places that offer safe supply if hanging over their heads is the stress of having to navigate discrimination and other oppressive social and cultural barriers based on their sexual preferences? 

It does mean that we need to address and deal with the social harms the Church presents. One segment of a community or population doesn’t represent everybody and cannot be dictating to all people how people live. So, the Church’s influence and involvement in maintaining harm to a segment of the population has to be addressed. It’s been suggested that a way to move this change forward is by finding the progressive members of religious communities and showing them the benefit of harm reduction and safe supply. If that works, it works. If it doesn’t work, straight out, confrontation. Because I believe in justice. You don’t need to pussy foot around this. Things need to change, definitely. 

Frank Crichlow: The Church seems part of the problem because the church should be addressing those issues. 

Michael Nurse: The Church is part of the problem and the Church appears unwilling to address these issues, but that doesn’t mean that  we should ignore them. We need to bring it forward and fight. My trust and my hope are not really in the Church, my hope is in the people. I certainly don’t have to accept anything that the Church says or that doesn’t make sense to me. I’m looking at progress. I’m looking at people beginning to assert their existence. To say, this is what I need. Look at me, I’m here! For me, that is where safe supply and harm reduction need to be led. How will people who use drugs come out of the shadows? It shouldn’t be a shadow issue. It shouldn’t be a shadow movement. We should be out of the shadows, living our lives. I mean respecting each other.

Frank Crichlow: So, should the Church address harm reduction or safe supply?

Michael Nurse: What I would say in answer to that question is that the Church needs to get real. The message that’s coming out of the Church in terms of sin and how people live their lives, is it touching people today? You know, it isn’t touching people today as it used to. My thing is more about focusing on how we collaborate to have laws, policies, programs, and services that represent us as people. And realize that we can.

Frank Crichlow: The reason why I ask that question is because you know when anything happens, the grandma and the great grandma say, “because you don’t believe in God” and they start praying, and they want you to start praying. So, what if they would go tell the preacher that the Church should address these issues of discrimination? 

Michael Nurse: Yeah, you know, I remember when dancing and winding up and so was seen as really wrong within the Church. Frank, you can’t really go into a Caribbean church these days and not hear reggae and soca music jamming, people singing to this music. It has changed, and the change doesn’t necessarily have to start within the Church, it has to start with people. And if it is right for the people, they will take it to Church, people will take it wherever, because it will reflect their lives.

Frank Crichlow: Yea. 

Michael Nurse: It does need to be real.

Frank Crichlow: Particularly at the barber shop. Anywhere Black people congregate, these conversations should happen. 

Michael Nurse: Yes!

Frank Crichlow: Everywhere Black people congregate, whether a street corner, whether in a bar, anywhere. And I think that is the solution there. 

Michael Nurse: We also have to take on a responsibility in terms of being proactive in challenging stigma and discrimination. The first time I walked into a needle exchange there were all these messages and images on the walls, and stuff that reflected positively on me and my lifestyle. And this wasn’t done because I asked for it. It was done because I was recognized by a group of mindful people, and they created that space. I always see communities as an extension of that needle exchange. And we don’t need to just make that space comfortable; make the whole organization, the social space comfortable. Bring those images and messages out so that people know. Make posters and stuff. Give them to the barber shops, give them to the church, too! Put that up there! When people come in, let them see this, show them that you represent this, that you’re okay with it. Show them that this is good, you know. I feel like that’s something that we can do, just promote that goodness, you know.

Frank Crichlow: Great, very good points, Michael. Thank you very much. 

Imagine Safe Supply is a community-based research project that explored participation in safe supply in Canada for people who use drugs and frontline workers. For more information on this research please visit here.

Marc McKenzie is a semi-retired frontline worker with Shepherds of Good Hope supportive housing in Ottawa. A lifelong human rights and development proponent in the social services world, he has worked in case management, mental health, and addictions harm reduction advocacy and is a founding member of the Men’s Health Group operating through the South Riverdale Community Health Centre in Toronto. Marc has a passion for music, especially jazz, and served as the transportation co-ordinator of the first Toronto Downtown Jazz Festival. For two years in the mid-90’s, he also was the host of two radio programs at CKWR, then a community radio station, in Waterloo, Ontario. Marc has a keen interest in the connectedness of all things: “Personal discovery, growth, and development is the best gig ever…so much life available, through listening”. 

Frank Crichlow is the Board President of the Canadian Association of People Who Use Drugs and President of the Toronto Drug Users Union. He works at the South Riverdale Community Health Centre in Toronto as a Community Health Worker and is a community advocate with multiple organizations for people who are unhoused and who use drugs within African, Caribbean, Black, and racialized communities.

Frank Crichlow: Marc, could you share a little bit about yourself in terms of your work or pursuits and how you came to be interested in the topic of safe supply?

Marc McKenzie: My interest in safe supply started when, many years ago, a lethal herbicide called paraquat started to be sprayed on marijuana crop, which made its way into the consumer marketplace in Canada none-the-less, as part of the war on drugs campaign. At that time, Mexican pot dominated the North American market, and the spraying of their fields was carried out by the Mexican government in response to mandates set by the American government. The action started quietly, almost covertly, without notification to the public, but was outed by the American anti-discrimination group NORML (National Organisation for the Reform of Marijuana Laws), a private advocacy group. To me, the war on drugs is foolish at best and unconscionable at worst, and I don’t think that humanity can thrive under that mentality. After first working for large corporations for a number of years, I redirected my energies to social work and advocacy. I started with peer work and then, over time, moved on to other forms of social work. At every turn, whether working on the frontline, in case management, housing, or some other aspect of support services, the need for comprehensive harm reduction – from operating philosophy through to integrated service delivery – always presents itself.

Frank Crichlow: There is currently a gap in culturally oriented harm reduction and safe supply models for African, Caribbean, and Black (ACB) communities. Imagine Safe Supply research findings point to the importance of ACB leadership in the development of organizational and social policies, and a greater involvement of racialized communities in the development of drug policy in general. For example, we heard about a desire for ACB and Black LGBTQIA+ counsellors that can respond to the cultural aspects of people’s needs. My viewpoint is that there are Black people in the lower staffing roles or who are receiving services, but where is the leadership? My question to you is, what advice would you give Black people transitioning into organizational leadership roles in social service and frontline organizations that would be part of safe supply access and support?

Marc McKenzie: The concept, “safe supply”, is seated in a radically different perspective from that of any other mindset that has ruled society up to this point. At the societal level, embracing it calls for a paradigm shift in core belief. History shows that legislators and elected officials are generally slow, if not disinclined, to move towards such a big swing. Among their many concerns is mainstream public opinion, even if making the move is an act of true leadership. Skillful advocating to the public is key to opening channels of discussion towards gaining a sense of permission to rethink, let alone act.

To Black people in service leadership roles, I would say if you don’t already have a solid grasp of the factors that form(ed) the history and subsequent present circumstances that shape the ACB experience, then make that learning a priority and share what you learn. Whether through intensive immersion or relaxed conversation, look to soak up as much relevant socio-political insight as you can, such as theory and practice of class stratification and the nature and full objectives of the systems by which Canada operates. Be mindful of your information sources and of your influencers. A grounded understanding of that mechanism – how it all works and to what ultimate ends – furthers the prospect of independent-minded growth and development. Successful advocacy for safe supply calls for the pursuit and maintenance of informed original thinking.

Home-grown talent is needed. Look to develop streaming programs that can cultivate new leaders, especially from within the ACB community. This goes for those who could be mentors, as well. In society at large, inequities that plague the ACB community and especially those needing safe supply, as unique and glaring as some of those are, are largely underexposed and remain unperceived. The war on drugs narrative currently owns centre stage. More and new vitality is needed; I think the ACB community voice would benefit from steady grassroots on up development, meaning steady progressive job positions for peers, frontline workers, and beyond, and for those who can mentor. Community self-determination and strength development needs to have more of a voice, and ears listening who are motivated to respond. Safe leadership means being in regular and ongoing meaningful contact with people who have current, recent, or long past /elder lived experience.

Check yourself closely and ongoingly as best you can, to have an updated sense of where you and your team truly stand on relevant issues and service ideas, and why. Know your limits. Know what the Canadian Constitution and the UDHR (Universal Declaration of Human Rights) say on human rights. Challenge status-quo practices that work against human rights and the promotion of health and well-being.

Gather input through dialogue from as wide a range of sources as you are able, including input from those opposed to the viewpoint you represent, to build community through relationship. Model open-mindedness and support the work of other safe supply stakeholders and allies. Look to contribute towards, utilize, and reference networks active in any medium that aim at furthering harm reduction ideals and services. Support initiatives that promote healthy self-determination. Grass-roots development and action is vital; demonstrate a spirit of advocacy in action as a community standard.

Bring the conversation forward at all relevant discussion tables and look for opportunities to have best ideas explored. In a country said to be aspiring to democracy, the way forward is through dialogue. True resolution of contentious matters is more successfully negotiated than fought. Do not be sidelined from pushing the discussion envelope beyond the existing company and/or industry narrative and practices. Use evidence-based awareness raising as an orientation for listeners. At meetings, through in-house and outside partner workshops, at community “town-hall” and “coffee house” gatherings, in any relevant forum, humanize the concern. Report on real-life lack of safe access story outcomes and the related further implications. Link these to the nation’s determinants of health, and health and well-being agenda. This also has implications for the CDSA (the Controlled Drug and Substance Act of Canada) and the broader Canadian legal framework in which many of the downstream inequities that negatively impact the ACB community play out.

Finally, be mindful of developing and maintaining an empowered proactive perspective rather than a reactive, victim-centric one. Having a personal need for safe supply or not, we share origins and overall group history with all the ACB community, and generally face some form of the same barriers, one way or other.

Frank Crichlow: We heard about needed aspects of equity for Black women in relation to safe supply. One, there’s a need for anonymous, non-medical safe supply avenues where Black women can speak about substance use without judgment or police involvement. Two, there is a need for spaces at harm reduction gatherings and conferences for Black women. Third is the need for better access to support services for Black women, such as mental health and housing. Question, are there any additional areas that you think deserve attention to ensure safe supply equity for Black women? What kinds of safe supply and harm reduction support do you think Black women need, and what are the considerations around this access?

Marc McKenzie: So, within the situational context of our society, Black women typically occupy the lowest rungs of the socio-political and socio-economic ladders. For me, theirs qualifies as a “special status” which arises from racism coupled with gender bias. I believe the inequities you mention (and others) are expressions or symptoms of the mentality that brokers power in this society.

Reordering society to support rather than oppress Black women – and therefore all Black community since the women are the nexus of its well-being – would quite naturally over time result in greater equity and abundance for everyone. By this I mean all of society, considering that in humanity if anyone suffers, everyone suffers. But this support would be at the material expense of those who currently enjoy the “privilege of more” as their circumstance and way of life. Oppressing the lives of Black women is the surest way to gut all Black people.

For ACB women needing non-medical safe supply, for a start, the relationship between these women and the police (and by extension the judicial system) needs to be improved and demonstrated through routine actions to the point where the women can know they are not being targeted or dismissed; that they are related to and are served as full-value members of society. This is tricky because ultimately, the police and courts serve the status quo. Still, often enough an event that spirals into more downstream negative outcomes for these women, and by extension their families, begins with a situation the police come into, or are not called into when they should be because of fear and trust concerns. In my view, how the police and courts treat a group of people generally sets the tone for how they are regarded by most other services, and by broader society overall.

As a place to start, a presence of ACB female police officers and other first responders, especially in lead roles, would likely invite a sense of approachability and reasonable engagement. Same goes for all other support services, especially counselling. In particular, a visible Black LGBTQIA+ councillor presence would be invaluable to this community. Such representation could help people move out of the silos they live in around substance use and step towards relationship building, brought on by action and response informed by recognition, respect, cultural affinity, and understanding. These are attitudes open to progressive solutions and which move away from the existing “war on drugs” impasse. Along with this, having non-uniform officers from “community-oriented-policing” units visibly involved in social justice and advocacy initiatives, even when just as listeners, demonstrates a willingness by “the system” to develop practical humanistic relationships with communities, which is an important signal to young people coming up.

Still, there is a primary factor present to this day, deep in the psyche of much of the ACB community at large, that underpins its vulnerability. Its impact expresses in a spiral of forms, but its origins come back to oppression and the denial of self-determination. The commonly used terms “baby mother” and “baby father”, for example, indicate it. These terms originated as a way of Black slave men and women who’d had a child together, referring to each other, arising from the slave owner program of disallowing marriage amongst them and pairing each with different sexual partners at each “breeding” session, as if managing cattle. This was a routine practise in Black slave history in the Americas, for a long time, applied as a device intended to damage the psyches of slaves through the disruption of family ties. It rendered these people “emotionally diminished” and thus easier to control. Additionally, any member of the union – man, woman, or child – could be sold off separately to another owner, at any time.

The result was a fragile and injured alliance between the women and men, and children chronically raised in forced single parent, variable half-sibling situations, as prescribed by external forces and not resulting from choices based in self-determination. Because the program operated to serve the interest of commerce, the drive of the institution of slavery-for-profit trumped human kinship ties. Enslaved people’s sense of grounding commitment between the sexes, and parent-child relationships, were destabilized if not torn apart (divide and conquer) and the ACB community has yet to fully recover. The ties between women and men are still often described and exercised more through the existence of a child they co-create, than by direct lasting commitment to each other as full-value people and equals. Self-esteem issues linger as a slave trade hangover and emotional trust remains at a premium, just as the program always intended. Subsequently, the sense of grounding and empowerment that a lineage of stable relationships between parents, grandparents, and ancestors provides the psyche of a child stands on shaky ground. With the weight of such historical scars on their shoulders, the children, in turn, live out the cycle as new marks for underdevelopment and exploitation.

The downstream impact is that society targets, discriminates against, and punishes people who come from this history. This impact plays out in myriad ways including restricted access to housing, stigmatization, discriminatory education streaming, reduced job opportunities and prospects, fear of the process around acquiring citizenship status and equity, and more. There is barrier-ridden health care that often means no situational or culturally sensitive (and sometimes, instead, even inappropriate) care available, and deliberate negative agenda-driven high incarceration rates have additional harmful impacts on development and stability.

These factors become the normalized circumstances that shape the lives of many in the ACB community. And reflexively, support services all too often treat members of this community as societal outcasts. This is the framework that harm reduction for the ACB community needs to know of, and to inform about, if it is to formulate appropriate responses to this community’s needs. And yes, I know that there are other important questions to be asked and answered, but you have to start with knowledge and sharing of the formative elements. Connecting the dots and letting everyone in on the secret(s) brings this matter out of the shadows, and at least invites permission to service providers across the board to think boldly in terms of solutions. Remember, we’re asking the system, which is reflected in the mainstream, to rethink itself.

The unique plight of the ACB community, especially with regard to harm reduction and safe supply, remains virtually unknown to the general public. Typically, politicians, even if they know, don’t want to deal with it. That is why I feel that, for the long term, the development of a grassroots leadership through people who can share ownership of the movement is the next step to bringing sustainable growth and improvement. Of course, this needs to be done while continuing to petition against the long list of existing and still developing day-to-day inequities and harms. 

At the end of the day, this initiative signals a spiritual, transformative quest for all of society. Safe supply and harm reduction are not really to be conditional privileges. They are actually woven into the human birthright.

Imagine Safe Supply is a community-based research project that explored participation in safe supply in Canada for people who use drugs and frontline workers. For more information on this research please visit here.