Troy Balderson apologized for running late. A water leak had sprung that morning at one of the shelters run by Lookout Housing and Health Society in Vancouver’s Downtown Eastside, which also runs the Powell Street Getaway supervised consumption site. Balderson is the charitable organization’s downtown projects manager. He had a lot on his plate, but the leak wasn’t a problem that fazed him. Not long before it was six people overdosing in a single night in one of their buildings. That put the other trials of his job in perspective.
“We understand that everybody comes from a past, and we’re not here to put barriers between them and our services,” said Balderson. We were sitting in his small office, filled with boxes of supplies, near the shelter’s busy entrance. The Powell Street Getaway also provides meals, medication administration, emergency clothing, social activities, and employment and internship programs as well as substance use and mental health programs. “We meet them where they’re at.”
“What do you think needs to be done to really address this crisis?” I asked.
“If we get enough people to understand that it’s not just a bunch of druggies shooting drugs,” he explained. “That it’s people suffering from many, many stages of trauma, from many, many walks of life.
“They’re invisible. If we take the time to speak with those folks, that’s all it takes. It’s a simple hello. A simple ‘I’m going to take five minutes out of my day. I’m going to spend it with you and you’re going to be heard.’ That in itself is probably a bigger gift than anybody knows. Just taking that time.”
Balderson’s words stayed with me as I stepped back from months of speaking with people on the front lines of the opioid crisis. It was now crystal clear to me: our response to this epidemic must begin with care and compassion for those who, for many reasons, have come to self-medicate the physical, psychological, and emotional pain and trauma in their lives using illicit opioids. That means no longer essentially criminalizing opioid use disorder but instead ensuring that people have safe places to use substances of known contents and potency. It means developing connections with them as a prelude to offering rapid access to evidence-based treatment options if and when they want to stop using.
As we’ve seen, Canada’s century-long experiment with drug prohibition and tough-on-crime drug policies has been a miserable failure. The opioid crisis has exposed the war on drugs as a fundamentally flawed response to the risks associated with illegal drugs. And it’s not just Canada that’s following this wrongheaded and punitive approach to dealing with drug users.
I couldn’t believe how far I’d come over the last 100 days: the things I’d seen and heard about, the people I’d met along the way. My mind had changed and my heart had expanded. A few years ago you couldn’t have paid me to wear a T-shirt that declared “End the War on Drugs”; now I wanted to order a caseload and distribute them myself. My investigation into the opioid crisis that started in my hometown of Vancouver had opened my eyes to a totally different reality. In retrospect, my previous views about illegal drugs were based on ignorance and ideology—a dangerous combination. Critically, they weren’t evidence-based—informed by medical or criminology research, let alone the actual experiences of people who use drugs.
And a remarkable thing happened as I began sharing my findings with people: they started opening up, too. When I talked about decriminalization to a friend of mine, an emergency room physician, it turned out that he was totally supportive of it. An old friend from university revealed that his girlfriend was addicted to heroin and that he was grateful for the research I was doing. My investigation has given me a better understanding of some of the challenges that people who use drugs are facing, although I’ll never fully appreciate what their day-to-day challenges are like.
I’ve come to see that there’s a clear moral wrong in this whole issue: the injustice of unmercifully judging and punishing people who are using drugs in an attempt to get relief from the pain in their lives. As I’ve studied, thought about, and prayed about this issue all along the way, that’s a truth I’ve come to understand not only at an intellectual but also at a spiritual level. It’s been a real transformation. I was dead wrong about drug policy. Our response to substance use must be one of care, compassion, and understanding for those who are using. We’re in no place to judge and condemn them. Rather, we’re called to love them. And establishing that loving connection can help bring hope for a better future—something crucial for addiction recovery that can’t be obtained through a prescription.
I went back to the list of questions I’d written up at the beginning of my investigation. Reading them again, it was clear that many were based on myths and stereotypes that I’d now thoroughly debunked based on my research.
The promise of prohibition was a lie—a quixotic, aspirational policy that’s not only unrealistic but dangerous. I’d have a much harder time purchasing unpasteurized milk in Vancouver than I would purchasing illicit drugs. Why? Because milk sales are regulated and subject to rigorous health and safety standards, whereas illicit drugs have zero oversight. Instead of stopping drugs, as it promised, prohibition has left the drug market as a “free-for-all” to be run completely by organized crime—they make their illicit products without any standards and are almost never held accountable when people die as a result.
Show me the peer-reviewed research that says prohibition works. You couldn’t design a worse approach to substance use disorder if you tried. What an insane system we’ve come to accept “for the good of society.” Prohibition isn’t good for society; it’s been a disaster. The first step in coming up with a new approach is admitting it, and ending our collective denial and apathy.
The threat of criminal sanctions doesn’t deter those with opioid use disorder from seeking out and using illicit drugs, but it compels them to use alone where they’re at greater risk of dying in the event of an overdose. And, for people who might be thinking of experimenting with street drugs, the distant prospect of criminal penalties for possession are nowhere near as discouraging as the ever-present risk of suffering a fatal overdose. The experience of Portugal in decriminalizing drugs is very promising, notably in reducing illicit drug overdose deaths and expanding treatment options. We need to fundamentally shift the starting point of our drug policy so that it’s understood to be not a criminal matter but rather a public health, medical, and social issue.
Prevention should also be part of the response to illicit drug use, but it needs to be done right. Lisa Lapointe, chief coroner with the BC Coroners Service, cites research finding that “interactive, skills-based approaches showed positive results, with targeted approaches being especially effective.”
What hasn’t been found helpful is fear-mongering. “Evidence suggests that the reasons for drug use are complex and multifaceted, and programs focused on scaring people from using drugs are not effective in saving lives,” Lapointe writes. “Additionally, they tend to increase the stigma surrounding drug use and actually discourage people from seeking help—an obsolete approach that has led to the loss of countless lives.”
This applies to young people as well. Lapointe cites the massive “Just Say No” and D.A.R.E. campaigns undertaken by the U.S. government to discourage youth from using illicit drugs—initiatives with a US$1 billion total price tag that were later found to have had “no positive effects on youth behaviour and may have, in fact, prompted some to actually experiment with using substances.”
We live in a lovely family neighbourhood in East Vancouver, a few blocks from a busy street. There are lots of great restaurants and small grocery stores, but you’ll also occasionally see used syringes in the tall grass beside the sidewalk near the thoroughfare. So we had to educate our children about staying out of the grass there and about what syringes were—to not touch them since it’s not safe, and to let an adult know if they come across any. It was also an opportunity to talk about drug use. One thing I’d already learned about kids is that telling them not to do something is the fastest way to make them do that thing. Same as with us adults, probably.
“Some people use drugs because they’re sad and want to feel better, then they can’t stop,” I said to my young kids. “But the drugs can hurt them and make things even worse.” Then I let them ask questions and answered them as best as I could.
“Kids need to get age-appropriate information on drugs and addiction. Especially the middle school and high schoolers—they must have current, continually updated information on drug safety,” said Leslie McBain. “If we want to look a little more long-term than next month or next year, kids have to start to understand themselves, their own anxieties, their own fears. Things that would make them want to try a drug to feel better. And also the dangers of just experimenting.”
Research has found that having higher self-esteem, supportive relationships with adults, and positive role models helps youth engage in less substance use. And as McBain says, giving them the facts about substance use in a sensitive, nonjudgmental manner is key. This includes the fact that fentanyl can be fatal if consumed, and how difficult it is to know whether it’s present in illegal drugs.
Here are some other tips from the experts about how to talk to youth about substance use:
• Educate yourself so you can answer questions. If you don’t know the answers, offer to look for them together.
• Become informed. Learn about the substances commonly used by young people. Find out how the substances work, what their street names are, and the signs of being under the influence.
• Be a good listener. Give your kids room to participate and ask questions. Respect their opinion.
• Stick to the facts. Avoid preaching, scare tactics and exaggeration. Research shows these tactics do not work, and may actually lead to a loss of trust.
• Look for natural opportunities to discuss substance use and decision-making, including stories in the news and social media.
• Be open and respectful. Ask questions about what they’re hearing, seeing, or have learned. Then, listen. Talk about why people use substances and the potential consequences.
• Focus on your heartfelt concerns for their safety and a deep regard for their wellness (in contrast to right/wrong, good/bad, obey/punish). Emphasize your deep caring and commitment to understand in contrast to setting them straight.
In the face of the scale and complexity of the opioid crisis, it’s easy to think that we have little power to effect change. But when we see suffering and injustice, one of the most important things we can do is respond to it directly. Here are 10 concrete actions you can take today to help address the opioid crisis.
1. Tell someone.
Among the biggest impediments to a more compassionate, evidence-based drug policy is a lack of knowledge and the prevalence of stereotypes. Truth will always be a powerful force for those who are able to hear it and are willing to speak it. Share this book and what you’ve learned with a family member, friend, or colleague. Many of them probably have the same questions I did when I started on this journey. Some of them have probably been affected by the opioid crisis or know someone who has been.
2. Show your support for a compassionate, evidence-based drug policy.
One way to demonstrate this support is by sharing my Vancouver Declaration on Responding to the Opioid Crisis, which summarizes the main policy and legal recommendations in this book. It appears in the Appendix that follows, and can be found at www.overdosebook.ca.
Some of these recommendations can have an immediate impact, whether in directly saving lives or in reducing the risks faced by people who use drugs. Others will take time to bear fruit. But the evidence is clear: they will benefit not only those who use drugs but also their family members, friends, and society as a whole. It’s taken over a century to get into this mess, and it will likely take a generation or more to make substantial progress in getting out of it. We have to start now.
3. Learn how to save a life.
Take the free online training course on how to provide emergency first aid in the event of a drug overdose at www.naloxonetraining.com. It takes only 10 to 15 minutes to learn how to save a life. As we’ve seen throughout this book, you never know when you may encounter someone who’s experiencing a drug overdose. Ask that this training be included in the health and safety training where you work, go to school, or volunteer. You never know when you might need it.
4. Get a take-home naloxone kit.
Once you’ve taken the online training course, get one of these kits—which, depending on where you live, may be available at your local pharmacy. Keep it secure, close by in your purse, backpack, or computer bag. You might feel nervous about getting one. Think about why that is. It’s the stigma of someone thinking you’re a drug user. Remember: you’re asking for something that could save the life of someone you know and love. Be a hero, just like Little Doug Nickerson.
5. Love and support friends and family members who use drugs.
Show friends and family members who use drugs your love and help them get into treatment when they’re willing and able. Connect with support groups in your community or a national group like Leslie McBain’s Moms Stop the Harm (www.momsstoptheharm.com) so that they can support you. It’s not going to be easy, but getting support from others who’ve walked this difficult path can make a big difference. Make sure friends or family members who use drugs know about tips for “safer use,” as suggested by medical experts. These include the following:
• It is important that help (9-1-1) is called immediately in the event of an overdose;
• Do not use alone (use drugs in an overdose prevention site or supervised consumption site where possible; have someone nearby who can call for help);
• Get trained in overdose response and have naloxone available;
• Start low (test a small amount of the drug) and go slow;
• Know your tolerance: if recently using less drugs or feeling unwell, use less of the drug; and
• Don’t mix drugs, or drugs with alcohol.
6. Raise awareness.
Host an awareness-raising event with your friends, work associates, church, synagogue, mosque, temple, or service club to tell them about the opioid crisis and commit together to doing something to address the problem. Reach out to people who have experience with substance use, and include them. We need to go from individual awareness and action to community-based awareness and action.
7. Help get our political leaders on board.
As we saw in the last chapter, one of the main reasons for inaction on the opioid crisis is a lack of political will. Politicians work for you and me. You’re their boss, and they typically want to keep their jobs. Make sure they know you care about this issue and won’t accept drug policies based on ignorance, fear, ideology, and stereotypes. Write, call, email, and social media message the political leaders in your community at the municipal, provincial, and federal levels to ask them to publicly support the recommendations in the Vancouver Declaration on Responding to the Opioid Crisis. It’s also sometimes helpful to focus on one concrete change you especially want to see happen.
8. Speak up.
Raise this issue in letters to the editor, on social media, at political debates, in the classroom or workplace, and at town hall meetings. There’s a real risk that people will simply forget about it, moving on to the next perceived crisis of the moment or cute cat meme.
9. Donate your time or money.
Donate your time or money to local groups in your community that are working to help people with substance use disorders, or groups working to help address related issues such as homelessness, mental health issues, or childhood trauma. Non-profit organizations need your help, since many of these services have been chronically underfunded for decades. That’s one of the reasons why the opioid crisis has hit so hard. Wherever we have the means to help out, no matter how little, we should.
10. Make a career out of it.
Consider making a career out of helping the millions of people in North America who are struggling with substance use disorders. There are a growing number of post-secondary education and job opportunities in the field. Or, just as I’m trying to do here, think of how you can do something to help in your existing job, volunteer positions, or circles of influence. There are people you can reach that no one else can. Achieving lasting change requires people with all kinds of unique talents and gifts. Don’t underestimate your ability to be part of the solution. Be creative.
How does the opioid crisis end? Unless we do something radically different to stem the tide, the realistic worst-case scenario is that overdose death rates decline because there are fewer and fewer people who use drugs left alive, month after month, year after year. In that catastrophic scenario, illicit opioid use will eventually abate by raw attrition. Crisis averted. And we’ll all go back to our regularly scheduled programming—except for the tens of thousands of friends, family, and loved ones left behind. That’s what I fear will happen if apathy and numb acceptance of massive overdose death rates become the new normal—and if prejudice, ignorance, and crass political considerations prevail over research, evidence, and a heart of compassion for people affected by this unnatural disaster.
Dr. Ronald Joe, medical director for substance use services at Vancouver Coastal Health, remarked to me that, with so many deaths among opioid users, one had to wonder whether it might stop only after everyone had died. “That’s not a very good endgame,” he said. “No one wishes that. We definitely do not wish that, but I could say that the thought is in our minds.” Of course, the threat of a poisoned drug supply remains a deadly hazard for new, occasional, or casual users, too.
In the midst of the despair, destruction, and death that has characterized the opioid crisis, is there any hope? This was the final unanswered question I had—and the one that almost everyone who read the manuscript had. Beyond the public health interventions, latest pharmaceutical treatments, social programs, and legal reforms, could this crisis abate? And even if we’re able to keep more people alive, is there any hope that people can be ultimately freed from addiction’s chains?
“Addiction doesn’t occur in needles and spoons and lighters and bottles and whatnot. Addiction occurs in the brain,” said Marshall Smith, senior advisor for recovery initiatives at the British Columbia Centre on Substance Use. “No matter what the substance is that people are using out there, this is a people problem. This is a crisis of community. It’s a crisis of connection and it’s a crisis that’s occurring in people, in families, in workplaces. We like to simplify that and say that it’s an opiate problem and point the finger at the drug as if it’s the bad thing, and that’s just not the case.”
Having hope for a better future is vital in overcoming despair. Indeed, without hope, people perish. Alone and without hope, people are continuing to die in large numbers during this epidemic. But there’s no prescription for hope. It doesn’t come in a pill. You can’t manufacture it.
“You know what gets you through? Number one is the community. It’s just having support. The second is faith,” said Bill Mollard, president of Union Gospel Mission. “When you talk to most of the people out on the streets, they all have faith. And how else could you live on the street? So there is a faith component out there. People are saying ‘I need something to believe in that’s on my side and willing to help me.’ And then they’ll begin to look at it.”
Finding hope through faith resonated with me. But I wanted to know whether there was any research that would support what Mollard was saying about his personal experience working in Vancouver’s Downtown Eastside.
Dr. Alexandre Laudet, director of the Center for the Study of Addictions and Recovery in New York, has investigated the role of faith in the struggle against addiction. “Human beings have long looked to faith for strength and support, particularly in difficult times,” she writes. “Scientific research and clinical practice were slow to acknowledge and to investigate the role of this dimension of the human experience, in large part because it is not easily defined or captured using traditional quantitative measures.”
Dr. Laudet notes that in recent decades there have been over 200 studies demonstrating the positive role played by faith in mental adjustment and better health. It’s been found to support greater emotional well-being and improved coping by giving people hope and strength to deal with stressful events. And there’s an increasing interest in the role that faith can play in addressing addiction.
“A growing body of empirical research supports the notion that religiousness and spirituality may enhance the likelihood of attaining and maintaining recovery from addictions, and recovering persons often report that religion and/or spirituality are critical factors in the recovery process,” Dr. Laudet writes. “The hope for a better life that sets many substance users on the path to recovery can be a reality.”
Recovery can be a life-changing transformation for people emerging from years or even decades of addiction. Since addiction has provided temporary relief from the pain and suffering in their life, being in recovery means finding new and healthy ways to deal with those feelings. Addiction has robbed them of genuine connections to the people around them, and may have disrupted their spiritual connection as well. Indeed, as Dr. Laudet puts it, some “substance users often come into recovery feeling abandoned by God or alienated from God or from the religious community.” And yet a new life is possible.
“Being in recovery has changed the way I see God. I came into recovery with a God, but it was a punishing, vengeful and unforgiving God. I had done so many things…I knew were ungodly, that I thought for sure I was going to Hell,” said Craig, a 44-year old in recovery. “When I came into recovery I found a new God. I found a God that was loving, forgiving, understanding and responsive to the need that I have. In retrospect, I can see that God has been with me all the time.”
A study of 14 countries (including Canada) by the World Health Organization found that people with drug addiction had the highest level of social disapproval or stigma of any class of individual—worse even than those with leprosy. That gave me real pause as I remembered back to why I started looking into the opioid crisis in the first place—a prayer to God for a heart of compassion for people affected by it. The same Jesus who I follow laid his hands on people with leprosy when no one else would even come near them. Are more professing Christians willing to similarly love and care for people who use drugs, rather than judge and condemn them? A diverse coalition, including people who use drugs, families and friends affected by the opioid crisis, health and medical practitioners, Indigenous communities, human rights advocates, liberals, progressives, fiscal conservatives, libertarians, and people of faith, need to be part of a major societal shift in how we think about and deal with substance use.
Each of us is on our own unique journey in life, but we’re not alone. It’s being increasingly acknowledged that the opposite of addiction is connection. When important relationships in our life are disrupted or never fully developed, it causes pain and suffering and makes it more difficult to cope with all the stress, challenges, and trauma of this world. Substances and unhealthy behaviours may appear to soothe that pain temporarily, but are ultimately self-destructive. That path leads to isolation, shame, and despair. Our society often makes it worse by heaping judgment and blame on top of that brokenness. The other path is totally different. It is one of connection, love, and hope. The first path leads to death, the other to life.
Many of the courageous people who are leading the effort to address the opioid crisis and whom I got to know through this book are themselves in recovery from substance use disorders. Today they’re leading recovery centres, running safe consumption sites, and acting as powerful advocates for change. They’re living full, satisfying lives. And each of them in their own way has found hope and is living free from the chains of addiction. What’s most remarkable is that they’re now supporting others in their journey of recovery. They’re sharing the love that was poured into their lives in order to help others who can hardly dare to imagine one day being free.