By Oona Krieg

My best friend died of an opioid overdose.

She was a vibrant and passionate person. Dichotomous, she was alive to the world and she suffered greatly. She had an intolerance to pain that made numbing by opioid appealing; heroin if she could get it.

One day, she took too much.

She died alone in her locked apartment.

I was on the other side of the locked door and couldn’t convince the emergency responders to act fast enough. She was a person in a complex situation, not a junkie, not a criminal. Law enforcement did little to help her in that moment she clung to the edge of breath. If we had knocked the “shame” of addiction off the table, if she wasn’t isolated, instead, if she had a person with her and naloxone she might be here today—maybe.

If we could see people in her position as people and not labels, what a different way we could be approaching this North American epidemic.

What we have now
The Downtown Eastside was once called Kem Kem a-Ley, the Place of the Maples. Since time immemorial the Musqueam, Squamish, and Tsleil-Waututh Nations would come and collect maple for paddle making, essential for sea and river-faring peoples. In colonized memory it was a mill, then Japantown, then Skidrow, and now we have the Downtown Eastside.

Not so much a location as a label.

People who live here are labelled by the general public to be addicted, homeless, impoverished, unworthy.

Traditionally, addiction has been considered a lack of moral fibre, an ethical dysfunction, or a lack of will power.

So-called moral and ethical reactions to addiction have created policies like prohibition, the war on drugs, and enforcement. The enforcement of these policies has backfired, and ended up hurting the people they were meant to safeguard.

Citing the late Vancouver poet-warrior Bud Osborn’s protests in “Raise Shit”—what happens when a war on drugs is waged? It becomes a war on addicts. We lose sight of an individual’s life in the virulent turmoil of trying to sort out a moral codification around addiction and who’s at fault. This code is built on social class, identity, and location. A suburban opioid overdose of a middle-class person is a tragedy. An opioid overdose of an interurban denizen near East Hastings is an arm’s length statistic.

They are both tragedies, one weighted differently to some because of stigma.

Beyond compare
In North America we have an unprecedented crisis. The illicit drug trade has been flooded by fentanyl. Drug users, community groups, community-based activists, medical and health professionals, emergency care providers scramble to limit the impact from the arrival of fentanyl. To say the morgue is at capacity is an understatement.

In Vancouver, agencies like the Vancouver Area Network of Drug Users, Overdose Prevention Society, Canadian Association of People who use Drugs, and the (now-closed) Drug Users Resource Centre have worked for the past 20-plus years to humanize the folks who use substances. Community-based action groups and agencies work against the stream, to address the stigma of addiction. However, if it wasn’t for the community engagement already in place in Vancouver, the fentanyl crisis would have a much greater toll across British Columbia.

Across Canada, 94 per cent of drug strategy dollars are spent on enforcement.

Vancouver raised $3.1 million in a tax hike that angered some landowners. And some of the money—instead of it all going toward evidence-based overdose prevention—is part of a plan to open a Community Police Station in Strathcona. Policing is not an evidence-based practice for lowering the death rate. Of overdose deaths, more than 1,200 people in B.C. died since January of 2016. Take that in a moment. Twelve-hundred souls. In 2016, we have seen a

227 per cent jump in overdose deaths from the year before. Since January 1, 2016, a person died every 8.8 hours. The death rate is increasing and in March of 2017 There were 120 suspected drug overdose deaths.

This is a 51.9 per cent increase over the number of deaths occurring in Mar 2016.

On the other hand, the introduction of naloxone, naloxone training, and education has made a huge difference for Downtown Eastside community members and their allies. The death toll would definitively be higher if the community hadn’t taken action. The Drug Users Network has volunteers patrolling the alleys day and night, Portland Hotel Society made bike teams for alley response.

The prevention society has volunteers providing ongoing outreach. There are pop-up responses that have been running seven days a week, 24 hours a day.

Wanting to understand more about naloxone, I sat down and talked with nurse Sarah P. who works primarily in the Downtown Eastside. She is someone who has reversed hundreds of overdoses, can prescribe naloxone, and trains community members to administer naloxone.

Life saving
As a frontline expert, Sarah explained to me that the most exciting changes that have happened in drug policy in Vancouver over the past seven years is the availability of naloxone prescriptions.

“Now even pharmacists can give it, which I think is beautiful because everyone should have access to it,” she says.

Sarah sees a community that has access to and training in naloxone as a community that can begin to deal with this public health emergency.

Since April 14, 2016, B.C. has officially been in a public health emergency. “The community can respond when trained,” says Sarah. She describes being called to respond to an overdose in the community and as she was heading toward it, people were breathing for the fallen and had called 911 by the time she had gotten there. “The difference between stage one and two of an overdose,” says Sarah, “is oxygen.” Hypoxia, or oxygen deficiency, causes brain injury and eventually death.

People knowing how to provide oxygen for someone who overdosed can be life-saving.

The introduction of fentanyl into the Downtown Eastside community has caused a shift in the way that people are needing naloxone. For starters, it is not only opiate injection users who are overdosing.

Sarah says that according to the drug testing at Insite, fentanyl is showing up in 90 per cent of the substances tested.

Fentanyl is in crack cocaine and crystal methamphetamine, and party drugs as well. People are overdosing from snorting and smoking it. Consequently, more people in more contexts need access and training for naloxone.

It takes a community
Over the past 20 years in Vancouver, grassroots and community-based action has been the only effective answer to extending life in the Downtown Eastside, and raising the quality of the lives saved. The research and work that people have done in this area has led to influencing life-saving protocols across Vancouver, B.C. and beyond. Access to services and a spectrum of care are key. Community education, multidirectional approaches and long term treatment plans can help unsettle the moral codification which barriers of people’s minds and consequently their policies.

The code words are addiction, addict, and recovery. Health Care, addiction, and mental health professionals, and the general public need a deeper understanding of the complexity of these words.

The experts in the situation, the drug users themselves, have clearly stated that to turn this terminal situation around, people need access to pharmaceutical grade opiates, treatment plans based on personal goals, and naloxone training for all community members.

According to the coroners report, 89 per cent of illicit drug overdose deaths occurred inside (54.8 per cent private residences, 34.3 per cent other inside locations) and 10.4 per cent occurred outside in vehicles, sidewalks, streets, parks, etc. There have been no deaths at supervised consumption or drug overdose prevention sites.

Editor’s note: One section of this article overlaps with an editorial Oona Krieg recently published in Discorder Magazine.