The Preventable Epidemic: Criminality of Drugs Directly Contributes to Overdoses
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The Preventable Epidemic: Criminality of Drugs Directly Contributes to Overdoses

Concerns that safe injection sites not accessible for users outside the downtown, many of whom are racialized.

In depth: Part three in a three-part series examining the opioid crisis in the city.

Amy Wright holds photo of her brother. Photo by Nikhil Sharma


Amy Wright’s brother was homeless for three weeks in rural Nova Scotia and died by suicide in September 2011. Drugs and alcohol were a factor, said Wright. It was not from an overdose, but the lack of resources in the area, such as harm reduction, that contributed to his death.

Weighing about 90 pounds with barely any teeth, Wright left Vancouver on a Greyhound bus and moved back to Toronto in 2011 to help herself get clean. She had four front teeth that were badly broken and cracked. Recalling the memories of a passport picture she had taken two days taking the Greyhound, Wright said she had aged about 10 years and was extremely pale looking. 

“What strikes me the most from those visuals, is that I had no life or light in my eyes,” Wright said. “They were so dark.”

She said her brother opened her eyes to where her life was going and gave her an out. He helped her find her true self and passion in life. 

“I’ve lost a number of people to substance use,” said Wright, who is now a community support worker in the 24-hour harm reduction drop-in at Sistering.

Despite having a safe place to inject drugs, users will remain in a difficult position whereby they must still buy drugs on the street, and Wright says that’s problematic. She doesn’t see a time when users will be able to purchase drugs at the safe injection sites, she says.

“This isn’t about making money, it’s about saving lives,” she said. 

Coming Together

Tuesday, February 21, marked the National Day of Action on the Overdose Crisis, and about 150 people marched through downtown Toronto to demand all levels of government take immediate actions to prevent overdose deaths.

Wright attended the march. She wondered why Toronto hadn’t had a rally like that before.

Activists and supporters march at the National Day of Action on the Overdose Crisis. Photo courtesy of John Bonnar.

“I came back from a place that was so supportive, to watch my friends forced to sleep in alleys and die from overdose,” she said.
Wright said losing Raffi Balian, a longtime advocate for harm reduction, has left her heartbroken and feeling an overwhelming survivor’s guilt. Balian died from “accidental overdose,” according to a release from the South Riverdale Community Health Centre.
“The rally meant the world to me, as I held my brother and friends in my heart,” she said.
“Coming into the rally, it was sad and emotional. Seeing my community after suffering a tragic loss. One that hits home in a way I thought I would never experience again. There was something very powerful about marching and chanting, creating awareness and making a statement. For me, that day gave me hope. Hope for a world that cares about everyone, regardless of how they chose to cope.”

Photo courtesy of John Bonnar

Wright said there is a certain stereotype, a certain look that is associated with being homeless and with being a “junkie.” She said she didn’t fit the profile and that put her in a dangerous position at times.

“Some dealers, even with seeing my tracks, would not sell to me,” Wright explained. “When I first came back to Toronto in 2011, while off heroin, I still struggled with injecting pill forms of opiates. I had found myself in a bare apartment, trying to convince two women that I wasn’t a cop. I didn’t know if they were gonna sell to me or kill me. Thankfully, I was able to convince them through listing names of dealers and street peeps I knew.”

Another Loss 

Leigh Chapman is a registered a nurse in Toronto, whose brother, Brad, was an opioid user and died of an overdose 18 months ago. Brad died alone in a alleyway on Walton Street about 400 metres away from Toronto Public Health’s The Works. 

Brad was a regular client there several times a day, and Chapman said he would have benefitted from having a harm reduction shelter. Brad overdosed using a needle exchange kit from Toronto Public Health.

Brad was taken from the emergency department to the intensive care unit where he stayed for eight days. 

But he suffered from irreversible brain death due to lack of oxygen, something he couldn’t recover from.

Photo Courtesy: Cori Chapman (Brad's mother)

Photo provided by Cori Chapman, Brad’s mother.

About 20 years earlier, Brad had been prescribed OxyContin to help battle pain from a brain tumour. 

It took a two years for doctors to diagnose him with a brain tumour, but by that time, Brad was already addicted to opioids. In response, doctors stopped prescribing him OxyContin, and he sought other opioids, such as heroin or street OxyContin.

“Because there is no harm reduction shelters in Toronto, which mean that if you’re homeless, like he was, and you don’t have a place to stay and you’re high, you don’t have a place to go. Which mean that you sleep on the street,” Chapman said.

Brad had tried methadone after being diagnosed and undergoing brain surgery, but he still suffered from acute pain. However, it helped him fight his opioid addiction. But there was no counselling or emotional support for him to explore why he was using it in the first place.

Chapman considers drug overdoses to be a epidemic, adding that 18 months ago fentanyl wasn’t on the radar in Ontario. And because of that there was no investigation into fentanyl being a factor in Brad’s overdose.

Brad was able to access some harm reduction services, but not harm reduction shelters or supervised injection sites, Chapman said.

Chapman said Brad would still be alive if he had access to a supervised injection site, as well as treatment and resources to be able to minimize his drug use.

A 28-year-old Indigenous, homeless man suffered a fatal overdose on heroin that may have been laced with fentanyl earlier this year. At about 7 p.m. on February 15, the man went to St. Felix Centre, which is one of the two warming centres that operates 24 hours a day.

The shelter was 10 people over its limit when the man arrived. The man was offered a referral to another location, but declined.

After being turned away from the downtown drop-in shelter,the man was found dead inside a KFC washroom in the Queen Street West and Bathurst area. Police suspected the drugs were laced with fentanyl.

Ward 27 councillor Kristyn Wong-Tam said the man’s death was avoidable for many reasons.

“If we were able to provide some additional support to him early on, maybe it would have led to different choices,” she says. “If we were able to supervise his injection and be on site with naloxone, if he needed it, we would have been able to resuscitate him. If he was on the street for a very long time and not being able to pull himself out of the trench, than we need to find out what we could have done differently.”

Accessibility Outside the Downtown 

Wong-Tam said she’s been hearing from drug users who don’t live or work in the downtown core and whose first language isn’t English. They tell her that they will never come downtown to use any of the facilities the City is proposing because the downtown is not accessible to them.

“Where they need support, which is culturally and linguistically appropriate for communities, are Scarborough, North York, and Etobicoke,” Wong-Tam said. “I’ve heard this loud and clear from advocates who’ve worked in those communities who say, “Councillor, it’s great that you’re getting supervised injection sites centres in the downtown core, but that’s not going to help the South Asian community that is living in Malvern, and that’s certainly not going to help the community that’s living in Rexdale.”

Haran Vijayanathan, executive director at Alliance for South Asian AIDS Prevention (ASAAP), said that while having supervised injection sites are needed in Toronto, having all of the sites only available in the downtown core may make it difficult for people who are living in areas such as Scarborough, who can’t afford to access transit systems to come down downtown to inject safely and then go back home.

“There is a fear for them to access the service because drugs are illegal,” Vijayanathan said. “There’s a lot of thinking behind what would it do to their family, what will that do to their immigration status…if they’re not a Canadian citizen or permanent resident. They feel unsafe going into clinics and hospitals to access services because they feel that they’re going to be turned away or judged for their use. There’s a huge mistrust between racialized communities and systems.”

According to the City, 49 per cent of those living in Toronto were immigrants, and the top three visible minority groups in Toronto were South Asian (12 per cent of total 2011 Toronto population), Chinese (11.4 per cent), Black (8.4 per cent), Filipino (4.1 per cent), and Latin American (2.6 per cent).

In 2006, 47 per cent of the population had a mother tongue in a language other than English or French.

According to the City, the top five mother tongue languages in 2006 were Chinese (420,000), Italian (195,000), Punjabi (138,000), Tagalog/Filipino (114,000), and Portuguese (113,000).

Among neighbourhoods with high rates of low-income families, four were in East York, one was in Etobicoke, 11 were in North York, 10 were in Scarborough, five were in he former city of Toronto, and three were in York, according to the Profile of Low Income in the City of Toronto.

Vijayanathan says they’ll have clients who are HIV-positive and have turned to substances such as drugs and alcohol to cope with the illness and cope with the stigma and discrimination they face surrounding their HIV status. Some don’t realize that they have an addiction problem as well, and don’t know where to go get support.

He said injection sites are a big step forward because they work from a harm reduction philosophy. But if sites are not going to placed throughout priority population neighbourhoods in the city, then people are not going to get the maximum access in the populations that need it.

Not everyone who uses substances speaks, reads, or writes English, he said. Vijayanathan wants the information available at the sites be translated into different languages such as Hindi, Tamil, and Urdu. Also, staff should represent the communities they serve.

“Someone who is coming Scarborough can’t justify to their family why they’re coming downtown,” Vijayanathan said.

ASAAP has applied for a needs assessment grant from the City to look at harm reduction within the South Asian community, including what substances people are using, barriers people are facing, success stories, and what harm reduction programming and support people from the community would like to see in place.

Robert Quenville, a friend of Wright whom she met while at Insite, moved to Toronto the same year she came back to the city to get away from heroin.

Wright said Quenville was coping well with the recovery process, and was using OxyContin once in a while for harm reduction. But once OxyContin stopped being manufactured in Canada in 2012 and was replaced by a new type of drug called OxyNeo, Quenville went back to heroin and slept behind a dumpster in an alleyway near St. Michael’s Hospital because he was constantly thrown out of shelters.

OxyNeo was supposed to reduce abuse of the drug, as the whole pill can be swallowed, but not crushed or injected to get high.

Quenville ended up dying of an overdose in August 2015.

“Having these barriers, contributes to the systemic oppression of street people who use drugs,” Wright said. “Women are constantly at risk being on the streets at night or they are forced into abusive relationships or toxic crowds, in order to have a place to sleep.”

Chapman attended community consultations for all three proposed sites. She said many residents don’t think of drug users as their neighbours, and they worry about the possibility of discarded needles. 

“A lot of it is based in fear and ignorance,” she said. “I think the continued consultation that the city is engaging in and limited resources from the province are actually an awful display of stigma that is entrenched in municipal drug policy. It is shameful.”

New Harm Reduction Strategies

Ottawa Public Health is attempting to overcome drug overdoses with the launch of a pilot project featuring vending machines that will dispense clean needles and pipes.

Screen Shot 2017-04-02 at 12.34.36 PM

Screenshot via Nadim Roberts‘s video on Crackpipe Vending Machines.

“Vending machines have a catchy ring to them because it’s vending machines and it sounds neat. Our model has to be how do we make sure that people who need access to clean needles and clean cracked kits, and others can access them,” said Toronto councillor Joe Cressy (Ward 20, Trinity-Spadina), who chairs the city’s drug strategy implementation panel and has been the leading voice on council for supervised injection sites.

Wright said she likes Ottawa’s vending machine idea because of the accessibility and unanimity that comes from it. But she says that harm reduction works because of genuine human connection and acceptance. 

“People come back because of relationships they develop with staff,” she said. “Some of them have nothing like it in their lives. Having that acceptance and support for where I was truly at, meant I didn’t have to lie anymore. I was finally able to address why I used substances to cope. I was also able to learn new ways of coping while still having my drug in my back pocket, just in case the new methods didn’t work. Eventually I got to where I don’t need it anymore.”