Eror attributes more significance to health concerns. One day, John Turvey brought her evidence of a case of AIDS traced directly to Back Alley. “I knew that was the end,” she says. “After that, there was no way they were getting grants.”
Kay describes Back Alley’s demise as the walls simply closing in. “We were shut down because the police had had enough of the facility, the ambulance people were coming there every other day, and I was at a point where I didn’t even want to go in there without body armor on,” Kay says. “It was getting really intense with the traffickers.”
Although he had grown bitter, Kay fondly recalls the opportunities he had to get to know the addicts who found a safe space there. “I would try to get their biographies, quick, from every addict I met,” he says. “I would ask what their class background was and what kind of families they had come from, how old they were and what the circumstances were surrounding the first time they put a needle in their arm. They were always working-class, lower-working-class people, with a few exceptions. And eighty percent of them had become injection drug addicts while they were still teenagers. There was some significant adult in their life—a sister’s boyfriend or somebody—who got them going. And that was it. Their entire lives. From the first poking of that needle in their arm. Boom. Destiny. They turned a corner and that was the end of them.”
Livingston remembers Back Alley with a smile on her face. She recounts her two youngest boys, both under the age of ten at the time, hanging out there with her when it was her turn to take a shift on the front desk. The space was large enough for them to ride their bicycles inside, and they would keep themselves entertained for hours that way. “It never felt the least bit dangerous,” Livingston insists. “We really did have a team,” she says. “At least we had each other. This bizarre marginalized shit-show that we were involved in.”
Kay similarly speaks warmly of IV Feed today. “It was a sloppy affair, but that it happened at all is interesting,” he says. But in the days and months immediately following the facility’s closure, Kay recalls being very unsure of what they had done. “When Armageddon came down, one of the officials from the downtown agencies confronted me and said, ‘You have set back harm reduction in this city ten years.’ There certainly were people who felt I had damaged the cause.”
Eror remembers the day Back Alley closed, on October 15, 1996. “It was a really good place, but there were a lot of flaws,” she says. “And we learned a lot. It’s too bad those lessons often didn’t end up going into effect.”
Asked how users took the blow, Hudlin shrugs. “They went back to wherever they were before,” he says. “People hanging out in alleys. It was the same as before.”
An essay published in April 1996 in the Carnegie Newsletter, a monthly publication named after the building where Livingston and Eror met, best summarizes the lasting impact of 356 Powell: “The idea that users can organize themselves is starting to grow, and even if IV Feed and the Back Alley were to shut down tomorrow, the idea that we must take control of our own lives, and that we have the numbers and the knowledge to do so, is here to stay.”
22Miro Cernetig, “Death Likes Canada’s Overdose Capital,” Globe and Mail, May 4, 1996.
23Frances Bula, “Addicts’ Centre Shut in Furore over Funds,” Vancouver Sun, October 18, 1996.
Chapter 8
Miami, Florida
In 2009, Dr Hansel Tookes decided he was going to establish a needle exchange in Florida. At the time, he wasn’t a doctor or even a medical student. He was studying public health at the University of Miami. America’s annual National Harm Reduction Conference was in Miami that year. Tookes attended and was impressed by a presentation made by a group of researchers from California.
“They had walked the streets of San Francisco, quantifying the number of syringes on the street,” he recalls. “And then they had interviewed a bunch of people who inject about their syringe-disposal patterns.” The San Francisco team used that research to make a very compelling case for the city to open a place where intravenous drug users could go to obtain clean needles and dispose of dirty ones. Tookes thought he could do the same in Florida.
Needles were cheap and available. They were mass-produced for pennies and sold without a prescription at pharmacies everywhere, even in small rural towns. Needle-exchange centres had operated in Europe and Canada for decades. More recently, many states across the US established similar programs, albeit often with restrictions. So why not in Florida?
Tookes spent the next seven years working toward his goal before Miami finally opened the state’s first needle exchange, in December 2016. “It was a journey,” Tookes says. One, he emphasizes, that continues today.
Beginning in 2010, Tookes and his UM classmates conducted hundreds of interviews with street-entrenched drug users concentrated in Miami’s Overtown neighbourhood. Recording data based on those conversations, they found that ninety-five percent of intravenous drug users admitted to discarding used needles on the street. After San Francisco opened its needle exchange, the California researchers found that that number was reduced to just thirteen percent. Tookes had identified a problem and an opportunity to fix it.
The team also knew that the issue was bigger than street cleanliness and that it affected people who had nothing to do with drugs. For a peer-reviewed paper that Tookes co-authored years later, he calculated that drug use-related infections cost Jackson Memorial Hospital in Miami more than $11 million (USD) every year.
Exactly what Tookes had to do was clear to him: give people clean needles. But there was a barrier. “Chapter 893 of the Florida Statutes made it illegal for anyone—a pharmacist, a doctor, a person on the street—to give a syringe to somebody if they knew that they were going to use it to inject drugs,” he explains.
In Florida, a pharmacist can sell a syringe if they are told that a diabetic will use the needle for an insulin injection. But if a person with a substance-use disorder lets a pharmacist know they will use a needle to inject drugs, the transaction becomes a third-degree felony, or first degree if the purchaser is a minor. “Which is absurd, from a doctor’s perspective,” Tookes says. “So we had to change state law to amend Chapter 893 to allow us to have syringe access here in Miami.”
By this time, Tookes was enrolled in medical school. A small group of his fellow students had taken a similar interest in the issue and together they came up with a plan. “A bunch of med students came to me and said, ‘We should use the Florida Medical Association resolution-writing process … to get legislation sponsored to authorize syringe exchange in Florida,’” he recounts. “We got together, wrote a resolution, passed a resolution, got a bill, and after four years, got a law.”
Almost. After four years of the idea slowly winding its way through the state’s glacial legislative process, an eleventh-hour amendment severely limited the scope of everything Tookes wanted to do.
The law was changed to allow Tookes to open his needle exchange, but only his, and only for a trial period of five years. Miami Dade received legislative permission to distribute syringes for the use of intravenous drugs, but needle exchange remained illegal everywhere else in Florida. The legislation also said that not a penny of taxpayers’ money could go to clean needles for drug users, so Tookes had to raise funds privately. He took what he could get and forged ahead.
There was new urgency. By this time, it was 2015 and an HIV epidemic was exploding across the state and especially in Miami. According to the US Center for Disease Control and Prevention, there were 2,332 new cases of HIV diagnosed in the Miami–Fort Lauderdale–West Palm Beach region in 2015, or a rate of 38.8 new cases per 100,000 people. It ranked Miami number one for new HIV infections among metropolitan areas in the United States. (For all of Florida, the rate was twenty-four new infections per 100,000 people in 2015, placing the state third, after the District of Columbia and Louisiana.)
The nation’s opioid crisis struck at the same time. In 2013, there were 2,474 drug-overdose
deaths in Florida. The next year, there were 2,634, then 3,228, and then an estimated 4,000 in 2016.24 On May 3, 2017, Governor Rick Scott declared the opioid epidemic a public-health emergency. “The individuals struggling with drug use are sons, daughters, mothers, fathers, sisters, brothers, and friends, and each tragic case leaves loved ones searching for answers and praying for help,” he said.
Tookes knew he couldn’t open anything like a supervised-injection facility in Florida. But he envisioned his needle-exchange program as a centre for every sort of harm-reduction supply he could offer within the limits of Florida state law. “We didn’t have to go through the steps that everyone else had to when this was implemented across the world twenty years ago,” Tookes says. “We could go straight into best practices, so we were able to start a pretty robust program right from the beginning.”
On World AIDS Day of 2016, December 1, the IDEA Exchange opened at 1636 Northwest 7th Avenue in Overtown, Miami. They named it after the bill that allows it to exist: the Infectious Disease Elimination Act. It’s nothing flashy, just two beige storage containers like the kind one sees moving around the country via train. They were outfitted with air conditioning units, then set down in a parking lot and positioned adjacent to one another in the shape of an L. At the container closest to the street, drug users can bring used needles and trade them for clean, packaged ones. A one-for-one exchange is a strict requirement, Tookes notes. He says he wanted a distribution model with no exchange requirement, but the law says one-for-one. The IDEA Exchange actually collects more needles than it gives out, he adds.
There are other harm-reduction supplies available at container one: condoms, for example, and everything one needs alongside a clean needle to inject drugs, including cookers, cotton balls, tourniquets, and sterile water.
Next door, at container two, there’s a small clinic. Drug users or anyone who walks by can receive help connecting with a substance-use counsellor or a detox or treatment program, if they’re ready for that. They can also do a free test for HIV, hepatitis C, and other infectious diseases, and get the results there, on-site. As of April 2017, IDEA Exchange also distributes naloxone (sold under the brand name Narcan), the so-called overdose antidote that’s used to reverse the effects of opioids.
The day the IDEA Exchange opened, there was a line of drug users down the sidewalk, Tookes recalls. The four-year battle in the Florida legislature that was waged to make the needle exchange happen had generated a lot of media coverage, and many drug users in Miami read every article.
But the program remained controversial in Florida and even in relatively liberal Miami. Other people were less enthusiastic. “The police did not receive the program well,” Tookes says. “They arrested everybody. It was bad. It was very bad.”
Anticipating some confusion to linger around the change in drug laws, the IDEA Exchange distributed needles with a card that explained the program. On one side was an IDEA Exchange member’s name and on the other side was an explanation of how the exchange operates legally. The actual statute is there, plus a statement saying that whoever is in possession of the card is not breaking the law by carrying a needle, even if an officer finds evidence that they plan to use it to inject drugs. But some officers did not respond well to drug users claiming they knew the law better than police.
“The cops would pull the syringes off people and say, ‘This card doesn’t mean shit,’ and they would throw it in the gutter,” Tookes says. “We lost a lot of people coming into our program at first because of that.”
And so the IDEA Exchange launched an education and outreach program, not for drug users or the general public, but for police. Tookes says that, to their credit, most of them came around quickly. He says it was narcotics officers who did the most to facilitate the shift in attitudes. After spending years around drug users, narcotics officers understood addiction and the benefits of harm-reduction programs like needle exchange, Tookes explains. They helped educate their colleagues on the force.
“The cops have ended up being a huge ally,” Tookes says. “It just took them a while.”
24Haden, Peter. “The Number of Daily Opioid Overdoses in South Florida Is Overwhelming Police,” PRI Public Radio International, April 20, 2017.
Chapter 9
The Killing Fields
Ann Livingston and Bud Osborn’s paths crossed several times before the two of them actually met. In photographs taken at the 1994 meeting at the Carnegie Community Centre, where Livingston connected with Melissa Eror, Osborn is sitting directly behind Livingston, just two rows back.
Then, just before Back Alley inevitably closed its doors, William Kay invited Osborn down to check the place out. The users there had covered the walls in poetry and graffiti, and Kay thought Osborn might be able to make something out of it.
“The felt pens kept disappearing,” Livingston remembers. “I have to have white paper and I have to have felt pens because I am a freak about how I do organizing. But the felt pens kept disappearing. Meanwhile, this poetry is all over the walls because everybody is writing all over them. Later, I thought, ‘That’s where all the felt pens went.’”
Livingston was at home with her boys the day Osborn took Kay up on his invitation. But she remembers the result of that visit. Osborn copied down everything that was written on the walls at Back Alley and put it into a book.
Livingston knew the name Bud Osborn from years earlier. She had come across another one of his books of poetry when she was still living in Victoria, but somehow it was not until 1996 that the two finally got to know one another.
The moment when Osborn first noticed Livingston was not one of her better days. For several years, Livingston had held a seat on the board of the Downtown Eastside Residents Association. On this day, she was losing that position. Made to stand at the front of a room of some 400 people, she held her tongue while fellow DERA members levelled every sort of accusation at her—charges that had to do with the illegal injection site Livingston had brought to the community and not a lot else beyond that. Livingston’s fellow DERA board members didn’t approve of her new interest in drug addicts.
Osborn recounted the spectacle in a 2002 interview with Nettie Wild, a filmmaker who later produced a documentary about drug users in the Downtown Eastside called Fix: The Story of an Addicted City. (Osborn was ultimately cut from the film. Wild shared the transcripts of their interviews for inclusion in this book.)
Osborn noticed Livingston at the DERA meeting because, while an entire room attacked her, she didn’t attack back. “I remember she said, ‘I hope whatever comes out of this will strengthen the community and be for the benefit of the community,’” Osborn told Wild. “She was the only one that had the community in her mind … I was very impressed that she did. And so, that was the first time that I really, really saw Ann.”
In 1996, the two bumped into each other at the Carnegie Community Centre and finally actually said hello. “I remember he was checking me out,” Livingston recalls.
By this time her relationship with Kay had fallen apart. “At one point, I said, ‘So, William, you’re going to keep coming over to my house?’” Livingston says. “‘We’re not moving forward with our relationship, so what is this? Like, squatters’ rights?’”
That was the end of it. Then, a few months later, Livingston noticed Osborn at a meeting of the Vancouver-Richmond Health Board, a regional arm of the provincial government whose jurisdiction included the Downtown Eastside.
John Turvey had pulled strings and gotten Osborn a seat on the board. Livingston recalls that she liked his poetry but that wasn’t what really impressed her about him—it was that he had a say in public policy. “He gets appointed to the health board, and I’m like, he might as well have had a fucking Ferrari.”
The two began spending more time together and one thing led to another. Livingston would often hold small community meetings at her apartment that would end late. One evening, Osborn spent the night.
Osborn had also go
tten to know Liz Evans and Mark Townsend, which made him an important intersection between the Portland’s world and Livingston’s.
Evans reached out to Osborn and asked if he would come to the hotel to hold a series of writing workshops for her residents. He loved the idea and quickly agreed. The only problem was that they didn’t have a space to hold these meetings, so the group that came to gather once a month with Osborn settled in a stairwell of the old building’s emergency fire escape. Residents shared their stories with him, mostly of hardship, and Osborn helped them commit those stories to paper. “He did that for years,” Evans recalls fondly.
Osborn remembered the Downtown Eastside in the mid-1990s as a neighbourhood on edge. “There was nothing but sirens, sirens, sirens, all the time. I mean, people were dying,” he told journalist Johann Hari. “And every time there would be a siren, I would wonder, ‘Do I know this person?’”
One morning in July 1997, Osborn was walking down East Hastings Street and bumped into an Indigenous woman named Margaret Prevost. She was in a wheelchair and so Osborn leaned in slightly to say hello. She told him that her cousin had overdosed and that when her husband had found the body, he had hung himself there in the same room. Their young boy was left without a home, Prevost continued, and so the extended family was meeting that afternoon to decide where he would go.
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