“That was one of the stranger projects,” Runne says. Using a large cardboard tube that had previously encased a concrete pillar, the maintenance team gave Small and Townsend the 100-foot needle they wanted. Then, on July 18, more than 100 VANDU members met at Main and Hastings to carry it through the streets.
“Drug addicts and advocates brandishing a giant … hypodermic needle rallied yesterday to protest against the recent closing of a controversial needle-exchange program,” reads one newspaper’s report about the day. “City police moved in to close down the program last month, alleging that VANDU volunteers who were staffing the tables were both using drugs and trafficking in them. Since then, both sides have engaged in a war of words that spilled onto the streets with yesterday’s demonstration.”31
VANDU’s participation in the protest was largely organized by Thia Walter, a prominent activist during those years who passed away in February 2012. Quoted in that report, she alluded to rising tensions among different arms of the government. While the health-care system was slowly acknowledging the benefits of harm reduction, law-enforcement agencies were not yet ready to do the same. “There appears to be a war between the health board and the police, and unfortunately the users are in the line of fire,” Walter told the paper. “Police tactics toward addicts have become extremely brutal,” she said. “They pepper-sprayed two dozen of them the other day because they didn’t move out of an alley quick enough.”
Small explains how several moving pieces would come together to create an action like one as large as the needle protest. “When I would have an idea like that, Mark would build the infrastructure in the background with Phong and the maintenance team,” he says. “And then VANDU would be there … with picket signs and would populate the event.”
It wasn’t just cooperation between two organizations with shared goals but a conscious strategy. “We made a decision at that time to create some avatars,” Small explains. “So we decided to explicitly put VANDU forward—we never discussed it with VANDU, but Mark and I discussed it. We put VANDU forward as the symbolic front of this movement. In part, it was done to protect the residents of the Portland from having services cut, in part to help build up the social capital of the drug-user movement, to validate their personhood. It was a strategic move. So they were shielding us,” Small continues. “That was the other piece of it. Absolutely, they were. This was a strategic move.”
Meanwhile, Townsend’s game of cat and mouse continued to create a nuisance for whatever poor beat cops were assigned to the corner of Main and Hastings on any given night. Then came the letter from the BC Centre for Excellence in HIV/AIDs that practically accused the police department of murder. And then VANDU went marching with a hypodermic needle so large it shut down six lanes of traffic.
“In the end, the police agreed to support a fixed site for needle exchange,” Townsend says. “There was a peace settlement.”
The police would not allow VANDU’s table to return to the corner outside the Carnegie Community Centre—that was a little too public for the establishment’s liking. Instead, PHS would finally break DEYAS’s monopoly on needle exchange and operate a public distribution point of its own. At the Washington Hotel, just across East Hastings from where VANDU had pitched its table, tucked in an alley about fifty feet (eighteen metres) back from the main street, PHS installed a little sliding window.
The health authority said it would deploy a nurse there who would sit at a desk in an office facing into the alley. Drug users could knock on the window and receive clean needles. It was a huge victory, but Small kept pushing for more. He wanted VANDU members—drug users, that is—employed at the window, effectively working as low-level health-care workers.
“I ended up negotiating with the health board, with a contract, that VANDU workers would be paid wages,” Small says. “They were stipends but they looked like wages. Which was huge. It symbolically validated the fact that people with addictions and their experience could be used by the clinical system officially.”
The government’s initial answer was a firm no. “I had been told, ‘Dan, there is no way that this health board is ever going to pay drug users to do clinical services. It’s not happening,’” Small continues. “So when that did happen, it was a key moment in the evolution of the health board and people with addictions.”
Today the Washington Needle Depot is believed to distribute more syringes than any other harm-reduction program in North America.
What began as a fight for public toilets had morphed into a needle exchange. Progress emboldens, and PHS kept going.
“Through the course of time and through peers, it was identified that there was a real need for injection materials at these supervised bathrooms,” McCurdy says. “And then people started injecting in the bathrooms. So we decided, ‘It’s fine. We’ll let people inject in the bathrooms.’”
But portable toilets are unpleasant, and for intravenous drug users they can also be dangerous. On several occasions, someone went into one of the porta-potties, closed and locked the door behind them, and overdosed, only to be found just in time. So, after a few weeks, McCurdy and his new VANDU friends began to brainstorm how they could make things a little more comfortable for everyone.
“I said we could rent one of those half-moon trailers [used by the film industry], park it somewhere, and use that as our bathroom,” he says. They got an old trailer, the kind one finds on movie sets (low-budget movies, in this instance). Inside were two toilets in separate compartments with doors that conveniently did not go all the way to the ground, so PHS staff could see if someone happened to overdose while they were in there.
VANDU and PHS agreed it would be entirely counter-productive to hire a security guard. But they had invested some money into it, and so PHS needed to find someone who was willing to hang out on the sketchy corner of Main and Hastings all night and keep an eye on everything.
Enter Coco Culbertson, another musician the Portland had recently brought on staff during its expansion into additional hotels. Culbertson had enjoyed a fair amount of success in music, even making it onto late-night shows with David Letterman and Jay Leno. But by 2001, she had a young son who was tired of being dragged around on tours, and so she was looking for something else. A friend introduced her to Liz Evans, who arranged another unconventional job interview.
Liz Evans (centre) and Mark Townsend (far left) had their first child, Kes, in March 2000. The community loved him, Evans remembers.
Photo: Mark van Manen / Vancouver Sun
Evans and Townsend had just had a child of their own around this time. Baby Kes was born on March 23, 2000. The pair had been living together since Townsend had first arrived to Vancouver in the summer of 1991. Beyond that, it’s impossible to get a date from either of them for when the relationship turned romantic. “I liked him very much right away,” Evans says. “But then it took quite a few years, to be honest. I mean, properly romantic?” She laughs. “I don’t know. It’s embarrassing.” Culbertson met with Evans while baby Kes played on the floor between them. “We met and talked and hit it off right away,” Culbertson says.
Continuing what by this point was a well-established pattern for Portland hires, Culbertson had had an unconventional childhood that she now found she could put to work for her. Her first shift was at the Washington Hotel, and there was a mattress fire to deal with.
“One of the arsonists we housed had set his room on fire,” she recalls. Darwin Fisher was also working at the Washington that night and he rushed upstairs with another staffer to take a look. They doused the flames with a fire extinguisher and before too much longer, everything was back to normal.
The police were called as a matter of standard procedure. (“We’re mavericks but we’re not outlaws,” Culbertson explains. “Most of the time.”) But the tenant was not evicted. The mattress he’d set on fire was thrown out and he was found another room. “We do call the police because that’s their job,” she says. “But our job is to keep th
e door open for them [tenants] when that process is completed.
“They handled it with such decorum and without any level of panic,” Culbertson remembers. “They even had a sense of humour about it, not in a light way, but in a way where everyone else was made to feel safe and cared for … They dealt with it so beautifully, it completely blew my mind,” Culbertson says. “I just thought, ‘Fuck, I want to be able to do that.’ I immediately wanted in.”
Like Tanya Fader—and just about everyone else Evans had hired thus far—Culbertson says she felt comfortable in the organization’s chaos. “All of the weird things I’d picked up through my dysfunctional upbringing completely applied to this unique scenario,” Culbertson says. “I realized I had the skills to be in this really chaotic, fucked-up workplace. It was like magic for me.”
When Townsend came looking for volunteers to take the night shift at the bathrooms, Culbertson raised her hand.
“That was my first management project, because nobody else wanted it,” she says, laughing. “Funnily enough, none of the other PHS employees wanted to be outside of Main and Hastings overnight, running a toilet and a needle exchange with only people high as fuck working with you.
“PHS was gently managing VANDU, which was really complicated,” Culbertson continues. “We’d have volunteers come onto their shift, go to the needle table, grab a couple of rigs, go into the bathroom, and smash a speedball.” (A speedball is a mixture of cocaine, an upper with intense effects that don’t last long, and heroin, from which a mellow high can last a while.) The trick for Culbertson was to channel that energy.
“One individual, who still works with us, loved to do up and down,” Culbertson continues, using a another slang term that describes a mix of cocaine and heroin. “And he would come out of the bathroom ready to go but just completely fucked out of his head. He would be mopping out in the alleyway … running around maniacally and then, like seven or eight minutes later, he’d be sleeping. And for the rest of the night, he’d just be nodding out.” She laughs. “I got three minutes of completely unproductive hyperactivity.”
Somehow it all made sense. There was a drug market in the middle of which VANDU had dropped a pair of portable toilets. Then, in response to open drug use there, the toilets became a distribution point for clean syringes. A trailer was better than porta-potties, so that was a logical improvement. Now there was a supervised-injection site.
“Folks would get rigs from the table and check in with VANDU and then go to the bathrooms right next door, inject, and then leave,” Culbertson says. “And if there was an overdose, we were there and we did respond.”
There hadn’t been a plan to open a supervised-injection site, but that’s what PHS had done.
The Thunder Box, as Portland staff came to affectionately call it, never attracted media attention during the few months it ran, and since then, it has all but been forgotten. But McCurdy recalls it as crucial to the evolution of PHS and harm-reduction in Vancouver. “The bathrooms became one of the prototypes for what a safe-injection site would be,” he says. “We learned a lot there”
Today, Townsend says he considers the Thunder Box a major step toward the founding of Insite, North America’s first sanctioned supervised-injection facility, which PHS would establish a few years later, in 2003. “You’d have clean rigs, and if something went wrong, we’d actually save your life and you wouldn’t have to die.”
There were hiccups. People selling drugs would occasionally try to set up shop inside the trailer, especially when it was raining. Culbertson recounts having to literally drag “the odd dealer” out by their ear. And some VANDU members resented having to operate the needle exchange under the umbrella of PHS. That meant there were often disputes between the two organizations about how exactly everything should run. But overall, everyone got along.
“VANDU was a great partner to have because they would never take shit from anyone,” Culbertson says. “But we were always on the sharp end of that stick.”
She describes the relationship as mutually beneficial. VANDU got the Portland’s managerial resources, bureaucratic know-how, and, crucially, banking infrastructure that their larger initiatives required. And PHS got to put VANDU’s name on more radical programs—for example, a toilet that was really functioning as an unsanctioned supervised-injection site—and pretend everything PHS was doing was above board.
“It was very symbiotic,” Culbertson reflects. “And at the end of the day, we were all rolling in the same direction and kicking against all the same pricks. So that unified us, regardless of our differences.”
31Adrienne Tanner, “Needle-exchange Fight Hits Streets,” Globe and Mail, July 18, 2002.
Chapter 13
Childhood Trauma and the Science of Addiction
Dr Gabor Maté did a poor job of following the rules. He wasn’t a troublemaker. He didn’t break the law or intentionally go out of his way to disobey professional guidelines. It’s more accurate to say that rule-breaking came to him naturally.
“The thing about me and medicine was, I was always uninterested in rules,” he explains. “I didn’t regard them as the ultimate guides to anything.”
This was not a quality that his employer found beneficial. Vancouver General Hospital removed Maté from his position as its medical coordinator for palliative care. “Part of the issue was, I just did things the way I thought they should be done,” Maté says, two decades later. “I would do things quickly and rather spontaneously, with good effect. I didn’t have any negative outcomes. But I didn’t necessarily do things by the rules … or explain things very clearly. I didn’t document stuff. I just had no patience for that kind of thing. So friction arose,” he adds. “I engineered my own firing. Not deliberately, but I did.”
A few weeks later, as fate would have it, Maté received a call from Liz Evans. “I don’t think she knew very much about me,” Maté says. “And then I was hired. Not that I think there were too many others breaking down the door.”
Evans recalls she actually did know quite a bit about Maté. “It wasn’t random,” she says. “We head-hunted him. I knew that he would be somebody who would be willing to go out on a limb.”
Evans did not know that Maté had just been fired but now says she doubts that would have swayed her from bringing him on board. “We had phoned a bunch of doctors and asked if they knew Gabor Maté,” she says. And what were his reviews?
“He was difficult to work with, opinionated, headstrong, arrogant, thought highly of himself, and didn’t listen to advice,” Evans recounts. “He got lots of negatives. But I knew that the negatives meant that he would fight the system.”
Maté became the latest member of Evans’s team of medical-establishment misfits. Evans had left her previous job at Vancouver General Hospital’s emergency psychiatry and assessment unit because she had trouble seeing her patients as sick. Mark Townsend carried with him the memory of his brother locked in a bathroom at Barrow Gurney Mental Hospital, facing a sentence of electro-convulsive therapy. Kerstin Stuerzbecher resigned from the home where she took care of troubled teens after she came to believe that the restrictions that she and her colleagues placed on youths could often do more harm than good. Dan Small obsessively read his forensic patients’ life histories at Colony Farm and concluded that the system he was working within was unlikely to bear positive outcomes for them.
Evans describes bringing this sort of like-minded group together as something that occurred naturally. “I think, on reflection, I never really felt like a misfit,” she says. “But I clearly was one. I identified very strongly with other people who didn’t fit in.” This became the Portland’s unique advantage.
“For me and Mark and Kerstin, a lot of the other things that we’d done in psychiatry had felt off-base—overly controlling or coercive, robbing people of their individual rights and freedoms,” Evans continues. “What the Portland represented for all of us, in the beginning, was an opportunity to not be controlling, not be coercive, and
to leave people to be human beings first.”
Now Maté joined them.
“I walk into this grungy hotel that had fallen upon hard times at some point—faded elegance,” he recalls. “There are all these people and a hubbub, people scrambling around. I felt right at home.”
He was given a small office on the second floor and the freedom to treat patients as he saw fit. From there, a new care model for addiction began to take shape and, eventually, a new understanding of addiction itself. “We saw the addiction not as characterizing the person, but as a coping mechanism,” Maté says. “And underneath, there was a very sensitive or creative, interesting human being, who had just suffered so much that the addiction became their way of coping.”
Expanding on the definition of an addiction beyond biological terms, Maté says he began to see it as a “normal response to an abnormal situation,” as a coping mechanism for trauma, and for the life-time effects of childhood trauma.
Gabor Maté was born to Jewish parents in Budapest, Hungary, on January 6, 1944. Two months and one week later, Adolf Hitler ordered Operation Margarethe and the Nazis invaded the city.
Maté recounts what happened next in a section of his first book, Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder. Two days into the Nazi occupation, his mother, Judith Lovi, was compelled to call the doctor.
“Would you come to see Gabi,” she requested. “He has been crying almost without stop since yesterday morning.”
“I’ll come, of course,” the doctor replied, “but I should tell you: all my Jewish babies are crying.”
Seventy-three years later, at his home in Vancouver, Maté wonders aloud about the effect the Nazi threat had on him as an infant. He notes there is nothing that such a young child could have known about the war, the violence, or the dangers his parents felt around them in every direction.
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