Fighting for Space

  The Dunlevy site was open for less than a year. When Livingston’s money for rent ran out and Roe’s research project wrapped up, that was the end of it. VANDU went back to being just VANDU. But Crowe maintains that the shabby little storefront across from Oppenheimer left a big mark on people.

  “I think the conclusion of Dunlevy is that it opened a vision of harm reduction to people outside of the community,” he says. “We showed them what can work.”

  The conclusion of Roe’s report focuses on the success of the VANDU Health Network as a health-care program run by active drug users.

  From a longer-term perspective, the VHN project was blazing a new trail in a new direction. After the project concluded, the trail remained, and others could travel it. We took an idea as far as we could in hope that we could persuade those organisations and policy makers to take up that idea and develop it further in their own way and for their own programs. I believe we were successful and that the idea of user-based service provision as a cost-effective auxiliary or supplement to existing services will be a feature of many new services in the DES [Downtown Eastside].

  The volunteers provided an excellent example of how services could cheaply and easily extend their “reach” to the “unreached” by employing drug users as active participants in the provision of service.

  For the course of the Dunlevy experiment, Wilson remained at the Hastings and Cambie office, rapidly growing into one of the Downtown Eastside’s most vocal political activists.

  One prominent VANDU member who stopped coming around was Bud Osborn. Ironically, it was likely because he was using more than he had during the preceding few years, when he had founded VANDU.

  “Bud would carefully word these things. Like, ‘I’ll never inject heroin again,’” Livingston says. “You didn’t realize, what else he’s saying is, ‘And I’ll do anything else except inject heroin.’”

  Livingston says it still took her weeks or even months to figure out he had relapsed. “People are telling me, ‘Oh, I saw Bud on the corner today,’ and it’s just not clueing in,” Livingston says. “It’s like your old man is having an affair and the whole town knows but you don’t know.”

  Years later, with hindsight, Livingston recalls Osborn calling her around this time in fits of panic, complaining he needed money for cigarettes or who knows what. She would drop whatever she was doing and run to his place with the cash.

  “One of the guys on the corner finally straightened me out,” Livingston continues. “They said, ‘Ann, he bought dope off me.’ So I clued in why I couldn’t get a phone call from him while I was working twelve-hour days.”

  Osborn’s return to heroin during these years didn’t help his relationship with Livingston, but it wasn’t what ended it, either.

  “I remember going there [213 Dunlevy] and Bud sitting in the car,” she recalls. “It’s hard to describe people like Bud. Always sick and not feeling good. And he got more and more like that.”

  37Hubert Beyer, “Canada’s Killing Fields,” [Prince Rupert] Daily News, July 21, 2000.

  38Shane McCune, “Fed-up Merchants Tell City to Arrest Junkies,” Province, August 10, 2000.

  39Shelley Solmes, “City Calls Moratorium on Facilities for Drug Users,” Vancouver Sun, August 10, 2000.

  Chapter 17

  Building Allies

  We had three kids, all doing really well,” Susie Ruttan begins.

  The Ruttans live on Vancouver’s west side, in an upscale-neighbourhood called Kerrisdale. Susie is a retired teacher. Her husband, Rob, is a Crown prosecutor. In the 1990s and early 2000s, he spent a lot of his time in a courthouse near the intersection of Main and East Hastings, prosecuting addicts, the dealers who sold to them, and women who were arrested for selling their bodies in order to pay for drugs.

  In 1995, their first child, Gregory (not his real name), started smoking marijuana. He was twelve or thirteen. Within the next year or so, he tried just about every other drug, and was injecting heroin in the Downtown Eastside when he was fifteen.

  “It certainly opened my eyes,” Rob says. “I began to realize how naïve my understanding of addiction was.” He explains how, in the years that followed, definitions of right and wrong increasingly failed to have any meaning.

  “We had managed to get a place [for Gregory] in a treatment program in Montreal,” he begins. “We had the plane ticket. He was set to go out the next morning, and he was in the desperate throes of craving. He just couldn’t face going if he didn’t use one more time.”

  Rob recalls feeling sick as he realized his options. He could leave Gregory to sneak off in the middle of the night and hopefully return in time for his flight the following morning. Or he could help his son get the illegal drugs he was asking for, going against every impulse he had as a parent, but keeping Gregory close until his flight to Montreal.

  “I finally came to the awful conclusion that if I didn’t let him do this, I wouldn’t get him on the plane,” Rob says. “I knew that if I let him do it, I might lose him and I wouldn’t get him on the plane anyway. But also that the only chance of getting him on the plane the next day would be going with him, down to the Downtown Eastside.”

  Together, they drove from Kerrisdale to find a dealer around the intersection of Main and East Hastings. Gregory unbuckled his seatbelt, stepped out of the car, and disappeared around the corner down an alley. Rob sat there waiting. Minutes passed. He lost track of time as his mind raced.

  “It felt like a long wait as I wondered if I would ever see my son alive again,” he says.

  “Is this going to be the beginning of a long relapse period, where he’s disappeared?” Rob remembers thinking. “Is this going to be the time where he has an overdose in the alley and I’m not at his side? As I sat there waiting for him, all these things were going through my head. Have I just delivered him to his death?”

  It felt like hours passed, but eventually Rob’s passenger door opened and Gregory stepped back inside the car. “He did score heroin, he did use, but he did keep his side of the bargain,” Rob says. “And we managed to get him on the plane in the morning.”

  That wasn’t the end of Gregory’s struggle with addiction. It was neither his first nor his last time entering rehab. Gregory was eventually diagnosed with an underlying bipolar disorder, which gave his family a better understanding of the causes of his addiction. The Ruttans learned that an estimated twenty percent of people with a mental illness also struggle with a concurrent substance-use disorder40 (for schizophrenia, the odds approach fifty percent41). The family’s battle continued for many years.

  Susie remembers the moment she realized just how tricky a problem drug addiction is to solve. She was at a meeting in the basement of a church. Gregory had just entered detox for his first time. She was feeling optimistic about his future. “I can remember people sharing [stories] as we went around the circle,” Susie recounts. “My good news was I had just gotten my son into detox, thinking that everything was going to be okay. And the more seasoned members of the group were saying, ‘I’m sorry to break this to you, but it’s not going to be over.’”

  In hindsight, Susie acknowledges that was probably obvious. But addiction was new to their family and, as parents, she and Rob badly wanted to believe that Gregory would be cured with treatment. “I didn’t want to sit down with other parents or talk about it,” Rob says. “At first, I was very resistant to the idea.” But he and Susie did and, to their surprise, discovered that the drug problem Vancouver faced in the 1990s and early 2000s affected a lot of families that lived nowhere near the Downtown Eastside.

  In 1999, Ann Livingston and Bud Osborn were looking for allies outside of their impoverished neighbourhood that nobody else seemed to care about.

  “There was a group I’d heard of in Australia of parents with teenagers who were drug addicts,” Osborn said. “They had become a very powerful lobbying group. And I thought, we need something like that here.”

  Osborn had remained in touch wi
th Simin Tabrizi, one of the co-authors of the proposal for supervised-injection sites that the health board had shot down in 1998. He’d shared with her his idea about a group of parents. Then, as chance would have it, Tabrizi received a request from a pastor to come and speak to a similar group who attended his church on Vancouver’s west side.

  Tabrizi recalls that the first meeting went well enough, but she didn’t think a lot of it. Then, as she was leaving, Rob Ruttan came running after her, shouting her name to get her attention just before she stepped into her car. “He told me that his son was addicted,” Tabrizi says. “And that he and his wife, Susie, were at their wits end.”

  Osborn recalled how excited Tabrizi was at this chance encounter. “She came back to me and said, ‘I think we found our group.’”

  For the next six months, Osborn and Livingston drove from the Downtown Eastside to Kerrisdale every Saturday to spend the morning with Tabrizi, the Ruttans, and the group of parents that gathered with them in the basement of St. Mary’s Church. “These were lawyers, administrators at the university, people with money. But they were like beaten dogs,” Osborn says.

  Susie jokes about how they actually called themselves the “Bud Osborn group … He was very charismatic but in a very quiet, low-key, compelling way,” she says. “He talked about his own struggles with heroin. And he talked a little bit about the Downtown Eastside.”

  The Downtown Eastside was a place that terrified Susie.

  “When you say the Downtown Eastside, it elicits a kind of a nightmare, because that is where I would go looking for our son when he was on the street,” she explains. “I would meet some amazing people down there. But it really was a scary place.”

  When Gregory would go missing, Susie would print small posters that included his name, a photograph, and her phone number. Then she would drive across town to the Downtown Eastside and hand them out to whoever would take one and post the rest on telephone poles throughout the neighbourhood. “Have you seen this boy?” she remembers asking strangers on the street.

  “It was a needle in a haystack,” Susie continues. But there was little else she could do. And sometimes she did find him, not always for the best. He would refuse to come home with her or beg for money, claiming that a dealer would hurt him if she didn’t give him what he asked for.

  “It is very easy for people to say, ‘You’ve got to exercise tough love. If you’re not, you’re enabling,’” Rob says. “Well, there is a very fine line between enabling and doing what you can to support your child, just to keep him alive.”

  Tabrizi recalls how the parents got to know Osborn and became more familiar with his arguments in favour of harm-reduction services. Before long, an injection site actually became an easy sell, much to their surprise. “When parents are scared every hour of the day—scared they’re going to find their kid at the morgue—they understand the idea of safe-injection rooms, where people can go and use but will be safe from overdosing,” Tabrizi says. “They could see that the most immediate safety net for their children would be a safe-injection room.”

  By this time, the group meeting in the basement of the church had a name. They were calling themselves From Grief to Action. Nichola Hall, another of its founding members, recalls how their relationships with Osborn, Livingston, and later VANDU were consciously strategic in nature.

  “Bud came to us and said, ‘Something needs to be done because people are dying in the Downtown Eastside, but no one is going to listen. The public is not going to listen. But if they know that there are people like you—that it is not just the scum of the Downtown Eastside that you can brush under the carpet—if they know that it is people like you who are struggling with the same problem, then they are more likely to listen,’” Hall says. “That made sense to me.”

  While the Ruttans, the Halls, and other parents were meeting in Kerrisdale, staff at Vancouver’s inner city hospital had grown increasingly alarmed by the outbreak of HIV/AIDS and where that crisis overlapped with the growing problem of drug-overdose deaths.

  Irene Goldstone was the head of nursing at St. Paul’s Hospital then. She recounts how for years, the Street Nurses who patrolled the Downtown Eastside’s back alleys visited her office and described scenes of utter indignity, of people injecting with water they had collected from puddles and sharing needles despite terrible risks of infection. They were stories of desperation, Goldstone recalls. “We were really frustrated with the ministry of health and the health board, because they didn’t have a strategic plan,” Goldstone says. “So we formed a committee.”

  That was the Vancouver HIV/AIDS Care Coordinating Committee, which met once a month with the aim of sharing knowledge and experience between both government and nonprofit groups. At these meetings, it became apparent that a new population of higher-needs patients had developed in Vancouver: people with multiple diagnoses of drug addiction, HIV/AIDS, and often also mental-health issues.

  In response, Goldstone organized a conference for March 2000 that she called “Keeping the Door Open: Health, Addiction and Social Justice.” It opened up the work of the Vancouver HIV/AIDS Care Coordinating Committee to a wider audience, bringing together some 3,000 people who attended meetings at six locations over the course of four days.

  At the very first meeting in an auditorium in the basement of St. Paul’s Hospital, there were police officers, prison guards, lawyers, doctors, nurses, and every sort of health-care professional. Livingston and Dean Wilson were there with several other VANDU members. There were a lot of people who were working on the frontlines of the gay and lesbian community’s response to HIV/AIDS. The Ruttans and other parents with From Grief to Action attended. Rob Ruttan delivered one of the keynote speeches on the first day. The Street Nurses were also there to deliver a presentation on how to inject drugs in as clean and safe a manner as possible. (They were cautioned to attend as individuals and not as representatives of the health-care system.)

  Fiona Gold, the Street Nurse who had gotten to know Livingston during visits to Back Alley, explains the challenge that hospitals were dealing with as HIV spread from the gay community to drug users. The two groups did not get along and each one stigmatized the other. Drug users didn’t want to visit a hospital’s AIDS ward for fear they would be labelled homosexual, and gay men didn’t want to be seen alongside drug users for fear they would be labelled junkies. “It was a difficult mix in the hospitals,” Gold says. “Street-involved users can be super chaotic, and when they came in, it could be chaos in the hospital. It was difficult as nurses to manage that.”

  The Street Nurses had tried to bring medical care to the entrenched drug users of the Downtown Eastside, but there was institutional pushback. They had been warned that they were walking a risky line on what was legal within the health-care system of the day.

  While Gold had visited Livingston’s injection site on Powell Street that ran there from late 1995 to early 1996, she remembers being explicitly warned to stay away from the VANDU site on Dunlevy that was operating while the Keeping the Door Open conference was happening.

  “My cell phone rang,” Gold says. “It was the solicitor general’s office in Ottawa. They said, ‘Whatever you do, don’t go and work at Dunlevy because you are going to lose your nursing licence.’ They were pretty freaked out.”

  It was this institutional hostility toward health care for drug users that Keeping the Door Open aimed to address. “It was a really important eye-opener for important people, the people who were really running the show,” Goldstone says.

  Toward the end of the fourth and final day of presentations and meetings, Livingston grew frustrated. Over the course of four days during which she attended eight hours of sessions each day, she didn’t hear one thing that she didn’t already know. As Goldstone spoke at the front of a packed auditorium in the basement of St. Paul’s Hospital, Livingston lost her temper. She stood up, raised a clipboard she held above her head, and issued a challenge for the roughly 200 people in attendance.


  Wilson remembers her stealing the day. “She stood up with that clipboard in her hand,” he begins, “and she says, ‘I don’t know about you but I’m going to open up a supervised-injection site. If anybody’s into it, stay after the meeting and put your name on this sheet.’

  “She said, ‘Is anybody willing to actually do something?!’” Wilson continues. “That’s what she said, in that way Ann does. And people thought, ‘Jeez, I better get up there and sign.’ She drives people to action.” It was an electrifying moment. Livingston was visibly angry, and people recognized that she had a right to be.

  “A bunch of people signed up,” Wilson says. “A bunch of straight people signed up. That, right there, was the moment when a group of people got together for a common cause to open up a supervised-injection site,” he continues. “We had the parents of young drug addicts from the rich west side, and we had all the Downtown Eastside people.”

  “I needed a sense of moving forward,” Livingston says. “Then I passed that clipboard around and I said, ‘Is anyone else sick of this? Should we just do something about it?’”

  Gold took a leadership position in the group that emerged from the list of names Livingston collected with her clipboard that evening. They called themselves the Harm Reduction Action Society, or HaRAS. There was now a group of stakeholders that reached far beyond the Downtown Eastside and that was working with the specific goal of opening a supervised-injection facility. “It was the first time that somebody had really galvanized things,” Gold says about Livingston’s role.

  The Ruttans also added their names to Livingston’s list. Rob explains how the idea of an injection site became tenable to parents. “We kept saying to ourselves, ‘We hope he never uses again. But if he uses, if his addiction drives him to use, we hope that he will use in a place where there are medical personnel handy to come to his rescue if he needs it, and where there are people who can put him in touch with other medical services,’” he says. “It would also send a message to them that our society cares about [drug users]. They are still valued and respected as human beings.”