Fighting for Space

  After the Keeping the Door Open conference concluded, HaRAS continued to meet in the basement of St. Paul’s. These meetings were co-chaired by Dean Wilson and Fiona Gold. She remembers them as unconventional; they often arrived at solutions that involved breaking the rules or even the law. But that’s what was needed.

  Livingston and Wilson were spending a lot of time together. In addition to the HaRAS meetings, they began travelling around North America representing VANDU at various drug-policy conferences.

  “We just hit it off,” Wilson says. Neither of them remembers a specific moment when they decided they were a couple. There was one night in Ottawa when Wilson showed up at her hotel-room door with a bottle of wine. A short while after that, Livingston invited him for a weekend at her mother’s home on Vancouver Island, and Wilson says he thinks he impressed her by making himself useful, fixing things around the house. They were attracted to each other for the same reasons. There was mutual admiration for the other’s passion and intelligence. But the relationship was doomed to fail, they both agree now.

  “It was always very tumultuous,” Wilson says. “I was trying to get straight and trying to have a new relationship at the same time, which is fucking impossible. As they tell you in AA, the only relationship you’ve got to worry about is breaking up with your heroin. So it did eventually become a terrible scene. But I still love her to death. I think she’s wonderful.”

  In June 2000, Thomas Kerr was a young researcher working for the Dr Peter Centre, a care provider for people with HIV/AIDS attached to St. Paul’s Hospital on the west side of Vancouver’s downtown core. He was thirty-three years old, a father to a three-year-old and a newborn, and in addition to his work at the centre, was pursuing a PhD in health psychology. Kerr was working sixty-hour weeks while still trying to devote as much time as he could to his young family. Then he received a call from his boss, Maxine Davis, who asked if he would take on a project for HaRAS.

  “I’ve been working with this group of stakeholders, including Downtown Eastside people, toward trying to maybe set up a safe-injection site,” Davis told him. “And everybody’s pitched in a couple of thousand dollars, so we have a tiny pot of money.”

  Kerr was tasked with drafting a proposal for a government-run supervised-injection facility. Whereas the VANDU document that the health board had torpedoed two years earlier was thin, consisting of little more than ideas, the document that Kerr eventually completed was the real deal, a detailed proposal.

  It begins by outlining the problems that such a facility aimed to address—primarily overdose deaths and the spread of HIV/AIDS, hepatitis C, and other communicable diseases, but also street disorder and crime. Next, it summarizes existing academic literature related to supervised-injection sites that were operating in Europe. It then details a program model for supervised injection tailored for Vancouver, right through from its establishment and an initial start-up phase to routine maintenance requirements and day-to-day operations. There are even suggested methodologies for reviews of the program.

  Kerr remembers the experience as one that nearly killed him.

  “One day I was ready to pack it in because I was too freaked out by Ann’s anger,” he says.

  There are two things about Livingston that just about everyone agrees on. The first is that she gets things going. The second is that she is not an easy person to work with. At the time, one of her most important roles at VANDU was to focus Wilson’s erratic energy on specific objectives. But now Wilson was often managing Livingston’s increasing impatience.

  “Dean came to the Dr Peter Centre and asked for me,” Kerr says. “He came to my office and said, ‘Look, I think you’re a good guy and your heart is in the right place. We can work this out and I can manage Ann.’”

  Livingston wasn’t the only one who was taking out her frustration on Kerr. Even though he was on their side, Kerr was from the medical community, and Downtown Eastside activists did not trust an establishment that had never given them any reason to. Kerr remembers one HaRAS meeting convened to discuss the injection-site proposal when Bud Osborn barged in unannounced and unleashed on the group.

  “Bud shows up and started yelling at us: ‘You people, you’re so fucking stupid!’” Kerr recounts. “I tried to speak reasonably to him, and he just screamed. I was devastated—this was Bud Osborn, an icon, a mythical figure whom I had never talked to before. But then, the next day, he called every single person [who’d been at the meeting] and apologized.”

  Livingston remembers the pressure that HaRAS placed on Kerr. “Thomas was treated very badly,” she concedes today.

  Between the Dr Peter Centre and his PhD, Kerr was working twelve-hour days before he would arrive home and have a chance to even start in on the proposal for an injection site. The entire document was written in the middle of the night, with Kerr typing away until three or four in the morning. But by November 2000, it was complete. Vancouver had a proposal for a supervised-injection site, a real one that detailed the nuts and bolts that running such a facility would require. But just as in 1998, the document went nowhere.

  “We kind of hit a roadblock,” Kerr says. One problem remained unresolved: everything that they proposed was still illegal under Canada’s Controlled Drugs and Substance Act. “The police came out and said, ‘That’s a nice idea, but it’s illegal, so we can’t allow it,’” Kerr recounts. “And we were really screwed there. Nobody knew what to do about it.”

  Despite so many sleepless nights and a lack of tangible progress, Kerr maintains that the project was worth his time. It was the first time that anyone in North America had ever asked the fundamental questions about what an injection site would require to operate. He recalls how Fiona Gold sat down with him to itemize and calculate the costs of every single chair, tourniquet, and cotton swab. “Down to the last Band-Aid,” he says.

  While Kerr’s specific proposal was not implemented, a lot of the information it included was used to inform subsequent projects, albeit without any credit. “When they opened Insite … they used a lot of that material,” Kerr says.

  The document is also notable for the names it includes on a page listing its contributors. While VANDU’s 1998 proposal was almost entirely credited to activists, the HaRAS proposal was backed by health-care professionals like Gold, Kerr, Kerr’s boss at the Dr Peter Centre, and other prominent service providers mostly from backgrounds working in HIV/AIDS. It also had the public support of Vancouver’s straight middle class via the involvement of From Grief to Action and parents like the Ruttans and the Halls.

  “It massively accelerated the conversation,” Kerr says. “Now we had a product. We could now talk to politicians about it. And that’s what I did. I ran around with it and met with people at the city … We flew to Ottawa and met with Health Canada to talk to them about it.”

  Livingston says the HaRAS proposal let them finally move beyond meetings among activists.

  “At some point, you have to make the fucking blueprint,” she explains. “Otherwise all you’re doing is describing things. This made it concrete. This one laid it out. Here’s what it’s going to look like, here’s the training everyone would need. Now we knew how much it was going to cost for staff, what kind of space we were going to need, and how many people per hour could come through. Now we were ready to do the RFP [request for proposals]. We were no longer kidding.”

  The year 2000 was a big one for PHS, too. Nearly a decade earlier, Mark Townsend had begun raising money for the new Portland Hotel, the purpose-built social-housing complex that he’d convinced the famous architect Arthur Erickson to design.

  The new hotel was located just half a block from the old one, but a lot of residents were very anxious about the move. For some, the old Portland Hotel (since renamed the Pennsylvania) was the only stable housing they’d ever known. And many struggled with a mental illness that made a dramatic change difficult to handle. So PHS tried to turn the day into a celebration.

  Townsend recalls that mo
ving the entire building in a single afternoon was a logistical challenge but that they were never going to do it any other way. “If you moved your family, you would all move together,” he explains. “So when we moved hotels, we did the same thing.”

  Liz Evans was there with baby Kes on her back that day. He was born just a few months earlier, and PHS tenants adored having a newborn around. “They loved him,” Evans remembers. “One very lovely resident named Dave went dumpster diving and brought me an amazing red plastic sixteen-wheeler Tonka truck.” Another man gave his penny collection to the child. Others gifted children’s books they’d found rooting through the trash. Evans tidied them up and kept every one, reading them to Kes and, later, their daughter Aza.

  There were only about thirty full-time staffers working for PHS in 2000, so Evans convinced them to bring their friends and families to help with the move. A parade of shopping carts filled with everyone’s belongings stretched from the old hotel to the new one. “We packed up everybody’s rooms and moved and had this giant celebration,” Evans says. “We even had a rockabilly band in the lobby and balloons.” As tenants made their way upstairs and found their new rooms, they discovered a box of chocolates and a welcome bag filled with little soaps and shampoo left on every bed.

  “‘Finally, I have a home where I can live for the rest of my life,” Evans remembers one the Portland’s first tenants, Stephanie Blais, telling her that day.

  Blais had lived at the old hotel since 1992. She says that for everyone, without exception, the best thing about moving was the bathrooms. The old Portland Hotel only had a couple of shared toilets on each floor and the building’s ancient plumbing often backed up. They were impossible to keep clean, and there was no privacy.

  At the new hotel, every tenant had their own toilet and their own shower. “That first night, the Portland Hotel had the largest hot-water bill in the whole city,” Blais jokes. “In the whole province! Having your own shower and your own toilet and everything—it was nice.”

  Evans had been stuck behind a desk for a couple of years by this point.

  “It was awful,” she says. “By the time I left the Portland to have Kes, I really didn’t return to the frontlines again after that. Of course, I always saw people I knew in the community and still had relationships with loads of them. But my job became running this organization, which I was never prepared to do. Now I was doing scheduling and staff supervision and training and going to endless meetings and writing grants … I hated it.”

  Still, Evans kept many tenants as close as family.

  Mark Rossiter doesn’t fit into any neat profile of the hard-to-house. He’s never struggled with a drug addiction. He’s different, but his mental illness is not disruptive to others. Evans simply describes him as “a very lost soul.”

  Rossiter recalls that his parents divorced when he was two, and he went to live with his father. After that, his mother never took much of an interest in him. “The only time I really ever saw her was at birthdays and Christmases,” he says. “And then for a while there, she really just dropped out of sight.”

  In February 1992, Rossiter showed up at the door of the old Portland Hotel and asked if he could have a room. “I remember knocking on the door and out comes this British person with bleached blond dreadlocks,” he says. Townsend showed him two rooms they had available that day. Rossiter picked one and has lived with PHS ever since.

  “Not too long after that, Liz’s mother was here,” Rossiter continues. Jane was in Vancouver to visit Evans and had stopped by the hotel to see where she worked. She met Rossiter in the lobby and the two “just hit it off,” he says.

  Evans remembers introducing them. “He had always wanted a mom,” she says. So Evans told Rossiter that he could share hers. “And then he saved up his welfare cheques to buy a plane ticket to England and visited my mom in Frinton on Sea.”

  By himself, Rossiter travelled to London, England, where Jane was there with a car to pick him up. “I scrimped and saved for one whole year,” Rossiter says. Together, they drove back to her little village.

  “We went to this little amusement park and we went to a cemetery where she said an actual pirate was buried,” he recalls. Rossiter stayed with her there for three weeks and they grew very close.

  “She is such a sweetheart,” he says, “I never had a sister but now I basically classify Liz as my sister.”

  Today Rossiter and Jane are still in touch. They regularly mail letters and small gifts back and forth.

  Evans finds the whole thing a bit amusing, given that her mother was seldom a consistent presence in her life when she was growing up. But it works for them, she adds.

  40Brian Rush, Karen Urbanoski, Diego Bassani, Saulo Castel, T Cameron Wild, Carol Strike, Dennis Kimberley, Julian Sommers, “Prevalence of Co-Occurring Substance Use and Other Mental Disorders in the Canadian Population,” The Canadian Journal of Psychiatry 12 (2008): 800-809.

  41Peter Buckley, Brian Miller, Douglas Lehrer, David Castle, “Psychiatric Comorbidities and Schizophrenia,” Schizophrenia Bulletin 35(2) (2009): 383-402.

  Chapter 18

  Rewiring the Brain for Addiction

  Marc Lewis was standing on the corner of East Hastings and Carrall streets outside the old Portland Hotel. It was a sunny evening and the sidewalks were crowded around him. A dealer leaned against the wall of a nearby corner store, repeating the standard Downtown Eastside pitch.

  “Rock? Powder? Down?” he called, over and over.

  A man in dirty clothes was down on his knees, using his bare fingers to dig cigarette butts from cracks in the sidewalk. A woman jumped from one discarded needle to the next, quickly checking each one for anything left inside that its previous user had missed. Across the street at Pigeon Park, a couple sat together on a bench, injecting heroin in plain sight.

  “I was blown away by how down and out people were,” Lewis says, looking back on that day. “There were so many people who looked like they were just struggling to hang on.”

  How did these people get this way?

  Lewis is a developmental neuroscientist at Radboud University in the Netherlands. He was visiting Vancouver to promote his book, The Biology of Desire: Why Addiction Is Not a Disease. PHS had invited him for a speaking engagement and now was taking him on a tour of the organization’s hotels and harm-reduction projects around the Downtown Eastside.

  While Bruce Alexander’s work on addiction focuses on the environment, and Dr Gabor Maté’s explains the significant role that childhood trauma can play in determining one’s propensity to develop a drug habit, Lewis’s book lays out an argument for addiction as a learned habit. It describes addiction as a normal process of brain development, albeit a destructive one. It’s an explanation that can easily apply to an individual who grew up in the most privileged home: an inclination to experiment with drugs can lead to repeat use, at which point the brain will begin to change.

  “The repetition of particular experiences modifies synaptic networks,” Lewis writes in the book. “This creates a feedback cycle between experience and brain change, each one shaping the other. New patterns of synaptic connections perpetuate themselves like the ruts carved by rainwater in the garden. The take-home message? Brain changes naturally settle into brain habits—which lock into mental habits.”

  Discussing this theory, Lewis expands on his comparison to rainwater. He imagines water dripping onto a flat surface of mud. As the raindrops repeatedly land in the same place over and over again, they alter the shape of the mud so that it is no longer flat. The falling water ceases to pool evenly. Instead, it flows in the direction that previous drops carved out for it. Tracks have formed in the mud and as the water continues to fall and then find its way into those tracks, they become deeper, precipitating more water to collect there and to continue to dig deeper paths.

  “When patterns start to form, they perpetuate themselves. The process is called self-organization,” Lewis continues. “It’s a feedback cycle. But it�
�s a feedback cycle that takes on a history. It’s a feedback cycle for a period of hours or days or weeks, but over months and years, it takes on the shape of a trajectory. A personality pattern. A growth trajectory. It becomes dug in over time so that it becomes increasingly difficult to alter.”

  The provocative subtitle of Lewis’s book, Why Addiction Is Not a Disease, is meant to emphasize the extent to which the changes in the brain that occur with a drug addiction also occur as a result of healthy activities, such as exercising.

  “To say that addiction changes the brain is really just saying that some powerful experience, probably occurring over and over, forges new synaptic configurations that settle into habits,” the book reads. “And these new synaptic configurations arise from the pattern of cell firing on each occasion. In other words, repeated (motivating) experiences produce brain changes that start to define future experiences.”

  Again discussing the book, Lewis explains that the repeated ingestion of drugs rewires sections of the dopamine system, affecting how humans assess motivations and rewards to prioritize specific short-term gains over long-term outcomes. At the same time, because repeat behaviour is habitual and therefore performed with less evaluation, the prefrontal cortex—the part of the brain responsible for inhibition—is used less. Because it is used less, parts of it will essentially become weaker, an effect called synaptic pruning.

  “If you continue to pursue the same attractive goals over and over again and it becomes very habitual to do so, then you’re going to prune unused synapses,” Lewis explains. “If you are not using that neighbourhood of cells anymore because you just do something and you do it automatically, then those synapses are going to get pruned away, with less traffic and less activation. And before long, they become less accessible.”