Fighting for Space

  Initial feedback was overwhelmingly positive. “The city manager loved it, the mayor loved it,” Macpherson recalls. “So the mayor organized a press conference. But first, he wanted to inform council about what we were doing … I didn’t even get one word out of my mouth. The councillors read it and they said, ‘This can’t happen.’”

  When it came to enthusiasm for harm reduction, a bit of a bubble had developed around the mayor’s inner circle. His colleagues on council—even those councillors belonging to his party—still had a ways to go to get onboard. “I went home that night and bought a bottle of wine” MacPherson says. “It was a total disaster.”

  The next day, however, Owen called MacPherson and told him to get back to work. A second draft incorporated changes suggested by the NPA councillors who had expressed concerns. The order in which the document presented sections on enforcement and harm reduction were swapped, so that enforcement received higher placement, and harm reduction only came in further down. Poems by Bud Osborn that had lined the original draft’s margins were cut. Quotes from drug users that included swear words were similarly stripped out. The document was made to look a bit more official, but MacPherson got to keep the guts of it and everything he wanted on harm reduction. His Four Pillars strategy said Vancouver should finally scrap its one-for-one exchange requirements for needles, for example, and work toward establishing a supervised-injection site for intravenous drug users.

  “To everyone’s credit, it was a better document by the end, because it allowed more people to support it,” MacPherson says. “Then Philip had his press conference and we launched it.”

  A six-month period of public consultation followed. Owen says he attended no less than thirty-seven meetings. MacPherson was at sixty-five, he says.

  “Donald put his whole heart and soul into this thing,” Owen says. Dean Wilson was often with him to represent the views of drug users directly. And together, the three made a passionate case for the document. “I realized this idea of taking a hard line on enforcement just was not the way to go,” Owen says. “That’s not the way my grandfather taught me.”

  Council formally adopted the plan on May 15, 2001. Implementation was still to come. But at least on paper, Vancouver would become the first city in North America to offer government services explicitly designed to make it safer for people to use illegal drugs.

  While progress was slowly being made up at city hall, a local filmmaker named Nettie Wild had been following Bud Osborn around with an idea of possibly making a film about the drug problem in the Downtown Eastside. Wild was a documentarian, but the two were exploring the idea of a dramatized script loosely based on Osborn’s life and poetry. One night in March 2000, Osborn suggested that Wild attend a harm-reduction conference in the basement of St. Paul’s Hospital called Keeping the Door Open. Wild didn’t think that anything of real interest was going to happen there. She didn’t even bother to bring along her cinematographer. But she went along with Osborn’s recommendation.

  “I walk in and at the front is this woman who I’ve never met before who was magnificent,” Wild remembers. “She was funny and sexy and smart, and she was on fire, absolutely on fire. She said, ‘Fuck it. We have to open this thing. No more talking. What are you going to do?’” Wild recognized that she had found something special. She thought that within four months, Ann Livingston would have North America’s first sanctioned supervised-injection site open and that she would have the whole thing on film.

  “Eighteen months later, I had many hours of film and no supervised-injection site,” Wild says. “But I had had the very real privilege of filming the birth of a social movement.”

  Fix: The Story of an Addicted City is a gritty portrayal of life in the Downtown Eastside. It’s an intimate window into the lives of Ann Livingston and Dean Wilson, a complicated portrait of Mayor Philip Owen, and it powerfully captures the fight VANDU was waging for improved rights for drug users.

  The film was originally going to be about Livingston and Osborn. They were still together when Wild began shadowing VANDU members. Then, when Osborn drifted away and Livingston began dating Wilson, Wild was forced to extricate Osborn from the film and refocus its story on Wilson.

  “She pulled all his footage out of that film,” Livingston says. “They didn’t know what to do. She’d thought the film was about me and Bud. When you make a movie, you can’t just put all these characters in it, or no one will be able to figure out what’s going on. So Bud just fades to nothing.”

  Wilson wasn’t the cause of their break-up, though he was there at Livingston’s side as soon as she became available. And while Osborn was once again using heroin, that wasn’t what did it either. In the early 2000s, he became intensely introverted and increasingly reclusive. In Livingston’s life as well as in Wild’s film, Osborn simply seemed to fade away.

  Sarah Evans (no relation to Liz), a close friend of Osborn’s during those years, agrees that around this time, he made a slow but definitive departure from public life. “His relationship with Ann was wonderful and also problematic,” Sarah says. “After they broke up, I think he burned out. He started to focus more inwards. That’s when he kind of dropped out of the public scene. I think it was burnout. I hope it was also healing.”

  Sarah remembers Osborn’s focus on drug policy reform as a form of redemption, making amends for the years he had lost to his addictions. But it was also a hard fight and often discouraging. Osborn had embraced drug policy reform as an issue that gave his life meaning; now he began to back away from it as it threatened to overtake him.

  “It was what he needed to do to survive,” Sarah concludes.

  Fix was released in September 2002. Less than two months later, Livingston gave birth to Joey, her fourth child, Wilson’s fourth child, and a bit of a surprise to both of them. It was a home birth, Livingston recounts, and one they had to perform in secret. She was forty-eight years old at the time, and so no midwife was willing to be involved unless Livingston agreed to check into a hospital. She refused and finally found a midwife who would remain by her side at home, as long as nobody knew what they were doing.

  Wilson was there but remained in the living room playing video games. “Catch the baby!” Livingston remembers the midwife calling to Wilson in jest. “I don’t think he was too happy about it,” Livingston adds.

  The birth went fine, and Joey was born a healthy nine pounds eight ounces.

  A few months later, Fix was released in theatres across Canada, and Wild took it on the road. Accompanying her were Mayor Philip Owen, Dean Wilson, Ann Livingston, and Joey.

  “I used to say, ‘I’m on the road with the user, the Christian, the mayor, and the baby,’” Wild says with a laugh. “We would hit a town, and Ann would start organizing drug users, Philip would try to get hold of the mayor and police chief to get them to come to the show, and Dean, if he wasn’t able to get a methadone-carry, would be trying to score.”

  The tour was intensely difficult for Wilson. He was very much addicted to heroin and cocaine and travelling to a different city every few days, often by plane, made it nearly impossible to maintain a steady supply of drugs. In those days, very few doctors were willing to write a prescription for methadone that the patient wasn’t forced to ingest on the spot, and so that meant the group’s first stop after the airport was a clinic or a hospital to explain Wilson’s circumstances and the need for a new prescription. Or he would run around the downtown core of wherever they were until he was able to track down heroin on the street.

  Dean Wilson says he’s seen a photograph of himself taken during a July 2002 march along East Hastings Street as far away as New York City.

  Photo: Elaine Brière

  “It was horrible,” Wilson remembers. “I was on sixty-six airplanes in a year, and I’m a fucking junkie. At one airport, I was in Ottawa, and I was just about to go through security, and this girl goes, ‘Hey, there’s the junkie from the film! Oh, we loved the film!’ I said, ‘Gee, thanks.’ And
then I hear, ‘Sir, would you come with us?’ I missed my fucking plane. That was just one of the nightmares from that year,” he continues. “It was all a nightmare.”

  Wild recalls a surreal scene in Quebec City where Owen, the conservative mayor, was at the hospital with Wilson, literally pleading with a doctor for methadone so that they could make it to the theatre in time to present the film. Owen, dressed in a smart suit, nearly lost his temper with the doctor on call in emergency. “Listen, can you get a move on?” he snapped. “We’ve got a show to get on the road!”

  That didn’t hurry the doctor along, and Owen and Wild were forced to make their way back across town to the theatre without Wilson.

  “The show is ticking along, and still there’s no Dean. Then, just as we’re about to walk out, Dean walks in, he’s got his methadone, and he is a rock star.” Wilson, who buzzes with energy even when he’s sober, could become highly erratic on cocaine and extremely irritable when not on cocaine. Further complicating matters, he and Livingston bickered a lot while on the road with Fix, at times prompting Wild to schedule them on alternate nights on the panel for fear they would break into an argument while on stage together.

  Somehow, the tour was a success. “Dean was fantastic,” Wild says. “He always got to the show on time, but how he got there was sometimes hell for him. The logistics were crazy. That was an eye-opener,” she says in retrospect, “about how insane this all was, to make a human being go through all that.”

  Along with the chaos of life on the road with an addict, Wild recalls a lot of joy and moments of tenderness, much of which came from having baby Joey along on the trip. Livingston and Wilson were both on welfare, and Wild had barely scraped together enough money to give the film its theatrical release, so they couldn’t afford to leave Joey with a sitter. He attended each screening with them and was asked to remain quiet for the documentary’s ninety-minute duration—not a request with which a toddler will often comply.

  After one or two nights of trying to keep him on her lap, Livingston gave up and let Joey roam free. He would pop up on moviegoers’ laps and crawl up and down the aisles. “It was gross—he would keep eating popcorn [off the floor], but whatever,” Livingston says. “Now Joey’s got a fucking immune system like you can’t believe.”

  Wild is modest about the film’s impact, but Fix had a profound effect on the public debate around harm reduction that was happening right across Canada. In 2004, it won the Canadian equivalent of an Oscar when it received the Genie Award for best documentary. Wilson accepted the award alongside Wild and took the microphone just before the group was ushered off stage.

  “In the words of Nancy Reagan,” he shouted, “just say no—to the war on drugs!”

  The auditorium roared with approving applause.

  Back in Vancouver, Joey was home with his grandmother that night. “That’s my dad on TV!” he cried with excitement.

  42Donald MacPherson, Comprehensive Systems of Care for Drug Users in Switzerland and Frankfurt, Germany (Vancouver, BC: The City of Vancouver, June 1999).

  Chapter 20

  Boston, Massachusetts

  A lot of North American cities have a Downtown Eastside. Vancouver’s low-income neighbourhood might be a little more concentrated than most, and perhaps a lot friendlier to drug users. But there are similar communities in cities across the continent. In Boston, Massachusetts, they call it “Methadone Mile,” or, as Dr Jessie Gaeta prefers, “Recovery Road.”

  “It’s a neighbourhood that has the city’s largest safety-net hospital, called Boston Medical Center, as well as a clustering of shelters and addictions services,” Gaeta explains. “There are about 1,100 shelter beds within a few block radius, two out-patient methadone programs as well as a detox program, Boston Health Care for the Homeless Program’s main hub of activity, and the state’s largest syringe-exchange program. All of these things are clustered in this one section of town.”

  There’s a large population of homeless people who sleep on the streets, intravenous drug use is common, dealers work out in the open, and discarded needles are everywhere. It’s not pretty, but Gaeta, chief medical officer for the Boston Health Care for the Homeless Program (BHCHP), puts a positive spin on it. She notes that so many people with addiction problems are there, roughly centered around the intersection of Albany Street and Massachusetts Avenue, because it’s where there is access to social services, including detox and treatment.

  About five years ago, the situation began to grow more desperate.

  “In 2012, we started to see data showing us, for the first time, that drug-overdose deaths had really replaced HIV and AIDS-related deaths as the number-one cause of death in our patient population,” Gaeta says. “We had been feeling this anecdotally, but it was really striking to see it so starkly in this research. It propelled us to take a critical look at our tactics.”

  Fentanyl had arrived in Massachusetts. According to a research paper later published by the US Department of Health and Human Services, in 2013, the proportion of opioid-related deaths involving fentanyl—a synthetic drug significantly more toxic than heroin—was thirty-two percent. By 2016, that number had increased to seventy-four percent.43

  Fentanyl was driving an overall increase in overdose deaths right across the state. In 2012, there were 742 opioid-related drug-overdose deaths in Massachusetts, then 961 in 2013, 1,361 the following year, 1,793 the year after that, and then an estimated 2,069 in 2016.44

  Each morning, Gaeta parks her car in a lot and then walks two blocks to her office at Boston Health Care for the Homeless Program’s headquarters at 780 Albany Street. Along those two blocks of Methadone Mile, she’s encountered so many overdoses that she’s lost count of the number of times she’s stopped to save someone’s life. “I carry about six doses of Narcan in my bag to and from work because I come upon overdoses so often,” she says.

  At Health Care for the Homeless, staff are trained to respond to overdoses and came to do so regularly. But each one required a mad scramble that badly frayed nerves. “We just had an emergency-response team that would stop everything they were doing and respond to a code blue and resuscitate someone who had injected heroin in our bathroom and then we’d ship them off to the ER,” Gaeta says. “And that was happening between two and five times a week.”

  There were a lot of close calls, it was extremely stressful for everyone involved and, for taxpayers, it was expensive. (An emergency room is an extremely inefficient system for dealing with an overdose.)

  Gaeta realized it was no longer enough to deploy staff to respond to overdoses in the streets or wait to stumble across a body in their bathroom. They needed an entirely new approach. The problem had become so acute that she felt Boston Health Care for the Homeless had to build some form of infrastructure specifically for the purpose of overdose response.

  Directly next door to Boston Health Care for the Homeless Program’s head office is the Access, Harm Reduction, Overdose Prevention, and Education (AHOPE) Boston Needle Exchange. Gaeta began to wander over on her lunch breaks and ask the staff there for new ideas about how the system could respond to the growing drug problem. What they really wanted to do was open a supervised-injection site, Gaeta says. But that would have been illegal. So they got creative.

  “I started to meet and brainstorm with them—the real harm-reduction specialists in our area—and we came up with this idea: We needed a drop-in centre where people could come right after they’d used,” Gaeta continues. “They couldn’t legally come to use, but right after they used, they could.”

  The first speedbump they hit was in finding a location. “We couldn’t convince anybody in the neighbourhood to give us space for this,” Gaeta says. “The only space we had was our conference room just inside the front door of our building, right next to our lobby.” It was the organization’s primary meeting space and staff would miss it. But it had everything they wanted for drug users: it was on the ground floor and easily accessible from the street, it was
large enough to comfortably sit about ten people, and its proximity to the needle exchange meant the target client population was already there in the immediate vicinity.

  Gaeta and her team collected the equipment they needed, which wasn’t much. They gathered a series of reclining chairs, a couple of basic medical devices used to monitor vital signs, and resuscitation supplies including oxygen and naloxone. And they were ready to go. “It’s pretty simple,” Gaeta says. They called it SPOT: the Supportive Place for Observation and Treatment. It opened in April 2016.

  Kate Orlin is a registered nurse and the program’s first director. She says people arrive at SPOT in a variety of ways. Some walk in on their own accord after realizing the drugs they’ve taken are more potent or something different than what they’re used to. Others are carried in by a friend, sometimes half-dragged. There are also outreach workers in the area who use wheelchairs to bring people they’ve found on the street to SPOT.

  “If somebody has used something during the day and they are looking pretty drowsy, we place them in a chair and put a vital-sign machine on them,” Orlin says. “With that, we’re able to monitor their blood pressure, heart rate, and oxygen, and we count their respiratory rate continually. So we watch them there and can do interventions based on what their vitals are doing. They stay as long as they need. If somebody wakes up and is ready to go, we’ll let them go.”