“Then, when Janet’s son died, it really profoundly affected everyone in the market,” Livingston continues. Since fentanyl arrived on Vancouver streets, Livingston is often found with Sarah Blyth, the former PHS staffer who helped set up the New Fountain Shelter and participated in the Rainier Hotel demonstrations. Now Blyth works at the Downtown Eastside’s street market. There she’s taken a lead role in the community’s grassroots response to the overdose epidemic.
“The workers [at the street market] came together and said, ‘We need to do something about this,’” Blyth recounts. “We cannot sit around and have this happen on our watch. We can do something about this, and we don’t have to wait for red tape or the government and bureaucracy. We knew that no one could stop us, because we were doing the right thing.”
On the afternoon of September 21, 2016, Blyth, Livingston, and a third Downtown Eastside activist who also works at the market, Chris Ewart, pitched a tent facing into an alley that runs just south of East Hastings Street. Inside, they set up a semi-circle of tables and chairs. On the right-hand side, they placed a jug from which people could take water to cook their drugs, clean needles and, crucially, a supply of naloxone, the overdose antidote that’s used to reverse the effects of opioids like heroin and fentanyl.
“People were overdosing in the back alley and they would call to us for help,” Blyth says while she’s working a shift at the tent. “So here we witness them and just create an atmosphere that is safe and clean, that is not the alley and not their houses, where they would risk using alone. We’re saying, “It’s better to come and hang out with us here.’”
Twenty-two years had passed since Livingston set up her first unsanctioned injection site, Back Alley, at 356 Powell Street. Drugs were still illegal, users were still marginalized and pushed into the alleys, and Livingston was still stepping in where the government would not.
“No one was going to come and help,” she says. “I felt really frustrated.”
During the winter of 2016, overdoses occurred at the tent and throughout the Downtown Eastside with increasing frequency. There were sixty-one fatal overdoses across BC in September, the month they pitched the tent. Then seventy-four, 137, and then 161 in December. In response, Livingston, Blyth, and Ewart, now calling their group the Overdose Prevention Society, pitched a second tent in an alley one block east of the first one.
“We went from seeing one overdose a day to seeing several overdoses a day to seeing seven overdoses in one day,” Blyth says. “Back to back to back. Just absolute chaos.”
Still operating without any government support—but also without interference—they staffed the two tents with past and present drug users. An online fundraising campaign brought in just enough in donations to pay small stipends. At first the tents saw 100 people inject there each day, then 200, and then 300. There were dozens and then hundreds of overdoses, but every single one was reversed successfully. Nobody died at either site. Livingston describes it as a miracle.
“Two weeks ago, it was an overdose a day or every second day back here,” she said in November 2016. “Then suddenly it was three every day. It’s doubled. You think, ‘It’s so high, it’s not going to get worse.’ Well, it did. Next, it tripled.”
On November 29, the BC Coroners Service confirmed that another synthetic opioid, called carfentanil, was detected near the body of a man who died in East Vancouver two weeks earlier. A news release warned that the drug was significantly more dangerous than fentanyl, describing it as “the most toxic opioid used commercially.”
A newspaper article from December 6 quotes a representative for the coroners service confirming rumours that the city’s morgues were often full. Health authorities were forced to store bodies at funeral homes. Meanwhile, the Overdose Prevention Society’s tents continued to operate outside the law, without government funding or support of any kind.
Everyone who worked there in those months had a story like the one that Blyth and Livingston tell about Tyler, a moment in time when they realized they could no longer do nothing.
At the first of the two tents during those cold months, the volunteer who spent more time there than any other was Lee Tran. At the end of a ten-hour shift on November 23—a Wednesday, when welfare cheques are issued—he sheds some light on what drives the group staffing the tents.
“Previously in my life, once, I was a drug addict,” Tran says. “So I feel what these guys are going through. I know what they need. And I heard about this work, so I felt like this was something I wanted to do.”
As the death toll climbed through November and December, volunteers there took to calling it “the endless winter.” Vancouver’s weather is quite mild compared to the rest of Canada, but the winter of 2016–17 was long and brutal. The unusual cold kept residents of the Downtown Eastside inside their small hotel rooms. There, they often used drugs alone, where no one was around to help them when an overdose occurred.
Across the street from the tent, down one block, and up eight flights of stairs, Jay Slaunwhite sits in the cramped room he lives in on the top floor of the Balmoral Hotel. It’s a private SRO building, one of the very worst in Vancouver, where there are no support services like what’s offered at PHS hotels.
“Narcan here,” reads a sign on his door. “Knock if someone is ODing. Anytime!”
Slaunwhite recounts how he came to function as the run-down hotel’s de facto paramedic. “The first time, someone actually asked me to inject them,” he says. “They knocked on the door, and I did. She only did half of what she had, but still she went under. She was on my bed, not breathing. So [I administered] CPR and naloxone, screaming for someone to call an ambulance. And they came, and that was that.”
It was after that experience that he put the sign up on his door. Since then, Slaunwhite says, people continue to come to him for help. Several times, he adds, someone whose friend had stopped breathing knocked on his door when he was all out of naloxone.
“I don’t have a lot,” Slaunwhite explains. “And more people have come when I didn’t have it than came when I did have it.”
Asked what happened to those people, he replies quietly: “I don’t know.”
Slaunwhite has never been in contact with anybody representing government or even one of the Downtown Eastside’s many nonprofits. He’s simply a former drug user who thought it made sense to let people know he could help. He acknowledges that it might be hard for people who don’t use drugs to understand why other people do, given how dangerous it’s become since fentanyl arrived.
“I hear people talking, like, ‘Why are these people still injecting? Are they just insane? Are they crazy? Are they stupid?’” Slaunwhite says. “That’s like telling someone, ‘You know the air is toxic and if you breathe in, you’re going to die.’ But you still need to breathe, so you’re going to breathe. For a lot of people, that’s what this comes down to.”
Two blocks east of the Balmoral, in an alley behind VANDU’s current headquarters at 380 East Hastings Street, a long-time VANDU member, Hugh Lampkin, emphasizes the extent to which past and present addicts—some of whom also struggle with mental-health issues—have come to play a lead role in the community’s response to the fentanyl crisis.
He recalls an event held on November 15 in which VANDU partnered with Vancouver Coastal Health to educate drug users on overdose response. “I believe we trained about 240 people that day,” Lampkin says.
VANDU also began dispatching foot patrols carrying naloxone through Downtown Eastside alleys. Lampkin estimates that those teams, working twelve hours a day, reverse more than twenty overdoses each month. He notes that it’s a “train the trainers” program, where volunteers instruct the people they meet in the alleys on how to respond when somebody overdoses.
In 2017, fourteen years after Insite opened its doors on the East Hastings 100 block, it operates at capacity, often with lineups for injection booths longer than ten minutes—a long time if you’re dope sick. So people continue to use i
ntravenous drugs in places where they lack the facility’s mindful care provided by nurses.
The situation inside the Portland’s hotels is better than most other places in the Downtown Eastside but has grown increasingly challenging. At the Stanley Hotel and the adjoining New Fountain Shelter, Andy Bond, now the senior director of housing for PHS, and Duncan Higgon, its shelter programs manager, speak openly about how staff are stretched to a breaking point. “Just in the last two days—in fact, in the last thirty-six hours—we have seen eight overdose interventions,” Higgon says. “We are delivering multiple, multiple doses of Narcan, having to use oxygen, and for periods of time that are really difficult.”
Bond says the situation is the same in most of the hotels that PHS operates throughout the Downtown Eastside. “Within our housing [sites], to give an example of just how bad the problem is, we have intervened in over 1,000 overdoses in the last twelve months, just within PHS units of housing,” he says in December 2016. “That is an astronomically, alarmingly high number of overdose interventions. And that is just in housing. That does not include Insite. Everyone is overwhelmed,” Bond adds. “And it doesn’t seem to be getting better. It’s getting worse as we go along.”
Back at the Downtown Eastside street market, Janet Charlie recalls the last time her son Tyler spoke to her. “The last time I’d seen him straight was on Mother’s Day [May 8, 2016],” she says. “He popped in where I was working at the street market. Him and his brother dropped off some chocolates for me on Mother’s Day. That was the last time I’d seen him normal. Then he was back to drinking and selling whatever he was selling.”
Charlie notes that it was only a year earlier that she lost her other son to alcohol poisoning. “Losing two sons in two years is hard,” Charlie says. “I’m saving what I make. I’m saving up for headstones for both my sons. And I’m paying each month out of my welfare cheque. Trying to pay for headstones for both of them.”
Ann Livingston in 2016.
Photo: Travis Lupick / Georgia Straight
In late 2016, BC’s provincial government finally sprang into action. On December 8, the health minister, Terry Lake, convened a press conference in the Downtown Eastside. The epidemic of deaths had prompted Vancouver Coastal Health to dispatch a mobile emergency room to the neighbourhood. Standing in front of the mobile ER, Lake announced that the BC government would sidestep federal drug laws, forego the application process that Insite had wrestled with, and immediately open more than fifteen new “overdose-prevention sites.” These locations would function similar to Insite, he explained, but with fewer complementary health-care services in order to allow for rapid deployment.
Lake told reporters that the drastic action—possibly illegal, he later acknowledged—was inspired by Ann Livingston, Sarah Blyth, and the tent they’d set up in the alley off East Hastings Street. “I woke up yesterday at four o’clock in the morning and was thinking about the pop-up tent,” he told a newspaper that month. “So we pulled the team together quickly. Vancouver Coastal had some plans in place. And so we just expedited everything.
“We can’t wait for federal changes in order to save people’s lives,” Lake continued. “We know people are using in alleys, they are using in their rooms, and they are not where the people who can help them are. And so in the face of this crisis, we really just wanted to do more.”79
Within a week, there were more than a dozen so-called overdose prevention sites established across BC, five of which were in the Downtown Eastside. Government help had finally come.
Since the arrival of fentanyl and carfentanil, there are two very different groups of heroin addicts in the Downtown Eastside. Bernadette is a member of the first.
She describes her life as an endless game of Russian roulette. A half dozen times every twenty-four hours, her physical dependence on opioids, combined with an intense craving for cocaine, forces her to inject unknown substances. “I always do a little amount,” she says. “Because if I use too much, I’m not going to be here to use again. But if I don’t use enough, I can always use more.”
At the Overdose Prevention Society’s injection site in the alley behind the street market, the thin Indigenous woman describes the fear that crept into the community when fentanyl arrived. “Even if I’m buying from the same person, it doesn’t matter,” Bernadette says. “Just because my guy doesn’t fuck with it doesn’t mean the guy that gives it to him doesn’t fuck with it. That’s why they call it a game of Russian roulette … And that’s why I come here,” she continues, looking around at the tent she sits beneath. It’s just a few plastic tables and chairs, but they’re always filled with people injecting or smoking drugs because of the relative safety offered there. If she overdoses, there’s someone around to revive her.
As she prepares a needle, Bernadette says she worries about buying heroin. She knows it probably contains fentanyl. She prays it doesn’t contain carfentanil, the even more dangerous synthetic opioid that health authorities confirmed had reached Vancouver just a few months earlier. “Depending on how it’s mixed, one part can be a lot stronger and the other part a lot weaker,” Bernadette continues. “So every time I get it off my guy, I always test it.”
Repeat overdoses have become a fact of life for members of this group of drug users. Bernadette has had two in recent months. In both instances, a friend used naloxone to bring her back to life. “That’s a nasty drug,” she says of naloxone. “It’s like having the worst hangover that you could possibly imagine. It’s like a whole bunch of bad things happening all at one time. It’s just nasty. You don’t want to experience that … But it is better than dying.”
Because heroin and cocaine are addictive and illegal, government policies of prohibition condemn Bernadette and people like her to find them on the streets. In addition to the chances they take with each injection, they burn through savings and sell possessions to pay for drugs. Many of the women in this group resort to sex work. Every single day is a circular hustle: wake up, get money, find drugs, use them, hopefully don’t overdose, and start the process over again.
Kevin Thompson is a member of Vancouver’s second group of illicit-drug users. His life is very different from Bernadette’s.
Stories of past abuse or neglect are common among heroin addicts. But Thompson took a different road to the Downtown Eastside, one that is similarly shared by a lot of drug-addicted people living there. He started recreationally, using at parties and then more regularly. Eventually, when the cocaine became increasingly difficult to come down off, Thompson began using small amounts of heroin. “I’d snort a line of it, take the edge off, and go home, chill out, and go back to work the next day,” he says. “Then one day I wake up thinking I’m sick and had the flu. That’s the day I knew I was wired,” he continues. “Haven’t stopped using heroin since.”
Despite his addiction, Thompson works forty hours a week at another of the city’s new overdose-prevention sites. It’s located inside one of the Portland’s hotels but open to anyone via an entrance into an alley near the intersection of Main and East Hastings streets. He still uses heroin. But instead of buying from dealers on the street, he gets his drugs from Crosstown Clinic, the only facility in North America that dispenses diacetylmorphine, the medical term for prescription heroin.
Three times a day, Thompson visits the clinic. There, a nurse gives him a specific dose that has been prescribed by a doctor. Then he carries on with his day. Thompson wakes up to an alarm clock and is seldom late for work. He doesn’t nod off on the job. The police never show up looking for him, because it’s been years since he’s committed a crime. “I’m living a normal life,” Thompson says. “Walk next to me and you probably wouldn’t even know that I use drugs. I have a full-time job. I’m a functional addict.”
At Crosstown Clinic, there are virtually no overdoses. The patients enrolled there don’t wake up in a panic each morning not knowing where their next fix is coming from. They don’t need to steal or sell their bodies. The vast majorit
y have found stable housing. They’ve left the street life behind them.
Thompson says he thinks about the first group of addicts every day and almost constantly. In his job at the overdose-prevention site, he has used naloxone to save many of their lives. “It disgusts me, really,” Thompson adds, “that they don’t have this [diacetylmorphine] for everybody else. It should be open to everybody.”
As of May 2017, there were between ninety and 100 people in Vancouver like Thompson: long-time opioid addicts who receive prescription heroin at Crosstown Clinic. Roughly another twenty-five patients receive injection hydromorphone, an opioid better known by the brand name Dilaudid. (These numbers vary slightly as patients move from one category of the program to another and as the occasional client graduates to abstinence.)
The clinic’s operator, Providence Health Care, estimates that the number of drug users in Vancouver for whom prescription heroin is appropriate likely numbers about 500. In 2017, the facility began a renovation so it could squeeze in more patients. But when that work is complete, its maximum client load will still only be between 150 and 200 people.
Vancouver’s prescription-heroin program was originally designed for long-term, severely entrenched addicts who have been on opioids for decades and who have repeatedly tried and failed with more traditional treatments like methadone. The arrival of fentanyl and carfentanil has led some advocates to argue that with BC’s drug supply now so contaminated with dangerous synthetics, the threshold to qualify for prescription heroin should be lowered to allow less-entrenched users to access a relatively safe supply of the drugs to which they’re addicted.
Among them is Vancouver’s old drug-policy czar, Donald MacPherson, who Livingston and Osborn had with them in Oppenheimer Park the day they founded VANDU so many years ago. MacPherson retired from his work with the city in 2009. He works for Simon Fraser University now, where he holds the position of executive director for the Canadian Drug Policy Coalition. Since fentanyl arrived, MacPherson has argued that access to prescription heroin should extend beyond the group of long-time addicts to whom it’s offered today. “With the overdose crisis across North America, why are we withholding a clean pharmaceutical drug from people who are overdosing on toxic, poisonous substances like fentanyl and carfentanil?” he asks. “Why do we not allow people to enter some sort of program where they can acquire a clean pharmaceutical product at a dose that works for them, that doesn’t kill them?”
Fighting for Space Page 39