Vancouver's other pandemic
More are dying from overdoses than COVID-19 right now, and we need long term, preventative solutions alongside harm reduction.
I think I have written draft posts about addiction numerous times and then deleted them all. But in light of this week’s news, that overdoses have continued to spike these past three months, I feel compelled to just buckle down and write this.
I’ve been hesitant because I’m not an expert on addiction. I don’t have medical or psychological education. But it’s hard to walk through Vancouver’s Downtown Eastside - North America’s “drug central” without recognizing that we have a problem.
Since I was a teenager, I have been interested in drug policy, however. Admittedly, part of this was libertarian angst to the tune of “how DARE the government tell anyone what to put in their bodies!”
But I also suspected another form of injustice at play, and that was this: illegality and poverty made drug use more dangerous. Who is more at risk: business executives doing high quality cocaine, or impoverished sex workers on the Downtown Eastside taking drugs likely laced with fentanyl?
As the fentanyl crisis has accelerated, this problem has become harder for any Vancouverite to avoid. For me, I truly woke up to this fact when a family member was put in a coma from a fentanyl overdose. And I realized that honestly, I didn’t know enough. I knew our drug policy was unreasonable, but I never really grasped how our addiction epidemic also comes from the fact that we have failed, as a society, to give traumatized people the resources they need. Mental healthcare is unaffordable and out of reach. The cost of living is high, and poverty is rampant.
After seeing what my family member went through in trying to recover from overdose, addiction, and the disabilities gained from the overdose, I wanted to understand addiction better. I was also working at a job that was trying to improve the lives of at-risk youth in Vancouver, where addiction came up a lot. I had spoken with our City Planners at length about the crisis, trying to get funding for our charity in order to provide mentorship to at-risk youth with higher propensities toward addiction. Already then, I learned a lot.
I also read a few books on addiction and trauma. This one, In the Realm of Hungry Ghosts, by Gabor Maté is a relatively known book in Vancouver and the first one that was recommended to me. It specifically draws from experiences with addiction here. I also read UBC Professor Benjamin Perrin’s book, Overdose, which he wrote after working for the Harper government and realizing its flawed drug policy. This other one that I read, The Body Keeps the Score, by Bessel A. van der Kolk, was more concerned with trauma and how it manifests. All were informative.
These books also confirmed some of my intuitions about suffering and human responses to suffering. In In the Realm of Hungry Ghosts, one part (that I’m about to botch, probably. I don’t have a copy handy) really spoke to me. Maté discusses addictions as a form of relief: drinking water feels more satisfying if you’re dehydrated than if you are not. Analogously, drugs feel better (and more addictive) to people dealing with trauma, because the experienced relief is more intense.
So clearly, it seems like dealing with addiction involves making it so that drugs are not suffering peoples’ only way to manage their pain. While I am critical of mental health care as it is, it is also true that mental healthcare (and medications) are not as available as they could be. Lack of access to extended medical insurance - usually only given to people who are employed in jobs that aren’t contract or gig work - means lack of access both to therapy and medication. And while some great initiatives exist in Vancouver for addicts, we don’t do a lot of preventative work. In schools, when children are educated about drugs, it’s typically through an abstinence approach.
It’s not only that approaches in schools teach that drugs must be avoided at all times for all reasons simply because they’re Bad and You Will Go to Jail. It’s that these lessons are hyperbolic. When I was in the ninth grade, photos on Facebook of my classmates and I consuming alcohol somehow made way to my school principal. He decided we needed to be “educated” on how substances are harmful, and we were taken to see a play about an ex-Hell’s Angel who also happened to be an addict.
The play was extremely hyperbolic, and essentially suggested that if you try pot once you’re definitely going to end up writhing on the floor in pain forever trying to quit smoking crack at some point. So of course, no one took it seriously. Everyone found the play kind of entertaining, but that was about it.
Rarely do we see drug education that is honest and that shows how drug use varies in severity and impact. And more importantly, rarely does drug education exhibit honesty about what underlies drug use. Instead of addressing the deep mental anguish - often exacerbated by social and economic factors - that causes people to use, drug education portrays drug use as merely a product of vice and weakness of will. We are taught to “just say no”, as if the road to addiction is paved by high school students at a party handing you a pill.
But to work on Vancouver’s addiction crisis, we have to move past telling people to just say no or to be careful at parties. We need to deal with the widespread personal anguish that causes people to use to begin with, and that includes eliminating various uncertainties and providing people with the opportunities they need to feel both secure and supported. Trauma-informed healthcare cannot just be a luxury that’s out of reach to the majority of Vancouverites. Housing cannot be a luxury commodity that places significant numbers of Vancouverites in a place of constant insecurity.
That doesn’t even scratch the surface of past histories that need to be rectified. Century-old trauma will not be wiped out with quick solutions, and the predominance of addiction in Canada’s Indigenous communities cannot be overlooked.
It is true that this issue is personal to me, but it is also personal to countless others. Just as we treat COVID-19 as a public health crisis, the overdoses happening in tandem deserve just as much urgent concern.
As I come from a place of politics and not healthcare, my observations and suggestions are:
BC must follow the recommendations of Provincial Health Officer Bonny Henry and decriminalize all drugs. Addiction is not criminal, and criminalizing drug use creates more dangers associated with drug use.
Housing law reform: eliminate arbitrary and unfair evictions that create additional instability for those of lower socioeconomic status.
Expanding healthcare coverage that makes vital health services - be it mental healthcare, pharmacare, or dental care - not depend on extended medical coverage from an employer.
Improving government funded rehabilitation centres to better accommodate both drug recovery and (mental and physical) disability of addicts.
Investing in preventative programs that help youth at-risk of developing substance addictions, such as mentoring programs.
I must reiterate I am not a health expert: this is simply an issue I am close to and that I deeply care about. I believe it is important for Vancouverites to take this crisis seriously. The stakes are too high not to.
Image of Dr. Mark Tyndall by Dan Toulgoet (2020)