Fighting for Space
FIGHTING FOR SPACE
Copyright © 2017 by Travis Lupick
FIRST U.S. EDITION: 2018
All rights reserved. No part of this book may be reproduced in any part by any means—graphic, electronic, or mechanical—without the prior written permission of the publisher, except by a reviewer, who may use brief excerpts in a review, or in the case of photocopying in Canada, a license from Access Copyright.
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Vancouver, BC V6A 1Z6
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The publisher gratefully acknowledges the support of the Canada Council for the Arts and the British Columbia Arts Council for its publishing program, and the Government of Canada, and the Government of British Columbia (through the Book Publishing Tax Credit Program), for its publishing activities.
Chapters 31 and 33 include sections from articles by the author that were previously published: Travis Lupick, “A Community Response: How the Worst Overdose Epidemic in Vancouver’s History Left the Downtown Eastside to Fend for Itself.” Georgia Straight, December 10, 2016. Travis Lupick, “Legal Heroin: As the Fentanyl Crisis Continues, One Vancouver Doctor Moves People out of the Alleys and into a Clinic.” Georgia Straight, March 11, 2017.
Text design by Electra Design Group
Cover design by Oliver McPartlin, cover photo by Amanda Siebert
Edited by Susan Safyan
Library and Archives Canada Cataloguing in Publication:
Lupick, Travis, 1985-, author
Fighting for space: how a group of drug users transformed one city’s struggle with addiction / Travis Lupick.
Issued in print and electronic formats.
ISBN 978-1-55152-713-0 (ebook)
1. Drug addicts—British Columbia—Vancouver—Social conditions. 2. Drug addicts—Health and hygiene—British Columbia—Vancouver. 3. Drug addicts—Civil rights—British Columbia—Vancouver. 4. Drug addicts—Political activity—British Columbia—Vancouver. 5. Drug addicts—Legal status, laws, etc.—British Columbia—Vancouver. 6. Drug addiction—Treatment—British Columbia—Vancouver. 7. Drug addiction—British Columbia—Vancouver—Prevention. 8. Opioid abuse—British Columbia—Vancouver. 9. Drug addiction—British Columbia—Vancouver. I. Title.
HV5840.C32V36 2017362.29’150971133C2017-904038-3
C2017-904039-1
Our governments and police have waged a war on people who use drugs. This book is for their victims; for those in prison, for those whom they have pushed into the shadows, and for those who are no longer with us.
Contents
Introduction
Chapter 1Toledo, Ohio
Chapter 2Hundred Block Rock
Chapter 3A Chance Encounter
Chapter 4Hotel of Last Resort
Chapter 5Rat Park
Chapter 6Growing Up Radical
Chapter 7Back Alley
Chapter 8Miami, Florida
Chapter 9The Killing Fields
Chapter 10A Drug-Users Union
Chapter 11Out of Harm’s Way
Chapter 12From Housing to Harm Reduction
Chapter 13Childhood Trauma and the Science of Addiction
Chapter 14Raleigh, North Carolina
Chapter 15A Drug Dealer Finds Activism
Chapter 16Taking the Fight to City Hall
Chapter 17Building Allies
Chapter 18Rewiring the Brain for Addiction
Chapter 19The Vancouver Agreement
Chapter 20Boston, Massachusetts
Chapter 21The Hair Salon
Chapter 22Establishing Insite
Chapter 23Opening Day
Chapter 24Consequences
Chapter 25Seattle, Washington
Chapter 26Drug Users with a Lawyer
Chapter 27Protests across Canada
Chapter 28Court Battle
Chapter 29Crossing a Line
Chapter 30Sacramento, California
Chapter 31Prescription Heroin
Chapter 32“The Assassination”
Chapter 33Fentanyl Arrives
Epilogue
Acknowledgments
References
Index
Downtown Eastside
Nonprofit Organizational Chart
Harm reduction in Vancouver’s Downtown Eastside
Vancouver Area Network of Drug Users (VANDU)
1Ann Livingston home
2Back Alley injection site
3Dunlevy injection site
4Carrall injection site
5Street Church (VANDU HQ 1)
6LivingRoom Drop-In (VANDU HQ 2)
7VANDU HQ 3
8VANDU HQ 4
9VANDU HQ 5
10Main & Hastings needle exchange
Portland Hotel Society (PHS)
11Liz Evans & Mark Townsend home
12Old Portland Hotel
13New Portland Hotel
14Washington Hotel
Visit fightingforspace.com to view this map online
15Sunrise Hotel (Dean Wilson home)
16Roosevelt Hotel
17New Fountain Shelter / Stanley Hotel
18Rainier Hotel
19Woodward’s Community Housing
20Washington Needle Depot
21Thunder Box injection trailer
22Insite/Onsite
23Drug Users Resource Centre
24Interurban Gallery
Other
25Carnegie Community Centre
26Oppenheimer Park
27Pigeon Park
28Crosstown Clinic
29OPS injection tent
“There are two kinds of people in the Downtown Eastside: the ones that desperately want to leave and the ones who know they’re home.” —Melissa Eror
INTRODUCTION
In a beat-up old hotel, Mark Townsend watched one of his tenants, a woman named Mary Jack, crawl up the stairs, so crippled by the symptoms of withdrawal that she couldn’t lift her body to walk. It was 1992, Townsend recalls, and doctors required a thorough examination and patient history before they would prescribe methadone to someone addicted to drugs.1 Often that took several days.
“How can we make this woman’s life bearable?” he remembers thinking. The rules were wrong, Townsend decided. He found a doctor who put Mary on methadone immediately. They broke the law. That still didn’t solve Mary’s addiction to heroin; she would struggle with that for many years. But they addressed her immediate pain and made her well enough to fight another day.
Like Townsend, activists, health-care workers, and some politicians in cities across North America are realizing that they will have to break and rewrite the rules on how society addresses addiction. The continent is in the grips of an overdose epidemic. In 2016, there were an estimated 64,000 fatal drug overdoses across the United States, up from less than 15,000 twenty years earlier.2 Roughly seventy-five percent of 2016 deaths were attributed to heroin and similar drugs like OxyContin and fentanyl.3 For people under the age of fifty, an overdose associated with an opioid is now the number one cause of death in the United States. Heroin has reached the middle class and suburban America. At the same time, public opinion is turning against the “war on drugs.” Many policymakers are beginning to look at addiction as a health-care issue as opposed to one for the criminal justice system.
One Canadian city has seen this sort of crisis before. In response, a grassroots group of drug addicts waged a political street fight for two decades to transform how Vancouver treats its most marginalized citizens.
Beginning in the early 1990s, activists pushed the city to adopt a “four pillars” approach to addiction. Authorities would continue with the pillars of prevention, treatment, and enforcement
, but also deploy a series of complementary programs described as harm reduction. The city defined it like this: “The principles of harm reduction require that we do no harm to those suffering from substance addiction, and that we focus on the harm caused by problematic substance use, rather than substance use per se.”4
In Vancouver, the municipal government accepted that it could not immediately help every addict stop using drugs. Therefore, for those people who had failed to get clean, or who simply were not ready for that step, it would attempt to make drug use less harmful.
Inherent in harm reduction is an understanding that it is not necessarily the drugs themselves that do the most damage to a user; the laws and systems of prohibition—which make drug procurement and possession illegal—are what hurt people the most. When a person addicted to cocaine injects with a dirty needle, it is not the cocaine that poses a risk of infectious disease but the syringe. So why not make a clean needle available? Yes, the risk of overdose remains, as does the much larger issue of the addiction itself, but the potential harm of an infectious disease is removed. When someone uses heroin in an alley, hurriedly injecting for fear of police, it is not the drug that causes them to rush and miscalculate their dose, possibly leading to an overdose. It is their fear of persecution. If they were offered an injection site where they could take their time and use under the observation of health-care professionals, the risks would be reduced. Again, the addiction remains. But if they overdose at an injection site and a nurse is there to monitor them, they live to make another attempt at long-term treatment.
Harm-reduction strategies are about keeping people alive and as healthy as possible until they can arrive at a place in their life where treatment or abstinence works for them.
Today, there are dozens of cities across North America at the point where Vancouver was in the 1990s. Toledo, Miami, and San Francisco, for example, have sprouted activist groups that are working with health-care professionals to slowly warm public opinion to this issue.
“Ninety percent of new heroin users are white. A rising number are middle class or wealthy,” a US official told Frontline on PBS in 2016. “It’s been true throughout American history that when drugs penetrate into the middle class—the white middle class—politicians panic much more than they do when the drugs are concentrated in poor neighbourhoods. It’s not fair and it’s not right, but that is the kind of country that we are living in.”
Jurisdictions across the United States are looking to Vancouver’s example with increasing interest. One of the founders of Vancouver’s harm-reduction movement, Mark Townsend, spent April 2016 in New York, helping the city expand needle-exchange programs. In October 2016, a delegation from Seattle visited North America’s first supervised-injection facility, Insite, in Vancouver. In early 2017, former BC coroner and mayor Larry Campbell was in Sacramento helping lawmakers draft policies that would allow for the establishment of supervised-injection facilities in California. Interest in Vancouver’s model has grown with the increasing severity of America’s opioid problem.
Fighting for Space is about people who slipped through the cracks. It is about those who have suffered the consequences of addiction and prohibition and who did not have family or friends to help them get back up. It is about those who, for a myriad of reasons, failed with treatment and rehabilitation. It tells their stories and explains harm reduction for communities that are struggling with overflowing jails, crimes fuelled by desperation, and people left in the streets to die.
It’s also about the activist movement that fought for harm reduction in Canada, which came out of a small neighbourhood in Vancouver called the Downtown Eastside. It’s only twenty square blocks and has long held notoriety as the poorest urban neighbourhood in the country. But in the 1990s, its residents banded together to demand a say in drug policy.
They called for harm-reduction services to provide the stability, space, and time that some people need to find treatment services that might help them eventually control their addiction. It’s a simple yet revolutionary idea: that everybody deserves a home regardless of their drug abuse or destructive behaviour, and that an addict is a human being who should be treated with dignity.
Despite officials’ reluctance, a conversation about harm reduction is being forced on North America by an unprecedented increase in opioid addiction and an almost-unfathomable spike in overdose deaths.
1Bruce Alexander, Barry Beyerstein, Teresa MacInnes, “Methadone Treatment in British Columbia: Bad Medicine?” Canadian Medical Association Journal 136 (1987): 25-28.
2“Provisional Counts of Overdose Deaths, as of 8/6/2017” (Atlanta, GA: Centers for Disease Control and Prevention, 2017). https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf
3Josh Katz, “The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years,” New York Times, September 2, 2017.
4“Four Pillars Drug Strategy” (City of Vancouver, 2017). http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx
Chapter 1
Toledo, Ohio
Matt Bell was in a coma for five days. He woke up in a hospital in downtown Toledo, Ohio. Although disoriented, he knew where he was and that he’d overdosed to get there.
“Fuck,” Bell remembers thinking as he opened his eyes. “I messed up again.” It was November 2014.
After another two days at ProMedica Toledo Hospital—while his body learned how to walk again—Bell was ready go home. He grabbed the bag that the hospital had stuffed his possessions into when he arrived, and his girlfriend drove him home. As he was unpacking his things, he found a business card. “Lucas County Sheriff’s Office,” it read. Bell moved to throw it in the trash but then slipped it into his wallet instead.
Bell had been a freshman at the University of Toledo. He’d graduated high school with a straight-A report card and received a full scholarship for baseball. Major League teams, including the Baltimore Orioles and Toronto Blue Jays, were already scouting him. How he found himself waking up from a heroin overdose in a Toledo hospital is a story that will sound very familiar to thousands of opioid addicts across North America today.
“I hurt my shoulder,” Bell begins. “They did surgery, and they gave me ninety Percocets. And that’s all she wrote. I abused Percocets to an extreme,” he continues. “And then somebody introduced me to Oxy[Contin] because those were stronger. And then I started doing Oxy. That became a $400-a-day habit. And then it went to heroin.”
In the eight years between his first time using heroin and the five days he spent in a coma at ProMedica Toledo Hospital, Bell tried and failed at rehab twenty-eight times. He was arrested thirteen times in four different states. He previously overdosed twice. Once he found himself in a back alley, where his dealer had dragged him and left him to die. The second time was at his mother’s house, where Bell woke up covered in vomit. Bell’s third overdose, in November 2014, was the one that came closest to killing him.
There were 2,744 drug-overdose deaths in Ohio that year, placing it among the top five states in America for drug fatalities.5
Twenty-seven hundred deaths is triple the roughly 900 fatal overdoses that Ohio saw one decade earlier, in 2004. Since 2014, the number has continued to climb, to 3,310 in 2015 and then to an estimated 4,000 deaths in 2016.6 In June 2017, NBC News reported that based on deaths during the first five months of the year, Ohio’s Montgomery County coroner predicted the state will see 10,000 fatal overdoses in 2017.7 That’s more than the entire country recorded in any given year during the early-1990s.
The overdose crisis that Ohio is experiencing is part of an epidemic playing out across the United States and Canada. In the 1980s, there were less than 10,000 drug-overdose deaths in America each year. Twenty years later, in the mid-2000s, that number had grown to 30,000. In 2017, it’s projected that America will see some 60,000 people die of a drug overdose, according to a comprehensive analysis by the New York Times.8
The very day that Bell chec
ked himself out of that hospital in downtown Toledo, he was using heroin again. After another nine months on the drug, he put a gun in his mouth.
He was tired of heroin and tired of the hustle it kept him on. Tired of waking up every morning in a panic over where the next fix was coming from, scheming every day for enough money to keep withdrawal at bay. He was tired of being an addict.
Then, with the gun in his mouth, he remembered the card in his wallet.
“I wasn’t even supposed to be around a gun,” Bell remembers thinking. “I had two active felony warrants in two different states. I had drugs and I had paraphernalia. But I called [the sheriff’s office], and they came there and they took me to treatment instead of to jail.”
Bell ended up at Zepf Recovery House, where he spent the next ten days going through detox and then beginning down the road to long-term recovery. At Zepf, he got to know a few guys who were in there for using the same drug, and they grew close. Before each group-therapy session, Bell and these four other men would form a circle, put their hands in the centre, count to three, and then break, raising their hands in the air like a baseball team does before taking the field. “One, two, three—Recovery!” they’d shout. Then they’d get on with their group-therapy session.
“It was a joke,” Bell says. “We were feeling like shit and we were just trying to do anything to make each other feel better.” But the nickname “Team Recovery” stuck.
Society doesn’t make life easy for people coming out of recovery for a drug addiction. Most job applications have a box you have to tick if you’ve ever been convicted of a felony, and a lot of former drug users have. They tick that box and then seldom receive a call back. Meanwhile, a lot of an addict’s friends are often still on drugs, which makes reconnecting with them a bad idea for anybody who’s trying to stay sober. It all makes for a lot of free time. “When we got out, we were bored,” Bell recounts.