fighting for space
(2018) by Travis Lupick (@tlupick)
intro’d via Johann here:
Johann Hari (@johannhari101) tweeted at 2:00 AM on Mon, Oct 29, 2018:
If you liked my book ‘Chasing The Scream’, I recommend this wonderful book by my friend @tlupick It’s the inspiring true story of how a movement of homeless drug users changed Canada’s drug laws – & the world https://t.co/7cHzvebiVf https://t.co/7kRvZdRibI
our govts 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 hose who are no longer with us..t
like (mark) townsend, activists, health care workers, and some politicians in cities across n america are realizing that they will have to break and rewrite the rules of how society addresses addiction.. in 2016 64 000 fatal drug overdoses across the us, up from less than 15 000 20 yrs earlier.. roughly 75% of 2016 deaths were attributed to heroin and similar drugs ie oxycontin and tentany for people under 50, an overdose associated w an opioid is now the number one cause of death in the us..
in vancouver, the municipal govt 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 in which make drug procurement and possession illegal – are what hurt people the most..
when a person addicted to cocaine injects w 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…
when someone uses heroin an alley, hurriedly injection for fear of police.. it is not the drug that causes them to rush and miscalculate their doesss.s. it is their fear of persecution.. if they are 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 fran for ie, have sprouted activist groups tha are working w health care professionals to slowly warm public opinion to this issue
‘90% 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 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’ snot fair an dit’s not right but that is the kind of country that we are living in’
one of the founders of vancouer’s harm reduction movement, mark townsend, spent april 2016 in ny.. helping the city expand needle exchange programs..
fighting for space is about people who slipped thru 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 w treatment and rehab. it tells their stories and explains harm reduction for communities that are struggling w overflowing jails, crimes fueled 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 th downtown eastside.. only 20 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
it’s a simple yet revolutionary idea: that everybody deserves a home regardless of their drug abuse or destructive behaviour, .. t.. and that an addict is a human being who should be treated w dignity..
despite officials’ reluctance, a convo about harm reduction is being forced on n america by an unprecedented increase in opioid addiction and an almost unfathomable spike in overdose deaths
1 – toledo ohio
society doesn’t make life easy for people coming out of recovery for a drug addiction. most job apps have a box to tick if you’ve ever been convicted of a felony and a lot of former drug users have… meanwhile a lot of an addict’s friends are often sill on drugs, which makes reconnecting w them a bad idea for anybody who’s trying to stay sober. it all makes for a lot of free time.
2 – hundred block rock
bud osborn – died may 2014 – johann interviewed him for chasing the scream
(on osborn recounting his childhood traumas) ‘i vowed i would never again be intimate w another human being’
it was a coping mech. if he wasn’t the cause of his parents’ abandonment – if it wasn’t he who had driven his father to suicide and led his mother to leave – that would mean he didn’t matter at all, that he was totally worthless, as if he didn’t even exist. it was better to think that, although he was only 5 yrs old, he’d done something to make them leave. . ‘i hated myself’ .. he remembered
after alcohol came heroin. ‘i felt that i didn’t want to kill myself anymore’ osborn said about his first time injecting the drug. ‘it made me feel like i want to be alive, as long as i could ge more heroin. and also, poetry. poetry helped keep me alive’
ended up in vancouver – downtown eastside 1986 dodging draft.. neighbourhood flush w potent china white heroin
(after describing how lost people were) – osborn felt at home like he never had before..
it’s chaotic.. but embedded in the commotion is a strong community.. there is crime and bad things happen here.. but if a woman is alone and crying on the street, another woman doesn’t have to know her before she’ll offer a hug.. people look out of reach other..
osborn was 39 when he moved into the neighbourhood
1977 documentary down here
osborn maintained that it wasn’t the drug that does the most damage, but rather the criminalization. ‘prohibition has made a nightmare of my life.. i was so screwed up. if i could have had heroin thru those times, thru those years, until i stabilized in some kind of way.. my life would have been very different..
3 – a chance encounter
on relationships of mark townsend and liz evans..
evans: ‘i just wasn’t particularly drawn to looking at people as sick. i didn’t find it a helpful mechanism for helping people’.. t
4 – hotel of last resort
everyone who lived at the portland (the hotel of last resort that she was put in charge of – for mental health) was severely addicted to drugs or alcohol. evans estimates that 95% were injection users.. the common denominator was’ my life is worth shit and i don’t matter’.. made me think about my mum and think’ these are just people in the world who don’t feel like their lives have a right to occupy space’..t
‘i never thought of her (mum) as sick.. i just thought she was a really nice person who was broken and said…. and so i just saw (the portland tenants) as broken and sad. these people are lovely, but they don’t fit. for whatever reason there is no space for them.. they don’t fit anywhere in the world, and the world, to them feels like a very unwelcoming place.’.. t.. inside the portland, she worked to create a sanctuary
(on all the diff ways they adjusted for people – stories on liz’s page)
‘it was never an option to kick somebody out.. it was like.. okay, what can we do to manage this situation.. everybody was a new challenge.. so what new solution did we have to create to make sure that person stayed housed‘ – liz.. t
the primary goal was not to fix people but to give them a space to live in the greatest degree of comfort that the portland could create.. there were a lot of unhappy endings at the hotel, but endings that would have been worse had they occurred on the street
‘i couldn’t fix things. i couldn’t make fred better. i couldn’t fix 40 yrs of chronic alcoholism. bu ti could bring him inside and be kind to him, and i could give him a clean bed. i could check on him every day, and he could have a home’ – liz
townsend reappears 1991
brings needles in.. ‘it scared the living hell out of some of us. it was against the law.. but then you started thinking.. well, who gives as hit about the law.. the law doesn’t give much of a shit about us or our folks.. – demerais
deyas’s pioneering work in harm reduction and specifically needle exchange is worthy of incredible praise but also fair criticism.. limited who could get them
townsend had other ideas.. it became obvious to him and evans that prohibition style drug laws were inflicting as much pain on their tenants as the drugs themselves. townsend esp was highly critical of deyas’s limited needle exchange programs
‘i remember the very first time someone overdosed in the building, there wasn’t a sense that they could tell us.. they would almost rather have died because they were so scared of being caught and getting evicted’ – evans
‘the biggest mistake an intravenous drug user can make is to use alone, behind closed doors.. when evans arrived that was the norm.. from fear of eviction‘..t
building trust and changing that space form a criminalized space to a human space was really complicated.. it first meant you had to explain to people that you weren’t judging who they were in the world, that you didn’t actually give a shit about their drug use, and that you just wanted to be there for them’ – liz
at the portland they had a room where they could be themselves, however difficult a person that might be
5 – rat park
on bruce getting into this via requirement to teach course nobody else wanted to teach – social issues (heroin) which took him to eastside.. in 78 published paper on results of their rat park experiments.. to test skinner’s thinking.. ‘housing conditions appear to play an important role in determining morphine self administration’..t
‘it didn’t matter if they were tasting it for the first time or going thru withdrawal symptoms.. the more time you have in rat park, the less you like to drink morphine..t
no response and/or hostile response.. from all but a few like ie: david suzuki
in 1984 an inspector paid a visit to rat park.. said not enough ventilation for th e rates.. so closed it down.. shortly after opened as a counseling centre for students. ‘with same ventilation system’ alexander notes..
natural next step .. experiment w humans.. of course, recreating the sort of condition for people the rats had endured wasn’t possible..t
the researchers could not confine humans in a monitored paradise where they had access to all the opiates they could ever desire..t
and they certainly could not sequester other humans in solitary confinement w a powerful drug as their only way to make the experience less torturous
alexander decided to look at history.. found first nations.. had little indication there was anything like addiction prior to the culture being destroyed and people being forced onto reserves.. after colonization , addictions, primarily to alcohol but also to other drugs, spread on reserves w the ferocity of smallpox outbreaks
‘their culture had been completely broken down.. their traditional ties to the land and sea and nature and everything else had been destroyed and they had been put into these little reserves. they weren’t in solitary confinement or cages, but they were so far from a natural situation for those people that it seems it was close enough..’ – bruce
‘and when you do that experiment which has been done all over the world.. not as an experiment but as colonization you find that the results are consistent’ – bruce
he recalls a visit to fort ware.. in n british columbia.. before colonial settlers dammed the peace river.. the people of ft ware lived in a river valley there..
bruce: ‘all of their tribal territory and all of their history is under water now. they were devastated. and now it si one of these places where you can say there is 100% alcoholism. that is one of the places where i asked, ‘tell me about addiction before you guys were colonized’.. no answer ever came.. that natural experiment is as good an experiment as any you could ever design’
he found 2nd ie in indigenous of bc…. june 71 nixon’s drug czar, jerome jaffe travelled to vietnam to assess concerns about heroin becoming a problem among young american soldiers.. nearly 40% tested positive..
‘nixon warned of incredible disaster because these hordes of addicts were about to return to us.. this was going to be an overwhelming wave of addiction. but it never happened’ – bruce
rejected results.. but alexander was fascinated..
‘their addiction was very much environmentally determined’ alexander says today.. in name lived in terrible conditions.. addiction rate went way up.. got back to comfort of being state side.. it didn’t remain up
‘people need to have a place in their community/family/world.. they have to feel connected.. and when not.. turns out addiction is wonderfully engaging thing’ – bruce
‘the diff between people and rats is, w rats , you can see the cage, and w people, you can’t always see the cage. you have to look for them carefully, and that’s what i’ve been doing for a few decades’ – bruce..t
whales in sea world as caged..
undisturbed ecosystem as next experiment
mark townsend -‘rat park was a very big deal for us’..t
indeed.. us too – ie: findings abstract
6 – growing up radical
(ann livingston history)
livingston took the lesson to heart (mother giving up her bed for drunk woman).. an entire lifetime later, at her apt at the four sister’s co-op, neighbours repeatedly reprimanded her for brining homeless people in off the street and allowing them to crash on her couch for night or two or sometimes for much longer..t.. ‘it’s just being neighbourly really’ livingston says..
among the lessons dorothy instilled in livingston when she was still just a child was a reminder that people can break the rules and should do so when a rule is unjust.. t
(her mother) was a professional w a degree who was mild mannered, a lay chaplain in the unitarian church and respected in the neighbourhood’.. that she would be defying the law to the extent that the police were tapping our telephone, that was really startling’
it prompted the entire family, including 13 yr old livingston, to grow acutely aware of state power and understand that not every exercise of authority is an application of justice..
my mother’s approach was ‘if there is a problem, let’s solve the problem and if the law is in he way, we’ll deal w that.. you can ignore the law and do what needs to be done
livingston and evans meet – never best friends.. liz found ann difficult to work with – an opinion shared by many – and ann never particularly liked mark .. but both recall an immediate sense of mutual respect and admiration for one another.. they quickly found they could work together on a shared cause..
7 – back alley
(larry campbell – 1981) ‘leaving the police and then becoming a coroner and moving from enforcement to just trying to keep people alive.. that was when the light went on.. realizing that many of the people who are involved in drugs are, basically, self medicating.. coming to realization .. that this was a medical problem that we were dealing w as if it was a criminal problem’.. saw rise in heroin overdoses.. mid 80s handful by 1993 354.. ‘sense of panic in eastside very palpable’
larry meets liz and bud – bud telling him injection sites ‘not some weird out there idea.. because it’s about health care’ larry: ‘bud had huge huge influence on me.. i can’t think of anything that was more important to me than what he told me that day’
Campbell’s two main projects in office were the Woodward’s building redevelopment designed by architect Gregory Henriquez and the establishment of a safe injection site to help curb Vancouver’s injection drug problem.
eror remember the day back alley closed.. 1996, ‘it was a really good place, but there were a lot of flaws.. *we learned a lot. it’s too bad those lessons often didn’t end up going into effect’ –
must take back control of own lives..
*resonations w findings abstract ness
8 – miami florida
2009 hansel tookes decides he’s going to establish a needle exchange in florida.. influenced by san fran’s work.. 2016.. finally opened state’s first needle exchange..
beginning in 2010 – tookes and his um classmates conducted hundreds of interviews on streets in miama.. found 95% of intravenous drug users admitted to discarding used needles on street..
found that drug use related infections cost jackson memorial hospital in miami more than 11 million ever year
had to change state law which prohibited giving a syringe to somebody if knew they would use to inject drugs.. took 4 years.. but then law was changed just for him and only for 5 yrs
at time miami highest in us for hiv infections
at same time opioid crisis struck.. in 2013 2474 drug overdose deaths in florida.. next year.. 2634 then 3228 .. then 4000 in 2016.. on may 3 2017 governor rick scott declared opioid epidemic a public health emergency..
program was still huge controversy.. police did not receive program well – they arrested everybody – ti was very bad.. so idea exchange distributed needles w a card that explained the program.. plus a statement saying whoever is in possession of the card is not breaking the law by carrying a needle, even if officer finds evidence they plan to use it to inject drugs.. but some officers did not respond well to drug users claiming they knew the law better than police.. .. pulling syringes off people and throwing cards into gutter.. ‘we lost a lot of people coming into our program at first because of that’
so launched ed for police.. to their credit.. says tookes.. most of them came around quickly.. .. narcotics officers did the most to facil the shift in attitudes.. they understood addiction and benefits of harm reduction programs like needle exchange.. ‘cops ended up being a huge ally.. just took a while’ – tookes
9 – the killing fields
on osborn first noticing livingston – when she’s at the dera meeting.. while an entire room attacked her, she didn’t attack back. ‘i remember she said ‘i hope whatever comes out of this will strengthen the community and be for the benefit of the community’ she was the only one that had the community in her mind.. i was very impressed that she did.. and so , that was the first time that i really really saw ann’ – osburn
then in 1996 two bump into each other – he already knew townsend and evans
then bud (and all) – we have to do something.. ie: evans remembers so intense that ‘some mornings she would vomit on her walks to work.. .. really anxious about what i was going to come across each day.. i was literally walking to work passing blue bodies in the stairwell every day’
on top of it all, they felt alone, as if nobody outside the downtown eastside was even ware of how many people were dying.. ‘decided to create giant banner in red and stretch it across the intersection of main and hastings and call the neighbourhood the ‘killing fields’.. and get 1000 crosses and build one for each person who had died in the last five years from drugs’ – liz.. specific to attention of city’s journalists..
townsend gets 500 copies of fed govt papers on hiv/aids in canada from the year before that no one had paid attention to .. and burn them on same corner.. ‘there are all these reports that gather dust on govt shelves while nothing happens’ – townsend
july 15 1997 – 200 gather at intersections.. fire burns.. chains to close intersection
liz evans first time in a public demo.. she recalls feeling guilty..ie: people late to work ‘they would roll down windows and i would shove pamphlets into car saying ‘i’m so sorry to bother you but did you know people are dying’
marched 3 blocks to openheimer park (a square block of green space in eastside that for decades has served as a living room for people who don’t have a home – baseball diamond.. shuffle board.. chess.. ), where group had worked since before sunrise, banging their 1000 crosses into the ground
‘people started to write name on the crosses.. which is something we hadn’t really thought of .. it was emotional and very upsetting’ – townsend
bud reads poem: ‘these 1000 crosses rep the overdose deaths of drug addicts.. who are not the only drug addicts in our society.. but only the most visible the most naked because the poorest.. there 1000 crosses reveal a culture.. pretending to be about life and health and hope but permeated w death and disease and despair..’
reflecting on that day more than a decade later, evans described it in a letter to friends as a ‘turning point a point when people began to ask questions about what was going on.. turning point at which people began to see that those images of people w needles in their arms were people who were suffering.. alongside families/communities who were suffering’
w killing fields protest.. osborn and livingston and portland’s management team finally grabbed public’s attention.. among those.. libby davies.. parliament
davies and osborn had been friends for years.. grown very close throughout 1996.. eriksen (her partner 25 yrs older than her) was mostly bedridden.. osborn visited often.. asking questions about eriksen’s work as an activist.. eager to learn what organising was about and how it happened..
when davies ran for office in 97 bud came canvassing w me.. he thought it was hilarious that he was out doing political canvassing’
so protest day – same year – davies looked across the field of crosses to see osborn reciting poem.. ‘it propelled me to ottawa.. i knew what i had to do.. i didn’t have a clue how i was going to do it.. i just knew i had to make this a critical issue..my constituents were dying and these were preventable deaths ‘ – davies
she (davies) took his (osborns) words (the ones i quote from p 111) to house of commons..
the seat john turvey secured for osborn on health board might sound minor but was in face unprecedented.. for first time seat gave someone who was open about an addiction to drugs a saw in how govt sent its money on addiction services.. but osborn didn’t know how to use the position to turn the needs of the eastside into policies that would address them. davies continue the lessons in activism that her partner had started w osborn the year before he passed..
‘when he was on the board, it just about drove him mad.. my job w him was to give him patience.. how to work it on the inside, how to figure out who your allies are.. who your obstacles are.. and how to work the system.. he was very frustrated so my first job was to help him keep the faith..’ – davies on osborn
at one meeting – osborn – called what was happening a ‘genocide’ and one for which he blamed the very people to whom he was speaking.. ‘the production of this epidemic can be found in the near criminal neglect and abandonment of our poorest and most afflicted citizens by all 3 levels of govt’
osborn goes to library.. gets defn of emergency.. davies helps him present to board that this was a public health emergency.. passes.. ‘declaring a public health emergency really ran an alarm and it caught a lot of media.. and i felt that the health board would have to then explain to people what a public health emergency is or define it. well, that isn’t what they did at all.. they didn’t do anything’ – bud
davies recalls osborn’s intense anger.. she said ‘getting it thru was one thing; giving it meaning and having action taken is a totally diff thing’
after another year of people dying.. able to hold the declaration up and say to govt ‘ a public emergency has been declared..we need you to respond’ davies describes it as ‘pivotal’ – thanks to bud
10 – a drug users union
(on informal meeting bud and ann had).. ann: ‘it was just me and bud, and we had a big piece of paper and i made notes.. it wasn’t that it was massively well attended. but i wrote down everything people said, and they could see me writing down what they were saying’.. that alone had a huge impact.. drug users were speaking and somebody was listening..t
livingston drafted a second poster.. ‘where can users go?.. how do users feel about having no place to go, nowhere to wash, inadequate detox, constant police harassment and no one who cares?’
alleyne (who became ann’s righthand man) on ann ‘she put so much trust in people’
about a year before osborn passed, johann hari asked him if, after nearly 3 decades of activism he could name a high point. ‘the highest moment was the org if vandu.. i would never in my life.. have believed .. a whole bunch of low bottom drug addicts from the worst places could come together as an org and accomplish something’
11 – out of harm’s way
portland hotel society was founded in 1991 under dera (downtown eastside residents assoc) – even though there was this tension.. dera seeking portland as dragging them thru mud.. just didn’t get what they were doing
liz: ‘there was a very deliberate decision on our part, that we made in the early 90s, when we started, that we would not talk out loud about what we were doing, because we worried it would jeopardize our ability to house people’..t
it was time for evans and the portland hotel to go off on their own.. she approached green and explained..’this is about protecting a more radical space that doesn’t really exist anywhere else.. in order to make sure we don’t water down what this is, we feel that we need to have a society created to protect what the portland is doing’.. green (head of dera) gave them his blessing
so 1993.. evans, stuerzbecher and townsend draft a constitution for portland hotel society .. stated purpose would be to provide housing and support for people that no one else would house.. would not push people into treatment..allowing each person to determine for selves the time, place, course, and method of therapeutic treatment chosen if any.. the constitution closes w an eviction clause: ‘the portland hotel society endeavors to find an alt to eviction in each and every situation… this clause is unalterable..‘t
on getting best architect to build new space (old portland hotel beyond help).. arthur erickson.. ‘instead of treating people like bedlam (psych hospital) patients.. in deplorable conditions.. we’ll have arthur design the building’ – townsend
so get him to on half budget.. took 10 yrs.. then in 1998 province purchased a number of old sro hotels in eastside.. similar to portland.. phs applied and got two (worst) of them.. so 1\ new portland 2\ sunrise (today called irving) and washington (today called ample)..
standing joke was phs employment program for out of work musicians
hold conference in oppenheimer park.. w global experts.. german, switzerland.. and bruce alexander.. to help people understand injection sites.. so that people who had to make decisions would listen.. to show vancouver that so called serious people – a judge, a police officer, drs, and lawyers – were talking about harm reduction..
plan was for 200 maybe 300 to attend.. 800 showed up.. lasted all day.. all of a sudden these totally radical and crazy ideas were no longer crazy or radical.. they were things that other people had done.. t
as killing fields protest caught libby davies.. out of harms way conference caught philip own.. mayor..
great day w (sad) postscript – angel jardine.. 28.. helped w day.. went missing.. police report next day nov 11.. police didn’t open file until dec 6.. dna found on a farm in vancouver’s neighbouring city.. property owner robert pickton confessed to murdering 49 women there.. vast majority of whom were taken from eastside during 80s and 90s..
shortly after conference.. portland picked up its 5th/final founding member: dan small.. didn’t join full time till 98 but history w org began in 92..
was student of bruce alexander.. ‘i though the was crazy.. i thought drugs were inherently addictive’ – small.. he made it clear that he intended to disprove alexander’s work on addiction.. to which the professor replied: ‘why don’t you become my honours student?’
‘i spend every ounce of my being as a young undergrad writing an honours thesis to prove his theory wrong.. but i didn’t succeed.. i started to have questions.. then i realized that bruce was right but actually *hadn’t gone far enough’ – small..t
*did dan go further..? (emailed him)
undisturbed ecosystem – rat park for people
small gets phd.. then evans and townsend call him to eastside.. to work with what they described as a ‘drug user union’..
12 – from housing to harm reduction
(on all employees being users ish).. culbertson: ‘all of the weird things id’ picked up thru my dysfunctional upbringing completely applied to this unique scenario.. i realized i had the skills to be in this really chaotic, fucked up workplace. it was like magic for me’
‘the bathrooms became one of the prototypes for what a safe injection site would be.. we learned a lot there’ – mccurdy
today, townsend says he consider the thunder box (bathroom that became injection site).. a major step toward the founding of insite.. n america’s first sanctioned supervised injection facility.. which phs would establish a few years later in 2003
13 – childhood trauma and the science of addiction
gabor maté did a poor job following the rules.. ‘the thing about me and medicine was.. i was always uninterested in rules.. i didn’t regard them as the ultimate guides to anything’
ie: wouldn’t document .. so removed from vancouver general hospital in his position as its medical coordinator of r palliative care.. a few weeks later, he received a call from liz evans.. maté: ‘i dont think she knew very much about me.. and then i was hired.. not that i think there were too many others breaking down the door’..
evans recalls she actually did know quite a bit about maté.. it wasn’t random.. we head hunted him.. i knew he would be somebody who would be willing to go out on a limb’..
evans did not know that maté had just been fired.. his reviews: ‘difficult to work with, opinionated headstrong arrogant thought highly of himself and didn’t listen to advice.. he got lots of negative. but i knew that the negatives meant that he would fight the system’ – liz
of Gabor Maté
evans describes bringing this sort of like minded group together as something that occurred naturally ‘i think on reflection i never really felt like a misfit.. but i clearly was one. i identified very strongly w other people who didn’t fit in’ this became the portland’s unique advantage
for me and mark and kerstin, a lot of the other things we’d done in psychiatry had felt off base – overly controlling or coercive.. robbing people of their individual rights and freedoms.. what the portland rep’d for all of us in the beginning was an opp to not be controlling/coercive.. and to leave people to be human beings first’ – liz
now maté joined them..
‘i walked into this grungy hotel that had fallen upon hard times at some point -faded elegance.. there are all these people and a hubbub, people scrambling around. i felt right at home’ – gabor
he was given a small office on the 2nd floor and the freedom to treat patients as he saw fit. from there, a new care model for addiction began to take shape and eventually a new understanding of addiction itself ‘we saw the addiction not as characterizing the person but as a coping mech.. and underneath there was a very sensitive or creative, interesting human being, who had just suffered so much that the addiction became their way of coping’ – gabor.. t
expanding on the defn of an addiction beyond biological terms.. maté says he began to see it as a ‘normal response to an abnormal situation’ as a coping mech for trauma, and for the life time effects of childhood trauma..t
maté breaks from the story to quote.. a h almaas (pen name for hameed ali).. ‘the child is very open and can feel the pain and suffering going on in its immediate environ.. the child is aware of his own body and can also feel the tension rigidity and pain in the body of the mother or of anyone else he is with.. if the mother is suffering the baby suffers too. the pain never gets discharged.’
almaas holes law – never discharged.. but we can refill the holes..
‘you make them afraid, you make them live outside the law, you ostracize them and you demean them.. that is a great way to create stress in people..it’s a great way to keep them mired in addiction’ – maté..t
‘most institutions try and fit the clients and everything into a process of a set of top down priorities.. whereas liz began w a simple question: what do these people need? what’s actually required
in better world.. only question would be ‘what are you curiosities.. today.
liz and mark same way.. not that they are rule breakers.. they created new rules..
maté: liz began w simple questions ‘what do people need.. what’s actually required’..t
14 – raleigh, n carolina
(on illegal needles.. to legal ones)
15 – a drug dealer finds activism
dean wilson (first injected heroin at age 12 with his brother): ‘i turned to him and said ‘i feel normal for the first time’.. i thought that was kind of an odd thing for a 12 yr old to say’..t
dan small moves wilson to portlands’ sunrise hotel.. he became a headache for staff and esp dan
wilson on meeting the 16 yr old pregnant on her bday (when her dad would pass her around to her uncles).. as credit to the beginning of the end of his days as a drug dealer… ‘this has got to change.. people in my position don’t realize how lucky we are..i was articulate, educated, white.. all these things come into play. then you come down here and you really start to get to know some people.. and you go..’how the f-k did they survive’.. i started thinking somebody has got to fight on behalf of these people.. ‘ (he was then president of vandu)
‘ann turned us all into a bunch of epidemiologists.. that’s one of the things that ann did that was really important’ – wilson
epidemiologists study patterns of frequency and the causes and effects of diseases in human populations. Epidemiology provides the scientific footings for evidence-based medicine and allows placement of strategies for improvement in public health.
16 – taking the fight to city hall
1977 killing fields 1000 crosses to 2000 .. 2000 crosses..
mayor – philip owen succumbs to community pressure to withhold funding.. vandu’s bryan alleyne did math on how many addicts owen’s spending ban would kill… 3 months moratorium on harm reduction measure is equal to 90 drug overdose deaths..’
he and wilson went up to city hall and took over..
ann’s advice to them (van of them w some of the crosses) ‘go easy on the mayor.. he’s in a tough place, but he is an ally.. don’t yell.. don’t do anything that could be attributed as violent.. protect the mayor.. listen to the mayor.. . he is an ally who is in a really difficult position’
all go into council meeting w coffin.. mayor says to wilson.. you have 5 min to speak and then please leave..
wilson ‘ .. one a day is dying.. and if one of you were dying every day.. every morning you woke up and there was one less person working at city hall – i’ll tell you that problem would be solved in two minutes..t.. end the moratorium is all we ask.. and then do something’
then they left.. and the mayor was impressed and said ‘i can work w that guy’
ann ‘if you watched closely you could see that philip owen was on our side.. ‘
seems to always be the way with mayors.. until they succumb to pressure
one week later.. council lifted moratorium on new services for drug users.. just 5 wks into the 90 days it was issued..
‘vandu was a bunch of street entrenched addicts rounded up by this naive, young, socialist type woman who thought something could be done w them.. she amalgamated them into this little force’ – wilson on ann
17 – building allies
gregory – getting a diagnosis of bipolar and his family got a getter understanding of the cause.. 20% of people w mental illness also struggle w concurrent substance disorder..
just read about nic today.. and his family and him.. being a bit relieved when he got his diagnosis.. wondering if that’s a good thing..? i don’t know..
rob ruttan: ‘there’s a very fine line between enabling and doing what you can to support your child, just to keep him alive’..t
simin tabrizi: ‘when parents are scared every hour of the day – scared they’re going to find their kid at the morgue – they understand the idea of a safe injection rooms...t
ruttans stat – from grief to action – (mostly wealthy people) – in church basement – bud tells them it’s helpful because people see it can be anyone
they hold a 4 day conference – rob ruttan one of speakers.. by end ann so upset.. she hadn’t learned anything new.. stands and says.. i’m opening a supervised injection site.. if interested put your name on this clipboard.. a bunch of people signed up.. parents of young drug addicts from rich west side and all downtown eastside people..
called themselves harm reduction action society haras.. now a group of stakeholders that reached far beyond the eastside..
ann and bud on and off.. ann and dean on and off.. liz and mark two babies and move the hotel.. not each room has toilet and shower.. highest bill in province that month
rossiter arrives.. not an addict.. just wants a room.. ends up sharing liz’s mom.. liz find it amusing as her mom was never that present in her life.. but it works for them.. she adds
18 – rewiring the brain for addiction
marc lewis: bio of desire: why addiction is not a disease..
while bruce alexander’s work on addiction focuses on the environ, and gabor maté’s explains the significant role that childhood trauma can play.. 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 w drugs can lead to repeat use, at which point the brain will begin to change..
i’m thinking the *explanation has more to do w almaas holes law – than habits forming (at a deeper level anyway)
i question that **inclination.. i think seemingly privileged people have just as many holes.. ie: look at suicides.. no favoritism there.. it’s the missing pieces of authenticity and attachment.. let’s go that deep..
this is huge because we keep looking for reasons for diff types of people.. we have to get to reasons for all of humanity.. so we can focus on that.. ie: 2 needs.. deep enough that 7bn would resonate w it today
bruce – rat park law
Marc David Lewis (born 1951) is a developmental neuroscientist known for dynamic systems approaches to understanding the development of emotions and personality. He is currently a professor at the Radboud University in Nijmegen in the Netherlands.
Lewis developed an integrated account of development as self-organization at multiple time scales to explain both the stability and change of emotional aspects of personality.
He has also co-authored two books with his wife, Dr. Isabela Granic. ..The second is a guide for parents about when to attempt sleep training with toddlers.
Infant sleep training refers to a number of different regimens parents employ to adjust their child’s sleep behaviors.
oy.. see this is what happens when we can’t trust us enough.. to just be.. (ie: have to have a reason why privileged people could get addicted.. rather than that they are human).. we don’t trust children/rhythm
perry sleep law et al
lewis: ‘when patterns start to form, they perpetuate themselves. the process is called self org.. it’s a feedback cycle .. bu ti’s a feedback cycle that takes on a history. i.. for a period of hours..days.. weeks.. but over months and years it takes on the shape of a trajectory.. a personality pattern.. it becomes dug in over time so that it becomes increasingly difficult to alter’
the provocative subtitle – why addiction is not a disease, is meant to emphasize the extent to which the changes in brain that occur w a drug addiction also occur as a result of healthy activities, such as exercising
this sounds like gabor.. addiction.. not a disease..
‘to say that addiction changes the brain is really just saying that some powerful experience, probably occurring over and over, forges new synaptic configuration that settles into habits’ – from the book
lewis describes the bottom line like this: ‘drug use is always a choice to begin with. an addiction is less of a choice’
lewis struggled w addiction himself.. he remained a functional addict and his book focuses on people like him: middle class professionals and uni students who struggle w very real addiction but who did not fall all the way into a life on the street
wow.. that has nothing to do with the brain.. that just has to do with money/privilege
he admits he was shocked by what he saw in the eastside
again.. just like people living in same neighborhood as homeless with no clue there are homeless people.. of course there’s shock when you find out.. bottom line.. we’re all the same.. all human.. we don’t need diff reasons.. other than that.. for whatever reason.. we’re missing a&a.. maté basic needs law
19 – the vancouver agreement
20 – boston, massachusetts
21 – the hair salon
22 – establishing insite
bud and dean worked on drug issue at fed level.. then after fix documentary.. philip own and larry campbell became more involved… (2002?)
about wilson and livingston and owen ..
meanwhile libby davies.. had been laying groundwork w osborn since the late 1990s
23 – opening day
heather hay: eventually i realized that harm reduction gives us an opportunity to keep people alive, to give them time‘..t
incite opens sept 2003
evans: ‘it can be hard for people to understand that safety isn’t about security guards or bars on windows.. safety is really about knowing people, having relationships, and an understanding about what somebody is going thru’..t
on safey: gershenfeld something else law
on knowing ness: 2 needs
24 – consequences
25 – seattle, washington
26 – drug users w a lawyer
27 – protests across canada
there was so much uncontested science and that insite had been so rigorously studied for a number of years was extremely powerful
god i hope
‘our case was that this law was actually contributing to the very harm and evil it was designed to prevent.. t this law was forcing people into the back alleys, where the evidence was that they were using puddle water to inject. so law was instrumental in actually causing death… in causing spread of hiv and hep c and all that.. ‘ – arvay
they win case.. conclusions: 1\ addiction is an illness 2\ heroin and cocaine don’t cause hep c or hiv aids.. rather .. unsanitary equip/techniques do 3\ risk ameliorated by injection in presence of health professionals
28 – court battle
vandu’s lawyer john conroy: ‘we were pleased to see.. insite would be kept open.. but we were disappointed that they didn’t see that the real problem was not inside insite, but outside insite. and that it was going to continue to be a problem until that was addressed’
29 – crossing a line
in 1991 the downtown eastside residents assoc gave liz evans 10 rooms to look after inside a beat up old building on east hastings street called the portland hotel
in 2013, phs community services society received more than 20 million annually in govt funding, operated w an additional 7 mn revenue and controlled more than 59 million in assets..
phs management team oversaw staff of more than 300 people.. evans and the org ran 15 social housing building in eastside.. providing care for more than 1 000 tenants. w mental health and addiction issues.. there were another 17 contracts phs had w health authority,.. the portland rand a bank, a half dozen commercial enterprises.. and insite..
when it came to social housing, phs had become the establishment it had always sought to reject.. in may ways it operated as an arm of the govt. but it didn’t act like it
the govt had come to call phs ‘low barrier’.. it was the bureaucracy’s term for the portland’s willingness to house drug users and people w mental illness and to not evict them when they exhibited symptoms associated w those issues.. what andy bond and kailin see envisioned for the new fountain would be ‘no barrier’
see: ‘we were trying to create a shelter for people who had been kicked out of every other shelter and banned from every other building’.. many homeless hate shelter even more than they do no shelter at all.. some can’t deal w rules.. no shopping carts inside.. no couples sleeping together, no smoking ..et al.. see and bond wanted to create a space where these people felt comfortable..
ended up being quite a bit younger on average.. and choice of drug was meth or crystal meth.. created a ticketed valet system..for shopping carts et al.. could sleep together.. could smoke.. nothing else like it.. people got to return to same bed each night.. even ended up taking some to france and brazil for annual soccer tournament – homeless world cup.. then bc housing discontinued funding for new fountain..
get funding extended for new fountain but via a loud protest.. so bc housing not pleased..
rainier shelter for women – no list of to do’s.. rather.. what do you need – after 3 years.. phs manager were point to the rainier as one of the fav success stories.. but health authority disagreed and took issue..
see and 40 women protest just standing in hall way .. wearing white masks
evans (to craig crawford bd housing vp of operations anger at the women intimidated and threatening and upsetting the govt people at the protest – who walked by the 40 masked women ..ignoring them): ‘you’re telling me that the same women who every day are at risk of being raped, killed, or violated whose lives are not seen and who people don’t care about at all, that they are intimidating to bureaucrats?’
dan small telling of townsend’s (leader of phs) anger getting in the way..
vancouver coastal health: ‘the manner in which this is occurring is completely unacceptable and undermines the credibility and sustainability of phs as a service delivery partner to vch.. the protest activities have become increasingly disruptive, invasive, and aggressive to the extent that vch must re eval being associated w such an org’
the letter states that these disruptions included ‘intimidating and harassing vch staff and clients. many have become fearful of coming to work and at least one has had to take sick leave because of the tactics being used as part of the protest activities.. while this may be seen as a victory for some in your org, we consider this to be an *intolerable situation‘
i get it.. i’m anti being mean to people.. but dang.. who’s in the *intolerable situation..?
bubbles ..keeping us from us
dan appointed to replace townsend as point of contact w vhs
letter ends w warning: ‘we will be closely monitoring any further protests.. and will take all necessary steps to ensure our staff and clients are *made to feel safe and supported when they come to work or to receive the clinical care they need’
nationality: human.. has to be all of us
in spite of warning.. phs did not stop
townsend – ‘it’s not like for the sake of it.. we had made a commitment to the women at the rainier.. we weren’t going to renege on that
protest.. 5 days after letter.. some 200 carried black coffins.. dressed like grim reaper.. most of rainier’s tenants themselves walked.. a powerful sight given that some of them were in frail health.. they called it a ‘funeral procession’ the message – cut funding for the rainier and you are killing women.
upon arriving at vch, small, dressed in a suit, walked into the building and present a cake and basket of cookies ‘we’re not going to come into the building, there’s nothing to be worried about.. this is an upsetting thing, but it’s about your boss’..
then as protest moved on to another location.. got more out of control
another letter from vhs – they no longer provided funding for the services at rainier.. the building remained under control of phs and the women who lived there got to keep their rooms.. but the programs phs had fought for were cut.
kerstin acknowledged that phs had initiated a shift in its relationship w authorities.. ‘we had started to use tactics that i think the govt took personal.. we did things that were more direct.. our strategy did change, and i think that that had consequences’
again.. i see that.. but wtf.. abuse/neglect is going on..
this is why ie: costello screen service law (unethical to fight/insist/diagnose.. when no real mech is in place for a solution.. an alternative for all of us) is so key.. and why this systemic illness begs a reset/leap
‘i felt devastated .. i felt i’d let the women down’ – townsend..
phs lost the battle and, though it would take a while before they realized it, it had also cost them the war
30 – sacramento, california
othersite (not real name.. location unknown)..injection site in us in operation since 2014.. kral (writing report on it).. calculated that if a city like san fran established a sanctioned injection facility, it would not only pay for itself but actually save taxpayers 3.5 million a year
31 – prescription heroin
naomi (n american opiate med initiative) trial.. a fixed term research project – 2005 to 2009 – gave heroin free to 251 participates.. avg number of years they had used injection drugs was 16.5
improved their lives (free so no longer had to work as ie: sex trade; talking to health care daily; et al; saved societal monies; )
devastating to participants when it stopped..
start meetings w former members.. (salome – study to assess longer term opioid med effectiveness) publish first paper: naomi research survivors: experiences and recommendations’..
boyd gave them copy of helsinki declaration .. an international agreement that governs human research ethics. ‘at conclusion of study, patients are entitled to be informed about outcomes of study and to share any benefits that result from it.. ie: access to interventions id’d as beneficial in the study or to other appropriate car or benefits’
murray remembers light bulb going off: ‘if a drug works during a trial, they can’t take it away from the people that it was benefiting‘..
eugenia oviedo-joekes heroin assisted therapy.. moves from spain to vancouver.. works on salome w scott harrison.. they had one condition – has to expand.. oviedo-joekes: ‘a saying in spanish.. the surgery has been a success, but the patient is dead’.. in ref to naomi returning participants to dealers on the street
more difficult to give people free heroin than one might think.. ‘people trust their dealers more than they trust the med system.. they have been traumatized by the med system, almost universally’
32 – the assassination
33 – fentanyl arrives
went from an overdose a day to several to seven a day.. back to back
thomspon (who the crosstown clinic is working really well for): ‘it disgusts me, really, that they don’t have this [diacetylmorhpine – medical term for prescription heroin] for everybody else. it should be open to everybody.. i’m a functional addict‘
crosstown clinic’s prescription heroin problem was originally designed for long term severely entrenched addicts who have been on opioids for decades and who have repeatedly tried and failed w more traditional treatments like methadone.. the arrival of fentanyl and carfentanil has led some advocates to argue that w bc’s drug supply now contaminated w dangerous synthetics, the threshold to quality 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..
donald macpherson (@donaldmacmac), who livingston and osborn had w them in oppenheimer park the day they founded vandu.. retired from his work w city in 2009 and works for simon fraser uni where he holds position of exec 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.. ‘with the overdose crisis across n america, why are we withholding a clean pharmaceutical drug form people who are overdosing on toxic poisonous substances like fentanyl and carfentanil‘.. t..’why do we not allow people to enter some sort of program where they can acquire a clean pharma product at a dose that works for them.. that doesn’t kill them?’
at time of writing, crosstown clinic’s 90 some patients remain only people in n america for whom prescription heroin is available..
townsend: ‘the drug use, for many people is a sense of disconnection.. we gave them a place where they could be together and where they had someone in the world.. where they had a connection..’.. t
march 2018 – travis’ book gets award
However, Lupick argues that a response to the current crisis based on harm reduction, “while important, is entirely reactive; it’s only reaching people after they’ve already ingested drugs that are potentially deadly” (p. 375). A more viable solution, he suggests, is the scaled up provision of prescription heroin for anyone at significant risk of a drug overdose. His suggestion was prescient, as this drug policy shift is imminent in British Columbia.
Put simply, to stem the current crisis, we need to address entrenched poverty in Vancouver’s inner city at the same time as we develop more and better biomedical and harm reduction interventions...t
indeed.. let’s try a nother way