When pandemics collide

Harm reduction in the time of COVID

While news of the COVID-19 pandemic has flooded our feeds, and rightly so, an opioid crisis of devastating proportions has been quietly ravaging communities in Winnipeg and across the province. 

Travel restrictions and general upheaval have disrupted the drug supply and made room for an influx of fentanyl and carfentanil that has resulted in the highest number of overdoses on record in our city. 

On Sept. 3, the provincial government announced that they were allocating $3.5 million to improve addiction support at the Health Sciences Centre’s emergency department. That $3.5 million sounds like a lot of money, especially when announced with ample fanfare, but compared to the kind of cash quietly spent by the City and Province on other projects (such as the expansion of Kenaston Boulevard to service ill-advised new suburbs, which ran the City and Province over $50 million), it seems like a pittance. 

According to Arlene Kolb, founder of Overdose Awareness Manitoba, this initiative will have very little impact on the drug crisis in its current manifestation. 

“I have to clarify that, actually, the government is doing nothing ... There is talk about HSC, but when you put a unit in HSC and hire new security guards and nurses, it is seen by the community as a security issue. It has nothing to do with care,” Kolb says.

The $3.5 million will be spent, as Kolb says, largely on security measures to deal with meth-related incidents, despite a dire need for safe supplies, injection sites and long-term programming. 

The provincial government allocated millions of dollars to increase security around addictions care at Health Sciences Centre, a move that experts say does nothing to address addictions.

In a provincial press release, PC Justice Minister Cliff Cullen explains that the new beds and security staff at HSC will help by “speeding up offload times and allow(ing) police officers to more quickly return to patrolling city streets and ensuring they are safe for all Winnipeggers.

“This investment reflects our government’s efforts to public safety and improving mental health and addictions services in Winnipeg and across the province, particularly for those suffering from meth-associated psychosis.”  

Marion Willis, executive director at Morberg House, says in a CTV article that it is precisely the lack of a supply of meth in Winnipeg, due in large part to travel restrictions, that has led to a rash of opioid-related overdoses, making this decision to amp up meth-related security out of step with the current situation. 

While increased funding at HSC will allow for a greater police presence on the street (despite petitions to defund Winnipeg police garnering over 150,000 signatures), it fails to address the real needs of people who use drugs. 

The introduction of fentanyl and carfentanil has poisoned Winnipeg’s drug supply and resulted in over 550 cases of naloxone (also known by the brand name Narcan) being administered by the Winnipeg Fire and Paramedic Service between January and June this year. These numbers would be much higher if administration of naloxone by community members and organizations could be accounted for. 

The Magnus Eliason Recreation Centre where WE24 is located. WE24 is a 24-hour safe space in Winnipeg’s West End neighbourhood.

Signs and mementos adorn the Manitoba Overdose Awareness Memorial Garden in Stephen Juba Park.

“The drug supply right now is cut with terrible things. When you work in this field for a while, you can identify different reactions, whereas now it’s unpredictable. Folks who are used to using a certain kind and amount of drug now overdose. It’s a big issue. Overdoses have gone way up,” David F. Cole, operations director of the West End 24-Hour Safe Space (WE24), says.

The staff at WE24 received training to administer naloxone through Street Connections. Cole says this training has been put to practice several times during the summer. 

Dustin Novak, a pharmacy assistant at Brothers Pharmacy (625 Selkirk Ave.) who provides naloxone training to community members and organizations, explains that a nasal application of the compound is much easier to use, which is crucial in a crisis.

“It takes seconds instead of minutes,” Novak says. 

Conversely, injectable naloxone requires using a syringe and breaking a glass ampoule, all while trying to give CPR and call an ambulance. Novak says while the pricing of nasal kits is higher than injectable ones, “I would assume that some of the other costs that are going into not having a nasal narcan program would be relieved, such as ambulance rides and potential deaths.”

Kolb believes a lack of easy access to naloxone is largely due to the stigma that surrounds drug use. 

“We have a premier who has no interest in educating himself about addictions. It is a moral issue of right and wrong (for him), and this trickles down. The way our healthcare system is run, our (provincial) government just says ‘no, don’t do it.’ There is a lack of education with our Minister of Health, the people who need to know these things,” she says. 

Long-term care and rehabilitation for people who use drugs is basically nonexistent in Manitoba, according to Kolb, which she believes is central to the problem. 

“A bed is not a home. We have to question what is enough,” she says.

Novak explains that detox programs provide a helpful initial step, but would be far more effective if followed by longer-term supports.  

“Detox programs are great, but it would be so much more help if they had programs that could go to long-term, new living situations. I see potential for so much more if they were to offer three-month or six-month or even two-year programs where people can get away from the lifestyle that led to addiction and have access to work and school programs,” Novak says.

Cole explains that “at WE24, we are all harm reduction all the time.” 

“It is a mindset. It’s how you approach caring for someone, which is individualistic ... Folks can come in (to WE24) in any state they are in. They can be high or coming down,” they say.

WE24 is unique in this aspect, as many programs and shelters require sobriety from participants. ArtsJunktion, a community organization that provides a safe and inclusive space for people to explore their creativity using pay-what-you-can, take-what-you-need recycled materials, also has an open-door policy when it comes to sobriety.

Lou Gandier (left) and Helga Jakobson (right) at ArtsJunktion in Winnipeg’s Exchange District.

Lou Gandier and Helga Jakobson, who are ArtsJunktion co-directors, have noticed a sharp downturn in the mental health and wellness of the community they serve. They have also heard positive things from people in their neighbourhood about how other grassroots organizations and the supports they provide are crucial. 

“People need to be welcomed into a community with whatever capacity they have. Resources from within community-driven organizations where folks are able to show up as they are are incredibly important. The increase in awareness of spaces like WE24, as well as resources for (naloxone) through orgs like Central Neighbourhoods and Street Connections, are creating a more well-informed harm-reduction approach,” Gandier and Jakobson say.

Harm-reduction principles, while readily embraced by many healthcare professionals, community organizations and the governments of other provinces, unsurprisingly do not appear to resonate with the Progressive Conservative provincial government here in Manitoba. 

Justice Minister Cullen referred to an NDP report outlining a harm-reduction approach to the crisis of addiction and overdose as “half-baked and dangerous,” going on to say “Wab Kinew wants to tell kids it's okay to do meth and other illicit drugs.” 

Premier Brian Pallister has repeatedly emphasized abstinence and law enforcement, and in a CTV interview said “there are as many dangers as positives out of having a so-called safe injection site. It draws drug dealers. It draws crime.”

In addition to safe-injection sites, which overwhelmingly lower overdose mortality, it is now possible for provinces to import prescription-grade heroin (diacetylmorphine) as a treatment for adults with opioid dependency. 

This option of a safe supply comes at the recommendation of Dr. Theresa Tam, Canada’s Chief Public Health Officer, but, given Pallister’s reticence to move beyond abstinence-based treatment models, it seems unlikely that Manitoba Health will pursue this potentially life-saving option. 

Pallister, who has infamously spent one-fifth of his time as premier on vacation in the tropics, often peddles austerity and has gutted Manitoba’s healthcare and social services throughout his tenure, despite receiving $400 million from the federal government in 2017 to fund health, including mental health and addictions services. 

In a letter sent to the provincial and territorial ministers, Canada’s Minister of Health, Honorable Patty Hajdu writes: “It is vital that we recognize substance-use disorder is a health and social issue, and that we treat people who use drugs with compassion and give them the support that they need.” In the letter, she also refers to the overdose crisis as “one of the most significant public health crises in recent Canadian history.” 

Between 2016 and 2019 alone, over 15,000 people lost their lives to presumed opioid-related causes in Canada. 

When viewed as a public health crisis that exists at the crossroads of colonialism, racism, poverty and trauma, rather than as a morally righteous “war on drugs,” it is nearly unbelievable that drug use and addiction are still criminalized, and that those who are dying are treated with stigma rather than empathy. 

As with so many aspects of our society, the pandemic has starkly revealed the deep cracks that have always existed in our social systems.

“It puts a magnifier on what is lacking, but we already knew those things were lacking,” Cole says.

Now we are being forced to reckon with these failures and decide as a culture if we want to do right by those who have been historically left behind due to age-old conservative notions of moralism and victim-blaming.

Published in Volume 75, Number 05 of The Uniter (October 8, 2020)

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