A staff member at the Overdose Prevention Site points to a red line indicating a positive result for fentanyl after testing a sample of heroine with recently available test strips in Vancouver, B.C., on Aug. 28, 2017.Rafal Gerszak
Katrina Pacey is executive director and founder of Pivot Legal Society, a law firm aimed at advocacy for communities affected by poverty and social exclusion.
Earlier this month, people in Canada witnessed the importance of community resistance and activism on issues of drug-policy reform.
Following Vancouver's lead, organizers and front-line workers in Toronto pushed Health Canada to do what is right and necessary in order to effectively respond to the overdose crisis. A community of care, driven to save the lives of friends, family and neighbours, set up two white tents in Toronto's Moss Park. Inside, volunteers at this popup "overdose prevention site" supervise drug use and save lives – something the federal government should have been doing long ago, when communities across Canada first began sounding the alarm. I visited the site last week and was moved by the commitment and compassion of the volunteers who were valiantly saving lives, day after day.
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In Canada, supervised drug-use sites need a federal exemption to protect staff and site users from drug-related charges and convictions. Absent this immunity, harm-reduction workers who operate the sites – and the drug users who use them – are in a legally precarious position.
Fortunately, police departments in B.C. and the Toronto Police Service have said they are not interested in shutting them down, presumably aware of the life-saving services such sites afford.
Mere days after the popup site began operating, Toronto Public Health received approval from Health Canada to open its own interim supervised drug-use site. Mayor John Tory said he would have liked to have seen the original popup site dismantled, but that didn't happen. In fact, another popup site opened in Ontario, this time in Ottawa – a bold statement to lawmakers in Canada's capital that federal drug laws must not stand in the way of life-saving health services. With each successful opening, another community of activists and volunteers is emboldened to brave the law and save lives in a similar fashion.
The reality is that the application process for Health Canada approval remains far too slow and resource-intensive, especially in the context of a crisis. Therefore, the need for communities to step up and provide service will not end. Moreover, there will always be a need for grassroots harm-reduction services, irrespective of whether formal sites already exist in the same jurisdiction.
As a human-rights organization that has worked extensively in drug policy reform, Pivot Legal Society believes there is an urgent need for both government-sanctioned supervised drug-use sites and popup sites run by the community. The latter should be fully funded and supported as a key part of the continuum of care, as popup community-led sites afford certain benefits to people who use drugs that formal sites may lack.
Community-led sites are an effective means of reaching vulnerable populations who might otherwise be prevented from accessing more formal, higher-barrier supervised sites. This is because exempted sites may present barriers for people with disabilities, people who use by means other than injection (i.e., inhalation), and people who, for other sociocultural reasons, may not feel comfortable using government-sanctioned sites. Even with the new interim site opened in Toronto, a record 34 people used the Moss Park site last Saturday. This need is real and must be met.
Harm reduction is not one size fits all. As with any population, people who use drugs are diverse, with varied needs and abilities. It is unreasonable to assume that one facility can provide adequate service to an entire demographic of people, especially when taking into account geographical restrictions, interpersonal relationships and conflicts, and types of services offered.
Most popup sites are led by peers and community members who have extensive experience when it comes to providing barrier-free supervised drug-use services. They know how to reduce stigma and build trusting relationships with people using the services, and the importance of these relationships cannot be understated when it comes to access to care.
Whereas many people who use drugs have reasons to avoid formal health services, popup sites offer a low-barrier space staffed with people who may already be fixtures in the communities of the populations being served. Allowing popup sites to operate in tandem with exempted sites reinforces and legitimizes the very necessary contributions people who use drugs have made in the context of an unprecedented opioid crisis.
The community at the heart of this crisis has the answers to it. The rest of us must learn to listen.