Sidney McIntyre-Starko was loved. So were the other 50,000 people who didn't get their stories told

Pixabay

I hope the inquest recommendations that have come out of tragedy in a University of Victoria residence really do lead to major change. What happened to Sidney McIntyre-Starko is very sad, and there were some major stumbles on a number of fronts leading up to her death at 18 from toxic drugs.

But if anyone is thinking that the terrible stigma that hangs over illicit drug use got eased by all the news coverage of this young woman’s death, just let that one go. If anything, the coverage deepened stigma.

Right to the final stories, we have seen photos of beautiful Sidney in all her active, “normal” roles, been reminded that this was the first time she’d ever used drugs. She was a good person, we have been assured many times by those quoted in the stories. She died because of system failures, the stories emphasize, not because she was a drug user.

And there it is. The stigma. The coverage is careful not to say out loud that Sidney was not like all the other drug users who are dying, but it comes through clearly. She was different – active and beautiful and loved, with a bright future. She even got her own inquest.

The lives of the other 50,000 lost souls who died the same way that Sidney did in these terrible nine years ended largely without comment, and certainly without government investing any scrutiny as to how systems may have failed them.

I mean no disrespect to Sidney or her family. Her death will change the way things are done, and that is a big deal. 

But this young woman’s tragedy has been put forward in a way that affirmed from the start that she was Not Like Those Other Drug Users. The coverage has confirmed - if not intensified - the terrible stigma that hangs over all the other active, beautiful and loved people with bright futures who also continue to die in the toxic drug crisis.

The irony is that in a way, Sidney was killed by stigma. If someone had said from the get-go that Sidney and her friend had just used random drugs someone had found in an abandoned case of wine coolers downtown, I expect things would have gone very differently.

But the young people who knew drugs were involved felt the stigma so heavily that they didn’t acknowledge it to any of the first people they asked for help even when two young women lay before them turning blue and having convulsions. That is some kind of stigma that can do that.

In a way, stigma likely led to those young women using the drugs they found in the first place. 

They went from age 9 to 18 in the years since BC declared a state of emergency over toxic drugs, which started killing so many people after the heavy-duty pain drug fentanyl and all its analogs started to creep into the street drug supply as a substitute for heroin.

How is it that two girls who literally grew up in the era of a horrendous toxic drug crisis in BC didn't know that using random drugs from an abandoned box of booze a friend found downtown was a dangerous risk to take?

I’m pretty dubious of that story if I’m being honest. But if it’s true, then that’s because of stigma too. And if it's not true, then there's the stigma again, getting in the way of these young people admitting that they'd actually bought the drugs.

If the conversations we have about street drugs were at all realistic, those young women would have known from years of education that just about the craziest thing to do in a toxic drug crisis killing 150-200 people a month was to take unknown drugs from a completely unknown source. At the very least, they'd have known to take them to the UVic drug-checking storefront first to see what was in them. 

If we hadn’t criminalized and cast shame over drug use (well, other people’s drug use, never our own), then we would acknowledge that lots of people use drugs, and that it’s actually in everyone’s best interest if people find their way to a regulated supply.

I don't know about you, but I really appreciate going to liquor stores knowing that none of the bottles has been topped up with methanol. I haven’t minded giving up the strange lengths I used to go to for acquiring cannabis now that it’s just in a store, with a label and everything.

I’m glad that when my nurse practitioner gives me a prescription, I know what’s in that drug, who made it, and that I’m taking the recommended dose.

People seek drugs. So why have we put this stigma around a very narrow little group of them, and told ourselves that we are protecting our children by doing that? And how is that working out for us, what with toxic drug deaths now the No. 1 killer in BC from age 10 up?

We are paralyzed with fear that regulating illicit drugs will put our children at risk through easier access. But that's like drawing a comparison to some dream world we aren't living in. The reality is that our children are at tremendous risk right now - never more at risk than now, in fact, and still we dither over our political opinions and our support of tactics that have failed us for decades.

That’s one tough stigma, locking us up like this so completely and for this long.

Sidney, you died far too young. I feel sure you were growing into as beautiful a person as all the photos of you in the media depicted.

But the families of all those other people who have died have those beautiful photos too, and there were so many system failures for so many of them as well. If something good can come out of your death, Sidney, I hope it’s a realization among all of us that there’s no difference between you and them.

What might we learn if we listened?

Image by Couleur: Pixabay

Nobody knows the challenges of getting out from under harmful substance use like someone who has actually done it. The third event in the Peers Victoria speaker series on the toxic drug crisis brought together a powerful panel of six past and present substance users to talk about their journeys with frankness, wisdom and so much insight. (I was the lead organizer of the series.)

But while we've got a complete video of the event, it's a rare devotee of the subject who would watch the whole thing, clocking in at over two hours. So I made a "greatest hits" compilation, if you will - 40 minutes all in, with clips reordered and with a bit of categorization that helps bring more focus to the panelists' comments. 

Here it is for your viewing pleasure. If you have people in your circle who are still saying stupid nonsense about substance users not wanting recovery sufficiently or being content to exist in a state of oblivion, please share it with them. 

What kind of systems for substance disorders might we have if we just listened to the people who have already been through this toughest of life challenges? 

As these six voices remind us, of course, we would be foolish to just listen to ONE voice when designing approaches (Marshall Smith, you're on my mind). The path to healing is so very distinct and different for each person, and the underlying pain and trauma that lead up to harmful substance use are highly individual as well. But if we genuinely wanted to address this crisis, the experts are all around us. 

Don't buy the snake oil

ChatBox AI image created by me

I generally stay out of the fray when it comes to commentary on politicking, so much of which is about as reliable as a snake-oil pitch.

But having caught Pierre Poilievre’s promise of addiction treatment for 50,000 Canadians, paid out of the money that will be saved when safe-supply programs are cut, I just can’t let that blatantly misleading statement stand unchallenged.

First, let’s start with safe supply. That’s the term used for when people are able to swap out their completely unregulated opioid-based street drugs for a prescription opioid from a health professional. It’s the most obvious immediate strategy to stop a toxic drug crisis that has killed 50,000+ Canadians – more than a quarter of them in BC - in the decade since the anesthetic fentanyl began dominating the street drug market.

That Poilievre actually thinks there’s enough money in the country’s teeny-weeny safe-supply response to pay for a major expansion of treatment beds and the cost of putting people into them for three, four or more times through – totally predictable with a relapsing health condition – well, that’s the first glaring sign that this promise is pure snake oil.

Here in BC, we have an estimated 100,000-125,000 people with opioid use disorder. A mere 4,600 of them are on the safe-supply program that BC launched at the start of the pandemic. That’s four per cent of the people who could actually benefit from safe supply.

Elsewhere in Canada, 10 other cities launched pilot safer-supply programs during the pandemic, nine of them in Ontario and one in Fredericton, NB. Federal funding ran out for most of them already.

In the few short years since, the mercurial public mood has shifted toward a view of safe supply as having “failed,” even though it actually barely got a start. So good luck grabbing all that big money invested in safe supply into treatment, Mr. Poilievre.

What really gets me with stuff like this is that a politician's comments are rarely challenged by reporters, leaving the public to assume that there really is some massive government investment in safe supply that can be transferred over to treatment.

I figure that whichever party ends up elected at the end of this month, we’ll get a few more treatment beds. That’s a good thing, because we really need them, along with government funding to support people accessing those beds without having to come up with tens of thousands of dollars multiple times to buy their way into a largely private system of care.

But any new beds will barely make a dint on the actual issues that are troubling the public - one of which is an unregulated drug supply managed in the shadows by international drug cartels that is killing their children, grandchildren, employees, partners, siblings and neighbours; and the other being a multi-faceted crisis of poverty, homelessness and mental illness manifesting ever more ferociously on the streets of our communities.

Substance use is definitely layered into that latter problem. But the main driver of the tragedy unfolding on our streets is poverty, mental illness and a housing crisis. Until we deal with those underlying causes, we’re going to be living with the soul-searing visibility of enormous suffering no matter how many treatment beds come into play.

Safe supply is an easy scapegoat for politicians, I suspect because we’ve been convinced over many decades to view the kind of drugs that end up on our streets as evil. BC’s tiny safe supply program was dealt a very hard blow recently when Premier David Eby got fussed about the supply being diverted into the illicit market, and withdrew people’s right to take their prescription drugs in the privacy of their own home.

Picture how that would go for whatever prescription drugs you might be taking, if suddenly you had to visit your local pharmacy twice a day, within their operating hours, to take your heart drugs, for instance, or use your asthma puffer.

Your job, your family time, your recreation activities – all of that would have to fit around getting yourself to the pharmacy twice a day, every day, to swallow your pills or inject your insulin in front of a health professional. How long would it take any of us to be looking for alternatives on the black market to spare us such misery?

Yes, diversion happens. An issue with safe supply is that it decrees what drugs you can swap onto, and fentanyl isn’t one of them. So some people on safe supply sell whatever drug they’ve been given to get the money for the fentanyl that they actually want.

You can look at that as a failure, I suppose. But toxic substances laced with unknown quantities of fentanyl and fentanyl analogs are now the No. 1 cause of death for British Columbians ages 10 to 59, exacting a massive impact on our collective productivity that is second only to cancer. What could possibly be a bigger failure than that?

So now let’s consider treatment as a “cure” for that failure, as Poilievre wants us to do.

First, the obvious: Many of the people dead in the toxic drug crisis weren’t in need of treatment. They were just average people using drugs for fun – not aberrant behaviour in a country where three-quarters of us consume alcohol regularly. They died because a toxic drug supply doesn’t differentiate between whether you’re a first-time user or an “addict.”

Then there’s also this tricky truth: Treatment for any chronic, relapsing condition is a long, hard slog. Whether it’s Type II diabetes, hypertension, or this thing we call addiction, 40-60 per cent of people will relapse after treatment. They will need many passes through treatment to reach a state of recovery, and some will never get there. Getting to where we need to be in terms of quick access to treatment is going to be expensive, just as it is for any other long-term health care interventions.

People using opioids are particularly vulnerable to dying during a relapse, as their tolerance falls significantly after a period of abstinence. Add in that little ongoing problem of a toxic drug supply - any hope of accessing safe supply during a relapse having evaporated under Poilievre’s plan - and it’s clear that expanding treatment alone will not get us out of this crisis.

And one more tricky truth: Treatment for this thing we call addiction is almost completely owned by the private sector – and increasingly, by multinational corporations and private-equity firms interested in consolidating many small community treatment centres into one big entity that will attract investors. (As is happening with veterinary services, lab services, mental health services, employment training, etc.)

Treatment for substance use problems is outside of the Canada Health Act. Private treatment centres are free to set their own rates and their own methods. If they report on their effectiveness at all, the data collection stops the moment a person leaves the centre. A person could relapse within hours of “graduating” and still be counted as a success.

The lack of transparency and absence of meaningful data collection leaves us with scarce knowledge to prove or disprove the effectiveness of any treatment approach. Nobody can actually say what’s working, or what happens once someone leaves a treatment facility in a state of abstinence and walks out into the big world where all their troubles await.

We simply don’t know how many times people relapse, because we don’t measure or track. We don’t know how long an individual stays abstinent after a round of treatment. There are no national standards for treatment. No followup.

So yes, let’s talk treatment. It’s a pillar of any health-care approach, as is access to regulated medications. But please don’t buy the snake oil.

One more walk down the road to failure

Sunil Kargwal, Pixabay

Thank you to long-time community organizer Ann Livingston for pointing me to this 17-year-old blog post that takes us back to 1950s Vancouver to remind us that there's nothing new about the strategies being talked about now to improve health care for people who use substances - or the political tactics used to block those efforts.

The Community Chest and Council, the forerunner to the United Way, struck a Narcotics Committee in 1952 to examine the problem. The Committee recommended a comprehensive drug strategy that included rehab centres, educational campaigns, and stiffer penalties for traffickers. But what really stirred debate was its proposal for clinics that would provide maintenance-level doses of heroin to addicts.

The drug clinic scheme was intended to “maintain a constant check on the number of addicts in any community. It would also protect the life of the addict and support him as a useful member of society. This existence would hasten his rehabilitation, or at least reduce the amount of his addiction since many of the stresses in the addict’s life would be reduced.” What’s regarded today as the novel philosophy of harm reduction was simple pragmatism in 1952.

Both the Province and Sun newspapers printed the Community Chest’s report along with gushing editorials endorsing its recommendations. The Sun noted that Vancouver alone had four times as many addicts as all of Britain, leaving “little doubt that the European system of cheap drugs and medical treatment is infinitely superior to our faltering system of straight police suppression.” The editor agreed that the Community Chest’s plan would eliminate the illegal drug trade by “destroying its root – the fabulous underworld profit in drugs.”

The Community Chest anticipated resistance to the drug clinics, predicting they would be “violently opposed by those who profit from drug trafficking and one should expect opposition and interference from such criminals.” Stiff opposition did kill the clinic plan, but it came from the government rather than criminals.

Soon enough, the government of the day was promoting involuntary care. What is now Matsqui Institution was in fact purpose-built in 1966 for the forced treatment of men and women using heroin. But they built it so it could be repurposed as a prison just in case - a good move, as it turns out, because the forced-treatment project was deemed a failure a mere three years later and Matsqui became just another jail. 

The John Howard Society also reported “a radical upswing in addict deaths in BC” since Matsqui opened. [The JHS's] Mervyn Davis explained that it was probably “the result of increasing police pressure on the drug market, which usually results in inferior drugs and a wider variety of potentially dangerous drugs – such as barbiturates – being used as a substitute for heroin.”

 But hey, 20 times is the charm, right? With more than 17,000 dead just since BC declared a state of emergency almost nine years ago and such a long, long history of abject failure on this issue, you'd think we might be ready for something new. Nope. We're pulling back even farther, leaving politicians, police and hysterical media pundits to continue calling the shots on a massive public health crisis. 

Watch this segment on moral panic from the Peers Victoria speaker series on the toxic drug crisis that just wrapped this week. There's the conversation we need to be having. 

 

Could the stories of the dead shake us out of this moral panic?

Pixabay: Erika Wittlieb

This is a callout to people who know someone who has died in the toxic drug crisis in the last decade. I've got an idea. I'll need your help. 

Nobody can look at the faces in this Moms Stop the Harm video of lost loved ones without questioning what's going on, with more than 17,000 people dead in BC since 2016 and us seemingly powerless to act. (We aren't, but I've already written about that, so more on that later.)

That emotional connection is exactly what's needed to shake off this ennui around a four-alarm public health crisis. We seem to have parceled the toxic drug crisis into the part of our brains where we hold faint understanding of something that we don't think affects us. But it does affect us, in so many ways. 

Normally I'm all about the stats and evidence, but as the fantastic panel on moral panic pointed out at the Feb. 26 event in Peers Victoria's speaker series, we've got stacks of evidence on this issue and quite a lot of stats, at least at the death end of things. So the question becomes how you get past moral panic to actually implement the evidence-based strategies that will substantially ease the crisis. 

I think it's through the heart. Not in a Sally Struthers way - teary-eyed, sobby, pleading (sorry, Sally, loved you in Man on the Inside) - but in that way that almost instantly shakes off some of that "this is not my problem" way of thinking. I don't know what it is, but it's like the blinders come off and you finally see. For me, it was Stephen Lewis, of all things, pointing his finger out to the audience that I was in one spring day in 2004 and saying, "What are YOU doing?"

I've seen it happen a multitude of times for other people, where someone sees or experiences something out there in the realm of suffering that hits them where they live, and they get it. You can't predict when they'll have it or what's the magic sight that will open their eyes, because everybody is different, but it's a beautiful thing to see. (Tony Joe, I saw you have one.) Here's harm reduction and recovery advocate Guy Felicella talking about his father-in-law's moment. 

It can often be a long way to action from that point. But there will be zero action until a person at least has that moment. That's an important strategic reality to ponder for anyone pushing for social change, especially when an issue is stigmatized.

So let's help get them to that moment, I say. Let's bring the faces and stories of people killed in the toxic drug crisis into the world. Moms Stop the Harm's video has 300 faces, but there are thousands upon thousands more. I think there would be much power in a Humans of New York style of story-telling (an image and 150 words max) for all these people we have lost to an entirely preventable crisis.

What I'd ask for is an image, and the answer to this question: What did the world lose when this person died? I'd like their age and at least their first name, and two names are even better, because being out there with your full self, while hard, is a rejection of stigma.

The tools are in our hands, and free. Instagram would be great. Facebook has potential, though my personal sense is that the algorithm doesn't like things about toxic drugs. On the other hand, it DOES love things about people. 

Podcasts are a possibility, to bring out the voices that will reveal the enormous grief hanging over this province solely because of this preventable crisis. It would be very brave to consider X, but we could warm up on the friendlier BlueSky initially. 

We'll need some kind of consent form, of course. It's a proposal that people will need to think all the way through before participating. Some thought is needed as to who can consent to the use of an image and story. I'm imagining that things will go wrong, because they always do, and I'll tell you right now that the haters are going to hate. You're going to have to be like little Ruby Bridges in 1960 Louisiana, bravely entering the first integrated school while the white protestors hurled vile insults. 

But if you are one of the many frustrated families and supporters who can't bear the lack of action on this issue one minute more, then maybe you're OK with that. 

This thing I'm thinking about is meant to memorialize and honour those who have died, and hopefully stab people in the heart until we get action. But the use of drugs that our society believes are "evil"  is also possibly the most stigmatized social issue of our times, so it isn't an easy choice to step up. 

If you're reading this and are one of the lucky ones who doesn't know anyone who has died in the toxic drug crisis, I'd ask that you ask around and then share this with someone you know whose name comes up. Because there's definitely going to be someone in your circle. 

If you do know someone, write to me at jodypatersonmobile@gmail.com and tell me what you'd want to know before going ahead with something like this. I'm just seeing us spinning our wheels while people die, and it feels way past time to take things up a notch.