A Tale of Two Crises: COVID-19 and the Overdose Emergency

Our response to COVID-19 shows how all levels of government and society can make radical changes to address a public health crisis. So why haven’t we done the same with our overdose crisis?

Calls for a safe supply and the decriminalization of drugs are getting more media attention lately, but what do they really mean and what would they look like in practice?

These were the guiding questions for A Tale of Two Crises: COVID-19 and the Overdose Emergency, part of our Distant, Not Disengaged series with Cityhive and the SFU Morris J. Wosk Centre for Dialogue. But the conversation went much further than these questions, and is just getting started.

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Am Johal introduces the panel

Am Johal, our moderator and partner for this event, started the conversation by posing our guiding questions to our guest speakers:

Garth Mullins – the host and executive producer of CRACKDOWN, a podcast about drugs, drug policy and the drug war led by drug user activists and supported by research.

Dr. Mark Lysyshyn – the Deputy Chief Medical Health Officer for Vancouver Coastal Health and Medical Health Officer for Vancouver and the North Shore who has been co-leading the public health response to the COVID-19 and overdose emergencies.

Angel Gates – a facilitator with Megaphone Speakers Bureau from the Haida Nation.

Susan Boyd, Ph.D. – a Distinguished Professor in the Faculty of Human and Social Development at the University of Victoria who sits on the policy committee of the Canadian Drug Policy Coalition. 

Susan Boyd: A history of drug laws in Canada

Susan Boyd turned our attention to the history of drug laws in Canada to help explain why our response to the overdose death crisis is so different from our response to the COVID-19 health emergency. 

She invoked a quote by James Baldwin: “The great force of history comes from the fact that we carry it within us, are unconsciously controlled by it in many ways, and history is literally present in all that we do.” From our history, we can see why some ideas about drug use are so deeply entrenched in our policies.

In the 1800s, medicinal plants and drugs were widely available and legal. They were used for cultural and spiritual reasons, as well as for pleasure. There was no distinction between medical or non-medical use of illegal or legal drugs. Opium, cocaine and alcohol were embedded in social customs and were rarely associated with criminality. 

With the colonization of what is known today as Canada came the Protestant ideas of sobriety and self-control as a template of white, Christian middle-class respectability. White supremacy, racial stereotyping and defending these colonial ideas of social respectability were central themes in advocating for drug control in Canada, Susan said.

By the 1900s, a criminal justice approach saw more and more drugs criminalized and police powers expanded. These drug laws were not based on evidence of harm – they were a social control mechanism to profile poor, Black, Indigenous and other racialized people in Canada (for instance, the banning of opium was intended to criminalize Chinese Canadians).

As we criminalized drugs, we failed to set up adequate treatment or drug substitution programs. Abstinence-based treatment models established in the 1960s failed – and were inaccessible to – most people.

Canada has enacted some of the most punitive drug laws of any western nation, Susan said. She pointed out how our drug policies shape and intersect with race, class, gender, sexuality and other other laws, such as the child welfare system. All of this affects how we see and treat people who use drugs.

But Susan points out that there has been resistance to all of this for many years. Those affected, along with their loved ones, have been influential in pushing back against drug laws and advocating for drug policies based on public health and human rights.

Garth Mullins: Renewed calls for civil disobedience

Garth reminded us that this is not our first dual public health emergency of a virus and an unregulated drug supply. In the 1990s, a supply of strong heroin and the HIV/AIDS crisis cut through the streets, to which drug users, allies and Downtown Eastside residents responded with a social movement pushing for changes to our drug laws.

With COVID-19, we see what a public health response to an emergency can really look like, said Garth. Borders were closed. Budgets were ignored. And all of this was well warranted, he said. “But the government never did this for us. There was no great sense of urgency for drug users.”

Garth noted that thousands more people have died from overdoses than from COVID in B.C. He said that if governments wanted to act, they could take measures to help drug users, but the unequal treatment of these crises is because “the wrong people are dying.”

In the 1990s, people started unofficial safe injection sites and gave out safe drugs long before Insite was set up. This rule-breaking, civil-disobedience approach was what finally embarrassed governments enough to act.

“Activists have to keep articulating that vision” for clean and safe drugs in front of public officials, Garth said. He called for a regime that legalizes drugs and said that we learned everything we need from overturning alcohol prohibition. 

“How many more thousands of people have to die?” he asked.

Angel Gates: “The best people for the job are us”

Angel went even further back in history than Garth to point out another dual public health crisis, reminding us of the 1918 influenza pandemic and how people were demanding a safe supply in the face of alcohol prohibition.

And as an Indigenous woman, she reminded us that this overdose crisis has disproportionately harmed Indigenous people.

She picked up where Garth left off speaking about the activism of Downtown Eastside drug users. “Nobody ever asks us what we need,” she says. “The best people for the job are us.”

“We told you we needed a safe injection site. They didn’t help. We did it,” she said. “Nobody has ever died in our safe injection sites.”

She applauded the public health response to COVID-19, but drug users, especially those in the Downtown Eastside, are still dying. She said much of this has to do with SROs barring guests, leading to people using drugs alone. 

“I’m tired of seeing my people die,” she said. “The Downtown Eastside – these are my people. I love these people, I need these people.” 

Angel came to this conversation as an active drug user, “but I am so much more than that,” she said, pointing out the stigmas and prejudices that actively harm people and stand in the way of change.

“People need to know that we’re people too. I live downtown. I have three kids. I work. I have a dog. And I use drugs, and I’m not really ashamed of it,” she said.

“If we could come out of the shadows and top hiding, less of us would be dying.”

Dr. Mark Lysyshyn: The root of the problem is a toxic, unregulated drug supply

“Essentially all of our public health resources were directed towards the pandemic,” said Dr. Mark Lysyshyn. “Now, as we emerge from the first wave, we’re seeing some of the harms that has caused.”

Reflecting back, he said this reveals that we’ve done nothing to address the root cause of the opioid overdose emergency, which is a toxic, unregulated drug supply.

There have been interventions to prevent overdose deaths, but Dr. Lysyshyn said that Vancouver Coastal Health has had trouble delivering them and convincing people to use them.  Overdose prevention sites and supervised consumption sites are now open again, but clients have not yet returned to them in the same numbers as before, due to natural concerns about COVID-19. 

Dr. Lysyshyn also said that fewer people have been coming to emergency rooms or calling 911 due to fear of COVID-19 infections, despite the growing number of overdoses. Additionally, he said, people may be less likely to observe overdoses right now as fewer people are out on the streets, and even if someone does witness an overdose, they may be less likely to step in to help for fear of getting COVID from close contact with the person overdosing.

Dr. Lysyshyn shared Angel’s concern about the restrictive guest policies of SROs and supportive housing. “How can you use drugs with someone else if you can’t bring them into your room?” he asks. 

“We have been able to make a little bit of progress towards safe supply,” he said. “But it’s hard to describe it that way because it’s such a tiny step.”

The provincial government did allow VCH to prescribe pharmaceutical alternatives to street drugs so people wouldn’t have to break isolation in the search for drugs during the pandemic.  But Dr. Lysyshyn notes that these alternatives are not really acceptable. While some people are using them and they are somewhat helpful, it is “too little, too late and not enough.” 

“Whenever we try to do anything for the overdose emergency, all we face are barriers” from regulatory colleges and governments, he said. Trying to overcome these barriers has become the core of his work on the overdose crisis.

These barriers were not present in the face of the pandemic. “The government and the public were willing to do more than was necessary to control the virus,” he said.

“I think the reason is because they felt the virus could affect them personally, and they feel that to a lesser degree with the overdose crisis.

“And I think that’s really too bad.”

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The conversation is just getting started

Watch the video above for the Q&A portion of the event, featuring a discussion on defunding the police, the difference between the decriminalization and legalization of drugs, and what our speakers think are the immediate actions governments should take to make positive change for drug users.

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Thanks to our speakers and everyone who joined us at this event; to Am Johal, the Director of SFU’s Vancity Office of Community Engagement and co-Director of SFU’s Community-Engaged Research Initiative for moderation; to Donald MacPherson, director of the Canadian Drug Policy Coalition, for guidance; and to Laura Cuthbert.

If you liked this conversation, we recommend a recent Below the Radar podcast episode featuring a conversation between Am Johal and Garth Mullins, and the CRACKDOWN podcast.