Service restrictions related to substance use cause further trauma and harm to people who use drugs

When I began my career as a case manager in the men’s shelter system six years ago, the lack of humanity for people who use drugs was evident. People who use drugs were being service restricted for having clean harm reduction supplies, for using drugs, and for overdosing in the shelter. Sometimes people were given the impossible choice of their harm reduction supplies being disposed of in exchange for keeping their shelter bed. I can only empathize with how difficult it must be to choose between a safe space to sleep for the night or clean rigs.  

Other people who use drugs have woken up from an overdose to find out that they no longer have a bed to sleep in for the night because they were service restricted for overdosing in the shelter. Service restrictions related to substance use cause further trauma and harm to people who use drugs. People do not need to be sober and drug free to deserve food, shelter, and kindness. People who use drugs deserve to be treated with the upmost dignity, respect, and compassionate care.

“I can only empathize with how difficult it must be to choose between a safe space to sleep for the night or clean rigs.”

Today, the shelter has slightly improved in supporting people who use drugs, but they are nowhere near where they need to be. Clean harm reduction supplies are still disposed of if found by frontline workers in the shelter. This is quite literally a waste of public health’s time and resources and encourages people to reuse or share supplies. People are no longer service restricted for simply overdosing, but if they overdose and are found with drug paraphernalia, they are still given a restriction. This contributes to the stigma associated with drug use as people are more likely to use alone and hide their substance use in the shelter to prevent a service restriction. This also puts people at an increased risk of overdose-related death due to using alone.

One overdose-related death in particular I will never forget. A service user was renting a private room in the shelter and he was found with another resident in his room with alcohol. One of the shelter’s policies is zero tolerance for drugs or alcohol in the building. I had to inform the service user he would be removed from the private room program and service restricted for having another resident in his room and drinking in the building. This person felt shame and embarrassment; and he was very apologetic, highlighting improvements he had made and the goals he was working towards.

Management at the time was very strict about the rules and there was no room for warnings or second chances, so there was nothing more I could do. That night, he died of an overdose. The guilt consumed me. I told myself I should have advocated harder for him. I was angry that our current shelter policies on drugs are inadequate and harmful. When he died, there were no consumption treatment services. People need a safe space to use drugs, so that they don’t keep dying alone in the bathroom or in an alleyway. We cannot help people when they are dead. How many more people need to die before there is a change?

As the pandemic hit, the opioid epidemic in our community intensified, with a rapid increase in fatal overdoses. The illegal drug supply has become more toxic and dangerous due to incredibly potent fentanyl and closure of the borders. My role as a frontline worker responding to an overdose has shifted during the pandemic. In the event of a suspected opioid overdose, I have been told not to do CPR (chest compressions and rescue breaths) as it may pose a risk of COVID-19 transmission. I should now administer naloxone (opioid overdose reversal drug) through an injection, whereas prior to the pandemic nasal spray was best practice. I now find myself recommending cleaning of surfaces where drugs are prepared, washing hands before using, and adhering to “social distancing” when using drugs with others. 

“We cannot help people when they are dead. How many more people need to die before there is a change?”

On the frontlines, people began to respond to overdoses on a daily basis, and it was normalized. In one day, there was a total of seven overdoses. Frontline workers were told they were “seasoned workers” and that responding to an overdose was part of the job. Responding to overdoses should not be normalized in shelters, it is traumatic for both frontline workers and service users. There is an obvious solution: consumption treatment sites (CTS) in shelters would save lives, improve health and safety, reduce burnout, and allow frontline workers to do the job they were hired to do.

A temporary CTS was put in place during a COVID-19 outbreak in the shelter system to encourage people to isolate in the building. Before the outbreak was declared over, the CTS was quickly closed. There were high hopes that the CTS would continue to operate permanently to reduce the number of overdoses, prevent accidental overdose deaths, and offer a safer and more supportive environment for frontline workers and service users. Shortly after the closure of the CTS, a resident died of suspected opioid overdose in his shelter bed and was known to access the CTS. Every accidental overdose death is a preventable one.

The shelter system needs to mobilize harm reduction principles that go beyond handing out naloxone and providing access to sharps disposal bins. There is an urgent need to provide people who use drugs with access to education, support, and harm reduction supplies amidst two public health crises. Now more than ever, there is a need to meaningfully involve people who use drugs in conversations about harm reduction and drug policy reform. Shelters need to implement policies and practices from a harm reduction framework to keep people alive and safe. People who use drugs must be meaningfully engaged and consulted in the design and implementation of harm reduction policies and practices that directly impact their lives. Their first-hand knowledge and expertise are essential in developing effective harm reduction policies and practices in the shelter system.

READ MORE: What is harm reduction

The collaboration and collective response to the opioid epidemic and COVID-19 pandemic between frontline workers, advocates, and people who use drugs has been inspirational. This has strongly motivated me to continue relentlessly advocating and drawing attention to the urgent need for transformational change in drug policies to better support our most vulnerable community members. I will continue to speak up for the injustices happening in our community and across Canada. The current approach to the opioid epidemic has clearly highlighted that current drug policies have failed people who use drugs. The government’s inaction continues to cause thousands of needless deaths, and the blood is on their hands.

A safe supply of drugs, a safe space to use drugs, and the decriminalization of drugs are evidence-based and evidence-informed solutions. So, we need to ask ourselves why the government is not working towards reforming harmful drug laws and policies with effective practices that would essentially reduce drug-related harms and prevent thousands of deaths.

About Canadian Drug Policy Coalition

Advocating for public health- and human rights-based drug policies grounded in evidence, social justice, and compassion. www.drugpolicy.ca