OAT “Therapy” and me

By Lenae Silva, Open Heart Collaborative

I live in Nanaimo, also known as the unceded territory of the Snuneymuxw First Nations. It’s a city that goes by many other names: “The City with No Pity”, “Fent City”, “Tent City”, “Fence City”, “Surrey by the Sea” … all highly negative, all positively real. 

This city is a place where you’re not more than 20 minutes away from a shopping center, bar, liquor store, or pot shop, where you can satisfy your legal mind-altering urges… cigarettes, coffee, vapes, weed and booze. And you are probably less than 10 minutes away from finding an illicit fix. A city that is separated by shopping malls and income inequalities. Youthful hopelessness and rich retirements. North and South, BIPoC and White, Young and Old, Lost and Founds and every other contrast. 

If you hop on the number 50 bus for 15 minutes, you travel through the outward beauty of Nanaimo. While right in front of you, people risk their lives asking for change on the meridians. Fences separate the wanted from the unwanted from experiencing this beautiful city. These fences dissipate, and disparities increase as you get away from the downtown core. A place I’ve lived all 32 years of my life.

I’ve been a heroin addict for 17 years now. Discovering alcohol, pot and meth as early as 11, easily accessible at school. Partially Indigenous, female, poverty ridden, and a blood tie filled with wistful losses of family members to suicide, OD’s, addiction and mental illnesses. Knowing these barriers were up, in my youth I pushed through school to graduate early with honors, so I could get to work and start paying for my habit. An adult in a child’s body, with adult worries, adult habits, an adult brain stuck in a childish world that is still young enough to know that anything is possible. I knew better, though. Most of us knew better. We saw our futures written in the cracks of this city like the lines in the palms of our hands, read by some unfortunate fortune teller. 

When you’re on those buses to the fenceless, rich, North End of Nanaimo, I often wonder if they have Methadone Clinics. There are countless, faceless, doctor’s downtown who offer liquid handcuffs. Legal dope. They seem to enjoy toying with you as much as the rare folly of the drug dealer who takes pleasure in torturing you, controlling you, having power over you. Most dealers aren’t like that, but most OAT doctors are. Even if you are lucky enough to have a doctor who truly cares, they’re just as handcuffed as you are. A municipal, federal or provincial mandate allows us only enough to keep us alive and desperate. To keep us coming back. 

Once upon a time, Methadone worked. If you’ve been an advocate, an addict, or an ally you’re familiar with this system. If you’re not, it’s a hidden, awful mystery that I hope you, or your loved ones never have to see. I’m one of the unlucky few to be all three of those A words, like the A’s on my report cards at school, I’ve always strived to be the best at everything I do, even self-destructing. I’m not very good at keeping vile secrets though. So let me tell you about this system…

Did you know you don’t get methadone for free? Did you know that even though everyone still calls it methadone, even though methadone isn’t available here? Did you know that the opiate receptors that methadone used to fill are no longer strong enough to hold on against the fight of fentanyl and etizolam, Carfent and benzos. Or some other mechanical sounding substance made in clandestine labs across the world. 

Many people started dying in the great British Columbian relapse of 2014, when without an option, notice, or any warning, our methadone was switched to methadose. A small difference in name, apparently completely the same, according to doctors, despite being 10x stronger and tasting like cherry mouthwash, people became very sick, very quickly. No longer did the old nectar of the gods exist, only this awful new cherry formula that kept the pain away for less than 12 hours. So we hopped back onto the streets, getting just enough illicit opiates to keep us functioning, but surprise, this was no longer the heroin we used to know. It was now strangely chemically tasting and what you used to have to shoot up to get “that high” was now available in smokable form. And legions of men and women, who fought recovery and won, now dropped like flies. 

Governments called it a crisis, an epidemic, an unsolvable mystery of death and despair. Yet we weren’t invited to those tables. Our simple solutions were just too radical. Since then, the death toll ticks away, starting originally, in days, then losses counted in hours and now minutes. Like cannon fodder on the frontlines. We are disposable in their eyes. Nothing but another platform question that politicians use to win votes. 

Our medical coverage took a while to catch up to the pharmaceutical change. Costing around $11 per ml of Methadose, people were on anywhere from 2 mls ($22) all the way up to 15 or 16 mls ($176) every day. Why would someone pay that for something that doesn’t work? A day’s worth of dope, enough to cover you for work… breakfast, lunch or dinner, ranged from $50 to $100 for maintenance, but of course tolerance increased. And then it decreased. Most didn’t know that the substance even changed. Diacetylmorphine, plant-based opiates were suddenly a chemical concoction. Just like Methadose, Heroin became fentanyl which is substantially more potent. But this wasn’t the legal stuff or a product of consistency. This was a crapshoot, mixed by people trying to make a profit. Easy to import in tiny batches. No vast poppy farms, some chemicals, and shipments in tiny packages meant increased profits. 

And now, despite many people switching to smoking, narcan being heavily available and a couple of dilaudid around if you’re lucky, we’re dying at an even higher rate. Why? Covid. The dual pandemic. Forcing the socialization out of drug use has unpleasant effects on people. Effects like death. With borders closed, and streets empty, and a sudden surge of money for people who knew how to play the system, every addict needed more and more. But supply was less and less available. So cuts with the fentanyl went from harmless sugars and milk powder to sleeping pills and benzos. Irreversible to narcan. An non prescribe-able pairing for doctors trying to mitigate substance use risks. 

It’s going to get worse before it gets better. 

But I am an optimist. An outreach worker. You have to believe it will get better to do this work. How, though? Have us at the tables. Address the reasons why we use. Consult with us. Ask WHY?! 

We need to rid ourselves from the same punitive system we’ve used for years. I’m an adult, I can drink myself to death and medicine still has to help. I know my body, so why can’t I get what I need to detox? Why have these infantile rules? Take my liquid handcuffs every day, so my doctor gets paid or they take your crutch. Depression? Anxiety? Obviously caused by drug use… 

The system that was once caught up has been shuttled back to the stone age. We have been left to rot. To fend for ourselves and our friends. Most of us would gladly volunteer to put our lives on the line to get better. To save lives in the future. To be a part of our community. To have a life… 

Just remember, no kid grows up believing they want to be completely consumed by a substance. We wanted to be astronauts, artists, and actors, not addicts, allies, and activists. 

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