June 16 – I am deeply grateful to be gathered here with you here on the traditional and ancestral territories of the Snuneymuxw First Nation.
My name is Sarah Lovegrove, my pronouns are she & her; and I am a settler of mixed European ancestry. I am a former Emergency Nurse, educator and community advocate. I have been a member of the Nanaimo Community Action Team for about 3 & ½ years now, and as a witness to how this community has been impacted by the drug poisoning crisis, I just want to say that I do this work because I love my community very much. I moved to Vancouver Island from Ontario about 5 years ago, and for my first year & a half in Nanaimo I lived in an apartment about one block over from where we are now, overlooking the back of this church on Chapel Street. There was one day during the summer of Discontent City when I worked a shift at NRGH ER where I had the opportunity to care for a 36 year old man post non-fatal overdose, saved successfully in community after being given naloxone. I spent a couple hours with him talking, letting him eat, cleaning up his feet, and trying to find him a warm place to stay that night, but ultimately had to discharge him back to the street. That evening I came home from work as I usually would, made dinner & got ready for bed, and when I looked out my window toward an inset in wall of the church across the street, I saw my patient lying there – asleep… still wearing the hospital pants I sent him off with, and not a whole lot else. I didn’t know what to do – paralyzed by fear and the shackles of professional boundaries, so I ended up spending the whole night watching him, just making sure he was breathing on his own – the next morning he had moved on and I never saw him again.
Decolonizing our mind:
Recognizing the essential work of decolonization in our systems and our communities, a necessary piece of the puzzle to collective healing (especially for white folks) is the work of decolonizing our own mind: thinking critically about what we have been taught and what we know to be true. When we consider what we have learned about prohibition and the War on Drugs, we have to understand that these are narratives drawn from a colonizer mindset; and the stigma that our bodies and minds have learned are stories rooted in a white supremacist patriarchy indoctrinated into culture, education, and the way we treat one another as people. So as we re-learn and reconsider how we think about the war on drugs & how this overdose crisis has come to exist, at the forefront of our conversations should be how we can undo the harms created by the oppressive policies and legislation that got us here in the first place, how racism and hate has been codified into our laws & into our systems; and how the only result of the war on drugs has been the criminalization of PEOPLE who use drugs.
Trauma, mental health & the roots of substance use
Substance Use works within the chemical realms of our minds & bodies and plays upon our dopamine reward system. Maladaptive substance use takes place when our brains and nervous systems become rewired to operate in ways that demand more and more to achieve the same dopamine reward or cover up the same pain. When we roll back the stigma and stories to see substance use in relationship to our physical bodies, we can understand that to use substances is to be human – and is something that we all do to cope with being human – from coffee or alcohol, to cannabis, plant medicines and heroin – substance use transcends race, labels, identities, sexualities, level of income, education and privilege.
As we talk about substance use in this space today, one important consideration to grow our own compassion is to put aside our previous beliefs about “addiction”, allowing space to understand that what lies below the surface of substance use is complex, and is rooted in experiences of trauma and systemic oppression. When we understand substance use to be a form of adaptation and coping to any or all of these complex issues, it is clear that the conversations we have here today require a trauma-informed lens, and approaches to solutions rooted in compassion.
I want to give a special moment of gratitude to the People with Lived and Living Experience with us here today. You are brave and you are survivors – your voices are so important. The next few slides will be full of numbers, stats & figures; so I want to offer a trigger warning now, and the invitation for you to take what you need to care for yourself. Please be assured that with each number I speak, I also see the faces of people lost or could be losing at any time.
COVID-19 & drug toxicity deaths
This past 14th of April was the 6th anniversary of the declaration of the public health emergency of overdose deaths in BC. In March of 2020 our entire world stopped when COVID-19 was declared a public health emergency. Sweeping shifts in public health policy were immediately implemented to prevent needless death & after over 2 years of strictly abiding by these evidence-based guidelines, we are now seeing the benefits of listening to science. The pandemic pushed people into social isolation and deeper into mental health crises and it wasn’t until fatal overdoses began to skyrocket again within this parallel public health crisis that authorities began to recognize the severity.
Nanaimo’s Drug Poisoning Crisis
According to the most recent BC coroners report, there have been over 314 drug toxicity deaths in Nanaimo since 2012, losing over 50 members of our community in the last 12 months alone. There are over 115 youth under age 19 that have died of an overdose since April 2016 and the number of illicit drug toxicity deaths equates to 5.4 deaths per day in B.C.
The vast majority of those dying are middle aged men, although all ages and populations of people have been impacted. Over 83% of deaths occur indoors, with 57% of deaths occuring in private residences and homes.
Illicit drug toxicity has become the leading cause of unnatural death in the province, accounting for more deaths than homicides, suicides, motor vehicle incidents, drownings, and fire related deaths combined. Illicit drug toxicity deaths are second only to cancers in terms of potential years of life lost in British Columbia.
First Nations Peoples make up 3.3% of population in BC but account for over 16% of all overdose deaths recorded
Indigenous women are disproportionately impacted with 37.4% of toxic drug poisoning events among First Nations involving women; compared to a rate of 22.6% among other residents of BC.
Throughout the pandemic in 2020, First Nations Health Authority found a 119% increase in toxic drug deaths among Indigenous people.
Toxicity of Opioids + Benzodiazepines
When we talk about a “drug poisoning crisis” in lieu of the term “overdose crisis” it is because the substances being consumed by people today are no longer predictable, they are not within safe dose ranges, and are often mixed in substances of unknown amounts – it is now the level of toxicity, not amount of substance consumed that is killing people .
Post-mortem toxicology results from the BC Coroner Service has revealed that there has been a greater number of cases with extreme Fentanyl concentrations in cases over the last year compared to those previous.
Carfentanil has been detected in 47 suspected illicit drug toxicity deaths thus far in 2022 and 189 deaths in 2021. Fentanyl and Carfentanil are chemical opioids 10-100x stronger than morphine or heroin.
The detection rate of Benzodiazepines found in illicit substances has rapidly increased from 15% of samples in July 2020 to 45% of samples in April 2022
Between July 2020 and April 2022, Etizolam was found in 40% of illicit drug toxicity deaths that have undergone expedited toxicological testing. Etizolam is a potent benzodiazepine analogue 10x stronger than Valium and non-opioid sedative
Benzodiazepines are a central nervous system depressant that Do not respond to Naloxone, nor can they be safely reversed or treated in community, creating challenges for first responders
Toxicology results shows no indication that prescribed safe supply is contributing to illicit drug deaths regionally or provincially. And absolutely no deaths have been reported at supervised consumption or overdose prevention sites.
BC Coroner Death Review Panel Recommendations
In March of this year, the BC Coroner Service convened a death review panel to assess and make recommendations to the province. I’ve noted their key findings and recommendations, and want to emphasize that this is evidence-based science. The information they have gathered is fact, and their recommendations are the only path we can take to create tangible solutions to our local situation.
The recommendations they prioritize are to Ensure a widespread Safer Drug Supply to those at risk of dying from toxic illicit drug supply. This recommendation included the need for the immediate decriminalization of drugs & access to drug checking services. While the province has made moves to follow through on decriminalization in a groundbreaking way this past month, the limit of 2.5grams and the prioritization of “public safety” over the lives of people who use substances is just not good enough. As this crisis has progressed, they emphasize that the 2017 recommendations are still relevant and required including the expansion of evidence-based treatment offerings, the expansion of harm reduction services and options, and the need for an integrated accountable substance use system of care to reduce deaths due to illicit drug toxicity.
This crisis is getting worse and worse every day. It’s time to cut the bureaucratic red tape & get things done to save lives.
Our most visible and significant issue facing the community of Nanaimo is homelessness – with over 600 people finding themselves under or unhoused as of 2020. Housing is a basic human need, and without a safe roof and a warm bed, people cannot be expected to heal. Underhousing and financial insecurity traps people within an unending cycle of survival, and when we add a toxic supply of drugs to this complex issue, the results are what we see on our streets today.
There are not enough or adequate services for people who use drugs in Nanaimo. Despite evidence-based practice and demands by people who use drugs in this community since before 2018, there is still no sanctioned space in Nanaimo for the safe inhalation of substances.
This community is poisoned with stigma – from our systems to ourselves – the hate & stigma is evidenced on social media, in access to services and spaces, in endless fencing, in people ranting at coffee shops, and in the violence experienced by people with living experience in our community.
British Columbia has a broken & burned out medical system that is not adequately prepared to compassionately manage this level of mental health and substance use crisis within an already overstrained system. The cycles of trauma repeat over and over again when people who use drugs attempt to access medical care. And the compounding contributions to re-traumatization result in a situation in which people would rather die on the street than seek care in the Emergency Department.
People who use substances often experience a multitude of physical and mental health concerns like any other human, which may or may not include pharmaceutical medical management. And despite any intention to use only single-substances, the mixed-bag-nature of illicit street drugs has any person who uses them exposed to multiple substances with varying effects – including stimulants such as methamphetamines, Fentanyl causing decreased consciousness and respiratory depression, and benzodiazepines resulting in persistent drowsiness as they depress the central nervous system.
The number of non-fatal overdoses experienced, the toxicity of drugs and the respiratory depressant nature of opioids has more and more folks experiencing acute brain injury as a result of hypoxia or lack of oxygen. This adds another layer of complexity to levels of cognition and behaviour, and impairments are often non-reversible.
There has been a palpable shift in our community’s felt-sense of safety – people refuse to go downtown and take their kids to parks because they aren’t sure what to expect or what they will be exposed to. These complex issues have reverberating impacts on local business and tourism from shifts in economic stability to break-ins and property damage, as well as being exposed to trauma and violence at work on a daily basis.
When we publicly fund an enforcement system that tickets or charges people without homes for sleeping in their car or bringing grocery carts into a public park, throws out people’s personal belongings when they have nowhere else to go, and creates zones in our community that make it criminal to be homeless – we need to reexamine our priorities. As a society, we have decided that the only way to keep people safe is to militarize communities with policing. And when the people who are elected or selected to serve this community refuse to act or decide issues like housing are “not their problem”, they are refusing to protect the people who live here.
Looking into the future, we can already begin to foresee generations of children without fathers, siblings, and safe homes – the product of intergenerational experiences with trauma and substance use. We now have cohorts of adults dependent on full time care from family members, the rise of collective grief as more and more people are impacted by fatal overdose; and ultimately we are in the midst of a collective trauma that will last in our cells for generations to come. The healing for that needs to start now.
Despite all of these challenges, I believe Nanaimo to be a resilient community rooted in compassion. I have witnessed heroes – people who have saved hundreds and hundreds of lives; people who are relentless in their advocacy for those they love; and activists who, despite all the violence and hate thrown against them, persist in this work today. Drug User Advocacy groups have always been first on the frontline operating peer run safe consumption services on the street since the presence of Discontent City. Those involved in those efforts have continued to advocate, provide outreach, support one another, and show up for their community: from SOLID and New Leaf Outreach to the Open Heart Collaborative, Drum, PUNK, NANDU, and all of the individuals with lived experience who continue to be the heroes that they are. The Community Action Team has been a provincial initiative to establish community response, operating on ~minimal~ funding by the BC Overdose Emergency Response Centre over the last four-ish years. What few are aware of is that the concept of the CAT is actually the local brainchild of former Medical Health Officer Paul Hassleback and his innovative then-master’s student Griffin Russell. As a result of these incredible efforts by our community, we have seen the initiation of trauma & violence informed practice education in Island Health ER’s, we see more accessible health services in the form of the Primary Care Outreach Van, and we see more and more peers being included and supported in research and roles throughout spaces and services across Nanaimo.
The Nanaimo Area Network of Drug Users is an organization that has been in operation in our community for the last few years, providing emergency witnessing services amidst a worsening drug poisoning crisis – offering space for safe inhalation, a service to our most vulnerable and marginalized population that authorities have not been willing to offer despite the evidence demanding its need. Peers at NANDU support each other with education, outreach, safe consumption and other harm reduction efforts to prevent death and harm.
This group faces a multitude of ongoing challenges including Continuous harassment from Nanaimo Bylaw and the City of Nanaimo, perpetual Hate & stigma from neighbours, and neighbouring businesses trying to get them to move or shut down services. They operate with Minimal funding and support, and depend upon volunteers and their peer membership to run. In addition to all of these challenges, NANDU does not have a permanent, safe place to call home, running their essential, life saving services out of a fenced off parking lot under a tent on Nicol street.
About Sarah Lovegrove
Sarah Lovegrove is a former NRGH Emergency Department nurse, harm reduction educator, and dedicated community advocate. With over a decade of experience in activism and social justice work, she is committed to operating from an intersectional, trauma-informed, anti- racist/anti-oppressive framework rooted in compassion. She holds a Bachelor of Arts in Art History & Psychology, a Graduate Certificate in Victimology, a Master of Arts in Women’s Studies, as well as a Bachelor of Science in Nursing; but has gained the most valuable education being immersed in community, listening to the voices of those most often in the margins. As she continues to heal from her own experiences with trauma, she is a passionate advocate for empowerment through evidence-based education; and as a long-time member of the Nanaimo Community Action Team Against the Overdose Crisis, has been an active local voice for equity-oriented policy change and the inclusion of people with lived and living experience.