I remember responding to my first overdose three years ago during my first ever shift inside a shelter. Someone yelled for help inside the bathroom. I was scared. I didn’t know what I was doing. I had so many questions.
Since then, I’ve responded to countless more overdoses. I’ve witnessed the never-ending interconnected trauma amongst my community. The burden only a few bear. Now, after working in 10 different locations and having observed several approaches play out, one thing is clear: we need to rethink our approach to substance use.
Public Health recently reported that each of our six shelters in Waterloo Region experiences 2-4 overdoses per shelter per week. That’s averaging 936 overdoses in our shelter system last year. Why is this happening? Why don’t they ban substance use from shelters? Why don’t they just kick out all the people who use drugs?
Well technically they do — every shelter is a “dry shelter.” They all have a zero-tolerance, punitive approach to drug use. “Service restrictions” are used to ban individuals when they are caught using substances; it’s the shelter’s version of criminalization.
So why are there still so many overdoses at shelters? Most individuals staying inside shelters use substances, sometimes to manage pain, reduce severe withdrawal symptoms, cope with mental health challenges, and/or mitigate the traumatizing realities of homelessness.
The threat of “service restriction” doesn’t address these problems. Many people are physically dependent on substances. Many of those individuals are self-treating their opioid use disorder, mental health, pain and withdrawals using the unregulated market because of the lack of legal, regulated options.
This isn’t just my opinion. Health Canada’s Expert Task Force on Substance Use has affirmed that our current drug policies are fueling the public health crisis, not preventing it.
Criminalizing addiction or substance use within the Controlled Drugs and Substances Act or via organizational and governmental policies does not stop it from occurring. It simply shifts drug consumption out of sight, somewhere else, typically into more dangerous areas.
For organizations serving people who consume substances, not providing one designated area for substance use results in substance use occurring in every nook and cranny in and around buildings. Every closed door, every stairwell, every bathroom can become an unsafe consumption room where people are forced to hide alone in fear of ridicule, restriction, and/or criminal sanctions.
Hiding substance use significantly increases the risk of an accidental fatal overdose and compounds the stress on long-ago traumatized staff members, like myself. Individuals self-managing withdrawal have to choose between safety or shelter — having both under the carceral framework is not possible.
Using alone is the difference between fatal and non-fatal overdoses. One of our greatest failures is that people are dying inside shelters because they have to hide, even in the presence of 24/7 supportive staff who care a lot about them.
Who is accountable for these deaths? As a first responder to overdoses, it feels like it’s me.
Shelter and housing initiatives have maintained punitive policies that contradict Waterloo Region’s Housing First principles. Housing First means abstinence is not a prerequisite for housing because housing is a human right. Why then are our shelters not viewed the same way?
It doesn’t matter if you ban people for months or try to deter people using the criminal justice system: these interventions never have and never will address problematic substance use at individual or community levels. This approach just creates revolving doors within our housing system. I’ve sat and heard hundreds of stories and have asked hundreds of questions.
The opposite of addiction is not sobriety, it’s connection
Substance use is often a symptom of many greater problems. People’s history of neglect, abuse, trauma all compound and result in mental health, pain, medical conditions, homelessness, and victimization. All while people internalize the isolation, disconnection, societal discrimination, and stigmatization.
Substance use isn’t the problem, the pain is. How will punishment fix these problems? The reality is that punishing substance use might actually be exacerbating these problems.
For a short period of time last year, I worked at one local shelter that permitted substance use for the first time ever. We provided a table, chairs, and a set of eyes so no one had to inject alone anymore.
Yet for some reason we were still having overdoses inside our bathrooms. I was confused by this; I figured it must have been from people smoking their substance and wanting to hide the fact they were smoking indoors. This irritated me because I assumed they could just smoke their substance on the picnic tables outside.
I was determined to stop this. I had crawled under enough stall doors over the years trying to reach people who were overdosing that it had become the traumatic norm. However, it had gotten to the point where the doors were ripped off its hinges for quick access during medical emergencies where seconds really do matter. We had traded basic washroom dignity for a chance at preventing death.
One day I walked into the bathroom, I could tell someone was smoking fentanyl again. I was fed up.
“Guys! Stop smoking inside the bathroom,” I called out. “Just go outside, I don’t care if you smoke fetty just do it outside so we can see you, it’s safer!”
A voice from inside the stall. “Jesse, I can’t!”
“What do you mean you can’t?”
“You can’t smoke fentanyl outside… it’s not like a cigarette.”
“What? Really? Why not?” They went on to explain that in order to smoke fentanyl you need a windless environment. No one had ever told me this! In fact, everything I’ve learned thus far has been from the community teaching me. I replied, “So what if we made you a safe consumption… shack, would you use it?”
“Okay, hold on, let me get a piece of paper and pen.”
With the input of people living this reality every day, we landed on this design. Within a week we had built a windproof shack in the parking lot.
Over the course of only a few days the culture shifted. No more drug use happened inside the bathrooms. No more hiding was needed. No one used alone. I no longer had to panic as I checked every nook. At that shelter, we essentially decriminalized people’s lives for the first time — and in the two months we operated, we had zero deaths.
The shack allowed us to sit outside together and have real conversations. When you have the ability to talk openly about drug use, you eventually talk about the why. But the first step is always providing a safe place for people to talk, listen and ask questions. Connections allow people to not only reconcile their past but dream of a different future. These trusting relationships are crucial to any potential success transitioning people into housing.
People left messages on the plywood walls. One message read, “Thank every staff member for the support, every life they have saved and trying to show each and everyone of us that life is worth living…”
Our collective responsibility
In a public report to regional councillors this year, the authors found that the leadership and staff in these shelters frequently recommended supervised consumption onsite as an immediate solution to preventing death.
However, this report recommendations omitted consumption services entirely and instead suggested developing a risk framework and online modules, improving data collection, clarifying policies, creating anti-stigma communications strategy, and developing a plan to make the region’s only legal consumption service more accessible. It was also suggested more resources go towards grief counseling to staff after someone has died.
Listen, I don’t want more grief counseling after seeing someone die. I want the structural changes that are guaranteed to prevent others from dying. We need a continuum of supports from dry shelters to substance supported shelters where substance use can occur in designated, supported spaces.
There are regional reports that recommended this approach nearly a decade ago. And don’t worry I haven’t forgotten about those who are in recovery or don’t use substances at all. For the minority who don’t use, a designated safe consumption area would benefit them too, reducing or eliminating their exposure to substance use in every room, bathroom, nook and cranny.
To decision makers: my colleagues and I call on you to find a few dollars to fund a table, a few chairs, and staff to establish consumption options in shelters to prevent more deaths. Other communities in Ontario are supporting consumption services through an exemption by Health Canada (Urgent Public Health Needs site) — an easy, inexpensive solution. Yet, we have not chosen to use this exemption in Waterloo Region.
Let us be leaders. Waterloo Region shouldn’t only be known for its innovative thinking in tech but how we structure our social systems.
I hate to be the bearer of bad news, but we will never arrest or “treat” our way out of this health crisis. In our Region alone we likely have a few thousand people dependent on the unregulated drug market. We can’t even seem to agree on how many people need shelter beds, let alone treatment beds.
Why? Because they are expensive, and we don’t really want to make this crisis our collective responsibility. It looks bad on us. I’ve taken account of my responsibilities as a direct service worker; I call you to do the same. We need effective ways of keeping people alive and connected to what really matters, relationships.
Effective drug policy change can be as simple as three plywood walls.
I get it. I used to not understand substance use. I used to be scared. That was until I built relationships and asked a lot of questions.
Reach out, let’s have a conversation.
Jesse Burt is privileged to work as an outreach worker in Waterloo Region alongside wonderful community members and coworkers that have taught him so much about himself, the work, and life.