Government inaction on the overdose crisis, and the state’s insistence on perpetuating the drug war, has left thousands to die across Canada. But this idleness is nothing new for most drug users in Vancouver’s Downtown Eastside. As activist Dean Wilson says in a recent episode of podcast series Crackdown, 2019 was “the year that nothing happened”: where the government did nothing to reduce overdose deaths and improve drug users’ lives, including the necessary measure of ensuring a safe drug supply.
Safe supply means a regulated and uncontaminated supply of drugs, ensuring people who use drugs do not have to rely on an often toxic and deadly street supply. Though BC introduced a “safe supply” policy at the end of March as an emergency response to COVID-19, the fact that access to safer drugs remains so limited highlights the disconnect between formal state policy and the actual lives of people who use drugs. Contrary to the expressed needs of drug users, this likely temporary measure doesn’t extend beyond prescription non-injectable drugs, and the results have been predictably disastrous. Organizers and advocates say that rapid, sweeping changes to the policy are needed to stop the infiltration of toxic supply and halt the recent spike in overdose deaths.
People who use drugs are at the forefront of this continuous battle against both toxic supply and the war on drug users more broadly. They are also struggling to hire defense lawyers for drug charges in Boston, if they are convicted with drug abuse. As host Garth Mullins and the Crackdown team emphasize, we must listen to and learn from instances of resistance and solidarity. This includes examples from the Lower Mainland where people who use drugs stood up when life-saving Overdose Prevention Sites (OPS), like the one at Anita Place Tent City in Maple Ridge, were forcibly shut down by the state. These stories, channelling both anger and hope, take direct aim at the one-sided, doom-and-gloom narratives of drug users often spun by the mainstream press.
Over the past decade, a certain sensationalism has often surrounded the overdose “epidemic,” with opioid-related deaths increasing by 600 percent between 2014 and 2018. From op-eds in the New York Times and Globe and Mail, to a wave of book-length historical overviews, to Netflix and HBO documentaries, there has been a proliferation of media devoted to chronicling the history and development of the crisis. These narratives are often driven by a desire to locate a responsible source or villain. We see accounts dedicated to uncovering the pernicious role of pharmaceutical companies like Purdue Pharma, which tactically pushed doctors to oversubscribe Prednisone online. With an estimated net worth of over $14 billion, the Sackler family (who own Purdue) made their fortune getting people hooked on pain medication.
What’s largely lacking in mainstream accounts, however, is a willingness to go further and deeper in apportioning this blame. Responsibility for the crisis is not confined to a handful of greedy pharmaceutical corporations, but a much broader system that prioritizes profit over human well-being. As author Donna Murch argues: “popular exposés have frequently centered on unethical practices by individual doctors and “pill mills,” rather than excavating how Purdue and other companies built a commercial infrastructure that revolutionized narcotics sale at enormous social cost.” We need a wider, more historically far-reaching narrative. What are the structural conditions that allowed overdose rates to increase so dramatically over the past decade? What are the roles of capitalism and colonialism as they continue and mutate in all of this?
Though we should treat the crisis with the severity it deserves, desperately bleak portrayals in the mainstream press can overshadow the actual experiences, autonomy, community, and acts of solidarity among people who use drugs. The occasional positive media narratives inevitably centre heroic doctors and policy-makers as protagonists in the fight against the overdose crisis, obscuring the fact that people who use drugs have been at the forefront of political movements that shape Canada’s drug policy. At worst, media stories can create the impression that drug users lack agency and need to be “saved.”
Speaking in a phone interview, Mullins points out that much reporting on the crisis fails to include the views and opinions of those most directly affected – drug users themselves: “[the Canadian media] were representing the crisis in a way we were not happy with, so we thought we’d better start telling our own stories. And the other thing is drug users’ voices are just never listened to by people in power, or people that have power over our lives. So we wanted to give it more punch, more legitimacy, to show people the expertise that’s there among drug user activists.”
For all their help in bringing the crisis to public consciousness, the mainstream narrative, Mullins tells me, can be one-dimensional and unrelatable. Reports are often unspecific both in terms of identifying the causes of the crisis and the people who are most stigmatized and marginalized. Cloaking the crisis in the language of universal suffering discounts the uneven way that addiction and drug use affects different communities. Consider, for instance, that in 2018 the rate of overdose deaths among First Nations people was 4.2 times higher than other residents of BC, and that the percentage of women in this category was significantly higher than for non-First Nations deaths. And the current statistics for overdose deaths among Indigenous peoples are even worse, showing a 93 percent increase compared to the same period last year.
Crackdown was launched last year by people who use drugs and by activists local to the Downtown Eastside. The podcast is a welcome and necessary alternative to popular representations of the overdose crisis. Mullins, the producers, and the editorial board, place drug users’ struggles in and against larger power structures, showcasing the way these structures intentionally and disproportionately impact marginalized groups. The episodes illustrate in startling detail that this is a war waged not only by big pharmaceutical companies but by callous health-care professionals (Episode 2, “Change Intolerance”), police violence (Episode 7, “Stand Down”) and a litany of politicians refusing safe-injection sites and decriminalization in favour of status quo policies detrimental to the lives of people who use drugs. Crackdown maps the range of historical and social factors that are to blame and plays out on a human level the way these abstract forces routinely interfere with and directly harm people who use drugs.
The podcast isn’t only about the broader context. It’s also about centering the needs and concerns of people who use drugs as valid forms of political expression and struggle. These are struggles interconnected with those around affordable and safe housing (Episode 6: Room 821), gender discrimination (Episode 8: The Cost of Cereal) and Indigenous rights (Episode 12: Love in a State of Emergency). Episodes have also reached out to the on-the-ground struggles of drug users outside the Downtown Eastside, in Portugal and Scotland (Episode 5: The Portugal Paradox; Episode 10: Passing the Marker). During our conversation, Mullins elaborated on the importance of culture in shaping struggles around harm reduction:
the culture of solidarity that’s part of social movement organizing (…) that is not different from group to group, in fact from struggle to struggle. When the politics are good and when the movement is mobilizing, you can feel that sense of solidarity is the same whether you’re on a picket line or whether you’re demanding a safe-injection site. That fighting for rights (…) that’s got a common culture to it and the more we can embrace the culture as it’s been brought from social movements from around the world over the last century, the better off we’ll be. There’s this constant drumbeat of “you can’t change things” that’s part of contemporary politics. So the only way you can change things is through the ballot box, you can only do it a little tiny, tiny bit in very small reasonable steps, and so breaking that culture, breaking the chains of that culture is really important.
These remarks stand in stark contrast to depoliticized narratives of the crisis marked by shame and sympathy for individual drug users, which have informed even progressive camps. Writer M.E. O’Brien points out that many socialist programmes have historically prioritized the dignity of work and full employment while disregarding or dismissing those that fall outside traditional images of the working-class and who are often embodied in the stereotype of the drug addict. Drawing on historical examples of harm reduction from the Bronx in the 1970s, in which groups like the Young Lords combined detox programmes and needle exchanges with anti-racist politics, she makes the compelling case for a radical politics that “does not assume respectability or stability, that does not divide the world between the innocently poor and the chaotically dangerous. When refusing their imposed disposability and isolation through revolutionary activity, junkies and their friends move towards a communism not based on the dignity of work, but on the unconditional value of our lives.” Like experiential workers or ‘peers’ who work at Overdose Prevention Sites, part of forming a culture of resistance lies with enabling individuals to lead a meaningful life in the here-and-now, not in the enforcement of certain types of work or treatment, or in a “dignified” communist utopia yet-to-come.
Some strands of social-democratic thinking affirm full employment as a remedy against capitalism’s alienation and separation from other humans and nature. But the pseudo-utopian character of such an argument bypasses folks who are increasingly structurally excluded from what we consider regular work. The fact that drug users often suffer the extreme effects of capitalist alienation does not mean that simply pushing work and work’s inevitable discipline is the answer. What’s perhaps needed is a reimagining of the very meaning of work itself, and indeed OPS often see users invigorated about being part of peer-run spaces where work is self-managed and less isolating.
Work not only has to be meaningful; it also needs to stop discriminating according to rules of abstinence, and rules dictating who is legitimately deserving of support. For O’Brien and Mullins, a discourse based on abstinence has eroded solidarity between groups unevenly broken by capitalism. One of the problems encountered when speaking about addiction is that it often moves into discussions focused on curing and healing. And indeed, addiction can sometimes be a cause (although far from the sole cause) in the debilitating cycles that can lead to the collapse of relations with family and friends, employment, and other social relations. The point is not to admonish anyone for whom abstinence personally makes sense as a form of treatment. Crackdown makes clear that what is being criticized is the way such narratives of cure take on a universal, moralizing character. When the media push exceptional stories of redemption through abstinence – as in the “comeback kid” narrative that Mullins also mentions in our conversation – they exclude a vast spectrum of experiences and foreclose the emergence of wider progressive movements connected through shared struggle.
Toward the end of Episode 12, Mullins asks Grand Chief Doug Kelly, President of the Stó:lō Tribal Council and Chair of the First Nations Health Council, what Coast Salish harm reduction looks like to him. Kelly discusses an immersion school where the Sencoten First Nations language is taught to preschool children, noting the children’s vibrancy and keen awareness of self and culture. For Indigenous communities facing addiction and overdose, language and culture can be forms of harm reduction. Harm reduction, saving lives in a state of emergency by giving people access to vital resources, is equal to enabling cultures to thrive and connect, rather than dictating their terms through the black-and-white view of abstinence.
With the COVID-19 crisis developing and mobilizing around public health, it remains imperative to meet the actual needs of people who use drugs. As the problems with BC’s safe supply policy continue to be revealed, we learn that we cannot leave it to government guidelines and regulations to identify and fulfil those needs. Mullins finishes our conversation by pointing out that, as the world shuts down, this is just when a culture of resistance should be articulating its demands:
This is exactly the time when big ideas, broad social change is possible and progressive, socialist, transformative social change is possible, like suddenly people are thinking why do I have to pay my rent if I can’t go to work? Why doesn’t my work pay me for sick days? Why can’t I afford pharmaceuticals, why isn’t that covered?
Further, as governments shut down public spaces and enforce “social distancing”, oftentimes against people who lack the luxury of homes and self-contained living accommodations, we must ensure that no one’s needs are glossed over:
If the government’s going to take the authoritarian measure to shut us down, then by Christ they better take the authoritarian measure to liberate all the empty homes in the city to put us in, to set-up the services that we’d otherwise be providing through VANDU, to give people the connectivity so that we can have meetings to support each other virtually.
Or, as the episodes of Crackdown repeatedly stress, “Nothing about us without us.” This is what people on the front line of the drug war have always been fighting for.
 See, for example, Beth Macy, Dopesick: Dealers, Doctors and the Drug Company that Addicted America. Head of Zeus, 2018.
 For Murch, capitalism’s role in the crisis additionally involves maintaining the image of a racialized underclass. Much has been written about the rise of addiction to prescription painkillers among whites, not just within deindustrialized communities but even in wealthy suburbs. Writing on this topic is important and needed. But little is being said about how, as Murch argues, the empowerment of pharmaceutical companies like Purdue is premised on a racialized understanding of what is defined as a public health crisis and what, on the flipside, is considered engagement in illegal “pleasure-seeking.”