Front Burner - Overdoses and COVID-19 on Vancouver's Downtown Eastside

Episode Date: April 7, 2020

Self-isolation and physical distancing are straightforward public health orders for most Canadians, but it's a near-impossible challenge for people without adequate housing. That's clear in Vancouver's Downtown Eastside, a dense neighbourhood with a large population of homeless people, who are now at risk of COVID-19. But the challenges don't stop there — the community has been battling another public health crisis for years: drug poisoning and overdoses. Today on Front Burner, Garth Mullins, host of the podcast Crackdown, tells us what that means for drug users.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. Physical distancing is something we're all being asked to do to stop the spread of COVID-19. That may be straightforward to do for many of us, but for thousands of Canadians who don't have adequate housing, it's pretty close to impossible. You can't self-isolate if you have no home. How can you wash your hands when you're on the street all day?

And in Vancouver's downtown Eastside, a dense neighbourhood that struggles with issues of homelessness, mental health and drug poisoning, that impossibility comes with great health risk. It's like we're being shut down from the outside world. Not only have we gone through a horrendous few years of the drug poisoning crisis, now we've got this? With this pandemic, Vancouver's downtown east side is vulnerable to two major public health crises, overdoses and COVID-19. Today, we take you there. This is Frontburner. I have Garth Mullins with me. He's a documentarian and host of the award-winning podcast Crackdown. It was created to cover the opioid crisis from the perspective of drug users themselves.

Haigar, thank you so much for being with me today. Hey, Jamie. Thanks for having me on the show. It's really our pleasure. Thank you so much. So for people listening to this who may have never been in Vancouver's downtown Eastside, can you give them a sense of why the neighborhood is particularly vulnerable to COVID-19? of why the neighborhood is particularly vulnerable to COVID-19.

I've seen articles with headlines like the ticking time bomb in the downtown east side. Yeah, I mean, it's a dense neighborhood and there's been a housing crisis in this city for over a decade. So people are just packed close together and there's not a lot of options. And there's, you know, a lot of drug users live in the neighborhood and all over British Columbia and Canada really. And anytime you're wired to something, you know, like you, you have an addiction, you

have to get it every day. It means you have to go see a drug dealer every day, you know, so, or, or pretty frequently. And so that makes social distancing really difficult. Um, so there's a kind of combination of things that are at work. It's check day. That means long lineups and close contact. Some residents, increasingly desperate as essential services, have shut down. Everybody's making a big deal of it.

Everything's closed. You can't get a meal. How stupid is that? It's going to hit down here like a storm. It's going to hit down here hard, hard and heavy. It's going to probably wipe out half these people, me included. Right. And I'm hoping that we can unpack all of that a little bit more today. I know Vancouver Coastal Health, the health authority that oversees the area,

they don't specifically identify where cases are unless there are outbreaks, like at a long-term care home. But do we know anything about the number of cases that may be in the downtown Eastside right now? Well, just like any community, you got to presume it's there. You got to presume the virus is there. But about 10 days ago, maybe two weeks ago, But about 10 days ago, maybe two weeks ago, the podcast was able to confirm one person who tested positive for COVID-19. And we talked to a lot of people who were at the scene where this person was sort of approached by health professionals and offered some kind of quarantine and that sort of thing. So we're quite confident that it happened. And of course, the health authority can't report it. But I think it's important for people to not wait for a test to show something. I think we have to presume it's

there. And also the fact that COVID-19 testing is rationed gives everybody this false impression that it hasn't gotten to their community yet, when I just think the opposite is what we should assume. Right. This impression that it hasn't gotten to their communities yet until they start to see deaths. I mean, this is what we're seeing all over the world. You know, you mentioned before that this is an area where people are packed into small spaces. Our producer Elaine spoke with Erica Grant, a support worker and resident in the neighborhood, and she lives in a single room occupancy hotel, an SRO. There is about 28 rooms in here and there's three floors. I live on the third floor and there's only two women's washrooms. There are three men's washrooms. It's kind of hard to self-isolate when you have to share the washroom with seven, eight other

people. And Erica wants to see more rigorous sanitation of housing like hers, more shelter space open so people can actually physically distance. And, you know, I should say that the mayor of Vancouver has made commitments towards this. The city is setting up a distribution center for supplies, a meal delivery program. We have secured a contract to provide two weeks of commercial cleaning for the 21 highest priority private single room occupancy hotels. We have secured contracts to provide two weeks worth of meal delivery to approximately 1,100 residents in private SROs. What do you make of these measures? Do you think enough is being done on this front? So woefully insufficient.

It's shocking. This city right now today has 25,000 empty condos and houses. Downtown Vancouver has empty hotel rooms. There is a housing solution waiting to happen, like right there. And the fact that people are considering in in parliaments and legislatures all over the country they're thinking about um curtailing civil liberties to keep people inside for you know pretty good public health reasons is canada considering a lockdown uh we are looking and at all possible different measures as i've said repeatedly nothing is off the table

but they're not considering um maybe infringing on property rights a little bit. This is the time to think about expropriating empty homes and giving people a place to be. You think about an SRO. I've lived in an SRO before. You get a very small room. There's no kitchen. There's any cooking facilities you've kind of jerry-rigged together yourself. The bathroom is down the hall, shared with everybody on your

floor, maybe on two floors. It's very hard to socially isolate in an SRO. It's impossible in a shelter, in a community center with a bunch of army cots spread out in a gymnasium. That's not possible either. And certainly people who are, you know, camping in tents in a park, that doesn't work either. On top of it being very difficult to physically distance in the downtown Eastside, a lot of the social services there have either closed down or scaled back what they do. Erica, the support worker we spoke to, said that a lot of residents feel abandoned because of that. When they see one another on the street, they're wondering why, you know, nobody's open with their hugs anymore. And this is a really tight-fitting community down here. And because they can't get together, you know, everyone's feeling sad now.

You know, I know I would think a lot of us went into panic, shock. And right now it's grief. They're grieving each other. They're grieving community. Is that what you've been hearing too? Yeah, I mean, I should preface this by saying I don't live in the neighborhood right now. I live about 10 minutes east of the neighborhood and I haven't been, I mean, I've been there very briefly just in the last 25 or 27 days that I've been in self-isolation. So I'm kind of out of it, you know, but I know the services that I work with, the harm

reduction services are operating at a greatly diminished capacity. Some are closed. There's PPE shortages, like masks and that sort of thing. And so there's less access for safe injection sites for people. There's sort of slightly less availability of harm reduction supplies, like new syringes and all those sort of things. So, yeah, I can imagine that it's feeling pretty bleak. And because of that sort of thing, overdoses are going back up around here. Right. And I understand that the city of Vancouver reported eight suspected overdose

deaths last week, the most in a single week since August 2019. And I heard Trey Helton from the Overdose Prevention Society, which is in the downtown east side, talk about how challenging it is right now to meet the needs of people coming in. Our smoking tent is now non-operational due to fears that it could be transferred to, transferred from people exhaling drugs in an enclosed space. So that's shut down completely. Our indoor space where we had 12 injection room tables is down to six. Is this what you're talking about when you're talking about the potential impact

of these services being scaled down? Yeah, I mean, I think so. I know Trey and my hat's off to him. He's going to work every day and trying to keep people safe. But it's a hard slog right now. He was saying too, which I found, you know, interesting, but also really difficult to listen to is that, you know, the safe injection site is trying to employ social distancing measures as well. We're dramatically seeing less people just because we can only let so many people in at a time. We're encouraging them to use in the alleyway and any harm reduction supplies and watching them as best we can. So, yeah, it's it's pretty scary. Yeah, that's right. And it's the same thing at our drug user union, the Vancouver Area Network of Drug Users. This is a place where people have organized and come to meetings. That's not really happening anymore. We have an injection room in the back that used to be able to accommodate six. It can just have three now. So there's a lot less people that can come in and kind of use the drop in and use the services. It's massively reduced. And when you think about all the services like that,

that are reduced, or a lot of them are shut, people are just having all that many less places to go. I know you've talked about this on recent episodes in your podcast, why drug users are particularly vulnerable to COVID-19. And can you tell me a little bit more about that right now? If you get wired, like addicted to opioids or stimulants or whatever, it's not like you can just quit easily. It's something that you're driven to every day and withdrawal symptoms can be extremely, extremely rough. So people got to go score off their drug dealer every day to kind of just keep an even keel, to just keep going. And it's very hard to not do that. And so giving people options to be able to not go to the illegal market is really important. We've called for that for a long time because the drug supply has been contaminated with them, with fentanyl, with all kinds of other stuff. And so it's really even more important now because it means that drug users can't socially distance themselves. Right. I was listening to your recent episode of Crackdown, and I know that you spoke with a friend named Ray,

who was more worried about dope sickness, withdrawal symptoms, essentially. It was really, it really hit home to me. When it comes to being really, really bedridden and sick for two weeks best case scenario i would pick that over two months of agony or a month of agony of this you know other option of not having your medicine if you're too ill to get there or you know yeah it's true i mean i've known ray for a long time and uh a lot of people are in that same boat as a criminalized person um as someone who's just uh sort of excluded from society in a lot of ways you recognize that you don't have control over very much and so you may

not be able to um socially distance yourself you may not be able to really have that much agency in whether you're exposed to COVID-19 or not. But you kind of know for sure if you don't do your hit in the morning or you don't get to the pharmacy to pick up your methadone or something, you're absolutely gonna get dope sick. So it's like the certainty of this very nasty sickness,

dope sickness, versus the possibility that you may not have any control over COVID-19. And that's a really difficult choice for people to make. I understand there were changes like a week and a half ago that would allow for something called safe supply. To properly battle the COVID-19 epidemic, we must tackle the poison drug epidemic. So I'm grateful to the federal government for enabling safe supply to move ahead. And now the province is hard at work to determine the rollout. And so what does that mean exactly?

And what has changed in the last week and a half? Well, safe supply is sort of a political demand the drug user movement has been making for a long time. And these vulnerabilities aren't just for people in the downtown east side. Anyone, any drug user anywhere in Canada is vulnerable to this. The difference in B.C. is we've had an organized drug user rights movement for 20 years here. This is how come safe injection sites exist in Canada is because we fought for them and even opened them first without permission until the government eventually caught up. The crisis, the overdose crisis was very bad. It continues on and we have called for several years,

just let us get the prescription equivalent of what we're using on the street so just about everything you know crystal meth uh heroin fentanyl all that has prescription versions of it that are of exact known potency known quantity all that stuff manufactured under sterile conditions all that stuff behind the pharmacist counter It's just the government makes rules about how and when you can get them. And so we've been saying to them, change the rules. People are dying. You know, a lot of people are dying. Like in the last four years or so, I think 14,000 across Canada. So, and they continue to today. Several weeks ago, I got a call from a doctor who works on the downtown East side said, Garth, what do people need?

What do drug users need to socially isolate and quarantine? And we started that conversation. Um, it joined up with other conversations between health professionals and, and people in government who were kind of trying to wrap their head around the same thing. And out of it came this policy that was originally thought to be local, you know, maybe for Vancouver, and eventually the province bought on. So all across BC now, the 50,000 people who have what they call substance use disorder, like me, we can now access not just the traditional medications like methadone and suboxone,

those are like nicotine patches that kind of help you use something safer. But you can also access Dilaudid, which is called hydromorphone. If you're an opioid user, you can access dexedrine. If you're a stimulant user, you can access benzodiazepines. If you're kind of wired onto street Valium or something like that. And there's even provisions for people who are addicted to alcohol and tobacco. So this was as kind of wide and as sweeping as we could make it. It doesn't yet include the pharmaceutical versions or a close adjacent version of what they're using on the street.

And it's our hope that people will be able to go and get a prescription for that from a doctor, go fill it out, you know, fill it at a pharmacy and take home a few weeks supply and then have the ability to socially distance and also to use something of a known potency so they're not overdosing and take a little bit of agency and dignity back into your life. You don't have to go grind every day, come up with the money, go to a drug dealer, all that stuff. It can be revolutionary for people. And have you spoken with anybody who has been able to access this in the last week and a half? So again, these are prescription versions of what people might be seeking out on the street.

I have. Implementation is bumpy. So I think some doctors aren't aware and maybe some are thinking, I don't really want to do this. And maybe some are thinking, I don't really want to do this. But there are a few people, like a couple of my friends have been able to access this. And in fact, we have tape of Crackdown editorial board member Laura Shaver and my friend of many years doing it for the first time. And what I'm doing right now is legal. This is a legal process that I have been accepted to do.

There we go. Wow, I definitely got a taste in my mouth. And just, you can hear in her voice the hope that this is her, I think she called it her exit strategy from having to use street drugs. I don't know. I just hope it's going to be a different chapter in my life. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. As you mentioned, you've been advocating for this for years. It's actually happening now with COVID-19. How do you feel about that?

Well, you know, I feel good. I also feel a little frustrated that so many of my friends and community members had to die to get here. I also recognize that we had a long struggle to be seen as human beings by the decision makers, by the people in power. I don't think we've won that yet. I think they don't yet see us as human beings. I think they fear us as disease vectors. And so that's why this is happening. But, you know, I don't care. I don't care about their motivations as much. I just care that a few more people I know might not die this year. Right. That's striking to hear you say that, that you think that these changes

are only happening because people in power are scared that drug users are disease vectors. And I, yeah, I think, I think the idea of us as disease vectors for the decision makers isn't just hypothetical. So I've been around for long enough that this is, you know, I've lived through my second overdose crisis now. In the 90s, there was an overdose crisis, a publicly declared public health emergency in Vancouver, as well as Vancouver having the highest rates of HIV

transmission in the industrialized world. Death is commonplace on these streets. That's why these protesters are calling this the Killing Fields campaign. Over a thousand people have died in the last five years from heroin overdose alone. It doesn't include all the other reasons people can die from drugs. The hepatitis C rate is out of this world. The AIDS epidemic is supposedly now peaking in Vancouver. And we had that HIV crisis here because the authorities were so stingy with needle distribution. And they wouldn't change and they wouldn't change and they wouldn't change. And we were, our community was exploding with transmission of HIV. And I think the same thing happened. I think they recognize that there's no magic wall around certain communities of drug users or whatever that that the HIV would get to their, you know, sons and daughters or whatever, too.

And so, again, they saw us as disease vectors there in the 90s. You know, the same thing is happening now. Regardless of sort of motivations now, do you think that you'll see some long term change come out of this? Or, or are you expecting for these new rules to be curtailed once we're kind of through the worst of this pandemic. I tell you what I know from my experience in this fight is nothing comes for free. So for this change to be permanent, we're going to have to fight for it. For it to be fully implemented, we'll have to fight for it. Every step of the way, we'll have to keep lighting a fire under people, uh, people in power to, you know, keep it moving.

And yeah, the, you know, the policy is supposedly set to expire in September. So not very long away. So this is going to be, this is going to be the next fight or one of the next fights for us is to make this permanent. Okay. Garth Mullins, thank you so much. Thanks, Jamie. Jamie? You can subscribe to Garth's podcast, Crackdown, wherever you get your podcasts.

Their last two episodes have been about COVID-19 and its impact on drug users in Vancouver. I'm J.B. Poisson. Thanks so much for listening to FrontBurner and talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.