Why do we still believe that letting drug addicts "hit rock bottom" is a good thing?

Our densely populated, low-income neighbourhood of the Downtown Eastside in Vancouver has 16,000 residents and about 6,000 injection drug users. Day after day, I’ve seen kind, funny and gentle people lose their families, get sicker, become more isolated a

New Statesman
Drug users at Insite, a legal supervised injection site in Vancouver. Image: Getty

Including people living with addiction into society should not be revolutionary thinking in 2013. However, in many ways the addict is the modern-day “nigger”, a term used to dehumanise, alienate, torture and abuse a group of other human beings. Today, people who use drugs – “junkies” – are expected to suffer, then blamed when they do, and if they die there is almost a collective sigh of relief.

Understanding the work that my organisation, PHS, does with addicts on the streets in Vancouver can best be explained by introducing you to one of my teachers. Tilly was a waif-like, 40-year-old aboriginal woman who I met in my early twenties. Her hollow cheeks and deep-set dark eyes were childlike, imploring and innocent – in spite of her “experience”. Locked in a room and malnourished as a child, Tilly was addicted to prescription pills by the age of 11. By the time she was 15 she had tried to end her life by slitting her throat with a kitchen knife.

When I met Tilly she was working in the sex trade, injecting heroin and cocaine, and drinking. One night she was raped and beaten, and as I held her in my lap, bloodied and broken, I rocked her like a tiny bird. She told me through her sobs that it was her fault. I felt her emptiness and I understood her cries. Hers were not the cries of a criminal but of a wounded soul who felt her life was worthless.

Our densely populated, low-income neighbourhood of the Downtown Eastside in Vancouver has 16,000 residents and about 6,000 injection drug users. Here, I started running a 70-room housing project in 1991, and for 23 years I have seen the human fallout of our collective ignorance. Day after day, I’ve seen kind, funny and gentle people lose their families, get sicker, become more isolated and die.

The people I have come to know and grown to love have helped me heal myself. My own white, privileged family was not unfamiliar with tragedy. My mother suffered her own pain and left us when I was a child. I knew what it was like to feel empty and alone.

We hear all the time how addicts are selfish liars who steal from their families, cause pain, smash car windows to steal things and get into fights. We have created brutalising conditions that result in addicts being vilified and that cause enormous harm. However, I have also experienced a unique window into the resilience, humanity and strength of people trying to survive while actively addicted.

Throughout the 1990s, alongside my partner and my colleagues, I had to go against the common logic of the day as we wrestled over how to help. We intuitively gravitated to the belief that people might be able to do better if survival wasn’t so hard, and over the years we have succeeded in creating spaces that are tolerant, respectful and inclusive – where people struggling with addiction can live, find social membership, a sense of belonging and the basics.

This flew in the face of the received wisdom that said people had to “hit rock bottom” or society was somehow “encouraging them”.

As the death toll from drugs mounted in 1997, we rebranded our community “the Killing Fields”. The number of drug users developing HIV was on a par with Botswana; meanwhile, more than 400 drug overdoses happened in our province in just one year. The level of grief was profound, so we flew in experts from around the world to talk about things that we could try: supervised injection sites, heroin maintenance, harm reduction.

Drug users themselves used their voices and parent groups spoke out. Brave politicians stood up and some lost their careers. Gradually the public became educated through extensive media coverage and community debates. By 2003, the tide had shifted and on 21 September we opened North America’s first legally sanctioned supervised injection site, or “Insite”, as a partnership between our non-profit organisation and our local health authority. We saw people come in to what felt like a sanctuary – out of the back alleys to indoors, where users could inject their drugs under the supervision of a nurse.

Over these past ten years almost two million injections have happened here, and 14,000 individuals have come in. Each year, 400 referrals are made into treatment. The staff revive, on average, 40 people a month who overdose and not one person has died.

Today, we have a more sophisticated understanding that an individual, while addicted, still has the right to live. We have created places like our dental clinic, art gallery and bank, and social enterprises that are reshaping the landscape. For example, with over 4,500 members, our community bank (a partnership with Vancity Credit Union) offers savings and checking accounts to people who are unwelcome, banned or followed by security guards in conventional financial institutions. New units of housing have been funded by our provincial government, targeting the most vulnerable homeless and addicted.

Health-care services have been established that are relevant to people actively using drugs. Social enterprises have been created to give people – addicted or not – jobs, at the vintage clothing store, chocolate and coffee roasters, art studio and retail store, commercial laundry and pest-control company.

For those of us who remember how dark it felt 20 years ago, there is much to celebrate in Vancouver in 2013. People in our community are living ten years longer.

Tilly was kind, sensitive, gentle and generous, but in the end she died of Aids because no one had cared enough to make sure she had access to a clean syringe. As a society, we told her that her life didn’t matter and she believed us.

It’s time to stop punishing and start creating solutions to the walls of intolerance and hatred we’ve built. These steps, though seemingly small, can create a new social context, one that redefines the addict from a non-person to a person, a criminal to a citizen, someone “diseased” to someone who just needs love, belonging and a community, just like me.

Liz Evans is the founder and executive director of PHS Community Services Society, which helps drug users in Vancouver