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

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

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

This article first appeared in the 23 October 2013 issue of the New Statesman, Russell Brand Guest Edit

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What type of Brexit did we vote for? 150,000 Conservative members will decide

As Michael Gove launches his leadership bid, what Leave looks like will be decided by Conservative activists.

Why did 17 million people vote to the leave the European Union, and what did they want? That’s the question that will shape the direction of British politics and economics for the next half-century, perhaps longer.

Vote Leave triumphed in part because they fought a campaign that combined ruthless precision about what the European Union would do – the illusory £350m a week that could be clawed back with a Brexit vote, the imagined 75 million Turks who would rock up to Britain in the days after a Remain vote – with calculated ambiguity about what exit would look like.

Now that ambiguity will be clarified – by just 150,000 people.

 That’s part of why the initial Brexit losses on the stock market have been clawed back – there is still some expectation that we may end up with a more diluted version of a Leave vote than the version offered by Vote Leave. Within the Treasury, the expectation is that the initial “Brexit shock” has been pushed back until the last quarter of the year, when the election of a new Conservative leader will give markets an idea of what to expect.  

Michael Gove, who kicked off his surprise bid today, is running as the “full-fat” version offered by Vote Leave: exit from not just the European Union but from the single market, a cash bounty for Britain’s public services, more investment in science and education. Make Britain great again!

Although my reading of the Conservative parliamentary party is that Gove’s chances of getting to the top two are receding, with Andrea Leadsom the likely beneficiary. She, too, will offer something close to the unadulterated version of exit that Gove is running on. That is the version that is making officials in Whitehall and the Bank of England most nervous, as they expect it means exit on World Trade Organisation terms, followed by lengthy and severe recession.

Elsewhere, both Stephen Crabb and Theresa May, who supported a Remain vote, have kicked off their campaigns with a promise that “Brexit means Brexit” in the words of May, while Crabb has conceded that, in his view, the Leave vote means that Britain will have to take more control of its borders as part of any exit deal. May has made retaining Britain’s single market access a priority, Crabb has not.

On the Labour side, John McDonnell has set out his red lines in a Brexit negotiation, and again remaining in the single market is a red line, alongside access to the European Investment Bank, and the maintenance of “social Europe”. But he, too, has stated that Brexit means the “end of free movement”.

My reading – and indeed the reading within McDonnell’s circle – is that it is the loyalists who are likely to emerge victorious in Labour’s power struggle, although it could yet be under a different leader. (Serious figures in that camp are thinking about whether Clive Lewis might be the solution to the party’s woes.) Even if they don’t, the rebels’ alternate is likely either to be drawn from the party’s Brownite tendency or to have that faction acting as its guarantors, making an end to free movement a near-certainty on the Labour side.

Why does that matter? Well, the emerging consensus on Whitehall is that, provided you were willing to sacrifice the bulk of Britain’s financial services to Frankfurt and Paris, there is a deal to be struck in which Britain remains subject to only three of the four freedoms – free movement of goods, services, capital and people – but retains access to the single market. 

That means that what Brexit actually looks like remains a matter of conjecture, a subject of considerable consternation for British officials. For staff at the Bank of England,  who have to make a judgement call in their August inflation report as to what the impact of an out vote will be. The Office of Budget Responsibility expects that it will be heavily led by the Bank. Britain's short-term economic future will be driven not by elected politicians but by polls of the Conservative membership. A tense few months await. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.