The authors of a study published in International Journal of Drug Policy show how this has disproportionately affected First Nations Peoples. They looked at safer opioid supply access among registered First Nations Peoples in Ontario between 2019 and 2023, and found that during that period the number of new program initiations increased nearly fivefold—from 15 individuals to 92. The rate was also higher than that of the general Ontario population.

Safer supply programs provide eligible patients with regulated, pharmaceutical alternatives to street-supply drugs, such as hydromorphone as an alternative to the unregulated fentanyl supply.

Coauthor Ashley Smoke was an early advocate for safer supply.

“We knew people were overdosing and dying when they did not have to,” Smoke told Filter. “What was needed was access to a safe and regulated supply of the substances people were already using, so they were not forced to rely on the poisoned street supply.”

Smoke, from Alderville First Nation, is a member of the Ontario Drug Policy Research Network Lived Experience Advisory Group. They are the cofounder of the Ontario Network of People Who Use Drugs, and wear many other hats in harm reduction and drug policy. In their first experience with safer supply they were referred to a program with a strong Indigenous culture, but struggled to access it because of the distance from where they lived.

Many Indigenous people in rural and remote areas experience the same problem. The study found that in 2023, only six of the 92 individuals who started safer supply lived in First Nations communities. The programs had been concentrated in urban areas. The authors also noted that providers within First Nations communities may be unlikely to prescribe safer supply, due to wariness about overprescribing.

The researchers cite ongoing trauma from the Indian Residential Schools and child welfare system.

During approximately the same time period used for the study, the overdose rate among First Nations Peoples in Ontario tripled. In 2022 the rate of fatal overdose was approximately nine times that of the general Ontario population.

The researchers cite ongoing trauma from the Indian Residential Schools and child welfare system. Between the 1830s and 1990s more than 150,000 Indigenous children across Canada were taken from their homes and sent to government-funded, primarily Christian boarding schools. In 2015 this was formally recognized as cultural genocide.

“Indigenous communities have been disproportionately affected by the toxic drug crisis for many years,” coauthor Katie Pine told Filter. “We continue to see the impacts on individuals, families and entire communities.”

Pine is an opioid strategic planning specialist for the Anishinabek Nation, based in North Bay. She said that while it was clear the crisis was continuing to disproportionately impact First Nations communities across Ontario, not enough is known about their on-the-ground experiences of accessing safer supply. The study showed that among First Nations Peoples there is “growing engagement with this harm reduction approach,” making the province’s current stance even more concerning.

“I don’t think any of the findings were particularly surprising to me,” Pine said. “I had worked with safer supply programs and had firsthand experience supporting people who were accessing those services.”

Pine hopes the paper reaches policymakers, and those in a position to fund these types of programs.

“Before safer supply, I had lost custody of my son,” Smoke said. “My relationship with my partner was broken. I had strained relationships with family members, and so much of my life was organized around trying not to be sick, trying to manage pain, trying to access substances, and trying to survive.” 

Safer supply changed all that. Once Smoke no longer had to rely on the unpredictable street supply, the “constant pressure, fear and instability” in their life decreased. They regained custody of their son. They were able to focus on repairing their relationships and building a career. Smoke and their partner now have their own home. Smoke credits safer supply for allowing them to make these changes.

“For Indigenous people, substance use cannot be separated from colonization, residential schools, the Sixties Scoop, child welfare, criminalization, racism, poverty, grief, trauma, displacement, and disconnection from culture, land, family and community,” Smoke said. “If safer supply only focuses on the prescription, it misses the full context of people’s lives.” 

Image via Washington State Healthcare Authority

The post How Ontario’s Safer Supply Programs Impacted First Nations Peoples appeared first on Filter.

SANPUD has been instrumental in empowering local networks of people who use drugs, providing them with the tools and support necessary to advocate for their human rights effectively. 

Shelly, who uses methamphetamine—or tik, as it’s called here—is currently an independent consultant for the United Nations Office on Drugs and Crime and the Global Initiative Against Transnational Organized Crime, as well as a research associate at the University of Pretoria’s Department of Family Medicine. He was formerly the executive director of Harm Reduction International. 

Filter spoke with Shelly about SANPUD’s early days, the organization’s future in a rapidly changing policy landscape and the challenges now facing harm reduction workers in South Africa. Our interview has been edited for length and clarity.

“The sex worker organization members were income producers, while the drug user members were net income consumers.”

Matthew Bonn: ⁠⁠Can you share how SANPUD was formed, and your role in that?

Shaun Shelly: In 2016, I was working at [South African nonprofit] TB HIV Care. We were a core group of ignorant, inexperienced, underqualified, but thick-skinned and highly motivated people who pushed forward despite the constant objections and restrictions we faced. These were the early days of harm reduction in South Africa. 

South Africa needed the voice of people who use drugs—not only in the programs that served them, but also at a political level.

That was easier said than done. The sex worker movement, another criminalized key population group, was moving forward. The drug user movement was having a repeated series of false starts.

The sex worker organization members were income producers, while the drug user members were net income consumers. This meant that we needed to pay people and could not rely on volunteers.

We needed structure, and some people who could drive and establish a movement [but who] didn’t need the movement to survive. I was very fortunate to receive unrestricted funding from the Open Society Foundations and other donors, such as Mainline, who bought into the vision, and TB HIV Care gave me free rein to use my time as I saw fit. 

We formed a board, registered as a nonprofit, and began appointing staff. Angela McBride became the executive director and has led SANPUD since those early days.

Before there was money to influence the way SANPUD would operate, we set out a list of principles. SANPUD would be a conduit and a representative organization—not a service provider. SANPUD would exist to ensure that small, community-based networks could have a representative voice at the national level; have the support and training to apply for grant funding; and become independent and viable organizations. 

In 2018, SANPUD was officially launched by the deputy minister of social development. They also received funding from the Dutch government, Robert Carr Fund and the Global Fund. Although I was appointed chair of the board, my day-to-day work with SANPUD was done.

MB: What have been some of the high points?

SS: To see SANPUD become a recognized and influential organization and secure funding from a range of global sources in such a short time was incredible.

To see small networks form and thrive despite being rejected by [others in] the community is particularly impressive. SANPUD funds a “Double or Quits” business incubator where networks compete to double an initial investment and secure further funding as they build small enterprises.

Politically, SANPUD has been pushing to ensure that the Global Fund Country Coordinating Mechanism creates a dedicated People Who Use Drugs sector. Ensuring participation, even as a sub-sector, has been a difficult task.

MB: What have been some of the challenges?

SS: There have been real disappointments when it comes to organizations that are supposed to protect the rights of people who use drugs, who have no understanding or consideration for their issues. We were initially encouraged by [the] country’s submission to the Global Fund that committed to funding SANPUD and its member organizations to monitor programs and record and follow up on human rights violations. These commitments never materialized. 

The past issues are minor compared to the situation many organizations currently face. The defunding of [the United States Agency for International Development] has, either directly or indirectly, resulted in services being reduced or even closed … including services to people who use drugs. This will be the biggest challenge that SANPUD has faced to date.

“We will continue to demand ‘nothing about us without us.'”

MB: What do you see as the next steps?

SS: Aidsfonds [recently closed] the Love Alliance program. Funding from the Dutch Foreign Ministry via Aidsfonds made up a significant portion of SANPUD’s core funding. Right now, despite all of the magnificent work done by SANPUD and the member organizations, and despite the critical role SANPUD now plays in the HIV, HCV, health and human rights sectors in South Africa, the future of SANPUD hangs in the balance. 

I am confident in the people and leadership at SANPUD. They have a strong foundation and a good strategic plan.

Ultimately, if SANPUD achieves the vision of a South Africa where drug policy aligns with our constitution, and people who use drugs are no longer criminalized, and enjoy the same rights guaranteed to all South Africans, then its work will be done. Despite all the progress, we are a long way from turning our vision into a reality.

The team and member organizations will do what they can with the little they have. SANPUD will have to find new sources of funding. This is nothing new for the community of people who use drugs. We will continue to demand “nothing about us without us.” But we long for the day when we are not seen as people who use drugs, but as people. 

Until then, to paraphrase the ending of Jon McGregor’s book Even the Dogs, SANPUD will do what people who use drugs and harm reductionists have always done: We rise. What else can we do? We fucking rise.

Anything I have achieved has been due to sheer luck and the hard work of the good people I am surrounded by. They know who they are. I had some good ideas and some terrible ones, but it was due to the efforts, hard work and expertise of others that anything went from idea to reality.

Image via US Navy via Picryl/Public Domain

The post What’s Next for South Africa’s Drug-User Rights Movement? appeared first on Filter.

When you have been injecting drugs for a long time, it tends to show on your body. After more than a decade, I’ve experienced many things that you wouldn’t know just by looking at me, like overdoses and hepatitis C, but I’ve also had some serious injection-related infections. And I definitely have some serious track marks.

Track marks are the darkened puncture marks that often develop on areas of the skin where drugs have been injected repeatedly. Some people have veins right at the surface that don’t roll and provide lots of different injection sites to choose from. Some people might have just one spot that works for them. But often the vein starts to leak from repeated use and eventually collapses.

I’ve never had “good veins” for injecting. My legs worked for a while, until they didn’t. And now I honestly have some of the worst track marks I’ve ever seen. My friend John Keating, the person who first taught me how to properly inject a transdermal fentanyl patch, once joked that it looks “like I have the map of Nova Scotia on my legs.” Bobby Morrison, one of my best friends in Halifax, Nova Scotia, said he thought I got “slashed or cut up by someone.”

When I first started injecting, I was with someone who could hit me better than any professional phlebotomist. Our whole relationship revolved around drugs. When the relationship ended, I changed my mode of consumption to smoking for a while, and actually went to detox and a sober living house. No surprise given the success rates of those places, I soon started using again. I met a different girl who showed me how to inject in my legs, and since then I haven’t stopped. 

The fentanyl-cocaine speedballs I love so much can be tricky to inject. Cocaine constricts the vein, making it smaller, and it also numbs the area—so it’s easy to miss. It was a while before I realized part of the reason my legs are getting destroyed is half-missed shots. Or full misses.

Since fentanyl and especially cocaine wear off pretty quickly, that can mean injecting a lot and not necessarily having a fresh, sharp needle every time. Cocaine doesn’t need to be “cooked”—it’s dangerous to inject heated stimulants—but people might still cook the opioid part of their speedball before mixing it with the coke, and most needles used for drug injection are so fine that they’ll get dull just from touching a cotton that’s still hot.

Another thing that makes injection-site bruising a lot worse is if you’re on the move when you do it. And that’s one of the big differences between having a private place inside where you can take your time, and having to do things in public. For folks who live outside, wearing two or three pairs or pants at a time just ups the odds of getting injection infections and worse scarring.

For the first time in my life, I am homeless. And I’m learning so much about how to properly inject drugs. I thought I knew a lot, but doing drugs in a nice tidy home is a whole other ball game than doing them on the fly.

I commend Morrison for his kindness and generosity in sharing his knowledge about safer injection. He has taught me so much in such a short period of time. We both like the good, strong East Coast cocaine, which in Halifax in particular has been getting better and better.

But Morrison is such a smooth shooter—no gnarly scars like mine, or at least that’s what I thought. I asked him if he had any track marks, and he said “a couple,” kind of sarcastically. But then he said “my arms look like they’ve been slaughtered,” and I could hear the internalized stigma in his voice. 

He talked about the embarrassment he felt. “What do people think, all of that?” he said. 

At times the stigma and judgment made him regret ever starting to use drugs. I told him he wasn’t doing anything wrong, and the words seemed to help a little. But it’s hard to take away that shame.

I’ve felt so much of that myself. During summertime I wouldn’t ever wear shorts because of the scars on my legs. Then one day in detox I met the love of my life. We were flirting, and I had to be real with her and show her my leg. She laughed and said, “What, do you think I never saw a track mark before?”

She didn’t care about the scars. Or about the severe substance use disorder or criminal record. I felt like my true self with her. Her name was Grace Lynn Davidson, and she died way too soon on August 10, 2025. I’ve been broken since she passed, but I’ve had the support of my street family—including Morrison, Wala, Boo, Wendell, Mitch, Scotty and Art—knowing how much she brought us all together. I don’t feel ashamed of my legs anymore. Now I take pride in them, and all I feel is love.

That’s why I love being a drug user. We are humans, we make mistakes, we may not always treat each other properly. But we also have each other’s backs. And we never forget the ones we loved the most.

In memory of Grace Lynn Davidson.

Top image via Madison County, New York. Inset images via Matthew Bonn.

The post Learning to Love My Track Marks appeared first on Filter.

In Canada and around the world, most OPC are located in densely populated areas. The Spot was different. By land area, Sudbury is the biggest city in Ontario and the second-biggest in Canada. As the city’s only OPC, The Spot served a community that was spread out and relatively isolated.

In the September edition of the International Journal of Drug Policy, researchers published a study examining what happened to the community of people who use drugs (PWUD) in Sudbury after The Spot closed its doors. The research focused on systemic exclusion and oppression of marginalized communities.

“[W]e understand stigma as a governmental tool that can mark specific populations as less deserving of care and resources,” the authors wrote, “oppressing and harming the health of marginalized communities through the systemic exclusion of health care investments.” 

With funding from the Canadian Institutes of Health Research, the authors hired five local peer research assistants with lived experience of injection drug use “to ensure the perspectives and experiences of people who use drugs are central to both the research design and analysis.” Some also had lived experience with hepatitis C. The authors also hired a “principal knowledge user” with lived experience of HIV.

“Participants often felt stuck. Caught between stigma, limited resources and geographic challenges.”

“[S]ubordinated groups (e.g., PWUD) have an epistemic advantage regarding their material, social and political worlds,” the authors wrote. “As such, we utilized a community-based participatory research (CBPR) approach that emphasized the voices of PWUD rather than those in positions of privilege.”

I have the utmost respect for corresponding author Dr. Geoff Bardwell and for people who work the way he does. Bardwell is an assistant professor in the School of Public Health Sciences at the University of Waterloo in Canada. Many know him as the director of Drug Lab, a research project that partners with PWUD in vulnerable communities.

The Sudbury study is titled “Necropolitics of the North: A rapid ethnography examining the effects of the closure of one of Northern Ontario’s only supervised consumption sites.” Bardwell told Filter that the simplest definition of “necropolitics” is that it’s a framework for understanding policy decisions that result in death—not always in an obvious way, such as laws that authorize the death penalty, but in ways that “dictate who is worthy and unworthy of living.” 

“Northern people who use drugs are subjected to many risks that those living in an urban environment are not,” Lucas Tucker, an Ontario-based graduate research assistant at University of Waterloo and one of the study co-authors, told Filter. “Participants often felt stuck. Caught between stigma, limited resources and geographic challenges.”

People who had used The Spot before it shut down—some of them multiple times a day—described how fear of police arrest led them to use alone, in alleyways or in the bush, significantly raising their risk of fatal overdose. But if they used in more public settings, they faced discrimination.

“I’m around people, so if I do go down, I know that someone will save and be there to help,” one of The Spot’s participants told the study authors. “And if I’m alone, then I won’t. I won’t be able to come back, you know?”

“The loss is not simply losing supervised consumption, but also losing a sense of belonging.”

Words like these make my bones shiver. My heart goes out to those people; I can feel their pain.

Canada recorded 52,544 overdose deaths between January 2016 and December 2024. That’s an average of 16 people every day for nine years. But in December 2024, the Legislative Assembly of Ontario banned overdose prevention centers (OPC) from operating within 200 meters of schools and childcare centers. Out of the 17 OPC that were operating in the province, this meant 10 were faced with shutting down.

One of the sites is suing the administration in order to keep operating. Nine have been converted to “homelessness addiction and recovery treatment hubs,” which allows them to receive a lot more government funding to provide other harm reduction services, but not OPC services.

Of the 10 OPC targeted by the new law, five were in Toronto—which is one-fifth the size of Sudbury, but has 16 times more people. There is an abundance of literature discussing the public-health benefits of opening OPC, and the harms of closing them. But little of it is focused on less densely populated communities, since it’s rare that they had an OPC in the first place. 

The Spot was more than a safe place to use drugs. It was a haven, a place to call home for the day. It’s customary for OPC to offer wraparound services and referrals to other housing and health care services, and their closure has an outsized impact for rural northern communities, where PWUD don’t have access to other harm reduction services the way they might in other parts of the country.

If Bardwell had the chance to speak his mind in the House of Commons, he’d tell officials to read the evidence in front of them and listen to the communities they supposedly serve. When people lose their routine and have no safe, supervised place to use drugs, that means they use drugs alone. Former participants have died since The Spot shut down. 

Bardwell described the community as resilient, but also devastated, and feeling the sense of hopelessness that many advocates have shared as the government continues to move away from harm reduction.

“The loss is not simply losing supervised consumption, but also losing a sense of belonging,” he said. “I don’t think anything will replace The Spot.” 

Image of The Spot in 2024 via Kaela Pelland/Creative Commons 4.0

The post Most Overdose Prevention Centers Are Urban. The Spot Was Different. appeared first on Filter.

In 2019, during my early days of becoming a harm reduction advocate, I visited Vancouver’s Downtown Eastside and heard about a celebration of life for Chereece Keewatin, a comrade lost to the drug war. Keewatin was president of the British Columbia Association of People on Opioid Maintenance and a member of the Vancouver Area Network of Drug Users, as well as an editorial board member of Mullins’ podcast Crackdown, which had just launched. Mullins and Keewatin were close friends.

I thought I had lost a lot of friends, but I could tell that day that the community I saw grieving had experienced much more than their share of these losses. That was the first time I saw Mullins—tall, bright white hair, a little awkward, with an extremely rad sense of style. And a unique kind of energy and confidence, where you could tell he had a passion for drug-user activism that had been burning for a long time.

Since then, Crackdown has become widely known among drug users, health care workers, and policymakers. It’s been added to the syllabus of many university courses, and taken Mullins to places like Portugal, Scotland and Switzerland. Through the podcast he shares stories of local drug users and talks with them about different issues facing their communities. I feel like Crackdown’s editorial board are the leaders of Canada’s drug policy family.

Over the past six years I’ve gotten to build a bit of a relationship with Mullins. I even made my own appearance on the podcast as part of a narrative review on grief and trauma that was recorded in Geneva, Switzerland. It’s one of my proudest moments as a drug-user advocate.

Once when Mullins came to Halifax we came to the place I was staying, and we poured stiff drinks and talked about a work collaboration that had gone wrong—a webinar that I ended up missing because I had recently overdosed and was out of commission. Mullins assured me that wasn’t my fault; it’s because we have a toxic drug supply.

Mullins grew up in Yellowknife, capital of the Northwest Territories. In his early teens he moved to Vancouver, where he started to use drugs. In his new memoir, the national bestseller Crackdown: Surviving and Resisting the War on Drugs, he shares stories from his life—from being arrested for possession in San Francisco, to going to graduate school in London, to getting on methadone maintenance—and sets out his vision to end the drug war. Our interview has been lightly edited for length and clarity.

My book is out now. Available anywhere. The audiobook too (which I read). It’s part memoir, part manifesto and aims right at the heart of the current Trump / Poilievre right wing backlash against harm reduction. https://t.co/hObgzkoGfo

— Garth Mullins (@garthmullins) April 16, 2025

Matthew Bonn: I absolutely loved the book and have been a huge fan of the podcast. How do you feel about sharing your story in such an open format? Were you nervous, scared, excited? 

Garth Mullins: Originally the book was going to be a series of essays with a few personal anecdotes mixed in. I shared an early draft of a chapter with my buddy Jeff Louden. Jeff read carefully, then looked up from all the citations and footnotes and said, “This is really interesting stuff, but reads a bit like an encyclopedia … keep it real. It should sound like you.” So I started again, this time with my own story. I get to make all the political and historical points. I get to mention the studies and the research, but within the context of my own life. Personal stories can be more compelling, more accessible. That’s what I thought the moment called for. So that’s what I ended up doing. It was pretty hard, because I had to be sensitive about the stories of ex-partners and family members. Theirs are not mine to tell.

MB: I love the chapter when you and Jeff met in Ottawa after you performed at your first punk show. I got to meet Jeff a bit when I was in Vancouver doing my study on drug smoking. Such a cool guy. How has Jeff influenced your activism? 

GM: Jeff is my best friend. He’s really my brother. We’ve had each other’s backs for more than three decades. My life is better for having met him for sure. I had already found heroin before we met, so it’s not like my life would have been radically different. Jeff is a loner, so I had to coax him into activism. He still tells me that we go to too many meetings where there’s too much talk and not enough action. He’s probably right. But he still shows up. 

“Methadone saved my life … I no longer had to spend all my time and money outrunning dopesickness. I could get on with doing the other things I wanted.”

MB: The chapters where you are talking about getting on methadone hit home. What role has methadone played in your success?

GM: Methadone saved my life. People dismissed methadone as just trading one drug for another—after all, methadone is an opioid just like heroin or fentanyl. But that concept was really revolutionary to me. The problems I was having—overdosing, getting locked up, being broke—were not because of the opioid molecules in my bloodstream, but about the way society organized itself in response. Methadone meant I no longer had to spend all my time and money outrunning dopesickness. I could get on with doing the other things I wanted. 

MB: I know all the Crackdown listeners who are on methadone will be able to relate to the chapter titled “The Switch.” Can you briefly explain what that refers to, and why it’s important?

GM: In 2014, methadone patients in British Columbia were forced to begin using a different formulation, which did not work for most of us. This was just when fentanyl started hitting the street here. Lots of people on the new methadone found it didn’t really last very long, so they were scoring off the street to top up. Overdoses started ramping up. We fought back for years, trying to get the government to reverse its decision. Eventually we won, and were allowed to access the old methadone again. The lesson is that we all rely on this medication and we are very vulnerable to decisions made by officials who have no idea what the impacts might be. So we all gotta stick together and organize, otherwise we are vulnerable to shit like this. 

MB: I want to ask a little bit about your time going to jail. Being young and in the United States, you must have been a bit frightened. Would you do anything differently now? And are you allowed to travel to the US?

GM: I was scared shitless. If I had to do it all over, I would’ve stayed in bed that day. I definitely would’ve tossed the drugs while the cops were searching for me. Travel to the US is difficult for me, as it has become for so many people now. Over the years, they’ve hooked up all the databases and it has become increasingly difficult to cross the border, to the point where I no longer try. 

“When I started getting active in social movements and in punk, I got exposed to all kinds of ideas and people—many of whom were involved in academia. It was a breath of fresh air.”

MB: I enjoyed the chapter of you going to London for your master’s program. Did your university education play a role in shaping your activism?

GM: It was the reverse really. When I was in high school, I never thought I’d go to university. I got bad grades and I thought of myself as a dumb kid. The intellectual environment of the 1980s was claustrophobic, like a long pep rally for capitalism. Margaret Thatcher said, “There is no alternative” to anyone who dreamed of one. But when I started getting active in social movements and in punk, I got exposed to all kinds of ideas and people—many of whom were involved in academia. It was a breath of fresh air and lit a fire in me to know more, to go find out for myself. I had no idea there were entire disciplines that looked at the society and history critically, and from the point of view of people who’ve been fucked over most of the time. I was jonesing for that kind of thought.  

MB: I really appreciate you sharing your experiences with PTSD and using Eye Movement Desensitization and Reprocessing (EMDR) as an intervention. Can you explain what EMDR is and how it helped you?

GM: I don’t really know how it works. When I went to the doc, she explained it, but it sounded like hippy bullshit to me. But I tried to keep an open mind and it worked. The doc asked me to think of an image associated with a distressing memory. She gave me a little electronic unit to hold in each hand that produced a rhythmic left-right buzzing. She had me focus on the image. Over a few sessions, the emotional intensity associated with the memory diminished. She said the memory was “reintegrated.” I can now think about it without feeling that hot stab of shame or pain. Supposedly the process mimics the natural memory processing that occurs during REM sleep, helping the brain reframe traumatic memories.

MB: I really enjoyed the chapter called “The Transmission” where you shared a little about the birth of Crackdown. What impact has hosting the show made on your life? 

GM: Hosting Crackdown has allowed me to meet some great people and travel to some interesting places. While the podcast is not about me, I do share little anecdotes here and there. I started telling my own story. After so many years of keeping my own history with opioids secret, it was very liberating. All the positive feedback helped me stop feeling ashamed of who I am. I have always felt that my truths were suspect. Nobody believes drug users. You can just feel suspicion building up in a room. But with the podcast, we back up all our experiences with research and for the most part, I think we are believed. That has been very gratifying.

Image (cropped) via Garth Mullins/Penguin Random House Canada

The post Garth Mullins of “Crackdown” on Loss, Methadone and Drug-User Organizing appeared first on Filter.

For those who survive, brain injury is a real threat that’s been described as a “hidden epidemic.” The accurate number of people impacted across North America is unknown.

A 2023 study found that overdose survivors were many times more likely to have a brain injury (toxic encephalopathy) compared with the general population in British Columbia.

“Severe cases of toxic encephalopathy can develop into toxic leukoencephalopathy, delayed post-hypoxic leukoencephalopathy, and amnesia,” the researchers noted. “It has been demonstrated to impact memory, executive functions and psychomotor abilities; ability to concentrate and recall information; speech; the visual system; and, in severe cases, lead to coma or death.”

Opioids such as fentanyl impact specific receptors in the brain that also regulate breathing. An opioid-involved overdose depresses respiratory activity to the extent that you’re deprived of oxygen. If this is not rectified quickly—through rescue breathing, another means of supplying oxygen and/or naloxone administration—brain damage begins to occur in as little as 3 minutes. The longer you go without oxygen, the higher the chance of brain injury. 

I’ve been wondering if I might be one of the people affected by brain injury.

I’ve used drugs for most of my adult life, and have experienced a lot of non-fatal overdoses. Sometimes I wonder how I survived. But since I was introduced to the issue through my work for a harm reduction organization in Canada, I’ve also been wondering if I might be one of the people affected by brain injury.

One time in Montreal, I overdosed and there was no naloxone in sight. Thank God for my colleague at the time, who provided rescue breathing for 16 minutes. It took me a while to recover after that, and I wasn’t sure if I ever really would. Did this or other incidents cause lasting damage to my brain?

Chloé Xavier, MPH, is an epidemiologist affiliated with the British Columbia Centre for Disease Control in Vancouver. She led that study on the prevalence of brain injury among people who use drugs in BC, which was published in the Substance Abuse Treatment, Prevention, and Policy journal in 2023.

“Since the public health emergency was declared nine years ago, more than 16,000 people in British Columbia have died from the toxic, unregulated drug supply, and many others have survived and are experiencing ongoing long-term health challenges,” Xavier told Filter. “Given that the drug poisoning emergency has impacted communities across Canada, brain injury resulting from drug poisoning is a concern nationally as well.”

“People in BC who experienced drug poisoning were 19.5 times more likely to have a brain injury compared to people with no history of drug poisoning.”

“Our research study found that people in British Columbia who experienced drug poisoning were 19.5 times more likely to have a brain injury compared to people with no history of drug poisoning,” she continued. “We recently updated our analysis, and found a significant increase in the number of people with brain injury in 2020 and 2021 compared to the period from 2015 to 2019.”

Xavier and other experts agree that tracking and diagnosis of overdose-related brain injuries is inadequate, masking the extent of the problem.

Dr. Mauricio Garcia-Barrera is a professor at the University of Victoria, where he specializes in neuropsychology. He’s passionate about raising awareness of brain injury to change the course of an emerging crisis, and he has a personal motivation for that.

“One of my uncles had a brain injury, a traumatic brain injury,” Garcia-Barrera told Filter. “He fell off a stair ladder under the intoxication of alcohol.”

“I do remember very clearly the significant change he had in the way he spoke, in the way that he moved, in the way he thought,” he continued. “He wasn’t the same person. I was very puzzled by that. I grew up with that very clear memory of a significant change in my uncle.”

After Garcia-Barrera shared that story, I felt comfortable opening up about my history of drug use and overdoses. I told him about my concern that I might have a brain injury, and asked him what he would say to someone with that fear.

“There are areas of the brain that cannot fully heal, but it is also true there are areas of the brain that can generate new cells to support neuroplasticity.”

“When we talk about brain damage and brain injury, oftentimes those are heavy words,” he replied. “They are often compared to terminal cancer or things that have no reverse, because we have learned in our culture misconceptions that the brain doesn’t produce new cells.”

“What is true,” he continued, “is that there are areas of the brain that cannot fully heal, but it is also true there are areas of the brain that can generate new cells to support neuroplasticity—allowing healthy brain regions to compensate for and take over functions lost due to brain damage.”

I found that pretty comforting. I may well have some damage—I intend to find out more—but the main thing Dr. Garcia-Barrera wanted to convey to me is that there is hope.

Knowing about the risk is key. And to address the lack of awareness of brain injury following non-fatal overdose, Garcia-Barrera led a three-year project, the BC Consensus on Brain Injury, advocating for a national strategy on the issue in Canada.

This project—which recently concluded, with a report expected soon—brought together community members and families impacted by brain injury, as well as politicians, to exchange information and engage with the research team about their experiences and perspectives.

“We really wanted to have a conversation about the intersections between brain injury, mental health and addictions, ‘cause we notice it’s very common, but not so common to talk about it,” Garcia-Barrera said.

“Prevention is the number one intervention,” he emphasized. “Anything that can be done before an overdose or drug toxicity event occurs helps reduce brain injuries.”

But if an overdose has already happened, how people respond to it is vital.

“During a drug poisoning event, it is important for people responding to call 911 and follow the SAVE ME protocol, which includes giving rescue breaths or administering oxygen to reduce damage to the brain,” Xavier said.

After that, as both Xavier and Garcia-Barrera noted, a big problem is the lack of diagnoses of brain injuries following non-fatal overdoses.

For people who come very close to death during an overdose, or who end up in a coma for a short time, medical providers may draw more attention to the possibility of brain injury. But from my own experience of overdoses, you’re typically seen quite briefly in an emergency department, then discharged without any mention of brain injury.

“Brain injury can significantly affect a person’s life, impacting relationships and compounding existing barriers such as housing access and employment opportunities.”

If that happens to you, one way you can do your own followup is to access community support. It costs nothing to engage with a provincial brain injury association in Canada. And one program that Garcia-Barrera wanted to highlight is the Cognitive Assessment and Rehabilitation for Substance Use program (CARSU), offered by Vancouver Coastal Health.

CARSU provides free assessment and treatment through a team of occupational therapists, social workers, neuropsychologists and psychiatrists. Treatment for brain injuries varies case by case, but typically involves rehabilitative work with specialists, and potentially medications. CARSU helps patients to improve their thinking skills through brain exercises and lifestyle changes, among other services.

The program aims to help people with cognitive impairment related to substance use, and their supporters, to better understand their needs and improve quality of life. In keeping with the principles of harm reduction, it doesn’t require anyone to be abstinent from drugs to receive support.

Unfortunately, such programs are rare. The gaps are glaring, given the scale of the long-running overdose crisis that North America continues to endure.

“Brain injury can significantly affect a person’s life, impacting relationships and compounding existing barriers such as housing access, employment opportunities and access to community support,” Xavier noted.

Researchers like Xavier are building the knowledge needed to bring more awareness and expertise to the issue. I asked her for an example of a particular area where more study is needed.

“Young adults (19-39 years) are over-represented among people experiencing drug poisoning events, and may not immediately develop brain injury symptoms,” she responded. “Young people who use drugs and experience repeat drug poisonings may see future impacts on health, which has implications for long-term care provision. I think this is something that requires attention and additional research.”

As someone who falls squarely into that particular at-risk category, I’ll be endlessly grateful if this happens.

One of the consequences of stigma is that when problems are seen as something you can’t talk about, it keeps them hidden, neglected and more painful than they need to be.

June is Brain Injury Awareness Month in Canada, which sees campaigns to raise awareness of the prevalence of brain injuries, the obstacles faced by those affected and the support people need. It’s a welcome event, but it seems like there’s much more to do to spread fuller awareness of overdose-related brain injury.

Fresh from his BC Consensus on Brain Injury project, Garcia-Barrera has further ideas on how to go about this. He suggested a massive educational campaign to reduce the stigma of mental health conditions and substance use. That’s because effectively reducing stigma, he feels, would have all kinds of knock-on effects on the care impacted people receive.

If neurologists, occupational therapists, emergency department personnel and other clinicians could finally understand why people who use drugs use drugs, he believes, doors would open—and not only the doors those professionals work behind. Policymakers and government agencies might finally allocate more resources to where they are sorely needed.

One of the consequences of stigma is that when problems are seen as something you can’t talk about, it keeps them hidden, neglected and more painful than they need to be. It helped me a lot to be able to speak with two inspiring experts who are working to shed light on overdose-related brain injuries. I wish more people in my position could feel similarly supported. 

Image via Picryl

The post An Invisible Crisis: Brain Injury From Non-Fatal Overdose  appeared first on Filter.

Bill 223 bans SCS within 200 meters of schools, childcare centers and similar facilities. That covers 10 out of the 17 sites currently operating in Ontario. They will be forced to close by March 31, 2025.

As well as intervening to prevent overdose deaths among people using drugs on site, these SCS offer a raft of resources critical to people’s health, like drug checking, sterile syringe provision, naloxone, safe supply and referrals to other services.

The governing Progressive Conservative party had announced the legislation in August; other Ontario politicians either supported or failed to adequately oppose it as it progressed.

The resulting law also bans local governments from applying for exemptions to Canada’s Controlled Drugs and Substances Act in order to decriminalize drug possession.

And it bans municipalities from applying to open new SCS or safe supply programs without the approval of the provincial health minister. That’s not likely.

In August, reporter Jack Hauen asked Health Minister Sylvia Jones if she’d estimated how many people would die as a result of the planned SCS shutdown. “Jack, people are not going to die,” she responded. “They’re going to get access to service. You know, I do not call watching someone injecting an illicit drug to be healthcare in the province of Ontario.”

The report noted that “in 2022/3 alone, the 10 sites that will be closed … successfully prevented fatalities from over 1,500 overdoses.”

December 3, the day after Bill 223 passed, saw the publication of a damning report from Ontario’s auditor general, Shelley Spence: Implementation and Oversight of Ontario’s Opioid Strategy.

The government’s SCS decision, made while the annual report was in development, was taken “without proper planning, impact analysis or public consultations,” it stated, including around “a potential increase in overdoses and emergency department visits” due to the move, when SCS “have been proven to prevent overdose deaths.”

Starkly, the report noted that “in 2022/3 alone, the 10 sites that will be closed upon passing of the legislation had successfully prevented fatalities from the over 1,500 overdoses that happened on site.”

Since March 2020, Ontario’s safe consumption services have hosted 1.12 million visits from 178,000 unique clients. They’ve provided over 530,000 service referrals—including to housing, HIV and hepatitis c treatment, and withdrawal management services. And they have averted 22,000 overdoses.

Ken Miller is the executive director of the Canadian AIDS Society. He lives in Thunder Bay, Ontario, where one of the SCS due to shut down is located.

“I wasn’t surprised,” he told Filter of the developments. “We’ve seen the coordinated effort from Ontario, Saskatchewan and Alberta to restrict or eradicate harm reduction services such as safe consumption sites or needle exchange programs.”

On October 21, Miller organized a “die-in” to protest the closure of the Thunder Bay site. Inspired by earlier advocacy around HIV/AIDS, over 100 people lay down outside city hall, their bodies outlined in chalk, to symbolize the lives that the policy would cost.

Thunder Bay protesters including Ken Miller (with megaphone). Photograph by Ryan Hill.

The provincial government cites public safety and crime concerns in the vicinity of SCS in an attempted justification of its actions. Such claims, common among opponents of harm reduction, are refuted by evidence.

Like other Canadian provinces, Ontario is now doubling down on treatment and recovery at the expense of harm reduction. In closing SCS, the government is touting a $378 million investment in 19 new Homelessness and Addiction Recovery Treatment (HART) Hubs.

“HART Hubs will add up to 375 highly supportive housing units, in addition to addiction recovery and treatment beds, that will help thousands of people each year transition to more stable long-term housing,” it said, in addition to connecting people with medical and social services. “With a focus on treatment and recovery, HART Hubs will not offer ‘safer’ supply, supervised drug consumption or needle exchange programs.”

The exclusion of harm reduction means many people are unlikely to be able to access the services, because they will no longer be alive.

HART Hubs “will in no way be able to fill the gap in services created by these closures.”

Epidemiologist Dr. Tara Gomes is the principal investigator at the Ontario Drug Policy Research Network (ODPN).

“Despite the investment by the government into HART Hubs, which have goals of helping coordinate care and treatment for people across the province, these new Hubs will not provide overdose response, supervised consumption services, access to safer opioid supply programs, or provision of needle exchange services,” Gomes told Filter, “meaning that they will in no way be able to fill the gap in services created by these closures.”

In November, the ODPN published a report, co-authored by Gomes, estimating the potential impact of closing five out of 10 in Toronto, as will happen under Bill 223. One further site, the report noted, “is likely to close after its lease expires.”

“Assuming 4 SCSs remain open and the service radius for an SCS is 500m, we estimated that 636 people (47% of current clients) would lose access if remaining sites were able to accommodate all clients within their service radius,” the authors wrote.

“Those people are going to be at higher risk for overdose, higher risk for death,” ODPN lead author Dr. Ahmed Bayoumi told Toronto’s CityNews. “We also know that many of the clients … are people who are unstably housed or homeless. So those people don’t have another place to go. They don’t have a private residence to go to. So most likely people who don’t have another place to go are going to inject in alleys, in parks.”

An estimated 525 people in Toronto lost their lives to opioid-involved overdose in 2023, even with 10 functioning SCS. Research has shown that Toronto neighborhoods with SCS experienced large reductions in overdose mortality, compared with no statistically significant decreases in other neighborhoods.

“This loss of supervised consumption sites will have devastating impacts on all of the communities that they currently serve,” Gomes said. “Research … shows that not only do these sites help prevent harms by reversing potentially fatal overdoses, but they also help connect people to treatment, housing and health care, reduce transmission of infectious diseases like HIV and hepatitis C, and reduce discarded needles and other drug-related materials within neighborhoods.”

The HART Hubs will not do most of those things, though they will seek to connect people with services. How much of a replacement will they be?

Dr. Dan Werb is the executive director of the Centre on Drug Policy Evaluation, at St. Michael’s Hospital, and a faculty member at the University of Toronto’s Institute of Health Policy, Management and Evaluation.

The government is “shutting down the best referral system this province had, which is supervised consumption sites, and replacing it with a model that is frankly untested.”

“It appears to be kind of an inpatient-like supportive housing intervention that has its goal linking people who use drugs with a range of services they may need,” he told Filter of the hubs plan. “Now, the irony here is that if you are looking to link people who are at risk of overdose with the services that they need, you only have to go to the Health Canada database. There is a national dashboard that tracks the number of visits at supervised consumption sites across the country and the number of referrals made.”

“The notion that the government is changing tactics here to try and focus on referrals is actually going to be shutting down the best referral system that this province had, which is supervised consumption sites, and replacing it with a model that is frankly untested,” he said.

Werb noted that the Ontario government “did not provide any clinical evidence” on the effectiveness of HART Hubs. “I fully don’t understand what the model is.”

“There are going to be other services that are affected by these closures, and I will highlight in particular drug checking,” Werb said, calling these services “a real straightforward and effective way to help people ensure they are not going to be consuming drugs that have unpredictable contents or adulterants.”

“Drug checking is generally co-located with supervised consumption sites,” he explained, “so if you close those sites people are going to have their access to drug checking compromised, which not only has a knock-on effect [on] an individual’s capacity to avoid bad batches but also compromises an emerging provincial drug market monitoring system that is based around the results of tests. If we don’t know what people are using, we can’t do drug market monitoring, responding through public health alerts to warn other people about the types of drugs circulating in the community, and that is really problematic.”

SCS “are not and have not been associated with increases in crime, and certainly not violent crime. Despite this, the rationale was one of public safety.”

For months, people who use drugs in Ontario, health care providers and academics have been fiercely advocating against the looming SCS closures, both by highlighting their lifesaving benefits and by pushing back on the government’s supposed justifications.

Werb’s Centre on Drug Policy Evaluation released a report on Ontario SCS in November which, among other things, analyzed crime data in light of the government’s claim of increased violent and other crimes around the sites.

Using 13 years of Toronto homicide data from the Office of the Chief Coroner of Ontario, the researchers found that after SCS opened, areas within 500 meters experienced a minimal but statistically significant decrease in homicides, while areas further than 3 kilometers away experienced a minimal but statistically significant increase.

Their analysis of nine years of Toronto Police Services data meanwhile showed that neighborhoods with SCS experienced significant decreases in assault and robbery rates after implementation, while other downtown neighborhoods showed no such decline. There were no significant changes in thefts over $5,000 after the opening of SCS, but both neighborhoods with and without the services experienced initial increases in break-and-enter rates, followed by significant downward trends.

In other words, the government’s claim that these sites increase crime is demonstrably false.

“They are not and have not been associated with increases in crime, and certainly not violent crime,” Werb said. “Despite this, the rationale that was put forward was one of public safety.”

“In one month alone after the site was closed, more people died from overdose than in the previous year.”

But the government has ignored all kinds of compelling evidence—most of all, how its plans are a recipe for mass deaths. Real-world examples underline that.

“There was a site that closed in March of this year in Sudbury, in Ontario’s northern region, which has been disproportionately hard hit by overdose,” Werb recounted. “Last year in Sudbury, which is a city of about 160,000 people, 100 people died from an overdose. By October of this year, after the site was closed, 115 have people had died of an overdose. So three quarters of the way through the year, more people have died from an overdose than in the entire previous year.”

Photograph by Ryan Hill

The bottom line is that the Ontario government is “morally” against the notion that people like or need to use drugs, and willing for people to die in its pursuit of that ideology.

In Toronto the sites being forced to close are: Parkdale Queen West Community Health Centre’s Bathurst, Regent Park Community Health Centre, South Riverdale Community Health Centre’s Queen, Toronto Public Health’s The Works, and the Neighbourhood Group’s Kensington Market Overdose Prevention Site.

Other Ontario sites being forced to close are: Guelph Community Health Centre, Hamilton Urban Core Community Health Centre, Thunder Bay’s NorWest Community Health Centre, Region of Waterloo Public Health and Emergency Services, and Ottawa’s Somerset West Community Health Centre.

“I would urge policymakers to immediately reconsider their decision to implement these changes, and work together with safe consumption sites to find ways to support their continued operation,” Gomes said. “We’re losing dozens of people every week in Ontario from drug overdoses, and we simply can’t afford to move backwards, removing access to evidence-based services.”

Nothing suggests that the Progressive Conservative government, led by Ontario Premier Doug Ford, will start listening.

“I think of the people involved in this movement. I think of the people who are no longer here in body because they have been taken too soon from this preventable issue,” Miller reflected. “I think about what needs to be said. I think we need to call it out. Is the new face of genocide inaction? Inaction towards communities who are not receiving proper support?”  

Top photograph of Thunder Bay die-in by Ryan Hill

Correction, December 11: The original version of this article misstated Sudbury’s fatal overdose figures before and after its SCS closure. The article has been edited with a corrected quote.

The post Ontario’s Unconscionable Supervised Consumption Sites Shutdown appeared first on Filter.

Today, like every year, I’ll take some time to reflect on these preventable deaths, and to grapple with grief I’ve barely had time to process before learning of the next tragedy. But remembering the loved ones and brave advocates we’ve lost is not the primary purpose of this day.

“International Drug Users Day is a day when we as the drug-using community are reminded to celebrate and feel pride in our identities and behaviors,” Judy Chang told Filter. “This is one of the hardest things to do in a world that tells us, as people who use drugs, that we should somehow be ashamed of who we are, when on the contrary we are an incredibly strong, resilient group and community of people that have done, and do, so much incredible work everyday for our communities.”

Chang, a friend and colleague of mine, is the executive director of the International Network of People Who Use Drugs (INPUD), a peer-led organization that defends the health and rights of drug users, challenging stigma, discrimination and criminalization. Based in Milan, Italy, she works closely with people who use drugs across the world.

INPUD, Chang explained, is “supporting grassroots organizations, networks and individuals from the drug-using community to mobilize around International Drug Users Day, as we want to showcase the work, ingenuity and creativity of the global movement.”

“What makes me proud to be a drug user is the strength and resilience it takes to survive under prohibition.”

This mix of activism and celebration means a lot to me as a drug user. People who use stigmatized, criminalized drugs often feel unable to be vocal about their own use, but will still cheer on these efforts from the sidelines. That used to be me.

“Like many drug users, it’s taken me some time to be proud and out about my drug user identity,” Chang said. “I am proud of being a drug user, not only because I feel that drugs of all kinds have expanded my mindset, worldview and experiences, but also [because they’ve] helped me through difficult times.”

“Most importantly, what makes me proud to be a drug user, is the strength and resilience it takes to survive under prohibition,” she continued. “No one but a drug user understands the hard work, struggle and determination it takes to be a drug user. Since I’ve been part of, and connected, and working together with the community, I’ve only become more proud of us all.”

It’s only because of people like Judy Chang that I feel able to be open and honest about my own use today.

Another person* doing invaluable work in this area is based in Vancouver, British Columbia. She’s the founder and CEO of the nonprofit J Healthcare Initiative Organization, and is also affiliated with YouthRise.

It’s about telling moms that “it is ok to open up about their drug use and not to be closeted.”

She’s a passionate fighter for the rights of people who use drugs, and that’s informed by her own lived experience. She was precariously housed just at the time when the street supply of heroin here in Canada was transitioning to fentanyl. She witnessed so much harm due to the Iron Law of Prohibition that she felt she had to do something about it.

Among these efforts, J Healthcare Initiative started a circle for a particularly stigmatized population: mothers who use drugs. They called it Motherhood Unfiltered, and it offers support in dealing with many issues, from overdose to interactions with child protective services.

More than that, it’s about telling moms that “it is ok to open up about their drug use and not to be closeted,” the CEO told Filter.

She believes in that for herself, too. “I take prescription stimulants and I’m proud of it; it saved my life, and I’m not planning on getting abstinent from it.”

“We love our mothers who use drugs,” she continued. For International Drug Users Day and beyond, “we’re going to do more campaigns about Motherhood Unfiltered for moms who use drugs, for women who use drugs.”

Depending on where you live and how you’re situated under prohibition and stigma, there can be huge barriers to being publicly open, and I would never criticize anyone for choosing not to be. But people who are able to do this, perhaps because they have more privilege, are doing a service for the rest of us, as prominent advocates like Louise Vincent and Dr. Carl Hart have pointed out.

We should reject the guilt or shame imposed on us for being resilient, resourceful and badass.

We need to get out of the shadows if we’re to be heard. So the main purpose of today, for me, is for drug users who can to be loud, proud and prominent. We must refuse to be second-class citizens. We should reject the guilt or shame imposed on us for being resilient, resourceful and badass. Considering all we’ve been made to endure, we should be proud as hell.

On this day, above all, we may be able to come as we are. We may be able to show people who don’t understand substance use that not everyone needs to stop.

People use drugs for a wide range of reasons, whether to enhance the good times or cope with the bad. If the only consequences of using drugs were negative, why would anyone ever do them?

A lot of us like ourselves much better on drugs—find ourselves more creative, more productive, funnier or more confident. In this, we’re not so different from all those people who openly rely on legal drugs like caffeine and alcohol in various situations. For so many of us, drugs are a huge part of our identity and help make us who we are.

I feel like I try to embody that spirit 365 days a year, but it’s not always easy with family, relationships and work. Writing is one way I can be open, in seeking to reduce the structural, social and internalized stigma that I and so many others have experienced for so long.

“We are a safety net for each other.”

Forming communities as drug users helps us know we’re not alone, but it’s also the primary way of keeping one another safe through mutual aid.

“We save each other’s lives by administering naloxone, test drugs for each other, demand and run drug consumption spaces and in some instances, put our own freedom at risk to make sure there is a safe supply of drugs,” Chang said. “We are a safety net for each other.”

I have overdosed multiple times recently. If it wasn’t for the love and support of other drug users, I would be dead. On two of those occasions, I was saved not by a health care practitioner or paramedic, but by a fellow drug user—familiar with overdose response techniques like rescue breathing and the jaw thrust maneuver, and practicing compassion.

As a drug user, I would never leave another drug user behind. That’s our code. We may not have too many friends and allies, but we have each other. We should embrace and embody that solidarity, and take pride in it. That is what International Drug Users Day should be all about.

Photograph by Luis Quintero via Pexels

* The name of this source was removed from the article in 2026, at the source’s request, for personal reasons.

The post To Me, International Drug Users Day Should Mean Pride appeared first on Filter.

But I’ve also experienced a whole lot of harms associated with drugs, and especially with the conditions of drug use under prohibition. I’ve contracted hepatitis C, and suffered injection-related infections and numerous nonfatal overdoses.

About a year ago, I decided that considering everything, I wanted to stop using drugs. So I applied for a sober living facility and started that journey. That doesn’t mean I think it’s the “right” choice for others. It just made sense for me, when by that point in my life, the risks and harms, and the impact on my mental health, had been outweighing the benefits.

Despite that decision, I recently overdosed again. I want to tell you about it because some of the circumstances could be relevant to a lot of people.

Sober living has been a mixed bag of experiences and emotions, and I’ve been in and out of facilities over the past year.

Again, recovery was the goal I chose for myself, despite past experiences with safe supply, and I went into this with my eyes open. The risk in abstinence-based treatment and sober living, as I already knew, is that you lose your opioid tolerance, so if you do use again, it becomes very easy to overdose. Researchers have often flagged this.

In early September, just over a month after I’d last left the sober living house, I got this sudden, strong urge.

Another risk is that if you’ve been in an abstinence-based culture and committed to that, the shame you may feel if you want to get high can make you hide the fact that you’re using, and choose to use alone.

I’d been making progress in my goal, sometimes going months at a time without using anything. But someone in my life started drinking again and experimenting with drugs like cocaine, and I started to partake with her sometimes.

I still felt like I was on a positive journey. Recovery comes in different shapes and sizes, and as author Johann Hari has said, “The opposite of addiction is not sobriety. The opposite of addiction is connection.”

I was keeping it light and not causing havoc. I was also on 20 mg of methadone at the time, a medication proven to reduce risks for people with opioid use disorder. But in early September, just over a month after I’d last left the sober living house, I got this sudden, strong urge.

A friend of mine had just ordered drugs off of the dark web and offered to let me try some for free. So I taxied out to his house to pick them up. I was planning to do a speedball—still commonly defined as cocaine mixed with heroin, but which in 2024, where I live, means cocaine with fentanyl.

I still had harm reduction in mind. We have a lot more harm reduction resources in Nova Scotia than we used to. One notable thing here is that syringe service programs teamed up with pharmacies to offer free “brown bags”—essentially mini using kits with syringes, cookers, cotton filters, sterile water, tourniquets and alcohol swabs. In most cases, if you ask for a “brown bag” at a participating pharmacy, staff will offer you a free naloxone kit as well.

Sometimes, like me that day, you can’t hold off until you are in a safer place, where people are with you with naloxone.

So after I scored the drugs from my friend, I got the taxi to drop me off at a pharmacy close to where I was staying. I knew they offered the brown bags (some pharmacies choose not to, for the usual reasons). I asked the staff for a bag of long tips and went right into the bathroom.

I wasn’t sick but I was still jonesing for a shot. That’s how it works sometimes, for a lot of people. Sometimes, like me that day, you can’t hold off until you are in a safer place, where people are with you with naloxone.

In the bathroom I grabbed a cooker, a syringe and some sterile water. Then I put two little pink shards of fentanyl into the cooker with about 2 points of cocaine. I heated it up with a lighter until it was all dissolved, took a cotton filter and meticulously sucked up my shot into the syringe. Then I tied off my leg and went for my old faithful vein there. I slowly injected, saw the blood flag and pushed the syringe in.

It felt great—exactly what I expected. I got the cocaine high, and then I slowly came down. And that’s all I remember.

I woke up surrounded by paramedics, police officers and pharmacists. They’d cut off my nice Adidas track jacket and given me six vials of naloxone. They saved my life and were like humble heroes. The group acted if they did this everyday. Which they probably do.

I knew my name, where I was, and the fact I didn’t want to go to the hospital.

They’d given me more naloxone than I’d needed, when one dose is usually enough. For a lot of people this can heighten precipitated withdrawal, causing unnecessary suffering and greater risk. I didn’t get that, because I was no longer too physically dependent on opioids.

Surprisingly, I was all there when I woke up. I knew my name, where I was, and the fact I didn’t want to go to the hospital.

The police officer who’d arrived first and found me, after the pharmacy staff called emergency services, said I’d turned blue before I received the naloxone. He urged me to go to the hospital.

But I was dead set on not going. I’ve gone to hospitals after several overdoses, and been treated like a piece of garbage almost every time.

Nova Scotia is a small place, and one of the paramedics who helped save me actually remembered me from a talk I did on harm reduction. He explained to me that they had to have some kind of care plan for me where I wasn’t going to be alone. So I quickly suggested: How about the overdose prevention site?

The paramedic talked to the on-call doctor about my plan, and they were okay with it. Back in the day I probably would have been going to the police station. But that day, the police officer dropped me off at the local overdose prevention site.

This whole experience left me feeling hopeful that some of the work to change minds has finally started to kick in.

Overdose prevention centers (OPC), which have a lot of different names around the world, aren’t just places where people can use drugs without the fear of arrest or fatal overdose. They also offer many other resources, and referrals to health and social services. But my favorite part is the community connection you get there. You’re with compassionate, understanding people, who let you know you’re not alone in this battle against the drug war.

In that environment I recuperated, felt supported and left feeling well. I want to thank everyone there.

This whole experience left me feeling hopeful that some of the work many of us have done to change minds about people who use drugs has finally started to kick in.

I could feel that the people I interacted with weren’t looking down on me the way they used to. Even when I was in the back of the ambulance, before the cop was going to drop me off, the paramedic and a student were with us, and in our conversation they encouraged me to teach the cop a few things about harm reduction, stigma, language and drug use. It turned something extremely scary for me into a learning experience for all of us.

I would choose an OPC over a hospital any day of the week.

There are obvious harm reduction lessons here about vulnerability after abstinence, naloxone, using alone and the way we all treat each other.

For me, it also raises the question of why we can’t routinely offer to take people who have overdosed to an OPC, where they’ll receive the best support and won’t need to take up a hospital bed.

OPC need resources to play that role, of course, and a lot of jurisdictions still need to open them in the first place. But it’s a thought I’ll pursue. We all deserve a choice—it’s a principle of trauma-informed care—and I would choose an OPC over a hospital any day of the week.

September 23 was Medic Monday in Nova Scotia, and I want to acknowledge all the hard work of the province’s 1,300 paramedics, who between them have saved my life on multiple occasions.

Photograph by Nova Scotia Ambulance via Wikimedia Commons/Creative Commons 2.0

The post I Just Overdosed Again. This Time, It Was Different.  appeared first on Filter.

Naloxone, the most common opioid overdose reversal medication, has been available for free over the counter in Canada since 2016. It’s very effective at reversing respiratory depression and allowing people to breathe on their own again. But if someone’s overdosing and you don’t have naloxone, rescue breathing can keep them alive until you do.

I once experienced an overdose involving fentanyl where there was no naloxone on hand. My boss at the time kept me alive for 16 minutes until help arrived, by performing rescue breathing.

The majority of the time, you’d tilt the person’s head back and lift their chin before you begin rescue breathing. The head-tilt/chin-lift is a simple maneuver to extend someone’s neck and open up their airway, and for most people responding to most opioid overdose emergencies it should be the go-to. But what if you have reason to worry the person injured their spine, and you don’t want to risk moving their neck?

While overdose doesn’t usually involve someone falling and hitting their head, for example, it can happen, and they still need their airway opened. If you’re properly trained, there’s an alternative to the head-tilt/chin-lift that’s safer to use on someone with suspected spinal injury: The modified jaw thrust maneuver.

I learned about the modified jaw thrust maneuver (sometimes just called the jaw thrust maneuver) from Derek Bevans, a former critical care paramedic in Alberta. He’s found that, if you know what you’re doing, the technique can be very effective—even in situations where spinal injury isn’t a factor, but the head-tilt/chin-lift isn’t doing the job.

“I’ve used this technique in medical overdose and in trauma where I couldn’t get an airway and I didn’t have my trauma kit,” Bevans told Filter. “The modified jaw thrust definitely pulled me through, as a layperson and [as a] paramedic.”

Rather than kneeling next to the person, in the modified jaw thrust you’re behind them with your hands on each side of their head. Done properly, the technique lifts the jawbone upward and forward, which in turn moves the tongue away from the back of the throat—clearing their airway without having to extend their neck.

“As soon as you do that, you generally get a little bit of a gasp,” Bevans said, “but then you can lose it again. So you have to continue to exert pressure until you hear that constant breathing pattern.”

When he first told me about the technique, I was shocked. Why isn’t this more widely taught?

We should be teaching the modified jaw thrust to peer workers, and to anyone who frequently responds to opioid overdose.

There’s a lot of misinformation and improper training about how to respond to opioid overdose. For instance, many public health authorities, along with law enforcement, advise performing chest compressions. But there’s a general consensus in harm reduction that this is not necessary to reverse respiratory depression, and it can actually be quite detrimental. In a typical opioid overdose the problem is a lack of oxygen, not a stopped heartbeat. Chest compressions don’t get air in someone’s lungs, and risk needless injury.

Performed incorrectly, the modified jaw thrust could potentially cause or exacerbate a spinal injury. The technique is more complicated than the head-tilt/chin-lift, and even trained paramedics sometimes do a poor job with it, so it’s important to only attempt the maneuver when necessary and with the proper training. But unlike chest compressions, it has the potential to help someone breathe in certain situations. We should be teaching it to peer workers, and to anyone who frequently responds to opioid overdose.

Claire Zagorski, a former clinical care paramedic in Alberta, said the modified jaw thrust maneuver was a major point of discussion at the Compassionate Overdose Response Summit in Pittsburgh in May. 

“Practice makes a world of difference, and good ventilation is often the difference between life and death,” Zagorski told Filter. “Having naloxone on hand is very, very important, but I also think that the more we can collectively get comfortable with opening airways and giving breaths, the better.”

Bevans used to use drugs himself—mainly methamphetamine, but when experiencing difficult times on the street he was often in a position to respond to opioid overdose. He’s used the modified jaw thrust countless times; people would even run up to him for help when someone nearby was overdosing, knowing he had this way of getting an airway open. In two instances, it allowed him to avert the overdose without administering naloxone.

Bevans, with a palpable urgency in his voice, stressed that the modified jaw thrust maneuver should be part of training for anyone who responds to overdose as part of their job. More often than not, the first responders in the overdose crisis are people who use drugs. I’m so thankful for people like Bevans who have saved so many lives, whether as a paramedic or as a layperson on the street.

Image via Mount Pleasant, Tennessee

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