Reprinted from "Opioids" issue of Visions Journal, 2018, 13 (3), p. 40
At the end of 2016, I received an important email. The email had been forwarded to me by someone who had received it from someone else who had received it from someone else, and so on—until it landed in my inbox sometime in November, more than six months after the overdose crisis in BC had reached such epic proportions that it had been declared a public health emergency.
Our staff at AIDS Vancouver Island had just been called to an urgent meeting with Island Health’s chief medical health officer—for the first time ever. “I can’t tell you the exact numbers,” he said, “but we know it’s in the triple digits.” As it turned out, 138 people had died from overdoses in BC that month, almost double the total of the previous month.1 What was already an unimaginably bleak situation had suddenly gotten much worse.
As I read through the email chain in my inbox, three words jumped out at me: Community. Overdose. Coalition. And then one more all-important word, especially to anyone working in a non-profit agency: Funding.
The email was about a new funding project called the Overdose Prevention and Education Network (OPEN), and it couldn’t have come at a more opportune time. As the largest harm reduction service provider on Vancouver Island, AVI had been on the front lines of the crisis, responding with limited resources to the needs of our clients. But we were doing it in isolation; OPEN promised the resources to enable us to reach out across Victoria to build a community-based response—exactly the sort of support that we and many others had been looking for since the crisis began in December 2015.
We immediately applied for funding and, by February 2017, eagerly began work on establishing a community-based overdose coalition to provide education and help build within the community the capacity to respond to the crisis. OPEN provided the tools for our organization to reach out to others whom we knew had been heavily impacted by the crisis.
Over the next three months, the AVI coordinator met with a diverse range of people and groups, including front-line organizations, Indigenous communities and people with lived experience of illicit drug use and their families. We were also able to work in new ways with our existing partners, including SOLID, the only peer-based agency for current and former drug users on Vancouver Island.
The people we connected with included many parents who had lost children to overdose; soon these parents were meeting regularly at AVI. Jenny Howard, who lost her only son, Robie, to a fentanyl overdose in May 2016, told us that her involvement in the OPEN project was both energizing and healing: “When we come together like that, it’s that sense of committed energy and that feeling of connection. Hearing from the ground up how the crisis was impacting people was a moving experience that broke down barriers.”
Our work culminated in a community activation event in May 2017, where we asked the important question Where to next? The symposium provided community members and service providers with an opportunity to reflect on the events of the previous year and a half in relation to the overdose crisis and to engage in dialogue about the short- and longer-term steps needed to reduce the number of our community members who were dying from overdose.
More than 100 people participated in the symposium, with the goal of honouring the work being done, caring for each other and finding a way through this crisis together. Community members came together to find healing and to find a path forward, articulating what they needed in order to be able to continue to address stigma and save lives. Discussion topics included access to treatment, supporting Indigenous peoples and communities, creating safety in housing, services for families, access to harm reduction and substance use services and supporting front-line workers.
What also emerged at the symposium was a sense of frustration on the part of those most central in this crisis—namely, the people who use drugs, their families and the front-line workers who care for both. This frustration stemmed from the common feeling that these individuals were not being considered in the decision-making processes that directly affected them. It was widely agreed that if community-level knowledge were included in decision-making, it would be clear why some approaches have fallen short.
We also heard about the need for greater accessibility: The need for treatment services to be available in the communities where people are, in harm reduction centres, in shelters, in housing. The need to look seriously at home-based detox programs, to expand access to opioid agonist treatment and provide people the support they need to maintain their treatment plans. The need to consider heroin-assisted treatment and other models that have been successful in stabilizing people’s lives and improving their health. The need for an end to the criminalization of people who use drugs.
We keep saying that addiction is a health issue, but until we really start seeing it and treating it as a health issue, in the same way that we see and treat diabetes and heart disease as health issues, then we are not going to make progress.
Our efforts also need to focus on creating supportive communities and services. Symposium participants recognized that one of the most significant challenges they faced was addressing the stigma around drug use and overdose. Fear of being stigmatized prevents people who use illicit drugs from accessing services. Stigma within communities makes it difficult to find neighbourhoods where new services can be located. Stigma also impacts the families and friends of people who use drugs or who have died of overdose.
Participants also agreed it was critical that public attention remain focused on the overdose crisis. We need to continue to build awareness and collectively express our outrage in order to build the community support and the political will necessary for change. We must continue to find ways to share our stories and our grief.
The symposium event spearheaded a number of important initiatives. A group of parents, peers, community activists and front-line workers started meeting weekly to organize activities to mark International Overdose Awareness Day on August 31. Dialogues with local First Nations communities and organizations and the First Nations Health Authority have continued. The symposium report with its recommendations was shared widely, and a copy was sent to the provincial Minister of Mental Health and Addictions.
Our coalition of OPEN partners also continues to meet regularly, promoting education and helping to raise awareness of addiction issues, safer drug use practices, overdose prevention and stigma reduction. We are advocating for an end to policies that criminalize drug use, and we are encouraging policy changes that enable swift access to life-saving treatments and interventions.
As I write this, we are nearing the end of the second year of the overdose crisis, and the number of drug-related deaths continues to increase. But I am constantly amazed by the compassion and resilience of those working on the front lines, and by the expertise of the harm reduction, housing and health care workers whose skills form the backbone of overdose prevention and response. I am humbled by the courage of family members who have found the inner strength and motivation to become community organizers. And I am continuously inspired by those who have experienced personal addiction and the loss of friends and loved ones but who still feel compelled to come to the table and share their wisdom and knowledge.
It has been a long road, and we have a long way to go. My hope is that our coalition will soon be one of many in the province, all with the aim of enabling our communities to better respond to the needs of all community members. Together we must prevail and bring an end to this crisis—because overdose deaths are preventable, and we must never, ever forget that.
Doing Grants Differently: Activating BC’s communities to respond to the overdose crisis
Community Action Initiative
What is OPEN?
Overdose Prevention and Education Network (OPEN) is coordinated by the Community Action Initiative (CAI), a provincially funded non-profit agency that has dedicated $750,000 in grants, training and other supports to community-based organizations across British Columbia. The goal of OPEN is to address BC’s opioid overdose crisis by getting communities involved and increasing their capacity to serve those in need.
Each organization funded by OPEN receives a grant to build partnerships with other community members. Organizations are encouraged to explore new collaborative relationships, especially with those who have direct experience of substance use and overdose (like drug user groups and the families of people who have overdosed). The year-long process culminates in the development of an action plan to tackle the issue of overdose in the community. During the term of the grant, organizations also receive training in various support and response skills and have access to other resources, such as an online community of practice (a web portal that provides a virtual meeting space for overdose responders to share resources and ideas: www.openanswers.ca) and a conference to exchange information and insights.
Currently, OPEN funds 10 organizations. It aims to double that number by February 2018, at which time organizations already funded by OPEN can apply for additional money to put their action plan into motion.
How does CAI’s OPEN project do grants differently?
CAI’s mission is to increase the capacity of community-based mental health and substance use organizations and support community-led solutions to mental health and substance use issues. Since its establishment in 2008, CAI has invested over $12 million in capacity-building efforts for over 600 organizations across BC. OPEN provides a unique opportunity for organizations to gather their community members together, assess their needs, build new relationships and come up with innovative strategies and responses to the opioid overdose crisis—without asking organizations to demonstrate that they have met particular service-oriented goals.
About the author
Katrina is the Executive Director of AIDS Vancouver Island (AVI). She has been working in the area of harm reduction for more than 20 years. She dedicates this article to the memory of all those who have been lost to overdose
BC Coroners Service. (2017). Illicit drug overdose deaths in BC January 1, 2007 to October 31, 2017 (Report). www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf.