On March 24, partners of the Peterborough Drug Strategy (PDS) held the first in a series of media and public engagement events intended to raise awareness of the local opioid crisis and reduce the stigma associated with substance use.
At the event, they also released the latest data illustrating the increasing severity of the crisis. Last year, there were 39 confirmed or suspected opioid-related deaths in the Peterborough public health region, medical officer of health Dr. Rosana Salvaterra said. For comparison, there were 29 confirmed opioid-related deaths in the region in 2019.
The crisis is getting worse in Peterborough, and it’s especially acute here compared to other Ontario communities. Peterborough’s rates of opioid-related emergency room visits and opioid-related deaths are almost double the provincial averages, according to Peterborough Public Health’s data.
With public health information and COVID-19 death-rates leading the news night after night, it can be easy to become desensitized to numbers like these. But the PDS partners stressed the need for continued attention to the drug crisis, which took far more lives in our community than COVID-19 did last year, and which requires the same level of response that has been mobilized against the pandemic.
The goal of PDS’s new public education campaign is “to foster greater understanding of the causes of the opioid crisis and evidence-based solutions needed to address it.”
Here’s what became clear over the course of the media event: If community awareness is needed to address this crisis, it can’t just be awareness of the latest death counts. The community needs a better understanding of the complex causes of drug poisonings and addictions, as well as the solutions available.
With this increased awareness, it is hoped that Peterborough will be able to remove one of the barriers that stands in the way of an effective response to the opioid crisis: stigma.
“We continue to blame people who use substances”
Stigma is one of the driving forces behind our community’s drug crisis, and it has been for years.
At Peterborough’s Opioid Summit held in the summer of 2019, Salvaterra presented a photograph depicting one of our community’s safe needle disposal boxes. Scrawled across the box was the graffiti, “DIE JUNKIE DIE. STAY DEAD.”
“It was shocking to see it here in Peterborough,” Salvaterra told the audience, “but it served as a powerful reminder of the stigma that exists toward people who use illicit drugs.”
At the Summit, Salvaterra called on attendees to become “goodwill ambassadors … so that more people in our community will feel included and worthy of care.”
Agencies that provide health care to drug users in Peterborough have struggled recently to secure suitable space downtown to locate their services, something they partly attribute to stigma.
Last year, PARN’s harm reduction program, which provides sterile needles, naloxone kits and other supplies to facilitate safe drug use, was made homeless after it was “ejected” from the King Street building where PARN rents office space, according to former PDS chair Peter Williams.
At first, PARN moved its harm reduction program onto its outreach truck. Then the program was taken in temporarily by One City Peterborough. PARN finally found a permanent home for its harm reduction program when the former Greyhound bus terminal was secured as Peterborough’s opioid response hub.
At a press conference in August, I asked Charles Shamess, who was then PARN’s executive director, whether stigma and discrimination were a factor in PARN’s difficulty finding space to operate their harm reduction program downtown.
“I would say it has played somewhat of a role,” Shamess said. “Many landlords are not able to or interested in leasing or renting to us because of the perception that service users are going to cause trouble. And that’s a good example overall of how stigma and discrimination works around substance use.”
Shamess drew a distinction between how mental health and substance use are currently discussed in our society. “For decades, mental health was stigmatized, and then we worked really hard over the last 25 to 30 years to destigmatize mental health,” he said. But on the other hand, “We continue to blame people who use substances as though it’s their own fault, they’re weak [and] they should deal with it themselves.”
It’s easy to point the finger at landlords and property developers who have either refused to rent their spaces to harm reduction providers or have publicly voiced their opposition to locating such services downtown. What’s harder, Williams pointed out to me last summer, is to acknowledge the much wider stigmatization in the community that influences these landlords’ decisions.
A business-focussed property owner who opposes harm reduction downtown might be acting on their own personal prejudices. But they’re also reflecting more widespread sentiments. The landlord who refuses to provide their space for harm reduction does so “because they think there’ll be too many repercussions for it to be a good business move. And we have to own that as a community,” Williams said.
Not long after Shamess and Williams made these comments, a local property developer did step up. Kevin MacDonald purchased the former Greyhound bus terminal at 220 Simcoe Street and leased it to FourCAST so it could be used as an opioid response hub, which could include a Consumption and Treatment Services site if approved by the federal and provincial governments.
This was hailed as a “breakthrough achievement” for harm reduction in Peterborough.
But it didn’t all at once change community perceptions, and last month the PDS partners again called on Peterborough to work to dismantle the stigma facing drug users, because it continues to hinder efforts to address the crisis.
“This stigma, manifesting in negative language and attitudes, drives people further underground at a time when it may be very crucial to ask for help,” said Dylan DeMarsh, the community resource coordinator at PARN. “It devalues people’s self worth, builds barriers to treatment and other services, and divides our community into an us-versus-them dichotomy that does not reflect the complexities of addiction and drug poisoning.”
Be mindful of language
After last month’s media event, I followed up with DeMarsh to ask for some specific guidance for those who may not feel personally connected to the drug crisis, but who want to become the kind of “goodwill ambassador” that Salvaterra challenged us to be in 2019.
First, DeMarsh pointed out that the presence of stigma sometimes leads to a false sense of distance from the crisis.
“People may be more connected to it than they think,” he says. You might know someone who is experiencing the crisis first-hand and not realize it, because “the nature of the stigma is people aren’t talking about their experiences with addictions or using drugs.”
Next, DeMarsh suggested thinking carefully about the language you use when you are discussing the drug crisis and people who use drugs.
“The words we’re using shape the narrative,” Demarsh says. He suggests avoiding words like addict and junkie, which “encapsulate the whole person,” and fail to capture the complexity of each drug user’s experience.
When these words are used, drug users notice, DeMarsh says. “They see it on Facebook. They see it on the news.”
“These aggressions add up. And they impact someone’s self worth and … how they feel about reaching out for help.”
Another word that you might want to reconsider is overdose. Demarsh acknowledges that this word is extremely common, and so it’s hard to shake off. But it does misrepresent the cause of opioid-related deaths, he suggests.
Demarsh recommends “drug poisoning” as an alternative. “Overdose is generally about taking too much or more than you expected of a substance,” he says. “These aren’t overdoses. These are people being poisoned by the drug supply.”
Learn about potential solutions
As I write, I’m reminded of the discourse around climate change, which has often been criticized for focussing too much on the responsibilities of individuals instead of the responsibilities of governments and corporations, which have more power to enact impactful solutions.
Every member of our community has a role to play in making drug users feel welcomed and included, it’s true. But elected officials and other authorities have their own responsibilities.
Last summer, CBC journalist Josh Bloch asked drug user advocate and documentarian Garth Mullins what specific policy changes would reduce fatal drug poisonings. “Decriminalize drugs, legalize a safe supply and defund the cops,” Mullins said bluntly.
Our community has made applications to operate a Consumption and Treatment Services site, and government officials are actively reviewing it.
Our local board of health has for years been supportive of a safe supply program, which would make it possible to prescribe some drug users with a safe alternative to street drugs. Safe supply programs were launched last year in Toronto and Cowichan Valley with federal funding. Locally, a research project is underway to explore best practices for a safe supply program in smaller and rural communities, says Emily Jones, the community development coordinator at the Peterborough Police Service.
Over the coming months, PDS will continue to share information about the causes of and solutions to the drug crisis. DeMarsh says the next session will focus on the principles behind harm reduction.
In the meantime, work will continue at a grassroots level to save as many lives as possible.
“A frontline responder who often gets overlooked in this crisis are people who use drugs,” DeMarsh says. “They’re the people administering Naloxone when a friend experiences a drug poisoning. It’s folks who come in to collect [harm reduction supplies] for a house or for a few houses on the street.”
There is “important community development work that’s happening at a really grassroots level,” he says, “and I think it’s probably upon us to try and capture that energy and bring that to the wider community.”