Unexpected view at the centre of a crisis
She carefully unfolds a foil wrapper, delicately removes the crumble of tar heroin within, places it in a spoon. Spits to moisten. Flicks a lighter to cook it, the substance dissolving into a viscous liquid. Rips open a clean needle and draws the solution into the barrel. Hands it to the man she loves. He leans over to look at himself in a small mirror. Plunges the needle into his neck.
His name, he says, is Oliver Smith and he’s 34 years old, addicted to heroin since he was 21.
On this afternoon, with rolling IV — saline bag and monitor — still attached to one arm, Smith has trundled over from St. Michael’s Hospital to the pop-up “safe” injection site at Moss Park for his fix. Even though he’s on a methadone regimen. He makes this excursion at least twice a day.
Plodding back to the hospital, passersby offer him food: a burger from McDonald’s, an apple, a doughnut. He is grateful. Especially so when a church volunteer presses a small Bible into his hand.
“Can I have one too?” asks his longtime girlfriend, Angie Austin.
She had just injected herself as well, immediately nodding off, chin sinking into her breast bone.
They are nice people, well-known in the neighbourhood. Many stop to say hello. “His sweetie,” says Austin to a street friend. Several inquire about the IV. “My foot got infected,” Smith explains.
Unlike many of their acquaintances, Smith and Austin aren’t homeless. They live in a subsidized apartment. But they are both deeply ashamed. “I grew up in Mississauga,” Smith says. “A Jamaican family living in a middle-class white community. I never felt accepted. Only when I got high with my friends, both white and Black. That gave me a kind of acceptance, you know? At first it was just dope, then I started snorting cocaine. But cocaine is really a nonsociable drug. When you come down, there’s this burnt-out feeling, yucky feeling. So I moved on to opiates.
“The fentanyl scares me. I’ve overdosed 11, 12 times.”
Austin: “You never know what you’re getting, what the heroin has been mixed with.”
That’s why they’ve been taking advantage of the Moss Park facility — an unsanctioned “safe” and hygienic facility operated by harm reduction volunteers, including a nurse who observes every injection. At least one OD has occurred at the site, last weekend, but workers — with naloxone kits (the nasal spray fentanyl antidote) holstered to their belts — were able to revive the individual before paramedics arrived.
Three permanent injection sites are planned for downtown, South Riverdale and Parkdale, but are not scheduled to open until the fall. This pop-up and perhaps others are intended to fill that gap amidst an opioids crisis in the city.
“Most of us work in harm reduction,” explains Nick Broyce, whose full-time job is in that field. “All these volunteers are highly experienced in harm reduction, how to respond to overdoses. We’ve revived multiple people.”
This is a tawdry area of Toronto, surrounded by missions and hostels, possibly the city’s most crime-infested neighbourhood. But businesses line Queen St. and there are new condo buildings nearby. Few are amenable to an injection site added into the mix, fearful of even more crime and violence as a result.
“I don’t think we’re drawing more people into the area who are problematic,” Broyce counters. “These are people who were already here. We’ve set up away from the park benches and the playground. And we clean up every day, remove needles that were discarded overnight.
The injection tents have been set up between 4 p.m. and 8 p.m.
Over-the-counter naloxone kits are available free from pharmacies in Ontario — 80,000 kits have been distributed by the Health Ministry this year — but Broyce points out that users seeking them have to show a health card. “Many don’t have them, don’t have any ID, don’t have a permanent address.”
Not all heroin users fit the stereotype, nor are they all addicts. But clearly many have all sorts of related issues — mental-health problems, poverty, the physical manifestations of living rough.
“They’re already highly stigmatized,” Broyce continues. “Is it better to deal with addiction as a health issue or a moral issue — bad people making bad choices? These are vulnerable people who often don’t know where their next meal is coming from. Many have serious mental issues. What is there for them to attach to? For all kinds of reasons many attach to drugs.”
Walking her boyfriend back to the hospital, Austin, 42, describes why she first turned to heroin nine years ago. “Because of him,” she says, referring to Smith. “Because he was using and at first I didn’t even know, he hid it from me. After I found out, I thought it would bring us closer, that it would help our relationship. It was the stupidest thing I’ve ever done in my life.” Smith: “I told her not to.” And now here they are, all these years later, leaning on each other, often trying — and failing — to get clean. “Withdrawal is awful,” Smith says. “It makes you sicker than anything you can imagine. I want a normal life, a job, to be able to see my young son without upsetting him. I don’t want him to see me like this.”
Austin, who has no family: “I would love to work with kids in some way. If I could help change just one child’s life . . .”
Toronto’s Medical Officer of Health, and others, have called for a public discussion on decriminalizing all drugs in the wake of the ongoing overdose epidemic; some 2,400 deaths in Canada last year believed attributable to opioid-related ODs.
A matter of health rather than criminality, they argue.
Which is facile to promote from a distance, from a harm-reduction posture, from even the outsider intimacy of front-line workers.
At ground zero of heroin addiction, the view is not necessarily what you’d expect.
Smith: “No, no, no, I’m not in favour of that. We shouldn’t make it easier to end up like me.”
Austin: “Being illegal, that’s what scares a lot of people away from doing it. I wish it had scared me. I wish I could go back.” Rosie DiManno usually appears Monday, Wednesday, Friday and Saturday.