TraciLetts first went to the Overdose Prevention Society’s drug consumption room in Vancouver in late 2019. Her own son, Mike, was in jail, but she was with a friend who was hoping to find her missing daughter. Letts’s suburban home isn’t far from the stretch of East Hastings Street in Downtown Eastside populated by fentanyl users who live on the street, their possessions strewn around them. ‘Searching for our kids is just something we do,’ Letts told me. In the OPS, people were injecting at the sterile tables along one wall, while staff with access to oxygen and naloxone, which reverses the effects of opioid overdose, observed. The space was full of people, dogs, bikes and belongings. There were couches and a free phone box. It felt safe. ‘There was an order to the chaos,’ Letts said. ‘Observing eyes were everywhere, people were treated with dignity. I just knew that no one would ever be turned away.’ The centre’s director, Sarah Blyth, couldn’t help Letts and her friend, but listened while Letts talked about her son.

The story was familiar. Vancouver is one of the cities worst hit by the opioid crisis – almost seven people die here every day from overdoses. Across British Columbia – a province of five million people – there were 1629 deaths between January and August this year. Almost 13,000 have died since the local health authorities declared a state of emergency in April 2016, as the use of fentanyl, a synthetic opioid, started to spread. Toxic drugs are the main cause of death in the province for people aged between 10 and 59, according to the BC Coroners Service, ‘accounting for more deaths than homicides, suicides, accidents and natural diseases combined’. Fentanyl, which is fifty times stronger than heroin, is present in the bodies of 85 per cent of these people.

In the 1990s heroin flooded the market in Vancouver and the spike in deaths from overdoses, and from Aids as a result of needle-sharing, led to the opening of Insite, the first legal supervised injection site in North America, which this September celebrated its twentieth anniversary. In that time it has had 3.6 million visitors, but no one has ever died there from a drug overdose. There are fewer than two hundred sites like this across the world, and none in the UK. An unsanctioned van run by Peter Krykant in Glasgow operated between September 2020 and May 2021, at which point Krykant could no longer cope with the workload. A pilot plan for a drug consumption room in the East End of Glasgow was recently approved by the council and the local health board, after the Scottish lord advocate, Dorothy Bain, announced that it would not be in the public interest to prosecute people using drugs at such a facility. There isn’t currently much fentanyl use in Britain, or indeed in Europe. Heroin and street Valium are much more popular in Glasgow, but even without fentanyl there were still 1051 drug-related deaths in Scotland last year, a rate more than three times higher than any other country in Europe.

A 2019 study by the BC Centre for Disease Control found that without the rapid increase in the use of methods of ‘harm reduction’ – safe injection sites, safe supply and take-home naloxone programmes – the number of deaths from overdose would have been more than twice as high. But over the last year right-wing politicians in Canada have been casting doubt over the value of overdose prevention sites, arguing that they simply encourage drug use and crime, and calling for an end to safe supply programmes, which provide drugs including heroin and fentanyl on prescription. The funding, they argue, could be diverted to ‘mandated treatment’ – abstinence-based programmes that drug users are forced to attend.

Letts believes that politicians are wrong to think this is a vote-winner with families that have been affected by drugs. She is a member of Moms Stop the Harm, an advocacy group launched in 2016, which supports families and aims to end ‘the failed war on drugs’. She says that not everyone using drugs fits the stereotypes. ‘These kids played softball and soccer and joined the boy scouts.’ Her son started using drugs as a teenager, first OxyContin – the prescription opioid made by Purdue Pharma which is often seen as being responsible for beginning the opioid epidemic, after it was aggressively marketed to North American doctors in the 1990s in the full knowledge that it was dangerous and addictive. He then moved on to fentanyl, after it flooded the Canadian market. Letts issued ultimatums, stumped up cash and drove Mike to rehab. ‘And three days later he’d leave. So many of us go down this route and then realise that we’ve thrown £50k down the toilet because our kids are only going because we force them to.’ For years she watched her son move between homeless shelters, prison and treatment. This time, she took Mike to the OPS when he got out of jail. She was reassured that ‘even if I didn’t have eyes on him, others would. That he had somewhere to go if he ever needed something or to use a phone to call me.’

As you walk along the blocks of East Hastings near the OPS you see people slumped on the ground, in wheelchairs, or frozen over walking frames. Some live in the tents that still line the streets despite recent sweeps by authorities; others sleep in nearby alleys or parks. The homeless shelters are often full. People greet their buddies and stop to check on one another, naloxone pouches clipped to their belts. Sometimes a shout goes up – ‘kid on the block’ – and people put away their drugs until the child and parent have passed.

Ann Livingston moved to the area in 1993 as a single mother with three small children, just as the first wave of the opioid crisis hit Vancouver. Her own mother had campaigned for women’s reproductive rights and the way forward seemed obvious to her. ‘When you want things to be better for people with disabilities, you get the people with disabilities organised. When you want things to be better for women, you organise the women. It was the same here with the drug users.’ The first meeting was held in her living room. Then she rented a community space and wrote down the issues people raised on a big flip chart. Despite the HIV epidemic, clean needles were scarce and police harassment common. ‘One day someone came in who had been injecting in the alley and said police had maced them,’ Livingston said. As they tried to get away, the needle snapped and embedded itself in the person’s arm. After that, Livingston helped to set up an injection site that came to be known as the Back Alley. It was shut down about a year later, but soon afterwards she co-founded the Vancouver Area Network of Drug Users (Vandu), which campaigned for a legal safe injection facility. Its members started to attend police board and city authority meetings. ‘We’d march into the public gallery,’ she told me, spreading her arms wide: ‘Vandu’s here.’ In 2003, when promises by the new mayor didn’t materialise, Vandu set up an illegal site. A couple of months later, Insite opened: a supervised injection clinic, with medical staff, and a legal exemption from the Controlled Drugs and Substances Act.

In 2016, Livingston and Blyth started running a street market on an empty parking lot off East Hastings. As fentanyl took hold, ‘people started running to us when there were emergencies,’ Blyth remembers. The drug is so strong that death happens fast. ‘We were dealing with overdoses all day long.’ In September that year, Livingston and Blyth set up an unsanctioned safe injection site in a tent in the parking lot. This was the first version of the OPS, which has had various indoor and outdoor sites since then. Other unsanctioned sites started to spring up across the city. This time the authorities didn’t shut them down.

The drug-related death rate spiked after Covid struck. On 20 June 2020 the local health authority announced that 170 people had died the previous month, a record number. Three days later, a group called the Drug User Liberation Front (DULF) blocked a busy city intersection, aiming to publicise its demand for safe supply of medical-grade, unadulterated drugs. Activists gave away more than a hundred packaged doses of cocaine, tested for contaminants like fentanyl and labelled (‘no cut/no buff’). In 2022 DULF opened what it calls a ‘compassion club’: they buy cocaine, heroin and methamphetamine on the dark web, test it and sell it at not-for-profit prices to people who can prove they are habitual users.

Under British Columbia’s decriminalisation pilot, launched in January this year and due to run until 2026, anyone found with under 2.5 grams of opioids, cocaine, methamphetamines or MDMA won’t be prosecuted. But selling drugs is still a crime. DULF maintains an uneasy truce with the authorities. One of its founders, Eris Nyx, told me that initial data gathered from 43 registered users is promising. No one on the programme has had a fatal overdose, there was a 35 per cent reduction in overdoses overall and none was observed at DULF’s overdose prevention site. More than half the users said their daily intake had reduced. Hospital admissions halved, as did ‘negative interactions’ with the police. ‘I’m not a big fan of seeing people’s lives get all fucked up because they’re addicted to opiates,’ Nyx said as she carefully filed unsold packages alphabetically and put them back in the safe. ‘But the alternative to this is that they end up dead.’

But drug deaths continue, only about 5 per cent of users in British Columbia have access to safer supply through government programmes, and large-scale investments in housing, welfare and drug treatment have not materialised. Right-wing politicians argue that the stubbornly high number of deaths shows that harm reduction has failed. Last October, Aaron Gunn, who is campaigning to become an MP, released a film called Vancouver Is Dying on YouTube. It alleges that violent crime is rising as a result of increased drug use facilitated by policies that encourage harm-reduction schemes. The film’s premiere was sponsored by a lobbying group called the Pacific Prosperity Network, which has received at least $380,000 from Chip Wilson, the Vancouver-based founder of the sportswear giant Lululemon, intended to help it be an ‘effective full-time voice for the right’. Wilson also wrote to business contacts asking for donations to the PPN of up to $200,000.

‘The political right has been trying to figure out which issue will get them momentum for a while now and they have settled on this,’ Garth Mullins, a long-standing member of Vandu, says. ‘Drug users are the scapegoats, blamed for an unequal system that’s failing everyone.’ Some Vandu members have already seen their safer supply prescriptions cut, and the Thomus Donaghy Overdose Prevention Site in Yaletown, one of only two Vancouver sites not in Downtown Eastside, has been told its licence will not be renewed next March, following threats of a class action suit by a resident of the next-door condo, backed by the company that owns a building nearby, a subsidiary of Wall Financial Corporation. It claimed that residents’ ‘quiet enjoyment of their homes’ was ‘unreasonably’ disturbed by the site.

If the ‘mandated treatment’ advocated by conservative politicians were to work – plans for which are most developed in the neighbouring province of Alberta – they would need a lot more money and resources. The OPS manager Trey Helton finds the idea laughable: bed spaces are so limited, he says, he has to coach people on what they need to do to get access. On the back wall of the OPS the detox centre’s phone number is spray-painted in huge figures for anyone who is ‘feeling done’. But it’s likely that there will be a two-week wait for a bed, Helton says, and when you’re desperate, that won’t cut it. He says that people find different ways of overcoming addiction. He came off drugs with the help of a twelve-step programme; his girlfriend sees a therapist. But without safe injection sites, he wouldn’t be alive. What helps people recover, he says, is solidarity. ‘When I was in addiction, there were some people who never really judged me. They just let me walk the path until I found a way out.’ Peer workers, who stay sober for shifts but still use drugs, can earn money at the OPS. As a result, one person is reducing the amount of sex work she does in Oppenheimer Park. Another – once BC’s most prolific cat burglar – ‘doesn’t have to do that kind of stuff any more’.

When people are more stable, Helton encourages them to ‘move towards safer using or safe supply options’. Some doctors have raised concerns about these programmes, but Helton wishes they were available to more people. ‘When I was using, I would be in a hospital begging a doctor for a prescription so I wouldn’t have to go out there and break into cars all night with an infected leg,’ he says. ‘And they’d be like: “I can’t do that.”’ Traci Letts’s son, Mike, used to be on a safe supply programme. He picked up his prescribed hydromorphone from the MySafe machine in the OPS, accessed with his handprint. But his prescription was stopped after he didn’t show up for three days. Now he’s back in jail again on remand. But at least he’s still alive.

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Vol. 45 No. 23 · 30 November 2023

Karin Goodwin writes about drug policy in British Columbia, and specifically the role of harm reduction, or measures aimed at improving the health and well-being of people who use drugs (LRB, 19 October).

The UK has the highest level of drug-related deaths in Europe, with rates in Scotland highest of all. The Office for National Statistics reports that in 2021 there were 4859 deaths ‘related to drug poisoning’ in England and Wales; the equivalent figure for Scotland, according to the National Records of Scotland, was 1444 deaths. The UK’s latest drug strategy was published in December that year. One of its stated aims is the reduction of the number of drug-related deaths by a thousand within three years. The document is largely silent on how this is to be achieved. Harm reduction is mentioned, but only in passing. Some of the measures mentioned by Goodwin are endorsed; others, including drug consumption rooms, are rejected. UK governments have stubbornly opposed DCRs, arguing that they would encourage people to use illegal drugs; would be against the law; and that their use is opposed by the UN’s International Narcotics Control Board.

The first of these arguments doesn’t make sense: the people likely to use DCRs have a long history of existing drug use. When the second argument was advanced in Denmark in 2011 at a similar stage in drug policy review, the reformers’ response was ‘So change the law.’ And on the third point, the UK government seems not to have noticed that the INCB has altered its stance and, along with all other UN agencies, now calls for drug policies that prioritise harm reduction and public health, including drug consumption rooms. Where DCRs operate they have contributed to reductions in drug-related deaths and other conditions associated with drug use, in particular the transmission of blood-borne viruses such as HIV and hepatitis C.

So it is significant that approval has finally been given for the opening of a drug consumption room in Glasgow. All relevant agencies and organisations in Scotland approved the proposals in 2022, and they were accepted by the Scottish Parliament. The Westminster government gave its approval earlier this year: it isn’t clear whether this was because it had been persuaded by the arguments or because it wished to avoid further constitutional confrontation with the Scottish government.

Blaine Stothard
London SW9

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