Redistributing Power: Drug Use and Safe Supply

Mon, 11 Dec 2023

By Ina Pace 
Research and Communications Assistant, SFU Public Square

The views and opinions expressed in SFU Public Square's blogs are those of the authors, and they do not necessarily reflect the official position of Simon Fraser University or SFU Public Square, or any other affiliated institutions in any way.

The annual Nora and Ted Sterling Prize in Support of Controversy recognizes and encourages controversial issues, celebrating people bold enough to address them publicly, despite criticism and stigma. 

This year’s winner is Nicole Luongo, a systems change coordinator at the Canadian Drug Policy Coalition. A significant part of Nicole’s work is advocating for those who are stigmatized and marginalized for using drugs amidst an ongoing drug toxicity crisis in British Columbia (B.C.), which was declared a Public Health Emergency in 2016. Nicole strongly supports a safely regulated drug supply and the decriminalization of all drug use. 

As an international intern from the UK, previously unfamiliar with B.C.’s toxic drug supply crisis, I was very intrigued by Nicole’s work and advocacy. My interest in this topic began after my first few commutes to SFU Public Square’s office, based out of a building in Vancouver’s Downtown Eastside (DTES). As a new visitor to the neighbourhood, I was initially taken aback by the open drug use and scale of the toxic drug supply. When I was asked to conduct an interview with one of the speakers from SFU Public Square’s fall events, Nicole was the ideal choice.  

I wanted to learn more about the nexus between the legislative powers of the provincial government and the surrounding (often negative) public perception. As I understand, both parties pathologize the user and assign morality to substance use, but "only in the context of illegal drug use" (Luongo, 2023). I also wanted to learn more about the extent to which both parties oppose each other. 

Over the last month, I have delved into research about the ongoing toxic drug supply and the establishments that have the power to make meaningful change. Nicole’s years of work and advocacy is evidence alone that these questions are not easily answered. 

I had the pleasure of meeting Nicole in November at the 2023 Sterling Prize Ceremony and Lecture. Audience members, including myself, heard her fascinating lecture about her work and advocacy, for which she received a standing ovation. After all the research I had done in preparation for this event, I found her speech both consolidating and refreshing, and I look forward to furthering what I have learnt thus far.

Below is our interview, which was conducted over email. Thank you again to Nicole for her time and dedication in offering such honest and vulnerable responses. 

Ina: Congratulations on receiving the 2023 Sterling Prize! This is an award that honours and encourages work that contributes to the understanding of controversy. Given this new exposure, do you think you may be susceptible to further backlash?

Nicole: Increased exposure to backlash is certainly possible. That said, we are in a moment of intensifying political polarization. Hostility toward drug users and drug policy reform has been ratcheting up, so I’m not expecting anything that I’m not already accustomed to. 

You are a strong advocate for the safe supply of psychoactive drugs and government regulation in a climate in which abstinence is often viewed as synonymous with recovery. However, as you have asserted, there are several intersecting factors which contribute to levels of drug use besides being 'healthy' or 'sick,' including mental health issues and financial difficulties. Can you elaborate on these other intersecting factors, and explain why, in your view, the current government efforts are not enough? 

First, it’s crucial to highlight that just as most people who drink alcohol do not identify as ‘alcoholics,’ the majority of people who use illegal drugs are not addicted to them. The term ‘recovery’ is therefore complicated and is often not appropriate when advocating for policies and laws that would improve community and individual health. The dangerousness of some drugs is directly linked to their legal status. Since substances such as alcohol, caffeine, and now cannabis are legal, they are manufactured and distributed with strict quality and safety controls throughout the supply chain. The fact that other drugs have no such oversight is the crux of the problem. Drug prohibition, or the criminalization of certain drugs (and thus certain people), has created an increasingly adulterated and unpredictable drug supply that renders everyone susceptible to fatal overdose, no matter their personal patterns of use.  

That said, as you’ve noted, there are observable patterns of drug use linked to social circumstances. For instance, people experiencing housing deprivation (e.g. homelessness) tend to be a population for whom illegal drug use is more common. Returning to the notion of health and illness, I would offer that drug use is a very reasonable, a very 'healthy' response to the stigma, discrimination, and social exclusion that is associated with extreme hardship. In practical terms, stimulants keep people awake and alert when they have nowhere to go and are at risk of being assaulted or robbed. Opioids and other sedating drugs may be a necessary intervention after periods of sleep deprivation. Furthermore – and this ought not be a taboo or controversial thing to say – drug use feels good. This is as true for illegal drugs as it is for legal ones, yet it is only in the context of illegal drug use that we pathologize the user or automatically see someone as 'sick' for deriving pleasure from a substance. To move beyond the healthy/sick binary, and to allow people to decide for themselves whether their drug use constitutes a problem, we must remove criminal and social penalties for it. This is the basis of policies grounded in bodily autonomy, consent, and rights-based frameworks. Otherwise, we will keep applying labels to people that often do more harm than good.

Can you elaborate on your advocacy against involuntary hospitalisation, especially within the context of mental health? 

In the midst of dual housing and toxic drug crises, addiction or mental health treatment are often the only available options for someone to meet their basic needs – food, a roof over their heads, and a bed. From my vantage point, this precludes someone from truly consenting to a program of treatment. When people are also institutionalized involuntarily (e.g., under the Mental Health Act in B.C.), we are adding an extra layer of coercion to what is already a coercive system. With involuntary institutionalization comes a near total repression of the basic human rights that we are supposed to have in a liberal democracy. 

For instance, patients admitted under the Mental Health Act are routinely strip searched, handcuffed, placed in solitary confinement, prevented from contacting the outside world, and forcibly medicated with pharmaceutical drugs that may elicit severe or adverse reactions. These practices have been designated as torture under international human rights law. Even if one isn’t exposed to very overt forms of abuse, a substantial body of research demonstrates that involuntary treatment is not associated with improved mental and physical health on a population level. People are often discharged from periods of forced hospitalization without having been addressed the material conditions that are strongly associated with extreme distress, and with little to no follow-up care. This dynamic is deeply traumatizing. In turn, it perpetuates cycles of even greater distress that may lead to subsequent hospitalizations, ad infinitum. I would like to see a change both in how we understand mental health and illness, and in how we care for people who are in crisis. This includes establishing networks of community care that are independent from psychiatry and the state.  

Other advocates who share your positions and beliefs include previous Sterling Prize winner Donald MacPherson, your fellow VANDU board member Garth Mullins, and psychiatrist Michael Krausz – to name a few. I’m wondering if you have learnt from other advocates in your field, and if so, how do they inspire you?

I’m relatively new to drug policy and drug policy advocacy, at least in terms of how it is defined in my current role. It has been a steep learning curve and I’m grateful to work alongside some genuine legends. In addition to teaching me about the practical details of different policy models, they have ultimately shown me that movement building requires employing a diversity of tactics. We are interconnected with complementary skill sets. The people I most admire may not be public facing figures, but each is willing to leverage their strengths as part of a broader, long-term strategy. 

 Portugal was one of the first countries to decriminalize drug use back in 2000, though this doesn’t mean the legislation wasn’t without problems and contradictions. Harm reduction is still resisted in Portugal, similar to B.C., where the possession of certain drugs for personal use was recently decriminalized in January 2023. Pushback is especially prominent when it comes to “transferring powers” from the hands of medical professionals to those of individuals, with say, injecting Naloxone.

Why do you think harm reduction methods, such as safe injection sites and safe supply, are controversial – both in B.C. and elsewhere? How do you see the current incremental changes and steadfast legislation towards decriminalization in B.C. progressing in the near future – will it be enough to save lives and shift public perceptions?

Drug policy and drug laws are fundamentally about power. It is critical to understand them as such. Having grasped this, it is easier to make sense of why some reforms are broadly supported, and to predict which interventions will receive more intense resistance. As a concrete example, safe consumption sites (SCS) are not wildly controversial in parts of B.C. This is because SCS are what we refer to as a ‘downstream intervention’ – they chiefly exist to reverse overdoses from the unregulated drug supply. They can also provide wraparound supports and be a vital source of connection for folks who are multiply marginalized, but – and this is crucial – they do not fundamentally address the conditions that cause overdoses or marginalization to begin with. 

Safe supply is more interesting this way. It has the potential to redistribute power from the state apparatus, including the criminal-legal and medical systems, back toward communities for whom drug prohibition legitimizes state violence and neglect. It has been aggressively targeted because entire industries would collapse, and multiple actors would lose much of their personal and professional legitimacy if drug users were seen as fully competent. I therefore do not expect our governments to introduce the bold reforms that would both save lives and meaningfully improve drug users’ quality of life; doing so would undermine their own interests. I retain some hope that public narratives about drugs and those who use them will continue to shift, and that pressure from the public will trigger changes in policy and law (which will in turn encourage further changes in public perception, and so on). The two are mutually reinforcing. Determining how much effort to dedicate to either is always a bit of a chicken-and-egg game. 

Finally, Nicole, you have mentioned that you will be donating your prize money. Would you mind telling us more about your decision? 

I will be distributing the prize money to a local drug user group. Now more than ever, it is important to support grassroots efforts. Communities of drug users, particularly in Vancouver, have shown us how to care for one another without first seeking permission through official channels. This is why we have legal safe consumption sites and needle exchanges in the first place, why I am still personally alive, and what motivates me on a daily basis.

If you’d like to learn more about Nicole Luongo and her work, watch the recording of the 2023 Sterling Prize Lecture here!