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In this episode we discuss how the overdose crisis is impacting people in the Alberta Capital Region and what we can do to turn the tide.
Peace Out Poverty highlights various aspects of poverty impacting the Alberta Capital Region community and what philanthropists in their 20s and 30s can do to take action.
Heads up today's episode is going to discuss addiction. Please take care while listening, if you or someone you know, is dealing with addiction. There are links to supportive resources in the show notes.
Hello. My name is Feven Worede. Welcome to season two of peace out poverty. The podcast that discusses social issues in the Alberta capital region and shows you how you can get involved. This season, you'll be hearing from a variety of hosts. Including myself as we explore how poverty has been impacting our local community today, we'll be examining the interrelationship between poverty and addiction specifically Alberta's so-called crisis, but we'll get back to that.
Put first, what are opioids? Opioids are a natural and synthetic class of substances that are commonly used for pain relief, like morphine. When opioids enter the body and interact with the brain, they activate the reward center and trigger the release of endorphins or feel good hormones. This creates feelings of pleasure and euphoria and makes them super helpful for people experiencing chronic pain.
However, it can also make them highly addict. When you take opioids repeatedly over time, your body builds up a tolerance, meaning you'll need a higher dose or a more potent opioid to achieve the same effect. This is where things can get quite dangerous. Last year, there were over 6,000 opioid related hospitalizations in Canada, a significant jump from the previous year.
There were also over 7,500 opioid related deaths in Canada. Again, that is up from the previous year. That's over 20 deaths per. By comparison in 2020 motor vehicle collisions in Canada caused five deaths per day. This crisis is widespread in Western Canada, particularly in the province of Alberta in May, 2017, the Alberta government declared a public health crisis in response to the increasing number of deaths due to opioid overdose, creating an opioid emergency response commiss.
Nonetheless in Alberta overdoses have continued to escalate year after year in 2021. Over 1,600 people died of opioid overdoses in Alberta, nearly triple the number of deaths from 2019. Given all this information you might be asking, what is the root cause of the quote unquote opioid crisis? Well, you may have heard about this crisis, starting with doctors and pharmaceutical companies, overprescribing opioids as pain killer.
But that's only part of the problem. The other part is socioeconomics. This crisis is not affecting everyone in the same way. Quoting from an article in the American journal of public health. Although drug supply is a key factor. We pause that the crisis is fundamentally fueled by economic and social upheaval.
It's etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness
to get root causes of opioid substance use in the Alberta capital region, we spoke with two local community leaders. First meet Lauren brawn wood. My name is Lawrence bran Woodbury. I am the director of service integration and advocacy at the Bissell center in downtown Edmonton. But the programs I oversee, one of them is the community space of day shelter, which is supported in part by the United ways funds for which we are so, so grateful.
Next meet Marli Taylor. My name is Marla Taylor. I am a registered nurse. I have been with the street works program for 27 years, uh, as the manager of the program. And because we are nestled as a part of Boyle street community services, um, I'm also the director of health services for Boyle street community services.
We reached out to both Lawrence and Marli to ask what insight their work at Bissell and Boyle respectively gave them on the opioid crisis. We're always really careful about not talking about the opioid crisis because we don't believe that's actually the crisis. the crisis is an overdose or drug poisoning crisis or a drug policy crisis because we're not handling it very well opioids in and of themselves play a very important role in terms of pain control around the world.
I am someone, you know, I've had a tooth out, you know, Get opioids to help deal with it, have surgery. So then when you look at someone maybe who has cancer, my gosh, uh, opioids are critical. We can't blame the drug. And that's what it sounds like when we're doing that. The other part to that is that a lot of people who are being poisoned by opioids right now are not actually trying to use opioids.
They're buying a substance. It could be that they think they're buying a stimulant, but because the drugs supply is so poisoned, right. They are getting opioids without meaning to, and so when you call it an opioid crisis, when people call it an opioid crisis, I don't think it actually describes what it is we're experiencing right now.
Thank you, Marla, for confirming that when discussing the topic at hand overdose crisis is the appropriate terminology we should be using. Now that that's settled, let's move on. We first asked our guests to what extent poverty plays a factor in addiction and substance use. Here's what Lawrence said to. I think it's, it's worth reflecting on some hard data as we start to answer this question.
And, and when I think about this question, I kind of refer back to a government of Canada study that came out in 2018, the government of Canada surveyed unhoused people across the country. And one of the key results was that. The most common reason they found for people entering houselessness in Alberta was addiction.
So there's a very clear relationship between houselessness and addiction. And it begs a question, which is what. Causes addiction in the first place. If we know that people are moving from the experience of addiction, to the experience of houselessness, what is prompting that? And I think the answer that the research keeps coming back to is trauma and yes pain.
There's the story that I think we're all familiar with of the person who gets injured on the job site and big gets prescribed painkillers and becomes addicted to them and struggles with addiction as, because it mediates the experience of pain. And I think. What we've seen over and over again, is that the pain that opioids mitigate, isn't just physical pain.
It's psychic pain as well. It's the pain that's endured as a product of trauma as a product of childhood trauma as a product of intergenerational trauma. The question that we need to reflect on is we're evaluating this move. Between addictions and houselessness and how these phenomena relate to one another is not what's wrong with these people, but what's happens to them.
And I think it's really important to reflect on as well, that when seen through this trauma informed lens addiction, uh, Emerges as, as an especially cruel phenomenon, it kicks people when they're down and as a social phenomenon, it worsens under crisis conditions. And I think that the research has shown pretty clearly that the underlying factors, you know, other than the trauma and the intergenerational trauma that we've talked about are broadly social and economic.
So we've seen economic precarity disinvestment from social services, a lack of access to mental healthcare as being huge pieces of this puzzle, that raw Kneebone study of the relationship between reduced income and elevated rent costs. Moving us towards houselessness, I think is a, a really strong indicator that.
Much of the cause of these phenomenon like addiction, public disorder in crime and houselessness is, has, has an economic base. So I've given you a lot there, there's the trauma piece, the intergenerational trauma. Yes. There's the social piece. And there's the economic piece. What we have seen with the data has shown is that there's that mutually reinforcing relationship between addictions and houselessness.
They function to, to reinforce each other, the takeaways that addictions and and houselessness are actually. Twin symptoms of trauma, social dislocation, and a society that's unable to support its most vulnerable. We know pretty well that addictions correlates strongly with houselessness, but I think a piece that's less recognized is that the experience of houselessness, intensifies and entrenches, the experience of addiction, which in turn can make it more difficult for a person to exit houselessness.
So houselessness and addictions are these mutually reinforcing. Social phenomenon. And so it's really important to design interventions that can either prevent houselessness or respond rapidly to people who have newly entered houselessness. In our conversation with Marla, she offered a practical lens for how addiction and poverty can interact.
People use substances for all kinds of reasons. And that is across all sectors of society. When we're talking about folks that are living in poverty, it is very hard to deal with life when you are faced by multiple challenges. For some people using substances removes some of the bad feelings, some of the.
The pain of trying to get through every day. Sometimes they give you energy to be able to get through the day. Or for example, if you're homeless and you need to walk all night, cuz you have no place to go and you're not safe, then using stimulants could help you keep your energy up and keep doing that.
So I, I think there's lots of reasons why people would use substances when they're poor and in many cases, I don't blame people. Um, it's, it is absolutely makes sense to me that life is incredibly hard and a little bit of relief from that works in, uh, someone's favor. When we asked what communities in Alberta are most negatively affected by substance use and why Marice pointed out that this problem occurs throughout all communities.
Considering substance use happens across all social strata. I'm not sure that there is a direct connection other than, as I said, trying to deal with life when you are living in poverty. That makes it very difficult. I think your risks go up when you're in poverty. Um, you know, someone who is in a wealthier part of town can use substances very quietly in their own basement in front of their big screen TV.
And nobody knows, and they may have people around. So if they were to have a, a bad effect, there's people there for them, but you know what, when you're living in poverty, it is much easier to be caught by the police to be in a location. It is riskier. You know, you don't have a place to live. You don't have good health because your nutrition is low.
I think those are some things that can make a difference in the reaction to someone using substances. So where are most of the drug poisonings happening? I, I think absolutely. There's no question. It's the downtown central Edmonton area. For some of the reasons I just talked about it. It is harder to be safer and healthier if you are poor.
And if you don't have a home, having said that, we know that substance use happens all across the city. Um, some studies that were done in 2017, talked a lot about one sector, which is the young men who are working in construction. There was an awful lot of folks in that group that were, um, having drug overdose.
But I think the majority are still are folks that are downtown, who might be street involved adding to that. Lauren spoke to more specific demographics being affected by substance use in Alberta. There's some surface level data out there that, you know, will tell you that 15 to 44 year olds are the ones that are most affected by this and, and by the opioid crisis.
And that most relevant to this context here in Alberta and Alberta capital region is the results that came out in 2021 around a Goa study that was called the Alberta opioid response surveillance report. And this study found that first nations people in Alberta have disproportionately higher rates of opioid use compared to their non-first nations counterparts.
First nations people represent approximately 6% of the Alberta population, and yet they represent 22% of all opioid poisoning. And I mean, that's an increase of 14% from 2016. So it's a worsening, it's a worsening issue and there's a lot there to unpack brutal history of colonialism, intergenerational trauma.
And of course, how COVID has disproportionately affected indigenous populations all over the world. But yes, here in Alberta as well are all factoring into why the opioid crisis dis like disproportionately and unevenly affects indigenous communities.
We asked Lawrence and Marice how their organization's Bissell center and Boyle street community services, respectively are contributing to finding meaningful solutions to Alberta's overdose crisis. We also wanted to know how community members could support this work. Here's Lawrence. There's a lot that's being done and there's a lot, that's being done internal to bile.
We, we provide safe use education and Naloxone training. We participate in overdose response. We participate in the distribution of safe supplies to prevent the transmission of disease. We. Creates and are part of referral pathways to detoxes and treatment centers. We have housing teams that can move people from houselessness to house situations.
We engage in advocacy for more affordable housing, supportive units, diverse housing solutions. And we have a really wonderful homelessness prevention program called community bridge, which finds creative solutions to prevent people who are experiencing precarity and, and are on the cusp of experiencing houseless.
You know, we've been concerned about overdoses in street works since about 2004. And it's fascinating when I think back to that, we had a week where there were four overdoses in a week that we'd heard about and we were mortified. And you know what, I'll tell you what, this morning in our center already.
We've had four overdoses just outside my window here. What we thought was a big problem. Back then, we had no idea what was coming. Um, at that point we wanted to address it. And we worked very closely with the Chicago recovery Alliance to bring community based Naloxone to the city of Edmonton. So we actually ended up being the first place in Canada to do it.
Now there's two parts to, to overdose. One is you wanna prevent an overdose from happening. And so in that case, we talk. With individuals about, you know, do you know what the source of your substance is? Make sure you don't use alone. Uh, if you have to use alone, make sure you're visible, do a small amount first.
You can add more later. So some of those basic things that we would talk about, but then you also have overdose prevention related to preventing death. And so that's where the Naloxone comes in. Someone may have done the best they could, and they still ended up having a poisoning. And so then are there people around that have Naloxone kits that are able to use them well, um, and who can help you?
So Naloxone has been a big part of our response, just general. Education trying to do advocacy. Um, you know, I, I was very pleased to be on the minister's opioid emergency response commission for several years, just trying to get the word out about risk of overdose, but also humanizing people who use substances and trying to think of better ways to have drug policy.
That makes sense. And that is actually gonna be useful to people. Both guests were able to provide various local detox programs and treatment centers that are dedicated to supporting houseless folks on the road to recovery. However, Lawrence reminds us that due to Edmonton's high demand for addiction services, it's been difficult for the nonprofit sector to successfully serve everyone seeking help.
There are some great, no cost programs in and around Edmonton. Right now, there are some fantastic treatment centers like pound makers or Henwood. There are some great, no cost detoxes like AHSS arc or the MDU that's being run by the George spy society. These are fantastic organizations doing amazing work, but.
You know, and there's unfortunately a, but here they're inadequate to meet the need that the city is currently experiencing. We're seeing wait times in these no cost treatment centers and detoxes that extend into the weeks and the months, the detoxes are turning away up to 20 people a day. And the treatment centers sometimes have a wait list that extends into months.
And that can be the difference between life and death. For someone who is working towards recovery or sobriety, well living or experiencing homeless. It's so, so important to be able to provide service. As soon as it's being asked for Marice shines a light on Alberta health services, as well as other community based organizations designed to assist those dealing with substance use disorders.
There obviously are programs in place, Alberta health services. Has a number of different kinds of programs that are happening where people maybe can get medical support around their dependencies. Uh, one of the newer ones and one that's been incredibly successful is the virtual opioid dependency program.
The V O D P. That's a situation where if someone wants to get on. It's called an opioid agonist therapy, which would be otherwise known as something like methadone or Suboxone or subcate that they can do a phone doctor appointment right here right now. And that's turned out to be very successful and we've had lots of people go through that program and do really well with it and are continuing to do well.
Opioid agonist therapy has always been a very good thing to do. And then in the last couple of years, Alberta health services also added the injectable opioid agonist therapy program. The IO program that has been restricted in the number of people that they will take. But we had sent people to that program that have just turned their lives around.
It has just been astounding, how useful the IO program has been to a number of people. For families. I often think about mom, stop the harm, which is actually an advocacy group, but they have two branches. One is the advocacy piece around enhancing society's response to drug poisonings, particularly from harm reduction perspective.
But then they also have, you know, support groups and sadly. It is mostly for people who have had children who've died of unintentional drug overdose and they have increased their numbers by thousands in the last few years. It is absolutely stunning. There's also another group that I probably would wanna mention, which is, um, one that is working with business and that's called each and.
And that actually started at a Calgary, but each and every has member businesses. A lot of them are bars because what they recognize is that they are also supervised consumption services in a establishment. And so these businesses are ones that welcome harm reduction thinking, uh, that would carry Naloxone that, you know, would do some advocacy and, and try and figure out ways to help address some of the issues.
Next. We asked our guests to give their take on what needs to occur to truly address the overdose crisis. We'll start with Lawrence. There has been a lot of data to support the success of a housing first initiative for combating both addiction and houselessness. We've talked about that relationship. So it's, it's really important, not only to make sure that people have access to secure housing, but that there is diverse housing stock.
That's able to meet the diverse needs of folks who are, who are, who are experiencing houselessness or who are on the edge of experiencing houseless. It's so important that there are more and better, no cost options for treatment in detox visit that there's more and better. Mental health supports that the health services that do exist are able to adopt a more robustly trauma informed approach that reduces stigma.
I would also emphasize the importance of options for families fleeing domestic abuse and domestic violence so that we can mitigate some of that trauma right at the beginning. I think it's important that when we're talking about the immediate crisis and not just sort of longer like medium to longer term solutions, like housing, that we, you know, talk about drug testing so that folks can test their supply and make sure that it's safe to prevent those overdoses.
That we, you know, look at some of the cutting edge work happening in BC around safe supply and not foreclose, any option that might be on the table that we really do approach evidence-based best practices and be open. The solutions that science has for us. And I think maybe above all, or perhaps as a backbone to all of these varied solutions that we move forward in a culturally informed way that prioritizes reconciliation, decolonization, and culturally aware practice that we bring ceremony into our work and that we prioritize indigeneity in, in all of our intervention.
Florence emphasized that having reliable data is essential to understanding the overdose crisis and finding meaningful solutions. Back in March, the Edmonton journal, they reported that over 1700 Albertans had lost their lives to drug poisoning in 2021. We know that a recent study based on HSS data has shown that mass responses to overdoses in, in, in Edmonton's inner city, went from 1,100 in 2020 to over 3000, in 2021 more than doubling.
And we should note that in that study as well, overdoses, weren't exclusively to downtown, right? Like opioid overdoses are happening in every neighborhood of the city. It's everywhere. But downtown was where we had that really stark. So the, there is data out there. However, the sector itself is pretty fractured and pretty fractious.
I haven't been able to find reliable overdose data, that collates information from, you know, AHS and EPS and fire service and the not-for-profit sector. At this point, it's difficult to get a handle on the true scale of the crisis in Alberta, because we, we aren't able to, to, to collate some pretty basic facts.
Um, so I couldn't tell you with any confidence, the number of overdoses in Alberta in 2021, just because that, that is not, hasn't been collated anywhere effectively. I don't really think it would be much of an investment at this stage. I mean, all that data is being collected. Then our profits are doing it.
EPS is doing it. It's just a matter of, of getting it all together and reporting on it. But I think that taking a step. The numbers that we do have, however, incomplete really do indicate the same thing that the opioid crisis is real and present, and that it is worsening and that is impacting Albertans every day.
In my view, data is an essential piece to understanding the crisis and effectively planning to respond to it. We can't effectively respond to a problem without really appreciating. What the problem is what the scale of it is, mapping that data, knowing where it's happening, when and why without understanding the shape of the problem, how can we possibly hope to solve it?
Maric had thoughts on what could be done on both a personal and systemic level. There are so many things that I often wish that people would do. And I guess number one would be to be informed. I think a lot of people don't understand or never even think about how many people are at risk or that are dying, um, on a daily basis.
You know, our emergency system is overrun right now. We we've had up to 22 overdoses in a day in this neighborhood. So each of those requiring an ambulance, that there are things that we can do, but I, part of it is having just people be aware and to, to raise their voice, that something different has to happen.
I think that I would always wish that people would. So then think about the world differently and challenge their thinking and really consider things like decriminalization or regulation of substances. What could the world look. If the police were not, you know, endlessly trying to arrest people for, for drugs, um, and that people were healthier and able to manage, you know, the world a bit better.
Um, so I think that some of it is, is being creative and being courageous. Um, and challenging our, our thinking of what we've been doing for the last 50 years that hasn't worked very well when it comes to substances. I, I think it is being people being aware of the intersection between things like poverty, houselessness, stigma, discrimination, carceral responses.
As being our main way of dealing with people, you know, prisons do not do a good job of rehab. It's not helping anyone to just keep throwing poor people into jail over and over again. So I, you know, but, but there's lots of intersectionality there. And I think that we need to think about that and to do things better.
So what that leads to also is just treating people like people. Instead of looking away when, when walking past someone even just saying hello or something like that, I think we are all human beings on this earth doing the best we can with what we have. And some people are doing amazingly with nothing, but let's not keep beating them up every time we walk by that does not help.
Uh, so then I think it's addressing stigma hugely, and I think it's being really aware of who you're voting. Whatever level of government happens to be having an election. Do you know what your, where your candidate stands on these things? Do you know, sort of what, what's the party, how are they going to address these issues?
Um, because it's big, like it's really big. I'm always surprised that it doesn't get more airplay in the political realm. But it's not, and I'm not sure why that is, but I would say if we had five or six people getting killed every day in this province, by getting hit by a bus, we would be doing something.
These are five or six people a day dying of an unintentional drug overdose. And the silence is deafening. So I think we need to stop and rethink how we're doing this, but a lot of that comes from politics. As I said, you know, this is one health issue where politicians tend to get involved and tend to make it a political issue.
And if we could just deal with it with the evidence that's out there and looking at it from a health perspective, rather than. Political or an incarceration issue or, or anything like that, we would be way further ahead. The other thing that we're not taught about substances is that there is a harm reduction theory around substance use called drug set and setting.
What that means is that three things impact how a drug will affect you. One is the drug itself. What kind, what is it that someone's using? Is it alcohol? Is it heroin? How is it being used? Is it being injected or eaten or smoked those sorts of things? Uh, is it mixed with other other substances? The set is about the person themselves.
How, how are they, how healthy are they? What's their mental health, their physical health, their, their emotional. You know, what's their motivation for using substances. So sort of the things that are in inside the person, and then there's the setting, which is what's going on around that person. Are they poor?
Are they without a house? Are they hiding out from people? Uh, because they're in danger though. All of those things have an impact on how someone will react to using a substance. The set and the setting and the drug are all much harder to manage when you're poor, because the responses are different. Uh, as I said, if you're in a, in a nice.
Location and you have money and you have family and you have everything. Your reaction to that drug will likely be different than someone who is scared and hungry and tired and experiencing mental health issues and bought something that they don't know what it is. So poverty overall has an impact on the safety and health of anyone who's using a substance.
And lastly Lawrence encourages all community members to stay curious and engaged. The one takeaway that I would urge you to, to hang onto is that the opioid epidemic is, is here in Alberta and it is worsening. And I would ask everyone listening to get trained in Naloxone and Naloxone use and keep a kit handy.
Every pharmacy in the province should be carrying. It should be able to pick it up at any one of them and just be ready to respond to that overdose in my personal experience. I've had to respond to overdoses at 7:00 PM walking along white avenue. The second piece that I would urge listeners to do is to read up on addictions, read up on its causes, read up on how it relates to house listeners.
A book that I can't recommend enough is Gabor Mate in the realm of hungry ghosts. Gabor Mate was a, or is a physician who served, who served the unhoused population of east Hastings. For many years. He has some truly brilliant insights, especially into the relationship between addiction and trauma. And, and I would, I would urge you to, to speak to your friends and family about addiction and trauma.
That one of the most important things we can do is to fight the stigma of addictions and trauma and houselessness. And I think it's really important to remember that we all need each other and ending homelessness in this province. It's it's gonna take all of us. Impoverished communities in Alberta are predisposed to addiction due to the poor socioeconomic conditions in which they.
And the victims of addiction expose the egregious holes in the socioeconomic fabric that upholds our society. The underlying driver of poverty and addiction is the pain and suffering caused by socioeconomic inequality. Pain extends far beyond the physical. It is a condition that includes economic and social disadvantage.
Communities who are impoverished and marginalized use opioids to numb and cope with the often overlooked, psychological pain, trauma, stress, and suffering, all of which poverty contributes to listeners. If you'd like to follow our guests on social media, learn more about their organization and check out the resources mentioned in this episode, all these links are listed in the show notes.
Thank you for listening to peace out Poverty's first episode of the second season, this episode was hosted by me Feven. It was also written by myself and Tokunbo. Interviews were done by Jenna Halabi. This episode was produced Castria. GenNext is a volunteer committee of United Way of the Alberta Capital Region.
If you'd like to learn more or find out how you can be a part of the plan to end poverty, visit myUnitedWay.ca.