Listen to Drug Users and Advocates, the CERB is Harm Reduction

Reckless. This is how Raina Gagnon, an addictions counsellor in Ottawa representing Centretown Pharmacy, described the distribution of emergency funds to people who use drugs in an opinion piece last week.

Gagnon argues that by accessing the Canada Emergency Response Benefit – a temporary income support of $500 a week during the COVID-19 pandemic – people who use drugs are sabotaging their recovery. Her proof? Increased demand for harm reduction supplies and a higher number of overdoses, some of which have been fatal. 

Gagnon’s concern for drug users is appreciated but her article offers correlation, not causation. Drug users are not struggling and dying because they are receiving additional financial support. 

We are in the midst of a global pandemic, a housing and homelessness crisis, and an overdose emergency in Ottawa. COVID-19 forced the closure of many resources across the city (like day programs and drop-in centres), while others function at reduced capacity. Physical distancing guidelines, enforced by bylaw, have deepened the isolation already experienced by many drug users. A lack of affordable and dignified housing means many users live in dangerous conditions. 

This lack of support combined with the fear of contracting COVID-19 and a general sense of uncertainty is more than enough to increase the slips and relapses that are part of the recovery process. 

To clarify this further, Overdose Prevention Ottawa has provided a line-by-line response to Gagnon’s opinion editorial. Our response is in red text. 

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“In the wake of the COVID-19 pandemic, the Government of Canada has tried to cushion the blow of financial instability during these times. But in the case of those who receive social assistance, it’s a different story.

For the majority of my patients, the introduction of the Canada Emergency Response Benefit (CERB) — which provides $2,000 a month for up to four months for people who lose their income as a result of the pandemic — has been reckless at best.”

Here, it is apparent that the author feels like giving social assistance and financial support to people who use drugs is “reckless”. But what is the alternative? Allow people who use drugs to remain in destitute poverty during a pandemic? This does not feel like a better alternative. 

“For some, it’s been deadly.”

Actually, what is deadly is a toxic supply of drugs and an unwillingness for the federal government to regulate them and respect the human rights of people who use drugs. 

“While it is excellent people are using clean supplies, it is a reflection of the increase in use. I have witnessed otherwise stable patients hit a hard stop in their recovery; some have been admitted to the hospital for bacterial infections associated with an increase in IV drug use. Some have been much less fortunate.” 

“The unusual influx of money into the hands of those who are not habituated to it has resulted in a much higher use of drugs, and a substantial increase in drug overdoses and related deaths. Drug culture is surging, and as a result, supply is insufficient to meet demand. Paired with the introduction of “orange” fentanyl into the Ottawa area, which is changing the game yet again from the “purple days,” folks are hard-pressed to stand a chance.”

Harm-reduction is not limited to the provision of sterile supplies. It is a framework and philosophy that guides the way all services should be delivered. Harm reduction does not have an expectation of sobriety or abstinence, but rather respects individual human rights and autonomy to make choices about one’s own life and body. To reduce it down to only the distribution of sterile supplies is a disservice to the significant work that has been done by people who use drugs and activists for over 30 years. 

Until recently, harm reduction work was performed only by people who use drugs. Users had no gear, no naloxone, no access to safe consumption sites and were often stigmatized by medical professionals. No one was paid for this work, people did it to survive and became harm reduction experts as a result.

 When drug consumption sites opened, it was drug users who taught nurses the signs of an overdose. It was drug users who offered compassionate, non-judgmental support to their peers. It was drug users who educated service providers on the day-to-day realities of living with illnesses like Hepatitis C. It is drug users who continue to perform live-saving work as they grieve loved ones lost to the ongoing overdose emergency.

 The harm reduction work we see in communities now is the result of people with lived experience sharing their expertise to save lives.  

What would have been useful here is to actually call for a safe supply of drugs, something that the harm reduction community has been advocating for. The statement above infantilizes people who use drugs and makes it seem like they cannot be trusted with money. Again, this is very stigmatizing. The author could have also called for an increase in funding to provide longer hours at safe consumption services in Ottawa, as we know their capacities have been greatly reduced during the COVID-19 pandemic. 

“The simplicity of the universal CERB application process, though well-intended, is flawed in that it is relatively easy to receive money which one is not eligible for through a series of simple questions. It has failed to take into account some of this country’s most vulnerable sectors, and as a result, we will be forced to deal with the aftermath of this situation for years to come.”

Is the author suggesting here that people who are marginalized, living in legislated poverty already, and at the intersection of various public health crises, should not be awarded money because they cannot be trusted? The author could have looked at why these communities are marginalized and made vulnerable in the first place and issued a call for upstream measures. People living in absolute poverty who receive some financial reprieve will not be what causes a devastating aftermath. What will result in a devastating aftermath will be allowing people to remain unhoused, forced to use an unregulated supply of unknown potency in the midst of a global pandemic, and to restrict the services and social assistance provided to them. 

“I like to say, “there are no problems, only solutions.” To that effect, I ask you to consider that those who are suffering from substance abuse disorders, including our sons, daughters, mothers, fathers, and friends, are worthy of compassion during this time when our general lack of foresight has exacerbated the issue with which they struggle. We are one people. It is in our humanity to demand no one gets left behind.”

Here, the author is literally asking for people to not be left behind, but in the above paragraphs has specifically requested the federal government to not provide them with money. So which is it?  What exactly are the solutions to be provided here? Do they want people to remain in absolute poverty in the hopes that the lack of financial resources will somehow push them to recovery and abstinence? This is a misguided, naive belief that is not based in reality or in evidence.  

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Harm reduction principles centre drug users as the experts of their own well-being. Harm reduction affirms users as the primary agents of reducing the harms of their drug use, and seeks to create spaces and relationships where users can support and empower each other. Harm reduction is a response to social and economic harms that make people more vulnerable, such as poverty and homelessness. Therefore, the last thing a harm reduction worker should do is advocate for the revocation of financial support from people who use drugs.

Gagnon’s article struck a chord with the harm reduction community in Ottawa. “We are struggling, we’re dying, and the second we get some relief they think we don’t deserve it.” These words from a drug user demonstrate the harm caused by Gagnon’s call to ‘limit accessibility’ to the CERB – a patronizing solution that leaves people with even fewer resources.

The CERB is not ‘deadly’ for people who use drugs. In fact, a Universal Basic Income is a harm reduction strategy.

Gagnon and others should remember that getting paid to work alongside drug users is a privilege and comes with responsibilities to the movement, and the experts, that made these roles possible.

Nothing about us without us. 

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