The Trailer Overdose Prevention Site (TOPS, as its usually called, or Area 62) in Vancouver. Photo by Travis Lupick.
In the summer of 2017, amidst an unprecedented and devastating wave of opioid overdoses in cities across Canada, a group of activists erected a couple of tents atop a ragged triangle of grass on the eastern edge of Ottawa's downtown core less than two kilometers from Parliament Hill.
This was the first overdose prevention site in the nation's capital and it offered people a safe place to use drugs. Like similar grassroots initiatives that activists have set up over the past decade in Vancouver, Toronto, London and elsewhere, the tents were a makeshift response to an unspeakably urgent crisis.
Calling itself Overdose Prevention Ottawa (OPO), the group initially set up one tent where people using opioids could come, sit down, inspect and test the drugs they bought to use, inject, then rest. Almost immediately, guests identified a need for a similar space to safely smoke crack, and so the organizers erected a second tent for that purpose.
For the initial handful of OPO activists, the impetus for the site was deeply personal. Many of them had long been involved in the city's grassroots harm reduction efforts. Others had experienced the acute pain of losing a loved one from an overdose. All of them knew people were dying and the authorities charged with protecting some of society's most vulnerable were failing to react.
More than 8,000 people have died from an opioid-induced overdose in Canada since 2016. In October 2018, health officials announced that the crisis of fatal encounters with opioids has become so acute it is causing a decline in life expectancy in B.C. If the trend continues, they explained, the same demographic effect will soon follow for the rest of Canada.
"This is the most significant public health crisis that we've seen for many decades," Canada's Chief Public Health Officer Dr. Theresa Tam told the CBC News before describing the scale of the crisis as something not seen since the AIDS epidemic of the 1980s.
In November, the CBC reported that 10 people a day are dying from drug overdoses in Canada. British Columbia and Alberta have the highest concentration of overdose deaths in the country. In B.C. overdose deaths more than doubled between 2011 and 2016. In January, Dr. Mark Tyndall of the BC Centre for Disease Control described the opioid crisis as "our Ebola."
This fall, federal Health Minister Ginette Petitpas-Taylor responded to the death toll by vowing to make the opioid crisis the ministry's top priority. Harm reduction, she claimed, would be a key pillar of the strategy.
Harm reduction refers to a complex of public health policies and practices that aim to reduce the harms associated with certain activities designated as risky. It is rooted in the idea that it is not necessarily the drugs that cause harm but the system of prohibition and punishment that society has erected and which makes buying and possessing drugs dangerous for the user.
"When someone uses heroin in an alley, hurriedly injecting for fear of police, it is not the drug that causes them to rush and miscalculate their dose, possibly leading to an overdose. It is their fear of persecution," explains Travis Lupick in his account of Vancouver's harm reduction struggles, Fighting for Space.
Drugs are dangerous, we are told, because of the nature of the substance itself. The conditions under which drugs are consumed are considered emblematic of their dangerous nature.
But hospitals dispense opioids every day to relieve pain. These drugs are not killing people in care because the quality of the supply is regulated, the dosages are managed, ingestion is overseen and, should a problem arise, there are trained people on hand who can intervene and who are not made afraid by the spectre of criminalization and stigma. Proponents of harm reduction argue that context matters and shunting drug consumption out of sight while criminalizing and stigmatizing it does the opposite of keeping people safe.
The announcement by Minister Petitpas-Taylor comes at a time of growing pressure linked to the scale of the crisis and the extraordinary efforts of the grassroots OPS movement, which has operated on shoestring budgets gathered from private donations and is fuelled primarily on volunteer labour.
Still, harm reduction remains a marginal position in mainstream health care. OPO's Lisa Wright points out that strategies based on reducing harm have received only 2% of the federal drug strategy's budget—even though harm reduction principles have nominally been at the centre of the strategy since the 1980s.
In Ontario, the Progressive Conservative government of Doug Ford evidently disagrees that the overdose crisis demands urgent public attention. This summer, as the death toll climbed, the province shelved plans to fund desperately needed safe consumption sites scheduled to open in Toronto, St. Catharines and Thunder Bay.
Conservatives like to argue that treatment leading to abstinence, not harm reduction, should be government's priority. But as Toronto nurse and OPS activist Leigh Chapman quipped in response to Ford's announcement, "you can't treat people if they're dead."
Ford's position is consistent with the rest of Canada's law-and-order establishment, which opposes harm reduction strategies and sees grassroots overdose prevention sites (OPS) and government approved and regulated safe injection sites (SIS) as condoning illegality.
At the federal level, the former Harper government fought hard to shut down Vancouver's INSITE, Canada's first legal SIS. After losing that battle at the Supreme Court, the government vowed to make it more difficult to open new sites by passing the Respect for Communities Act. Such moves seemed designed to bolster a decades-old punitive War on Drugs conception of public safety while the undertow of criminalization is battled in courts, clinics, legislatures, in the media and on the streets.
The question of how to address the crisis is marked by deep societal polarization. In the conservative imagination, the drug user is designated as an object of fear and social breakdown and the idea of rights for and humane treatment of drug users is seen as condoning crime and rewarding immorality.
But among a spectrum of service providers, researchers and grassroots activists, addiction is seen as symptomatic of a broader mental health and social crisis, which for many is rooted in legacies of colonialism, the kind of alienation and sense of dislocation that has preoccupied critics of capitalism for the last two centuries, and the crisis of care in an era of gutted welfare states. Calls for intensified criminalization are one response. The OPS movement is another.
Wright describes the establishment of the tents in the park as a watershed moment for people who do not have access to a safe place to consume drugs in the city and who have borne the brunt of stigma, criminalization and fear as a result.
Visitors to the site would say, "Oh the tents changed everything," she recounts. "One guy came in during the first days and asked, 'Why are you doing this? No one has cared about us our whole life.'"
Activists identify two catalytic events driving their decision to open the site despite the risk of prosecution: a friend's fatal encounter with fentanyl and the recent launch of an OPS in Toronto's well-worn Moss Park. This and similar sites operating without government consent or support in Vancouver's Downtown Eastside represented a public affirmation of the rights of drug users to inhabit the city and receive care.
The tents provided a critical infrastructure of support in parts of the city weighed down by suffering, fear, neglect and loss. In so doing, they created the city anew.
That is perhaps what Henri Lefebvre would say were he here to witness this extraordinary example of grassroots organizing of urban infrastructure. The French intellectual came up with the idea of the right to the city in 1968, while participating in Paris' clamorous summer of social discontent.
For Lefebvre, the right to the city wasn’t a "pseudo-right" to simply appear and touch the surface of urban life as the powerful dictate. Rather, it represented a "transformed and renewed right to urban life." The right to the city in Lefebvre's view means much more than a formal right to be present in the city. It is an affirmation of the need to participate in the making and remaking of our cities.
Lefebvre was participating in and writing about the right to the city in times that were not so different from our own. Paris in the late-1960s was ablaze in debate about urban renewal and the expulsion of poor and working class people from the urban core, furious discontent with institutional authority, and unbridled enthusiasm for the de-alienation of urban life. Lefebre’s writings celebrated the re-conquest of the city's urban core by those who had been shunted aside by forces we now call gentrification.
In recent years, urban geographer David Harvey has revived Lefebvre's ideas for our own era of recurrent crisis, austerity and gentrification. The right to the city, he argues, reminds us that another vision of the city is made possible by creative alliances of the dispossessed and the discontented.
For Lefebvre, the urban street was the domain of spontaneity and the authentic arena of transformative politics. And what could be more spontaneous than a group of activists coming together in sorrow and rage to launch a radical endeavour of care, a transformative project aimed at enabling those rendered most vulnerable to participate more fully in the production of urban life?
The eruption of OPS initiatives in Vancouver, Ottawa, Toronto, Thunder Bay, Guelph, Montreal and beyond over the last few years is an extraordinary story of grassroots activists creating infrastructures of care. By securing safety for some of society's most vulnerable people, the OPS movement expands everyone's right to the city.
The story of the OPS movement is not just a story of life-affirming service delivery, but also a struggle of people devoting themselves to improving life in an increasingly inhospitable urban landscape, in the face of entrenched stigma, criminalization and official neglect.
Once the tents in Ottawa went up, pressure from the city, the police and some of the area's homeowners started to mount. Police circled the site, some angry neighbours intimidatingly took photos and video of people accessing the tents, and Mayor Jim Watson complained about "children and families" not being able to use the scrappy triangle of grass. At one point, Wright recounts, someone dumped 400 pounds of horse manure right in front of the tents.
But Wright also notes that each act of aggression against the site attracted more and more support from the wider community. "People drove in from the suburbs with their families to bring us granola bars and juice boxes.Something you just don't expect."
At first the core group of organizers figured the site would be held together by less than a dozen people working for free, around the clock, "but soon we had over 200 volunteers converging from around the city," says Wright. The core organizers still worked around the clock to keep the space going while engaging with the steady flow of visitors, volunteers and media, as well as naysayers, but they were certainly not alone.
Standing outside Ottawa's OPS tents last summer, University of Victoria nursing professor and OPS organizer Marilou Gagnon explained to MacLean's magazine, “I have this feeling of being at the right place at the right time doing the exact right thing. It’s just very special to witness the kind of resilience and support that people have. And the message that they get [from OPO volunteers] when they visit us is, ‘You know what? We show up every night on our own time and on our own money because your life matters.'”
So much of the public discussion about the opioid crisis in North America has focused on adjudicating drug users' right to receive care if they are not in treatment. Much of the media coverage of the crisis has been devoted, understandably, to the devastating scale of the deaths and the morality conflicts surrounding drug use, criminalization, permissiveness and treatment.
Less often highlighted is the remarkable eruption of grassroots infrastructures of care that have saved countless lives and modelled a dispersed and democratic vision of public health. The story that needs to be told and repeated is not only about the epidemic, but also about the activism transforming the city by making life livable.
We live in times when it is not difficult to see hints of societal psychic crisis, a sense of pervasive existential despair. "My theory around addiction is social dislocation," explains Gagnon. The OPS tents seek to provide a counter to that.
"We had food, people felt accepted, we treated them as people, not a clients, and I saw people's lives improve just by using the site. At the OPS people felt safe. They could nod safely [after injecting] because they didn't worry about their stuff getting stolen or being assaulted."
But criminalization, contends Gagnon, makes everything really hard. Prison makes everything even worse for people. And in addition to providing people with a safe place to carefully test out and use in the company of others, one of things an OPS does, Gagnon states, is provide protection from the police.
There was no opioid crisis when Lefebvre was writing about the urban revolution, but today's OPS movement would have impressed him. The labour-intensive work of the OPS is caring labour, generally uncompensated, intensely arduous and life-saving. Without it our cities would be even more devastated and people more imperiled.
Overdose prevention sites across the country have saved countless lives, either by direct intervention when guests overdose in a tent or because being in the tent allowed users to feel safe enough to take their time, test their drugs, and feel a sense of community. Lefebvre would recognize the sites as vital expressions of his call to "de-alienate" urban life, to make life livable for the many who are struggling to improve their cities and their world.
Fiona Jeffries is is a writer, educator and activist working in the autonomist tradition, and the author of Nothing to Lose but Our Fear: Resistance in Dangerous Times (Between the Lines).