Working outside the law, Sarah Blyth leads a grassroots response to the overdose epidemic

The founder of two pop-up injection sites won’t stay silent during the fentanyl crisis

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      Last Christmas Eve, Sarah Blyth was working the front desk at one of the Downtown Eastside’s nonprofit hotels when she heard a call from the alley out back.

      “There was a person outside and he was dying,” the former park board commissioner recounted in an interview last January. “So I went running over with the Narcan kit.”

      It was Blyth’s first time injecting somebody with the overdose antidote, and she admitted she was shaken by the experience.

      “At that point, it [an overdose] happened, but it happened once a week or a couple times a month,” Blyth said in an interview last week. “It was still a thing, like, ‘Whoa.’ Now it’s normal business.”

      Today, Blyth oversees operations at two unsanctioned injection tents for drug users that together have seen a skeleton staff use naloxone to reverse more than 200 overdoses since mid-September. (They recently stopped counting and note that number continues to grow every day.)

      Blyth recounted a meeting she held with volunteers earlier this month. One mentioned how nice it will be when the overdose crisis is over and they can all finally catch their breath. Then another volunteer interjected: “What does ‘over’ mean?” she asked. “What if this is just the beginning? What if it is always going to be like this? Is it ever going to end? Is it going to get worse?”

      During the first 10 months of 2016, 622 people in British Columbia died of an illicit-drug overdose death. That’s up from 510 in 2015 and 370 the year before. Fentanyl has been detected in about 60 percent of deaths this year. Despite those unprecedented numbers, it looks like things are going to get worse.

      On November 29, the B.C. Coroners Service confirmed that a synthetic opioid called carfentanil was found near the body of a man who died in East Vancouver two weeks earlier. A news release warned the drug was significantly more dangerous than fentanyl, describing it as “the most toxic opioid used commercially”.

      Blyth said that has her team preparing to establish more unsanctioned tents.

      “We thought fentanyl was a nightmare,” she added. “We thought, ‘How could it get any worse than this?’ But it can.”

      Blyth runs the tents with the help of two other Downtown Eastside activists: Ann Livingston and Chris Ewart. They operate outside B.C.’s health-care system, without government support or official permission. And because they offer people supplies to use heroin and cocaine, the whole operation could run afoul of federal drug laws.

      The Vancouver Police Department has said that it considers the tents a health-care issue as opposed to one for law enforcement and will not move against them or arrest anybody who brings drugs there. Meanwhile, Vancouver Coastal Health, which operates Vancouver’s sanctioned injection site, Insite, as well as hospitals and clinics throughout the city, has emphasized it does not condone the tents but similarly has no plans to shut them down.

      An unsanctioned tent where harm-reduction supplies are distributed can be seen in the background while paramedics used naloxone to resuscitate a man experiencing an overdose.
      OVERDOSE PREVENTION SOCIETY

      Blyth and her staff keep the program going with nothing but small donations collected via a GoFundMe page. That has kept them spread thin, but she noted that it also gives their group a unique independence and greater flexibility to respond to changes on the ground.

      “It would be nice to have government funding,” Blyth said. “But up until now, it has been great to have that ability to speak for all the frontline workers and all the people who are overdosing, to show what the situation is we’re dealing with. Because we are funded by the people, we can have a voice and we can say whatever we want.…We are in a really good position to push where other agencies aren’t allowed to speak.”

      But it’s not easy operating on a shoestring. The Overdose Prevention Society—not a registered charity but what the group calls itself—spends about $250 per day to keep the two tents staffed and stocked with supplies. (Technically, people aren’t paid a wage but receive an honorarium.) They also require things like cleaning supplies. Blyth said the group has also come to spend small amounts on memorials. She explained that many of the volunteers at the tents are drug users themselves and they have lost people to the same epidemic from which they’re working to save others.

      Asked about plans to expand should the crisis continue to get worse, Blyth recounted how the entire operation evolved organically in response to perceived necessities.

      “We’re just trying to figure out the best way, the quickest way, to save lives as fast as we can with a bunch of compassionate people and with a government that is not doing enough,” she said.

      What drives Sarah Blyth?

      Blyth has worked in the Downtown Eastside since 2008. She started at the Portland Hotel Society as a temp assigned to short stints at various supportive-housing projects as well as Insite. Later, she managed the New Fountain homeless shelter and organized Vancouver’s first homeless soccer team, which subsequently travelled to international tournaments in Rio de Janeiro and Paris.

      “You could see that there was a lot of gaps where people were needing to get help and there was just nothing there for them,” Blyth says of those early experiences.

      As the fentanyl crisis has intensified, burnout has become a major problem among frontline staff. Every time someone responds to an overdose, their body releases adrenaline, and so many waves of the powerful hormone can leave a person exhausted. Responding to three, four, or five overdoses in a single shift can also cause a heightened state of vigilance accompanied by feelings of stress and anxiety.

      Blyth noted that if a staffer responded to an overdose one year ago, they were sent home for the day to rest. But that’s no longer possible.

      “I’ve kind of burned out a couple times,” Blyth conceded. But she said her years of experience in the neighbourhood have helped her learn how to cope.

      Vancouver doctors set up an informal clinic in a Downtown Eastside alley near an unsanctioned tent offering supervised-injection services. 
      Travis Lupick

      “Once you’ve burned out a couple times, you kind of can figure out when you’re on your way into burnout mode again and pull yourself back,” she explained. “You realize what you can and cannot do and how much you can take on.”

      Blyth said that a key part of pulling oneself back from emotional exhaustion is acknowledging one’s limitations.

      “There are a lot of things that you can’t do anything about,” she said. “You want to help everybody but there are not enough resources.”

      In the past, Blyth has spoken openly about her struggles with ADHD. Prodded by the Straight, she explained how that condition has contributed to feelings of empathy for people who live in the Downtown Eastside and who might feel marginalized or discriminated against.

      “I know what that feels like,” she began.

      “When you’re in elementary school, people start to separate,” Blyth continued. “If you don’t have very good motor skills, you don’t make the basketball team. And then you don’t do this or that. And then it starts to be these other people who are the normal guys and then there’s the group of people who are stigmatized or the people who are slightly different in any way.

      “Anytime you are any different, you can just kind of end up going in a different direction,” she said. “So it makes it easier for me to understand how people could end up down here.”

      Blyth suggested that those same forces gave rise to a sense of community in the Downtown Eastside that led it to rally and come together in response to the fentanyl crisis.

      “I feel more comfortable in the Downtown Eastside than I do in any other part of Vancouver,” she added. “Here, people really tell you straight-up how they feel. People say hi to each other; people have character; they are up-front with their issues. Whereas other sectors of society internalize everything and keep everything hidden.”

      The public can make donations to the Overdose Prevention Society through GoFundMe.

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