The weekend of July 28, Zoë Dodd was enjoying a rare vacation in Montreal when news reached her that there was a wave of overdoses sweeping through her hometown of Toronto.
A harm-reduction advocate who coordinates a hepatitis C program for drug users, Dodd cut her trip short and caught the next bus back to work.
“Toronto police issue warning after 7 overdoses, 2 fatal; fentanyl suspected,” reads a headline from that Friday (July 28).
“We felt frightened,” Dodd said in a telephone interview. “We knew those sorts of spikes were happening because we were already losing people. We were having memorial after memorial for coworkers and friends that had died. So that spike wasn’t anything new for us. But that was the first time that the police had ever released anything about a spike in the city.”
The bad batch of drugs continued to make its way through Toronto for the next several days. Dodd said the worst of that weekend still hasn’t been reported. “We knew of 12 deaths by the time the weekend was over and into the following days,” she explained. “And those were people that we knew.”
For more than a year, Dodd and other Toronto harm-reduction advocates have kept in close contact with activists in Vancouver, where the dangerous synthetic opioid fentanyl arrived earlier. They chat on Facebook and Twitter, share news from the frontlines, offer advice and support to one another, and strategize on how best to push their respective governments to adopt more controversial health-care policies that might help save lives.
After the July spike in overdose deaths in Toronto, this informal network kicked into overdrive.
Following Vancouver's example
Last September, Sarah Blyth and two other women who work in the Downtown Eastside grew frustrated with the B.C. government’s lack of an urgent response to rising numbers of overdose deaths. They pitched a tent facing into a back alley, stocked it with clean needles and naloxone, and invited people to come and inject drugs there. They called it a “pop-up” overdose-prevention site, or OPS.
Leigh Chapman traveled from Toronto to Vancouver and visited Blyth’s tent last February, when she was in town for a conference about the overdose crisis.
“My one key message that I came back from Vancouver with is that we need pop-ups,” Chapman told the Straight. “That this is a viable thing that the harm-reduction community can do, taking matters into their own hands. And that this is something that we need to do.
“I even wrote a grocery list of what we would need to do a pop-up,” she added.
For the first four months that Blyth’s tent offered supervised-injection services, the operation relied on donations collected via a GoFundMe page. After the surge of overdoses in Toronto, Chapman consulted members of the Toronto Harm Reduction Alliance and asked them what she could do to help. On August 4, she started a GoFundMe page of her own. At the time of writing, it had more than $15,500 in donations.
Meanwhile, the wave of deaths in Toronto continued.
“Six people in six days have died of suspected drug overdoses in Toronto,” reads an August 4 article in the Globe and Mail.
That night, Chapman sent Blyth a text message.
“Can we set up a time to chat with you on Tuesday sometime?” she asked. “Need to pick your brain.”
“Anytime for u,” Blyth replied.
On Tuesday (August 8), the two connected for that call. Chapman told Blyth that Toronto activists were talking about setting up an unsanctioned injection site, like she had, but that they were nervous.
“When you’re thinking about doing something that is illegal, you over-analyze everything,” Chapman explained. She asked Blyth for her advice.
“Sarah said to get the tent and supplies and not to worry about all of that other stuff. To not worry about the police and everything, the media, the mayor….She said, ‘Just do it’.”
“I said, ‘Do what you’ve got to do,” Blyth recounted. “Don’t think about it too much. Don’t wait too long. Go to Costco or another big-box store, get yourself a tent, get yourself some tarps, get yourself some Narcan [brand name naloxone] and tables and chairs, and put them where people are dying….Just do it.”
Blyth added one final word of encouragement: “‘I want to see a picture of a tent in my news feed this Saturday,” she said.
Chapman said she didn’t think they were ready. Then, three days later, on August 11, Dodd and her team at the Toronto Harm Reduction Alliance convened a news conference and announced their intention to open an unsanctioned site.
“Toronto harm reduction workers are taking matters into their own hands,” reads a CBC News article from that day. Another member of the Alliance, Matt Johnson, is quoted there. "We just can't wait any longer,” he said. “With this many deaths we just can't afford to.”
Chapman was in class working on a PhD at the time and missed the news conference. When she finished with her meeting and checked her phone, there was a text message from Dodd asking her to take the money that they had raised with the GoFundMe page and purchase a tent. Chapman got into her car and drove to Canadian Tire.
Toronto's first unsanctioned site
The morning of August 12, the activists met on the edge of Moss Park, in an area of Toronto’s East End neighbourhood where drug users congregate.
“We all got together, got all the supplies we needed, loaded everything up, and then we went to the park and we pitched a tent,” Dodd recounted.
By this point, the media had taken a keen interest in the story. Reporters were calling nonstop, asking where they should head to witness the operation take shape.
In the background, an Ottawa-based associate professor and president of the Harm Reduction Nurses Association named Marilou Gagnon was managing public relations. In a telephone interview, she explained that the activists had previously agreed they would use the news media and, this being 2017, social media, to communicate the group’s actions and objectives in an effort to rally public support.
“To send a signal that this movement is not about to stop,” Gagnon said. “And that we are actually helping each other.”
Back in Moss Park, the activists watched Gagnon’s work on social media pass through the screens on their phones.
“On Twitter and Facebook, we had people from the harm-reduction community in Australia following us and tweeting that they were in solidarity with the work we were doing in Toronto,” Chapman said.
As they finished setting up the tent, two members of the Toronto Police Service (TPS) arrived on bicycles.
“You’ve got to come down here,” one of them said over the radio to his superintendent. “We’ve got a situation in Moss Park.”
Dodd spent the next two hours speaking with the officers. She explained who they were, emphasizing that several of them were registered health-care professionals. Dodd also mentioned that she had spoken with a lawyer, a member of the Toronto-based Movement Defence Committee. And they discussed the recent wave of drug-overdose deaths.
“Negotiations happened with him [the superintendent] and senior commanders and they decided to let us continue on,” Dodd said.
After an initial wave of frantic interest from media and police had begun to subside, the tent’s first potential user slowly walked over.
“He was a crack user,” Chapman recalled. “We explained why we were there and he said, ‘Oh, great, I’ll do this in here’. And we sat and had a conversation while he was toking away. And I thought, ‘This is why we are here’.”
Ottawa is next
Gagnon suggested the establishment of the pop-up injection site in Toronto is not the end of this story but the beginning of a larger one.
After Toronto police made clear they would allow the unsanctioned site to operate, she connected with Jordan Westfall, the Vancouver-based president of the Canadian Association of People Who Use Drugs (CAPUD). Together, they got to work drafting instructions for exactly how other cities can follow the examples set by Vancouver and now Toronto as well.
That document is titled “Pop-Up Overdose Prevention Sites: Quick Start Guide”. It provides a detailed, 13-point plan for how activists in Canada should break the law and establish illegal injection sites to serve as a stop-gap measure and challenge authorities to do more to prevent overdose deaths. It’s now receiving final revisions. Gagnon and Westfall intend to make it available online before the end of this month.
But the draft is already circulating online among harm-reduction advocates. Activists in Ottawa received a copy last week and, on August 25, used it to establish an unsanctioned-injection tent in the nation’s capital.
That tent is now providing overdose-prevention services in Raphael Brunet Park in Ottawa’s Lowertown neighbourhood. A GoFundMe page for the Ottawa group is collecting donations online, just as the Vancouver and Toronto groups did before it.
This weekend, activists in Kitchener, Ontario, are debating whether they should make their city the fourth in Canada to host an unsanctioned overdose-prevention site.
The federal Liberal government has approved applications for 17 supervised-injection sites since it assumed office in November 2015. However, overdose deaths were already climbing across Canada when the Liberals took power and have continued on that trajectory.
Gagnon, who helped establish the Ottawa pop-up, said it’s encouraging to see activists advance harm-reduction programs beyond Vancouver. At the same time, she emphasized that has only happened because health authorities have failed to respond to the overdose crisis with sufficient urgency.
“At some point, the federal government and provincial governments will need to acknowledge that something is happening,” Gagnon said. “It is great that people are coming together to do this. But this is not normal and it would not be acceptable if this were any other health issue.”