Balls of Rice

Category: Mental Health

  • Fighting For Space

    The following book review of Travis Lupick‘s book Fighting For Space first appeared in Briarpatch Magazine‘s Prairie Edition, and online.

    In 2002, a group of residents and advocates met at the intersection of Main and Hastings in Vancouver holding a 100-foot-long hypodermic needle made out of a giant cardboard tube, stopping traffic. They were protesting the forced closing of a needle exchange on the corner of Main and Hastings in the Downtown Eastside. Earlier, in 2001, front-line workers had distributed clean needles in a trailer outfitted with washrooms, and ensured those using in bathroom stalls didn’t overdose. Affectionately known as “the Thunder Box,” the trailer became one of North America’s first unsanctioned supervised injection sites.

    These stories are among countless actions detailed in Travis Lupick’s Fighting for Space, which tells of the struggle that led to the implementation of Canada’s first official safe-injection site in Vancouver in 2003. The history of the harm reduction movement is one of direct action and protest – an “act first, ask second” attitude that was the only reasonable response to an outbreak of preventable disease and a crisis of premature deaths. Lupick focuses on the Portland Hotel Society (PHS), the groundbreaking housing non-profit that offered low-barrier housing to the city’s most vulnerable, and the Vancouver Area Network of Drug Users (VANDU), the advocacy group that pushed for accessible health care and decriminalization of drug use. The two worked in tandem, with VANDU often willingly taking the heat for direct actions to protect the more diplomatic and funding-restricted Portland Hotel Society.

    The history of the harm reduction movement is one of direct action and protest – an “act first, ask second” attitude.

    The 1990s saw a dramatic spike in overdose deaths and high rates of HIV diagnoses in Vancouver – not unlike the current fentanyl crisis playing out across Canada. But this time the human cost is much higher, with 2017 being the deadliest year on record for overdose deaths in B.C. The strategies used by advocates on the West Coast, honed over decades of persistent work, can provide guidance for similar struggles being newly waged in neighbouring Prairie provinces like Saskatchewan, where fentanyl has killed over 40 people since 2015.

    While revealing the staggering numbers of diagnoses and deaths is key to understanding the scope of the problem, it is the stories of the people who’ve lived through the harm reduction movement that makes this history real. By telling the accounts of people struggling for dignity against politicians and a public determined to dehumanize them, Lupick reinforces two basic claims of the harm reduction movement: people who use drugs are human, and all people deserve safety and health.

    In one of their first organized meetings, members of the newly formed VANDU agreed that they wanted somewhere safe and healthy to spend time, a space that was free of police harassment. The Portland Hotel Society’s first residence was known as the “Hotel of Last Resort.” Simplifying their message to one of “health and safety” – one that politicians and the public couldn’t reasonably reject – has grounded all of their actions and successes in the harm reduction movement. Lupick concludes the book with an epilogue about a family — Mary, Molly, and Mikel — in a quietly triumphant story of three generations living in the Portland Hotel Society, all experiencing stability in their health and housing.

    Lupick reinforces two basic claims of the harm reduction movement: people who use drugs are human, and all people deserve safety and health.

    Lupick does not deify Vancouver’s advocates or their process – rather, he shows them to be people offering the simple necessities of safety and support, while working toward inclusive public health policy. He demonstrates a proven way to effectively build low-barrier health care and housing systems: through persistent action coupled with advocacy, and building partnerships with sympathetic policy-makers. Without this infrastructure, the number of overdose deaths in B.C. last year would have been much higher.

    The current situation on the Prairies is nearly as dire as the one Vancouver faced in the 1990s. Saskatchewan’s HIV–AIDS rates are the highest in the country, and with 79 per cent of the people newly diagnosed as HIV-positive self-identifying as Indigenous, programming must prioritize consultation with Indigenous communities. Meanwhile, harm reduction programs have been heavily stigmatized by a predominantly conservative public and openly scrutinized by political leaders. In 2009, former premier Brad Wall said his government would limit the number of clean needles handed out, despite a Saskatchewan Ministry of Health report proving the success of needle exchange programs. In 2017, The Sask. Party threatened community based organizations with a 10 per cent funding cut that would hit operations deemed not to be “core services,” like needle exchanges. Though the party eventually opted against the funding cut, when harm reduction programs are routinely among the first to be threatened, the work being done by those of the front lines is delegitimized and destabilized.

    When harm reduction programs are routinely among the first to be threatened, the work being done by those of the front lines is delegitimized and destabilized.

    For years, doctors, front-line workers, and advocates in Saskatchewan have been pushing for the province to declare a state of emergency regarding rising HIV rates. But if we continue to wait for a provincial government to take necessary action – especially as two newly elected party leaders wade in slowly, in a province where the health of First Nations people is systematically neglected — it may never happen. Prairie activists and front-line workers struggling through those bureaucracies must instead act upon their values and conscience to build systems of equitable health care and human services, regardless of whether they have been granted permission by the state.

    Nicholas Olson is the author of A Love Hat Relationship, a photobook of collectable prairie hats; and a series of illustrated zines with accompanying audiobook narrations. More can be found at ballsofrice.com. He lives in Treaty 4 Territory.

     

  • Advocating for Alcohol Harm Reduction Policy in Regina, Saskatchewan

    Advocating for Alcohol Harm Reduction Policy in Regina Saskatchewan
    Understanding Chronic Addiction and Responsible Public Health Practices
    Nicholas Olson – Housing Support Worker – Carmichael Outreach

    Background

    Severe alcohol dependence is common in individuals experiencing or at risk of homelessness in Regina, Saskatchewan. For individuals who have experienced violent or psychological trauma, alcohol is often used as a way to cope with the mental and physical pain that comes when this trauma is left untreated. Aboriginal populations overrepresent those experiencing homelessness in Saskatchewan and Canada, and many of the traumas they have experienced are directly related to unstable family settings caused by the lasting effects of residential and public schools and other programs created under colonial policy. Homeless populations have a high rate of alcohol dependence and for this reason face significant barriers to stable and safe housing, and are often unable to access shelter systems. In Regina, the few housing support programs that are willing to work with individuals with severe alcohol dependence are finding that the Housing First model is not always enough to keep individuals housed, healthy, and stable. Alcohol harm reduction is the next clear step to support Regina’s most vulnerable.

    What is Alcohol Harm Reduction?

    Alcohol Harm Reduction aims to reduce the harms associated with the use of alcoholic substances in people that are unable or do not desire to stop (International Harm Reduction Association). Harm reduction functions under the idea that all individuals deserve the dignity and respect to be treated in a manner that best supports them as a whole person, not just as an addict, and to be treated medically in a way that is understanding, empowering, and compassionate to their specific needs as a person experiencing an alcohol addiction. For many, the traditional abstinence model is unrealistic and does not take into account the desires of the individual who may not want, or be able, to discontinue use. Alcohol Harm Reduction aims to support the individual to live a healthy life regardless of whether they intend to become abstinent. This may be done by assisting them to consume healthy forms and volumes of alcohol through different programs tailored to the individual, supporting them to be safe during and after consumption, and working with them to maintain good health and, if desired by the individual, to reduce their alcohol consumption overall.

    Alcohol Treatment

    The development of Alcohol Harm Reduction through a Managed Alcohol Program (MAP), Alcohol Swap Program, Beer Co-op, and/or Prescription Alcohol is the best practice in supporting the addictions of a marginalized population in Regina primarily between the ages of 30-55. Since individuals experiencing or at risk of homelessness often have fixed or no incomes, beverage alcohol is unaffordable due to the high cost of controlled substances in Saskatchewan. This, coupled with the marginalization of individuals experiencing poverty, addiction, and mental health, has made beverage alcohol even more inaccessible because these individuals are often not permitted to enter establishments that sell beverage alcohol, and in many cases are unable to even access basic health and emergency services. Non-beverage alcohol (NBA) purchased in grocery stores, convenience stores, and pharmacies including mouthwash, hand sanitizer, hairspray, and rubbing alcohol is being consumed in large quantities because of its potency and availability.

    Non-beverage alcohol can be any form of alcohol that is not fit for human consumption. Ethanol, or ethyl alcohol, is found in beverage alcohol and is safe to consume in moderate amounts. Denatured ethanol, or alcohol denat, found in products such as mouthwash, hairspray, and some hand sanitizers, is ethanol with chemical product added to make the alcohol unfit for human consumption. The chemical additives also allow the producer to avoid the product being designated as a controlled substance. Methanol, or methyl alcohol is toxic and has caused death when consumed through hand sanitizer (CBC). Isopropyl alcohol, found in rubbing alcohol and some hand sanitizers, is toxic if ingested as well. While it is often stated that the extremely high alcohol content in non-beverage alcohol is the most toxic ingredient, with sustained use and high dosage, serious risks are present from the other toxic ingredients in each solution. Hairspray, for example, can have long term effects such as internal bleeding, kidney and liver damage, respiratory problems and death (CBC). Each receptacle of non-beverage alcohol clearly warns of the risks of consumption and strongly advises to contact poison control if consumed in any volume (Pauly 10).

    Alcohol Contents and Types

    Table1.1
    (costs listed are based on saskliquor.com)
    (approximate calculations were done at http://www.cleavebooks.co.uk/scol/ccalcoh4.htm and should not be used as a substitute for medical advice)
    1 The LCBO is recalling four brands of sherry (LONDON XXX SHERRY INCLUDED) that tested positive for a potential carcinogen. “This is not like E. coli or botulism where you’re acutely affected. To be affected by something like this, you would have to consume it for a long time for many years, so there is no risk at all,” he said. “It’s very, extremely difficult for anyone to get cancer from this type of chemical, unless you’re consuming it on [a] daily basis and you’re drinking large amounts of it.” (http://www.cbc.ca/news/lcbo-recalls-sherry-for-carcinogen-risk-1.619474)

    Table1.2
    (costs listed based on retail prices at given locations)
    (approximate calculations were done at http://www.cleavebooks.co.uk/scol/ccalcoh4.htm and should not be used as a substitute for medical advice)
    2 Medicinal Ingredients: Eucalyptol (Eucalyptus Clobulus-Leaf) 0.092%W/V, Menthol 0.042%W/V, Methyl Calicylate 0.060%W/V, Thymol 0,064%W/V
    Notice: If more than used for rinsing is accidentally swallowed, get medical help or contact a poison control centre right away.
    3 Ingredients: Aqua, Ethyl Alcohol, Denatonium Benzoate, Camphor
    Notice: For External Use Only, Poison, Inflammable. If swallowed, do not induce vomiting. Call a physician immediately. If patient is unconscious, give them air. Danger: Harmful or fatal if swallowed.
    4 Ingredients: Alcohol denat, water (aqua), acrylates copolymer, aminomenthyl propanol, fragrance, octylacrylamide/acrylates/butylaminoethyl methacrylate copolymer, PEG-12 dimethicone, tritely citrate, hydrolyzed silk, hydrolyzed keratin. Alcohol content TBD but could be between 50-70%.
    5 Medicinal Ingredient: 62% Ethyl Alcohol. Non-Medicinal Ingredients: Aqua, polysorbate 20, carbomer, aminomethyl propanol, glycerin, tocopheryl acetate (vitamin E acetate), denatonium benzoate.
    Warnings: For external use only, do not ingest. In case of accidental ingestion contact your physician or a Poison Control Centre.

    Limiting availability of these products has proven to be an ineffective means of managing the consumption of the toxic forms of alcohol, as many or all of those accustomed to drinking non-beverage alcohol regularly travel to the suburban areas of the city to purchase from larger box stores and centres where they haven’t yet been banned. When individuals don’t have to spend their energy finding their next source of alcohol and managing their withdrawal symptoms, it allows them to begin to spend that energy on developing life skills, focusing on housing, setting goals, and working on improving their overall health.

    The only responsible, healthy, and compassionate way to support those who consistently consume non-beverage alcohol is to understand that in these cases abstinence is potentially a dangerous, unhealthy, and unrealistic treatment, and that reducing the harm they are causing to themselves means assisting them with the consumption of safe forms of alcohol. This can be done with Managed Alcohol Programs where individuals are given a regulated amount of alcohol at regular intervals during the day to help them deal with withdrawal symptoms and feel normal and well, Alcohol Swap Programs where individuals not necessarily receiving comprehensive housing supports can swap out certain quantities of non-beverage alcohol for beverage alcohol, a Beer Co-op where individuals are trained in proper and safe ways to brew their own alcohol for safe consumption, and Prescription Alcohol, which like a MAP, would regulate volumes and quantities based on medical assessments and administered in similar harm reduction models such as methadone. These programs, specifically MAPs, have been implemented across Canada and the US to reduce both the harms inflicted upon alcohol-dependent individuals, and the subsequent costs upon the health and justice systems.

    While other potential treatments for alcohol dependence include medications such as benzodiazepines, which include diazepam, or Valium, the lifestyle and the desires of the patient must be taken into account, and for many, discontinuing alcohol use is not desired and is not a possible solution. Using diazepam as a treatment for alcohol withdrawals does not respond to the fact that many individuals would rather not discontinue alcohol use, and even with regulated and prescribed diazepam treatment, many individuals will continue to drink different forms of alcohol when it is presented to them. This would lead to an increased risk of addiction to diazepam, and a “high risk of overdose, loss of consciousness, coma, and death.”(American Addiction Centers) Benzodiazepines are also used as a short term treatment option, with only 1-2 percent of adults continuing treatment for 12 months or longer, and carry substantially higher risks of dependence and misuse in populations with a history of substance abuse (Longo). When supporting an individual living in community, monitoring all the substances that enter the home is impossible, therefore it is best to prescribe that which reduces the most risk and harm to the individual.

    The harm reduction framework aims to support individuals to make healthy choices and this begins with offering assistance in managing quantities of beverage alcohol, and accessing beverage alcohol in a cost-effective manner, while at the same time being careful not to perpetuate the stigma of using non-beverage alcohols that is often present in community supports and medical services. Many populations are stigmatized even within social circles for drinking non-beverage alcohol, and this stigma is magnified in many professional health settings. Following the harm reduction framework means focusing on the needs and desires of the individual, not reducing addictions to a moral or ethical choice, and understanding the barriers that have led to less-safe alcohol consumption. It is important that harm reduction treatments are in place and practiced by health professionals, as professional knowledge is needed to create public health policy that can be safely and confidently administered by community entities.

    Understanding

    Each individual receiving alcohol harm reduction support will consume a different variety, style, and amount of beverage and non-beverage alcohol each day. It is important to understand what the approximate quantities of non-beverage alcohol are to ensure that the proper volume of beverage alcohol is supplied to each individual. Having a set schedule of beverage alcohol consumption would ensure that a moderated amount of alcohol is consumed, which, ideally could be lessened over time based on the desires of the individual. Clinical medical advisement through a MAP or prescription may be required to ensure that the individual is getting a safe dosage, and that an understanding of the individual’s history with addiction and their personal and traumatic history is taken into consideration. In an evaluation of a MAP in Vancouver, BC, alcohol consumption did not necessarily decline in six months for all of the participants, however the consumption of non-beverage alcohol did decline, and most participants reported improvements in mental health, social connectedness, and general well-being, and consumed alcohol in a safer setting with less harms that come from drinking large quantities at one time (Stockwell 6,7).

    Below are some comparisons of alcohol contents. Though it is clear that the ethanol present in beverage alcohol is different than the types of alcohol present in non-beverage alcohol (denatured alcohol/ethanol, isopropyl alcohol) and the “high” achieved through using non-beverage alcohol would therefore be different, the comparisons below are a guideline for quantities consumed knowing that the denatured alcohol and isopropyl alcohol have added chemicals that are toxic for human consumption.

    For example, as shown in Table 2.1, one litre (1L) of Antiseptic Mouthwash has an alcohol content of 270mL, which is equivalent to 12.5 cans (4.4L), of strong percentage beer, or nearly two bottles of a strong sherry wine. Similarly, as shown in Table 2.2, it takes nearly 10 times as much strong beer to equal the same alcohol content of 449mL that is obtained through 725mL of Hand Sanitzer Gel. While the point of alcohol harm reduction isn’t necessarily to meet the alcohol content that an individual would consume drinking non-beverage alcohol, it is important for service providers and community supports to understand just how much beverage alcohol it takes to help cope with withdrawal symptoms.

     

    Table2.1-2.2

    Conclusions

    It is clear both to the uneducated outsider and to the affected individual that the consumption of non-beverage alcohol is extremely damaging to one’s physical and mental health. By offering support to individuals in their addiction through alcohol harm reduction programs, the dignity of these individuals is upheld as they are receiving compassionate medical treatment that views them as a whole person. Through these programs, these individuals would be able to access supports that are often only accessible to less-stigmatized populations, including detoxification programs that in Regina are inaccessible to many with reduced mobility and high physical needs.

    Access to inexpensive, clinically regulated and adequately strong forms of beverage alcohol is key to the physical and mental health and well-being of the individual. Regulated quantities of alcohol must be customized to each individual based on their own personal symptoms and histories. While having professional medical advice involved is clearly the best practice, disallowing access to safe forms of alcohol because of lack of confirmed policy is irresponsible and lacks the compassion necessary in the human services sector and in a responsible community.

    Policy driven by the Regina Qu’Appelle Health Region, monitored and planned by medical professionals, delivered by community organizations, and tailored to the needs of the individual are imperative to the success of an alcohol harm reduction program, and the timely nature of its implementation is extremely important to ensure the safety, health, and survival of a large population of vulnerable people. A responsible community and health region would not allow the continued consumption of controlled poison when clear, simple, and practical alternatives exist.

    Sources
    International Harm Reduction Association, What is harm reduction?, http://www.ihra.net/what-is-harm-reduction
    CBC News, Hand sanitizer ingestion linked to 2 Ontario deaths, Oct 25, 2013, http://www.cbc.ca/news/canada/toronto/hand-sanitizer-ingestion-linked-to-2-ontario-deaths-1.2252046)
    CBC News, Hairspray abuse plagues northern town, Feb 16, 2001, http://www.cbc.ca/news/canada/hairspray-abuse-plagues-northern-town-1.293513
    Pauly, B., Stockwell, T., Chow, C., Gray, E., Krysowaty, B., Vallance, K., Zhao, J. & Perkin, K. (2013) Towards alcohol harm reduction: Preliminary results from an evaluation of a Canadian managed alcohol program. Victoria, BC: Centre for Addictions Research of British Columbia.
    Carnahan RM, Kutscher EC, Obritsch MD, Rasmussen LD. Acute ethanol
    intoxication after consumption of hairspray. Pharmacotherapy. 2005 Nov;25(11):1646-50. PubMed PMID: 16232026.
    http://www.ncbi.nlm.nih.gov/pubmed/16232026?report=docsum
    American Addiction Centers, Dangers in Mixing Valium and Alcohol or Drugs, http://americanaddictioncenters.org/valium-treatment/dangers/
    Longo LP, Johnson B., Addiction: Part I. Benzodiazepines–side effects, abuse risk and alternatives. Am Fam Physician. 2000 Apr 1;61(7):2121-8. Review.,
    http://www.aafp.org/afp/2000/0401/p2121.html
    Stockwell, T., Pauly, B., Chow, C., Vallance, K., Perkin, K. (2013). Evaluation of a managed alcohol program in Vancouver, BC: Early findings and reflections on alcohol harm reduction. CARBC Bulletin #9, Victoria, British Columbia: University of Victoria
    http://www.uvic.ca/research/centres/carbc/assets/docs/bulletin9-evaluation-managed-alcohol-program.pdf

  • The Carmichael Free Press

    This originally appeared at CarmichaelOutreach.ca.

    Carmichael Free Press copy2
    Noel, Rocky, Mike and others sat in the coffee room on a Thursday afternoon and asked what was going on for programming that afternoon. “Art Class!” I proclaimed on my way downstairs. I brought up the box of scrapbooking supplies that former gourmet chef and art mastermind Mike Wysminity paid for with money he raised himself by selling tomato plants at the Farmers Market in pots hand-painted by Carmichael art participants.

    I tossed markers, fancy-edged scissors, stickers, moon-shaped hole punches on the table and people started creating. Noel wrote an inspirational quote and drew a cartoon. Mike wrote a poem. Lisa wrote a note to her son under a picture of him taken from a previous Carmichael Hockey Day. Brian wrote a story. Then staff members cut them out, organized them, and pasted them on the template, made copies, and printed them for the masses.

    The Carmichael Free Press is a grassroots publication on it’s fourth edition so far—a zine style scrapbooking newspaper that anyone can contribute to. Not topical, always different, the Free Press is a creative home for real, not-pretentious, unknown writers, artists, painters, comics, mothers, children, and more, not only to produce something they are interested in—they are proud of, that makes them laugh—but to have it shared with their group of friends, the Carmichael staff, and the greater community.

    The first ever headline of the Carmichael Free Press was borrowed from a photograph from a previous Carmichael photography class partnered with the Heritage Community Association and Sask Arts Board.

    “Here you go!” he said, as he passed his page to me with the inevitable nervous feeling of sharing something you just created. The headline read, “The Princess Royal Walk – Her Royal Highness Visiting Heritage Centre in Regina Sask…..” with an up-close picture of a loyal volunteer. Everyone in the room laughed at the joke. Real news be damned, street news is what matters. The experiences of people in your neighbourhood who you have never met are what truly matter, not the business interests of private national media. Hailed by its creators as “The most important newspaper in Saskatchewan,” the Free Press begins its climb to the top.

    Thursday afternoon Art Class at Carmichael has evolved as necessary from painting to drawing to scrapbooking to newspaper-making to who-knows-what-next, depending on interest, on funding, and on person skills of the facilitator. The informality and drop-in style of the Art Class is what makes it a success. Peter walked into the coffee room, saw his friend sitting at the table, saw markers, scissors, empty pages of the Carmichael Free Press, and sat down for ten minutes, drew a remarkable drawing of a pipe with the smoke forming a buffalo, eagle, bear. He thanked us for the time and headed on his way.

    Big Mama Page

    Every person has the right to have their voice heard, published, and distributed. People in your city are depressed, pissed off, a little bit high, lonely, in love, tired, dope-sick, or extremely happy, and they are entitled to these feelings. The power that is gained in sharing these feelings, putting them in some creative form, is invaluable. Outside of the online world of status updates and cartoon smiley faces, people need to have a forum to express themselves, and since Facebook and other online media aren’t accessible to those without internet access and aren’t really collective, the Free Press fills the void.

    Authors and artists work years to get things published or get their art hanging in a coffee shop in the over-marketed world of writing and art, but that doesn’t make the voice of the amateur any less important. If anything it makes it more significant; not being sold as a commodity or graded like a high school paper.

    The Carmichael Free Press is the perfect example of Carmichael programming—drop-in-style, no cost, inclusive to all, hilarious, frustrating, and motivating. Sober or not, published or not, practiced or not, community members can use the Carmichael Free Press as a home for personal expression, a place for injustices to be made public, love to be shared.

    The sign-off of our first edition reminds readers what the Free Press is trying to proclaim each and every edition—the importance of listening to and helping out people you have never met, and encouraging you to get to know them one way or another, possibly by participating in your local Free Press!

    “Sisters and Brothers, we are all on the same page. So don’t flip me!”

    Carmichael Free Press copy