“No Man is an Island”: Some Thoughts Inspired by International Overdose Awareness Day

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DRUG overdose deaths are not just about numbers; they are about people who die without intending to.

In the early ‘90s, opiate-related overdose deaths set a new benchmark for Toronto, and as a committed healthcare worker in the Parkdale neighbourhood, I lost about a client a week. These were very painful experiences for an outsider like me. But on the tight-knit Parkdale drug-using community the impact was devastating. Toronto at large took little notice.

Celebrities aside, the deaths of people who die of drug OD are not frequently reported on. They hit the media, if at all, in black and white – newsprint colours – but it is not often that members of the heterogeneous group of people who use illicit drugs are recognised as people’s parents, siblings, aunts, uncles, friends–or even as people. They are numbers, ciphers. Written off. “Othered.” Reduced to a label: drug users or junkies.

When it comes to how many have died of accidental overdose, and what drug or drugs were the cause of death, numbers are hard to come by. Each death is determined individually, and decisions are made slowly, and as accurately as possible. Deaths are deemed either accidental (that is, by OD), suicide or undetermined.

We know this, though: once again, we are seeing a spike in overdose deaths, particularly those caused by opiates. This is true in Toronto, in Ontario, in Canada and, in fact, all of North America. In some jurisdictions, accidental OD deaths rank highest of all accidental deaths, exceeding the rate of accidental vehicular deaths. I don’t know where Ontario’s OD death rate ranks right now (2011 stats are not yet ready), but it is high. I ask: does it really matter if it is first, second, third? Not really. This matters, however: overdose deaths are preventable if we wish to do anything about them.

There have been several initiatives that have helped slake the tide of OD deaths. A major one is supervised injection facilities. When people can inject drugs in a safe, clean environment where they don’t have to do it hurriedly, secretly or alone, they don’t die of overdose. This has been the experience worldwide.

Another is the passing of “Good Samaritan” laws, which, in the most basic sense, allow people who call 911 to report a drug overdose to escape police charges for drug possession. For many people, fear of police action stands in the way of taking this life-saving action, even on behalf of a good friend. This creates a terrible dilemma, and the results are often tragic for both people. At the moment, there are no Good Samaritan laws in Canada. There are laws in an increasing number of US states.

Yet another is education – not just for people using drugs (most of them already know the best ways to be safe) but for the general public and politicians, so that drug use is understood and not stigmatised. This is a long discussion in and of itself, and beyond the scope of this short piece. But it is important to remember that the experiences of those who use substances constitute a form of evidence that can inform our addictions system in Ontario.

All of this brings me to International Overdose Awareness Day, which takes place every August 31, and which was observed in Toronto at South Riverdale Community Health Centre (harm reduction workers Molly Bannerman and Zoe Dodd, pictured left). That day, the Health Centre declared their facility to be a Good Samaritan Zone, assuring people that they wouldn’t be penalized for drawing attention to an overdose occurring on the site.

International Overdose Awareness Day was initiated in the year 2000 by the Salvation Army in Australia, in the city of St. Kilda, in the state of Victoria. It commemorates those who have died from drug overdose or are living with a permanent injury after suffering from drug overdose. It is also a day dedicated to raising awareness about drug overdose and to lower the stigma attached to drug use.

That first day, the Sally Ann planned to hold a local event and give ribbons out for anyone who wished to commemorate a friend, partner or family member who had passed away. Any member of the community, even if not directly affected, could wear a ribbon to offer their condolences to those who had suffered overdose. On that first year 6,000 ribbons were distributed not only locally but throughout the state of Victoria and beyond.

Now, International Overdose Awareness Day is marked throughout Europe, in the Scandinavian Countries, in Russia, in the United States, and in a growing number of cities in Canada. It is even recognised by the UN.

Drug use is not a moral issue. But perhaps our response to it must be.

A few years ago, in Albany New York, the Catholic Diocese chose to run the needle exchange program when no one else would take it on. You can imagine the turmoil this stirred up. But the diocese based their decision on its moral and ethical principals … and held firm. The dissent has quieted down.

Incidentally, some of the early needle exchanges were started by nuns in Australia. They were closed down by the pope. Times change.

In Iran, drug users in prisons are provided with not just methadone but also new needles. A fatwah was issued by the grand ayatollah to allow this, on religious grounds. I have seen photos of an Iranian nurse, in a niqab, grinding pills so users could inject them.

In Vancouver, a nurse working in the supervised injection site, INSITE, sees her role there as a manifestation of Christian grace, and wrote about it, eloquently, in a Christian journal.

These are just a few examples. I am convinced that if we dig below the surface for the reasons why passionate, committed harm reduction workers do what we do, we will find endless moral and righteous reasons.

Why do I – an atheist – put forward these examples? Perhaps because I cannot differentiate between what is moral and what is ethical. Perhaps because, as a concept, morality may be easier to grasp than ethics. Perhaps because in our efforts to see a rational end to the war on drugs and drug users, I feel that the fiscal arguments are excellent but insufficient, and I see morality as an under-respected and under-utilised resource.

International Overdose Awareness Day itself is cut from moral cloth. And I celebrate this. It gives me hope. As the early 17th-century poet John Donne wrote:

No Man is an Island, entire of it self; every man is a piece of the Continent, a part of the main; if a Clod be washed away by the SeaEurope is the less, as well as if a Promontorywere, as well as if a Manor of thy friends, or of thine ownwere; Any Man’s death diminishes me, because I am involved in Mankind; And therefore never send to know for whom thebell tolls; It tolls for thee.

Surely this applies to this day and the people we memorialise on International Overdose Awareness Day. Everyone who dies of a drug overdose diminishes me, diminishes each of us, diminishes all of us. And so, when the death bell tolls, it tolls for all of humanity.

WALTER CAVALIERI is Director of Canadian Harm Reduction Network. Learn more about the network here.

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