Love in the Time of Fentanyl

Love in the Time of Fentanyl is a documentary that follows some of the personalities involved in the Vancouver harm reduction scene. It is now screening at select venues across North America, which is updated regularly on the film’s website. Below is a blog from Ronnie Grigg, the Founder and Executive Director of Zero Block Society, and one of the focuses of the film.

A new documentary has been making the rounds at film festivals and local screenings that features a look at the daily activities of Vancouver’s pioneering Overdose Prevention Society (OPS). It follows a few of the personalities involved, including a part of my own story. Entitled Love in the Time of Fentanyl, filming took place mainly in the early part of 2019. It started as a short film about a mural that Smokey Devil, a famous Vancouver street artist, painted of me. He called the mural the Narcan Jesus- it was a cool story of the history Smokey and I have which is part overdose intervention, part history of relationship, and part funny story of some random young person calling me Narcan Jesus years prior as I was attending to multiple overdoses on my own in an alleyway.

The film is the first feature length documentary by Colin Askey. Colin and I have known each other for many years. We first came to know each other as harm reduction workers in Vancouver’s Downtown Eastside over 10 years ago. He and his wife Kailin, known for supporting the emergence of many innovative harm reduction programs herself,  have since relocated to New York City where Kailin remains involved in harm reduction work. She in fact has been heavily involved in opening the first sanctioned supervised consumption facility in the US. Get at it, America- lives are at stake. With Colin’s background in film he became involved in doing short documentaries featuring the various programs in Vancouver and then later in NYC. We affectionately called him “The Propagandist” for how effectively he represented the story of the complexities of harm reduction work. He was well positioned to do this film because of his pre-existing relationships with many of the people in the film and his knowledge of harm reduction work.

As he tried to capture the history of Smokey’s mural the filming began to grow to feature the vibrant life of the Overdose Prevention Society, with its art programs, its peer focussed community response, and mainly its critical life-saving service of overdose prevention. And the funding also grew, as Colin was able to secure funding through Independent Television Service (ITVS– the funding arm of PBS, the US public broadcaster) as well as the Sundance Institute. Also important has been the support of Executive Producer Sean Baker, an accomplished Los Angeles based film maker known for such films as Tangerine, the Florida Project, and most recently Red Rider. Sean had been working in Vancouver pre-Covid trying to support the stories and efforts of harm reduction work in the face of an ongoing public health crisis that has taken so many lives. A part of that effort brought Sean to OPS as a volunteer.

The film premiered in May 2022 at DOXA documentary film festival in Vancouver where Colin suitably won the award for best Canadian Director. It also screened at Northwest Fest in Edmonton in May. After a few quiet months the opportunities for screenings have increased- we were able to embark on a small tour that included Nelson and Kamloops in British Columbia, where Dana MacInnis, one of the featured storylines in the film, and I were able to attend. Then on to a screening in Thunder Bay, Ontario, at Vox Popular Media Arts Festival where Norma Vaillancourt, another featured storyline, was able to participate in a QnA in her hometown along with me. Then Commfest Film Festival in Toronto and Cinefest in Sudbury, my hometown. The response has been overwhelmingly positive with strong community support. In Kamloops the screening coincided with local International Overdose Awareness Day activities which brought approximately 400 people to the event. We were given the experience of a standing ovation of which I’ve never experienced before. It was deeply moving. In all of the places where there have been screenings, there have been opportunities for me to introduce myself to people and organizations heavily involved in overdose and homelessness response.

This film experience has fit extremely well with my vision for Zero Block Society, the harm reduction non-profit that is emerging into a real thing. With “Support the Work, Support the Workers” being the guiding mandate, my hope has been to bridge the knowledge of lived experience outside of the Downtown Eastside where I live and work. This bridge is mainly meant for harm reduction workers in other communities, but also for those outside of the harm reduction sphere who want to support and further educate themselves.

Love in the Time of Fentanyl has been an effective experience to allow people to witness the intensity and challenges of responding in a constant state of crisis, but also the deeply compassionate and humanizing aspects of the people responding to their community’s needs. The feedback has been beautiful and affirming- one person expressed to me that the storytelling had them cheering for the characters in the film, another person described it as a timely gift that galvanized their understanding of harm reduction and the deep potential found in the compassion of meeting people where they exist without the judgement or expectation of abstinence only based outcomes.

We’re hopeful for ongoing community engagement. Currently the film is able to be screened in Canada. We’d encourage any community groups or festivals to reach out with your interest. It will premiere in the US at DOC NYC, the largest documentary film festival in the US, on November 15 with an additional screening November 17 which I’m hoping to attend. Also it is beginning to be screened internationally, specifically in Ireland and hopefully more (Hello Mexico, Australia,  other parts of Europe, still hoping to get out your way). An exciting aspect of the American support is that it will be broadcast as an episode of Independent Lens on PBS on February 13 and will be preceded with a month of pop-up screenings throughout the US. Those pop-up screenings will support community conversations in many US regions, many of which I hope to join.

This is an exciting turn of events and a necessary emergence of the story of harm reduction work. We always appreciate the support we receive as this film tours and as the work of Zero Block Society increases. If you’d like to support this ongoing work, please do. There are two readily available ways to do so:

1. Talk about us through social media and through your community networks, and
2. Financially support us through donating to Zero Block Society. Your support matters deeply.

To a more compassionate future,

Ronnie Grigg

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Love in the Time of Fentanyl

Premiering tonight at the DOXA Documentary Film Festival is “Love in the Time of Fentanyl,” featuring our very own Ronnie Grigg!

Directed by Colin Askey, the documentary follows Ronnie and other workers at the Overdose Prevention Society in Vancouver. The film screens May 10 and 11 in Vancouver, May 13 in Edmonton, and will be streaming online through the DOXA film festival website.

Still Here

Today is International Overdose Awareness Day. What a strange but necessary day. It’s a day to try to gather the grief and outrage of communities around the world. And it’s about awareness. Awareness focusses the light on the fact that there remains a massive divide among us- a divide of stigma, shame, and ultimately death. It’s death by policy, a life taking drug policy long known to be ineffective, and death by shunning. Any of the stigmatizing titles we have depended on- drug user, substance dependent, addict, all point toward a great unwelcomed segment of our communities that gloss over deeper truths. The truths are that some substances are more acceptable than others, some levels of consumption (of those same substances) are more acceptable than others, that there are contexts where those same substances are used (such as when they are prescribed) that are more acceptable than others, and that access to necessary and fundamental care- medical, social, but mainly basic human needs such as housing and food, are more accessible for some than others. 

There are communities that carry this weight in a grossly imbalanced way. This is a part of the injustice- communities marked by poverty, mental and physical illness, and racial marginalization have been most likely to acquaint themselves with the grief and trauma of this long drawn out crisis. Awareness brings these experiences into the light. I grew up in a small town in Northern Ontario with a population roughly the same as Vancouver’s Downtown Eastside, where I currently live and work. If that community experienced years of hundreds of deaths annually as a result of a common experience and failure we would certainly memorialize that experience. We would do everything in our power to change it- and we would not only remember but insist on not forgetting, in case we were to experience that same threat in our community ever again.

A Day of Awareness is a small part of the effort to bring this light forward. We have the passion and creativity to solve this crisis. So many people have readily engaged to provide overdose prevention services, harm reduction services and education, and advocacy and resource building. This work is made especially difficult in a culture of indifference and resistance to the message. Herein lies the problematic mythology- overdose deaths aren’t only a Downtown Eastside issue. They’re not limited to those experiencing poverty and mental illness. Overdose deaths are in fact widespread in many families and communities, hidden because of the stigma, shame, and threat implied by the current public discourse. We need new conversations and approaches simply because the existing approach has failed and become increasingly lethal.

Decriminalization, access to safe supply, increasing overdose prevention services, and supporting and listening to the people who provide those services is the way forward. If you know a frontline harm reduction worker- take a second to thank them

Bevel App

Okay so this is a weird one… How does a guy that needs help taking pictures on his phone launch an app? How do two computer science students make an impact on the overdose crisis? The answer is community collaboration to create community solutions. 

One of the fundamental purposes of harm reduction is to connect individuals with services if they want or need them. So, couple of years ago, we submitted a proposal for a project to a student organization called Coding For Change. Since then we’ve been working on developing a resource for people who are most deeply impacted by the overdose crisis: first, those who use substances that are most at risk from the current poisoning of the drug supply, and second, the variety of frontline harm reduction workers who have been overwhelmed with the need and immensity of the response. 

What we’ve come up with is Bevel App. If you’ve been around harm reduction environments for a while you get it. If you haven’t, Bevel App is a nod to the foundational documentary called Bevel Up which, in 2007,  provided an overview of harm reduction education. Check it out if you have the opportunity.

In its launch format, Bevel App will be a harm reduction services resource that will map out where to access services. It will initially launch in Vancouver, with a provincial, national, and hopefully continent-wide rollout to follow.

At Zero Block Society we’re proud of where this project has arrived. Aside from the coding (which was done by the student-run Code the Change Foundation), the look and content of the app has all been created by community members – service users and frontline workers alike. It has been developed with zero funding, with the artwork and labour being donated or exchanged. We will need to change how it’s funded in the very near future but we’ve gotten it to this point as a community-driven project in collaboration with the student programmers.

And now we’re beta testing. In the next few days the app will finally be on the phones of frontline workers and those who access services for the first time. And soon it will downloadable by anyone.

Your support is appreciated. We hope this is one small step toward a future of zero deaths by overdose.

Crisis? Which one?

A public health crisis and the Downtown Eastside – we’re left to ask “Which one?”. We know crisis. Dare I say we’re good at it. That’s not okay. Crises are carried on the backs of those on the frontlines who are face first with both the urgency and the limitations of the response. We need to be heard and supported because we know crisis.

So which one? We can start with the pervasive systemic crises of poverty in an affluent city, of homelessness and a housing crisis, and the crisis of an inadequate mental health care system. And we can proceed to the late 1990s to a public health crisis related to skyrocketing deaths by overdose and the rampant transmission of HIV. The outcome of that crisis has been a globally standard setting network of harm reduction and HIV services that includes supervised drug consumption services. Then more recently we endured, and are enduring, the poisoning crisis due to a tainted drug supply. And now this COVID-19 pandemic with its global reach, a global reach that includes the Downtown Eastside despite regularly feeling outside of global priorities. Other communities are similarly affected but the concentrated experience on such a small community makes the weight feel so much heavier. This current public health crisis is unique in that we’re anticipating it’s inevitability, waiting. The others were crises in motion; perhaps there were prior indicators but mostly the responses were reactions to what was already happening. But now we wait in dread. But we can’t. In the days of COVID-19, the rapidity of transmission is too excessive and the symptoms too severe. As a collection of survivors of many crises, it should be acknowledged that we know something. My familiarity with facing a public health crisis fuels an urgency that this experience be incorporated into our public response. 

I was one of the many frontline harm reduction workers in the Downtown Eastside when black-market fentanyl surfaced. I’ll never forget it. That incident has shaped so many of us through grief, loss, and trauma but also in pride through our resilience, and in our increased capacity to care and to endure. I was working at Insite the day it first surfaced. We had a care model at that time that was dialled in: overdoses were readily managed, we had strong community trust, and staff displayed a level of consistency and stability, amplifying the impact of Insite’s relational care model. That changed in a day. We moved from averaging 10 overdoses a week to averaging 10 per day. Unresponsive bodies were dragged into the site in those first few days as people rapidly “dropped” from unexpectedly potent and lethal levels of a drug supply. 

From that time on, instead of care being done almost exclusively inside the site, staff began to regularly run from the site down alleys, up sidewalks, into SROs with the uncertainty of how long someone had been unresponsive, what they had ingested, or the security of the situation encountered. Every excursion out of the site required the remaining staff to be less supported for the crises on the inside. So many frontline workers were also doing the same from understaffed SROs and shelters, to clinics and social service locations.  As we moved through Vancouver on our own, we dealt with the anxiety of venturing out without naloxone knowing that at any momentwe may encounter a critical need.

Decision makers also responded. A public health crisis was declared, and crisis funding was allocated. The onset of the overdose crisis as described above began in October of 2014. The public health crisis was declared (and remains in place) in April of 2016. And the crisis funding emerged in November of 2016. There were 2 years where drug users with naloxone kits, on the ground frontline harm reduction workers, and first responders were the only response to an exponentially greater problem. We did well. Amazingly well.

The things we did well should be noted. Despite our workplace becoming more demanding and less safe, we worked harder. We supported and cared for each other. Despite being exhausted we advocated for better care and support often on our own time. We worked beyond the original mandate of our jobs. These were responses to life and death circumstances, and we didn’t turn away.

But a long two years passed, and there were things that didn’t go quite so well. Frontline workers knew what to do yet what we encountered was silence from decision makers. It’s worth noting that the people involved in Vancouver Coastal Health, the City of Vancouver, and PHS community services at this time are no longer the same people from 2014. Calling someone out for that experience is not what I’m interested in here. It is a reflection that current decision makers primarily have an indirect experience of the crisis experience of the recent past, so my intention is to fill in the gaps of that experience.

Please hear this as a constructive criticism: frontline workers were not listened to in a meaningful way. We were told we were valued and even admired, but it took 2 years to change anything and that change came through some high-risk advocacy like the people who started Vancouver OPS. 

Instead, policies were implemented that complicated frontline workers’ capacities to respond. For instance workers were directed to not respond to offsite overdoses; this meant refusing the frantic pleas of someone asking for life and death help for their friend. The ethical implications of that are a trauma in themselves. I stated clearly to upper management that as a supervisor I couldn’t and wouldn’t require that on the shifts I was responsible for and that I would personally intervene if I encountered any coworkers refusing life and death responses. Furthermore, a tent city was dismantled on the first day of subzero temperatures, when overdose rates were at an all-time high, putting further pressure on services  due to the crush of a displaced and vulnerable homeless population. 

Frontline workers at that time were (and still are) making $21 per hour, which is considered the base living wage marker in Vancouver. If you live in Vancouver outside of nonmarket housing that is in reality considerably below a living wage. The frontline workforce was increased exponentially 2 years after the initial response, primarily by people with lived experience, now engaged in high stress overdose response positions while living in shelters, substandard housing, and quite frequently street homeless yet being paid considerably less than the regular frontline workforce.

This crisis needs to be different. Frontline workers are spent and exhausted from this recent and ongoing overdose crisis. A year ago, we were tempted to think that things in the overdose crisis couldn’t get worse, then benzodiazapenes began to surface regularly in an already contaminated drug supply. That made things significantly worse. Overdose management became the uncertainty of victims stabilized and breathing yet remaining unconscious from 2 to sometimes 6 hours. Now we are experiencing a compounding crisis of an overdose crisis and the coronavirus pandemic (and did I mention poverty, housing crisis, and a lack of mental health supports?).

Here’s what needs to be different. We need a plan that is clearly and regularly articulated. We can’t remain in the dark. We know about handwashing, PPE, and social distancing. We need to know the broader plan as it exists now and as it changes. For social distancing to be effective in a vulnerable homeless or underhoused community it requires shelter, access to safe supply for both opiates and stimulants, food, cigarettes, and social supports. And the experiences of trauma, disconnectedness, and mental illness will amplify during these times of stress. Frontline workers know better than anyone that finding solutions are complex, but also know that maintaining them once they’re established are equally as complex. 

Frontline experience also needs support. Grocery store workers and Starbucks employees are all being told their jobs are important and are being extra compensated for showing up. In contrast frontline harm reduction workers have had their tools taken away. By no longer being allowed to administer oxygen to people who are overdosing, another ethical dilemma arises: do you risk the spread of infection or watch someone, whose name you know, who you call friend, whose support we have assured day in and day out, be oxygen deprived and risk brain damage and death? 

Recall the years of advocacy for safe supply, which if listened to, would enable us to better manage overdose risk and responder safety right now. Fewer overdoses by way of safe supply results in both greater stability for the drug user and decreased risk for the frontline response. 

It needs to be acknowledged that frontline workers take risk on a daily basis. Responding to public health crises has been normalized for us but that’s not what the job originally required. This is inherently unsustainable. At the onset of the previous crisis the burnout levels were much lower than they are currently. Now an overtaxed working group is being asked to do more with less tools in an even more dangerous setting to their personal health, seemingly without option nor consent and certainly without added compensation. We still have to scramble through our lives with inadequate income to buy services and time that would help us recover from our work. 

Please, please, please don’t be silent. Take of care of this heroic and compassionate group. Compensate them. Add to their set of tools. Listen carefully to their ideas. Hear and respond to them. And please do it urgently.

Follow Ronnie on Twitter at @ironnieg, and follow Zero Block Society on Facebook, Twitter, and Instagram.