The Record: ‘We’ve never been here before,’ say Waterloo Region outreach workers

CTV Kitchener – March 7, 2022: WATERLOO REGION — In an unprecedented time of drug poisonings, homelessness and COVID-19, outreach workers who help the region’s most vulnerable people say their expertise needs to be acted upon to reduce harm and make structural changes.

Jesse Burt does outreach work for The AIDS Committee of Cambridge, Kitchener, Waterloo and Area (ACCKWA.) That includes outreach with those living in encampments. He said three crises have intersected to make the work even more complex, yet front-line outreach workers aren’t being consulted on how to make changes.

“We started off with a housing crisis, there’s a long history of the failed drug policy crisis that’s been worse every year, and then we added COVID,” Burt said. “This work was already extremely complex, and now — we’ve never been here before — this is even more complex.”

 

In 2021, 158 people in Waterloo Region died of drug poisoning. That’s up from 145 in 2020 and 105 and 2019. Homelessness is at a high for this region, with 1,058 people identified as homeless during a point-in-time count that was released in November. In 2018, that number was 333.

“You can either care about the humans who are dying and therefore it’s the compassionate route or you don’t even have to be compassionate, you don’t even have to care about people you can just care about how much money we’re wasting on ineffective solutions,” Burt said. “That all of the issues you feel unsafe or uncomfortable with could be addressed.”

Sara Escobar has been doing outreach in the region for more than 20 years. She said COVID-19 shouldn’t be an excuse to stop doing good work,

“(Let’s) not allow this pandemic to become the excuse to change things up,” she said. “Things were working; things were working better than they are right now.”

She said people who use unregulated drugs or are experiencing homelessness are so much more than stereotypes. Simply forcing someone into a shelter or trying to get addictions treatment is too simplistic a view. It’s the complex structures and failed drug policies, Burt and Escobar said, that are the true barriers to reducing drug poisoning deaths, harm and homelessness. Those include prohibition and criminalization.

Waterloo Region has the sixth-highest rate of opioid-related offences in Canada and the second-highest in Ontario, according to a February report to the Waterloo Region Crime Prevention Council, but that hasn’t stopped people from using drugs or being poisoned by them.

Pre-COVID, there were working tables and groups in place that did seek lived input. That included a group that brought people with living experience to the table with Region of Waterloo staff, Escobar said.

Those with living experience offered input on reports and items that would be going to regional council for decisions. It reflected the “nothing about us without us” approach. That is no longer the case, Escobar said. She wants to get back to that type of meaningful consultation.

But that’s easier said than done.

“You have to have people coming and actively participating and being heard and their feedback actually being used as opposed to just a token representative,” Escobar said. “So when you see programs that usually sometimes will have one peer worker, that’s tokenism.”

The realities of vulnerable populations aren’t being reflected at the political and community levels, Burt said.

“There’s a real disconnect in terms of understanding the complexities of the problems that we face and the realities that are told to all levels of government and the public,” said Burt. “These are things that we wrestle with all the time.”

So what is working?

For starters, there’s the consumption and treatment services site on Duke Street in Kitchener and a safe supply program operated out of two downtown locations, including the CTS site.

Safe supply provides prescription drugs to those struggling with addiction. It prevents deaths from unregulated street drugs and allows those with the challenge of addiction to take their focus and time off worrying about getting the drug they need and instead work on other challenges like housing, employment or health care.

It’s an upstream approach, Burt said, because it’s preventing harm caused by poisoning or death.

Most of the incidents commonly referred to as overdoses are actually poisonings that occur when a substance contains something the person ingesting is not aware of or if the potency of the drug is stronger than expected.

There are more tools available to municipalities that would significantly reduce harm.

The option endorsed by the Waterloo Region Crime Prevention Council was to legalize and regulate all drugs. The council passed a motion to that effect in February.

All drugs would be treated similarly to marijuana and alcohol, with strict regulation of production, distribution, sales, possession and consumption. The consumption site could go further to address how people actually use drugs by allowing inhaled drugs. Many of the poisoning deaths the Ontario coroner saw in 2020 and 2021 were people who chose to inhale drugs.

Locally, research by the crime prevention council in 2020 showed those using fentanyl prefer to smoke them. All of the respondents, 43 people, had witnessed an overdose before COVID. Seventy-four per cent overdosed at least once before COVID, and 33 per cent overdosed at least once during the pandemic.

The crime prevention council wrote to regional officials asking them to secure the necessary infrastructure for Duke Street to allow people to smoke their drugs. Under federal regulations, this can be permitted. Municipalities can also apply to establish what is known as urgent public health needs sites.

These are different from safe consumption sites in that they are short-term facilities to deal with the drug poisoning crisis and can be set up faster than a safe consumption site. They’re similar in that the same core function occurs. Staff monitor people while they use a drug to prevent drug poisoning deaths.

“Some of the urgent solutions that need to be implemented now, these are not easy things to wrap your head around,” Burt said of the need for outreach workers to be consulted. “These are not things that you can learn by one staff presentation.”

There is frustration and burnout in the outreach community as front-line workers watch preventable deaths and harm occurring — whether that be squeezing under a bathroom stall door to rescue someone who is on the brink of death by drug poisoning or knowing that the harm is preventable.

Escobar said the work outreach workers do is just as complex as the issues being experienced in vulnerable populations.

“You’re told your job is easy,” Escobar said. “Oh, it must be so fulfilling. No, no it’s just not, because you don’t want to fund us, you don’t want our government to fund us, so it’s not easy, and it’s not happy, and it’s not fulfilling.”

There’s frustration with the seeming neutrality in the community.

“If we changed policy in this region that’s going to improve the life of some, not going to change the life of anybody else, it’s literally only going to improve the life of some, why fear that change?” Escobar said. “What’s the hesitation?”

“It’s not trying to convince you why you should care, it’s wondering what’s keeping you from, what’s not allowing you to care,” Burt said.

There is significant turnover in outreach work as people experience trauma and watch people die.

So what do Escobar and Burt stay?

Escobar said she had a change in thinking at some point that clarified everything for her. It was the realization that some people will live their entire lives in shelters, using drugs to soothe the pain they have experienced in their lives.

“So I choose to stay because that person needs love and care the whole way through,” Escobar said. “They exist, and they live, and they are our neighbours, they live in our community, they share our buses.

“They exist, and so they deserve to be loved, and so I stay because where else are they supposed to go? Who is going to love them? So I stay because they’re going to need love the whole time.”

Burt said he’s inspired by the people he works with.

“Watching the people I support hold on to hope and love each other despite everything that they’ve gone through and the systems that have failed and the fact that they can still press on,” he said. “They teach me a lot.

“They teach me a lot about love.”

He added, “We’ve done them a disservice by painting them as a community that is helpless and hopeless. There needs to be change but it does not take away people’s rights and autonomy and love and creativity and talent.”

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