https://www.thestar.com/politics/federal/2022/10/23/can-drug-users-lives-be-saved-by-giving-them-uncontaminated-heroin-and-cocaine.html

These days, Eris Nyx is dressing up like she’s in the Vietnam War.

“I have a full tiger stripe war thing,” she says, referring to the camouflage patterns used during the conflict, “because it’s a war zone out there, and nobody is coming to help us.”

People continue to die around her — people she knows — of drug overdoses, as Canada remains in the grips of a deadly toxic drug crisis that has claimed the lives of tens of thousands.

It’s a crisis that has been blamed on a war — the war on drugs — fuelled by what policy experts and people who use drugs say is a mix of prohibition, criminalization, lack of supports and stigma.

In the face of what she calls government foot-dragging on providing the tools needed to stem the tide of death, Nyx and others are taking action, recently launching a fulfilment centre and compassion club in Vancouver, which procures, tests, repackages, and distributes drugs to people at high risk of overdose.

The group is risking their liberty in the process, as the club is not legal — but they’re fighting the federal government in court so that it can be. They haven’t been shy about publicizing their activities, and have even been visited by the federal minister for addictions.

The compassion club — run by and for people who use drugs — is a model experts say should be scaled up and adopted across the country in the face of inaction on widespread access to safe supplies, as people continue to die due to the toxicity of drugs purchased from the illicit market.

And it’s a model that has been seen before, such as when there were medical cannabis compassion clubs prior to legalization in 2018.

Nyx and Jeremy Kalicum are the co-founders of the Drug User Liberation Front (DULF), a coalition created in 2020 to provide “tangible solutions to the ongoing drug poisoning crisis,” such as compassion clubs.

“All we’re asking for is for everyone to stop dying and that’s all we’ve ever been asking for. Any strategy that reduces the amount of death is great with us,” Nyx said in a recent interview.

“Nobody can improve the circumstances of their life if they’re dead.”

The last fatal overdose Nyx responded to was a month ago.

“The thing is, I’ve gone totally crazy. I don’t feel any emotion,” she says. “I wake up screaming in cold sweats, but when you’re in that kind of state of war, you don’t think about anything but war. I respond to overdoses constantly and I don’t feel a single f—g thing. It’s very bad.

“All of that’s gonna catch up with me one day, but now is not the time, because no one is co-operating with us, and I don’t have the time to deal with my own mental health.”

How does the club work?

Nearly 31,000 Canadians have lost their lives through overdoses since January 2016, the year British Columbia declared a public health emergency.

The Public Health Agency of Canada says drug toxicity “continues to be a major driver of the crisis.” The illicit drug supply in Canada has been tainted for years with powerful opioids like fentanyl; in the case of people purchasing opioids off the streets, those drugs can end up being far more potent.

DULF’s operation is a pilot program launched this summer in partnership with the Vancouver Area Network of Drug Users (VANDU). It provides tested, safer supplies of heroin, methamphetamine and cocaine to a small cohort of users who are at high risk of fatal overdoses. DULF says the program will be evaluated before expansion. Among other criteria, the individuals must be members of VANDU and over the age of 19.

Unlike other safer supply programs, the compassion club model does not require a prescription or regular interactions with the medical system — a system advocates say can be difficult to navigate due to stigma — and also provides drugs those other programs typically don’t have.

The drugs are purchased from the dark web, then sent to a drug checking project in Victoria before DULF repackages them at a secure location for distribution.

A label for cocaine on DULF’s website indicates it is 100 per cent pure, along with directions to keep away from children and pets, and warnings that “cocaine can cause dependence, addiction and overdose,” as well as impair the ability to drive.

Nyx says the non-profit organization sells the drugs at cost to its members and therefore is not making any money. DULF also follows up with the members at least once a week.

The push for a legal operation

The compassion club is also illegal.

“We’ve had zero fatal overdoses from people taking the drugs, so if I were in enforcement looking at this, I would see it more as an improved variation of drug checking, rather than as drug dealing itself,” Nyx says.

If they were arrested, charges would likely include drug trafficking, which carries a punishment of up to life in prison.

DULF and VANDU applied to Health Canada last year for an exemption from the Controlled Drugs and Substances Act, which governs the criminalization of illicit drugs, to legalize their operation.

Such an exemption was granted this year to the British Columbia government to decriminalize possession of small amounts of drugs in the province for three years starting in January.

“We know that a compassion club model would increase consumer power and protection, allowing (people who use drugs) to know what they are buying, thus preventing death from the unpredictable drug supply,” says the DULF/VANDU application.

The proposal was backed by prominent individuals and organizations, including outgoing Vancouver Mayor Kennedy Stewart on behalf of city council, the local public health authority and the British Columbia Centre on Substance Use.

But Health Canada rejected the application this past summer, a decision that is now being challenged in court. The agency said it could not approve the model because of the “associated public health and safety risks” from purchasing drugs over the dark web.

(Nyx says the compassion club has an exemption to provide a drug-checking service, but that it does not cover other activities of the club.)

The organizations told Health Canada they would prefer to get their drugs from a pharmaceutical or legal source, but that route simply doesn’t exist at the moment.

Health Canada “said it was putting Canadians in danger to engage in the dark web, which I think is just a really torqued way of seeing the situation we’re currently in,” says VANDU executive director Brittany Graham, “because by doing nothing we’re actually hurting Canadians.”

DULF is public about its activities, issuing regular news releases, such as when federal Mental Health and Addictions Minister Carolyn Bennett stopped by its operation in August.

“Yes, I was walking down the street and they came and invited me in to have a look at what they were doing,” Bennett said last week when asked about the compassion club at an unrelated funding announcement in Toronto.

Bennett declined to say much more about the program, given the ongoing court challenge over Health Canada’s rejection.

“I am concerned that DULF is obtaining the drugs from the dark web. I am concerned that there is difficulty testing adequately,” she said.

Nyx argues there’s simply no better option at the moment.

“This is a harm reduction intervention,” she says. “Show me a model that could be operationalized right now that could save lives, and I will gladly quit my job and never work in public policy again.”

A “pivotal” safe supply model

Compassion clubs “are going to be a pivotal way of addressing the overdose crisis in this country,” says Gillian Kolla, a post-doctoral fellow at the Canadian Institute for Substance Use Research at the University of Victoria.

The best way to address the toxic drug supply “is to ensure that groups of people who use drugs — (they) know who is using drugs and which drugs they’re using — have access to drugs that they can distribute among their members,” she says.

“This sounds a little bit out there because we’re so steeped in ‘just say no’ prohibition mythology, but the fact of the matter is, the uptick that we’re seeing in drug-related deaths in Canada is due to this change that happened in the unregulated drug supply, and due fundamentally to the variability of the drug supply.”

A compassion club model “puts the power and control back into the hands of people who actually use drugs, rather than forcing people to continually engage with a system that has not served them well in the past and has been disempowering and stigmatizing,” says Matt Johnson, a health promoter at a safe consumption site in Toronto.

“I think buyers’ clubs also have the potential to cater more specifically to individuals’ needs, as the safer supply programs that are currently sanctioned are really limited in what they can offer.”

It’s a model that “emerges in response to a non-response by government,” says Donald MacPherson, executive director of the Canadian Drug Policy Coalition. “They’re just trying to do what communities do in any kind of disaster,” he says. “In a crisis, the community wants to help.”

MacPherson was a member of Health Canada’s expert task force on substance use. The panel told the federal government last year that scaling up access to safer supply should be an “urgent priority” and be done in partnership with people with lived experience, including developing “new pathways” for outreach and drug distribution.

A year later, Health Canada says it is still reviewing the task force’s recommendations.

The way forward

Ultimately, the government needs to regulate currently illicit drugs in the same way it does with tobacco, alcohol and cannabis, according to the task force’s top recommendation. Bennett told the Star last month that the government is working toward a regulated safe supply, but has provided few details.

She said in Toronto last week that she recognizes many of the people dying of overdoses do not have a substance use disorder and would not qualify under a prescriber-based safe supply model. There are people who use recreationally, or even just once, who are also dying, and “it’s heartbreaking,” Bennett said.

“We are going to have to innovate, and be creative, and be able to be open to ideas that will save lives,” she said. “We know that people with lived and living experience will have very good advice.”

Experts say compassion clubs could play a role in a regulatory system as one of several delivery models, but they should be sanctioned to operate now, given that such a system could be years away.

“Some of our most effective interventions have come from people who use drugs themselves,” Kolla says. “We have to trust the expertise of the communities of people who use drugs when they’re telling us this is a really, really great idea.”

Nyx says DULF knows its system isn’t perfect, but argues it’s exactly the kind of innovation the expert task force called for — and one that is necessary, as thousands continue to die despite current interventions.

“We didn’t want to die ourselves,” she says. “For us, it grows from a place of ‘I don’t want to die,’ to ‘I don’t want my friends to die,’ to ‘I don’t want my direct community to die.’

“It’s very stressful and maybe that what’s makes us so powerful. It’s that we don’t want to do it. We’re unwilling victims of circumstance.”

Jacques Gallant is a Toronto-based reporter covering politics for the Star. Follow him on Twitter: @JacquesGallant