Dispatches from Montreal’s International Harm Reduction Conference

in 2016, an estimated 2,300 Canadians died from an overdose. In the US, overdoses now account for more annual deaths than either car accidents or guns.


Last week, I paid tribute to a deceased friend.

At a downtown Montreal conference centre with Rick Lines, executive director of Harm Reduction International, we reminisced about our late friend Raffi Balian. Before passing away from overdose in February, Raffi was a leading author on harm reduction, a crucial fixture at South Riverdale Community Health Centre and someone who shaped both our views of drug use and human rights. In the ‘90s, Rick and Raffi performed HIV/AIDS support in prisons (with PASAN). For five years, Raffi was a close advisor on my documentary about life in Regent Park, The Stairs. A gentle soul who cared deeply for others, he taught us a great deal and touched many lives.

I was one of 1000 delegates from 75 countries attending HRI’s International Harm Reduction Conference from May 14 to 17. Held every two years in a different country, the event covered a host of topics related to the global state of evidence-based public health policies and practices, and human rights-based approaches to drugs. Its four days included academic presentations, panels with nurses, frontline workers, activists, politicians and a film festival.

In his opening remarks, Rick memorialized Raffi as a major international figure in the field. Raffi loved hearing about the different reactions to my movie in various cities and countries. I had just held screenings in South Korea and Baltimore and there were stories I wanted to share with him. Audience members frequently comment on the bonds between the film’s frontline peer workers and the sense of community and caring among people with lived experience as users – a testament to Raffi’s influence. Lifetimes of stigma and discrimination also unite people. They help each other because they can’t count on anyone else to. It’s unsurprising that a slogan frequently heard last week was: “Life Won’t Wait.”

Those words were displayed during a keynote speech by Health Minister Jane Philpott, which came to embody the entire conference – and perhaps the state of harm reduction in Canada. On one hand, it was an occasion to celebrate: the announcement that a supervised consumption site will open shortly in Montreal, the first outside of Vancouver. Days later, Parliament passed Bill C-37, streamlining the process for more consumption sites to open across Canada. It’s a testament to tireless work by many people, including users groups, who fought to keep InSite open through the Harper era and are seeing changes that seemed unthinkable just a few years ago. Cannabis will be legalized next year in Canada. Internationally, supervised consumption facilities recently were approved in Ireland and opened for the first time in France.

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Charles Mackay/Harm Reduction International

Harm Reduction International’s executive director Rick Lines pays tribute to the late author and activist Raffi Balian at the 2017 International Harm Reduction Conference in Montreal.

But it was also reported that in 2016, an estimated 2,300 Canadians died from an overdose. In the US, overdoses now account for more annual deaths than either car accidents or guns. Numerous speakers, including Minister Philpott, acknowledged that the mortality rate is currently worse than at the height of the AIDS epidemic in the late 80s and early 90s. Many delegates expressed a mixture of urgency, exasperation and burnout from working on the front lines. The conference felt shrouded in death.

Many delegates expressed a mixture of burnout and exasperation for being in an environment that can be hostile towards science. Of course this isn’t limited to evidence-based things like harm reduction: there’s plenty of opposition to climate change, vaccinations and teaching sex-ed class. Some people don’t want the facts because they already know the truth. In harm reduction, you see this a lot. The Philippines’ President Duterte has overseen thousands of extrajudicial killings in his drug war: he’s been invited to the White House by that “fascist loofa-faced shit-gibbon.”

Toronto Health’s Susan Sheppard presented a timeline of recommendations for supervised injection sites, from a feasibility study in 2005 to approval for three sites in 2016. Over roughly the same period (2004-2015), overdose deaths in Toronto rose 73 per cent. The three Toronto sites are expected to open soon (although no date is announced), but in the face of abundant and readily available data, why did it take so long?

As one Toronto health worker noted, her workplace is heavily stocked with masks in case of flu outbreak, but access to life–saving resources that address the current overdose crisis are extremely limited. It’s a choice – to restrict care to marginalized populations and prioritize others. It was a choice to deem SARS a health emergency, but not the overdose crisis, just as it was a choice to ignore AIDS for years and glacially respond while people died.

So when Minister Philpott addressed the conference and declared that more data was needed for further action, numerous activists stood and turned their backs to the stage in protest. They chanted, “They talk, we die,” and held banners, reading: “We fight for those we love and lost.” Many of them knew Raffi and hundreds more like him.

Minister Philpott appeared shaken. For some, it was difficult to see an overseer of tangible progress take the brunt of so much collective frustration and anger. But it also wasn’t a time to be warm and cuddly. “Our friends are dead,” shouted activists from the crowd. “It’s a national emergency.”

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