Reducing drug and Mental Health Harms: State of the Inner City Report 2019

Forest for the Trees artwork by Kathleen Shellrude

Since 2005, the State of the Inner City research project has collaborated with Winnipeg community-based organizations (CBOs) working in the inner city. The project researches issues that matter to CBOs and the communities they serve. It connects the personal struggles of the people who live in the inner city with the ‘big picture’-the structural and political realities that affect their lives. While socio-economic marginalization exists outside the boundaries of the inner city, the inner city is an area that has been historically divided by class and race. This demands dedicated attention. Attention to the unique challenges, but also the unique strengths.

This year’s topic is not an easy one, but it is a necessary one. In 2016 we began to see increased attention to the startling number of opioid overdoses and deaths. That attention quickly shifted to the increased use of methamphetamine in Winnipeg. Community-based organizations (CBOs) working in the inner city told us that they are seeing many of their clients presenting with increasingly severe needs and in some cases behavioural challenges relating to meth use. People are arriving at their doors in states of emergency, but they have far fewer resources than already-stretched emergency rooms, and they are struggling to respond.

During the 2019 provincial election, the PC party’s ‘comprehensive strategy’ to address methamphetamine, Safer Streets Safer Lives promised treatment, education and enforcement. Of the $20 million promised to mobilize this strategy, $8 million is directed to criminalizing responses. This strategy is informing the provincial government’s current response. Alongside this, other governmental documents such as the VIRGO Report and the Illicit Drug Task Force Report are also informing drug policy responses. It remains unclear however which recommendations within these documents are being prioritized, which in turn raises concerns about strategy, accountability and transparency.

The framing of the situation by government and media as a ‘meth crisis’ is worrisome to many in the community because they see the presentation of meth as a symptom of a much larger social crisis, a crisis rooted in deep inequality, colonialism and a failure by the government to address the basic needs of people who experience the highest level of marginalization. In this year’s State of the Inner City report, we examine the Inequality of substance use, problematic substance use and drug-related harms. This research shows that people who experience socio-economic marginalization, including the effects of colonialism and inter-generational trauma, are more likely to develop problematic substance use and mental health issues and experience harms related to drug use that are more severe.

This research also problematizes the Province’s focus on individualizing responses such as treatment, education and policing which seeks to modify the psychology and behaviour of individuals with little attention or effort directed toward the larger environment in which individuals succeed or fail. This work draws on research which shows that for people with depleted family and community resources, individually- focused addiction treatment is often less effective. For those who lack protector factors against relapse, treatment may actually make people more vulnerable to relapse, overdose and death. In the case of increased policing, empirical evidence has shown little impact on reducing overall illicit drug use, yet people experiencing socio-economic marginalization are more likely to experience harms under a tough on crime approach, as the provincial government is advocating for.

In response to what many community members see as a lack of action on the part of government to meaningfully address the social crisis some communities are working to identify what a caring response could look like. One chapter within this year’s report by Erica Charron, outlines an on-going collaborative project in West Broadway. It demonstrates how one community is mobilizing in the face of ineffective government action.

A secondary topic of exploration in this year’s State of the Inner City Report is one of discourse. After all, how we understand the problem informs how we respond to it. Katharina Maier’s chapter Meth, Media and Crisis: An Overview explores how the media reports the story of meth and crisis and why the way we talk about drugs and drug use has important implications. the construction of a crisis discourse can result in a disproportionate focus on the people who use drugs and their ‘failings’; in effect redirecting the public’s attention away from broader structural issues such as poverty, inequality, marginalization, classism and racism. The peer project How is Meth Depicted in the Media? Peer Working Group Perspectives also explores and problematizes how the media portrays meth use through the voices of those with lived experience. The Manitoba Harm Reduction Network Peer Working Group collaborated on this project.

The ‘forest for the trees’ on the issue is that we need to understand and respond to root causes if we are ever going to achieve big picture change. We will never eliminate all drug use. Nor are such efforts necessary, as we know that drug exposure alone does not cause problematic substance use. If it could, the problem would occur in every person who tries drugs or alcohol. Unfortunately, that ‘old story’ seems to be guiding policy action in the province, particularly relating to increased criminalization of drug use and people who use. This is not to make light of the problem, because as family members, community activists and CBOs have told us, there is indeed a problem. Responding with effective policy however demands that we fully understand what the problem is.

By now, many people know the story of ‘Rat Park’. This was a research study which demonstrated that changing and improving the living conditions of rats originally caged in solitary confinement drastically reduced the amount of drugs they consumed. Fewer perhaps are aware of a study, which examined soldiers returning from the Vietnam War. Nearly half of U.S. soldiers had tried heroin while overseas and of these, just under half qualified as ‘addicted’ at the end of the war. The U.S. Government was highly concerned about what would happen when these soldiers returned home. Upon returning home however, the majority of them quit on their own and without treatment. After speaking to the soldiers, researchers concluded that the main reason why the majority of Vietnam War veterans broke their addiction was less a result of willpower or change in attitude but rather a radical change in their environment.

This demands that we ask ourselves, what are the conditions that make some people feel as though they are living in Vietnam instead of Rat Park? This project demonstrates that at least some of these conditions originate from short-sighted government policy which creates and perpetuates inequality. Yet, that is not quite the full answer because many people who experience a high degree of socio-economic privilege also experience mental health issues, drug-related harms and problematic substance use. Regardless of social location, it is possible to feel like the proverbial rat in a cage.

This report presents responses that are rooted in evidence and compassion rather than fear and punishment. It presents suggestions, some of which already exist within the myriad of government policy reports on this issue, but for some reason are just not being prioritized. It identifies the need for a clear and comprehensive drug strategy that is rooted in principles of public health. Ideally this would occur at the provincial level, but many municipalities have their own drug strategies and so we encourage the City of Winnipeg to follow this lead. Harm reduction must be incorporated, as an official principle of any developed strategy because evidence also shows, that by and large, the harms associated with drug use is a result of structural harms, rather than the substance itself. This includes prohibition, which is linked to increasingly dangerous illicit substances.

Community partners told us that meth has deep roots in colonization and that self-determination alongside the decolonization of structures, policies, and programs is necessary.

Another common refrain we heard during community consultation was that there is a need for a shift around the idea of wellness, abstinence, sobriety and healing. Johann Hari (2015) encapsulates this sentiment well when he writes that ‘the opposite of addiction isn’t sobriety, it’s connection’. CBOs can act as important connectors that help develop and promote a sense of hope, meaning, belonging and purpose in their communities. But they must be properly funded and supported. Further, they cannot be expected to provide for people’s basic needs. That is the role of government.

Last but not least, the voices of those who experience mental health and substance use issues needs to be listened to when developing strategies and policy. They are the experts in their own lives and effective policy must meaningfully incorporate this knowledge and wisdom.

Ellen Smirl is a researcher for the Canadian Centre for Policy Alternatives Manitoba.