Ashley Larnder // University of Victoria
Bruce Wallace // University of Victoria & Canadian Institute for Substance Use Research (CISUR)
Dennis Hore // University of Victoria
The Vancouver Island Drug Checking Project receives funding from the Health Canada Substance Use & Addictions Program as well as a grant from the Vancouver Foundation. I would like to acknowledge Piotr Burek and Amanada Farrell-Low with the Canadian Institute for Substance Use Research for reviewing earlier drafts. I would also like to acknowledge the vital role of staff and clients at Solid Outreach and AVI Health & Community Services in trusting me as a co-op student to learn in their spaces and to the other staff and students on the Vancouver Island Drug Checking Project for their teachings and support.
This article describes my entry into the world of harm reduction through an analytical chemistry position with the Vancouver Island Drug Checking Project. This position was offered through the co-operative education program at the University of Victoria, which allows students to gain practical work experience in their field. The Vancouver Island Drug Checking Project offers and evaluates drug checking as a service within Victoria, British Columbia, Canada. It was developed in response to the illicit drug overdose crisis, which continues to be a national problem throughout Canada. Drug checking is a growing harm reduction method that uses chemical analysis to provide information about a substance so that users can be more informed and take preventative steps prior to use.
The article is written as a post co-op, experiential journal that illustrates my experiences working as a drug checking technician. I describe the unconventional knowledge I learned, like handling illicit drugs, understanding drug use and addiction firsthand, and understanding the role of harm reduction in my community; the types of information that aren’t readily accessible within a classroom. While in this position I experienced a paradigm shift in my understanding of drug use and I overcame personal prejudices from my previous standpoint, in which I had the media as my primary narrative. The article explains the understanding I gained about my community as I encountered people living their everyday lives while using illicit drugs.
The illicit drug overdose crisis continues to be a national problem throughout Canada. In 2018 alone, there were 4,460 apparent opioid-related deaths; this translates to a Canadian losing their life to overdose approximately every two hours (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2019). The province of British Columbia (BC) is considered the epicenter of the crisis, contributing 1,533 of these illicit drug overdose deaths in 2018 (BC Coroners Service, 2019). Opioids stand as a significant factor in these deaths as it was detected that 87% of them involved illicit fentanyl (BC Coroner’s Service, 2019). These escalating rates triggered BC’s Public Health Officer to declare illicit drug overdoses a public health emergency, which has remained in effect since 2016 (BC Centre for Disease Control, 2017; BC Ministry of Health, April 14, 2016).
Though BC has been heavily impacted by the overdose crisis, it has also been the most progressive in the harm reduction movement. In September 2003, Canada’s first medically supervised safe injection site, Insite, opened with the goal of safer consumption and reducing the spread of infectious diseases, like HIV and Hepatitis C (Kerr, Wood, Small, Palepu, & Tyndall, 2003). Other methods, such as increasing naloxone distribution, which previously required a prescription, opioid agonist treatments, and overdose prevention sites have been expanding, but the crisis continues to be a prominent issue (Strike & Watson, 2019). There lies a root problem in that the present illicit drug supply is becoming increasingly toxic and is killing people on a regular basis (Kolla, Dodd, Ko, Boyce, & Ovens, 2019). Users are unaware as to whether the substance they purchased is cut with fillers or contains adulterant drugs. Drug checking is a harm reduction method currently being researched that offers services to chemically analyze a substance prior to consumption in order to allow users to be more informed and take the necessary preventative steps prior to use (Sherman et al., 2018).
A current project that is applying drug checking as a service and researching it as a harm reduction tool is the Vancouver Island Drug Checking Project, which is the result of a University of Victoria collaboration between Chemistry and Social Work. They operate a free and confidential drug checking service at harm reduction agencies in Victoria, providing access to several drug-checking technologies. The project is one of several projects funded by Health Canada to explore drug checking’s potential role in responding to Canada’s overdose crisis. In the province of British Columbia specifically, the use of the Emergency Health Act permitted expanding overdose prevention services that were once heavily regulated, including drug checking. During service, people have the opportunity to check drugs, discuss results with project staff, and access information and supplies for safer drug use. The team uses multiple analytical instruments to determine a sample’s main active ingredients, fillers or cutting agents, any unexpected drugs, and the presence of fentanyl. As researchers, they evaluate and compare the utility of several instruments and technologies in terms of cost, efficiency, and portability, as well as conduct surveys and interviews with service users to explore the utility of drug checking services in the contexts of what works for whom and in what settings.
The rest of the article will explain what it was like to work on the Vancouver Island Drug Checking Project as part of a co-op placement and the unique perspective that I, a chemistry undergraduate student, gained while working as a drug checking technician during the four-month placement.
In the classroom, being a chemistry student expands your understanding of the world on a microscopic level. From the hydrogen bonding between the fatty acid tails in a cell’s lipid bilayer to the amphiphilic properties of detergents, chemistry occurs everywhere. Yet this information can feel overly theoretical as, in reality, all you really see is your skin or some dish soap. I have often felt a disconnect between the theory of chemistry and the human interactions of everyday life, but starting a co-op position in harm reduction exposed me to a real-world application of chemistry outside of a lab.
As a technician on the Vancouver Island Drug Checking Project, I helped to run the drug checking service, which is operated within downtown Victoria at AVI Health & Community Services, Solid Outreach, and Lantern Services. When a client brought in a substance, I would explain our service to them and record basic information, including what the substance is expected to be and if there have been any unexpected effects with its use. I would then run the substance through our chemical instrumentation, including fentanyl immunoassay strips, Raman spectroscopy, surface enhanced Raman spectroscopy, Fourier-transform infrared spectroscopy, and gas-chromatography-mass spectrometry. Results from each instrument were analyzed together for an overall interpretation of the data. This is where I was able to apply my classroom knowledge to interpret the various spectra within their software to get an idea of sample composition. During the analysis process, the client was given the option to complete a survey that would give our research team an idea of demographics, service accessibility and utility. Once analysis was complete, I discussed the results with the client. This was an engaging process where we as technicians could explain the results, answer questions regarding the substance chemistry, and discuss safer use strategies.
The project was my entryway into understanding the world of drugs, users, addiction and harm reduction. The media offers some information on these subjects, though it often comes alongside negative connotations and misconceptions. This is where my previous understanding had come from, so interacting with people who use drugs and struggle with substance dependencies in the real world was a unique perspective to learn. Working hands-on with illicit drug compounds, learning about their use and chemical effects, was also a unique experience that I would never have learned within a classroom or a lab.
Learning and Language
As I started the co-op position and began handling illicit drugs, I was interested to learn and research the substances further. I began creating a mental map of the drugs being used in Victoria, trying to understand their chemical effects and how that translates to a user experience. Learning this kind of drug knowledge was of course interesting, but it allowed me to more genuinely interact with the people accessing service. As they explained common drug effects and used the typical slang, I could follow along and better answer their questions. My goal was to not appear as an outsider who clearly wouldn’t understand their side of the story. Thankfully, I had a well-educated and experienced co-worker who was able to guide my learning and be a resource for my endless questions.
Within my first month of being a drug-checking technician, my perspective encountered a paradigm shift regarding the stigmas and stereotypes that are associated with drug use. I began to regard the way I spoke as I became more aware of the influence of language and the word choices we use. This thought process originated from some readings that highlighted the difference between calling someone a “person who uses drugs” rather than simply a “drug user.” Though this subtle play on words may often go unnoticed, I feel that the underlying associations can cause a huge change in perception. It comes from viewing a person as an individual who may engage in the action of drug use instead of defining them by that action alone. I think these shifts are important to adopt as it places the focus onto the person as an individual rather than linking them to a stereotype that people are strongly prejudiced towards and have predetermined opinions about.
When we as a society define this population as a “waste of space,” we are sending the message that the life of a drug user has no purpose. In adopting this mindset, people who use drugs may start to ask, “why seek help if my life is worthless?” Developing an accurate understanding of this population is difficult due to the influence of stigmas and the misrepresentation by the media. There are numerous pictures that have been painted in our minds and we have started to believe them over the real people living in our communities. I can still remember my first exposure to drug usage back in my eighth-grade computer class. We viewed graphic pictures of people injecting with needles, losing hair, picking at imaginary bugs in bleeding scabs, as well as violent fights and cops coming to the rescue. It was simply presented to us that this was the life of a drug user and what our lives would become if we were to use. It’s hard not to make the wrong associations when this is the narrative you have to base drug usage and addiction off of.
I started out my co-op position with some apprehension about the people I may encounter, but I was hoping to grow my understanding and keep an open mind to all the unfiltered information I would gain. As I entered the world of harm reduction, I started to get a better understanding of what it all meant. Within even a couple weeks on the project, my past prejudices towards people who use drugs were gone. When previously walking down the streets of downtown Victoria, I felt discomfort and some fear when passing a person who was clearly intoxicated. Now I see a person who is simply using, and that is something that is ok.
I have come to realize how easy it is to condemn people for not making the normative choices when we view it from a stable and comfortable life. The people I encountered during my co-op position challenged me to search more deeply into some underlying reasons behind drug use and addiction. I quickly came to understand the hard reality that systemic problems exist in our communities where certain populations face inequalities and barriers that contribute to the development of substance dependencies. People also experience suffering in our world, suffering that doesn’t discriminate based on demographic. Whether it be past trauma, physical and emotional pain, a need for an escape, or even just a need to feel something good for once, there are many reasons a person may use drugs and may develop a dependency. People who use drugs are still people who feel, people who live in the same town as me, and people who have rights. They are present amongst all populations in my community.
New Skills, New Knowledge
As the co-op position went on, I felt more confident in my abilities to analyze spectra and interact with clients during service. I began trying to further engage them within the process to offer a better understanding of what happens during a drug check. I aimed to carry out the fentanyl strip tests as a demonstration for the clients so they could see the process and repeat it on their own if they had access to strips. I also tried to explain some of the basics behind our instrumentation and invite people to view some spectra from the analysis so they could understand the complexity of their substance. As I continued to learn about the process, my goal was to help others to better understand more about how drug checking worked as well.
Though I was gaining confidence in my position, there were also days when I questioned my role as a student. An example of this is when a man in his mid-twenties was accessing services and accidentally spilt his entire baggy of drugs onto the carpet. He grew extremely upset and frustrated as he proceeded to get down on his hands and knees and scrape whatever he could salvage from the carpet. I felt discomfort picturing the “what ifs” of his situational anger and the physical power difference in my being a female, but I also came to realize a different kind of power complex embedded in the situation. From his vulnerable position on the floor, the man said, “Sorry lady, this is so embarrassing.” The fact that he called me lady rather than girl, as I was clearly younger than him, and his feelings of embarrassment made me think twice about the way people feel around me. Just by being in the position of a scientist, running machines that he is unfamiliar with and being able to provide information he could not determine himself, created a power complex of its own. If only he knew that in reality, I was an inexperienced student just beginning to understand the world of drug use and harm reduction.
I also had the opportunity to listen to personal stories from some of the staff members at Solid Outreach, the drug user union where we offered service twice a week. I remember being told a moving story about what it was like to lose a close friend to overdose. I realized that this was the first story I had heard about an overdose that didn’t come from either an article online, a statistic, or from the news. The staff member spoke passionately about the loss and it was these moments during my co-op where I was able to understand the utility of the harm reduction movement and why people are ardent about it in my community.
My position on this project placed me into what I felt was a middle ground. On one hand, I was a university student pursuing my education with the chance to work directly with instrumentation and data acquisition. On the other hand, I was working in harm reduction where I could directly see and interact with the people bringing in substances. I never viewed the data as a drug sample being recorded as when and where, but as something that will be put to use by a person in my community. Many people don’t have the opportunity to work directly in both the instrumentation and harm reduction sides of the project, so I felt like I was able to get an accurate picture of the role of drug checking. By also getting to work with our community partners I felt like I was provided with the resources to best share and raise awareness to my peers who don’t have this kind of accessibility.
Public Perceptions and Prejudices
Near the end of my co-op placement, the University of Victoria organized a media announcement for our project that included the Federal Minister of Health from Ottawa, the Vice-President of Research from our university, our community partners and many others. I had the opportunity to present on the instrumentation used within our service in front of those attending the event. This was a unique opportunity that made me nervous, but served as a good step forward in spreading the word about our project so it can further its impact in our community.
Throughout my co-op, I wondered how I should accurately share my work with my family and friends. As the media announcement led to the release of news articles on the project, I decided to share one on Facebook with a story about how my position had challenged my prejudices on drug use and addiction. I received a lot of positive responses and it led to a number of genuine conversations among my family and friends. Yet when I looked into the more general posts about the project, I was horrified by the dehumanizing comments I found. I knew that drug checking was a controversial topic, but the opinions people had posted were downright cruel. From saying “people should go to rehab already” to “drug users are a waste of resources” to “overdosing is a harm reduction method in itself,” it was readily apparent that a big disconnect exists between the different demographics. This was a confirmation that we need to further the awareness of substance use and accurately portray the realities of addiction. People need to understand that addiction is a disease that remodels the chemical composition of the brain and can alter synaptic function with prolonged use (Nestler & Lüscher, 2019). Rehab isn’t just a one-stop fix for those that choose it.
As a student, being a drug checking technician is a really unique experience to bring up with my peers. It’s easy to get peoples’ attention when I can share about handling illicit substances and their applications, so I use this attention to try to bring some awareness to the real issues going on in our community. During some of these discussions I have gotten the, “Wow, you are really saving lives,” and it never sits right. I am not saving lives and it is not my actions that are making the difference. I am simply helping to run some tests to allow people to become more informed users and to make more informed decisions. I have no say in what the client chooses to do with the knowledge I help to provide. It is the clients themselves that are empowered to make their own decision. The client’s life is in their own hands.
Though I have completed the co-op position, I am happy to be continuing
on with the project through research as I begin to conduct an honours thesis project
at the University of Victoria. I appreciate the real perspective I have gained
about my community from this experience. While walking the streets of Victoria
I now think about acknowledging someone with a smile or stopping to check if
someone is breathing while they lay asleep instead of simply ignoring them. It
has opened up plenty of opportunities to engage with different demographics and
I’ve since had some interesting conversations with people who use drugs, like
hearing a whole history of the Beatles music from a random encounter I had
walking the streets of downtown Victoria. From all these experiences I’ve
realized how easy it is to separate ourselves from those within a different
demographic and how much we really all are just regular people trying to live
our lives. I appreciate the Vancouver Island Drug Checking Project because it
serves all populations and empowers the people in our city to make safer
choices. I am excited to see how the project will continue to grow in accessibility
and instrumentation analysis in order to become a more efficient tool in the
BC Centre for Disease Control. (2017). Public health emergency in BC. Provincial Health Services Authority. Retrieved from http://www.bccdc.ca/about/news-stories/stories/public-health-emergency-in-bc
BC Coroners Service. (2019). Illicit Drug Overdose Deaths in BC: January 1, 2008 – December 31, 2018. Retrieved from https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf
BC Ministry of Health. (April 14, 2016). Provincial health officer declares public health emergency [press release]. Retrieved from https://news.gov.bc.ca/releases/2016hlth0026-000568
Kerr, T., Wood, E., Small, D., Palepu, A., & Tyndall, M. (2003). Potential use of safer injecting facilities among injection drug users in Vancouver’s Downtown Eastside, Canadian Medical Association Journal, 169(8), 759-763.
Kolla, G., Dodd, Z., Ko, J., Boyce, N., & Ovens, S. (2019). Canada’s overdose crisis: Authorities are not acting fast enough, The Lancet Public Health, 4(4), e180.
Nestler, E., & Lüscher, C. (2019). The molecular basis of drug addiction: linking epigenetic to synaptic and circuit mechanisms, Neuron, 102(1), 48-59.
Sherman, S. G., Park, J. N., Glick, J., McKenzie, M., Morales, K., Christensen, T., & Green, T. C. (2018). Fentanyl Overdose Reduction Checking Analysis Study. Retrieved from https://americanhealth.jhu.edu/sites/default/files/inline-files/Fentanyl_Executive_Summary_032018.pdf
Special Advisory Committee on the Epidemic of Opioid Overdoses. (2019). National report: Apparent opioid-related deaths in Canada (January 2016 to December 2018). Web Based Report. Ottawa: Public Health Agency of Canada.
Strike, C., & Watson, T. (2019). Losing the uphill battle? Emergent harm reduction interventions and barriers during the opioid overdose crisis in Canada, International Journal of Drug Policy. doi:10.1016/j.drugpo.2019.02.005.