O n February 6, 2017, Federal Minister of Health Jane Philpott authorized the opening of three safe injection sites in Montreal, a decision that marks the end of a fifteen-year battle for users and harm-reduction organizations. The Regional Director of Public Health took four years to fill in the best application possible before sending it to Health Canada in 2015. With the support of the provincial and municipal government, and the city’s police, it only needed a final push from Ottawa to remove the strict requirements imposed by Stephen Harper’s government. Here are the stories of five regular users who confirm that safe injection sites have been long awaited by the community.
Photography by Valerian Mazataud / Hans Lucas Juliette (not her real name) uses heroin and other opioids several times a day, an average of four days a week. Juliette, in her early twenties, just finished her studies in visual arts, and looks nothing like the preconceived idea of a heroin user. The drug came to her two years ago, after she was diagnosed with depression. “It helped me chase away my suicidal thoughts,” she says. Whenever she has to inject outside of her home, she opts for a back alley or a bathroom. However, she explains, “You never know with what the drug was cut. Injecting is like playing Russian roulette.” In 2014, an exceptionally deadly year, Montreal faced an epidemic of 233 overdoses due to bad product. Even though a safe injection site would not offer product-testing services, it would certainly act as a hub for information on which product or dealer to avoid.
In 1986, Cactus Montreal was the very first site in North America to provide sterile kits for injections. In 2015, 1 million sterile syringes were distributed on the island of Montreal, and Cactus alone distributed 600,000. Soon it will become one of the three safe injection sites in Montreal. “Finally, we’ll have a tool to be present at a crucial point in the consumption cycle,” explains the organization’s director, Sandhia Vadlamudy. “We are here before the act, but not during the actual injection, even though it would be a good time to deliver messages about prevention.”
“Controlled consumption was not a given for me. I’ve known homelessness and all that goes with it. When you have nothing, drugs become a social bandage,” says Jerome, who now has a job as a social worker, an apartment, and a network of friends. He uses drugs occasionally “for fun,” he says, two or three times a month. “When I buy my dope, usually downtown, it happens that I want to inject right away, that I can’t wait to be back home. If there was a safe injection site, I would go there.” Right now, just like a large number of users in the downtown area, he hides in a back alley or in the bathroom of a cafe. “Luckily, I look alright, so I don’t get many suspicious questions.”
An injection squat on Boulevard René-Levesque that has since been cleaned by authorities. Jerome, a drug user who injects two or three times a month, thinks that safe injection sites will save lives but also protect users from the street’s insalubrity. “In a back alley, with the urgency of withdrawal and the fear of getting caught, risks are higher,” he says. “You’ll miss the vein, you’ll use dirty syringes, or even dilute your drug with water from a street pond or a public bathroom.”
During her twenty-five-year career in an accountancy firm, Rebecca (not her real name) kept her heroin use a secret. At first she was just curious to try the drug on weekends, but she quickly became addicted. That was thirty-five years ago. She then opened a thrift store and “enjoyed a good life.” She now works with drug addicts and still injects every day. Whenever she needs to use away from home, she has a friend with her. “If you are in cardiac or breathing arrest and no one’s here to bring you back, you die in just a few minutes,” she says. “I can organize my consumption to be in the right place, but many addicts find themselves in withdrawal in the street. They’ll buy anything from the first pusher they’ll meet. Accessing a safe injection site would be vital for them.” Rebecca is part of Cactus’s street-messengers group who patrol injection spots and hideouts in downtown Montreal every day. They pick up dirty syringes, distribute sterile kits, and keep in touch with a network of users, which is an essential part of the harm-reduction approach.
Dirty syringes found in corners and back alleys in downtown Montreal. Safe injection sites would significantly reduce the quantity of hazardous material in the streets. Quebec’s National Institute for Public Health has compiled around forty studies on safe injection sites worldwide and the conclusions are crystal clear: they significantly reduce the effects of drugs on public order, they don’t contribute to a rise in drug-related infractions, and they don’t encourage new drug users to inject. “Users are already in the areas where the safe injection sites are planned to open,” says Jerome. “It can only benefit the community. It means less dirty syringes, and less probabilities to meet someone intoxicated or dead in a back alley.”
Alice (not her real name) works a regular job from home. She has a husband, a kid, and a detached house in Montreal’s northern suburb, with strawberries in the garden and toys on the floor. She is fighting for a new life after being addicted to heroin since she was fifteen, when she was homeless and a sex-worker. She still injects from time to time, and methadone helps her a great deal. “Withdrawal is not the hard part,” she says. “Figuring out what to do with your life after is. You have to learn to think about something else than finding your dose. If I could control it, I would stop altogether.” She still drives downtown to get her sterile injection kits. Safe injection sites will be great for homeless addicts, she says, but for people like her, privacy is important. “I don’t want to see other people injecting or feeling observed. Injection is a very private thing.”
Jules, twenty-nine, and Mickael, twenty-three, minutes after a heroin injection in the “snakepit,” an infamous downtown street injection spot near Université du Québec à Montréal. Both live in the street and would be ready to use a safe injection site, but that is not the case with all the users who share their profile.
It just took six months for Moxy (not her real name) to tumble down from “the good girl in the private college” to injecting cocaine on a regular basis. For twelve years, drugs took control of her life so deeply that she never thought she would leave that world. It’s been over for eight years now, with the street and the sex work behind her, even though she still injects two or three times a month. “What I went through was extreme and I am not going back,” she says. “I used to walk with my eyes on the floor. I was ashamed. Even though you never want to inject in front of people and give that image, I did it. I just knew I needed my injection and nothing else mattered. It was not a choice.”
The courtyard of an old convent in downtown Montreal is used as an injection squat by regular users during the summer. “Drug addiction is not only a matter of public security,” says Carole Morissette, who is in charge of the safe injection site case for the Regional Director of Public Health. “It’s a health issue. We’re talking about real humans in very difficult situations.” With federal approval, it may well be only a matter of months before the actual opening of safe injection sites in Montreal. For some, including the members of the Quebec Association for the Health of Drug Users, they will believe it when they see it. “We’ve heard too many times someone say, ‘It will open next spring.’ Until then, we’re counting the dead.”