Astigmatisn’t.

On visits to my local coffeeshop I like to sit outside, to enjoy the fresh air and to escape the obnoxious pop soundtrack.

The downside of sitting on the patio is that you’re exposed to the nuisance of passing cigarette smokers, noisy motorbikes, and muttering headcases. The last are harmless enough, but they can be scary as they tromp past, eyes downward, zigzagging unpredictably and cursing at invisible enemies. Occasionally they glance around, and if their eyes catch yours you might be drafted temporarily into their gallery of devils.

Not long ago I made the mistake of failing to ignore a pair of filthy sweatpant-clad legs that shuffled to a stop alongside my table. Looking up from my newspaper I saw that the sweatpants belonged to a vagrant of unusually revolting appearance who, until he felt my eyes on him, hadn’t been aware of me at all. He asked if he could join me, though there were empty tables nearby.

My instinct was to call for a policeman to turn a high-pressure hose on this creature and sluice him down the street and out of my sight. As a civilized person, I obligingly pushed out a chair.

He introduced himself as – I can’t remember – let’s call him Joe. He had stringy grey hair and a pockmarked face and looked about seventy but may have been scarcely older than me. Some combination of drugs and booze had addled his mind until his speech was a half-coherent rasp of mumbles and fucks. He wore headphones and carried a ratty knapsack which he lowered into an empty chair and a paper Starbucks gift bag which he dropped on the table and which, I pointed out politely, appeared to be leaking. He blinked at it but made no attempt to arrest the leak, which slowly spread across the table’s surface. I shifted position to keep my elbow clear of the unknown liquid.

***

This was back when the weather was still nice, just before the launch of the recent Canadian election campaign. Around the same time, I came across this editorial in the Vancouver Sun:

We must make drug decriminalization a federal election issue
By Dr. Derek Chang

As an addiction-medicine physician, I work regularly with patients who suffer from the illness of addiction. Over the years, I observed two important things. First, addiction doesn’t discriminate. I have worked with patients in Vancouver’s Downtown Eastside. I have also treated many who were established professionals: professors, lawyers, accountants and doctors, to name a few. They were men and women, gay and straight, Indigenous and Caucasian, Christian and Muslim, etc. Addiction can affect anyone, just like any other chronic illness.

The other thing I observed was that addiction does not kill a person on its own. Stigma does. Insite, the first supervised injection site in Canada, is the proof. Since its opening more than a decade ago, zero fatal overdoses occurred in that facility even after the overdose crisis started.

Anyone watching me read this would have suspected, from the way my eyes kept rolling back into my head, that I too was suffering from “the illness of addiction”. But the fact that an opinion is clotted with trendy jargon doesn’t make it untrue. Maybe decriminalizing hard drugs would, as Dr. Chang contends, bring some relief to the denizens of the urine-reeking, syringe-littered alleys of the Downtown Eastside.

Consider Insite, the “safe injection facility” lauded by Dr. Chang. In Vancouver you can bring your illegal drugs to a discreetly marked storefront on Hastings Street and shoot up under sanitary conditions with a team of trained medics standing by to prevent your act of temporary self-obliteration from tipping into permanency.

A scroll through Insite’s Google reviews is illuminating. This slumming out-of-towner may or may not be for real – the morbid joke in the final paragraph makes me suspect the work of a subtle satirist – but the details match up with what can be found elsewhere:

God bless Canada! This place really made my vacation. First of all its easily accessible from the light rail, it is a short walk from the waterfront station (most people don’t pay for the light rail, so don’t be a chump) … Once you get within a one to two block radius of Insite you probably want to score your drugs. I chose to go on a heroin bender while I was there. And you should have little trouble finding what you want just ask someone who looks high …

Just knock and they should buzz you in. Now from what I understand once you have made it inside you will not be busted at all. And even outside you have to try pretty hard to get hassled. I’ve seen people passed out with the tourniquet on and the needle in their arm still and the cops did nothing. …

Once at your booth you should know what your doing. But if you don’t that’s OK the staff is there to help, the nurses can do everything except push the plunger down. That’s means they’ll cook, tourniquet you, find a vein, draw back Blood, but it is up to you to do the deed. Then the world will melt around you.

This is a good time to go to the chill room. A. They serve juice, coffee, and snacks, and B. This opens a booth up for the next person. Dispose of your waste and sharps/hypos accordingly. You will still be observed for ODing in the chill room, I seen multiple people get oxygen or taken out by paramedics. Once you feel fine you can leave whenever you would like. I enjoyed it so much I literally got sick when I stopped going. Vancouver is awesome and this is the only place like it in north America. I highly recommend crossing it off your bucket list.

Another reviewer mentions that there’s also an after-hours number “for mobile nurses who will drive to you and drop off any supplies.” This mobile needle delivery service, like all the services described above, is of course provided absolutely free of charge.

Also worth skimming is this 2012 master’s thesis by Jennifer Vishloff, “Striving for Connection: A Phenomenological Examination of Nurses’ Experience Supervising the Injection of Illicit Drugs”. [1]

It’s impossible to come away unimpressed by the bravery and compassion of the Insite nurses, mostly female, that Vishloff interviewed. It’s equally hard not to notice the cultishness of their devotion to the philosophy of harm reduction, which asks them to believe that they are “providing medical care” to their patients as they help them inject unknown concentrations of potentially deadly chemicals into their bloodstream.

One nurse recalls her early experiences providing such care:

It’s a little, kind of scary with the fact that you don’t want to mess it up because you know that people have spent a lot of their day and money and time and effort to get what they’re injecting, like their drugs. So you just don’t want them to like spill it, or you don’t want them to miss their shot, so there’s that pressure when you initially start working there.

Another describes her satisfaction in helping educate a user about safe injection practices, an act Vishloff characterizes as “empowering”:

They just go, “Wow, that worked!” And you’re like “Yeah! Try and do that next time. You can do it on your own, if you have trouble ask for my help again.” And they haven’t asked for help since. And it’s just, being able to have that kind of impact and provide that independence to people.

“The excitement [the nurse] shared,” Vishloff chirpily observes, “is in response to bringing something valuable to her client’s life.”

I assume that Vishloff’s interviewees would agree with Dr. Chang that “addiction does not kill a person on its own. Stigma does.” And it’s unquestionably true that through Insite’s efforts, hundreds of drug users are alive today who would otherwise not be.

What’s harder to quantify is how many people who would otherwise be leading happier lives have ended up as mumbling vagrants because fearless, compassionate advocates like the nurses of Insite have helped destigmatize drug use.

***

It eventually became apparent that Joe had sat down in order to change the batteries in his Discman. The operation took over twenty minutes as he kept forgetting what he was doing, stopping now to light a cigarette, now to harass some customers at another table, now to untie his sweatpants and piss against the wall in the doorway of an adjacent drugstore.

Finally he returned and rummaged in his knapsack, removing four crumpled beer cans and tossing them to the ground one by one, until he found a pack of fresh AAs. The dead batteries soon joined the beer cans under the table.

As Joe gathered his things to go, his sodden Starbucks gift bag gave way, and the source of the mysterious leak – a plastic cup half-full of water – splashed to the ground. He left the cup and the busted bag among his other litter and shuffled away without a farewell.

I sat feeling conspicuous among Joe’s trash. When it came time to leave, I resignedly gathered it all up and carried it to the bin along with my own.

As I hope is clear, I’m not without sympathy for Joe. I’m less confident than you might think that I could never end up living as he does. He may have been deprived of certain advantages that I’ve enjoyed; or he may merely be somewhat further along in the squandering of his advantages.

At some point he began pissing in doorways because business owners wouldn’t let him use their bathrooms, for the very sensible reason that once he got in there, they couldn’t be sure he’d leave. Now he pisses in doorways because no-one is bold enough to tell him not to.

I suppose it’s fair to say Joe is stigmatized. Go ahead, let him use your bathroom.

***

I’m not crass enough to say “destigmatization kills”. I leave such shallow sloganeering to politicians and Vancouver Sun editorialists. While I’m pretty sure there’s a correlation between the decline of the addiction stigma and the growth of addiction, I wouldn’t presume to say that the first factor is the cause of the second.

But it’s easy enough to imagine a scenario where the two trends are mutually reinforcing. With more addiction around, we’re likelier to have personal knowledge of its effects – either because we’ve suffered them ourselves, or because a friend or family member has – making it harder for us to sustain crude generalizations about the moral unworthiness of addicts.

Meanwhile the weakening of the stigma means people who would otherwise have been scared off from experimenting with drugs are willing to give them a go. Which leads to more addiction, more addicts, and more wishy-washy thinking from the rest of us that our friends and family members aren’t really responsible for the consequences of their terrible decisions.

This wishy-washiness, which is just as crude in its own way as the stigmatization that it has supplanted, filters up to professionals like Dr. Chang who pretend that it is the ever-less potent stigmatization, and not the ever-more potent drugs, that is killing addicts.

I have a simpler theory for why drug addiction is on the rise. As I argued last year in an essay about the impossibility of permanently defeating terrorism:

The perpetrators keep innovating cheaper and easier methods of mass destruction; every innovation, once introduced, becomes part of the permanent repertoire.

Likewise, every new drug, once invented, is added to an ever-expanding repertoire. Alcohol and opium date to prehistoric times; heroin, cocaine, and methamphetamine to the 19th century; LSD to 1938; carfentanyl to 1974. Chemists are continually tweaking the formulas of these and countless other drugs to make them more potent and cheaper to produce.

Therefore, all else staying constant – “all else” embracing such minor details as law enforcement, the justice system, and the culture – we should expect addiction to increase year over year, as the drug peddlers keep discovering better ways to hook us.

Law enforcement agencies, in their turn, are continually innovating new tactics – though their adoption is hindered by the innate creakiness of big bureaucracies. But the emerging progressive consensus aims to rule out certain avenues of enforcement altogether. We should decriminalize drug possession, we’re told, and at the same time forego incarcerating non-violent dealers. In other words, remove or neuter all statutory obstacles to the spread of drugs.

Meanwhile, on the cultural side, we are instructed to regard addiction exactly as we regard psoriasis or kidneystones – as a matter of pure bad luck, for which the sufferer bears no blame.

As for the externalized costs of addiction – the measurable costs of sanitation, policing, health care, and housing, and the immeasurable ones of ugliness, anxiety, and petty irritation – we should pay up, and smile. To complain would be to contribute to the stigma which, as Dr. Chang has medically established, is more deadly than the disease itself.

***

It’s getting chilly. The other day on my visit to the coffeeshop I perched on a stool by the window, overlooking the passing crowd. I noticed a scruffy-looking guy had climbed over the railing of the patio and was using a metal implement to peel long strips of bark off a tree. Some mentally disturbed junkie, I thought.

Then my anti-stigmatization reflexes kicked in. How do I know what he’s up to? Maybe he’s an off-duty arborist who detected signs of disease in the bark, which he has taken it upon himself to remove.

I considered stepping outside to ask the guy what he was doing but – look, there were any number of ways that encounter could have gone badly, okay? I buried my nose in my newspaper.

By the time I finished my coffee there was a sizable heap of kindling at the guy’s feet. Pedestrians streamed by, paying the tree abuser no mind. I joined the flow.

It’s a beautiful tree. In the summer it provides shade for the patio and a refuge for the sparrows that hop charmingly among the tables, scavenging for crumbs. It would be a shame if it were seriously wounded. But who am I to interfere with a stranger’s pleasures?

M.

1. I found my way to Vishloff’s thesis by way of Tristin Hopper’s op-ed in the National Post, “Vancouver’s drug strategy has been a disaster. Be very wary of emulating it.”