Episode 3: Discussing the opioid crisis with Eric Bollman

Episode transcript and show notes provided by William Huang.

[00:00:05] Zaynab: Hello everyone and welcome to Episode 3 of Beyond the Blankets. I am Zaynab Aseem, and I am one of your podcast hosts. I am in my second year, doing a Specialist in Neuroscience and a minor in Applied Statistics at the University of Toronto Scarborough. At Blankets for T.O., I am currently the Content Director. The past episodes, we have been discussing how BTO started and how we are helping the homeless community. We also got into myths regarding homeless people. This episode, I am joined by Eric Bollman and we will also be discussing another myth surrounding homeless people: how homeless people are “drug addicts”. I’d like to pass over the mic to Eric Bollman to discuss and introduce yourself to our audience here. Take it away Eric.

[00:00:54] Eric: Sure, my name is Eric Bollman and I am the Communications person at the Canadian Psychological Association but I am also the Secretary of the Board of Directors of Operation Come Home, which is an organization providing wrap-around services to homeless youth in Ottawa. I have been involved with them for 20 years, and have been on the board for 17. We do all kinds of things in Ottawa with things like addiction counselling, mental health assistance, housing, education, employment, and we provide the only hot breakfast in Ottawa for homeless youth to access at our drop-in everyday.

[00:01:31] Zaynab: That’s amazing! Eric is an amazing person and I was also fortunate enough to be on a podcast episode for his podcast for the CPA and it was great talking with him. I’ll link that podcast in the description of this episode for you to check it out. Well today Eric, I want to discuss how one of the myths about homeless people is how they are “drug addicts”. In our previous episode, we talked with Professor Joordens (you also had an opportunity to talk with him, too!) and we discussed a few myths: how homeless people are mostly white caucasian males, and how homeless people “choose to be homeless”, but today we want to discuss why homeless people are “drug addicts”. I remember that last episode we briefly touched on the topic but one thing that stuck with me from Professor Joordens is that homeless people, the thing about them being drug addicts is that it is an outcome of their stresses; whether that be external stresses (financial stability, familial feelings and how that affects them) that they don’t have the financial avenues to counter with. So they may end up seeking drugs to counter those emotions. And that’s how we end up seeing homeless people dabbling in the world of drugs. I want to pass this over to you now: how do you think this cycle starts and how do you think homeless people get to rely on drugs? How did this myth come into existence? What are your thoughts?

[00:03:22] Eric: I am not sure it is a myth as such but I do think that people misunderstand the root causes. I think all studies will show that drug addictions are a symptom of mental health issues, and that mental issues predate drug addiction in virtually every case. Some drugs certainly create a chemical addiction in the brain but a ton of them don’t. No one chooses to be an addict. And most of us have tried one of them at one time or another. And most of us don’t become addicted. And when you don’t have supports around you … like whenever we face financial stresses we may turn to supports like family or friends that we can speak to, we can find an outlet for that stress … but when you don’t have supports, that outlet may be alcohol, it might be weed, it might be something more serious like heroin, cocaine. Drugs that people start taking just to escape from the daily realities of life. 

[00:04:33] So when you’re homeless and out on the street – and I’ll tell people this all the time, especially with Operation Come Home – are youth (young people, 15, 16, 17 years old, up to maybe 25, that we see at a drop-in) … they don't end up on the street because of drugs. And that’s the myth. The myth is that people start using drugs at home, become addicted to the drugs, and all their money gets poured into the drugs, so they don’t have money for rent and food, and they end up being kicked out to live on the streets. This is rarely the case with young people. Take a look at the population that we have in our drop-in. The Stats Canada for the percentage of LGTBQ youth in Canada is somewhere around 4%. But we have 20% LGTBQ youth at our drop-in. And at our unemployment program it is 40% youth who identify as gay, bisexual, transgender. That’s because their home situation is so bad that they prefer to go out on the street and once they are on the street, there is no support for them on a regular daily basis. The only thing that can help them on a daily basis is some form of escape, and the readily available form of escape on the streets is drugs, alcohol, substances that can take you away for a short time. Then there is no way for them to get out of it because once you start using it and it becomes your daily method of escape, then it becomes a daily habit and it is very difficult to break that cycle. So I would say that virtually none of the youth who come to Operation Come Home, initially, come there because of drugs but virtually everybody that comes to our drop-in ends up becoming addicted, in one way or another, to drugs. 

[00:06:35] Zaynab: Yeah, the way that you put it was very essential for the audience to hear. As I said, I don’t know if it’s a myth anymore. I feel like the way that it is perceived may be the myth and I really liked how you mentioned youth and it is crazy to think about – let’s ignore the part of being homeless – drug addiction, how no one wants to be an addict, and the consequences of being an addict on poorer physical and mental health, drowsiness and confusion, all those things. I’m thinking about it right now, ignoring the homelessness right now: when you are experiencing things as a addict, let’s say with stable housing, you still have avenues to go through like drop-in counselling or general therapy, whatever it may be, but now when you factor in homelessness, you don’t really have anywhere to go to. Even if you do, you may not have the finances to go to that and it just makes it ten times worse. I was doing some research into a recent story and I found that 50% of people who report addiction and substances as a cause for homelessness actually experience it in their youth, and it wasn’t because they were drug addicts at first. It was because their home conditions and their familial relationships were not so good that they had to go outside. And when they went outside, it was drugs that helped them to numb the pain of not being home. So it is really crazy when you put it this way. Besides that, I like how you mentioned mental illness because with mental health issues, reports suggest that 33% of homeless people do battle mental illness and the effect that drugs can have on your mental health can also be really damaging. And besides that, just the effect on your physical health because your physical well-being is also related to your mental health well-being.

[00:08:42] One of the crises that we in Canada are experiencing right now is the opioid crisis. For folks that need a better understanding of the opioid crisis and what opioids are, here is a quick summary. Opioids can be bought in legal forms, they can affect your mind and how you perceive pain, often giving a sense of euphoria. They can be highly addictive. And one of the drugs that is impacting homeless people so much so that 20 people die everyday is fentanyl, which is a synthetic opioid. I know that Eric, you have written a few articles and have worked a bit on fentanyl, the opioid crisis and how it affects the homeless community. So Eric, would you like to get into that with the audience? 

[00:09:28] Eric: Sure. I’ll tell you and go back a bit, alright? This is a story from about 15 years ago. Operation Come Home was a much smaller organization and we had a little office down on Rideau Street right in the Market here in Ottawa. And we helped homeless youth with a drop-in and we had a little school; that was all that we had. And one of our youth – a group of them actually – were sleeping under an overpass here in Ottawa. Middle of the summer. It was a place that was sort of out of the way. It was safe to congregate together. And then there came a guy out of town drinking and what have you, who started peeing outside right under the overpass. So one of them confronted him and said that “We’re sleeping here so please get out of here”, and then ended up stabbed to death. His name was Cactus. Out of a tribute for him, we renamed our drop-in to Cactus Drop-in and we put a board up on the wall, a memorial board. All the youth loved him and he was a lovely and caring part of that homeless community, so they all signed the board. And that stayed up in the drop-in for a long-time. 

[00:10:50] And then, over the years, we lost a few others. There was one woman who was murdered by a guy who was targeting prostitutes and killed them in Ottawa. So she got a board on the wall. Another guy died by suicide so he got a board as well. Then, when fentanyl came to Ottawa, we ran out of wall space. We put up boards for everyone that died that was part of that community and there was no wall space anymore because there were so many, one after the other. We then took the boards down because the youth who came to the drop-in at first saw the Cactus board, shared good memories of him – that was why it was up there – but it became such a crushing reminder for them, every day they came into the drop-in, that their daily life could result in death at any time. And then it was such a terrible thing for them to be seeing every day that we had to take all of it down. We had to shelve it and remove it – I don't even know where it has gone now – because you can’t just walk into a place and feel comfortable when you’re surrounded with reminders of death. So that was in the past 5, 6 years. It had never been like that before and all of sudden it has become so much worse. And there is no way to know – there is no regulation, no public health announcement that this batch of heroin is laced with fentanyl that could be deadly. No way for them to know this in advance before someone actually dies and then you can say, in that community, that that right there is bad. Until that time, there is no way to know. And that impact is very very clear, certainly within that community and I don’t know how much of the outside world knows or can understand how that can affect people.

[00:13:09] Zaynab: And yeah that is so crazy to me because I volunteer at a pharmacy and on a daily basis we deal with narcotics, fentanyl and many opioids. My pharmacist was telling me that it is a grey area in the system because all the drugs that are expired and that we cannot use anymore, they go to this company and we don’t know where it goes. Most often, maybe they go to third world countries and we don’t know how these drugs are being dealt with. Some of them are really dangerous, especially fentanyl because just a small dose of fentanyl can kill someone. And I was looking at my pharmacist point blank at the face like “You’re telling me the drugs are going out there and no one knows how it is being dealt with.” And if it gets into the hands of people, especially youth, who honestly do not have the capacity to think about how that can really affect them. And even homeless people who are seeking any avenue that could give them any sort of relief and numb them from the pain. If these drugs get into their hands, we don’t know what could happen to them. 

[00:14:17] So I do really hope that there is some better system that could help people with that and I was reading this other stuff about how there is history of abuse, addiction, poverty and things like that for people that lack access to housing, how they are at an increased risk of harm and substance abuse. There are over 89 000 people in Canada who inject substances on a monthly basis and that number is just so crazy to me. So I was wondering: what are your thoughts on the legalization of opioids or any ways on controlling these drugs especially for the youth? Any ways for managing these drugs for the youth? 

[00:15:10] Eric: Well, my thoughts on basically all drugs is that they should be legal. I think every drug should be legal. The thing about opioids is that they were legal; they started out legal. And 10-15 years ago, I got into a serious accident, I got into a lot of pain and I was prescribed oxycontin back before it was pulled off the shelves. And I remember taking one too many one day and I sat in my backyard for five hours just blissfully happy sitting in my chair while my dog licked my legs. My dog licked my legs for five hours up till the point where I was bald on my leg from my knee down because my dog had licked all the hair off me and I just didn’t care. It was an awesome experience. It felt fantastic. And I fully understood how that could become something that people become really really dependent on. It scared me enough to stay: “Okay, I am never going to touch this stuff ever again.”

[00:16:21] But for people who have chronic pain – I was lucky enough that my pain was a temporary one and it went away quickly after that and I could manage it somewhat with Tylenol – for people with chronic pain who get prescribed this who end up, down the road, having no choice but to continue using this, well then after they stop prescribing it then where do you go? They go to heroin. Heroin dealers who want to make as much money as they can so they cut it with whatever substance that they can find. Fentanyl is really cheap and it absolutely works within that drug and it produces the same effect, but if you do it wrong, you start killing people, right? 

[00:17:03] Zaynab: Right.

[00:17:05] Eric: So all of that was legal but there wasn’t an oversight system. There isn’t a good regulatory system. We don’t communicate well with other countries. Like what you were saying with your pharmacist, you have all these expired medications that go to who knows where. They just disappear and there isn’t a good regulatory system. And that is because we don’t treat drug addiction as a public health issue, right? We treat it as a criminal issue. So when something crazy happens, like this Opioid crisis started by the Sacklers and Purdue Pharma and the rest of that, there is no good mechanism to hold them legally responsible or even force them to acknowledge the harm that they are doing. And at the same time, on the other end, you criminalize drug addicts so there is no public health resource for them to get out of that situation.

[00:18:09] And I think that by legalizing all drugs, you at least create a framework for it to become a strictly public health issue. So you can regulate it the same way that you regulate other things, right? There are public health agencies across the world who will recall a batch of lettuce because it has listeria. So you say “well, I am not going to use that brand of lettuce for the next few weeks because they recalled it all because there was a listeria outbreak at that plant”. Then other companies start to have to do it themselves. There was just a recall on Banana Boat sunscreen, because of carcinogens, right? So that company does that on their own. They chose to do that because the public pressure would be too much otherwise down the road when they find out that this product was in it. And these are things that could make people very sick, things that could, over time, cause cancer. But fentanyl is something that could kill you today. And there is no way to regulate the supply. There is no way to test it before it goes out to people. It’s all coming through illegal channels. So I think that the framework can only exist if it’s legalized the way marijuana is legalized now and there are government dispensaries, government tests and government regulations of what can and can’t go into them.

[00:19:34] Zaynab: Yeah that’s just crazy to think, especially if you put it that way. It should be a public health issue rather than a criminal issue, especially when there are staff that say that 20 people die every day at the hands of fentanyl. Another really interesting stat that I found was that, after substance abuse, there are people who are fortunate enough to go to hospital. And some of them are homeless people. Those who have access to housing who were hospitalized spent a total 6 days at the hospital with acute and patient care and any strong care provided. Whereas those who have no sort of housing spend 11 days in the hospital. And the crazier thing is that there are also people who choose to just leave the hospital and those who have housing, they make up a total of 3% of people leaving the hospital against medical advice. But those who do experience homelessness and have no sort of housing make up a quarter of that, 25% of people who just end up leaving the hospital against medical advice. And this, in my head, is translated into: “Those with housing are being given better treatment and preference because in total, six days till you are fully treated, given care and out of hospital. And only 3% are those who are leaving the hospital against medical advice, but those who are experiencing homelessness are in the hospital for almost two weeks.” We don’t know the kind of care that they are getting and they make up the majority of the 25% that leave the hospital against medical advice. That makes me wonder why there is this dis-proportionality here and how are these drastic numbers still not a cause for the government to put some sort of action into place. So, again I want to pass it over to you: what are your thoughts about how hospitals are treating patients and this bias existing even in the care provided?

[00:21:39] Eric: I think that two things are happening there and one exacerbates the other. One is, yes, hospitals and medical professionals are not equipped to deal with chronic drug addiction and all the other problems that come along with somebody experiencing homelessness who is experiencing drug addiction. They are just not equipped to deal with that in the same way that they are equipped to deal with somebody who, yes, has housing and has a job and maybe even has healthcare benefits that can cover their stay in rehab or their hospitalization for this kind of thing. But the second part is that, because they aren’t equipped, and the people experiencing homelessness who end up in the hospital for one reason or another, very much can feel that they are not equipped to do this. They stop trusting the hospital. So our youth who overdose and get revived and get sent to the hospital will try their best to get out the very next hour, as soon as they wake up. Because they instinctively know that no matter how long they stay there, there is not anything that is going to be done for them that can help them long term. They have to come to terms with the idea that “I need to go into a rehab centre”. We’ll connect them with the Dave Smith Rehab Centre in Ottawa. We connect them with those services and resources when they come to that on their own. But there is no forcing somebody to come to that and when the healthcare system tries to force you, and you’re already instinctively distrustful of all government systems, of all authority structures because you’ve experienced so much discrimination at the hands of the housing structure, the medical establishment, the police, you just don’t trust that anyone is actually there to help you. And so you end up avoiding that help at the same time. 

[00:23:48] Zaynab: Yeah, when you put it that way, it starts to make a lot of sense. I like how you mentioned that hospitals are not equipped to deal with these people and these situations and I was thinking about how, when the first person that a homeless person with addiction sees is a police officer, the police are definitely not equipped at the moment for dealing with those with drug addictions and they will most often probably take it as a criminal issue rather than a public health issue, and they may not be understanding of where the homeless person is coming from. I guess to relate back to what you said about trying to make this a public health issue; it will really benefit homeless people. And also thinking about the main priorities for a homeless individual who is also an addict, compared to someone with housing that is an addict meeting the basic requirements of food, water, because in Maslow’s hierarchy of needs, physiological needs make up the greater part of the pyramid (food, water and shelter). Even if you offer drug counselling to a homeless person, they may not care as much because in their head is food, water and shelter at the moment, instead of something that in their head is giving them some sort of relief. So I think it is also a bit tricky to go about it that way. 

[00:25:23] And now, before we end this podcast, I want to get to some of the initiatives that are currently there. I know that you mentioned that you did write some articles for “Starts With Home” regarding the opioid crisis and LGTBQ youth in the homeless community. Do you want to discuss a bit about their journey and how they are helping the homeless community who are facing these issues?

[00:25:51] Eric: The Starts With Home campaign was started by the Alliance to End Homelessness Ottawa and really it is a way for us to do our very best here in Ottawa to apply pressure on elected officials in the lead up to the municipal elections coming up in October to make housing a huge priority. We are losing affordable housing at an alarming rate. We are not building any more affordable housing. The affordable housing that does exist tends to exist all in one place. And this is sort of an issue for a lot of government organizations.

[00:26:28] Imagine that you are a homeless person and you deal with the police on a regular basis. The police keep issuing you tickets; tickets for panhandling, tickets for trespassing, for sleeping in the doorway of the business. And they keep giving you tickets which you have zero way of paying. You will never be able to pay these tickets but they keep piling up, piling up, and piling up. And then you need to go and get an ID, a driver’s licence, but you can't because you have a whole pile of tickets under your name and that makes everything more difficult. How are you going to find housing on your own? You have less than no credit because some people have $30 000 in unpaid fines that they will never ever be able to pay. So the police are criminalizing you, and then you have an incident where you end up taking something that was laced with fentanyl, your friends revive you … [inaudible] … and the police end up taking you to the hospital. Then at the hospital, you’re now associating that with the police who have been giving you tickets that you have zero way of paying, that absolutely have no public benefit. And so when it comes to housing, if you had a house in the first place, all of this could basically have been avoided. 

[00:27:49] So it’s really trying to hold the government’s feet to the fire to implement what the Housing First strategy is designed to do. And very often, the easiest thing for a city council to do is: “Ok, we’ll just create an apartment building. Right now, there are a lot of empty apartment buildings downtown, and because of COVID, people are not going to work so there are office buildings that could be converted to apartments so we’ll put everybody in there.” Well, that is not a great solution. The police are in favour of that because they think of those people as the criminals that they continually deal with, so “now we only have to make one stop, there is one building where we have to go to where everybody is.” But is everybody else who is in a similar situation, who requires a community outside of this existing community of people experiencing homelessness, going to move on and get their life on track? 

[00:28:57] So we are in favour of a scattered housing approach which is that, if you are a developer who is creating a new building, the city really should be subsidizing 10% or 15% of units in that building for affordable housing. Because, as you said, imagine that a homeless person spends twice as long in the hospital for the same thing as someone with housing does. Well that is costing the system an awful amount of money. The police are issuing tickets to homeless people, so that takes up time and policing resources. Then the tickets don’t get paid and that takes up court resources. It costs so much more to have someone to be homeless, living on the street, than it does to just pay for their housing until they get on their feet. And the only way they can get on their feet is if they have housing, so that is the push that we are going with here. 

[00:29:56] Part of that, too, is to treat drugs as a public health issue rather than a criminal one. Safe injection sites, harm reduction; all of that is going to help people to get out of that situation and we can’t end homelessness without it. One analogy I like to make is abortion. This is in the news now: abortion in the United States, Roe v. Wade gets overturned. That’s because the United States treats abortion as a criminal issue. Should it be legal, should it be illegal? And that is the central question about it, which leaves out the healthcare portion of it entirely. Here in Canada, we treat abortion as healthcare. And so deciding whether or not it should be illegal is almost like deciding whether cancer should be illegal. You can say that it is illegal to have cancer, but that is not going to stop anybody from getting it. It is definitely not going to help in a public health sort of way. And it is just another way to shame people who have cancer. 

[00:31:10] There is a researcher at the University of Windsor, named Ben Kuo, who has done some great work in this space. Mostly around racism and that, but his work is about what we as a society consider of other people. Whether we consider other people to be “dieable” or “killable”. And the notion is that the more you can criminalize somebody and the more you can think of them as a criminal, the more you can stop caring about whether they will live or die. And it is okay to lose a certain number of people, as “they have made a moral choice that made them a criminal and therefore I don’t have to care about what happens to them.” And this is something that politicians frame all the time [with] illegal immigrants. “You have come into my country illegally and that makes your very existence here criminal which makes you a criminal and that means that I don’t have to care what happens to you. Whatever the government decides what to do with you is totally fine because you have been placed into the box of ‘criminal’ and I can stop caring.” So that is a huge part of this initiative as well. Make sure that we care about what happens to every person so that every person can have the same chances that the rest of us do. 

[00:32:37] Zaynab: I think that the takeaway here is that the myth is that they are criminals where the actual situation is that they are a victim of their situation, which is also at the hands of inadequate government services. I feel like when you start thinking about it as a public health issue – I really loved your analogy because it truly hit me – I hope that the audience really understands where this is coming from and where the actual issue is stemming from. I was doing some research and I ended up finding an initiative called “Reaching Home” that is a community-based program that aids in preventing and reducing homelessness across Canada by providing funding to Indigenous and rural communities to help them address local homelessness needs. And there are a lot of organizations doing this work. At Blankets for T.O., we are trying our best to help homeless people by doing donation drives, food drives, going to shelters, trying to spread awareness so any and every donation would really be helpful. But I know that a lot of the audience would want to know ways of how to support, so Eric, do you have any words or ideas for the audience and how they can potentially contribute? 

[00:33:57] Eric: I think that you want to find an organization in your area, in your city, something that is immediately tangible for you. So, in Ottawa, Operation Come Home, Youth Services Bureau, Shepherds of Good Hope; there are a ton of organizations – the Alliance to End Homelessness Ottawa. And follow nationally like the Alliance to End Homelessness Canada, which is constantly doing great work and point-of-time counts of homeless people in various communities and looking around the world to see what has worked in other countries, in other jurisdictions. Here in Ottawa, there have been small towns that have actually been able to end homelessness by creating homes. And this is the idea of the “Starts with Home” campaign: none of this is possible if you don’t have a home. This all starts when you have a home. And everything else comes from there; you can’t get support if you have no place to get it from.

[00:34:55] So yes, I think everybody should support and hold to the fire the feet of politicians in your area who are tasked with implementing the Housing First federal plan, which is a good one, but just really isn’t being done in many places because affordable housing is too difficult to come up with. Developers will push back on it because they don’t want to have affordable housing in their new condo buildings, but until we force them to put some in and until we subsidize it ourselves, we will not be able to achieve it. By subsidizing it ourselves, as taxpayers, I think we have to realize and make it a point to others that this saves us money. Pouring money into that today will save us money tomorrow, and will also save us money today as well. It saves us money in the healthcare system, in the policing system, in the welfare system. It saves us money everywhere. It is silly not to do and we have to reject the silly arguments that pretend that it is too big of an ask because it really isn’t. 

[00:36:13] Zaynab: Right, those are some really good resources. And all those organizations that you mentioned, I will put them in the description. And I think what I’ll also do is make a list of the organizations across the different provinces here, so it encourages our audience to also contribute. Blankets for Toronto is also open for more members and is always open to more donations, so we could also do that. Thank you so much, Eric. That was so insightful and eye-opening and just your whole analogy really put a lot of things into perspective for me as well and hopefully for the audience too. Once again, thank you for being here and thank you for discussing this very important issue.

[00:36:54] Eric: Thank you for having me. I appreciate it and I think that the more we talk about this, the better.