6 Jail Break

In a December 2022 op-ed in the National Post, Conservative Party of Canada leader Pierre Poilievre asserts: “Everything feels broken, and the government’s approach to addiction policy is top among them.” Across Canada there were more than eight thousand opioid toxicity deaths recorded in 2023, averaging twenty-two per day (Government of Canada 2024). Poilievre diagnoses the lack of governmental initiative to make addiction treatment more accessible as at the heart of this crisis. “People struggling with addiction belong in treatment, not prison,” he writes. “Governments across Canada should do everything possible to build and support effective systems of addiction care. We require compassionate intervention that is built around treatment and recovery programs that break addictions altogether.” Drenched in the rhetoric of care and compassion, Poilievre notes that “people with addiction are not bad people. They are sick people who deserve our care and respect.” Yet, just as he affirms drug users as deserving of care and respect, Poilievre describes addiction as an illness that “takes away the individual’s ability to choose.” “We need to be compassionate, but firm, with individuals who are suffering from addiction,” he concludes.

Constructing discourses of sick and suffering addicts in need of treatment is an “individualized wellness practice” that is, as Nicole Marie Luongo (2021, 3) argues, “prevalent in neoliberal societies whose citizens are responsibilized to see health and happiness as personal obligations.” While the idea that “addicts” are merely “sick” individuals who are driven to engage in deviant behavior is often framed as a way of reducing the stigma of addiction, decades of critical disability and mad studies scholarship also alerts us to how labeling a person “as ‘ill’ or ‘diseased’”—or, we add, disabled, mad, addicted—“evokes connotations of dangerousness and incompetence” (2). Conjuring people who use drugs as dangerous and incompetent serves to manufacture consent for their policing, surveillance, control, and involuntary treatment.

Even as Poilievre claims to be shifting paradigms away from Canada’s “broken addiction policies,” his plan to “fix” purportedly broken people through “compassionate” yet controlling interventions is nothing new. Canada has a long and ongoing history of implementing policies that use prohibitionist frameworks to individualize and pathologize drug users—framing them either as broken individuals in need of rehabilitative repair or as unfixable and therefore disposable—while obscuring the broader social conditions and state policies that are driving the crisis (Linton and Fritsch 2024). What is more, forced treatment policies have seen bipartisan support. For example, in September 2024, British Columbia’s left-leaning New Democratic Party announced that their government would expand the province’s system of involuntary “care” to detain people identified as having concurrent brain injuries, mental illnesses, and substance use disorders, to the detriment of properly funding on-demand voluntary mental health and substance use services (CMHA-BCD 2024).

Carceral approaches to health care won’t bring us to a desirable fix; instead, they function to obscure what is broken. For example, the British Columbia Division of the Canadian Mental Health Association reports that people seeking voluntary services continue to face significant barriers and are unable to “get the care they need at the right time” (CMHA-BCD 2024). They further highlight ongoing issues within involuntary care facilities across the province, including inappropriate use of restraints and seclusion rooms, the coercive use of sedation, a lack of trauma-informed care, and distressing accounts of gender-based violence. A growing body of research demonstrates the ineffectiveness of involuntary treatment more broadly, showing that compulsory rehabilitation not only increases the risk of death and disability from drug overdose upon release but also leads to people avoiding needed medical or harm-reduction services because they fear being detained. Mandating recovery also does little to address the dangers of an unregulated drug supply, which can be just as harmful for those using drugs recreationally—or even for the first time—as it is for those deemed to have a substance use disorder (CMHA-BCD 2024; Thomson 2024). For example, the unpredictable potency and composition of the drug supply can lead to fatal overdoses, while even nonfatal overdoses can result in debilitating brain injuries due to oxygen deprivation. These harms are preventable by regulating supply (PHAC 2021). Furthermore, Statistics Canada (2023) reports that despite rising substance-related deaths, the prevalence of substance use disorders did not increase between 2012 and 2022 and has, in fact, declined. This highlights that what is broken is not drug users who need involuntary treatment but rather an unregulated drug supply that leaves people to consume substances without access to reliable information about what they contain. This is why harm-reduction activists mobilize slogans like “Safe Supply, Not Left to Die” and “Stop Caging Us with Your Bad Policies,” emphasizing that the crisis is not rooted in individual addiction but in a debilitating and deadly unregulated drug market.

Unfortunately, in our current context, even people who can access a safe supply of regulated drugs are often subject to punitive carceral logics. For example, by 2023, every patient in the Canadian province of Alberta who was able to access a “prescribed supply of hydromorphone (a synthetic opioid) was forced to accept a regimen of ‘witnessed oral dosing’ in central facilities” (Thomson 2024). Such practices of witnessed dosing are a form of carceral control and have been called “liquid handcuffs” by drug users. It is described this way because witnessed dosing requires a daily trip to the pharmacy during specific operating hours. While many may dismiss this as a simple annoyance, it is a form of control and surveillance that can “restrict drug users’ employment options, quality of life, and leisure time based on the operating hours of the pharmacy, transit options for getting there and back, and waiting times for supervised consumption” (Linton and Fritsch 2024, 216). Witnessed dosing can also make it difficult (or impossible) to travel for work, leisure, or visiting family or friends, as missing a dose “comes with significant risks, forcing drug users to weigh the options of finding illicit doses or going into debilitating withdrawal” (216). Carceral approaches to health care cause harm.

Situating rehabilitation as the only legitimate goal also ignores the many important reasons why people may use drugs, including to reduce pain, to experience pleasure, or to ward off worse. Drug use is an imperfect yet often necessary tool to obtain relief or experience pleasure amid ongoing and intersecting social, political, economic, and planetary crises—many of which have already reached or are rapidly approaching a breaking point. The drug crisis to which Poilievre refers is not merely a collection of individuals in crisis but a reflection of broader systemic and structural failures that abandon entire neighborhoods, communities, and regions. Addressing this requires more than punitive interventions; it demands a fundamental transformation of the very structures that produce and sustain harm. At this juncture, decarceration and depathologization must be conjoined struggles as we turn away from systems and structures that are broken by design and toward the promise of abolition. Engaging with disability justice and culture alongside the politics of madness and harm reduction shows us that while we do not need to be well to find ways to move together, it is not easy to break away from the powerful forces that seek to incarcerate and rehabilitate our community members or leave them to die. In our broken worlds, a politics of disabled kinship rejects the abandonment and disposability of nonrehabilitated drug users—which is central to medical and criminal approaches—and instead embraces approaches that affirm consensual, informed drug use as part of collective survival: to shift reality, survive violence, seek pleasure, navigate unwellness, or attend to pain and physical need. There needs to be an openness to the ways in which “drugs are intensely and pleasurably embodied, experienced as both capacitating and sublime,” to subvert “dominant pathologizing narratives” (Harris and Luongo 2021, 1). Such an embrace needs to come alongside a recognition that for some, drug use may not always be pleasurable or else may be harmful or destabilizing. And yet, even as some drug users may experience affliction, there is a crucial distinction between feeling afflicted and being reduced to an affliction (Harris and Luongo 2021).

While the state continues to rely on a constellation of punitive prohibitionist practices that criminalize, pathologize, and impose involuntary rehabilitation on people who use drugs, drug users and activists creatively innovate ways to care for and protect one another when the state won’t. Through both sanctioned and unsanctioned overdose prevention and drug-consumption sites, needle exchanges, drug-testing facilities, interdependent practices of sharing and splitting drugs, assisted injections, sharing vital drug composition and potency information, and distributing naloxone and other harm-reduction resources, activists navigate imperfect constraints to meet people and communities where they are. Resonating with the stopgap maintenance measures explored in chapter 5, drug users and allies mobilize harm-reduction practices in the present while simultaneously advocating for long-term systemic change and experimenting with collective practices of care, access, and abolition.

There has long been a need for accessible, noncarceral, and voluntary health-care treatment options, and activists and organizations have taken up this struggle in many different ways. For example, on November 11, 1970, thirty-five drug users alongside members of the Health Revolutionary Unity Movement and the South Bronx Drug Coalition took over the sixth floor of the Nurses’ Residence of the Lincoln Hospital to implement a community-run drug and education program to serve an estimated forty thousand drug users in need of support and resources. Volunteer physicians offered physicals, assigned beds, and provided medication. In response, hospital administrators called in the police, who arrived in riot gear and arrested fifteen people. Reflecting on this event in Palante, a semimonthly bilingual newspaper published by the Young Lords Party, Carl Pastor (1970, 6) asks, “Who can better determine what’s best for ourselves than us? . . . We must begin to create struggle everywhere we go not only in the hospitals, but in all institutions that control the lives of our people. We must make them more responsible to our needs.”

Zoë Dodd and Alexander McClelland (2017) further outline examples of how harm-reduction activists bypass barriers to drug-user wellness through practices of mutual aid and resistance to state surveillance and hierarchical control that are grounded in community knowledge. These examples include the work of Raffi Balian in starting a network that distributed, and trained people how to administer, thousands of vials of naloxone in Canada years before it became available without a prescription in 2016. Balian also worked with drug dealers, sharing knowledge about naloxone and harm reduction, and took samples from the dealers to get tested. Harm-reduction workers in Toronto, Ontario, also started a “crack pipe train,” transporting crack pipes to Montreal before public health authorities in the province of Quebec began distributing them in 2015, helping reduce hepatitis C transmission. And in British Columbia, long before any government-sanctioned facilities opened, the Vancouver Area Network of Drug Users (VANDU) created a drug-user-run needle exchange and supervised injection site, where they also provided assisted injections.

Building on these harm-reduction practices and forms of direct action, on June 23, 2020, community members from several different existing drug-user groups and allied professional organizations in the Vancouver area came together under the banner of the Drug User Liberation Front (DULF) to block a busy downtown intersection, erect a tent, and distribute individually packaged doses of cocaine and opium (see Figures 18 and 19). “Every package contained an information slip explaining the exact content of the drugs, as determined by community-based drug-checking services available in Vancouver,” enabling “those who received these substances” to know “precisely what they were receiving,” members of DULF and VANDU (2022, 4) write in a history of their actions. Emerging out of the success of this event, and in an effort to continue to pressure the government and health authorities to take seriously the need for regulated supply, DULF started a sustainer campaign, using the raised funds to provide a tested and labeled supply of cocaine, heroin, and methamphetamine to drug-user groups in Vancouver every time the BC Coroners Service released new data on the number of illicit drug toxicity deaths. Between August 2022 and October 2023, DULF operated a drug compassion club, reselling “drugs of known composition and purity” until a police raid forced its closure (Bowles et al. 2024, 1–2). Research emerging out of these actions shows that not only did the DULF compassion club allow users to purchase drugs of predictable content, it also provided a safe social and physical space for drug users to gather. This space was described by drug users as “a refuge from worry of violence or exploitation,” which was an especially beneficial outcome for people who otherwise tend to purchase and use illicit drugs alone (11). This research also shows that there were no fatal or nonfatal overdoses associated with the drugs obtained through DULF’s events, sustainer campaign, or through its compassion club. Despite these beneficial outcomes, on May 31, 2024, two cofounding members of DULF were charged with three counts of possession for the purpose of trafficking under the Controlled Drugs and Substances Act, charges that carry “the possibility of life sentences or mandatory minimum jail time” (DULF 2024). In organizing legal defense against these charges, as well as launching a constitutional challenge against the law as unjustly criminalizing access to a regulated drug supply and discriminating against disabled people with substance use disorders who must rely on dangerous unregulated street drugs, DULF members and allies are fighting for a collective future where drug policy is driven by a social-justice-oriented form of compassion that does not include carceral approaches to health care.

These creative and life-saving initiatives are insufficient on their own but demand our support and expansion. This is no easy feat, and history shows us again and again how, following Alice Wong (2023), “vital community care is because the state will not save us—it was never designed to in the first place.” By prioritizing solidarity and collectivity, it becomes possible to embrace alteration and unwellness within and across our communities and build on the harm-reduction practices and forms of direct action that can help bring into fruition the kinds of noncarceral health care that we all deserve.