Harm reduction in Kenora

I just returned from the town of Kenora in Northwestern Ontario.where I am the consulting psychiatrist to the Kenora Associations for Community Living. Many of the individuals we support are dually -diagnosed. They have Intellectual Disabilities , Fetal Alcohol Spectrum Disorders, Autism Spectrum Disorders and co-morbid mental health concerns and addictions, which are most often attempts to self -medicate or are forced upon them. I travel to Kenora a week a month, flying form Toronto to Winnepeg in Manitoba , then driving to Kenora , Ontario . You get to see lots of snow while listening to good music and marvel at spectacular view of lakes. Over the last several years, a crystal methamphetamine ( meth ) has ravaged this town. Its changed how we do business in our support model.

On the last work day of my trip, I was informed my hotel was ablaze with fire and smoke.I could not access my luggage , rental car or passport.My loving colleges found me an alternative car and hotel room to lay my head. I bought a new tooth brush and toiletries, bought food from my favorite fast food place, choose not to go to the LCBO or Beer store and was offered a new car by the rental agency , all withing two hours of the fire staring . I had my computer in my brief case , so posted pictures of the fire and documented my gratitude on Facebook. I told all in my support circle that I was grateful for the many loving friends and family who inquired about my saftey and well-being. I was grateful, but also reminded of the different levels of privilege that divide our society.

Earlier that day, I has spoken to a young Ojibway man who has been homeless for 4.5 years.He looked and smelled like he is under the influence of marijuana but not crystal meth. If he as tweaking on meth, I would ask him to leave because he could explode unpredictably , as he does when he assaults his girlfriend "Where have you been sleeping? , I ask?"Wherever", he says ." Couch -surfing?", I inquire, "No, my friends cannot afford couches" he explains patiently. "Tell them ( the housed population in Kenora ) to not close down the shelter again." His drug of choice is crystal meth amphetamine.n our conversation he was alluded to the business practices of the Indigenous gangs in Kenora who control the distribution of this soul -killing and shame -inducing drug, in a philosophical way.

Young women, survivors of inter generational trauma, and the Ontario and Manitoba child welfare systems ,are introduced to IV meth while tied to a bed and then , at the risk of death to do otherwise, introduced to the sex trade. "Its just business", the girls shouldn't take it personally", my wise beyond his years client says . He notices a paper I am reading about the crystal meth epidemic in Kenora which has touched the lives of all community members, and says "I know that guy, he loves opiods" pointing to a picture on the front of the article.He notes , "this is about meth but they seem to know , you have to come down sometime .That's what hydrophone is for". He asks if he can keep the article to read." Of course", I respond.

I am thinking of the presentation of Complex Post Traumatic Stress Disorders in the women we support, shamed by their freezing and fawning responses to the perpetrators of their abuse. Fawning;, appearing behaviorally to collude with trauma perpetrators, is a survival choice.They may be told to return to their pimps with money and friends, knowing what this means to their friends immediate future. Not too long ago, a young lady, ( age 19 ) we are supporting , had accepted a ride with a total stranger form Kenora to Winnipeg. Through incredible advocacy provided by her case manager and Winnipeg police and Kenora OPP,who cooperatively communicated with each other , she returned physically safe to Kenora , from the home of a man identified by Winnipeg police as being " very dangerous" That's code for very, very dangerous. I look at her and tell her of our concern. She says, "I know you don't want to hear this Doc but top shelf drugs and new clothes are pretty exciting" . I didn't want to hear that .In fact,I hate hearing that. Makes me cry.I detest acknowledging that , in the short term, these things are understanding perceived to be better than sleeping in a wet, cold tent or alleyway , waiting for a soup kitchen to open in order to eat in order to have enough energy to find your next drug fix.

So what do you say to that? .Nothing for a minute, I recommend. You breathe and remind yourself of the principles of Harm reduction. Meet people where they are.Thank her for being here right now, and for being coherent and not being wasted on meth.

Remember , abstinence from the beginning of a therapeutic relationship is not attainable for most of our clients. Would you trust a stranger you met for the first time on the street ?. Were you abused by those in positions of power and authority and family members professing to love you ? If you claim to be 'trauma-informed', now is the time to walk the talk . Show up and being present. Be nonjudgmental and authentic. Choose to listen more than to speak. .Focus on keeping your clientele alive until they initiate their own move through the cycle of change. Recognize the shame that will potential kill. Don't add to it !! . For me and maybe for you , recognize that a Higher Power possibly found through attendance at AA , CA and/or Al-Anon, will guide your clients to embrace sobriety, to finally believe they are not we not alone in this . The Creator, God , Buddha, Allah , the Force and/or the universe... are part of the recovery process.You and I do not have to to try to be the savior .If we try, we will be taught about our imperfections and the enormity of the challenge before us yet again . Live what you teach. See if you can over time , create an dissonance between where people are and where they dream to be . She wants to be an anesthetician . He is thinking about being an addiction counselor .Wow! Lived experience is so powerful in cultivating compassion and the capacity to empathize, to learn to bare witness to the grief and sadness experienced by those marginalized to the edges of society. It also can hard wire your BS meter.If you are enraged and righteously indignant when an individual with an addiction lies, check yourself , not them. Thats the illness talking. There , for a while can be no other way.Its a diagnostic confirming gift if you chose to re-frame it . The lies might keep your client saty alive on the street for a while longer in circumstances, which are so dangerous, they are beyond your and my scope of understanding.

So , I am going back to Kenora next month.We have a new , young family physician in town who is on fire with passion and compassion. He has traveled to Vancouver to learn of the components of the recovery model based on harm reduction pinciples there. I read and listen to Gabor Mate, a Canadian physician and world expert on harm reduction techniques.There is talk of a free standing Addiction Hub, and a safe consumption site; attempts to reach those existing in the Realm of Hungry Ghosts. This is a Buddhist concept Gabor writes about- an acknowledgment that attempts made by the traumatized among us to fill insatiable holes in our souls with substances that will eventually kill our will, induce shame and lead to physical death. As a community partner,I have offered to treat co morbid mental illness .My colleagues will help me avoid being vicariously traumatized a second time in my career.We will actively honour choice, strengthen community partnerships, and facilitate opportunities for traditional healing.

We will educate those opposed to harm reduction , the believers in the notion that needle exchange programs and safe consumption sites are enabling , expensive drains on community and provincial financial resources.They don't get it yet .The war on drugs is a war targeting ill individuals, who share your and my humanity. No more, and no less.

1. I just heard a song on U tube called The Spiritual Journey of Gord Downie and Chanie Wenjack written and sung by Rick Desnoyers, from Ottawa, Ontario.It is a very moving song. Thank you Rick. Gord was the lead singer of the Tragically Hip , as many know ,and powerfully articulated his concern for issues marginalizing Indigenous individuals. This became one of his passionsin the last phase of his life . His project , The Secret Path, is of Chanies' life, a 9 year old Ojibway boy living very unhappily in a residential school in Kenora. He ran away and froze to death days later as he attempted to find his way home. If you would like some inspiration, consider listening to it.Listen to it twice if you are tired and really need inspiration. That's what I did .Then I wrote this piece and shared it with you.

Peace