Just before Guy Felicella overdosed for the first time, his dealer warned him to take a lower dose than usual.
It was 2013 and fentanyl was beginning to crop up more in Vancouver’s Downtown Eastside, ground zero for Canada’s overdose crisis.
“He just told me it’s a really strong batch of dope and he said you can’t do it the way you do dope,” said Felicella, who had been using heroin for decades at the time.
Felicella didn’t heed his dealer’s warning and he was hospitalized due to an overdose. Afterwards, he went back to his dealer’s place.
“I said, ‘What the hell, I OD’d,” said Felicella, now sober and a peer clinical advisor with public health authority Vancouver Coastal Health. “He said ‘Listen, it’s fentanyl… I told you you cannot use that amount that you used and you didn’t listen.’”
Though dealers are often left out of the wider conversations around drug policy reform, they can play a crucial role when it comes to harm reduction because they can caution their customers about the potency of certain drugs or warn them if a bad batch of drugs is circulating.
But there’s a major event that disrupts the relationship between drug sellers and their customers: evictions. And with an increasingly volatile drug supply flooded with fentanyl, that disruption leaves people who use drugs much more vulnerable to overdoses and death, according to Ryan McNeil, assistant professor of medicine and director of Harm Reduction Research at Yale University.
“What we found is that the period immediately following an eviction and the months after were hugely impactful in terms of people’s health,” McNeil told VICE World News.
In March, he described the looming eviction crisis being exacerbated by COVID-19 as a “public health disaster.”
Mass unemployment due to the pandemic has left millions of people in the U.S. and Canada at risk of eviction. According to a U.S. Census Bureau survey from July, more than 7.4 million adults reported being behind on rent. And while many jurisdictions paused evictions, those moratoriums are now lifting as vaccines become more widespread. A Centers for Disease Control and Prevention moratorium on residential evictions expired on August 1, though the agency has extended it for 60 days following a protest led by U.S. Rep. Cori Bush. In June, Ontario lifted its eviction moratorium, and the City of Toronto has begun clearing homeless encampments in parks, sometimes violently.
According to McNeil, being evicted impacts people who use drugs in a number of damaging ways but it’s not an area that’s been subject to much research.
In March, McNeil published a study in science journal Drug and Alcohol Dependence that looked at the experiences of 56 people living in the Downtown Eastside who’d been evicted. The study found that evictions impacted people’s relationships with dealers, changed their substance use, and could leave them more vulnerable to violence, criminalization, and overdoses.
“That really impaired their ability to assess risk in those situations and really left them exceptionally vulnerable to overdose,” McNeil said.
McNeil said that data from major longitudinal studies involving people who use drugs in Vancouver showed that 40 percent of people had been evicted over a five-year period.
“This is a very commonplace thing in people’s lives,” he said, adding that most of the people in his study had been evicted unlawfully because they are drug users—not because they were behind on rent.
He said that while some of the study participants tried to maintain their regular drug seller post-eviction, many of them had to source drugs from someone new with whom they didn’t have a relationship.
“Instead of being able to go to someone they trust and who they would often talk to about what was in drugs they… had to often just purchase whatever they could,” McNeil said.
A 54-year-old trans woman who took part in the study said being separated from trusted sources due to her eviction resulted in her overdosing when she bought drugs from an unfamiliar dealer.
McNeil said the situation is exacerbated when people are experiencing withdrawal and therefore “buying under duress.” Withdrawal also caused some people to take greater risks getting money to buy drugs, he added.
McNeil said evictions also push people into unsafe injection environments, or into situations where they have to inject drugs in public in a rush without enacting harm reduction practices.
Elizabeth Holliday, director of Overdose Emergency Response and Harm Reduction for Vancouver Coastal Health, previously told VICE World News that fatal overdoses had gone up during the pandemic in part because people weren’t going to safe injection sites as much due to the “stay at home” advice.
The study also found that some people who were evicted either started or increased their use of stimulants—especially methamphetamines—to stay awake and avoid cops or city workers who sweep the streets and throw out goods.
“People are having to try to survive, stay awake and keep themselves protected,” McNeil said.
McNeil said the study demonstrates the need for adequate housing, policies that protect tenants, and safe supply policies that center people who use drugs.
“We are losing so many people and are we just going to accept that their lives are collateral damage in the continued prosecution of the war on drugs? Or are we going to move towards a model that would keep those people safe?”