Grief and resilience on the frontlines of the worsening opioid overdose crisis

Zoë Dodd reached a breaking point this February when her longtime mentor and prominent drug policy advocate, Raffi Balian, died of a drug overdose. Balian, who was 60, had been attending a meeting on supervised injection sites in Vancouver, B.C., ground zero for Canada’s worsening opioid crisis that has claimed thousands of lives in recent years.

Like many workers in the field of harm reduction, Balian was an experienced drug user, but even he wasn’t safe from the supply that’s become increasingly tainted with highly potent opioids such as fentanyl and carfentanil.

For Dodd, who’s been a vocal harm reduction worker at the South Riverdale Community Health Centre in Toronto for years, the loss was unbearable on top of the countless other co-workers and clients she’s lost in quick succession. Balian used to provide guidance and support as she navigated her complicated and often frustrating work, which she says gets little recognition from most politicians and the general public who often despise drug users.

“I realized, wow, we are living in a nightmare, it was the kind of grief I can never explain,” Dodd told VICE News in the months following Balian’s death. She was already struggling at the time, having just lost two people from her Hepatitis C support group to overdoses.

“It’s constant grief and loss and trying to sort out how to take care of yourself, but you don’t even have time to grieve the last death before the next death,” said Dodd, who has been working overtime with low pay and few mental health supports. “After Raffi, I cried endlessly and had to go off work, there was no way I could … do my best work.”

Dodd said she also knew it was time to take a break when she started using benzodiazepines—medication for anxiety—to cope with all the losses. “I got myself off of them, and then had to deal with the fact that I can’t cope this way.”

‘COMING FROM ALL SIDES’

Amid all of this, Dodd and other healthcare experts are constantly coming up against municipal and provincial leaders who move slowly on providing the things they’ve been requesting for decades to help curb overdoses and deaths — including access to naloxone kits, mental health services, and affordable housing. The Ontario health ministry has repeatedly rebuffed hundreds of doctors, nurses, and advocates who have repeatedly called on the province to declare a public health emergency over the overdoses, something that would release much-needed funding and staffing.

Matt Johnson, another harm reduction worker at a clinic in Toronto’s west end, also says the crisis has left him burned out and grief-stricken like never before. Earlier this summer he lost another peer worker to a drug overdose, someone who was also a close friend. There seemed to be an especially potent batch of heroin going around at the time, and he was worried about clients and friends using alone — something that creates a perfect storm for a fatal overdose. The typical harm reduction techniques, like testing a small amount of the drug to start, just aren’t working like they used to.

“It feels like it’s coming from all sides,” explained Johnson, who was a heroin user and is currently on methadone. “It’s not like I can leave work and go to my safe suburban life where everybody I hang out with is safe and secure, it never fucking ends … I leave work and I’m talking to friends about friends who have overdosed and died.”

HELPLESS AND POWERLESS

The uncertainty has become so overwhelming for Johnson that he wishes he could turn to heroin, but the fear stops him. “Believe me, I’m super stressed out. I would love to use,” he said. “But if I die, what’s going to happen to the people I supervise.” Johnson took a short holiday in the hopes that it will help him recharge for the winter months.

“But we’re fighting against a system that is so much bigger than we are and feeling helpless and powerless,” Johnson explained.

Dodd returned home to northern Canada to decompress and returned to work a few weeks later. She and other colleagues planned a special memorial for Balian one hot summer afternoon on the roof of their office building, complete with a slideshow of their favourite photos of him and a buffet of his Lebanese recipes.

Dodd wiped away tears as she took the microphone to give a speech, a recitation of a piece Balian wrote for a local magazine in 2012 on the impacts oppressive drug laws. “We will win this war not because we are more powerful, but because we are all fighting for our lives,” Dodd read from a piece of paper as the crowd cheered.

In her own words, she concluded with a reminder of the never-ending death toll. “We’ve just had a fucking hell time,” she said. “We really have to take care of each other. While they do nothing, we have each other to do something. No more drug war.”