Harm reduction agencies are giving chronic alcoholics "beverage-alcohol" to stop them from drinking poison.
The type of booze Fernando Pacheco drinks comes with a dire warning label—"ingestion will result in severe gastrointestinal disturbance, unconsciousness, and death."
Pacheco, 50, a Portuguese Canadian who grew up in Vancouver and lives in the Downtown Eastside, consumes rubbing alcohol compound, a.k.a. isopropyl, on a regular basis. A "drink" for him is about one third of a 500 ml bottle mixed with water. The effect is practically instantaneous.
"It screws my inside out," he told VICE in a phone interview, comparing the taste to gasoline.
"Your brain and your body feel warm."
His skin flushed, tummy burning, and vision blurred, he said the high wears off quickly. Within half an hour, he typically blacks out.
"Two weeks ago, I lost my cell phone, my house keys, my laundry that I got cleaned... I wound up in jail."
Pacheco is a member of the Eastside Illicit Drinkers Group for Education, a subset of the Vancouver Area Network of Drug Users. The group is currently seeking funding for a Managed Alcohol Program (MAP), a form of harm reduction that provides chronic alcoholics with booze in order to stop them from drinking "illicit alcohol" such as rubbing alcohol, mouthwash, hand sanitizer, rice wine, and hairspray.
A patchwork of such programs exist across Canada, with addictions advocates in cities like Calgary and Vancouver lobbying for more.
The purpose of a MAP isn't to get people off drinking (though that's sometimes a positive by-product), so much as it is to halt visits to jail, the hospital, injury, and death, all of which are more common when non-beverage alcohol is a factor.
"Someone going through a 500 ml bottle of rubbing alcohol in a 24 hour period is the equivalent of drinking 30 beers," said Coco Culbertson, a director of programming with the Portland Hotel Society (PHS).
Hand sanitizer, mouthwash, and rubbing alcohol are cheap, easy to obtain, and get a person drunk very quickly—a bottle of rubby costs around $5 [$3.75 USD] and can be up to 90 percent alcohol—which makes them appealing to addicts. One EIDGE member told VICE that crews regularly hit up hospitals to steal large quantities of hand sanitizer, known on the street as "gel." The problem is so common in the Downtown Eastside, residents say local corner stores have jacked up the prices of products like Listerine.
The PHS, a nonprofit organization that once sold crack pipes via vending machine to curb the spread of HIV and Hepatitis C, runs two programs in the area to help severe alcoholics refrain from drinking these more toxic forms of liquor.
One is a pilot residential program, through which 12 people are given shelter and are prescribed 12 doses of alcohol under doctor supervision, not unlike the way a heroin addict would receive methadone. The other, less formal in structure, is a brewer's co-op. Around 130 participants are now involved in the latter; $10 [$7.50 USD] a month allows them to brew several liters of beer or wine. Twice a day, groups gather to mix and bottle their own stuff, which they can take home.
An exchange component allows people to swap hand sanitizer, rubbing alcohol, etc. for drinkable booze.
Once a week, members have a "drinker's lounge" meeting, said Culbertson, where they can socialize, find support, and discuss harm reduction. It also provides an opportunity to mourn peers who have died—a sad but fairly common occurrence amongst this demographic. Over at EIDGE, 40 members have died in the last four years alone.
"The folks we're dealing with are already on a serious trajectory of illness and death," Culbertson said, noting it's not uncommon for people in PHS buildings to overdose. Many are indigenous and have a history of trauma or are survivors of the residential school system.
Brewmaster Tyler Bigchild, 35, grew up off reserve in Red Deer, Alberta, drinking heavily from the age of 13. His mother, who would take him to the bar with her when Bigchild was a teen, and his aunt both died of alcohol-related illnesses, he said, adding the only time in his life he's ever been sober was when he was in prison; he's spent around six years locked up for crimes like car theft.
At his lowest point, Bigchild, who drinks from 10 AM until he goes to sleep, said he would resort to drinking rubbing alcohol, sometimes just to get over morning withdrawal. He takes prescription drugs to stop from shaking.
"When I drink compound, it looks a lot like iced tea. It's not bad, you mix it with juice."
But, in addition to his deceased family members, he can easily list the names of three friends who recently died due to chronic alcoholism.
While research on the effects of drinking illicit alcohol is limited, one study, published in the Southern Medical Journal in 2009, said the minimum dose of isopropyl alcohol necessary to kill an adult is just 100 ml (about two shots), but that death and kidney failure from ingestion is rare.
Due to lifelong use, many PHS clients are in stages of liver failure, have diabetes, pancreatitis, brain injuries (falls can be very extremely dangerous when highly intoxicated), and suffer from severe withdrawal symptoms without access to booze, causing seizures, Culbertson told VICE. At its worst, alcohol withdrawal can be fatal.
The illicit products most commonly consumed all advise calling a doctor or poison control center in case of "accidental ingestion" and the non-alcoholic chemicals they contain can be particularly rough on the stomach.
Alberta Health Services said there were around 80 emergency room visits in Calgary the last few years due to poisoning from toxic substances like mouthwash, though the numbers do partially take accidental ingestion into account.
Additionally, because of its consistency, drinking hand sanitizer without diluting it properly can result in choking—something that recently happened to an EIDGE member who subsequently died.
The University of Victoria and Vancouver Coastal Health are in the midst of studying the impact of managed alcohol programs across the country. Speaking to VICE, lead researcher Tim Stockwell, who is also director for the Center for Addictions Research of British Columbia, said early indicators are positive.
He cited an inpatient program at Shelter House in Thunder Bay, Ontario, where 15 residents receive six ounces of white wine every 90 minutes, from 8 AM to 11 PM. It's enough to keep withdrawal symptoms at bay without getting people wasted.
"One of our main findings was... MAP participants tended to be doing much better than the controls in terms of how many police contacts they had and how many hospital admissions they had. ER visits were much lower for the MAP residents," Stockwell said.
Brad King, who manages Shelter House, added withdrawal services have been reduced by 88 percent.
But he said the MAP concept isn't without controversy.
"People say, 'Are you enabling substance use?' We're enabling access to food and shelter and medical care and addictions care as people need them."
Mark Townsend, former executive director of PHS, told VICE programs like this often get "bureaucratized" when the government gets involved, but the reality is they should probably remain informal. There are few happy endings, he said.
"This isn't a way of getting people off alcohol and not necessarily a way of saving their lives. They're probably still going to die."
Shelter House is always full and has a wait list. It and similar MAP programs, which also exist in Ottawa and Toronto, are the few options for homeless illicit alcohol drinkers, who aren't eligible for dry shelters. Many drink at bus stops, parks, under bridges, and on the street, where it's easier to get arrested, become victims of robbery and violence, or even choke on vomit and die without anyone noticing.
"I've been beaten up left and right," Pacheco told VICE. His most recent arrest took place outside of a Salvation Army in the Downtown Eastside. Blind drunk, he was told he was pounding on the store's windows and yelling, "Feed me!" The level of intoxication that comes from using rubby is much more intense than with regular booze, he said, as is the comedown.
"I can't consume food, I feel sick, I get the shakes, I sweat. It's awful."
Fellow EIDGE member John Skulsh, 55, told VICE for seven years he downed half a liter of mouthwash every day. He was compelled to stop after he gave himself second-degree burns while making a pot of instant noodles.
"I dumped the whole thing on my chest. I was by myself, I was so drunk," he said. "I was in excruciating pain."
Skulsh said he's been off mouthwash the last ten months but still routinely drinks beer.
EIDGE is calling for a non-residential MAP, to give users a place to legally hang out and drink indoors.
While MAP participants sometimes stop drinking non-beverage alcohol and reduce their overall liquor intake, they generally don't get completely clean—and that's not really the point, administrators say.
"What we're trying to do is ease some of the pain for these people and extend their life if we can," said Culbertson. "It's about being kind and re-humanizing a population that's been very, very ignored."
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