In 2016, the BC government declared the opioid epidemic a public health emergency. Since then, more than 3,600 British Columbians have died from drug overdoses and poisonings. While the BC government and health authorities look for ways to mitigate the impacts of the crisis and reduce deaths from drug poisonings, on average three people continue to die every day in BC.
Years-long efforts led by grassroots groups and those with lived experience to reduce the harms of the “war on drugs” has led to calls for significant harm reduction services and the decriminalization of illicit drugs. Perhaps even more important, this intensive grassroots advocacy has also led to calls to stop criminalizing people who use drugs.
While the crisis has focused on the impacts on men, women make up about 30% of overdose deaths in the province. Looking at the statistics alone can obscure the gendered dimensions of the overdose crisis, which are largely under-examined and under-reported, including the varied ways that women, transgender, two-spirit, and non-binary people experience the epidemic.
The intersections of social location can constrain access to health services, particularly among those negatively impacted by intersecting marginalizing forces (e.g., gendered violence, racialization, transphobia), yet, under the constraints of prohibition, women and gender-diverse-focused and culturally responsive harm-reduction initiatives continue to remain under-prioritized and underfunded.
In fact, women and those who experience multiple intersecting forms of marginalization and discrimination face unique and additional barriers in accessing the harm reduction and health care services that do exist. In the recently published Red Women Rising, women contributors cited a lack of safe consumption sites for Indigenous women, long waitlists for treatment, and a lack of trust in the system as just some of the barriers to accessing health care and harm reduction services.
A journal article published in earlier this year examines the relationship between gender and the overdose crisis. This is a particularly important lens, write the authors, “given that drug use is gendered, with research demonstrating that women—especially marginalized women and gender-diverse persons—are differentially impacted by drug-related risks and harms in comparison to cisgender men who use drugs. This includes increased vulnerability to physical and sexual violence, HIV and hepatitis C transmission, and injection-related harms.”
Photo Credit: Tobias Tullius on Unsplash
Recently, I had a chance to connect with the senior author of that 2019 article to find out more about how the overdose crisis uniquely impacts women, trans and gender-diverse people. Jade Boyd, PhD, is an assistant professor in the Department of Medicine at the University of British Columbia and a research scientist with the BC Centre on Substance Use (BCCSU), a provincially networked organization with a mandate to transform substance use policy and care in BC with an integrative approach to evidence-based education, research, and care. (Full disclosure: I’ve known Jade personally for many years and count her as a close friend.)
In her research, Jade draws upon qualitative, ethnographic and community-based methods to examine social, structural, and environmental factors that impact people who use drugs, with particular emphasis on how gender—intersecting with race, class and sexuality—influences drug policy and practice. In her role with the BCCSU, she collaborates with local and national peer-based, drug user-led groups, as well as leads a program of qualitative and community-based research activities investigating drivers of drug-related harms among women, including barriers to harm reduction and the criminalization of women who use drugs.
Over email, Jade shared a little bit about her research and the challenges faced by women and gender-diverse people who use drugs in the context of the overdose epidemic.
Question: Can you share a little bit about what drives you to do this work?
A: I’m interested in social justice, and this drives all of my work.
The wonderful researcher Jade. Photo Credit: BCCSU
Question: What is the most pressing issue or broad/major challenges facing women and gender-diverse people who use drugs today?
A: I think there are a range of issues impacting women who use drugs, as women and gender-diverse people are differentially impacted than men by drug policy and harm reduction initiatives. Marginalized women who use criminalized drugs continue to experience racialized and gendered forms of social and legal discrimination.
Right now, we need to pay attention to these differences as we contend with overdose epidemics increasingly driven by a drug supply poisoned with illicitly-manufactured fentanyl and related analogues.
The intersections of social location can constrain access to health services, particularly among those negatively impacted by intersecting marginalizing forces (e.g., gendered violence, racialization, transphobia), yet, under the constraints of prohibition, women and gender-diverse-focused and culturally responsive harm-reduction initiatives continue to remain under-prioritized and underfunded.
This is significant as Indigenous women in BC, for instance, are disproportionately impacted by the overdose crisis. Yet we know that Indigenous and racialized women, as well as transgender people can experience some overdose interventional settings, such as overdose prevention sites, as discriminatory.
Criminalization, stigma, lack of childcare and the threat of child apprehension, as well as gendered and racialized violence remain constant barriers to marginalized women who use drugs accessing drug and health services.
Photo Credit: The Gender Spectrum Collection
Question: Can you share some of the ways in which gendered violence show up in the context of substance use?
A: There are many ways that gendered and racialized violence manifests in the context of substance use.
One way is through the governance of women who use drugs’ reproductive and maternal rights, who are dominantly perceived as unfit mothers. Another way, on a more micro level, is through everyday interpersonal violence that many women described as made worse by the overdose epidemic.
Many women I spoke with [in my research] described initially feeling more rapidly intoxicated with fentanyl-adulterated drugs than they were used to, and expressed fears that this amplified both their risk of overdose death but also their vulnerability to predatory violence—particularly Indigenous, transgender and/or unhoused women.
Unfortunately, gendered and racialized violence can also extend into service setting. Women I spoke with emphasized predatory violence, in particular, as interconnected to their experiences of overdose-related risk. And I think this is inseparable from, and interconnected to, Vancouver’s recent history of male and state violence against poor, Indigenous women and girls, as well as sex workers and women (including transgender and gender-diverse people) who use drugs.
Drug user groups, activists with lived experience of drug use, and their allies have really led the way, historically and currently, in mobilizing to address drug-related harms, including overdose, exacerbated by the criminalization of particular drugs and people.
Question: What’s been the impact of safe consumption sites, especially SisterSpace, on the harms of the overdose epidemic?
A: I think SisterSpace is a vital intervention in a context where women who use illicit drugs are both criminalized and marginalized [who are] contending on a daily basis with the intersections of state, social, and interpersonal violence.
It is a low-barrier, comfortable, non-medicalized, women-centred and gender-diverse environment with a diversity of staff with lived experience of drug use enabling knowledge sharing among women using the site, increased control over their drug use (women are not told how or with whom to consume their drugs), and a reprieve from male-violence and police encounters. These things enhance the accessibility of this life-saving service for some women who feel their safety is jeopardized in mixed-gender spaces.
Question: What would solidarity from the feminist legal community look like? And what, if anything, gives you hope?
A: There remains an urgent need to reexamine how drug laws and policies contribute to the overdose crisis, including increased attention to how gendered discourses on drug use, and the intersection of factors such as poverty, criminalization, systemic racism, gender inequality and transphobia, structure the lives, as well as the deaths, of women who use drugs.
This is one area where the feminist legal world could provide invaluable support. Drug user groups, activists with lived experience of drug use, and their allies have really led the way, historically and currently, in mobilizing to address drug-related harms, including overdose, exacerbated by the criminalization of particular drugs and people.
Without ignoring the suffering that women experience, I think it is their amazing perseverance, strength, resiliency and empathy, even amidst substantial marginalizing forces (e.g., poverty, colonialism, an overdose crisis), that provides hope.
Photo Credit: Pixabay
Thank you Jade for sharing your research and reflections. The overdose and drug poisoning crisis requires more than one-size-fits-all solutions that take into consideration the health, social, and human rights implications for those already marginalized as a result of the enormous failures of our drug laws and policies. We must acknowledge and examine the ways in which drug prohibition, misogyny, racism, classism and ableism combine to create the conditions for this epidemic to continue. An intersectional approach that increases access to harm reduction services and overdose prevention sites is critical if we want to address the severe harms of the epidemic experienced by marginalized communities.
For information on consuming drugs safely and harm reduction services in BC visit:
https://towardtheheart.com/
Basya Laye is director of development and engagement at West Coast LEAF. She has strong interests in public health, inequities in health care, ending the war on drugs and decarceration.