Since her brother Brad’s death from an overdose in 2015, Leigh Chapman has become an outspoken advocate for harm reduction. Photo by Kourosh Keshiri.

In August 2015 Leigh Chapman was working as a nurse at a summer camp in Georgian Bay when she received a text from her mother. It was about her brother Brad and the message was short, but devastating: “Brad has overdosed and is braindead.”

Leigh is the middle child of three. At the time, she had a complicated relationship with her older brother Brad, an experienced drug user who had lived through homelessness and incarceration. But despite their occasionally thorny bond, Leigh spoke of him with fondness and appreciation. To those who knew him, Brad was an affable, intelligent father of three with a talent for music. His friends saw him as a normal, decent guy who also happened to use drugs. “I think he remained hopeful even throughout the difficult times,” says Leigh. “He always thought that things would eventually get better.”

Through the texts and phone calls that followed, Leigh learned that her brother was at Toronto General Hospital. She hurriedly found a nurse to replace her and left the camp for Toronto, filled with dread. The hospital staff received Leigh and her family with bewilderment. Brad had been in the Intensive Care Unit for over a week as a John Doe and now, suddenly, a roomful of people were gathered at his bedside. From the hospital report, Leigh and her family learned that Brad had overdosed in an alleyway on Walton Street in downtown Toronto, which led to brain death due to “prolonged downtime.” He had multiple drugs in his system at the time of his hospitalization, including fentanyl, cocaine, and Levamisol, a drug used to treat parasitic worm infections and a common street drug adulterant. Police had arrived on-scene first before paramedics eventually came and took him to the hospital.

On August 26, 2015, eight days after he arrived in hospital, Brad died after being removed from life support. At first, Leigh and her family didn’t have any suspicions about the circumstances leading to his death. However, when the Chapmans connected with the detective on Brad’s case, they were unsettled by his attitude. He seemed more eager to discuss the various items of drug paraphernalia found on Brad at the time of his overdose than the circumstances that led to his death. Brad’s family pressed to understand why it took a week to identify him after his admission to the hospital, which the detective dismissed as a “mistake.”

“It was like it was no biggie,” Leigh remembers. “That was when the alarm bells went off. He didn’t care. We knew Brad got impeccable care in the ICU. We had no questions about his care. It was just that… when the police officer was so callous we thought, ‘You know what? Let’s get the records.’”

After an appeal to the Office of the Privacy Commissioner, the Chapmans gained access to all the documentation surrounding Brad’s case. When they read the details leading to his death, they were horrified. A hotel security guard had called the police communications non-emergency number requesting a well-being check for Brad who he saw in the alleyway and assumed was drunk. Brad was breathing and moving when the police first arrived, but the officers’ subsequent phone call requesting an ambulance was delivered as a casual suggestion. When Leigh and her family listened to the officer’s call to EMS, they were flabbergasted by the lack of urgency apparent in the officer’s tone and instructions.

Thirteen minutes later, the ambulance pulled into the alley. Both attending staff were Advanced Care Paramedics. Even from a distance, they instantly recognized that Brad was in serious medical distress. One observed that Brad appeared “purple and mottled.” The other said he looked “ashen.”

The paramedics immediately instructed the police to start CPR while they examined Brad and the surrounding area. That’s when they realized that Brad no longer had a pulse. For thirteen minutes, Brad had sat untouched in the alleyway under police supervision with his head slumped forward. Such a prolonged time in this body position — in a state of semi or unconsciousness — can severely impede the integrity of an individual’s airway. For Brad, a person experiencing acute medical distress and drug poisoning, such a position may have been deadly.

Today, in the midst of an overdose crisis that seized more than 4,000 lives in Canada last year, supporting the work of harm reduction is more important than ever.

Leigh and her family filed a complaint with the Office of the Independent Police Review Director (OIPRD). In February 2017 the OIPRD ruled that there was no police wrongdoing or negligence. The Chapmans disagreed. “He was moving and breathing when the police got there,” says Leigh. “He had a fighting chance. But of course, it was too long without oxygen to his head and he was braindead.”

For Leigh, Brad’s death was a preventable tragedy. It is also an illustrative example of why many public health experts believe that law enforcement has no place in the current overdose crisis. As agents of the state, police are viewed with suspicion and fear by marginalized communities, including people who use drugs. Distrust of law enforcement is widespread. And for people who need medical attention but fear punishment by the legal system, this distrust can be fatal.

***

In early 2016, I had the opportunity to work at a harm reduction agency during my graduate studies. During that placement, I had in-depth conversations with policymakers, frontline workers, and the diverse and abundant community of people in Toronto who use illegal drugs such as heroin, fentanyl, crack cocaine, and crystal meth.

Even then, two years ago, the overdose crisis was accelerating at a devastating rate across Canada, killing off whole communities of people in what many frontline workers describe as a massacre. As a public health researcher, the importance of harm reduction was clear: evidence, worldwide, shows that harm reduction services prevent the spread of communicable diseases, reduce accidental death, and increase referrals to community resources, such as detox centres. Furthermore, peer-reviewed research conducted by Martin A. Andresen and Neil Boyd in 2010 showed that supervised injection sites could save the B.C. provincial health care system more than 6 million dollars a year in social costs.

Today, in the midst of an overdose crisis that seized more than 4,000 lives in Canada last year, supporting the work of harm reduction is more important than ever. And those who know this crisis most intimately continue to name criminalization as a key driver of preventable death and suffering.

In Toronto, when someone calls 911 for a medical emergency, paramedics, fire services, and the police are all alerted. But some activists and health care workers are trying to end police presence at overdoses, which they say should be handled as a straightforward medical emergency, barring distinct extenuating circumstances. (Toronto Police Services did not respond to multiple requests for interviews).

In Canada, approximately one fifth of incarcerated adults have been imprisoned for drug-related offenses. Criminalization for drug use continues to disproportionately target and punish Indigenous, Black, LGBTQ2S and other materially deprived communities. For drug users and those who love and work with them, decades of experience with the police have created a deep distrust of law enforcement. This fear of prosecution inhibits people from seeking medical attention during an overdose. Experts say that decriminalization and ending stigma are two key points for stopping the overdose crisis.

The Good Samaritan Drug Overdose Act, passed last year, is supposed to protect people at the scene of overdoses from criminal prosecution. But the laws are not all-encompassing and cannot fully shelter people from legal consequences, even in the midst of a grave emergency. Whether or not people will avoid a charge of simple possession (protected by the act) or be charged with Possession for the Purposes of Trafficking (not protected by the act) is largely at discretion of police.

Through a freedom of information request, The Local/OpenLab obtained all 394 reports written by the Toronto Police Service for overdoses they attended in 2016. Though the documents are heavily redacted, there are noteworthy statistics. Police arrived on scene after paramedics for 45 percent of overdose calls and were recorded providing first aid at just one percent of overdoses at which they were present. They were not recorded administering Naloxone, the life-saving medication that can reverse the effects of an overdose, once in 2016. Police have now begun to carry the medication, which will hopefully prepare them for saving lives in future encounters with people who have overdosed.

Police frequently followed victims to the hospital to question them while they received medical care, asking them where they obtained their drugs. The presence of stigmatizing language throughout the reports is also striking. At least 13 percent of documents described people on scene as being “known users,” a “drug addict,” having a “drug problem,” or a “history of addiction.” Furthermore, at least 71 percent of overdose victims were not notified that reports containing details about information such as their drug use, their address, and officers’ impressions have been filed in the TPS database.Though 97 percent of Overdose Reports are classified either “Closed” or “No Further Action (Parked)”, these reports contain accounts of individuals’ drug use, which poses a significant risk for privacy and stigmatization during future interactions with the police.

Though the reports are written in the bureaucratic language of law enforcement, they paint a clear picture of police activity when responding to an overdose. People who use drugs face a high risk of imprisonment on potential drug charges and, during what is undoubtedly a disturbing ordeal, they are being confronted by members of the police force who largely do not perform first aid, ask them about the source of their drugs, and perform surveillance as they are recovering in-hospital.

“There is no trust from drug users to the police,” explains Tave Cole, a harm reduction worker who works at both a Supervised Injection Site and Overdose Prevention Site in Toronto. “Police have arrested people at overdoses. This is a huge problem for people who might want help when an overdose happens.”

***

In April 2017, Olympia Trypis overdosed in a schoolyard park. Trypis is 23 years old, a prolific and talented artist, and an active advocate for people who use drugs. After being revived by her friend through three doses of Naloxone, they walked to a nearby church before they called for medical attention. Police were the first to arrive on scene. In addition to the extremely sickening sensations that accompany withdrawal after taking Naloxone, she says she felt harassed by one police officer.

The officer entreated her to consider her mother and younger brother — people who could suffer in a “real” emergency while medical services were forced to attend to people “like her.” Once the ambulance arrived, the police officer spoke on her behalf, despite her protests, and physically forced her into the ambulance to the hospital.

“I didn’t like how they were touching my body and moving me around when I could do it myself,” says Trypis. “They were being rough and talking to each other about me, instead of addressing me.”

“What we hear from people over and over again is that having police around — even when police have the best intentions — scares them”

The police followed Trypis’s ambulance to the hospital, against her request, where they pressured her to make a statement incriminating her friend, under the suspicion that he was a dealer. After she refused, they lingered at the hospital and called for backup, resulting in four officers monitoring her, despite her clear and repeated protests. She says she was restrained against her will until her mother arrived at the hospital and insisted she be released.

Gillian Kolla, a PhD candidate at the Dalla Lana School of Public Health at the University of Toronto, has been working in harm reduction for over a decade. “What we hear from people over and over again is that having police around — even when police have the best intentions — scares them,” says Kolla. “Thinking that police will come means that they won’t call. That is a really big problem when you’re trying to intervene in something as large as the current overdose crisis.”

In Vancouver, advocacy efforts have led to an alternative protocol for police attendance at overdoses. Police do not routinely show up at overdose calls when people call for an ambulance and are only present in situations that pose a threat to public safety. Official police policy on overdoses recognizes that “overdoses are first and foremost to be treated as a medical health emergency.”

Tracey Mann, a social worker and manager at a harm reduction agency, says we’re at a critical juncture for policymakers and society as a whole. “In terms of public health, I think we’re in a really socially transformative space,” says Mann. “Harm reduction and other social movements have highlighted that a shaming and blaming approach to health concerns is not effective, nor does it bring us closer to our goals. We are in an epistemological shift as to how we’re understanding social challenges. We can’t look at them outside of a context of power.”

The overdose crisis is a public health issue that highlights the complex interplay of law, social determinants of health, and access to health care services. As drug use remains criminalized in Canada, police are obliged to prioritize law enforcement over the health of those who call them. This tension cannot be resolved without decriminalization. No one should face harassment, imprisonment, or lifelong stigma after experiencing an overdose or offering assistance to someone who has. To truly intervene in a crisis that continues to devastate Toronto, policy changes must be made to foster trust towards health and social services, while reducing the risk of death due to fears of institutionalized violence.

***

In the years since her brother’s death, Leigh Chapman has become a fierce advocate for harm reduction. It’s one way she has confronted her grief. On August 12, 2017, two years after Brad’s death, Chapman was one of a small group of volunteers who gathered in the southeast corner of Moss Park to construct Ontario’s first Overdose Prevention Site (OPS). The modest-looking tent in Moss Park was created by community members determined to calm the rampage of preventable overdose deaths. This collective act of civil disobedience had been percolating for months, as construction of government-sanctioned supervised injection sites lagged behind Moss Park’s need for services. Finally, concerned harm reduction workers could no longer comply with widespread institutional apathy. On its first day, after an afternoon of negotiations with law enforcement, the OPS received provisional approval and a tenuous assurance that the OPS would be a “police-free” zone.

As of early May 2018, 212 overdoses had been reversed and 7725 injections have taken place onsite. The OPS will soon move from the lawn of Moss Park. As an approved recipient of Ministry funding, it will be move indoors to Sherbourne and Queen beginning in July. For Chapman, the success of the OPS means something more. She and her family are still working to establish a better understanding of the circumstances of Brad’s death through a Coroner’s Inquest. But, she says, she knows her brother would be proud to have contributed to such a monumental development in harm reduction advocacy.

Thank you to Leigh, Olympia, Tave, Caitlin, Gillian, Tracey, Akia, Peter, Aaron, Kristin, and Emily for sharing your knowledge and experiences with me for the purposes of this article.