Shohan Illsley: Harm Reduction and the Fight for Dignity

Stuart Murray  0:00  
This podcast was recorded on the ancestral lands, on treaty one territory, the traditional territory of the Anishinaabe Cree, Oji Cree, Dakota and the Dene peoples, and on the homeland of the Metis nation.

Amanda Logan (Voiceover)  0:20  
This is humans on rights, a podcast advocating for the education of human rights. Here's your host, Stuart Murray,

Stuart Murray  0:30  
on this episode of humans on rights, we shine a light on the Manitoba harm reduction Network, an organization working in the front lines to support people who use substances reduce stigma and build healthier, safer communities. Their work is about compassion, dignity and meeting people where they're at. Today, we'll explore how harm reduction is saving lives and creating pathways to hope. And my guest on this episode of humans on rights is Shauna Ilsley, the executive director of the Manitoba harm reduction network. Shauna, welcome to humans on rights. Thank you. Thank you for having me so Shauna, one of the things that I always try and do at the outset of the podcast to just say, you know, can you introduce yourself and explain a bit about what you're doing, please.

Shonan Illsley  1:18  
I'm a settler here. I come from Iceland and England and Scotland. And my family came here, you know, 18 my Icelandic family came here, 1875 so I've been on these lands for a little while now. My ancestors have been on these lands. I was raised in treaty five territory up in the Paul Pasquale Cree Nation and Churchill Manitoba. And I reside here in Winnipeg with my family, and I've been here since 1996 so I've been down here as a guest in treaty one for many years. And I grew up in an environment where people use substances and raise their children and were great parents as they use substances, and all of the folks in my life had different varying degrees of relationships with their substances, and so I think that's important to share looking at what's brought me to this work. So I've had many family members who have had substance dependence or substance use disorder, and I've had family members who have moved through their life with their relationship to substances, sometimes going from a place of being problematic to now not using at all, and that includes many different substances. So I think it's really important to acknowledge those teachers in my life that have brought me to this work and continue to teach me in this work.

Stuart Murray  2:29  
So excellent and so so, you know, with that kind of introduction, Shauna, just explain sort of what you do your role at the Manitoba harm reduction network, and then we'll get into some of the specifics, some of the programming, some of the opportunities, and particularly some of the education that I think has to happen with the conversation around harm reduction. So So over to you. Just give us a sense of of what it is that you're you're doing at the Manitoba harm reduction network.

Shonan Illsley  2:56  
Please. Yes. So we are a provincial network, and so we have 11 sites in the province. 10 of those sites are rural, remote. Brand is included in that which some people identify Brandon as urban. So we have a site in Winnipeg, Brandon, and then our more rural sites, of course, are Thompson, flim Flon, the paw, Swan River, Dauphin portial prairie, Asher Selkirk and pine falls and then Brandon in Winnipeg in addition. And so our intention is to improve access to services for people who use substances throughout the province, and we do that by coordinating local harm reduction networks, which is made up of service providers who work with people who use substances, as well as what we call peer advisory councils, which is made up of people who use substances locally and are impacted by colonial and structural harms like manufactured poverty, homelessness, things like that. And the peer Advisory Council folks are folks who are focused on improving access for for themselves in their communities around harm reduction, but also things like housing and health care, and all of the things that we need in order to improve our health outcomes, to reduce harms related to their substance uses or our substance uses, because the research shows anywhere from 80 to 90% of people have used illegal substances in their lifetime. And so it's really important that we recognize that for many of us, we had varying supports throughout our life to help us around our substance use, but there's some folks who haven't had those same supports to support them around their substance use. So our intent as a network is to figure out, how do we support people in a really meaningful way to reduce harms related to their

Stuart Murray  4:38  
substance use? Yeah, and you know, it's, there's a lot of conversations about safe site or safe injection sites, and conversations around that Shauna. I wonder if you could just maybe explain, you know, from your perspective, why the work that you're doing through the Manitoba, harm reduction the network. And I really would maybe focus a bit on when. Peg, but we can focus on Manitoba. Why is is the work that you're doing so important here in I'll just say Manitoba,

Shonan Illsley  5:07  
we are one of the, I think one of the reasons it's important is because we are one of the few provincial organizations that are doing some harm reduction work outside of Winnipeg. We know the Regional Health Authorities also participate in that, but having local networks, we every single one of our communities, are impacted by having relatives who are struggling with their substance use, whether it be, you know, experiencing harm, not not being dependent on their substances, but using substances and experiencing harms like a toxic supply, which it's really important that we recognize. We have lots of folks who we have lost to a toxic drug supply, who did not have substance use dependence and did not have substance use disorder. That includes like young people. You know, we've had 17 year olds who have who have unfortunately died due to due to a toxic drug supply. Last year, our numbers were 570 people in this province who died of a toxic drug supply. The year before was 571 our numbers since 2014 is over 3000 people who have died of a toxic drug supply. And so when we're doing our work in rural and remote Manitoba, one of the one of the goals of harm reduction is to keep people alive, and that means responding locally to toxic drug supplies, but it also means responding locally to other harms related to problematic substance use or substance dependence. And so how do we do that without engaging the people who are most impacted by that? Right? So that's part of the importance of our work. Is that we have, I think our last time I looked at the number, we had over 800 people in the province engaged, and those are folks who do have problematic substance use and impacted by homelessness and manufactured poverty. And so how do we know what folks need? We need to talk to the folks who are living that life and have them lead the interventions.

Stuart Murray  6:54  
Shawnee, you mentioned toxic substance explain that, please. What do you mean by that?

Shonan Illsley  6:59  
That's a great question. So I'm going to back us up a little bit to talk about this toxic supply. So previously, we had folks who are using opiates, and they had a safe supply of opiates, which was a pharmaceutical grade opiate, and when that opiate, mainly oxycodone, was taken off the market in 2013 I believe it was, it created an environment for illegally manufactured opiates to hit the market, and illegally manufactured opiates are not regulated in the same way, of course. So it means we don't know the potency. We don't necessarily know what's in it. And you know, Stuart, I'd like you to think about going to the Liquor Mart, and there be no labels on any of the alcohol in the Liquor Mart, we wouldn't know what was in it. We wouldn't know the potency. And then we start to see that there's some real significant risk to that. And as we fast forward the illegally manufactured fentanyl, we know are we done some testing, and we keep continue to test the different substances we are seeing on the streets, and they're not necessarily report or we're not necessarily finding them to be what they're reported to be. And so there's some adulteration happening, which is usual in a illegal market. For that to happen, not usual, I shouldn't say it's usual, but in the context of having a pandemic that shut down borders, and then having the War on Drugs amped up, it's something we would expect to see when people aren't getting a regulated supply. And so when I talk with toxic supply, it means that people are using a substance that they don't know what it is anymore. So when they were using an opiate back prior to 2013 they knew what it was. It was a regulated pill that they knew exactly what they were getting. Fast forward to today, people are purchasing from the illegal market, and they don't know exactly what they're getting. So when we refer to a toxic drug supply, that's what we're referring to, is people not knowing what they're getting and not knowing the potency of what they're getting.

Stuart Murray  9:00  
Yeah, and Shauna, is there an opportunity and just that, you know, I think I mentioned to you, just before we went on air, that, you know, my daughter just did her PhD thesis and defended her topic was that young people recreational drug use and safe practices in a changing world, you know, really sort of talking about taking harm reduction to a level that is part of everyday conversation. And you know, one of the things that they have in the Netherlands is the ability for people, particularly if they're going to festivals, to actually go to a place and test what it is that they purchased. Is that part of the conversation here Shauna that you're having with the provinces or how like, for example, when you you so eloquently said the transition from a prescribed opiate to something that's on the street. I mean, the whole point of harm reduction is for people that are addicted or use a substance. They should have every ability to know what it is they're. Using just like you used with the liquor store example. Is that part of the conversation in terms of allowing people to check what it is that they've purchased?

Shonan Illsley  10:08  
Definitely Stuart so so we know, in order to address this toxic drug supply, people need to one have access to a safe supply. That's where we're falling short. They have to be able to test their drugs so they know what they're using. And we do have a few drug testing options here in the city, outside of Winnipeg, maybe Brandon has one now, but outside of Winnipeg, as far as I can recall, there's no drug testing available yet other than drug testing strips. So we have two kind of options. We have drug testing strips, which there's a bit of a science to administering. Those ones to find out. And those ones really are limited to fentanyl. There's a little bit where you can test for benzos as well. But again, there's a bit of a science, so you have to be prepared to do those correctly. And then there's the FT IR machine, that is a machine where you could put a small sample of your drug into that, and that are onto that, and then it will tell you exactly what's in it. And that machine, we do have that machine available, Mops, Sunshine house, the mobile sunshine house, yeah, as well as Nine Circles Community Health Center here in the city, and we're hoping to expand and work with the province to expand sites for that. So drug checking, absolutely is part of it, but we also know in order to respond to the drug poisoning, I said, safe supply, I said, drug checking. But we also need really robust access to Naloxone so that in the event that somebody experiences an overdose, we can respond and reverse it. But of course, along with getting Naloxone out there, people have to be trained in how to recognize an overdose and also how to create safety in the environment, so that people there's somebody monitoring folks for an overdose. And then, in addition, safe consumption sites. We know safe consumption sites are well grounded in evidence to prevent drug poisonings and overdoses. And in fact, to date, we opened up the first safe injection site in North America in 2000 I believe it was in Vancouver, and of course, that's insight, and we have had additional safe consumption sites since then. And even though, at safe consumption sites, we can have folks experience an overdose or drug poisoning, we've still, to date, had zero people die in an overdose or sorry in a safe consumption site. So it saves lives. And at the end of the day, we love our relatives and we want them to live. And if people, if people die, we can't help them anymore, right? So we need to keep people alive until, and if ever, they're ready to adjust their relationship with their substances. And

Stuart Murray  12:32  
just a, you know, one of the thoughts, if somebody was listening and wondered, Shauna, if, yeah, if I reach out to get this, am I going to be arrested because I'm carrying something else that's illegal, you know, or, you know, just, I mean, there's, it's that trust issue, right about, how can I make sure that what I'm getting information for is is really all about harm reduction, not about, you know, finding if somebody is using something illegal.

Shonan Illsley  12:57  
I think that's a great piece that we have to add to the analysis Stuart is that we're talking about a behavior that has been criminalized. And so when a behavior is criminalized, it means many folks will not reach out for resources or support around it, for fear of them themselves being criminalized. And of course, once people are criminalized, it has some pretty astronomical impacts, particularly if you're a parent, or if your job, if you have a full time like there's lots of potential harms to come out of criminalization. And we know here in Canada, we do have a war on drugs that continues to criminalize people, you know, around their substance use. And so what I can say is that if people connect with the Manitoba harm reduction network, it certainly is confidential and private information, and we definitely do not report any of that to police, but also people, just because people reach out doesn't mean they actually are using substances or that they have substances on hand. But I really think it's important to recognize that that criminality is also the very piece that leads to many people who have loved ones who use substances to perpetuate that discourse that all drugs are bad, and people who you know ultimately that leads to the narrative that people who use drugs are bad. And I really want to be clear that the Canadian Center for Substance use and misuse regularly does a alcohol and drug use survey in Canada, they just have launched it again. I just got a call a couple weeks ago to fill out my survey, and what they did in 2019 was the last time they did the big one. And they talked to 15,000 people, and of those 15,000 people, 51% reported that they had used an illegal or illicit substance in their lifetime, and it is suggested that that number is under reported. Now at the Manitoba harm reduction network, we do harm reduction training, and in our training, we ask everyone in attendance if they've ever used an illegal substance in their lifetime, and in our. Data, 82% No, it's up to 83 83% of people reported that they have used an illegal or illicit substance in this province that have attended our training. And important to note that the people who have attended our training are health care providers and social service providers the majority. And so the issue is really a complex one, because we all are impacted whether we use use, or have used an illegal substance, or we have loved ones who have used it. So, so when we add criminality to it, it, of course, creates distrust in in people accessing services. So Should people be worried? You know, depends on who they're going to go talk to about their substance

Stuart Murray  15:42  
and, you know, just a couple of comments about, you know, the issue about decriminalization. You know that that's such an important part of this conversation, Shauna, because I think a lot of people would sort of say, wait a minute, I just went to a cannabis store. It's legal, so I bought it. It's legal. What's this issue between a product that's legal and decriminalization? Can you just put that into perspective at the impact that it has?

Shonan Illsley  16:09  
I want to touch on the legalization of cannabis. Prior to the legalization of cannabis, people were purchasing an elite from the illegal market, and when people purchase from that illegal market, they did not know the potency of the cannabis they were getting. They also didn't know if there potentially could be something else in there. We don't have evidence there was anything else in there, which is important for me to say, but, but still, people didn't necessarily know. And what we also know is that when a substance is illegal, the potency is higher. That is the nature of a criminal market is that, and it was that what we saw during prohibition of alcohol, when you no longer could get four or 5% alcohol, and you could, in fact, you didn't know what the potency was, but we know it was anywhere from 70% and higher. When cannabis got legalized, we now can go into the cannabis store and one, we're getting a regulated, safe supply. And two, we also get to now decide on the level of intoxication or high that we want to have, and how we want to get that high, whether it's smoking or ingesting, you know, through through edibles or drinking or any other way that folks might or, you know, like oils under your tongue. Like there's lots of different modes. Now, what we also know is that people can people are selecting lower dosages. Of course, there's some people who want a higher dose, but in general, people pick a lower dose. Just like when, when prohibition of alcohol ended, people went back to drinking 4% 5% 8% alcohol, and we're no longer drinking 70% with cannabis. We see people having lower doses and micro dosing with cannabis, which you couldn't do in an illegal market. And so that, of course, overall, infects affects levels of intoxication. So really important we we recognize that the D, the legalize and regulation had some benefits there. But was it perfect? Absolutely not. There's lots of challenges with it as well. In the context that we legalized, but going back to decriminalization, Portugal did decriminalize, and they decriminalized across the board, for all substances. And what that has resulted in is that 70% of people in Portugal who have challenges related to their substance use are connected to health and social services in Manitoba or in Canada, we are nowhere near 70% of folks who are having challenges. When we decriminalize it, we also destigmatize it, and so it means that people, the second they're starting to have some harms related to their substance use, are comfortable, just like we were talking about earlier, comfortable going to a healthcare provider or social service provider and saying, I need some support related to my substance use because I don't have a fear of being criminalized now, and I know that the system is set up to help me around my substance use.

Stuart Murray  18:51  
Yeah, no, appreciate that. I mean, under this, you know, sort of with this podcast, Shauna that air Sean, I should say that's perfect. I mean, just to give us a bit of a sense, right, if people want to get more information, they're going to be able to do a deep dive into what the Manitoba harm reduction network is doing, and we'll let people know how to do that. But I guess, look, you know, the question is, just from your perspective, you've got a network across Canada, you've got a network here in Manitoba. Maybe it's broader than Canada, but just to bring it home to Manitoba and Canada for a second, Shauna, do you get a sense that there's a conversation around decriminalization. Do you hear anything about that? Or do you have a sense that they're moving in that direction, in any

Shonan Illsley  19:27  
way, shape or form? Um, I don't think they're moving that way. BC, had just had an exemption which they were decriminalized. They decriminalized small, small amounts of illegal substances, and they have now pulled back on that, I would be hopeful that we would start to look at decriminalization and regulating a safe supply across this country. But I don't think we're, I don't think we're there,

Stuart Murray  19:54  
got it, yeah, fair enough. I mean, there's again, you know, one of the things that I try to do with this podcast, the. Shauna is to have people like you on to talk about the education, the advocacy, where, you know, where the where the issues are, you know, I'd like to kind of jump into the issue of, you know, open supervised consumption sites. I know there's a conversation around that I know. Again, you know, try to steer away from the politics of this thing. Just talk about the realities of it. You mentioned the fact that there was one opened in Vancouver. And did you say 20 years ago?

Shonan Illsley  20:26  
Yeah, in 2000 that one opened. So 20 insights been open, I guess 25

Stuart Murray  20:31  
years now. And you mentioned there's been no fatalities on that site, yeah,

Shonan Illsley  20:37  
and any because we have safe consumption sites across the country. Manitoba is the only province west of Quebec that does not have a safe consumption site. We, the premier mandated, mandated a safe consumption site in October of 2023, and of course, we know that that's something that the community has been working with the government to move forward. We definitely are hopeful that a safe consumption site will be opening here soon.

Stuart Murray  21:04  
Yeah. So here's kind of one of the things, right, Shauna, is that people you know that aren't necessarily listening or or getting a sense of understanding of the situation, the top line when you hear that, it's like, oh, well, that's just gonna encourage more people use drugs, right? And so people go, Yeah, I guess. So it's some kind of a safe consumption site. Seems like it would. Why is that such a myth?

Shonan Illsley  21:28  
One people are already using drugs, and we don't have safe consumption sites, right? So it's already happening. The intent of a safe consumption site, the main goal of safe consumption site is to stop people from dying. We are in a drug poisoning crisis, and we need a way to stop people from dying, and a safe consumption site has been proven to do that. And in fact, insight when, and this is old research now, but when insight first opened, they they a ton of research was done, of course, and they found that insight had reduced drug poisoning deaths in the 30 block radius by 30% I think it was by the second year of insight opening. And so when we think about a safe consumption site, and when people say, well, then everybody's just going to come and use substances at a safe consumption site, there's a couple key things about it. One is that we want to put a safe consumption site in spaces where people are already using substances outside. So it means it's a community where there's already substance use happening, that substance use is outside. And what the research shows is that if we can move that substance use indoors to a safe consumption site, it will do some pretty profound things for that community. One, it will reduce public drug use. Two, it'll reduce publicly discarded drug paraphernalia. Three, it actually lowers public intoxication in the community. Why? Because when people use in a safe consumption site, they then can stay in a safe consumption site for 20, 3040, minutes, and so by the time they're in the time they're in the community again, their level of intoxication is already going down. And so it reduces some of those The other thing it does that's really key is that, and why it has to be where public drug use is happening, is because the evidence shows it impacts a 30 block diameter, a 15 block radius, which means people aren't going to come from other communities to use substances there? Why? Because people in other communities already have a safe place to use their substances, right? It's really about impacting the community where people are already using substances.

Stuart Murray  23:30  
Let's just talk a perfect world for for a second. How many safe consumption sites would make sense in Winnipeg, just when you look at sort of, you talk about, sort of the 30 blocks, the 15, you know, the radius, you know, I mean, again, I think there's a stigma that it's only happening in one area.

Shonan Illsley  23:48  
What we would want to do really, Stuart, is we want to look at what the data is telling us. So where are, where is fire? Winnipeg fire paramedic responding to outdoor substance use and overdoses. Where is that happening? And those are the areas where and there, there potentially could be more than one. What we also know is that we need a brick and mortar safe consumption site, but we also need other safe consumption services in other areas of the city. So maybe we don't need a safe consumption site, but we do need some support for people to come and get support around their substances. So many organizations now have safer bathroom policies because we know if people are impacted by homelessness in that neighborhood, or have an unsafe home to use substances in, or they just don't want their loved ones to know that they sometimes will use in a bathroom at a social service. And so how do we then make sure that they're safe and everybody is safe in that social service if people are using substances in the bathroom. And when I say when everybody is safe is that if somebody is unconscious in the bathroom, we want to make sure everybody in the environment is safe.

Stuart Murray  24:50  
I talked to a fellow who had worked at insight in Vancouver. He's here now in Winnipeg, and he I had a. I had him sort of speak to a panel of people that were part of the business community, just to share his experience. And one of the things I think that's going to open people's eyes is when you said, you know, when I worked at the safe consumption site, he said, I was a user. I don't use now, but he said, I just want to share with you that some of the people that were coming in to use that safe consumption site where lawyers, members of the Canadian Football League, sports, athletes, etc, you know, to the point Shauna, where I think a lot of times again, the stigma is, who's using, you know? And I know that, you know, you talk about the the notion that, that, you know, I mean, culturally, I think a lot of people look at, you know, this is a First Nations, or it's a certain community that's using and I think, again, the education of this element is so important to understand that it's not just a specific area or a specific culture. It is broad in its in its mandate, and it touches all sorts of lives. And I guess, you know, when I think about the work that the Manitoba harm reduction network does, how can you get that message out that, you know, this is really about touching. I mean, it's about the compassion and the dignity of people's human lives. And it's not about, you know, sort of targeting a demographic of a community,

Shonan Illsley  26:22  
we know that every single community there's substance use. In every single community, and in every neighborhood there's substance use, whether it's methamphetamines or cocaine or crack or alcohol or other substances. We know it touches every single community, and we also know that some communities experience more harms related to their substance use. So even if we think about substance use dependence or substance use disorder, which that's what it's called, now used to previously be labeled addiction, we we've broken that down because we know addiction is not it's so much more complex and complicated than and more nuanced. But when we're looking at substance use disorder and substance use dependence, we know that for our relatives who do experience that, it's quite complex. It's connected to mental health, it's connected to adverse childhood experiences, it's connected to unresolved trauma. And when I talk about mental health, I'm talking about like untreated, often undiagnosed, mental health challenges. So we know that, for example, we know that meth isn't the problem. We know that alcohol isn't the problem. We know that people's mental health and wellness is where the challenges are stemming from, as well as added for some of our communities, adding in structural and colonial violence. So we know institutions create some harms for some of our relatives. And if you're already using substances and having challenges with your substances, those systems then create further harms. So for example, if I experience substance dependence and I go to access the healthcare system, we know I'm not treated well in that system. So now I'm going to have more harms related to my substance use. Why? Because I can't access I can't access the healthcare system to get supports around my substance use right, whether that means an infection or whether that means even having a pneumonia. You know, because my my substance use and the way I've been treated around my substance use means I'm not even going to access we know across all segments of society, there is substance use. We know across all segments of society there is problematic substance use and substance dependence, but we know that there still is a cohort of people who will experience more harms related to their substance use. Why? Because they're more likely to be criminalized, because they're more likely to be engaged in systems that are harmful to them, etc, etc, and that was just like we do a whole three day training to synthesis like, to make this all make sense, but just as a quick two minute sound bite that's basically, we know it's complex, and we know it impacts everybody.

Stuart Murray  28:52  
So, so let's just touch on a three day workshop you talk about. So who, who goes to those workshops? Or who, if somebody is listening to this, saying, Can I go to that workshop? How? How does that work? Who's involved in that?

Shonan Illsley  29:03  
Yeah, so we, we do three day workshops with organizations that invite us into their organization to do training on harm reduction, our harm reduction training, I should kind of explain a little bit about what it looks like it day one starts with using an anti oppression and anti racism lens to what's happening for folks who are using substances and then day two is really challenging our understanding of how we've been conditioned to think about substance use. We know that by the time children go to kindergarten, if you ask them about drugs, they say drugs are bad. And of course, our brain equates. Our five year old brains equate drugs are bad equals people who use drugs are bad. And so we really challenge how we've been conditioned to think about substances over our lifetime. And we talk about the war on drugs, of course. And then on day three, we say, now that we understand the context in which our relatives are using substances, how do we now support them in a really compassionate kind way that's grounded in human rights and dignity and. And so that training again, we can go out to organizations. If they reach out, we can come out and do trainings for their organizations. We also will open up trainings for folks to join us. We do have one that will be launched next week where we'll be doing a three day training in November, in line with national substance use Awareness Week, and folks can just check out our website to get information on

Stuart Murray  30:23  
that and again. So if somebody just wants to be, you know, interested, or if they want to volunteer, or maybe they want to take involved in in Nine Circles, or sunshine house, or some of these organizations that do amazing work in this area, is this something that would help them to get involved in that process.

Shonan Illsley  30:41  
Shauna, the training is not required in order to get involved in that process, but it certainly helps with creating an environment of unlearning, which is really where we're at when it comes to substance use. We've had in Canada, our first drug law was in 1908, and so we've had a long, long history of learning a narrative that drugs are bad and people who use drugs are bad, and so we hope that our three day training sets an environment where we unlearn a little bit of that and challenge how we've been conditioned to think about substances and our relatives who use substances, and ourselves if we use

Stuart Murray  31:15  
substances, one of the things that you know just share with you that my my daughter spoke about in in her PhD presentation, when she was defending her thesis, was the difference between harm reduction from below and harm reduction from above. And talking about the issue about peer practices and formal strategies that people develop themselves, which is from below versus the formal interventions and services and and, of course, I'm tremendously biased in these comments, but incredibly well thought out. And just, you know, sort of sharing a different perspective of how we as a society can start to learn and destigmatize some of these incredible things. As you say, Mo, there's so much unlearning to be done. And I think so often when you know, if governments or whoever are looking at policy that you know, you hope that this notion about harm reduction from below, engaging those people, because they're the ones that can front line, that can help you, can give you advice, can give you suggestions, versus, you know, somebody who may be sitting in a more comfortable environment looking at what they think is right or wrong.

Shonan Illsley  32:26  
That principle itself is called Nothing about us, without us. And what we know is that harm reduction is a grassroots on the ground movement. We know harm reduction never comes from the top down. It has always been the community of people who are like nobody's taking care of us. We're going to take care of ourselves and also informing these are the things we need as people who use substances, who are taking care of one another and so. So we recognize that people who use drugs have always taken care of people who use drugs, people who are living with HIV, have always taken care of people who live with HIV, right? Like we know that the communities themselves have always taken care of each other and so in harm reduction that is fundamental to how we do the work, is that it's really and that's why we have the peer advisory councils, because we know that the folks on the peer Advisory Council are taking care of people that we don't even ever have access to take care of. We also know that they know better what they need and their community needs than what somebody like me would, you know what I think they would need so really important that everything is driven from the ground up. And in fact, Stuart, when we have programming that comes from the top down, those of us who work in harm reduction are like, are very skeptic, because we're like, Ah, how do you know what you need to do if you haven't talked to people who use substances?

Stuart Murray  33:45  
You know, I think about some of the work that's, that's done here in Manitoba, particularly in Winnipeg, whether it's, you know, Bear Clan or the Aboriginal Health and Wellness Center, you know, there's, there's obviously some, some really good work being done. But, you know, I guess the question always is, and I would just sort of ask you to sort of reflect Shawna on your your time at the Manitoba harm reduction network. I mean, you have you shared at the the top of this podcast about your personal relationship with your relatives and substance use. How do you see it when you're looking today versus when you reflect back in terms of improvement, some of the things that have been worked really well, maybe some of the things that have not gone so well. Where are we at in terms of your in this, in this sort of journey of where we're looking at around harm reduction?

Shonan Illsley  34:36  
Oh, that's a great question. So harm reduction is a field where we take two steps forward and three steps back, and sometimes more steps back. Some of our provinces right now are taking even more steps back. What I want to be very clear is that even when policies and decisions are made that take some of our practices a few steps back, what happens on the ground does not change. We just. Have to work harder than to keep each other alive. And so people have been making decisions for people who use drugs for a very long time, but people who use drugs take care of each other, and they have stepped up for one another. And we have people who are alive today because of other people who use drugs keeping them alive, and that model is really what's going to get us out of where we're at if we continue to do the same thing over and over, where we just attack and dehumanize people who use substances, particularly we don't dehumanize everyone who uses substances. Really important to to note that that, of course, intersects with oppressions who we who we demoralize or dehumanize sorry. And if we continue to do the exact same thing, we're going to continue to see the exact same outcomes we're seeing, which is an increase in death, an increase in toxic supply, an increase in things like homelessness, things like people not accessing healthcare, people not accessing treatment services. Like we really need to look at ourselves as a society right now and think about, how do we have the courage to do something different? And just like our friends in Portugal said, we were just going to try it out, and if it didn't work, when we decriminalized, we were we would go back and do what we were doing before, and what they found was it worked so well that nobody wants to go back. They're clear. It's not perfect. There's still some things we're trying to figure out, and there's still some international laws and policies that impact us being able to move things forward, but nobody wants to go back to the old way, and they're decriminalized in 2003

Stuart Murray  36:41  
Yeah, and are there other countries that you're aware of, Shauna, that are looking at that model?

Shonan Illsley  36:46  
Well, there's, there's other things that have happened in other countries where they supported, they made decisions to support people who use drugs, like Switzerland did some stuff. There's lots you can check out the Canadian Drug Policy Coalition, and they have a lot of that available on their website, but I think I really want to focus on here in Manitoba, we have an opportunity right now to do things differently, and we're talking safe consumption. We're talking improving access to a safer supply for people who have dependence. We We have some great programming and some great grassroots programming that's happening, and we don't want to lose that momentum, and we definitely don't want to be taking any steps back. And so, for example, we know a housing first model has way better outcomes than a treatment first model. So how do we support a housing first model? And the other, you know, layer that we really want to add to this is is manufactured poverty. And we know that manufactured poverty and homelessness, which is a result of manufactured poverty, has a direct link to some of the harms we're seeing around substance use. It also has a direct link to why we need a safe consumption site in the first place. If everybody was housed, we wouldn't need a safe consumption site, right? So we would need other safe supports around around substance use to make sure that people are safe in their homes, but it would look a heck of a lot different.

Stuart Murray  38:10  
Yeah, and you know, that's again, I think one of the challenges that that when I talk to people or listen to people you know, such as you Shauna, about, you know, kind of what your work is doing and what your team is doing, and how passionate you are about, you know, sort of making this the human rights and the dignity that goes along with and even the terminology. And if I've used, if I've mistakenly said substance abuse, it's really substance use. It's not abuse anymore. It's substance use. Is the, is the, I believe the proper terminology, but I guess you know some of it, would look at saying the Portugal situation of what you just described, and I'm glad you said it's not perfect, because I think a lot of people look at it and say, Well, how can we, how can we solve this issue completely? Well, that's just not on the radar, I mean. And I think somebody would ask that question, is being unrealistic? I mean, it's never going to completely, completely go away. It's, it's part of the DNA of humankind, I mean, who we are. But you know, if there's improvement, if people have a sense of compassion, how they're treating people with with substance use, or the dignity that they're allowing those people who have substance use to continue on in their daily lives, then, you know, sure you'd look at that and say, Isn't that worth exploring? Absolutely.

Shonan Illsley  39:27  
And the other piece to add to that is that we know the opposite of problematic substance use is not sobriety. The opposite of it is connection. And so the question becomes, for our relatives, who are quite isolated, for all of our relatives, how do we build connection? How do we start to connect them to the things that are important to the to them in their lives, at the things that they would rather be connected to. And then, if we think about our relatives, who are impacted by, you know, substance dependence and maybe are completely isolated, the question becomes, how do we then lean and figure out how to support them? And connect them to the things that are important to them, because we know the more disconnected we get, that correlates with with our relationship to substances. And so how do we then reconnect people as a society, and we're at a time this, you know, this interesting time in society where we are so individualized and so disconnected from one another, we know that just being together helps our mental health. We know that being together with with people we love and care about helps our mental health, all of those kinds of things. So how do we re humanize the issue and bring people together in environments where we can continue and start to rebuild our connections with one another and rebuild our relationships? I

Stuart Murray  40:38  
want to be very cautious how I say this. I'll just say the the premier of the day. You know, it doesn't matter the political party, but at the premier of the day, happened to say, Shauna, your your team does great work. What advice can you give us to try to sort of further enhance the compassion elements shown towards those people that have substance use, or how can government play a better role in trying to move the dignity that these people are looking for and deserve in this process? From a from a I guess I'd look at it from a policy standpoint. If that's a fair question,

Shonan Illsley  41:16  
that's a huge question, and there's lots of different ways it could be tackled. The number one thing we need in our in our province, is a living income. We need people to be able to afford to live in our province and and we know that if people have that income, their relationships to substances changes. Why? Because now I'm housed now I can afford to eat now I can afford to do things and I can focus on other things, like getting a job or reconnecting with my family or what, etc, whatever is important to people. So a living income is one of our our first and then also affordable housing to go along with that living income, we need people to be able to have safe, affordable housing. And then we have to start to really dismantle the war on drugs, and what that really means, because the war on drugs really is a war on people, and we know the War on Drugs itself is grounded in racism. Historically, every single drug or every single drug law has been connected to racism. It has never been about safety, and it has never been about community. And so how do we start to dismantle that as a province, and how do we really critically think about what recovery or what wellness means in our communities? Because wellness in our communities is not absent of substance use. Many people use substances and it improves their wellness and so and substances have been here since time immemorial, and we know that people use substances. Animals use substances. You know, the only time substance use becomes problematic is when people are using it in an unnatural environment, and being homeless on the streets and isolated as an unnatural environment, being isolated even in your own home, in jobs that you know are traumatizing or environments that are traumatizing, is an unnatural environment. And so how do we start to really address the root causes of why some of our relatives, which is a small portion, only up to 20% of the population, has challenges related to their substance use? So we really want to critically look at what's going on for them, and how do we start to dismantle that, all things that are impacting that.

Stuart Murray  43:23  
And, you know, one of the things that I so appreciate is, I don't mean to ask you these big questions, you know, just the question, but when you realize it's, it's more than just a small answer, because it's so tied, it's not just one issue. It's so tied to so many which I think you you very eloquently, sort of, you know, put together Shauna. So thank you so much for that. You know, we're kind of in that position where I always sort of say the the hands of time, sort of start to bring this podcast to a close. But I want to just say first and foremost, obviously, thank you for finding time to be on this podcast, and perhaps even more importantly, Shauna, to you and your team at the mattitiba harm reduction Network. Thank you for the great work you continue to do in the community, the difficult work you're doing in the community. But I always sort of try to end my podcast with just saying to you, is there a question that you were hoping I was going to ask you during this conversation that I have not asked you,

Shonan Illsley  44:24  
you had some very good questions, and they are really big questions, and I want to be clear as to why they're big questions. They're big they're all big questions because there's so many players in this and it there's no there's not a simple solution to how we we address and change how we're handling substance use in our society, it is really complex, and it's grounded all the way from pleasure and excitement and joy all the way to the harms that we see, which include potentially loss of life and and. We're in this interesting time, not even interesting. We're in a really sad, hard time when regardless of what your relationship is to your substance, whether it's for joy or pleasure, everybody's at risk of dying because they're all sourcing from the same toxic drug supply. So that could be a 17 year old, that could be a 23 year old, that could be a 50 year old, and that can include people who have really great relationships with their substances and have never, you know, that wouldn't qualify for treatment. So if we only have one response that's grounded in treatment, we're missing the majority of people who use substances that also can experience a harm so as a society, or as a as a province, we really want people to just we just challenge people to say, like, can we just be brave and try something new? Like, can we just try it? And what we're asking people to try, I also should be very clear what we're asking people to try are interventions that are grounded in evidence, where they have been proven to have the desired outcomes we want. How do we start to do that? So, yeah,

Stuart Murray  46:03  
yeah, can we just try it? Yeah, can we just try it? Yeah, I love that. Okay. Shawna, Ilse, thank you so much for taking some time to chat with me today. It's always a great learning opportunity for me to find out some of the amazing work that people like you and others are doing in the City of Winnipeg and the Province of Manitoba. So thank you for finding time and again. Thank you for the great work that you and your your team are doing,

Shonan Illsley  46:29  
and thank you for having me. 

Matt Cundill  46:31  
Thanks for listening to humans on rights. A transcript of this episode is available by clicking the link in the show notes of this episode. Humans on rights is recorded and hosted by Stuart Murray, social media marketing by Buffy Davey, music by Doug Edmond. For more, go to human rights hub.ca

Tara Sands (Voiceover)  46:51  
produced and distributed by the sound off media company.