Art by Valerie Thai

Aaron Campbell was 37 when he walked away from his world. For 27 years he had been told that leaving would jeopardize the chance of eternal salvation for him, his wife, and their four children. Yet salvation was just what he needed, and immediately. “Ultimately, I said, ‘If I don’t [leave], my mental health is going to continue to suffer to a degree where I don’t know what I’ll do,’” he recalls. “That was very scary for me.”

Campbell grew up in 1980s Wainwright, Alberta, a farming town of about 5,000 southeast of Edmonton. Until age 10 his community consisted of his mother, his brother and sister, and a handful of neighbours. Then, his single mom’s search for social support and spiritual direction led her to the Mormon Church (officially called the Church of Jesus Christ of Latter-day Saints since 2018, after God urged a “correction” to the abbreviated LDS in a revelation received by church president Russell M. Nelson).

In many ways Campbell, whose name has been changed to protect his privacy, was raised by the Wainwright branch of the LDS, amid tight community and tighter programming. Monday was Family Home Evening: a religious lesson and activity for family completion. A weekly schedule of age-specific meetups, seminary sessions, and miscellaneous social gatherings followed, culminating with a three-hour church service on the Sunday Sabbath.

The church provided friends and support, but prescriptions and proscriptions cast a shadow. “The messaging was subtle: that if you do these things it will enrich your family, it will bring you blessings,” says Campbell. “But the implication was: if you don’t do these things, bad stuff will happen to you.” Family reputation was paramount, and meant prioritizing the programme. “It required me to basically put my authentic self to the side,” Campbell recalls. “To be accepted into the community, in order to be accepted into my family, I felt I needed to perform and have a mask on.” There was, he says, “very consistent, daily reinforcement of: the person you are is not acceptable.”

Rural, pre-internet life meant that Campbell knew no different, and his mental health suffered. At 15 he was put on SSRIs, and enrolled in a national health system with scant appreciation for therapy or supplementary practices. Only after 20 years of futile treatment did he identify his relationship with the church, invisible in its ubiquity, as the root of his suffering. “When I left, it was like putting a tourniquet on a wound,” he says. “The wound had stopped bleeding, but I’ve still got a wound. Now I got to deal with this.”

Angry and confused, disillusionment with the medical system led him elsewhere in search of remedies. He went “all in” on exercise, cannabis, and keto dieting to little avail. Then, in 2017, he came across Johns Hopkins University research documenting the alleviating effect of psilocybin on end-of-life anxiety and depression in terminal cancer patients—an early harbinger of the so-called psychedelic renaissance, which started to go mainstream with Michael Pollan’s 2018 book How to Change Your Mind. Inspired, Campbell contacted a fledgling psychedelic group in Calgary. Little did he know, he was initiating a journey into a community that would change, and possibly even save, his life.

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Mormonism was founded by Joseph Smith in New York State, amidst the fervent Protestant revivalism of the Second Great Awakening. On April 6, 1830, 11 days after the Book of Mormon was published, about 55 people gathered on Whitmer Farm near Fayette for the first Mormon congregation.

At first glance, tripping on psychedelics seems a sinful departure from Mormon tenets. The Word of Wisdom, a revelation Smith said he received from God in 1833, commands Mormons to refrain from alcohol, tobacco, tea, and coffee. Church prophets have since added substances that “impair judgement or are harmful or highly addictive.” But did the first prophet do as later prophets have preached? Convincing evidence suggests that psychedelics were in fact integral to Mormonism’s visionary beginnings.

In 1820 or 1821, a teenaged Smith experienced his First Vision after entering a grove of trees near Manchester, New York, seeking wisdom. “I saw a pillar of light exactly over my head, above the brightness of the sun, which descended gradually until it fell upon me,” he later reported. Heavenly “personages” then told him of the imminent Second Coming, and condemned all existing Christian churches for teaching incorrect doctrine. Smith experienced a string of such visions, from which several cardinal Mormon doctrines emerged.

A 2019 paper by Robert Beckstead, Bryce Blankenagel, Cody Noconi, and Michael Winkelman presents compelling evidence that these visions came from entheogens (chemical substances that produce altered states of consciousness when ingested). During his First Vision, Smith experienced mouth dryness, paranoia, and vivid hallucinations: symptoms consistent with entheogens—including two psychedelic mushrooms, psilocybe ovoideocystidiata and amanita muscaria—either scientifically documented to have grown in every area Smith lived, or almost certainly available through established trade networks.

It’s highly likely that Smith was familiar with these substances. His mentors, including his father, were enmeshed in folk magic, the occult, and esoteric Christian practices, some with entheogen links. His family possessed a panoply of magic-adjacent artifacts, from astrological charts to an alchemical amulet. His visions echoed those experienced by both of his parents and foreshadowed those of many early Mormon converts. Multiple eyewitness accounts describe the unusually intense visionary nature of early Mormon congregations, with symptoms seemingly manifesting on demand after drinking Smith’s wine sacrament. There was widespread suspicion that the wine was spiked.

Smith was shot dead by a mob in 1844 while awaiting trial in Carthage Jail, Illinois, after causing uproar by destroying a Mormon-critical press and, according to some reports, imposing martial law while mayor of the city of Nauvoo. Brigham Young became the new Mormon prophet. He shepherded the church to Utah and away from its probable, or at least possible, psychedelic genesis, which for nearly two centuries has been forgotten or denied.

But modern Mormons and ex-Mormons are returning to these visionary roots. The “Mormons on Mushrooms” podcast is dedicated to “alternative methods for healing from trauma” and “exploring higher consciousness while healing from toxic religious shame.” Since launching in 2020 it has grown a monthly listenership of over 10,000. Divine Assembly, a Utah-based “magic mushroom church,” was founded in the same year by ex-Mormon and former Republican state Senator Steve Urquhart and his wife Sara. Though not all of its roughly 5,000 members are ex-Mormons, the church was founded in large part to help people leaving religious environments find healing through psychedelics. These congregations contain clues about the power of collective psychedelic practice to help people find new ways forward and process past pain.

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Campbell’s first psychedelic journey came courtesy of five grams of psilocybin mushrooms. Sitting in a circle of 15 fellow trippers and six sober space holders, he became the universe. He recalls creating stars and planets and music as scattered parts of himself. He felt giggly and joyous. “It was just a magical experience,” he says.

Campbell emerged from his trip feeling more connected to everything around him. He had felt a radically new sense of perception, free from hierarchy and suppression—a mode he still feels able to slip into to view situations differently, even though no experience since has recaptured that first sense of interconnection.

The decision to contact that Calgary psychedelic community started a chain of small events that, Campbell says, have “fundamentally changed the course of my life and, frankly, probably saved me from a trajectory that was going to end up in suicide.” Much of this stemmed from feeling like he was spending time with people who understood him, who saw him for who he was rather than how well he followed the rules. The Mormon church doesn’t exactly encourage experimentation and self-exploration.

On the “Mormons on Mushrooms” podcast, two ex-Mormon friends, Mike and Doug, have languid conversations about psychedelics and related matters. It sounds like Seth Rogen and his best pals running a The Kardashians-style show. In a June, 2024 episode, they talk about basic milestones in their lives their religious loved ones may not necessarily condone, like the times when they each had their first drink.

Mike and his wife were travelling, and one day he just looked at her and asked if they should share a drink. “Then we were like, ‘fuck it! Let’s just each order one drink! Let’s order our own drink!’” Doug laughs uproariously. “What a decision-making process that was, though, right? Like so scary, so terrifying to wade into those waters, right.”

“Yeah…” and the conversation sobers.

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From 2001 to 2021, the number of people in Canada reporting no religious affiliation doubled. In the U.S., church membership dipped below 50 percent for the first time in 2020. Canadian census data contains 87,725 self-identifying Mormons in 2021, down from 105,365 in 2011. Even official LDS data, which includes inactive former members, shows Canadian membership growing slowly in absolute terms, but shrinking as a proportion of the population.

The ex-Mormon community, on the other hand, is growing—and connecting. The r/ExMormon subreddit, with 302,000 members, is the headline example, but Campbell says there are countless other ex-Mormon pockets of society. “There is something about the Mormon experience that teaches people to organize really well,” he says. The internet fundamentally changed things, and those who leave the church are now better able to connect again outside of it. Campbell says this means the church no longer controls their narrative.

Meanwhile, the psychedelic renaissance has bloomed. Psychedelic practice has a long history, from ayahuasca use across the Amazon Basin to iboga ceremonies among West African Bwiti communities and peyote usage among North American Indigenous peoples. But prohibition has reigned in the contemporary West, with promising medical research suppressed through the war on drugs. Until recently.

Research increasingly points to the potential of psychedelics in treating mental-health issues (despite serious methodological challenges, like ensuring double-blind trials with mind-altering substances and navigating the complex knot of possible mechanisms). Tectonic legal shifts are nudging countries, including Canada, toward clinical trials, medical use, and decriminalization debates. Stores selling psychedelics are semi-tolerated across Canada. Investment has boomed with the hype. And facilitated psychedelic experiences are accessible through an underground network of practitioners.

This renaissance holds growing appeal for religious communities, as evidenced by an emerging network of psychedelic chaplains integrating psychedelics into spiritual thought systems, as well as people processing the psychological challenges of leaving totalizing religions like Mormonism. Campbell is careful to stress that every experience of apostasy is unique, but there are patterns. Abandoning Mormonism generally means relinquishing a moral and spiritual worldview, which often creates a deep need for sensemaking. “You just need something to matter again,” an ex-Mormon Divine Assembly member and psychedelics user told Rolling Stone. Leaving can mean losing a tight-knit community of friends and family, plus the navigational framework of a familiar culture. This, in turn, can trigger the task of discovering your authentic self, which may contain characteristics long repressed through shame, like sexual desire or identity. For many, it can feel like being fully alive for the first time.

Powerful psychedelic experiences are inspiring some ex- Mormons to facilitate those experiences for others. Campbell now guides people through psychedelic journeys, from pre-trip preparation to in-trip support and post-trip integration. He isn’t formally trained or licensed, and doesn’t stick to a particular modality, but adapts his approach to individual clients. He works underground, mostly with ex-Mormons new to psychedelics and looking to make sense of life after leaving. They are typically middle-aged, well resourced, and curious.

Psychedelics are pattern disruptors, Campbell says. He believes the reason there’s so much research into how they can help people trying to break addictions is that they make people question their reasons for doing what they do. He helps people deconstruct these patterns as a precursor to long-term change. He typically works with somebody once, either recommending practical next steps or referring them to a medical professional with relevant expertise.

Campbell’s understanding of his work highlights what seems obvious, but is often effaced by psychedelic discourse focused on individual treatments and miracle trips: that our psychology is shaped by the systems we live within. “Any system that is well established basically tricks people into thinking that it’s not alive,” Campbell says. “It hides, and the more it can hide, the longer it will last.” This can lead ex-Mormons and others to mistake mental-health challenges for personal failings, or scapegoat leaders without recognizing how systems also enclose those scapegoats.

Community is a powerful vehicle for identifying and understanding systemic patterns. Psychedelics are often most effective as deconstructive tools when used with others who understand and can help process that deconstruction.

Later in the “Mormons on Mushrooms” podcast, Doug talks about a recent trip he took that felt different. He was contemplating what makes him feel fear and anxiety, and thinking about how, once the thing he thought was causing those feelings dissipates, something else comes and takes its spot. He and Mike agree that being afraid of death is the same as being afraid to live. They talk about overcoming shame in the way we can only do with someone who really gets us. Doug talks about this moment he always has when he’s high and feels super dirty, but says it’s the grounding part of the trip for him. It reminds him, “Ya popped up from the earth, big dog! And yer going back down.” Mike murmurs understanding.

Campbell experiences similar seamless conversations now, too. “I don’t have to explain the acronyms, I don’t have to explain the backstory of any of this stuff,” he says of his experiences in ex-Mormon psychedelic circles. “People are like, ‘Yep, I get it,’ right away. That feeling of being understood, being heard, being validated, is huge —huge.” Psychedelics alone didn’t save Campbell; psychedelics plus finding community did.

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This insistence on collective psychedelic practice resonates beyond the ex-Mormon community, and represents a broader call for a different psychedelic renaissance. Writing in Jacobin, Benjamin Fong identifies two possible renaissances. The “psychiatric paradigm” sees government institutions and psychedelic companies administering psychedelics in tightly regulated medical settings to alleviate specific mental-health symptoms. Critical psychedelics podcast “Psymposia” dubs this corporadelia: psychedelics as commercial service and psychological adaptation.

The collective paradigm envisions an alternative renaissance, rooted in a systemic understanding of psychedelic possibilities and what conditions our mental health. This paradigm proposes supplementing psychiatric services with decentralized, community-centred psychedelic practices, and connects individual healing with the need to acknowledge and even reimagine the social, economic, and political systems that shape mental health. Whereas the psychiatric paradigm reduces psychedelics to “just another little pill for skull-bound ailments,” in the words of Ross Ellenhorn and Dimitri Mugianis, co-founders of psychedelic-assisted therapy organization Cardea, the collective paradigm is more radical. “When used correctly, these substances are not quick-fix cures for illness but consciousness raisers,” they write. “And raised consciousnesses tend to find the public causes for personal pain.”

The collective paradigm heeds what we know about how psychedelics work. One of the few concrete research findings is that the context around a psychedelic experience— set and setting—affects its outcomes. The systems that shape us are the bedrock of that context. Proponents also cite the array of Indigenous psychedelic practices—encompassing religious, social, medicinal, creative, and warfaring rituals—as evidence of collective psychedelic possibility. Another touchstone is Mark Fisher’s “acid communism,” which holds that the psychedelia of postwar New Left counterculture helped people transgress boundaries, generate new artistic forms, and bolster new social relations capable of undermining “capitalist realism:” the seeming impossibility of imagining beyond capitalism.

What the collective paradigm should look like in practice is a complex, contested question. But experimental answers are sprouting in Canada and beyond, like mushrooms after rain. Motivated by the exclusion of racialized communities and issues from existing research, professor and clinical psychologist Monnica Williams is pioneering research exploring psychedelics as a tool for processing intergenerational racial trauma. “When people are traumatized, usually it’s of an interpersonal nature,” she recently told The Conversation Canada. “But also we find that people heal through connecting with other people.”

Williams has been involved in research documenting the impact of naturalistic (non-experimental) psychedelic use on racial-discrimination symptoms among Indigenous, Asian, and non-white people in North America. Her ketamine-assisted psychotherapy work has alleviated PTSD associated with racial trauma. Through both individual therapy and group sessions for specific communities, like Black women, she applies psychedelics to historic, cultural forces impacting mental health at systemic scales. Her work gestures toward the possibility of improving mental-health outcomes and raising consciousness around collective issues in therapeutic settings.

There is growing experimentation around collective psychedelic care. Daan Keiman is a psychedelic practitioner and Buddhist psychedelic chaplain. Formerly through The Synthesis Institute, and now through The Communitas Collective, he is at the forefront of work to develop holistic models of psychedelic care, including training for potential psychedelic practitioners, that integrate systemic, spiritual, somatic, and relational dimensions. Keiman sees systemic issues and collective experiences as integral to healthy, transformative psychedelic practices. “Psychedelics can offer us these experiences in which we feel part of something bigger again,” he says, because they help dissolve boundaries. “It becomes so incredibly important to make sure that the model of offering psychedelic care to someone can address both these experiences: of communitas, and underlying problems of alienation and belonging.” Research shows that systems shape mental-health outcomes like alienation and loneliness, he continues. Who and how we are changes with social setting, and a sense of belonging guards our mental health. Collective psychedelic practices can not only demonstrate these findings and cultivate empathy, but can also prove more accessible and cost-effective than individual services.

Another example of collective psychedelic activity is the patchwork of Canadian associations offering psychedelic advocacy, education, and experiences, from the Psychedelic Association of Canada down to local communities like Vancouver’s The Flying Sage. Empowered by creeping psychedelic permissibility, Michael Oliver started The Flying Sage after working for the Multidisciplinary Association of Psychedelic Studies Canada, which has been instrumental in enabling psychedelic medical research. While he recognizes the health benefits and trojan-horse strategic value of medical trials, Oliver imagines broader cultural possibilities. So The Flying Sage aims to destigmatize psychedelics by pairing them with activities like cold plunges, breath work, and dance.

“Psychedelics are really great at tapping into this collective unconscious,” Oliver says. “It’s a very powerful aspect of psychedelics which at the moment isn’t really being talked about at all in the mainstream narrative.” As a meeting space for underground and overground practitioners to connect, The Flying Sage is one example of how hidden collective-paradigm psychedelic communities are underpinning the ostensibly individualistic psychiatric paradigm.

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Campbell has learned that people are finding value not only in psychedelic trials or miraculous doses, but by combining psychedelic experiences and time spent with others. His ultimate goal is for psychedelic practice to be integrated into communities. The point isn’t that all communities must use psychedelics, but that normalizing safe, connected psychedelic experiences can help more people.

Campbell says he is struck by “just how not unique the work is that I do,” meaning it isn’t so different from the many forms of care that sustain healthy people and communities. He cites American spiritual leader Ram Dass’s culturally integrated conception of care, and his notion that “we’re all just walking each other home.” Thanks to finding both psychedelics and deep connections, Campbell has made it back to a home in which he knows himself better than ever before. He’s more present; a better parent. Regardless of faith, he hopes and thinks more people will soon be served by collective psychedelic guidance.

Art by Valerie Thai

Ronnie Riley learned through social media that their first novel was facing censorship. Riley was scrolling late one evening when they saw what appeared to be a leaked school memo. Their middle-grade book about a non-binary pre-teen named Jude was one of four 2SLGBTQIA+ books that Ontario’s Waterloo Catholic District School Board was trying to get out of students’ hands.

The book wasn’t explicitly banned, but there were enough hurdles for kids to access the novel that Danny Ramadan, the chair of The Writers’ Union of Canada, called the decision a “shadow ban” in an interview with the Toronto Star. (Ramadan’s book Salma Writes a Book, part of his children’s series about a young immigrant, was also challenged by the school board.)

Riley, whose work so far is most prominent in the Canadian children’s literary scene, says that while they anticipated having some issues in the U.S., it’s difficult to acknowledge that Canada is not immune to book bans. “In the States…they’re more vocal,” Riley says. “But I do believe that it’s happening in Canada, just very quietly.”

Advocacy groups in the U.S.—Parents’ Rights in Education, Citizens Defending Freedom and Moms for Liberty are three of the most vocal organizations—represent a growing trend of censorship there. By re-framing language as advocating for parental rights rather than literary censorship, groups like these have been able to successfully ban books. This harms children by suppressing their ability to access information, though advocacy groups often claim that they’re trying to protect children from explicit and inappropriate materials. And, though in its characteristically slower, slightly quieter way, the same has been happening in Canada, with an increase in book ban requests here in recent years.

It’s not just these authors’ books that are at risk. Without them, children have fewer opportunities to learn about other people and customs, and about themselves. Children’s education and exposure to different ways of life are under threat, and public libraries may be, too.

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In the U.S., recent data from the American Library Association (ALA) found that “[books] targeted for censorship at public libraries grew by 92 percent from 2022 to 2023,” and “47 percent of challenged materials represent the voices and experiences of those in the LGBTQIA+ and BIPOC community.” In Texas, 578 books were banned in the 2021-22 school year, 424 in Pennsylvania, and 401 in Florida.

Moms For Liberty, a so-called parental rights group that reports having over 130,000 members, has often made the news due to its continuous calls to ban children’s books in libraries and schools across the country. In July 2023, they were successful in getting five books banned across Leon County schools in Tallahassee, Florida. The books had characters dealing with HIV, sexual assault, leukemia, and life after death.

While parental calls to ban books aren’t always successful, the ones that are can set off a political ripple effect for other parts of the country. “What we know to be true in several states is that they’ve been following each other in a race to the bottom about how many books you can ban in how many different ways,” says John Chrastka, executive director and founder of EveryLibrary, a non-profit political action organization focused on fighting book bans in the U.S.

Chrastka references data from the Unpacking 2023 Legislation of Concern for Libraries report, created by EveryLibrary to examine the status of bills in the U.S. aiming to censor access to books in both school and public libraries. Chrastka says that EveryLibrary was able to track that some bills, despite being in different states, were using the same language as one another to ban books. “That cut and paste job—that copycat—is sometimes very explicit,” he says. “And sometimes it’s based on the intent of the law: how can we make it easier to call a book criminal, call a book obscene, call a book harmful?”

There’s a clear “feedback loop,” Chrastka says, between groups like Moms For Liberty and politicians when it comes to banning books, meaning that citizen organizations and political leaders are influencing each other. “It is a witch’s brew of interest groups that are utilizing a fairly soft target—public libraries—which are intended to be, under law, under Supreme Court precedent, public forums, and the materials are available for all—as long as they’re legal,” he says. “If you can say that those books about those human beings are obscene or criminal or harmful, you can make an attack on those populations by proxy, whether it’s LGBTQ or Black and Brown communities.”

When libraries refuse to remove books from their shelves, parents sometimes push to remove their funding altogether in retaliation. Chrastka says that while not every library will lose funding from continuing to stock challenged books, there have been and continue to be states where this is the case. In Alabama, a legislative code change, enacted this past May, made $6.6 million in state funding for public libraries contingent on their compliance with the Alabama Public Library Service Board’s guidelines about restricting access to books deemed inappropriate for certain ages.

This isn’t just happening in southern states. In Michigan, the Patmos Library nearly lost 84 percent of its funding after the town’s residents voted twice that taxpayer money shouldn’t support the library as long as it continued to supply 2SLGBTQIA+ books. But library staff would not remove the books, and after a third vote, the library will remain open.

When asked whether parental requests for libraries to censor 2SLGBTQIA+ materials could lead to budget concerns, the ALA told This Magazine in a written statement that while they don’t have national data to validate this correlation, they felt this outcome was unlikely: “Although it is challenging to quantify, these incidents emphasize the ongoing importance of defending libraries as vital community resources,” the statement reads.

As Chrastka says, though, “This is not a casual social interaction. This is a political movement.” It’s a movement that’s travelling north of the border, and in an unprecedented way.

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Fully banning a book in Canada is a tough task, and it’s not always clear how it can be done. Public libraries, though funded by municipalities, are run by independent boards which have jurisdiction over the contents of their shelves. Libraries usually respond to disputes by following their challenge policies or request for reconsideration policies. In Canadian schools, the process for vetting books often involves the board developing selection methods through training with librarians, and then trusting librarians to implement those methods. Curricula are set by provinces, and teachers decide how best to meet the curricula. It’s not the role of school boards to police individual books, though parents sometimes appeal to them in attempts to bypass any formal selection and reconsideration processes that boards entrust librarians to follow. When these policies do not exist—and they often don’t—it’s often board members and administrators who end up handling the issue and responding to parental pressures.

Shadowbanning, though, is easier to accomplish. It can include what happened to Riley, where their book was moved to a shelf inaccessible by students and “a teacher must provide the Catholic context” before students are allowed to borrow the book. Basically, citizens and school districts are finding other ways to get books out of people’s hands rather than outright banning them. In the words of Fin Leary, the program manager at We Need Diverse Books, a nonprofit organization focused on making the publishing industry more diverse, the goal is to “not have them seen as often.” He says it’s much harder to fight this kind of censorship.

Regardless of whether or not a book is challenged in a public library or a school, book bans affect both readers and authors. A November 2023 statement from the Ontario Library Association said that a diverse representation of books helps students “learn how to navigate differences and develop critical awareness of their environments.” The largest worry, according to Canadian School Libraries, is that groups calling for censorship in the U.S. will continue to inspire Canadians to use similar organization tactics.

According to data from the Canadian Library Challenges Database (CLCD), Canadian libraries facing the most calls for censorship are the Edmonton Public Library (143 requests), the Ottawa Public Library (127 requests) and the Toronto Public Library (101 requests). While the database has information from as early as 1998, some libraries have only reported censorship requests from recent years.

Michael Nyby, the chair of the Intellectual Freedom Committee of the Canadian Federation of Library Associations, said in an article published on Freedom To Read’s website that library challenges from September 2002 to August 2023 represent the highest number ever recorded in Canada in a twelve-month period. According to data from the CLCD, books and events with 2SLGBTQIA+ content made up 38 percent of all challenges in 2022. (Between 2015 to 2021, less than 10 percent of all challenges were connected to 2SLGBTQIA+ matters.) Books surrounding sexual content (19 percent) and racism (16 percent) made up the next highest percentages. The influence of library censorship in the U.S. also extends to books on drug use, abuse, violence, grief, and death.

Though Riley’s novel’s shadow ban was overturned after public outcry, concerns about a rise in book censorship in Canada, and calls to defund in the event that it doesn’t happen, aren’t without reason. At the Prairie Rose School Division (PRSD), a Manitoba-based school board, 11 requests for books to be banned were made in just 2023. Among them were 2SLGBTQIA+ books like Juno Dawson’s This Book is Gay. Dawson, who spent seven years working as a sex-ed teacher, described the nonfiction book as “essentially a textbook.” Each chapter of the book focuses on a different aspect of queer life, including definitions of 2SLGBTQIA+ identities, the history of HIV/AIDS, and sex. The book also addresses the importance of queer dating apps and using sexual protection. According to the PRSD, parents proposed banning this book (among multiple others) for reasons of pornography— though the book teaches children about bodies, and is not pornography. The school board said there was “some connection with the Concerned Citizens Canada Twitter account,” but not whether the parents proposing the ban were part of the group, which self-describes as “addressing sexually explicit materials being made available to children in our public libraries.” Still, the group’s account falsely tweeted that This Book is Gay was encouraging minors to solicit sex from adults on Grindr. The school board did not end up removing Dawson’s book (or the others proposed in the ban), but Concerned Citizens Canada is just one of many social and political groups that continue to advocate for book censorship.

In the summer of 2022, Manitoba’s South Central Regional Library was also pressured to remove three books about puberty and consent from shelves. Residents protested a library board meeting, flooded city council meetings, and said public library funding should be removed if the books weren’t, calling them “child pornography.” However, both Cathy Ching, the library services director, and local city councillor Marvin Plett both denied these claims. “Calling books pornographic does not make it so,” Plett said at a Winkler council meeting in July 2023. “Censuring books based on content that some find objectionable can have far-reaching and unintended implications.”

Around the same time, in Chilliwack, B.C., the RCMP were called to investigate after books there were reported for alleged child pornography in schools, too. Also in 2023, library picture books about gender in Red Deer, Alberta were vandalized. A page about using a singular “they” pronoun for nonbinary people was ripped out, according to a news report from the Red Deer Advocate.

Though the case in Chilliwack was dismissed and the books in Red Deer were replaced, parents’ calls to defund the Manitoba library if certain books aren’t removed echoes bills proposed by American lawmakers stressing that libraries should lose funding if bans aren’t enacted. And while books aren’t being overtly removed from shelves in Canada very often, there are other, sometimes more insidious impacts this attitude is having on queer and racialized youth.

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The Toronto Public Library (TPL) is Canada’s largest public library system. When asked about whether groups like those in the U.S. seeking to defund libraries for not removing 2SLGBTQIA+ material could affect what happens in Toronto, the media team at TPL said in an emailed statement that its budget is not affected by these groups. “We are governed by a library board and while our budget is ultimately approved by City Council, our materials selection is governed by our Board policies,” the email reads.

TPL’s Intellectual Freedom Challenges – 2023 Annual Report states that none of the requests to remove books from its shelves were successful that year. However, the same report also acknowledges that there are other issues at play. “TPL has experienced objections to 2SLGBTQ+ content outside of the formal request for reconsideration process, with opposition to Drag Queen Story Time programs at five branches and protests at three of them; damage to Progress Pride decals at eight branches; vandalized Pride Celebration displays at two branches; and vandalized 2SLGBTQ+ books at one branch.”

Historical book banning represents violence and censorship. Current book bans, though they may be disguised as parental rights, are more of the same. Vandalism of Pride displays at TPL is another form of violence, and while it may not be physical in nature, it has lasting effects that can harm queer youth for years beyond the act itself.

Banning queer and trans people’s books sends the message that these folks shouldn’t exist, at least not publicly. Ideas like these contribute to the state of widespread violence against them. Recent data from Statistics Canada found that around two thirds of 2SLGBTQIA+ Canadians had experienced physical or sexual violence. However, this number could be much higher: data from the same report found that around 80 percent of physical assaults against this group within the year prior to the survey didn’t “[come] to the attention of the police.”

Many 2SLGBTQIA+ people also struggle with feelings of suicidality. In the U.S., data collected by the Centers for Disease Control and Prevention showed that 29 percent of trans youth have attempted suicide. In Canada, researchers at the University of Montreal and Egale Canada reported that 36 percent of trans people in Ontario experience feelings of suicidal ideation. Systemic discrimination, erasure, and invalidation contributes to this, and book banning is part of this wider package of behaviours that harms the community.

Canadian author Robin Stevenson was interviewed for PEN Canada about her children’s rhyming picture books, Pride Colors and Pride Puppy!, being targeted by the recent wave of book censorship in the U.S. and Canada. “Book banners say that they want to protect children, but they are doing real harm to the very children they claim to protect,” Stevenson said, explaining that “learning to hate yourself was far more dangerous than any book could ever be.”

Leary says that removing these types of books from libraries can send a message to publishers: if they notice that titles aren’t making it to school libraries or are banned, it could discourage them from publishing and promoting them. “As much as the book bans are horrifying, they also are so much scarier when you consider the larger context of why they’re happening—because it’s to legislate folks out of existence, or to legislate folks out of having an education about these topics.”

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Representation matters because it helps reduce stereotypes. Books with diverse representation are vital. They can help teach empathy and understanding, while also showing readers that they aren’t alone in their experiences. Diverse books also teach a fuller picture of history, sharing stories previously overlooked. They are a key aspect of a well-rounded education.

While it is a terrifying moment for queer and racialized writers, authors are not silencing themselves as a result of the pushback. Protecting their work from the possibility of being banned, though, will take a concerted effort on the part of anyone hoping to support them.

Riley believes that the shadow ban of their novel at the Waterloo Catholic District School Board was only overturned because of statements from not only their publisher, but other authors as well. They say they had a sound support system, and that helped.

That kind of unified support is crucial to fostering an environment that permits the continuation of freedom in publishing. Leary says that from an advocacy standpoint, parents opposing book censorship have the most power when they stick together. “Our voices are stronger when we are collectively organizing, and it also kind of allows parents to have each other to lean on,” he says. One way to do this is by communicating with school board members and going to community meetings that include opportunities to speak to these issues.

Riley keeps their final advice to anyone passionate about this issue simple and blunt. “Keep speaking out,” they say. “Keep making sure that books get into the hands of kids—especially queer books.”

Photo courtesy of the Bent Arrow Traditional Healing Society and Community Outreach Transit Team

They’re slumped over on the seat, head almost touching the floor of the train car. The other passengers try to politely look away, avoiding sitting in their vicinity. Is the person asleep, unconscious? Possibly unhoused, with random personal items spilling out of a ripped backpack, they might need assistance. Yet no one moves to get involved.

Concerned, someone finally calls an Edmonton Transit Service peace officer. Someone else also shows up alongside them: a Bent Arrow Traditional Healing Society (BATHS) outreach worker. Together, they gather the groggy person up and help them off the train.

This new social program, the Community Outreach Transit Team (COTT), was put into action along Edmonton’s train lines as a pilot project in 2021 to help give meaningful and humane support to unhoused people and people in distress who use the trains and bus system as shelter. The wider purpose of BATHS, “is to make sure that all Indigenous children are connected to their culture and families, especially to make sure that we’re also building on the strengths of Indigenous children and families, to enable them to grow spiritually, emotionally, physically, and mentally so that they can walk both in Indigenous and non-Indigenous communities,” says BATHS senior manager Lloyd Yellowbird. Working off a similar program model as the Human-centred Engagement and Liaison Partnership in Calgary, the City of Edmonton, partnering with BATHS, felt that a related strategy could benefit the city’s unhoused people.

Together, this team is working to help end homelessness in Edmonton. Outreach workers, also staff members of BATHS trained in trauma-informed responses, connect people with inner-city programs that offer long-term solutions to those who choose to engage with the team members. They help unhoused people get ID and transportation to access medication and other services. Specialized training is important because, “a lot of times [houseless people] face living in a traumatic lifestyle to begin with. [They] don’t want to go to shelters because they don’t feel safe,” Yellowbird says.

After the successful end of the first pilot phase of the partnership in 2021- 22, 2,700 general interactions were logged, and there were 510 instances where referrals were made to assistive services. In March 2023, the city agreed to continue the COTT project, allocating funding of $2.1 million until Aug. 31, 2026. These funds are used by the outreach teams to connect their clients with housing programs and financial assistance services, and to reconnect families and communities. With seven active teams working along the transit system, from 6 a.m. to 2 a.m., seven days per week, Yellowbird says that there will hopefully be funding for four more teams soon. COTT also continues to assist those who have received support from them in the past. “It’s not just a one-off kind of system. Support is always there,” Yellowbird says.

The work that BATHS does to connect displaced people to their communities is something that could, and should, be replicated in other cities. BATHS’s success is one way to help those who have been marginalized to find the community connection that leads to personal fulfillment.

Jenna Rizvi was spending a significant chunk of their time organizing naloxone training workshops and fentanyl testing strip distribution events. But this isn’t what they do for work; they were volunteering during their first year as a student at the University of British Columbia (UBC) in Vancouver.

In the 2021/22 school year, students at UBC relied on student groups like the Social Justice Centre (SJC) and the Alma Mater Society (AMS), the university’s independent student union, for drug- testing supplies. Rizvi, now a third-year UBC student and member of the SJC’s harm reduction working group, says the university was not widely providing these resources to students at the time.

Now, two years later, UBC offers drug testing supplies to students. But Rizvi says issues remain, particularly around harm reduction policies in student residence. Despite the start of a new provincial decriminalization program earlier this year, residents in collective living situations in B.C., like students in UBC dorms, could be subject to a range of drug policies, including some that severely restrict their use.

In January 2023, the B.C. government launched a three-year pilot program to decriminalize the possession of small amounts of certain drugs to help address the province’s ongoing toxic drug crisis. Under the new program, adults over the age of 18 cannot be charged or arrested for possession of 2.5 grams or less of opioids, crack-cocaine, powder cocaine, meth, and MDMA. Instead, law enforcement is supposed to offer information on local health services and, if requested, treatment options.

“The Province decriminalized people who use drugs to fight the shame and stigma of addictions. Breaking down these barriers will help create new pathways to life-saving services and care, so more people will feel comfortable reaching out for lifesaving supports,” a media relations spokesperson from the B.C. Ministry of Mental Health and Addictions wrote in a statement to This.

But, according to the ministry, drug use on private property may continue to be prohibited in many cases. For people living in collective housing, this could mean they are subject to different policies depending on where they live.

More than 15,000 student residents live on campus at the two biggest universities in B.C.—UBC and the University of Victoria (UVic)—and they are subject to stricter policies. According to the UVic 2023/24 residence contract, the possession, use, or trafficking of illegal drugs could result “in eviction from your Accommodation and/or referral to the Office of Student Life, and/ or the Saanich Police Department.”

In a June statement, a UVic spokesperson said “UVic’s housing policies are adapted every year to ensure the best possible experience for students living on campus. We make changes based on our expertise in creating a safe and healthy university residence community, as well as evolving provincial and federal laws.”

The spokesperson said it was too early to tell how the decriminalization program would affect UVic’s policies, but that the university will continue to monitor and adjust as necessary. When asked if UVic believed this policy followed a harm reduction approach, the spokesperson said all UVic residence staff take such an approach.

Meanwhile, UBC changed the language around the consequences for drug possession and use in its 2023/24 year-round and winter session residence contracts following student advocacy.

Previously, possession, use, and trafficking could result in eviction and referral to the police. Now, possession and use could lead to “the application of Residence Standards points (which could result in an Eviction) or discretionary sanctions,” while the consequences for trafficking remain the same.

“Given the decriminalization of some drugs for personal use in B.C., we are currently working to update the language in our housing contracts to reflect that change,” Matthew Ramsey, director of university affairs at UBC’s media relations department, said in a statement.

“Regardless of the evolution of the language in the contract, our practice will continue to be what it has for some time in these situations—to focus on the wellbeing of our residents.”

Ramsey added that only one student resident has been evicted over the past three years due to illegal drug use that had “repeated and significant impacts on other residents.”

Kamil Kanji, the vice-president academic and university affairs of the AMS, says the new language is a step in the right direction, though more needs to be done.

But Rizvi says the tone of the housing contract remains the same, despite the new language. “The idea that [the housing contract] is based in is the same which is, ‘We’re anti drugs and we’re not trying to help you,’” they say. Rizvi acknowledges the low number of evictions resulting from UBC’s housing contract, but they say the inclusion of such policies creates stigma regardless, reinforcing the idea that it’s okay for people who use drugs to be unhoused and have barriers around education.

In contrast, those at temporary and long-term shelters for unhoused people could potentially expect more lenient rules than those in residence. B.C. Housing, which partners with non-profit shelter operators across the province, follows the Housing First model that emphasizes housing as a basic need and doesn’t impose barriers to access, according to a statement sent to This in June. However, they noted that it is ultimately up to individual non-profit operators to set their own shelter policies.

Of the four Vancouver shelter operators that responded to This by press time, two, Lookout Society and PHS Community Services Society, have open drug use policies. The other two—Directions Youth Services and the Downtown Eastside Women’s Centre Association—will not turn away or kick out those who use drugs.

Directions Youth Services, a division of Family Services of Greater Vancouver, offers shelter for people aged 13 to 25. “Our primary goal is to help youth access the services they need to stabilize so they can start to figure out what’s next for them,” says director Claire Ens.

In the meantime, public health researchers and advocates across the province are celebrating the start of the decriminalization program, but say additional measures are needed— particularly as some B.C. towns are trying to bypass the program through new bylaws and Conservative politicians criticize the program.

At UBC, Kanji and AMS president Esmé Decker say the AMS is continuing to work with the university to expand existing drug safety resources on campus, including increasing access to fentanyl and spectrometer testing and creating information campaigns on drug use. Fentanyl testing relies on strips (think pH test strips) to detect traces of fentanyl in a given sample, while spectrometer testing uses infrared light to detect up to six substances in a sample.

Rizvi says UBC should adopt a medical amnesty policy in student housing— something she says the SJC and the Canadian Students for Sensible Drug Policies have called for. A medical amnesty policy would allow students to seek help during an overdose without facing repercussions from the university or law enforcement.

Whether it’s around housing or policies that affect campus more broadly, Rizvi says UBC should adopt a more neutral stance on drug use that encourages learning and reduces stigma.

“Let students adhere to what is provincially and federally the law and aside from that, [UBC] doesn’t really have a place, as I see it, in enforcing anything beyond that.”

Charlotte Munro and her mom smiled for a selfie high above the frothy water of Niagara Falls. Amidst a difficult year where Munro endured both opioid withdrawal and a near-deadly infection, the weekend trip should have been a respite. But the getaway quickly turned sour because she was forced to forgo packing one essential item—her medication.

In 2014, after years of opioid use that began with a prescription for a fentanyl patch from her doctor for leg pain caused by necrosis, Munro decided to try methadone, one of the most effective medications in treating opioid addiction. It works by activating the same opioid receptors in the brain as drugs like heroin and fentanyl, except it’s slow-acting. This means that it can prevent withdrawal and reduce drug cravings. However, methadone itself is an opioid and subject to strict regulations in Canada and abroad.

These regulations limit access to take-home doses, forcing many patients to visit a pharmacy or clinic weekly or even daily to be observed while they take their medication. Patients are evaluated for signs of intoxication before they take their dose, watched while they take it, then their mouths are checked to confirm it’s been consumed. The purpose of these restrictions is to ensure methadone is used as prescribed, but the ensuing limitations on movement have caused some to refer to the drug as “liquid handcuffs.”

Daily observed doses shouldn’t render a patient completely tethered to their home pharmacy. Ralf Gerlach co-founded a harm-reduction organization in Münster, Germany just over 30 years ago and found his clients unsure if they could travel after starting methadone treatment. In response he wrote Methadone: Worldwide Travel Guide. He maintains that people should have access to this care wherever they go. “Denying freedom to travel is counterproductive to the goals of treatment,” Gerlach insists. “If doctors feel their patients are not stable enough for take-home dosing, courtesy dosing should be arranged at the place they travel to.” In practice though, courtesy dosing can wreck a two-day vacation to a nearby city.

Munro wasn’t prescribed any take-home doses for her trip, so she and her mom took a detour to a pharmacy near the Falls. Even though her doctor had called ahead and she had her ID and previous dose receipts, Munro’s methadone, which usually came in the form of a small, fruit-flavoured drink, hadn’t been prepared. She had to wait for the pharmacy to empty before being seen to. “I wasn’t given a fair turn in line like most people would get if you’re just going to the pharmacy to pick up a script,” she says. “I felt like a second-class citizen.” In her eight months of taking methadone, that was the only trip Munro attempted to make.

“A change of scenery and feeling like you’re part of society is healthy, it’s needed,” she says. Research shows exposure to new environments—in other words, travel—can boost our happiness. But for those who take methadone, this kind of happiness may not be available.

Tens of thousands of people across the country take methadone to treat opioid addiction. Treatment duration can range from less than a year to decades. While Canada struggles to address an opioid crisis that has killed more than 30, 000 people since 2016, aggravated by a drug supply poisoned with fentanyl and, more recently, benzodiazepines that render naloxone ineffective, methadone treatment for opioid addiction has proven critical—cutting a person’s chance of dying in half.

Although strict restrictions on take-home doses are slowly easing, they continue to impose barriers which may lead to people experiencing interruptions in treatment or discontinuing it altogether. They also limit freedom of movement for those who do take it. The drug is treated differently than many other life-saving medications; retrieving a dose from the pharmacy or methadone clinic is burdensome and can be deeply stigmatizing. What’s more is that research proves that lessening these restrictions is better for patients.

*

The first methadone treatment program in the world was founded in Vancouver in 1959. Residents of the Kitsilano neighbourhood originally set to house the clinic protested its opening and succeeded on the grounds that it would devalue their homes. At the time, two distinct conceptions of addiction treatment were clashing in B.C. Where the criminal model saw addiction as a moral shortcoming and pushed for indefinite compulsory treatment with a goal of abstinence, the medical model vied for voluntary treatment over punishment. The latter’s proponents suggested giving people addicted to heroin controlled levels of the same drug to help stabilize their lives, but this approach was ultimately rejected.

Amidst the discord Dr. Robert Halliday began treating patients for short-term opioid withdrawal with methadone. The drug had been synthesized by German scientists only 20 years prior and its efficacy for treating opioid addiction was mostly unknown at the time. Initially patients were given 12 days of methadone treatment to taper off the illicit opioid they were addicted to, but a few years later the clinic implemented what Halliday called “prolonged withdrawal”—allowing patients to take methadone for as long as they needed.

Both approaches had positive effects, however prolonged withdrawal saw more results, particularly for older patients who had been using drugs longer. Halliday cautioned against using abstinence to measure methadone’s efficacy. In a 1967 study that featured interviews with more than 150 of the clinic’s patients, he wrote that it’s “illogical to equate abstinence with a cure,” and compared methadone treatment for opioid addiction to insulin therapy for diabetes.

Instead, Halliday used factors such as relationships with family, work, a patient’s psychological wellbeing, and whether they developed healthy coping mechanisms to determine the success of methadone treatment.

At the turn of the millennium, professor Benedikt Fischer, a drug policy researcher, published a 40 year history of turbulent methadone policies in Canada. The success of Vancouver’s small-scale methadone treatment program prompted the practice to be widely accepted and 23 methadone programs opened across the country. In the early 1970s the government’s LeDain Commission published a series of reports on the non-medical use of drugs, including opioids, in Canada. It concluded that methadone was an effective treatment for opioid addiction and recommended a heroin substitution program when methadone was not adequate.

At the same time as the LeDain Commission, a special committee was struck to investigate methadone programs after a significant increase in the import of methadone into the country prompted concerns. It found that methadone was responsible for several overdose deaths and the widespread availability of the drug was brought about by private doctors without the knowledge to properly prescribe it. The committee thus recommended methadone guidelines that said it should only be prescribed to those with at least one year of opioid dependence, frequent urine screening for illicit drugs should occur with treatment, written prescriptions for methadone should be prohibited, patients must take the drug under supervision, doctors need authorization from the federal health authority to prescribe it, and any violation of the guidelines would be a criminal offence.

As a result, the number of patients taking methadone in Canada decreased from about 1,700 to about 1,100 in just three years. Over the years restrictions on people addicted to opioids continued—B.C.’s Heroin Treatment Act proposed compulsory treatment of up to three years for opioid addiction. While this was struck down in the province’s Supreme Court, policies restricting access to methadone persisted over the following decades.

In 1995, the federal government abruptly transferred oversight of methadone programs to the provinces. Since then, rules and regulations for methadone treatment, now one of several medications used to treat opioid addiction known under the umbrella term opioid agonist therapy, have developed differently in every province, with services in B.C. and Ontario expanding the most.

However, consistent throughout the country is the concept of contingency management, where people can earn take-home doses through meeting program requirements such as daily attendance at the pharmacy or clinic to receive an observed dose and frequent urine testing to check for prescribed and non-prescribed drugs.

“I was on methadone and suboxone for 18 years. And in that 18 years, I never once earned a take home dose,” says Toronto- based Andrew McLeod.

The restrictions on methadone and suboxone, a similar medication used in opioid agonist therapy, isolated McLeod. Being forced to make daily pharmacy visits means “you’re not engaging in society; instead, you’re kind of observing it,” McLeod says.

His rigid daily appointment made finding work difficult, with one employer never calling back after hearing he would be gone for half the day to visit the methadone clinic. It also affected his ability to spend time with loved ones. For nearly two decades, if McLeod wanted to be with his family at the cottage in Kingston, Ontario, away from his pharmacy, he had to secure heroin or fentanyl or else risk withdrawal, which he describes as excruciating. “It’s probably one of the worst feelings in the world. The withdrawal is what often takes people back.”

“Take the worst flu you’ve ever had,” he says, “then multiply that by 25 or 50. I’ve seen people violently sick.” At that point, McLeod explains, if he could not make it to the clinic in time or there was an error faxing his prescription, he had to find an alternative opioid. “I cannot live in that sickness.”

“One of the most dangerous situations is when someone decides for whatever reason, they want to abruptly stop their opioid agonist therapy,” says Dr. Vincent Lam, an emergency and addictions physician in Toronto. “Sometimes this can happen just because they’re frustrated with the limitations of the program.”

In the agony of withdrawal, patients are more likely to access another source of opioids, and with a lower opioid tolerance, this can be deadly.

*

Alongside take-home doses for people who want them, activists in B.C. and across Canada are fighting for safer supply, meaning access to prescribed medication in lieu of potentially toxic illegal drugs.

In B.C., small pilot programs providing hydromorphone to those who use illegal drugs and are at risk of overdosing were established in 2020. However, the province continues to suffer the consequences of toxic supply with 2,300 people dead due to poisoned drugs in 2022. This year, B.C.’s government decriminalized the possession of small amounts of drugs, though activists and researchers warn that without an accessible safer supply, this is not enough.

After starting his career as an emergency room physician, Lam yearned for more continuity of care. He began working in addictions medicine and was surprised at the positive impact even a couple of weeks of opioid agonist therapy had on a patient’s wellbeing. Lam explains that addictions medicine has historically been the subject of additional oversight and scrutiny compared to other specialties, and says it’s a field which, in many ways, is stigmatized within the medical community.

Lam recently spearheaded the drafting of new methadone take-home dosing guidelines to make the program more accessible, replacing the former contingency method. These new guidelines are meant to help advise physicians in taking a more patient-centred approach. Instead of sweeping, generalized criteria for take-home doses, doctors are encouraged to look at factors such as whether someone can safely store their medication, a person’s overall stability, and their amount of time on methadone. Abstinence from non- prescribed drugs is no longer required to access take-home doses, although it may affect how many are permitted.

Changes to the guidelines were in part brought about by the COVID-19 pandemic. To reduce the risk of an outbreak, take-home dose allowances were increased for those who already had them and provided to people who were formerly only permitted observed doses. Researchers found that as a result, in Ontario the risks of treatment discontinuation and opioid-related overdoses were lowered.

A lingering point of concern for those critical of loosening methadone treatment rules is the potential for diversion. That is, methadone being acquired or used by someone it’s not prescribed to. While diversion does occur and improperly stored doses pose a public health risk, studies have shown that the main motivation for diversion is to provide safer drugs for others during an overdose crisis.“People have done it for me. I’ve done it for people who are dope sick. I’ve given them some of my methadone before to help them along so that they don’t have to do something else,” says Garth Mullins. Mullins is a board member of the B.C. Association of People on Opioid Maintenance and host of “Crackdown,” a podcast about drugs run by drug users.

Mullins first encountered harm reduction when he was 19, sleeping in a San Francisco park and using black tar heroin. At the time, syringes were difficult to find in the U.S., needle exchanges were illegal, and HIV was spreading among people who injected drugs. Mullins remembers using bleach in an attempt to sterilize needles and a match striker to sharpen them when they dulled. Then a group came by with buckets and new syringes. “It was a guerilla needle exchange. It was an act of civil disobedience in public health. It touched me and left a mark,” Mullins says.

While he has been taking methadone for more than 20 years and travelled abroad to Portugal with take-home doses during that time, Mullins understands why someone wouldn’t continue treatment. “A lot of people have just had enough. They don’t want any more people monitoring their lives, and want to get back a little bit of that dignity and self-determination…A methadone clinic seems like this weird hybrid between a place of healthcare and a place of punishment,” he says.

Alongside restricted travel, limited or no carries means someone fleeing disaster can’t access a supply of emergency medication. With wildfires burning more of the country every year and floods increasing in frequency and severity, this issue is growing more pressing.

The same restrictions that prevent people taking methadone from traveling are exacerbated for people in need of treatment living in remote regions. While opioid addiction is still prominent in rural areas, geographical barriers mean daily pharmacy access for some is impossible, like for Charlotte Munro, who was often forced to forgo treatment when her town’s pharmacy was closed on Sundays. If she wanted her medicine, she’d have to take a 45-minute cab ride to Stratford. Harsh regulations meant Munro’s access to methadone was precarious, putting her at risk of entering withdrawal. Her doctor was aware she was missing doses on Sundays, but that didn’t change her predicament.

*

Almost a decade since Munro waited for a pharmacy to empty in Niagara Falls, the evidence of medical stigma sits in a box in her hallway. A few months after the weekend trip she became severely ill with endocarditis, an infection of the inner lining of the heart. Munro was turned away from three hospitals in one week. “They weren’t doing the tests, they were just thinking I was trying to get drugs,” she explains. She feels that her methadone prescription sparked bias.

The Friday of that week Munro fell into a coma and was rushed to Stratford General Hospital. She remained unconscious for two weeks and spent months recovering.

Now an activist and full-time student in Indigenous Social Work at Laurentian University, Munro requested her medical records from that period. She intends to go through the large box to understand why she was treated so poorly and present her findings, but hasn’t felt emotionally ready to relive the experience.

Even last year, however, Munro was traumatized by her treatment at the hospital while giving birth to her son. Munro wasn’t given adequate support with breastfeeding, her concerns were dismissed, and her chart noted that she had consumed alcohol during the pregnancy, which she says is untrue. “I’ve been so successful in my recovery… and then I go in there and none of that matters. It’s just what they see on paper. It was probably a flagged file,” she says. “I feel like it robbed me of certain things that I should have been enjoying with my son,” Munro recounts. “I was basically being looked at like an unfit parent.”

Both Munro and Andrew McLeod are co-authors on the new set of methadone take-home dosing guidelines, offering their perspectives for a more human- centred approach. McLeod is now a social service worker and addictions counsellor.

“Addiction, it’s got a lot of pieces to it. It’s not just as simple as changing carries and everything will get better,” McLeod says. Three-and-a-half years ago, he tapered off of methadone by slowly decreasing his dosage. The process was physically arduous as he endured some withdrawal, but he’s experienced new freedom. “Instead of having to make my way to this pharmacy, I could get up in the morning and I could go to work, or I could go to school. I was able to go visit my mom and my kids. I was able to go to college,” says Mcleod. Last summer, he went to B.C. for his first vacation in over 20 years, which he says is sad.

Alongside changes to how methadone is prescribed, McLeod believes that housing, access to education, jobs, especially for those with criminal convictions, and support to help families affected by addiction are all equally as important. Without housing, family, and employment opportunities, McLeod believes many will look at methadone treatment and think “what’s the point?”

However, the truth about the treatment of opioid addiction in Canada has been clear for more than 60 years. Abstinence- based, compulsory, and punitive programs are often ineffective. Yet echoes of these regressive policies remain and fester in strict contingency management, lack of patient-centred care, and a continued resistance to implementing harm-reduction from officials at all levels of government.

*

Accessible opioid agonist therapy is a matter of life and death. While new person-centred and evidence-based methadone take-home guidelines and the decriminalization of small amounts of drug possession in B.C. are steps forward, the restrictions to travel Charlotte Munro faced nine years ago are still a reality to many across the country. The stakes could not be higher. An average of 20 people per day died of opioid-related overdoses in 2022. Safer supply programs that would provide people with unpoisoned drugs are difficult to access and although smoking is now involved in most overdose deaths in B.C., inhaled drugs are only permitted in a handful of safe consumption sites across the country. Ensuring freedom of movement for those who take methadone as well as improving access to this life-saving drug is critical.

An ocean away from Munro and McLeod, Gerlach still monitors drug policy in North America. Set to retire from his organization this year, Gerlach plans to continue updating the guide, now called Substitution: World Travel Guide, to include other opioid agonist therapy medications like suboxone. Poring over almost 200 sets of national import regulations and securing contact details of doctors and clinics is tedious work, but 26 years after the guide’s first publication, and in spite of limited funding, it’s helped thousands of people travel internationally. For Gerlach, it isn’t a question of whether someone taking methadone or other opioid agonist therapy medications should travel, but of how. “Travelling,” he says, “is a human right.”

“Sharps container” by Indrid__Cold is licensed under CC BY-SA 2.0

New Brunswick’s Health Minister, Dorothy Shephard, announced in February 2021 that the provincial government plans to implement overdose prevention sites this year.

But Debby Warren, executive director at Ensemble Greater Moncton, wants the government to work toward a robust set-up that allows people dealing with addiction to leave with more than just a surface-level solution.

Ensemble Greater Moncton is an organization that seeks to alleviate social challenges by reducing harm in relation to drug use.

“Unless we address their past trauma, it’s just a Band-Aid,” says Warren. “We really have to get to the root.”

The community stakeholders committee Warren is part of has been trying to open an overdose prevention site during their two active years but had to stop because they lacked funding. She says because of the funding from the government’s initiative, the committee can continue their project, but it needs to be done right.

She hopes that one day there will be nurse practitioners or primary care providers at the sites which could allow people dealing with addiction to access health care they wouldn’t normally have access to, such as having someone who could understand their past trauma.

Warren does not want the overdose prevention sites to be done on a shoestring budget. Prevention is key. If someone with an addiction delays getting health care for serious infections or abscesses, they can turn into something more critical later on. According to Warren, it costs taxpayers $55,000 to treat endocarditis (an infection of the heart valve) or $35,000 for skin or bacterial infections, but if someone goes to the overdose prevention site for a clean needle, which could prevent infection, it’s only 14 cents.

“[The government] is planning on opening sites around the province,” says Warren. “Sometimes we try to skimp, and this is a population who have been skimped [on] all along.”

People with addictions face discrimination in the healthcare system where they are not always treated respectfully because they’re often flagged as “seeking drugs,” she says.
An overdose prevention site is a place for people to use substances where there are new and sterile resources for them. Warren says that while a lot of the work is harm reduction, it’s also about preventing HIV, Hepatitis C, and other blood-borne infections.

In the beginning, the sites will be basic and not have “all the bells and whistles.” But once the need is demonstrated, the end goal would be to have a centre where people with addictions can get counselling and health care, as well as stabilization and a better quality of life.

PHOTOS COURTESY BLOOD TIES FOUR DIRECTIONS CENTRE

A 240-square-foot house may not seem like an ideal living situation, but for some people who are unhoused, tiny homes can be a creative solution tackling a small part of the issue.

According to a 2018 Canadian government report, approximately 35,000 Canadians experience some form of homelessness on any given night, and the Territories face unique challenges including extremely high building costs and a shortage of vacant housing. Blood Ties Four Directions Centre, a non-profit organization offering HIV/AIDS and Hepatitis C support in Whitehorse, Yukon, started one tiny home in 2012 when funding for housing was a pervasive issue amongst their clients, as well as discrimination and inadequate/insufficient housing types.

“It’s really hard to help a person get on Hepatitis C treatment and care when they don’t know where they’re going to sleep that night,” says Patricia Bacon, former executive director for Blood Ties. Bacon thought, why not start small? “We wanted to be able to do something within the scope of our agency,” she says.

From 2012 to 2016, the one, 240-square-foot tiny home served as transitional housing for five clients. Then it moved into storage while Blood Ties searched for a permanent lot. After securing funding and getting a zoning change, they were finally able to build four more homes creating the Steve Cardiff Tiny Home Community. (Steve Cardiff was a Yukon Territory MLA and supporter of Blood Ties who died in a car crash in 2011.)

Since opening in January of 2019, 10 people have lived in the homes—two people have stayed since 2019, says Brontë Renwick-Shields, executive director for Blood Ties. One client, who struggled with chronic homelessness for many years, found stability in a tiny home, says Bacon.

“That is a hugely successful outcome.”

But the homes aren’t for everyone—some people have challenges with collecting excessive belongings, something which can offer a sense of security, and others need 24/7 support, says Bacon. The homes are not suited to those with limited mobility either. The Steve Cardiff homes have sleeping lofts accessed by stairs, making it difficult for those with mobility issues.

“The tiny houses definitely work for folks, but we also need to have mixed models because one style of housing doesn’t work for everybody,” says Renwick-Shields.

But the idea has caught on. Tiny home communities now house veterans in Calgary’s Homes for Heroes development and people in Carcross/Tagish First Nation, Yukon.

For Blood Ties, the project is a success—even if it is only a small one. “I think we have had a lot of clients that have appreciated having their own little house to call home,” says Renwick-Shields.