Jimmy John Howland had never used fentanyl before landing on the streets of Vancouver in May 2021. Howland, 52, had recently lost his leg due to a blood clot. With his disability preventing him from holding a job, he had no source of income and found himself homeless.
“I never was an opiate-addicted person. And about seven months into my stay outside, I was noticing that everybody really wanted these blues,” he said, using a common term for fentanyl pills.
Howland’s drug of choice had been methamphetamine since the age of 17 when he started using with his mom, he said. He began using meth again while homeless to cope with the challenges of living outside.
Then, he tried fentanyl, a drug 50 times stronger than heroin. The pills are cheap and easily accessible; Howland said there were over a dozen places he could get them just in the encampment where he lived.
“At first, I was smoking one pill in the morning,” he said. “That led to two pills a day. I got up to sometimes five pills a day, on average three pills a day. That’s really, really low. People are doing like 40.”
He ended up overdosing, and needed three doses of naloxone to bring him back. “I just couldn’t believe it. It was just so powerful,” he said. “They’re a very sneaky drug. They sneak up on you. They snuck up on America.”
Teams step up
Vancouver Homelessness Response Coordinator Jamie Spinelli saw fentanyl use “explode” on the city’s streets within the past year and a half. Though there is no official data, Spinelli estimates about one in four people experiencing chronic, unsheltered homelessness in Vancouver are struggling with fentanyl addiction, based on her outreach experience with the city’s Homeless Assistance and Resources Team.
This number varies by camp. “There are some encampments that we go to that historically had a high volume of discarded syringes,” Spinelli said. “Now, that’s kind of shifted to foil. Like you just see foil everywhere, because that’s what they use to smoke (fentanyl) off of.”
In response, outreach workers with lived experience of substance use have stepped up to offer supplies and services to those willing to accept them.
“Things are being addressed. Outreach people — they deserve an applause,” Howland said. “I cannot respect them more.”
XChange Recovery’s Street Medicine Team visits the downtown homeless encampment outside the Share House about once every two weeks to give out basic necessity items — including naloxone — for those who need it.
“I’m pretty sure half the people on this block would be dead right now if we didn’t have Narcan,” said Mike Dixon, who has been homeless for about five years and frequently goes to the Share House encampment. “This epidemic of blues hit the market and took everything over.” Narcan is the brand name of a device that delivers naloxone.
XChange Outreach Coordinator Jacob Phillips said the organization’s budget typically provides for 60 naloxone packages over 30 days — not nearly enough to accommodate the need, in his view. “We could hand those out in 20 minutes,” Phillips said. “Most people need multiple Narcans. People need Narcan maybe three, four, five times before they come out of it.”
Another outreach service, the Recovery Navigator Program through the Recovery Cafe of Clark County, formed last year in response to the Washington Supreme Court’s State v. Blake decision. Under Engrossed Senate Bill 5476, individuals must be referred to treatment on their first two drug-possession offenses.
Recovery Navigator Supervisor Charles Hanset responds to referral calls in urban Clark County. Navigators are sent to the scene within 30 minutes to serve as resource brokers, connecting people with recovery programs and other services.
Almost all urban Clark County calls are for people who are homeless, and about 90 percent are related to fentanyl, Hanset estimated. In his experience, it typically takes meeting an individual several times before the person agrees to get help. “When they’re ready and willing, we got to be able to do our job and provide those services the best we can,” he said.
Taking over the streets
According to Spinelli, though substance use isn’t the primary reason why people become homeless, it is often the reason they remain homeless.
People living outside might resort to drugs as a survival technique, as they provide a way to stay warm and awake in the cold, wet winter months. Some begin using as a response to trauma: “As one of my navigators said it perfectly, ‘I’m in recovery from trauma, and the side effect of that is drug addiction,’” Hanset said.
Spinelli also thinks drug use can create a sense of inclusion on the streets, making people feel less like outsiders among the homeless population. “It’s just helpful in so many ways,” she said. “That probably sounds like a terrible thing to say. But it does help with coping with all parts of homelessness.”
Others begin using fentanyl by mistake. Because drugs like methamphetamine and even marijuana are now being laced with fentanyl, some users like Howland who never used opioids before are unknowingly getting hooked.
This can be a hard reality to confront, Hanset pointed out. “Back in the day, it was like, a meth user hated heroin users. Like, ‘I’d never do that. They’re a junkie,’” Hanset said. “Now they are experiencing full-on opioid withdrawal from methamphetamine.”
People in this situation sometimes refuse to go to treatment, according to Hanset. “The individual is so prideful, they would rather sleep outside and die on the street than go in to say, ‘Hey, there’s fentanyl in my meth, can I please get help?’”
Once a person starts using fentanyl, physical addiction makes it difficult to stop. Howland said when he started coming down from a high, his anxiety peaked. “I wanted to crawl out of my skin,” he said. “And I never really got any farther than that, I always found a pill or something.”
After Howland overdosed, Spinelli helped him get a spot at Hope Village, Vancouver’s second Safe Stay Community at 4915 E. Fourth Plain Blvd. Housed and surrounded by community, Howland was able to detox himself, breaking the addiction. He described the withdrawal as “every single sickness you’ve ever had thrown at you at once.”
“I went through hell,” he said. “I did it. I made it. I got through it. Six months I was addicted to that.”
In Spinelli’s opinion, supportive housing is key to helping people overcome addiction. She noted that several residents at both Vancouver Safe Stay sites have successfully broken their habits.
“We have a lot of folks who are out on the streets who would go to treatment, but they know that they’re going to be homeless again when they get out of treatment. So why bother?” she said. “It is so very important to have a safe space to be if you’re even going to consider getting off fentanyl or drugs of any kind.”
Hanset agrees that more support is needed to keep people in their homes. Though he thinks the Housing First model is effective in Clark County, he said he wants to see more focus on retention. He’s found that many people with fentanyl addictions are homeless “many times over.”
“Most of them, if they’re hooked on fentanyl and they never learned to live inside before, especially the young population, they’re not gonna keep their house,” Hanset said. “And it turns into a trap house, it turns into a drug den, and it just all turns out bad for everybody.”
For Hanset, a former heroin addict, it took more than a year to feel stably housed after getting off the streets, even with the help of a supportive housing program. “For most people, I would say (it takes) at least a year or two before they feel fully supported,” he said. “And it’s not linear either, you fall back.”
With the support of Hope Village, Howland is staying off fentanyl. But in Howland’s opinion, there’s still a long way to go, especially when it comes to stereotypes people hold of the homeless.
“There’s a line, a visible line, between society and the homeless that we’ve built. This side, that side. I would really like it to not be like that,” Howland said. “Obviously, we’re people. We’re obviously human.”
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