The downtown Eastside sector of Vancouver is home to perhaps the most concentrated drug use in North America. “In a few square blocks radius you have thousands of people dependent on injectable drugs, often injecting in the back alleys and the streets," says Dr. Gabor Maté.
He has the look of a person who has weathered a lot, though he is highly accomplished. Born in Nazi-occupied Budapest in 1944, he lost relatives in Auschwitz. His immediate family emigrated to Canada in 1956. Operating a family practice for two decades before entering the addiction field, he always had a few drug-dependent patients among his clientele. He eventually became a tireless advocate for addicts in Vancouver.
Maté is a compelling speaker, as his agile phraseology and hard-earned authority bear out—regardless of whether you agree with his conclusions. And some people don't. In Vancouver he’s worked at Insite, the only supervised injection site on the continent. There, people bring illegal drugs and inject them with clean needles in a a safe space under medical supervision.
It's a harm-reduction technique, says Maté. Overdoses can be prevented this way, as well as the spread of disease. "Giving somebody clean needles does not stop their addiction, but ... it means there isn’t HIV being transmitted from one person to the other.” Maté says providing sterile swabs for addicts to clean their arms doesn’t treat addiction, but it also doesn’t promote it. “It just makes it less likely that that person will be sick and suffer more, and consequently cost society a lot of money in terms of health care costs.”
Critics say Insite equates to government facilitation of drug abuse and does nothing to deter dependence or treat it. They suggest it could send a mixed message to young people. Conservatives in Canada’s government have made attempts to shut Insite down.
Data out of Vancouver seems to confirm the efficacy of the harm-reduction approach. According to the Sept. 6 issue of The Province, the 1996 life expectancy for people in the downtown Eastside area was nine years below that of other British Columbians. In 2011, the life expectancy was just two years short. However, other factors, such as gentrification, might have played a role in those statistics.
According to a New Mexico Department of Health report for 2011, Bernalillo County suffered the most drug-induced deaths in the state. Most commonly, unintentional overdoses resulted from the use of prescription opioids, heroin, cocaine, muscle relaxants and antidepressants. Overall, New Mexico had the highest drug-induced death rate in the United States, the report states, as well as nearly twice the national rates of alcohol-related disease and death.
“It’s all about getting something from the outside to make you more complete, make you more satisfied.”
Dr. Gabor Maté
KC Quirk, executive director of Crossroads for Women, has seen the fallout firsthand while helping people who are coping with mental health issues, homelessness and the transition out of incarceration. The organization is bringing Maté to speak in Albuquerque because his humanistic philosophy is in line with Crossroads’ mission.
"We're coming to that from a really, I believe, much more humane and much more realistic perspective,” Quirk says. “Most people don’t, you know, decide to quit using drugs and alcohol and adapt perfectly.”
The Albuquerque seminar on drug abuse takes its name from Dr. Maté’s book, In the Realm of Hungry Ghosts: Close Encounters with Addiction. Within its pages, he candidly exposes his own issues with shopping addiction. Though it doesn’t damage his life in the same way as drugs and alcohol, Maté’s dependency has adversely affected his relationships and self-esteem. But it also allows him to better relate to drug addicts. The title includes a reference to the bhavacakra, or “wheel of life,” in Buddhist mythology.
There are six realms people cycle through, Maté says: The human realm is where we are our ordinary selves. In the animal realm live our appetites and passions. The god realm is home to our spiritual sense of peace and satisfaction. The hell realm encompasses raging emotions, terror and fear. The titan realm is marked by envy. Finally, in the hungry ghosts realm, the creatures are shown with scrawny necks, small mouths and empty stomachs. “They’re never able to fill their bellies sufficiently to feel satisfied,” says Mate, “so they keep going around trying to get satisfaction and fulfillment from the outside, and that’s the realm of addictions.”
Contrary to conventional medical thinking, Maté doesn't attribute addiction to genetics alone. "Neither does science back it up nor does experience prove it,” he says. Addicts are typically people who’ve experienced significant loss or trauma in their childhood, says Maté. The greater the degree of trauma or stress they’ve experienced, the more vulnerable they are to addiction. “In the population that I worked with, all the women had been sexually abused as kids, and the men were traumatized repeatedly, as well, in childhood."
Criminalization of drug use is a kind of cruelty, Maté argues. "You begin with an abused child: Society did not protect you, so you had those experiences growing up, no one to turn to. Then you turn to drugs to soothe the pain, and you’re a criminal.”
In a culture where people meet their needs via the acquisition of products, the achievement of status and the approval of others, addictive tendencies are widespread, he says. "It’s all about getting something from the outside to make you more complete, make you more satisfied. It’s a society like that—in which there’s also a lot of insecurities, which leads to a lot of stress—people find ways of distracting themselves from their internal problems.” And, says Maté, those methods tend to become addictive.
People don't like to look at this cultural issue, and a drug addict represents it to the highest degree, he says. "We say that they’re the ones with the problems. They’re the antisocial element. They should be excluded from society. But we’re not looking at ourselves or the nature of the society as it is.”