Michael Nurse is a harm reduction practitioner, activist, and advocate. He resides in the city of Toronto where he has worked for the past 20 years delivering harm reduction-based street outreach from a lived experience perspective.
Michael Nurse: Andre, I want to thank you for being here. For agreeing to share your perspective on some of the findings from the Imagine Safe Supply research. Could you talk briefly about your background, like your pursuits, your work, and how you came to be experienced and interested in the concept of safe supply?
Andre Hermanstyne: I am a former substance user. I used every substance from fentanyl to crystal meth; I been using injection for many years. Overdose is a part of my experience, not only responding to overdose but overdose in myself. I have held many different positions on the frontline including for Black CAP, creating Canada’s first harm reduction program focusing on the needs of African, Caribbean, and Black (ACB) people. I’ve worked also for the Jewish response to homelessness. And my experience brought me also to working for public health for a bit at an injection site. And I spent some time on the safe supply program. I am still kind of on it, but I get a Sublocade injection. So, I’m really interested in commenting on this research because I mean nothing really happens unless there is data to really support changes. I feel like as somebody who is a racialized person, that we are often left out of the discussion while these things impact us at higher rates than many other cultural groups.
Michael Nurse: As you are speaking of safe supply, what is your understanding of the purpose of safe supply. Why safe supply?
Andre Hermanstyne: So right now, there is a poisoned drug supply. So, the fentanyl that people are expecting to be fentanyl, its often adulterated and mixed with different agents. Some of these agents are supposed to create I guess an additive effect and I guess produce a better high. But the result is lowering the respiration of the user to the point where they stop breathing and eventually die. Safe supply comes in where now you can get the drugs that you need to use but a safe product. So, like the hydromorphone that people are taking, Dilaudid. Or they are being prescribed morphine, but that slow-release morphine in the form of Kadian, like the pills so that they can inject them and use them in a safe way. Now these are drugs that have been manufactured and they are pharmaceuticals, and we know exactly what is in it. How much the dosage is and that they are not adulterated. So as a result, my understanding is that it has resulted in a lot less death.
But also, so like taking the drug trade out of the hands of, let’s say the ‘black market’ for lack of a better term, and providing people with an option to go into a doctor. We know that people who use drugs, they are struggling with a lot of complex issues. And some of those issues can be addressed – dental care and health care and things of that sort – just by virtue of them coming in to access safe supply.
Michael Nurse: OK, that’s a very significant point, thank you for sharing that. And thank you for such an articulate response to that question. I would like us to focus on some selected findings from the Imagine Safe Supply research related to safe supply for African, Caribbean, and Black (ACB) people and their communities. Findings from the research indicate that some of the challenges to effective safe supply services for ACB communities include a lack of culturally specific harm reduction spaces for ACB people, a need for harm reduction services developed for ACB people, and significant absence of ACB people in leadership and decision-making for frontline services. Considering these expressed concerns and challenges, how prepared would you say the ACB community are for delivering safe supply services that are accessible and relevant for ACB people who use drugs?
Andre Hermanstyne: I think we are ready. I think we are ready for it because I mean if you look at some of the stats around incarceration rates and stuff like that, and when I think of my own personal experience of being incarcerated, this was directly as a result of my substance use. Selling drugs just to support my habit. Stealing things, committing robberies and stuff like that. Now I don’t have to engage in those type of behaviours. I know I can go to my doctor and get my drugs now. And like that’s a huge burden. So, I mean I haven’t had a criminal charge in many years.
Michael Nurse: But reflecting on the challenges that were mentioned from the findings, do you think that these are things that need to be addressed for safe supply to be effective?
Andre Hermanstyne: Yes. How they are addressed, I don’t know. I don’t have the answer for that but yes, they do definitely need to be addressed.
Michael Nurse: OK yea so, some of the findings from the research suggest that effective and sustainable safe supply for ACB people and their communities require an approach and understanding that is uniquely ACB. And by uniquely ACB I’m talking about services that are developed to respond to aspects of culture, language, nationality, class difference, between and within ACB communities. So we are looking at challenges and aspects of the ACB community that need to be considered to develop safe supply. How does the idea of ACB specific safe supply correspond to your vision of safe supply services for ACB people?
Andre Hermanstyne: I think that it is needed. A culturally specific approach is needed.
Michael Nurse: Another key finding indicated that for safe supply to be successful in ACB communities an involvement of ACB women at all levels, particularly in leadership roles, is essential. And considering that many ACB homes are led by women, what are your thoughts about the importance of Black women in the development and practice of safe supply for ACB people?
Andre Hermanstyne: I had some time to really think about this question and how I want to respond to this. So, I had some friends, and they were pregnant, and they gave birth to twins. Now the twins that they gave birth to, I think they gave birth at 23 weeks which was just a little over half of the full 40-week process. These twins were girls. Both parents were ACB people. So, these girls they ended up surviving. What the doctor said, which I found to be very interesting, was the reason that they survived was because they are Black females. And out of every child that is born with any type of challenges around the birthing process, the Black female has the highest chance of survival. So that speaks to the strength of Black women and the need to heal a lot of the trauma that we as Black men have inflicted on Black women and that was experienced by the transatlantic slave trade. So, I think it is important that we heal, we spend some time healing our Black women. But that they definitely need a leadership role for the survival of our existence.
Michael Nurse: You are talking about in general as well?
Andre Hermanstyne: Yes, and specifically to this program of safe supply.
Michael Nurse: What is the uniqueness that you see for Black women in the development of ACB services? I know some people say that Black women do most of the caring in the community, that Black women are involved in organizing support for people. Do you see this as a significant factor?
Andre Hermanstyne: Absolutely. Not only from those viewpoints but just the strength that a Black woman possesses just by her presence alone. Her knowledge and her insights are needed. We can’t move forward without the Black woman.
Michael Nurse: That’s a very deep answer, thank you for that. Another question, the research heard that religion and faith influences stigma about drug use in ACB communities. And that it would be important to find ways to engage religious leaders in addressing stigma or harm reduction or even safe supply. What are your thoughts on this issue?
Andre Hermanstyne: I totally agree that we need to address the stigma that is associated with religion because like I mean from a religious aspect these are sins. Drug use is sinful behaviour. So, it’s an all-or-nothing kind of abstinence-based approach. But a harm reduction approach, we meet people where they are. So, I mean I think engaging those ministers who have more of a progressive stance and encouraging them to then bring that message, or package that message to deliver to the ones that have more of I guess a narrow view, would be essential.
Michael Nurse: And you know, I’m going to say I always learn from talking with you. And even that comment that you made about reaching out to the more progressive ministers to get that connection is a distinction that I really didn’t consider. Is there anything that you would like to say about safe supply for ACB people that we haven’t covered here?
Andre Hermanstyne: No, but it just seems that you guys are on the right path. Because like I mean we can’t have anything without the necessary research. And you know the challenges that we’ve had like working together at Black CAP, just to get funding for ACB programming. And even after I left, I heard that the drop-in had been cancelled because the stigma that is associated with people who are using substances, being in that building in the financial district, was creating challenges itself. So, I mean we need to start knocking over some of these barriers and having a space for people who are Black who are choosing to use drugs, that they can feel safe. And live.
Michael Nurse: Andre, I want to thank you for being here. And for being open to sharing your experience and expertise on this topic.
Andre Hermanstyne: Thank you so much Michael and if at any point you have any more questions or whatever feel free to just give me a call. I know we’ve been planning to do some coffee for some time. But maybe we should really get on top of that.
Michael Nurse: I would like that. Thanks Andre.
Andre Hermanstyne: Thank you very much, I appreciate you Michael man.
Michael Nurse: I appreciate you too my brother.
Imagine Safe Supply is a community-based research project that explored participation in safe supply in Canada for people who use drugs and frontline workers. For more information on this research please visit here.
