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Zoe Dodd began working in harm reduction nearly two decades ago, beginning as a coordinator of a community Hepatitis C program.Galit Rodan/The Globe and Mail

Zoe Dodd had just given an emotional presentation to Toronto’s Board of Health when she realized that something wasn’t right. It was mid-November, the COVID-19 pandemic had exacerbated Canada’s runaway toxic drug crisis, and the long-time harm-reduction worker was in tears as she spoke about front-line workers responding to thousands of overdoses and finding bodies in portable toilets and doorways.

“The ripple of death is grim, and it will take decades for people impacted by this loss to heal,” Ms. Dodd told the board. “We are abandoned by all levels of government, who point fingers at one another, and we are burning out.”

A couple of days later, she awoke feeling foggy-headed and disassociated from reality. Her heart raced and the room seemed to vibrate. She felt like she was in another dimension.

Ms. Dodd would later learn that she was experiencing derealization, a mental state that can be triggered by heightened periods of stress and trauma. In recent years, she had faced one fatal overdose after another – of close friends and strangers – and hundreds of other near-death encounters.

“One day, it just all came to be – just in a constant state of disassociation, like I was in a movie,” she said in an interview, recalling the episode that sent her to the emergency department.

Workers on the front line of both the toxic drug crisis – in which an increasingly volatile illicit drug supply has led to unprecedented overdose deaths – and the COVID-19 pandemic are not okay. Sixteen months into the fight against the novel coronavirus, as infection rates fall and provinces lift restrictions, the country’s other epidemic quietly rages on, killing thousands of people every year. But there has been no marshalling of national resources for this emergency, no daily updates or action plans, and front-line workers like Ms. Dodd are running on fumes.

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From January, 2016, to December, 2020, at least 21,174 Canadians died from apparent opioid toxicity, according to the most recent national tally from the Public Health Agency of Canada. Provincial data from 2021 show that this year is on pace to be another record year for such deaths.

Vikki Reynolds, a B.C.-based registered clinical counsellor who works extensively with those responding to the toxic drug crisis, said harm reduction and social service work is “totally different” from that of first responders as it is often more emotionally laborious.

“For a firefighter or a police officer, or someone in that professional capacity, they are responding to an event,” she said. “There is a human being there, but it’s not someone that they know. For harm-reduction workers, for shelter workers, these are [often] people that they have known for years. They are connected in community. It is complicated grief.”

Ms. Dodd began working in harm reduction nearly two decades ago, beginning as a co-ordinator of a community Hepatitis C program. Days were spent co-facilitating support groups, advising clients and attending conferences to talk about the liver disease – then one of the most pressing issues for drug users. It was fulfilling work, and it pleased Ms. Dodd to see clients’ health outcomes improve all the time.

But as fentanyl began to sweep the illicit drug supply in the early 2010s, Ms. Dodd’s work began shifting to overdose response. By 2015, it became the bulk of her job.

“You could see the increase in people dying – and then friends and co-workers of mine started to die,” she said. “And then that just continued.”

After being overwhelmed with grief, battling thoughts of suicide and landing in the emergency department for her mental-health episode, Ms. Dodd stepped away from the front line last fall. This spring, she was named inaugural community scholar for the Toronto-based research centre MAP Centre for Urban Health Solutions, a role in which she will examine drug treatment systems. She rediscovered hobbies she had long forgotten: music, hiking, bird-watching.

“I know I have to prioritize myself, because I want to be here,” she said.

Corey Ranger is the clinical nurse lead for a program in Victoria that connects people who use drugs with safer pharmaceutical alternatives through an outreach model. His work takes him to settings such as parks, encampments and supported housing, where he forges relationships with clients and connects them to safer substances and other health care services.

He is haunted most by the clients he worked hard to support, whom he grew close to, who then died when he was not there to help them.

“It’s very morally distressing to know that, oftentimes, whatever it is that you’re doing is not going to be enough,” he said.

Mr. Ranger says he has seen more trauma and despair during the pandemic than in all his previous years of work combined, which has resulted in a constant state of anxiety. He has grown fearful of answering his phone because there is likely bad news on the other end. He experiences panic attacks and has nightmares during the weeks when social-assistance cheques are distributed, knowing that a spike in overdoses will follow. He sleeps maybe four hours a night.

“When I’m alone and isolated and it’s quiet, that’s when all of the memories that I try to avoid are suddenly unavoidable,” he said. “The faces of the people who we failed play like a slide show.”

In Vancouver, a social worker in the city’s Downtown Eastside spoke with The Globe and Mail about developing post-traumatic stress disorder (PTSD) in February of 2020. After years of stress, he experienced what he believed to be psychosis; his brain felt intensely overactive and like it was “screaming,” he said. The Globe is not identifying the source because of concerns about the professional consequences of discussing his mental health.

He took stress leave, saw a doctor and a counsellor, and received a formal diagnosis. When he felt well enough to file a claim with WorkSafeBC a few months later, he was promptly rejected. The social worker had described the cause as cumulative stress but the provincial agency said he needed to prove that his mental injury stemmed from specific, unexpected events that arose from his employment, he said.

Most provincial workers’ compensation boards have “presumptive” clauses for some or all occupations that assume psychological injuries are caused by the job unless proven otherwise, streamlining the process for mental-disorder claims. Manitoba extends presumptive coverage to all workers diagnosed with PTSD, for example, while Saskatchewan does so for all workers for a range of psychological injuries. B.C. and Ontario extend that coverage to only select public-safety jobs, such as paramedics, firefighters, police officers, correctional officers and emergency dispatchers.

Several unions, including the Health Sciences Association of B.C., have called on governments to further broaden presumptive coverage, citing fairness and stigma. In e-mailed responses, both B.C. Labour Minister Harry Bains and Ryan Whealy, acting press secretary for Ontario Minister of Labour, Training and Skills Development Monte McNaughton, said the provinces continue to consider expanding presumptive coverage.

Dr. Reynolds, meanwhile, says what many front-line workers are experiencing is not trauma or anxiety, but dread from tragic deaths caused by bad drug policy.

“When we use language like ‘vicarious trauma’ and ‘burnout,’ we’re talking about workers as if they’re mentally ill, or broken on the inside, or don’t have enough resiliency. And that’s unaccountable,” she said.

“These folks are dealing with so many tragic deaths ... and you can’t just get over tragic deaths. Grief and loss counselling is based on ideas of moving through stages like rage and acceptance. You can’t accept deaths that are entirely preventable by better drug policy. You can’t accommodate yourself to that. That would be a test of your inhumanity.”

Dr. Reynolds advises workers to create solidarity teams – a community of support to shoulder them up – to work in line with their ethics, and to keep a fingerhold on “believed-in hope.”

“What I’m talking about is not optimism or positivity,” she said. “I’m talking about a necessity for social change. We have got to believe there is something else coming.”

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