Without peer workers like Thomus Donaghy, overdose prevention sites couldn’t run. Peers — people who have been or still are drug users — are able to develop trust with vulnerable people who might not otherwise use the lifesaving sites.
And yet peer workers are paid less and often not considered employees, meaning they don’t have access to the same worker protections, vacation or health benefits as other site workers.
“Peer workers in general aren’t given the same level of support and care as other workers and are often put on the frontline of the frontlines,” said Andrew Ledger, the president of CUPE 1004, a union local that represents some overdose prevention site workers.
“And that’s a real issue for us. We don’t believe that workers, because of their socioeconomic status or housing status, should be treated any differently or treated as lesser.”
The issue has come to the fore in the wake of Donaghy’s death on July 27. The 41-year-old peer worker stepped outside for a break while on duty at an overdose prevention site on the grounds of St. Paul’s Hospital. Police say he became involved in a fistfight and was fatally stabbed. No arrests have been made, and police have appealed to witnesses to come forward.
Donaghy’s co-workers are now speaking up about long-running concerns about safety at overdose prevention sites and the wide gap between peer workers and others who are considered full employees.
“We would have understood an overdose. But this we can’t understand. We can’t reconcile that someone willfully took Thomus’s life,” said Nikita Volkova, who worked with Donaghy at the Maple and Molson overdose prevention sites in the Downtown Eastside, both operated by PHS Community Services.
“It’s a fear that we have constantly lived with and that we have voiced fears and concerns about for a number of years.”
Peer workers don’t get the recognition they deserve, said Rachel Plamondon, a manager at the St. Paul’s overdose prevention site, which is operated by RainCity Housing.
“They do just as much work as the unionized staff and they get paid less, which is bullshit in my opinion,” Plamondon said.
Vancouver’s overdose prevention sites were started by community activists during the height of the city’s overdose crisis in the fall of 2016. Users consume drugs with workers or volunteers ready to intervene with first aid if they overdose.
Before 2016, Vancouver had two safe injection sites, but operators had to go through a long approval process to open new sites. Overdose prevention sites — at first operated illegally — were a new, low-barrier model that could be opened quickly in the midst of a deadly crisis.
Since Vancouver’s first OPS started running in 2016, the sites have been heralded as a key lifesaving measure and have spread across Canada and the United States in response to a North America-wide poisoned opioid epidemic.
In B.C., overdose deaths had been dropping before the COVID-19 pandemic. But with services closed, an increasingly poisoned supply and more people using drugs alone, the death toll has again spiked, setting new records in May and June.
Donaghy was devoted to the work of overdose prevention. Friends say he would roam the streets late at night when he couldn’t sleep, looking for people who needed help. Co-workers say he had a unique ability to make others feel at ease. Right before he died, he had helped an inexperienced staff member reverse a potentially fatal overdose.
Stephanie Smith is the president of the BC Government and Service Employees’ Union that represents some workers at the St. Paul’s site. Smith called the work “inherently risky,” but said what she’s heard from members who work at the St. Paul’s site is that verbal outbursts happened, but they rarely escalated to violence.
“They said mostly it’s generalized anger and resentment about the individual’s circumstances or a denial of service,” Smith said.
Smith said the BCGEU is now trying to find out why Donaghy was not a member of the collective bargaining unit.
RainCity Housing did not respond to a question about why Donaghy was not a member of the union. In a previous interview, executive director Catharine Hume said the St. Paul’s OPS was known to be a calmer site, with extra security guards hired when it started two years ago.
But Volkova said that at the Molson and Maple overdose prevention sites, where she often worked with Donaghy, violent incidents were common. On two occasions, Volkova said site users falsely accused staff of taking their drugs, leading to tense situations that escalated to the point where staff feared for their safety.
“We’ve locked down the site, we’ve tried to evacuate as many people as we can,” Volkova said. “We’ve literally been held hostage in our own injection site.”
Julie Day, who also worked at the Molson site with Donaghy and Volkova, said she doesn’t want to blame overdose prevention site operators. The problem is the lack of funding from the city, provincial and federal governments for mental health supports and housing.
For instance, Day said, some crystal meth users can go days without sleep, a state that can turn into psychosis.
And the “underlying criminal element” behind the illicit drug trade is the cause of many of the situations that happen at overdose prevention sites, she said.
“This could happen to anybody,” Day said of addiction and mental illness. “It could be your mother, sister, brother — it crosses all boundaries.”
PHS Community Services sent The Tyee this statement in response to questions about safety at its sites: “PHS always prioritizes safety for everyone at our projects. Our staff often work with members of the public who may at times be in distress, and our team is trained in de-escalation and managing conflict.”
CUPE 1004 has been trying to organize the peer workers who work at PHS Community Services overdose prevention sites. A vote has been held, but the ballot box currently sits at the Labour Relations Board, sealed and with votes uncounted, because PHS has disputed the union’s list of employees, Ledger said.
“They don’t believe that our list of peers, that the ones that we’ve identified as employees, are indeed employees,” Ledger said. “There’s a formal objection from PHS that has to be heard and then the ballots can be counted, and we go forward from there.”
Peers often start out as volunteers who receive a paid cash stipend of around $10 an hour — less than minimum wage. As they gain more experience and start to work more steady shifts, they’re often paid between $15 and $18 an hour, Ledger said. Unionized workers make $21 to $28 an hour, and starting Oct. 1 will make $27 to $28 an hour under a new collective agreement.
Peers may or may not have access to vacation, health benefits or mental health supports, Ledger said. Peer workers’ duties range from making users feel welcome, to reversing overdoses, de-escalating conflicts and connecting people with support services.
The system has developed this way because it provides low-barrier employment to people who may still be drug users, are sometimes unhoused or have not held a job in a long time.
Sarah Blyth, the co-founder of the first overdose prevention site, said the Overdose Prevention Society is still almost entirely staffed by volunteers who are paid stipends. The society helps people get better jobs once they’ve worked as volunteers for some time, she said.
The arrangement also ensures that peer workers don’t lose access to their income assistance or disability benefits, which limit recipients’ earnings to $12,000 a year for people with disabilities or $8,400 for people on income assistance who have multiple barriers to employment.
Day said she was worried that unionizing would mean more barriers to employment for people who haven’t worked in a long time.
But Ledger said the way the peer system has developed, with some peers working for years without being considered an employee, is discriminatory.
PHS declined to respond to Ledger’s comments because of ongoing union bargaining. The society said it follows WorkSafeBC guidelines.
But when it comes to reporting and assessing violent incidents at overdose prevention sites, Ledger said there appear to be few standards.
“It’s very discretionary,” he said. “There aren’t a lot of clear policies and protocols around violence and how to document events and how to determine if something is or isn’t a violent act.”
Story updated on Aug. 6 at 11:50 a.m. to correct previous references to peer workers as peer support workers. The correct term is peer workers.