Do you see them? All over Vancouver’s Downtown Eastside there are junkies, addicts and alkies. On street corners, in alleys, lurking outside the ancient hotels. All over Downtown Eastside there’s also help available for junkies, addicts, alkies—detox programs, 12-step meetings, residential treatment centers, methadone clinics, safe-injection protocols. Some of the programs are sponsored by the local churches. There are also doctors and shrinks and healers and pipe carriers and studies and grants and.… It goes on.
And yet there always are more junkies, addicts and alkies in Eastside.
“It has a long history as an enclave of rather traumatized and damaged and hard-living individuals. It’s 20 or 30 or 40 years of this going on,” said Gerald Thomas, a researcher with the University of Victoria’s Centre for Addictions Research of British Columbia (CARBC).
Philippe Lucas, another CARBC researcher, described Downtown Eastside as a “site of the highest rates of drug use, hepatitis C and HIV/AIDS in the Western world. And a large percentage of that is a First Nations population, an urban Indian population.”
In light of such persistent and pervasive pain, poverty and disease it is clear that most treatments for addiction offer only short-term relief. Is that the fault of the junkies, the addicts and the alkies? A failure of will?
Or perhaps, argues one physician who works intensively with addicts, mainstream treatments for addiction “completely ignore causes and only deal with effect.” Dr. Gabor Maté says that if we don’t get to what causes addiction, we can never effectively treat it. He thinks the answer is another drug, ayahuasca, a hallucinogenic plant mixture from the Peruvian Amazon.
Maté’s recent work conducting ayahuasca ceremonies for 150 to 200 addicts, often among British Columbia First Nations bands, created a media stir, including a documentary, The Jungle Prescription, that aired on the CBC in November. The buzz caught the attention of authorities at Health Canada, who sent Maté a letter last November ordering him to cease or face loss of his license and even prosecution.
Canadian national drug policy mirrors that in the United States, which considers three of the ingredients in ayahuasca—harmaline, harmalol and N,N-dimethyltryptamine—to be dangerous, even though, consumed in its indigenous state as a thick brew, it’s hard to find any evidence of addiction concerns associated with it.
Maté complied with the order, but he’s not happy about it, citing a Health Canada exemption issued a few years ago that allowed a Montreal church to use ayahuasca as a sacrament. “Health Canada agreed the plant was not addictive or toxic,” he says. “So what is their problem then, exactly? Why is it restricted to a particular religion when it can be used to help so many other people?”
It’s not an easy question to answer, apparently.
“Look at them. They’re stuck here.” Stan, a 45-year-old Native, a drug-addict just back on the streets after spending 18 months in jail, is looking out a window in a Downtown Eastside clinic and describing the cluster of fellow addicts gesticulating and pacing across the street in front of the Army and Navy store to Maté, who treats patients at a clinic run by the nonprofit Portland Hotel Society. “You know, Doc, their life stretches from here to maybe Victory Square to the left and Fraser Street to the right. They never get out. I want to move away, don’t want to waste myself down here anymore. Ah, what’s the use? Look at me—I don’t even have socks.”
He tells Maté that whenever he gets on a city bus—sockless and in his tattered sweats—“People…move away from me. You know what that feels like? Like I’m an alien. I don’t feel right till I’m back here. No wonder nobody ever leaves.”
Maté recounts this conversation early in his most recent book, In the Realm of Hungry Ghosts: Close Encounters With Addiction, in which he lays out findings in early childhood development and brain research to argue that the war on drugs does little to deal with addiction except to marginalize and imprison people.
In the late 1990s, when he was in his mid-50s, an age when many turn their thoughts to retirement, Maté, a longtime family physician in Vancouver, began working with junkies, addicts, alkies in Downtown Eastside. “That was…a population that needed a lot of medical help. It was a population I very poorly understood, but…it was something, that as a physician, called to me,” he says. He has been there 13 years and has become increasingly frustrated at mainstream treatments that ignore the roots of addiction.
Addictions of all sorts can be traced to early trauma and abandonment issues in childhood, he believes, that leave an emotional hole that neither shaming nor incarceration will never fill. “Everybody I work with has been traumatized as children. Everyone. All the women, for example, have been sexually abused.… It’s not just my personal interpretation. The research literature is totally clear: Drug addicts, almost without exception, suffered severe adversity in childhood, and that’s exactly how addiction arises.”
But somehow, he says, the research “is not very well known by most physicians.” Further, any sort of compassionate, cause-addressing treatment is pushed aside in the war on drugs. As a result, as Stan pointed out, people are trapped. Trapped in places like Downtown Eastside by poverty and demons and addictions. Further trapped inside addiction by early childhood trauma and abuse. Until those are addressed, addicts often repeat their behaviors.
How to break out? Maté insists that neither punishment nor moralizing is the way. He’s become a proponent of harm-reduction strategies (such as Downtown Eastside’s controversial safe injection site, where clean needles reduce the spread of hepatitis and HIV/AIDS) and his support for the Vancouver Area Network of Drug Users, whose members fight for better treatment and have gained some political clout. More recently, Maté has been exploring the use of shaman-led ayahuasca ceremonies in which the drug becomes a spirit guide—there’s really no other way to describe it, according to those who’ve experienced it—that can lead people out of the emotional emptiness causing their addictions.
Maté estimates that he has helped as many as 200 people explore the roots of their addictions via ayahuasca ceremonies in the last couple of years. Last year, he approached a coastal British Columbia First Nations band seeking permission to conduct an observational study among their members. CARBC researchers Lucas and Thomas signed on as coinvestigators. (Neither CARBC nor the University of Victoria had a role in the study.) Lucas says participants should remain unnamed—including the name of the band itself—to protect the integrity of the study and also to shield against any blowback from Health Canada or other authorities. (The director of the band’s health department did, however, speak freely about the study.)
“I’ve been looking at the use of cannabis or ibogaine and, more recently, ayahuasca [for addiction treatment],” says Lucas. “I’ve known Dr. Gabor Maté through his work in harm-reduction, and I’d heard that he’d developed this new methodology to treat addiction. He said he was having amazing success with this new methodology, which includes a combination of psycho-spiritual group counseling and two ayahuasca ceremonies in the Shipibo tradition. The Shipibo is an indigenous Peruvian tribe that has been using ayahuasca for hundreds, if not thousands, of years. So I coordinated a research project in order to be able to both observe the process and then follow up with 20 participants.”
Guillermo Arrévalo, one of the best-known Shipibo shamans, or ayahuasqueros, traveled by ferry from Vancouver to the First Nations band along with Maté and the
researchers to meet the band’s chief, leadership council, its council of elders and health administrators in February 2011. “We came in and asked in a very respectful way and, believe it or not, the shaman was actually there,” Thomas says. “And this guy has some presence, man. Even through an interpreter, he really conveyed to [the tribal officials] that this had some potential for helping their people, and that he respected their culture…developing really nicely the parallels that his culture was damaged by Westernization and all those kinds of things, but that they had to hold onto this ritual and bring it forward into the modern world.”
The band granted permission for the ceremonies to be conducted in its longhouse. “Which was an amazing honor,” Lucas says. “One participant described the longhouse as being the church, the courthouse and the hospital for the band members. It seemed to be the ideal place to be conducting these retreats.”
The band’s health director said the ayahuasca rituals were permitted because addiction among members is “rampant—almost epidemic. We had to try to think outside the box. I can send people away for a long period of time and spend a whole lot of money on treatment—which has been the traditional course of doing things—but then they come back. We wanted to give a shot to something different. We’ve been supporting people [at residential treatment programs] in staying away till they get strong. Here, you do a four-day retreat with pretty astounding impact.”
About 20 band members with addiction issues—ranging from gambling to heavy drug use—were recruited and screened for general health and for medications they were taking that might react poorly with ayahuasca. The recruits had their resolve challenged several times to determine how serious they were, and were placed on special diets.
Two retreats were scheduled, one in summer and one in fall. Each lasted four full days, and each featured two ayahuasca ceremonies, along with plenty of group discussion. There were eight people in the summer retreat, 12 in the other, including four from the first who wanted to do it again. “For them, it was a positive enough experience [to repeat] despite the emotional pain that many people go through—open weeping is not unusual at an ayahuasca ceremony,” Lucas says.
“The first day starts with Dr. Gabor Maté talking about peoples’ addiction and in a very novel way,” recalls Lucas. “He starts out by asking, first and foremost, what was positive about peoples’ addictions, which was fascinating to observe. It really cut to the chase. People’s responses were that it gave them a sense of belonging, that it filled an emotional hole in their heart. So he [explained] it’s pretty normal for people to not want to be in pain, for people to want to feel they belong. And so the idea that people would seek a substance if nothing else were available to them to reach those outcomes is not an unusual step. In fact he said it was very normal under the circumstances and the trauma these people have suffered that they seek an outlet like this and that they shouldn’t be shaming themselves.
“And then he asked folks what’s negative about their addiction, and the responses were the very thing that was positive in the first place in that eventually it made them feel bigger holes in their heart, and made them feel more disconnected from their loved ones, it made them feel more pain rather than less pain.”
The health director said this daylong, opening conversation about addiction is important: “Alcoholism or drug addiction seems to be a symptom of something much worse. We’re peeling back those layers and getting at a cause. They spend a whole day working on their intention. They spend a whole day formulating and reformulating it so it’s clear.… That’s what Gabor and the ayahuasqueros do is they work with the people around formatting it in way that it will be somewhat positive.”
“The first evening, they set what they were hoping to get out of their ayahuasca experience,” Lucas says. “For everyone, it was something a little bit more symbolic and deeper than ‘I want to get off drugs,’ with the common factor being people wanting to have a greater sense of self and self-worth. Many of the participants had been through drug treatment processes, some of them six or seven times, unsuccessfully. They’ve talked about their substance use and abuse with counselors and therapists in the past, and so at some point you could see them leave the script and start a much deeper exploration.”
On the second day, Lucas says, “the entire group is together and the room is darkened. The head ayahuasquero is there with two or three apprentices, and on top of that, there were two or three other helpers from the band health office to assist. So it has a very high safety level. People drink the [ayahuasca] brew. There’s about an hour of silence and it’s dark while the brew takes effect. Then the ayahuasqueros start chanting songs, known as icaros, that both call in the healing spirits and also help with the purging.
“Part of the ayahuasca process—for most people—is purging, vomiting. It’s not a drug experience, per se. You wouldn’t take this for a rave.… It’s mostly very internal. Most people lie very still, other than the purging.”
Thomas adds, “I didn’t have visions, but I did have a sense of a feminine presence walking around to each of the people as they were purging, talking to them and coaxing the darkness out of these people. I became aware of how the ayahuasquero works to bring the energy out, and how sacred this work is, how important it is.”
Lucas, Thomas and others have been conducting monthly follow-up research ever since the last ceremony in September to “see if it actually has affected quality of life, substance use, and a construct that we call internal freedom,” Lucas says. “Internal freedom is what we describe as the ability to make positive decisions about your life that lead to good outcomes.
“It’s fair to say we are dealing with a very traumatized population—many have been through high levels of physical and sexual abuse,” Lucas says. “The more I study addiction, the more I really I believe I am studying trauma—with addiction just being one of the outcomes of serious physical, psychological and sexual trauma.”
He cautions that results are preliminary, but “the early signs are that this has been a very successful intervention, but it appears we need more pre- and post-care follow-up. For some it has really stuck, had a lasting effect, while for others, purely in terms of substance use and some of the other challenges, it’s been more short-term.”
The band’s health director had similar observations. “I would say definitely there was some good. The key now [for participants] is integrating their experience into their lives.”
To people in the mainstream, just hearing about such a drug-treatment regimen, Maté can come across as a “rogue” doctor, as one British Columbia health agency administrator described him. “He’s a bit of a pariah. He’s on the edge, for sure,” Thomas says. “But he’s not a loose cannon. He’s just willing to take some risk.”
Shelley Reilly, Métis, an addiction counselor at the Association of BC First Nations Treatment Programs, in Creston, British Columbia, says, “I really like his approach. It resonates with the way our program is structured here. Our belief is that addiction is just the symptom, right? So it’s imperative there be some trauma healing in order for there to be any success.” Reilly works in five-week residential treatment programs that mix Western counseling and psychotherapy with ritual and ceremony. “Ceremony is huge in healing,” she says. “Cultural and traditional ceremony are huge.”
Even one of Maté’s critics—Perry Omeasoo, who works for Vancouver Coastal Health, who called Maté a “rogue” doctor—cites the importance of spiritual and cultural elements to addiction treatment, but he argues that plenty of addiction-treatment programs already incorporate elements of coastal and prairie indigenous culture. He adds that Sun Dance and other ceremonies from his Cree heritage learned during his childhood on Alberta’s Hobbema reserve, helped him out of addiction.
But when it comes to ayahuasca ceremonies, “I would say no to that. I wouldn’t encourage any of my clients or any of my people to start taking a foreign plant that we don’t know of, that’s not from here, and think that addiction’s going to get fixed by it,” Omeasoo says.
Others seem to think that if a house is on fire, don’t argue about which hose to use.
“For me, on a personal level, anything that can help us has value. If you can help one person change that [addicted] lifestyle around before death—or creating any more trauma—there’s value in it,” the addiction counselor Reilly says.
There is no argument that alcoholism and addiction is a scourge among First Nations people—a house that’s on fire. “Addiction is well-recognized as an aboriginal health issue,” says Dr. Evan Adams, aboriginal health physician advisor for the British Columbia Ministry of Health.
For First Nations people with addiction problems, Downtown Eastside has become the burning house where they attempt to live.
Omeasoo agrees with Maté’s claim that there are traumatic roots to Native addiction. He says he grew up nested in traditional culture on the Hobbema reserve, not even speaking English until he went away to residential school as a sixth-grader. In mainstream culture he hid his “Indian-ness” and, he says, even though “I bought a house and met a nice woman and had nice kids on a soccer team, I always felt there was an emptiness.”
A void he filled with substance abuse, he says. He got sober when he reconnected with the traditional ceremonies his grandfather had once conducted. And now he has become a pipe carrier, and is honored to carry his grandfather’s pipe to sacred ceremonies.
Which is just the sort of message Maté would like agencies such as Health Canada to hear. “If you look at traditional healing practices around the world, they all seem to involve plants and ceremonies and rituals,” Maté says. “There is nothing unique about ayahuasca. The shamans in the Amazon jungle didn’t invent it in order to deal with addiction—it’s something that came along as a spiritual healer and teacher, like many other plants. Like Native North Americans might use tobacco or peyote.”
Maté is both irritated and baffled that Health Canada threatened him with arrest last fall in a two-page letter from Johanne Beaulieu, director of Ottawa’s Office of Controlled Substances (as recounted in The Globe and Mail). Beaulieu was also quoted as saying, “We’d welcome scientists like Dr. Maté talking to us before they start their work. Our intent is not to stop research or treatment. It’s to ensure the safety of Canadians.”
Lucas, Thomas and Maté feel strongly that ayahuasca is not suited for clinical medical trials. “Clinical trials are designed for factory-based pharmaceuticals, not for traditional plants.… They can’t fit that particular square peg into this round hole—you just can’t do it,” Maté says.
The trials would also be costly—up to a half-million dollars, Thomas says. The observational study they conducted last year lacks key elements of a clinical trial—they had no control group, the sample population was small (making statistical analysis difficult), and the drug was consumed as a brew, with variable potency.
Adams, the aboriginal health official, points out another problem: “If ayahuasca isn’t patented, who will fund these trials? Usually a pharma company would take on that risk, not Health Canada, taking a hit if it failed, and reaping the benefits if it works. I’m not saying it’s right, it’s just how new drugs are developed.”
People who have observed the ayahuasca ceremony argue there is a spirituality and an art to it that is not suited for a clinical trial. Instead, Maté suggests First Nations groups seek an exemption on sovereignty and the cultural grounds of traditional plant-based healing. “They need to establish their own way of dealing with things because certainly nobody can argue the Western modalities are doing the Native communities a whole lot of good,” Maté says.
The First Nations band that allowed the ceremonies last year has said it is willing to help. “When it comes to going after Health Canada to get approval, we would be more than supportive,” the band’s health director says.
But other First Nations health and governmental officials are reluctant take a position on the matter. Adams is the one of the few willing to comment, and while he “generally supports” traditional medicine, he adds, “Traditional medicines from other countries being used in new ways by health professionals? No comment. Sovereignty over our traditional medicines and our ability to use and make laws concerning them? Absolutely!”
Adams holds out little cause for hope: “I haven’t been directed by the chiefs to investigate either this traditional medicine or the process to access it.… I would think First Nations have bigger fish to fry with their law-making abilities. Why fight federal law with a sovereign law around the legality of ayahuasca when they could be creating laws banning alcohol, legalizing marijuana, changing school attendance requirements, official language designations, etc.?”
Why fight for ayahuasca? Maté has an answer ready: The plant helps people get well. “It is not something you take in order to feel better. It’s a teacher, and it’s a healer. And it needs to be approached respectfully and in the right context with the right kind of support and the right kind of leadership and the right kind of ceremony. It’s not something that you just take as you would a medicine to make you feel better. It’s not about that at all.”
But right now, it does seem to be about politics which means ayahuasca is at a dead-end in Canada—for now.