I remember when Nancie came home after her first stint in treatment, or at least the first stint in the 10 plus years I knew her.
I didn't ask. It's not my place to judge, but she offered, simply, "it hurts too much to be clean."
Nancie (not her real name) was fiercely private and although I knew her as well as she allowed and better than most, it wasn't well.
She shared stories with me over the years, of her own violent separation from her biological mother, being locked in the crawl space of her new and scary home when she misbehaved, raped by her adoptive brother, losing her own children to government care, violent assaults, often targeted because she was Indigenous and homeless.
The loss of her youngest child was a particular and searing pain that was never far from the surface. I rarely asked but instead let her talk about it, whenever she felt able.
I offered on a few occasions to take her to visit her child and she would cheer up, but her shame and her anguish always got in the way.
Nancie was wicked smart, articulate and had a laugh that could light up the day. Even when she lived rough, she was always immaculately put together.
She died in late November. Alone in her room. As I knelt down to say goodbye to her tiny, half naked, brown body, I felt something between relief and agonizing sorrow.
For some reason Nancie was attached to all of us at Atira. She wasn't always happy with us or with me, but for more than 10 years she moved from one of our buildings to the next, whenever she got restless.
I had always hoped we would open a treatment program where she felt safe, at home, and that maybe, just maybe, we could offer her the safety and support she needed to begin to heal.
Treatment is an integral component of our response to the opioid crisis, a response that requires a systems approach — naloxone, decriminalization, food, clothing, shelter, jobs, belonging.
All of the pieces need to come together, all at once.
Not everyone will survive their ongoing relationship with substance use.
Not everyone wants to.
If and when people are ready, they need to be able to access services that will support them to explore reducing, managing or stopping. 914 people died of apparent illicit drug overdoses in 2016.
176 of them were women.
We need unique treatment programs for women, informed by our understanding that women's experiences of gender-based violence is central to their use of substances.
We need an understanding of the intersections between women's experience of violence, poverty, racism, gendered patterns of drug use/harms, and lack of support for mothering.
These understandings are critical to developing programs that are seamless and increase opportunities for women to keep themselves and their children safe.
Most of the women we work with in the Downtown Eastside grew up in the foster care system. Most have lost children to the system. Women need access to their children, supported in such a way as not to cause their children trauma. Children need access to their mothers — they need to know they are loved and that their mothers are safe.
I met Nancie's youngest child for the first time at her mother's memorial. I was shocked at the resemblance; how similar they were in mannerisms. As many as 100 people crammed into the room we secured last minute because of the turnout.
We all made huge efforts to let her child know just how much her mother loved and missed her. I will always regret not getting The Rice Block open before Nancie died.
It might not have changed anything, but then again, it might have changed everything.
Janice Abbott is the executive director of Atira Women's Resource Society, which operates the newly opened Rice Block, a 38-bed substance-use treatment centre for women.