Alberta harm reduction advocate, drug user challenges government focus on abstinence

It was in a hospital that a Calgary woman says she recalls feeling happy for the very first time as an opioid raced through her body.

"When they gave me that IV of hydromorphone, all of the horrible things that I was feeling just went quiet," says Ophelia Cara, 21.

"I felt like I could breathe again for the first time in a long time and, in some sense, for the first time ever."

Being introduced to hydromorphone, sold under the brand name Dilaudid, would change everything for her.

While stories of opioid use are often tragic — with thousands of attributable deaths in Canada in recent years — Cara says using them has saved her life.

Cara doesn't go by her given name for fear it could threaten her prescription, as tensions rise in Alberta about how to respond to the overdose crisis.

As the provincial government focuses on a recovery-based approach, while cutting harm reduction services, Cara has become a well-known advocate in Calgary for services that support people who use drugs.

Not only is she fighting to save the city's drug-use site from closing, but she's highlighting that abstinence doesn't work for everyone.

"I tried everything I could to stay sober. None of it worked," says Cara. "I am still very much an addict but I'm also more recovered and more mentally healthy now than I've ever been."

Sipping tea on a couch in her home in southwest Calgary, Cara details a lonely childhood where she often chose the comfort of a school book instead of making friends.

From an early age, she faced significant mental health issues like depression that continued into adulthood. Cara says her life hit an all-time low during the COVID-19 pandemic.

Her job in a nightclub was put on hold and her relationship with a man she loved was rocky. An unrelated sexual assault landed her in the hospital in the summer of 2020, and that's when she received the hydromorphone drip.

After that visit, she turned to street drugs — cocaine and fentanyl. She suffered numerous overdoses, one of which resulted in a massive seizure that Cara says left her unconscious for an hour.

Her dad tried to force her into sobriety, taking her to a small town in Mexico.It didn't work. She overdosed almost immediately after returning to Canada.

"I don't recommend drug use to anyone," says Cara, speaking specifically of street drugs. It marked her life, she says, with hospital visits, toxic relationships, unbearable pain and severed ties to family and friends.

It was at Calgary's drug-use site where staff helped her realize there was an option to be "safer with drug use without getting sober," and she started doing research.

Prescribed opioid medication provides her stability

There are opioid agonist treatment programs in Alberta where powerful opioid medications, like methadone and suboxone, are prescribed to treat substance use disorder. Safe supply programs, which offer prescription alternatives to street drugs, are also becoming known across Canada.

Cara says she was rejected by multiple doctors before finding one that would prescribe her Dilaudid.

In addition to therapy, she says the prescription drug helps with her mental and physical health. It provides her stability so she can study and work while leaning into her passions, like cross-stitch and advocacy.

"Generally, the reason that we say that people need to get sober is because there's this idea that someone who's using drugs can't live a balanced life and that all they care about is getting high," says Cara.

"But I am more productive now than I was when I was sober, because now I'm actually stable. I'm no longer in survival mode."

She carries a drug kit that houses naloxone, sterile equipment, vitamin E oil for her skin and contact cards for local agencies, among other supplies to support safer drug use. A pin attached to its mesh interior reads "can't recover if you're dead."

While abstinence may work for some people, says Kinnon Ross, an Edmonton-based harm reduction nurse, recovery should instead be viewed as any step that improves someone's quality of life.

"If it means having a less chaotic outcome from your drug use then that's a step into recovery," says Ross.

In some ways, Cara is still like her younger self and can often be found with her head in a book. She plans to get a doctorate in chemistry and pharmacology to dive into how drug use can be made safer.

Cara says she chose the name Ophelia after reading William Shakespeare's Hamlet, where a young noblewoman by that name dies by suicide after being dealt many wrongs by men in her life.

"I wanted to give her a better ending than the one she chose for herself."