The Death of an Advocate
The Death of an Advocate
Alexandra de Kiewet knew both sides of Canada's opioids crisis. As an intervention worker, she saved lives and as a drug user, she cheated death countless times. But her life's work is far from over.
The last time I saw Alexandra de Kiewet alive, we ate leftover birthday cake for lunch.
She had just turned 44, a minor miracle when you consider how many times Alexe cheated death.
There were years when Alexe’s full time job was being a dope addict. She worked as an escort back then, navigating a world of heroin dealers and undercover vice cops eager to make a show of force.
“Now I don’t know if you’ve ever been in a city jail overnight but it’s not something I recommend,” Alexe said, in between bites. “Pure chaos. We were crammed in this cell and everyone’s on edge. There’s no way I’m getting any sleep because it’s loud and I’m about to feel sick from heroin withdrawal.
“Next morning, they haul me in front of a judge and I’m absolutely haggard. It’s like the worst flu you ever had and you’re supposed to be in court, defending yourself. So there I was — hurting so bad I wanted to die — exhausted, covered in sweat, smelling like a jail cell and the judge is lecturing me about my life choices. Fuck, man.”
We sat in the breakroom of her work that day in June, shoveling fluffy caramel into our mouths as she laughed about the old days.
Alexe was a tiny thing, standing a few inches over five feet with limbs like toothpicks. She’d squint and smile from behind a thick pair of glasses, like she’d just heard a private joke.
There was no quit in her. She survived overdoses, prison, HIV and whatever the streets of Montreal could throw at her. When she got through the worst of her addiction, Alexe spent her life keeping drug users from dying alone.
She worked for practically minimum wage at safe-injection sites. And with what little free time she had, Alexe created the Canadian Association for People who Use Drugs, sat on the board of directors at the HIV Legal Network and spoke at conferences across the world.
She did all of this without ever quitting drugs.
“There’s so many people that are alive today because Alexe was there to help them,” said Sandra Wesley, who worked with Alexe at Stella — an advocacy group for sex workers.
“Not just because she helped people come back from an overdose. She also trained doctors to treat drug users with respect. Nurses too. It makes a huge difference when a doctor knows how to help someone use drugs safer. Because the alternative is to cast them away and let them take their chances on the street. Alexe found that unacceptable.”
On that last day we spent together, Alexe wasn’t her usual self.
She had just witnessed a friend overdose on fentanyl and brought him back to life using naloxone — a drug that blocks the effects of opioids. When he came to, police were at the scene and arrested him. Alexe spent the night trying to find out where he was being detained.
Adding another layer of desperation to the mix, Alexe was also flat broke. She lived in a tiny apartment by the train tracks in St-Jérôme, never sure if the government grant that paid her meager salary would be renewed. No matter how much she achieved in that world — and Alexe was, above all, an overachiever — she lived paycheque to paycheque until the very end.
I can’t remember if she cried that day or if it was during our phone conversation the night before, but I was scared for her. Maybe she sensed that. Because by the end of our afternoon together, Alexe was her usual bubbly self again.
A crossing guard watched us as Alexe and I walked together outside her work. For a moment, I worried she was staring at the patchwork of syringe marks on Alexe’s arms. People did that a lot. Luckily, it was something endearing, a moment I’ll keep with me for a long time.
“I just wanted to say I love your style,” she told Alexe, who bowed her head and did a little curtsy.
“This style? Thank you! I was going to say I noticed you earlier this week and I appreciate your smile.”
When we got back to her office, Alexe hugged me and told me to kiss my daughter for her. I promised to do my best to meet up with her in Montreal before summer’s end but that never happened.
She died four months later.
***
Canada’s opioids crisis has reached an inflection point.
Some 21 people a day die of an overdose in this country. That’s a 66 per cent increase compared to pre pandemic numbers. In British Columbia, there were 2,291 overdose deaths last year compared to 806 in 2016. And more Quebecers died of an opioid overdose last year (450) than in traffic accidents (387).
There are two competing models that could address the crisis. The first, a harm reduction approach advocated by folks like Alexe, doesn’t punish people for their addiction. It aims to have them use opioids as safely as possible so that one day they might be ready to moderate their consumption or quit drugs altogether.
The other is a “recovery” model embraced by conservative politicians that puts an emphasis on getting people to abstain from drugs through rehab programs and other treatment. Conservative party of Canada leader Pierre Poilievre recently described harm reduction as a failed experiment by the “woke” government of Justin Trudeau.
The surge in deaths during the pandemic is partially linked to the isolation so many of us experienced in the early days of COVID-19. More people started using opioids alone, which dramatically increased their chances of a fatal overdose.
But COVID-19 also wreaked havoc on the supply chain that connects dealers in Canada to opioids and cocaine from international suppliers. To mitigate any loss in profits, drug dealers began cutting their product with the more readily available fentanyl — a synthetic opioid that’s 100 times more potentl than heroin. That’s when things really got out of control.
“Once you use fentanyl, there’s no turning back,” Alexe once told me. “Your body starts to get used to it. Regular old heroin or dilaudid won’t do it anymore. They just don’t pack the punch fentanyl does. But then, it’s really hard to dose something as strong as fentanyl. It doesn’t take much of a miscalculation for your whole body to just shut down.”
In B.C., where 2,292 people died of an overdose last year, the provincial government decriminalized the possession of small amounts of hard drugs last spring. The measure is meant to encourage people to have their drugs tested for lethal contaminants and for them to use it in a safe-injection site (SIS).
Proponents of this “safe supply” approach also advocate for substance users to be prescribed pharmaceutical grade opioids instead of buying fentanyl on the streets. One study, published in the American Journal of Public Health, found that access to a steady and clean supply of opioids helped users take back control of their lives. They didn’t binge use as much, their supply wasn’t laced with fentanyl and they didn’t live with the fear of going into withdrawal.
At Insite, Vancouver’s first SIS, there hasn’t been a single overdose death in over 3.6 million visits since it opened in 2003. And each of the nearly 7,000 overdoses on site ended with the person’s life being saved.
Even so, Poilievre is leading a sort of counter-revolution in the fight against overdose deaths. In a video released two weeks ago, the Tory leader advocated Alberta’s “safe recovery” program, preaching a policy of abstinence and addiction treatment. He points out that, after Alberta saw a surge in fatal overdoses early in the pandemic, it cut monthly opioid deaths from 174 in November 2021 to 92 in July of this year. (My colleague Paul Wells has an excellent breakdown of this in his newsletter.)
But Poilievre doesn’t mention, in his video, that the drop in deaths coincides with Alberta’s big investment big in harm reduction.
During the pandemic, Alberta’s public health department increased its rollout of methadone — an opioid substitute which keeps people from going into withdrawal. It also funded a massive distribution of naloxone in communities across the province.
“Poilievre is playing with people’s ignorance of the crisis,” said Isabelle Fortier, who works with Moms Stop the Harm, an advocacy group that represents the families of overdose victims. “I was in Edmonton last month and one of our mothers, her son is on the streets. He uses. He’s had to be revived. So now this mom uses her own money and volunteers to patrol the streets of Edmonton with naloxone.
“The government isn’t helping them but they’re out there saving lives. That’s devotion. It’s inspiring. But she’s doing it because the services just aren’t there. No matter what Poilievre says, there’s still going to be hundreds and possibly over 1,000 fatal overdoses in Alberta this year. We can do better.”
Fortier knows all too well what the opioids crisis is doing to families across Canada. She lost her daughter Sara-Jane to a fentanyl overdose in May of 2019 and she’s spent the past three years fighting for safer supply.
“Before I lost Sara-Jane, I thought abstinence was the only way to prevent overdoses,” Fortier said. “I would have loved to bring my daughter to treatment, I would have loved for her not to use. But the more grieving mothers I meet with, the more experts I talk to, it’s just clearly not the most realistic approach. Opioids hijack your brain. At some point, the substance is in control of the cockpit and you’re just sort of along for the ride. You can’t just up and quit the thing your body and brain want most in the world.
“I mean, some people can do abstinence and I’m rooting for them. It can work. But I know that in Sara-Jane’s case, she probably would have required methadone or safe supply. It doesn’t mean she wouldn’t be able to decrease her consumption and live a ‘normal’ life. It just means it’s not all black and white. When you turn drugs into a moral instead of a public health issue, you’re treating people with addictions like they’re defective and that’s not helping.”
In Quebec too, the government has dragged its feet on harm reduction. During the first year of the pandemic, when 571 people died of an opioid overdose, the government allowed its strategy on fighting opioid deaths to expire. And while 2020 saw a 30 per cent increase in overdose deaths, the provincial government didn’t budget any additional cash to help keep people alive.
As advocates like Alexe helped secure new testing equipment to help keep lethal drugs off the streets, the federal and provincial governments waited for months to give organizations like CACTUS or Dopamine permission to test narcotics on site. Who knows how many lives that cost?
“Drug users are not a priority for this government,” said Fortier. “We have to fight tooth and nail for the most basic compassion from our politicians. And losing someone like Alexe, in this struggle, is a huge blow to the movement.”
***
Hugo Bissonnet sat next to Alexe’s hospital bed, convinced she had cheated death again.
“I told her she was unkillable, I told her she was going to get through this just like she always did,” said Bissonnet, who worked with Alexe at Le Dispensaire, a St-Jérôme clinic that helps people test their drugs.
Alexe was admitted to the hospital with a blood infection. When doctors did an ultrasound on her heart, they found an infection in one of the valves. It’s a common health complication that arises when people shoot opioids but one that’s treatable with surgery.
“I brought her that gross black liquorice she loved so much,” Bissonnet said. “I wanted her to have something that wasn't soggy hospital food and she had a real sweet tooth. Mostly, I just wanted to see her and let her know everything was gonna be okay. Things had been tough at work and I told her I’d always have her back. And then in the middle of our conversation, she had a stroke.
“I just kind of lost her, I saw her freeze and slip away. She wasn’t hooked up to any monitors so I had to run and get the nurse. After that, she never came back.”
In the tight knit world of intervention workers and activists that Alexe helped create, news of her death was devastating.
“She was a pioneer,” said Jean-François Mary, who met Alexe when she worked as a columnist for L’Injecteur, a magazine written for and by intravenous drug users. “She was one of the first generations of drug users to cross into advocacy and shape the national conversation of substance use. There aren’t many left. Most of them are dead now, from HIV, overdoses and I guess just street life.
“It’s not easy, when you come from that world, to be in a room full of academics and hold your own. Of course, Alexe would blow them all away. She was a tornado. It wasn’t just her lived experience. Yes, she had guts like no one else, yes she was punk rock and yes she had seen things most academics never would. But she was intellectually curious with a knack for connecting people’s everyday struggles to holes in our public policy.”
Mary and Alexe wound up working together at CACTUS Montréal, a safe-injection site and resource centre. But even in that world, where people are sensitive to the challenges that people like Alexe face, there was a lot of judgement.
“I couldn’t speak at her funeral because my last vivid memories of her were too sad,” Mary said. “Before she left CACTUS, she would come to my office before her shifts and cry. People in our milieu, who know better than to do this, would stigmatize her drug use. She would come to me to build up her courage and face another day, knowing people out there would assume the worst of her because she used drugs.
“She had more guts than just about anyone I can think of. And if we didn’t live in a world where people buy drugs off dealers instead of having access to safe supply, Alexe would still be alive. Her death was preventable. How many people develop a blood infection from injecting diabetes medication into themselves? How many people miscalculate their dose of antidepressants and die from it? It doesn’t happen because it’s unacceptable. Alexe’s death is unacceptable.”
Sandra Wesley, who worked with Alexe at Stella, recounted how Alexe used to pretend to brush the judgement off.
“There was this conference in Thailand and Alexe was scared she wouldn’t be allowed in the country because of her background,” Wesley said. “Everybody gets nervous before a flight but with Alexe there was a real possibility she’d be turned away at the border. So, instead of dwelling on it, she would stand in my office and start trying on all my ‘normal’ clothes and pretend to be normal. We would sort of role play me being the customs agent and her being a ‘normal’ woman.
“It was hilarious, it was charming, it was Alexe.”
***
“If we contacted Alexe’s ghost on a Ouija board, she’d probably get a kick out of all this fuss we’re making over her.”
Bissonnet’s voice shook on the other end of the phone call.
“She had two speeds: in a coma, or fucking warp speed. She lived a full life, one with lots of remorse but no regrets. There aren’t many people in this world who had the outsized impact Alexe did. But beyond all that, she was such a joy to be around.”
I first knew Alexe as a source on a story I wrote for Ricochet almost two years ago.
She told me about her life on both ends of the opioids crisis. As a user, she’d overdosed in the spring of 2021, nearly dying on the floor of an west Montreal apartment because Alexe used drugs from an unfamiliar dealer. As an intervention worker, just a few months earlier, she climbed into the backseat of a tiny German sports car — syringe full of naloxone in hand — ready to save someone who stopped breathing after injecting fentanyl into himself. The man survived.
She was like one of the X-Men, an outcast trying to save the very society that shunned her. Alexe even had a de facto superhero outfit — fishnet stockings, a black skirt and black tank top. Though, on the day we met, she took the time to mention that most of her good clothes were in the wash. She wore a New York Yankees ball cap and jeans. That was as close to boring as Alexe got.
Lately, I’ve been thinking a lot about Pierre Poilievre’s hardline on drug policy and while I feel a great deal of anger towards him, I mostly just wish he could have met Alexe. Because, in his worldview — where abstinence is the answer to drug overdoses — people like Alexandra de Kiewet can’t exist. And that’s a shame.
Alexe was never going to be abstinent. If it wasn’t for the daily methadone treatments she received, she probably would have died on the streets a long time ago. Instead, she lived and saved lives.
It’s a funny thing telling people’s stories. You set up a meeting, shake hands and then they tell you their darkest secrets. Though, with Alexe, there were no secrets. She never lied about her drug use or alleged misdeeds. Alexe was an open book, someone who shared her story so others could see the person behind the addiction.
I suppose we became friends. We’d talk on the phone just to catch up or I’d go to one of her events without any intention of covering it. I just liked being around her. She was funny, she made me feel good and she always reminded me that behind everyone, from the toughest cop to the most down and out drug user, here is a person — someone’s friend, someone’s lover, someone’s kid and someone who means the world to someone else.
It was our mutual friend Stéphanie Lareau, who worked with Alexe at Stella, who texted me the news.
“Hey Chris, I don’t know if anyone told you but Alexandra de Kiewet had a stroke and she’s on life support. There is no chance of survival. They are pulling the plug tomorrow. … I’ll be saying goodbye later. I know she liked you a lot and that you had a lot of respect for her so I wanted you to know.”
She died in the same hospital our daughter Wednesday was born in. I don’t know why but that detail just occurred to me now.
They laid her to rest on an unseasonably warm day in November. We met in the back of Théatre Ste-Catherine, where Bissonnet, Mary, Wesley, Lareau and dozens of others gathered to pay their respects. On the buffet next to the stage, Alexe’s street family made a spread of black liquorice, bacon-wrapped hors d’oeuvres and an assortment of the dangerously unhealthy food she loved so much.
My partner Marie-Pier and Wednesday came along because I regretted that neither of them got to meet Alexe. After one of the eulogies, the crowd cheered and baby Wednesday — who just learned to clap at daycare — joined in enthusiastically.
Now, you might call me a weirdo but in that moment it felt like Alexe was winking at us from the other side.
Rest In Peace, Alexe.
My condolences for the loss of your friend. It sounds like a lot of people are going to miss her.
OMG! so so sad but beautiful inspiring story