Pubdate: Fri, 05 Sep 2014
Source: Tyee, The  (CN BC Web)
Copyright: 2014 The Tyee
Website: http://thetyee.ca/
Cited: http://vancouver.ca/people-programs/healthy-city-strategy.aspx

VANCOUVER'S ADDICTION AMBITIONS, REVISITED

What happened to North America's boldest drug policy experiment?

In the late 1990s and early 2000s, drug policy pulsed at the heart of
Vancouver's municipal politics. In 2002, Larry Campbell, the former
RCMP officer turned chief coroner, carried his newly adopted COPE
party into city hall by campaigning on a harm reduction platform.
These ideas -- clean needle distribution, supervised injection sites,
and methadone -- were presented as pragmatic solutions to the harms
associated with drug use.

Campbell rode a wave that was already building throughout the '90s. In 
1993, over 200 Vancouverites died of illicit drug overdose. With high 
overdose, HIV, and Hepatitis C rates, it was clear that the city needed 
a new way to deal with its drug problems. After much campaigning by 
activists, academics, and public health officials, council approved an 
85-page document called A Framework For Action: A Four-Pillar Approach 
to Vancouver's Drug Problems. Those four pillars, approved in 2001, 
included 36 recommendations for a more progressive drug policy -- 
including the recommendation that lead to Insite. It was the most bold 
and progressive drug policy of any city in North America.

Where do those four pillars stand today? Some of the people who helped
erect them fear the city may be failing to maintain what's been built.
While the shocking rates of overdose death and HIV transmission have
fallen, poverty and addiction remain pressing problems in Vancouver.
As civic politicians enter a new election season, however, their focus
is on different issues ranging from housing affordability to bike
lanes and pipelines.

In the five-part series that begins today, The Tyee and the University
of British Columbia's documentary radio series, The Terry Project on
CiTR, investigate the state of Vancouver drug policy. This piece
provides an introduction to The Four Pillars. In the coming weeks, the
series will investigate each of the pillars -- prevention, treatment,
harm reduction and enforcement.

'Rebranding'?

Philip Owen was the mayor of Vancouver from 1993 to 2002, and is
widely credited for making The Four Pillars possible. Today, he argues
that Vancouver has not supported The Four Pillars since Sam Sullivan
left the mayor's office in 2008.

Vision Vancouver Mayor Gregor Robertson "doesn't want to have any part
of it," contends Owen, "and hopes that it will go all away."

Owen and Sullivan both were members of the Non-Partisan Association
(NPA) party.

Donald MacPherson, the author of The Four Pillars and now executive
director of the Canadian Drug Policy Coalition, says that the city has
stalled.

"Robertson is rebranding the city. He's onside philosophically, but
not comfortable with the issue," says MacPherson. "Things have
changed. People used to come and look at Insite, and now they're
coming from around the world to look at our bike paths."

But Vision Vancouver city councillor Kerry Jang says that's not true.
"We have absolutely supported the issues." Not only has the city
continued to support the "groundbreaking" four pillar approach, he
says, but Vision Vancouver's has broadened the city's response to drug
dependency by addressing complex, related issues like mental and
physical health.

Four Pillars: A new philosophy

The Four Pillars marked a revolutionary shift in the way Vancouver
understood the problem of addiction, re-conceptualizing illicit drug
use as a public health problem that can be managed, rather than a
moral or legal one that should be dealt with mainly through policing.

Each of the pillars -- prevention, enforcement, treatment, and harm
reduction -- has multiple recommendations for all levels of government.

Many of Vancouver's most progressive drug policies developed out of
these recommendations. Most prominently, the pillars called for
research into supervised injection sites.

In 2003, that recommendation became Insite, North America's first
supervised injection site.

Thomas Kerr, a researcher at the BC Centre for Excellence in HIV/AIDS,
credits Insite and The Four Pillars for reducing cases of HIV,
Hepatitis C and drug overdose deaths.

"The most encouraging statistic is the decline in the HIV infection.
Vancouver had what was described as the worst HIV epidemic ever seen
outside of Sub-Saharan Africa," says Kerr, "but the epidemic
completely plummeted."

Since 1996, the number of AIDS cases has dropped by 80 per cent. This
May, Vancouver Coastal Health closed St. Paul's Hospital's dedicated
AIDS ward due to a lack of patients.

Meanwhile, some activists and public health workers say that Vancouver
still has a serious drug problem.

"The issue in this town is public drug use," says Ann Livingston, a
nurse and founding member of the Vancouver Area Network of Drug Users.
"There has never been this much public drug use in Vancouver."

Evan Wood, the newly appointed Medical Director for Addiction Services
at Vancouver Coastal Health, recently told reporters that St. Paul's
emergency room that has seen an 89 per cent increase in
hospitalizations related to addiction over the past four years.

Over the last three years of reporting, 2011 to 2013, an average of 98
have died annually of accidental overdoses on illicit drugs. Earlier
this summer, Vancouver police warned intravenous drug users to be
extremely cautious after seven people were suspected to have
non-fatally overdosed on heroin in a single day.

Moving on or moving back?

Today, Vancouver no longer has a drug policy coordinator. The Four
Pillars section of the City of Vancouver's website has not been
updated since 2011, and there have been no recent progress reports.

The City of Vancouver maintains that the document still guides its
drug policy. However, Owen says that it is uninterested in furthering
the vision of The Four Pillars.

"It's somebody else's playbook. It's somebody else's agenda. We didn't
create it, we didn't want it. And a lot of us don't like it anyways.
We can ignore it and it will go away," says Owen, characterizing the
views of Vision Vancouver.

Councillor Jang rejects Owen's contention that Vision Vancouver has
abandoned the pillars. "Clearly he is not paying attention."

Jang says that the city has evolved the strategy to follow urban
health research, which stresses the importance of healthy
neighbourhoods. The Four Pillars is groundbreaking policy, says Jang,
but not enough.

"Ten years hence, it needs to be broadened out," argues Jang. "It
needs to be attached to more than just addiction. It needs to be
broadened out to understand people with complex issues."

The City of Vancouver is developing a Healthy City Strategy, which
focuses on a wide range of issues, including food, transportation,
mental health and environmental sustainability.

Advocates of the pillars say that there is still a lot of work to do.
MacPherson points to underfunded prevention education, unpredictable
drug treatment programs, limited harm reduction initiatives, and high
incarceration rates as evidence that The Four Pillars vision was never
fully realized.

Opposed by the Harper government

When Vancouver adopted The Four Pillars approach, it was the boldest
drug policy innovation at a city level in North America. However, in
Canada, the municipal government has only so much control over what
can be done. Health care falls under provincial jurisdiction, and drug
laws are a federal matter.

Today, the federal government opposes The Four Pillars philosophy. The
Conservative government recently passed the Respect for Communities
Act, making it much more difficult for supervised injection sites to
receive exemption from the Controlled Drugs and Substance Act. The Act
was a response to a 2011 Supreme Court decision, which stipulated that
the Ottawa did not have the authority to revoke Insite's exemption
from federal drug laws.

Larry Campbell, former mayor and chief coroner, says that Prime
Minister Stephen Harper is the number one obstacle to The Four Pillars
today.

"We're filling the prisons. We're destroying lives and destroying
families," says Campbell. "For what? Some guy with six plants of
marijuana? Some guy who got caught with heroin?"

According to Jang, the best Vancouver can do is provide statistics,
encourage reforms, and facilitate new programs. He points to a 2013
commitment by Victoria to fund an extra $20 million to combat mental
illness and addiction in Vancouver. In the past, the City of Vancouver
has been able to overcome opposition from other levels of government.

In the late '80s, then-premier Bill Vander Zalm, a socially
conservative Catholic, threatened to fire Vancouver's chief medical
officer, John Blatherwick, for supporting AIDS education in schools.
However, Blatherwick went forward.

Further, in 1989, Blatherwick and the City of Vancouver opened a
needle exchange, despite provincial opposition. The municipal
government spent $100,000 to fund the initiative.

Advocates of the pillars think the municipal government should once
again demonstrate that sort of audacity to push other levels of
government for further reforms.

'We're going to drift'

In the '90s, it would have been difficult for Vancouver politicians to
avoid the issue of drug use. To draw attention to mounting overdose
deaths, the Vancouver Area of Drug Users delivered a coffin to
council. Today, those political battles have fallen into distant memory.

Kerr describes the late '90s and early 2000s as a time when
Vancouverites had an incredible appetite for progressive political
action. However, he laments that it didn't result in a fully-realized
vision of The Four Pillars.

"It's very rare to see a city suddenly decided that it really cares
about hardcore drug use and what's happening to the most marginalized
people in the city. That happened in Vancouver," says Kerr. "I think
that letting it slip away was sort of a missed opportunity."
MacPherson says that it is up to Vancouver's politicians to make sure
that the city keeps moving forward on drug policy reform.

"Somebody has to keep the pressure up," says MacPherson. "Otherwise, I
think we're going to drift. As governments worry about budgets, we may
lose ground. We may lose some of the ground we've gained."

- -------------------

Next Thursday: When it comes to lessening the harmful effects of drug 
use in Vancouver, where does the city stand today on the key pillar of 
prevention?
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MAP posted-by: Matt