Street roots
March 2, 2012
VANCOUVER, from page 8
the economic and cultural heart relocated to
the area around Burrard and Robson.
Describing the Downtown Eastside in a
1965 report, city planner W. E. Graham
called it a backwash in the westward drift
of downtown.”
Though a 1958 MacLeans magazine
article described Columbia and Hastings as
Canada’s most notorious underground
rendezvous”, throughout the next two
decades, alcohol was the undisputed drug of
choice in the neighborhood. Specifically, it
was beer and liquor for those who could
afford it, and noxious substitutes like shoe
polish and Lysol for those who couldn’t.
Throughout the 1970s, one of the
ongoing campaigns of the Downtown
Eastside Residents Association (DERA) was
to dry out the neighborhood. In practice
this meant lobbying for more effective
treatment centers, shutting the
neigborhood’s B.C. Liquor store, and in
1980, converting the dilapidated Carnegie
Library at the corner of Main and Hastings
into the Carnegie Community Center - one
of the few communal spaces in the area
where drinking wasn’t allowed.
The ubiquitous and unconcealed drug
market that many now associate with the
Downtown Eastside began to thrive only in
the mid-1980s. It started with the pre-Expo
development of Granville Street and
continued with the displacement of sex-
trade workers by West End community
groups and the gentrification of Yaletown
and Coal Harbour.
The drugs were different, too. Suddenly
cocaine was everywhere, uncharacteristically
cheap and dangerously pure. In the mid-
1980s, South American production began to
rise dramatically. With the increased flow of
people and money into the city for the
Expo, some of that supply made its way to
Hastings Street.
Donald MacPherson, who would later go
on to become the first drug policy
coordinator of Vancouver, was a program
director at the Carnegie Community Centre
in the late 1980s. He says that abundance of
cocaine changed the street scene of the
neighborhood.
“You had so many more transactions and
it was such a busy market,” he says. “There
was more crime, disorder and violence.”
Whereas an addicted heroin user might
need a few fixes a day, a cocaine high comes
and goes quickly. This meant more frequent
buying and using. The public health
implications were grim. Anyone injecting
the stuff — either as powder or, as became
more frequent in the 1990s, as crack —
might be slamming cocaine into their veins
20 times a day.
The Downtown Eastside Youth Activities
Society (DEYAS) was one of the first
community groups to respond to the surge
in injection drug-use. Under the direction of
John Turvey, DEYAS secured $100,000 from
mayor Gordon Campbell to operate
Canada’s first needle exchange in 1989.
Sadly, clean needles would do nothing to
curb the rising trend of overdose fatalities
across B.C. The most common culprit: a
new grade of heroin, generically coined
“China White.” Ten times purer than
anything that had been on the street a few
years earlier, it began flooding into
Vancouver in the early ‘90s.
been one of the first times that drug users
were asked what they actually thought about
anything.”
The Cain Report was published that
September. With recommendations
reminiscent of the 1952 Community Chest,
Cain dismissed the war on drugs as “an
expensive failure” and recommended, most
controversially, the establishment of
supervised injection sites.
While city hall was only beginning to mull
over the implications of Cain’s
recommendations, some in the Downtown
Eastside were already beginning to act.
In 1995, Livingston created the group IV
Feed. Using funding from DEYAS, she
rented a storefront at 356 Powell St. to set
up a “drop-in center” for addicts. In reality,
the Back Alley Drop-In was an injection site.
With no medical personnel, the
underfunded and under supplied facility
“had every kind of problem you can
imagine,” says Livingston. “It was like fear
and loathing on Powell Street.”
But it was still preferable to an alley, she
says. This was a place where addicts could
escape, to access clean syringes and to fix in
a safe environment. The police, recognizing
the benefits of having junkies off the street,
mostly turned a blind eye to the operation.
The Back Alley lost its funding the next
year. Livingston would go on to operate two
more illegal injection sites-in 2000 and again
in 2003, before Insite opened.
A growing epidemic
Along with the overdose crisis, it was also
becoming clear that intravenous drug users
were being ravaged by communicable
disease.
Dr. Steffanie Strathdee at the BC Centre
for Excellence in HIV/AIDS began to
investigate this problem. In 1996, she
helped set up the Vancouver Injection Drug
U s e rs S tudy (VIDU S), an ongoing h e a lth
survey of over 1,000 local drug users. The
1997 results confirmed what many in the
community already knew: the neighborhood
was facing a severe epidemic. Nearly 90
percent of those surveyed had Hepatitis C,
while more than one in five was HIV
positive. Within the Downtown Eastside
specifically, HIV rates hovered closer to one
in three. The neighborhood, it was declared,
had the highest HIV/AIDS rate in the
developed world.
In September of that year, Vancouver’s
chief medical health officer, John
Blatherwick, declared a public health
emergency in the Downtown Eastside. The
reminder was hardly necessary for many in
the neighborhood.
In July of 1997, activist and health board
member Bud Osborn planted 1,000 crosses
in Oppenheimer Park for the drug users
who had died across B.C. in the previous
four years. A few months later, he and
Livingston held the first public meeting of
what would become the Vancouver Action
Network of Drug Users (VANDU). An
organization principally made up of current
and former drug-users, it was legally
incorporated and granted health authority
funding the following year. VANDU would
later play an instrumental role in organizing
unrestrictive needle exchanges and lobbying
city hall for more action.
The Four Pillars Approach
Raising Cain
With the physical evidence of a crisis
passing through his office everyday, B.C.
Chief Coroner Vince Cain spent the summer
of 1994 compiling a report. The previous
year, there had been 331 fatal drug
overdoses in the province.
Ann Livingston, who had recently moved
to Main and Powell, recalls going to the final
public hearing of the coroner’s commission
that June. She brought her kids along,
towing them in a wagon to keep them quiet.
“So I kept going back and forth with the
wagon at the back of the Carnegie Centre,
listening to what all the people were
saying,” she says. “I think that must have
On a rainy November day in 1998, the
Portland Hotel Society (PHS) organized a
public conference in Oppenheimer Park.
Called “Out of Harm’s Way,” organizers had
invited an international panel of drug squad
cops, public health wonks and legal experts
to speak authoritatively on the wisdom of
supervised injection sites.
“I remember standing on the corner of
Hastings and all these drug users coming up
to tell me that this was just a terrible thing,”
says Mark Townsend, PHS executive
director. “That this was like giving candy to
a baby.”
It was a familiar argument. When
Townsend and his partner Liz Evans
founded the society in 1993, they were one
reduction platform would end your political
of the first housing providers in the
career. In Vancouver, it had become a
neighborhood to encourage safe drug use.
political necessity.
“That was seen as a devilish, evil thing to
do,” Townsend recalls. “Now most housing
The way forward
providers are more than happy to provide
rigs.”
When Insite finally opened in September
Like that debate, the call for a supervised
2003, it was permitted to do so under the
injection site just seemed to Townsend and
condition that it serve the purposes of
his colleagues to be the logical step in
research. From its inception then — through
addressing a health crisis. But if something
the election of the first Harper government
so unfamiliar was to be opened in the
in 2005, to the court battle that ensued
neighborhood, Townsend knew he would
between PHS and Health Canada in 2007, to
need the community’s support. About city
the Supreme Court ruling last September in
hall, Victoria or Ottawa, he was not so
favor of Insite - the impact of the facility
concerned.
has been rigorously documented.
“People higher up in the government
The results are unambiguous. Needle
already understood,” Townsend says.
sharing, overdose deaths and the
One of those people was Philip Owen.
transmission of HIV and Hepatitis C are all
First elected mayor in 1993, Owen was
down in the vicinity of the site. During its
businessman of the center-right NPA, hardly
the politician one
first year of
would expect to stake
operation, nearly 500
his career on harm
users overdosed
reduction.
within the facility.
None of them died.
But Owen’s first
Of equal
term also coincided
la any o i l i e r city la North
with the
importance, says
America, says Donald
Russ Maynard,
intensification of the
MacPherson,
Wancoaoer^s
program director at
public health crisis in
firs t drug policy coordinator, PHS, is the role that
the Downtown
Insite plays in
Eastside. Looking at
running on a predtarm-
bringing drug users
the HIV epidemic and
reduction
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would
into a network of
the overdose deaths
end
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l
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In
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Those services
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WancoiiTCr, It bad become a
include Onsite, the
was obvious to him:
p o litic a l necessity.
detox and treatment
“You can’t incarcerate
facilities located
your way out of this
upstairs from the
problem.”
injection room. Each
In 1996, Owen
year, says Maynard,
created a committee
over 400 users climb up those stairs.
tasked with researching alternative drug
Given those numbers, it’s hard not to see
policies. The following year, he invited
last year’s legal victory as a conclusive
MacPherson to city hall, installing him as
vindication of harm reduction policy. In
d ru g policy co o rd in ato r. In 1999,
MacPherson self-financed a trip to Europe.
He wanted a firsthand look at the best
practices at work in harm reduction. The
Netherlands had opened the world’s first
supervised injection site in the 1970s. Since
then, dozens of sites had sprouted up across
the continent.
“I knew what I was going to see there,”
MacPherson says today. “But I was still
surprised at the thoughtfulness and the
experimental approach. It was very different
from the thinking in North America, where
the primary objective is to punish drug
addicts.”
Upon his return, MacPherson was asked
by the mayor to work on a report. In
October of 2000, “A Framework for Action:
A Four Pillars Approach to Drug Problems
in Vancouver” was presented to the city
council.
Under the plan, the city would focus on
four areas of drug policy: prevention,
treatment, enforcement, and harm-
reduction. Though harm reduction - which
entailed supervised injection sites and a
heroin maintenance program-was only one
of the four pillars, it received the most
attention and generated the most
controversy. The strategy was endorsed
unanimously by the city council, but behind
the scenes, there was dissent within the
mayor’s ranks.
“There was a great element of Stephen
Harper-types on council,” Owen says now.
“They didn’t understand addiction and they
didn’t want to learn.”
Tensions between Owen and his caucus
built until 2001 when Owen lost his party’s
endorsement for re-election.
Despite the best attempts of the NPA to
sweep the issue under the rug, the Four
Pillars plan had received enormous national
attention upon its release, much of it
positive. When Larry Campbell, the
outspoken former coroner and cop ran on a
harm-reduction platform with COPE, he
beat the NPA’s Jennifer Clarke in a
landslide.
This was the moment, says MacPherson,
when Vancouver “inverted the political risk”
of drug policy. In any other city in North
America, he says, running on a pro-harm-
so m e se c to rs, th e m o m e n tu m fo r f u r th e r
policy innovation seems to be there.
Vancouver Coastal Health is now working
to secure the authorization of a second,
albeit currently operational, supervised
injection site at the Dr. Peter Centre. But
later on, says Patricia Daly, Chief Medical
Officer at VCH, she hopes to see supervised
injection incorporated into community
medical services across the Lower
Mainland.
A heroin-maintenance program, proposed
off and on by reformers since 1952, was
finally tested in 2005. The results of the
North American Opiate Medication Initiative
(NAOMI), published in 2008, showed,
maybe unsurprisingly, that heroin addicts
are more physically and psychologically
stable when given heroin over methadone.
But for all that, Mark Townsend of PHS
says he finds the political focus on harm
reduction — the enthusiasm and
demonization alike — “kind of annoying.” It
oversimplifies the issue, he says. And the
debate over its merits distracts from a larger
issues.
“The debate should really be about
something more complicated,” Townsend
says. “The real issue is how people have
gotten to where they are. How is it, for
example, that a human being can start to
drink hairspray?”
But sitting in the back office at Insite,
looking at statistics with Maynard, it’s
impossible not to feel optimistic. Admittedly,
a mirrored booth, the watchful eye of a
nurse and some jazzy mood music piping
over the injection room sound system will
not make a person whole again. It is a very
small step, but it is, one can’t help but think,
a very small step in the right direction.
“This has been a huge success so far,”
says Maynard with a wave of his hand. “But
if that day ever comes when there aren’t
enough people coming in to warrant this
place, we will throw a huge party before
shutting it down.”
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