Pubdate: Sat, 02 Dec 2000
Source: Vancouver Sun (CN BC)
Copyright: The Vancouver Sun 2000
Contact:  200 Granville Street, Ste.#1, Vancouver BC V6C 3N3
Fax: (604) 605-2323
Website: http://www.vancouversun.com/
Author: David Beers, Vancouver Sun
Note: While this article is the last of the series in the Sun, MAP will 
continue to use this link for Vancouver plan items appearing in 
the   newspaper.
Series: Searching for solutions - Fix on the Downtown Eastside
http://www.mapinc.org/thefix.htm
Also: As of 24 Nov 2000 the draft plan may be found at:
http://www.city.vancouver.bc.ca/

A CALL TO ACTION

First Vancouver Ignored Its Drug Problems, Then It Spent Years
Investigating Solutions. In This Finale To Our Series On Drugs, Writer
David Beers Argues It Is Now Time To Act.

Sam Sullivan grew tired of seeing the prostitute hanging out in front
of the local grocery store. He was tired of what her presence said
about the direction his Collingwood neighbourhood was headed. So he
prepared a few harsh words, and up to her he wheeled.

Wheeled, because Sam Sullivan happens to be paralyzed from the waist
down. He also happens to be a Vancouver city councillor, a member of
the majority NPA slate that rules city hall.

Those two facts -- that he is disabled, that he wields power -- would
help Sam Sullivan arrive at some very different thinking down the
road. Only, however, well after he had come to know the prostitute and
embarked upon a small social experiment with her.

For now, all he wanted to do was chase her off. Up he wheeled ... and
they began conversing. Why did she hook? For the rent money. Truly? To
pay the rent? Well, no. She needed money for drugs, for heroin.
Without it, she got sick. How much did she need a day to not get sick?
Forty dollars. Here, said Sullivan. Here is $40 so you don't need to
sell your body today. If you need $40 tomorrow, I'll give that to you,
too.

"It's somehow ingrained in our Protestant ethic, the idea of the
perfectibility of man," philosophizes Sullivan today, nearly two years
after he first met the prostitute. "And we resent these addicts for
forcing us to acknowledge that maybe this isn't the way the world, the
universe, works."

This girl certainly was a long way from perfect. She was young, and
still quite beautiful, but already she carried diseases, and her
addiction made her sometimes lie, connive, debase herself. Oddly,
Sullivan came to like her best, he says, when heroin flowed in her
veins. Then she was lucid and funny, and she would speak of the house,
the child, the spotless white carpet before the warm, crackling fire
that she wanted to have some day.

Days went by, which became weeks, and still Sam Sullivan would give
the girl $40 when she said she needed it. Along the way, he took more
opportunities to talk with her about setting some realistic goals,
about getting into treatment and making it stick.

"So I like to say that Vancouver did have a heroin-maintenance
program," Councillor Sullivan says. And it worked very well, for a few
weeks. Sullivan's $40 a day might seem a strange investment for any
one citizen to make in another, but the logic of it is embraced by
many a government around the world these days.

The Logic Of Harm Reduction

Sullivan began with the desire to improve the social environment of
his neighbourhood. To do so, he had to know the honest facts of the
prostitute's predicament. From such facts flowed a strategy. At
minimum, Sullivan's $40 a day was meant to eliminate prostitution from
in front of the grocery, while exposing the girl to less disease and
degradation. At best, Sullivan's $40 a day might keep the girl close
to his encouragement, and eventually into contact with people who
would help her kick.

This, in essence, is the logic of harm reduction. Treat drug addicts
as a health problem; undercut the black market through prescribed
drugs and substitutes like methadone; provide a full range of
treatment options to addicts wanting to quit, along with help with
jobs and housing; punish the kingpins severely. By 1994, when B.C.'s
former chief coroner Vincent Cain issued his too-controversial report
suggesting this harm reduction approach for B.C., it would have drawn
a stifled yawn in England, Holland, Switzerland and Germany, where
such ideas had been tried, tinkered with and proven effective, in some
places, for nearly a decade.

When Cain wrote his report, the intravenous drug scene and related HIV
rates in the Downtown Eastside were as bad as just about anywhere in
the world. Given that hard drugs and needle-born diseases have since
continued to kill hundreds of people a year in the region, the slow
and unimaginative response by city, provincial and federal government
amounts to a deadly scandal.

With "bewildered" horror at the official inaction, Donald MacPherson
watched the Downtown Eastside drug scene unravel throughout the 1990s.
He was a community worker at the Carnegie Centre at Main and Hastings
and then, in 1997, became a planner at city hall. "What was happening
on the street was absolutely intolerable, unbelievable, with no sense
of urgency at any level of government. It seemed very chaotic,
uncoordinated."

That drift didn't change until three years ago, when the
Vancouver/Richmond health board, citing an HIV epidemic in the
Downtown Eastside, finally declared a public health emergency, says
MacPherson. Just two weeks ago, after much internal hand wringing, the
city released its "Framework for Action," a proposed strategy drawing
from European harm-reduction models, authored by Donald MacPherson and
now circulating for public discussion.

A cynic could easily read the "framework" as one more dodge dressed up
as an action plan. The city is asking for millions of dollars worth of
new facilities and programs from provincial and federal authorities,
while putting up nary a dollar of its own. Indeed, since June the city
has sat on some $3 million in provincial and federal funding for
facilities, including an addict resource centre and a treatment centre
for pregnant women. Instead of approving sites for the projects, the
mayor declared a moratorium on all new addict services in the Downtown
Eastside.

An optimist could take the mayor and his sweeping plan at face value,
noting that he is shouldering the responsibility of selling to the
public a "four-pillar" approach that includes harm reduction. An
optimist might also conclude that once the mayor gains public approval
for his plan, the way is open for Victoria and Ottawa, under the
recently signed Vancouver Agreement, to do their parts -- and for the
city to green-light those held-up projects in the Downtown Eastside.

"We'll be ready to go," says mayor Owen, "when we finish our public
forums in the spring." Shortly after, there will be a newly elected
government in Victoria, perhaps with a mandate to match the one just
handed the Federal Liberals. "It couldn't work better than to have two
governments get a mandate within five months of each other," Owen
declares. "Two governments will be more bold than they would have been."

A pragmatist would do well to study not only the in-depth reporting in
these pages over the past two weeks, but the hard data emanating from
Frankfurt, Germany and other cities that have inspired city hall's
proposal. A close reading yields four points to be conscious of in
working toward solutions.

Commit To The Continuum

One, commit to the continuum. In 1998, Mayor Owen attended an
international symposium on crime prevention and drug treatment here in
Vancouver, and remembers European delegates shaking their heads at our
haphazard approach. "You mean you have a single needle exchange, but
no serious treatment for addicts?" they would say in disbelief. "You
mean you arrest users, but have nowhere to send them other than jail
or back on the street?"

Experts speak of the "continuum of care" needed to lower addiction
problems, stretching from the child in school who has never tried
drugs to the addict who won't quit but presents a public health risk.
In May of this year, when the Kaiser Foundation looked at British
Columbia's "continuum" it found "a broken chain": "Inconsistent and
under-funded education and prevention efforts. Wasted opportunities
for intervention. Fragmented components for counselling and treatment.
Inadequate data-collection and research capacity on which to build
good decisions. Waiting lists for counselling and treatment." The
foundation's report on addiction was damning in its assessment.

This points to the risk that as the city's four-pillars approach
circulates, it will be treated like a smorgasbord, with only the most
immediately palatable options swallowed politically. But it likely
won't work to have, say, more prevention, treatment and policing
without the last pillar, harm-reduction measures for addicts who keep
using -- measures as controversial as safe injection sites and
prescribed heroin. Indeed, beyond the four pillars lie other essential
architectural elements, housing, jobs, mental health care and other
keys to offering a way out of addiction.

Someone Has To Be In Charge

Two, someone has to be in charge. Given the picture painted above, you
can see why one single addict -- a Shai or a Don, to name the two The
Sun has followed during this series -- is today the intersection point
for three levels of government and a crazy-quilt of jurisdictions
among them. Just recently, the Vancouver/Richmond Health Board, a
provincial body, asked for and got responsibility for dealing with
drug addiction as a health issue. But none of the other health boards
in B.C. have followed suit, and so there the responsibility remains
with the ministry of children and families. Vancouver funds the
police, but a police board dominated by provincial representatives
dictates their actions. St. Paul's Hospital might like to start a
heroin-maintenance experiment and share the findings with the rest of
Canada, but Ottawa would have to pass a law first. You get the
convoluted picture.

It's why Frankfurt put in place the weekly Monday Morning Meeting,
where top officials from health, housing, policing, etc. would compare
notes and plan action together. It's why the Kaiser Foundation
report's title is: "A Case for an Independent Substance Abuse
Prevention and Addictions Commission for British Columbia." Only a
powerful, "arms-length" body can cut through the bureaucratic maze to
get things done, argues the report.

Nothing About B.C. Makes Success Politically Impossible

Three, nothing about B.C. makes success politically impossible. When
Councillor Jennifer Clarke traveled to Frankfurt and Amsterdam, she
returned with good things to say about their approaches, but in public
presentations she worries that we lack the city-state like political
structure to get it done. She points to their budgets many times
Vancouver's own. But those budgets also include big expenses we don't
shoulder, like welfare. Nor need we despair that those Europeans are
inherently more socially empathic and liberal-minded than us, and so
more easily embrace a program like harm reduction.

Frankfurt's drug czar, Werner Schneider, says "the 'power of European
cities compared with Canadian cities' is not at all an argument
against starting the program in Vancouver. Despite the fact that
European (at least German) cities seem to have more money and power,
when the city of Frankfurt started to implement the new drug strategy,
we had to do this against the expressed will, official policy and
enormous pressure from our state and federal government (which both at
that time were conservative governments).

"Your provincial government as well as your federal government seem to
be pretty much supportive in term of the new strategy, which creates a
much better situation for Vancouver (compared with
Frankfurt)."

Small Experiments Do Not Bring About The End Of Civilization

Four, small experiments do not bring about the end of civilization.
Some perspective: We are talking about trying a new approach for
perhaps 15,000 people from a provincial population of four million.
The Europeans sell their harm-reduction attempts as limited
experiments with announced aims, like better health and public safety.
And they treat them as such, collecting data and reporting back to the
public when the allotted time is up.

"I don't know how many more experts we can invite from overseas, how
many more forums we can have," says Carnegie Centre activist Tom
Laviolette with exasperation. "I would even like someone to try
something and make mistakes. We don't even get that far." When
Europeans try something and make mistakes, they change a losing game.
When it works, they expand the experiment, with well-earned public
support.

An Invisible Disability

And what of Vancouver city Councillor Sullivan's own, private
experiment? One thing he learned is that a heroin trial, done his way,
can get expensive. It irked him that, "If I gave her 500 bucks, one
dollar went to the actual cost of the drug and 499 went to the
infrastructure of organized crime." That made him think like an
economist and conclude that prescribed heroin might be a
cost-effective way to subvert criminals while staving off his friend's
sickness.

He also learned that addiction often is a chronic illness, and can't
be always cured on a timetable. His friend promised to try treatment,
then missed the appointment he helped set up. By then he was running
low on funds and learning another lesson. Addressing drug addiction
may be cost effective in the long run for society -- the estimate is
that a dollar spent on treatment saves seven -- but it requires a lot
of commitment and resources all the same.

By himself, Sam Sullivan didn't have enough. He told her it was
over.

"I remember the very, very cold way in which I did it. I said, "No.
No, I can't give you any more money. I felt very bad because I knew
what I was essentially saying was: I'm throwing you on to the street.

"Then that started making me resent the system that I was responsible
for. That it would be so dysfunctional as to have required this young
girl to have degraded herself in order to not be sick. I've seen her
when she has the red yes, runny nose, throwing up."

Even as he sent her away, Sullivan drew a comparison, and contrast, to
his own life. It haunts him, still.

"As a disabled person I find that I have an advantage. My disability
is in your face, it's very visible, it immediately receives people's
acknowledgment that this is something beyond my control and I'm at a
disadvantage. I think visible disabilities are ones we most feel bad
for. So what happens when I break my neck? I get picked up, taken to
the hospital, treated reasonably well, and I'm given all sorts of supports.

"But the drug addict is a good example of an invisible disability.
When a person has a disability like a drug addiction, we throw them on
to the street, let the worst predators of the community prey on them
and abuse them. So I see this difference.

"And I know that a few centuries ago societies used to believe that
having a disability was a sign of moral weakness. A punishment from
God. I think our treatment of addicts is like a holdover from some
really feudal, primitive idea. A person who, for whatever reason,
ended up chemically dependent on some drug, is caused by moral weakness.

"You know, when you go to the Downtown Eastside and near horrible
stories, you think: 'How can they not be a drug addict, having gone
through that life?' But then there are a lot of people with really
nice lives, seemingly middle class, and you think they ought not be on
drugs. But you often find there is this thing that made them feel
disassociated, that made them not feel good enough somehow, not
accepted, and that can lead a person into using drugs. So what do we
do as a society to people who are suffering from the feeling of being
disassociated, excluded? We label them criminals and officially
disassociate them. That's really what they need!"

Sullivan gives a rueful laugh.

Once in a while he would see the girl standing on Kingsway, looking
for another trick, another fix. He hasn't seen her for a while,
though, and that has him wondering if time hasn't run out on her dream
of the house and the child and the spotless white carpet before the
warm, crackling fire. 
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MAP posted-by: Richard Lake