The Politics of The Politics of ChangeChange

A PUBLIC HEALTH OR A PUBLIC HEALTH OR CRIMINAL JUSTICE ISSUECRIMINAL JUSTICE ISSUE

In The BeginningIn The Beginning

DTES (Downtown Eastside)DTES (Downtown Eastside) Origin of Vancouver – Skid RoadOrigin of Vancouver – Skid Road Vibrant community – retired, Vibrant community – retired,

families, businessesfamilies, businesses 70’s Decline – Woodwards70’s Decline – Woodwards 80’s Cocaine80’s Cocaine 90’s Crack/Meth90’s Crack/Meth

Four PillarsFour Pillars

Wide public discussionWide public discussion 2002 – drug policy passed2002 – drug policy passed ““Preventing Harm From Preventing Harm From

Psychoactive Substance Abuse” Psychoactive Substance Abuse” Website - http://www.vch.ca/sisWebsite - http://www.vch.ca/sis

27 recommendations27 recommendations

What are the motivators What are the motivators behind drug use and some behind drug use and some

solutions?solutions? Vancouver - the four pillar program – Prevention, Treatment, Harm Vancouver - the four pillar program – Prevention, Treatment, Harm

Reduction and EnforcementReduction and Enforcement Vancouver’s policy and plan for reducing drug-related harm is Vancouver’s policy and plan for reducing drug-related harm is designed to deal designed to deal

with overdose deaths, public disorder and root causes of poverty.with overdose deaths, public disorder and root causes of poverty.

Circumstances that led to harm reduction programs Circumstances that led to harm reduction programs poverty;poverty; substandard housing;substandard housing; high unemployment;high unemployment; increased availability and low cost of heroin and cocaine;increased availability and low cost of heroin and cocaine; flight of legitimate business from the area;flight of legitimate business from the area; de-institutionalization of the mentally ill without adequate support;de-institutionalization of the mentally ill without adequate support; structures in the Lower Mainland;structures in the Lower Mainland; displacement as a result of enforcement initiatives in the 1970s and 1980s that displacement as a result of enforcement initiatives in the 1970s and 1980s that

had the effect of pushing street level drug dealers into the Downtown Eastside had the effect of pushing street level drug dealers into the Downtown Eastside from other areas of the city, thereby increasing the concentration of these from other areas of the city, thereby increasing the concentration of these factors in this community.factors in this community.

Today's drive-by journalists - little understanding of historyToday's drive-by journalists - little understanding of history Attribute the problems of the downtown eastside to the treatment Attribute the problems of the downtown eastside to the treatment See a community of addicts and blame it on the individuals rather than lack of See a community of addicts and blame it on the individuals rather than lack of

housing, programs, criminal records etc…housing, programs, criminal records etc…

GoalsGoals

Reduced individual, family Reduced individual, family neighbourhood and community harm neighbourhood and community harm from substance usefrom substance use

Delayed onset of first substance useDelayed onset of first substance use Reduced incidence (rate of new cases Reduced incidence (rate of new cases

over a period of time) and prevalence over a period of time) and prevalence (number of cases at one time in (number of cases at one time in population of problematic substance use population of problematic substance use and substance dependence; and and substance dependence; and improved public health, safety and orderimproved public health, safety and order

Why Harm Reduction? - Why Harm Reduction? - InsiteInsite

BC - overdose deaths Increase from 39 in 1988 to 201 in 1993 (Insite opened in BC - overdose deaths Increase from 39 in 1988 to 201 in 1993 (Insite opened in 2003)2003)

1998 injection drug use - leading cause of death for adult males age 30–49 in 1998 injection drug use - leading cause of death for adult males age 30–49 in British Columbia.British Columbia.

Not always heavy users who overdose - properties / quality of street heroin not Not always heavy users who overdose - properties / quality of street heroin not known plus mixing heroin and alcohol increases risks dramatically known plus mixing heroin and alcohol increases risks dramatically

We help alcoholics and prescription drug users but dehumanized and vilify We help alcoholics and prescription drug users but dehumanized and vilify addicts as weak and useless – This is neither productive or useful to society.addicts as weak and useless – This is neither productive or useful to society.

Insite (2006)Insite (2006) Over 7,200 registered usersOver 7,200 registered users women 26%, women 26%, aboriginal peoples 18%,aboriginal peoples 18%, Heroin 41% of injections, Heroin 41% of injections, Cocaine 27%,Cocaine 27%, Morphine 12%. Morphine 12%. Over 453 overdoses at center Over 453 overdoses at center > zero fatalities.> zero fatalities. Over 4,000 referrals to counsellingOver 4,000 referrals to counselling 40% for addiction counselling.40% for addiction counselling. 2 individuals per week are referred to methadone maintenance.2 individuals per week are referred to methadone maintenance. 607 average daily visits.607 average daily visits. Over 2,000 interventions for abscesses. Over 2,000 interventions for abscesses.

Growing problems, same Growing problems, same old failed solutionsold failed solutions

Drug use is a health issueDrug use is a health issue If we treated alcohol and tobacco in the If we treated alcohol and tobacco in the

same fashion as marijuana, we would have same fashion as marijuana, we would have identical problems with respect to crime, identical problems with respect to crime, quality/content and addictions.quality/content and addictions.

Incarceration, increased sentences, Incarceration, increased sentences, criminalization and prohibition has criminalization and prohibition has failed to obtain the desired results of failed to obtain the desired results of reducing use and associated crime.reducing use and associated crime.

Scientific EvidenceScientific Evidence

Constant researchConstant research Proper Scientific testingProper Scientific testing Peer reviewedPeer reviewed Published in reputable journalsPublished in reputable journals All positiveAll positive Website:Website: http://http://

www.communityinsite.ca/science.htwww.communityinsite.ca/science.htmlml

Scientific PapersScientific Papers

30% increase in detoxification30% increase in detoxification Reduced syringe sharingReduced syringe sharing Improved public orderImproved public order Reduced public injection drug use and Reduced public injection drug use and

public syringe disposalpublic syringe disposal No increase in drug trafficking or No increase in drug trafficking or

assaults/robberyassaults/robbery Decline in vehicle break-ins/vehicle Decline in vehicle break-ins/vehicle

thefttheft

Scientific Papers Scientific Papers ContinuedContinued

Large number of O.D.’s – No DeathsLarge number of O.D.’s – No Deaths Disease intervention – HIV, HepsDisease intervention – HIV, Heps

Time for Change is upon Time for Change is upon usus

The Canadian public is intelligent and educated enough to The Canadian public is intelligent and educated enough to understand that there is a problem with current drug understand that there is a problem with current drug policies.policies. Although many cannot agree on the approach, there are only Although many cannot agree on the approach, there are only

two viable directionstwo viable directions Greater incarceration, policing, criminalization and legislation Greater incarceration, policing, criminalization and legislation

(which has failed in the(which has failed in the USA) USA) or or

A framework of legalization and regulation of drugsA framework of legalization and regulation of drugs legalize least hazardous drugs , manage worst AND research legalize least hazardous drugs , manage worst AND research

to reduce consumption ratesto reduce consumption rates Teams of specialists would propose suggestions, Teams of specialists would propose suggestions, treatments that treatments that

workwork Teams should include specialists from various fields including: Teams should include specialists from various fields including:

Medical Medical ScientificScientific Social Social Addiction Addiction EnforcementEnforcement

Who should be in Who should be in charge?charge?

Medical officials should be tasked with treating and Medical officials should be tasked with treating and reintegrating addicts reintegrating addicts In addition: In addition:

Alternatives to harmful addictive drugs can be distributed Alternatives to harmful addictive drugs can be distributed (Methadone/B(Methadone/Buprenorphine) uprenorphine) and education can be used to and education can be used to discourage usediscourage use

Harm reduction facilities should be expanded for those who are Harm reduction facilities should be expanded for those who are not yet willing to clean upnot yet willing to clean up

Treatment facilities which remove the addict from the drug Treatment facilities which remove the addict from the drug community need to be drastically increasedcommunity need to be drastically increased

Affordable, safe and clean housing needs to be a priority for those Affordable, safe and clean housing needs to be a priority for those individuals who have cleaned upindividuals who have cleaned up

Hospitals for the mentally ill need to be reintroduced in society Hospitals for the mentally ill need to be reintroduced in society and funded properlyand funded properly

Law enforcement should be used to deal with criminals Law enforcement should be used to deal with criminals and should not be expected to provide counselling and and should not be expected to provide counselling and medical advise to addicts and mentally ill patients. Locking medical advise to addicts and mentally ill patients. Locking up drug addicts in prisons where criminals and drugs are up drug addicts in prisons where criminals and drugs are in abundance is simply counterproductive.in abundance is simply counterproductive.

What are the benefits of What are the benefits of moving drugs into the moving drugs into the

health fieldhealth field Save tax dollars spent on enforcement and reinvest in education, treatment and harm reeducationSave tax dollars spent on enforcement and reinvest in education, treatment and harm reeducation Eliminate the stranglehold which the criminal element has on sales and distribution of drugs Eliminate the stranglehold which the criminal element has on sales and distribution of drugs

(thereby reducing the level of drug related harm through overdose and gateway activity(thereby reducing the level of drug related harm through overdose and gateway activity Empty jailsEmpty jails Improve society by treating addicts as human rather than annoyances.Improve society by treating addicts as human rather than annoyances. Removal of employment barriers due to criminal records will help to eliminate poverty and create Removal of employment barriers due to criminal records will help to eliminate poverty and create

a more productive societya more productive society

Greater investment and research into various treatmentsGreater investment and research into various treatments Methadone or Methadone or buprenorphine for heroine and other opiatesbuprenorphine for heroine and other opiates Pharmacotherapy and behavioural treatment for cocaine and crackPharmacotherapy and behavioural treatment for cocaine and crack

Through investment in these types of solutionsThrough investment in these types of solutions Users able to lead Users able to lead productive lives, maybe not rocket scientist but better than lying huddled productive lives, maybe not rocket scientist but better than lying huddled

in the street or in a cellin the street or in a cell reduce risks associated with injection drug use.  reduce risks associated with injection drug use.  Methadone $10 a day vs. Methadone $10 a day vs. $141.78: per prisoner/per day in provincial jail$141.78: per prisoner/per day in provincial jail

What about the children? What about the children? denying sex education to teens in Africa, and refusing to distribute condoms creates a public denying sex education to teens in Africa, and refusing to distribute condoms creates a public

outcry in the west but when we deny grown adults access to clean needles and refuse to give outcry in the west but when we deny grown adults access to clean needles and refuse to give our children honest information about the effects of drugs, we consider it protecting. No our children honest information about the effects of drugs, we consider it protecting. No different than the aversion to sex education.different than the aversion to sex education.

As with sex education, by keeping children ignorant they are left susceptible to myths, criminal As with sex education, by keeping children ignorant they are left susceptible to myths, criminal influence and overdose, Make them aware of the risks and they have the tools to make their own influence and overdose, Make them aware of the risks and they have the tools to make their own decisionsdecisions

Remove the glamorous act of rebellionRemove the glamorous act of rebellion

Summary of Summary of recommendationsrecommendations

Public educationPublic education Employment training and jobsEmployment training and jobs Supportive and transitional housingSupportive and transitional housing Easily accessible healthcareEasily accessible healthcare Legislative and regulatory changes to Legislative and regulatory changes to

create a regulatory system for all currently create a regulatory system for all currently illegal drugsillegal drugs

Control potentially harmful substances Control potentially harmful substances Limit the control that organized criminals Limit the control that organized criminals

have over the drugshave over the drugs

So why does there continue to be a drug So why does there continue to be a drug problem in Vancouver?problem in Vancouver?

Inadequate treatment facilitiesInadequate treatment facilities A focus on criminalization and incarcerationA focus on criminalization and incarceration Inadequate housing / specifically affordable or subsidisedInadequate housing / specifically affordable or subsidised Criminal records which prevent users from reintegrating Criminal records which prevent users from reintegrating

into into Communities of users who are excluded from societyCommunities of users who are excluded from society Poverty, no hope, lack of employmentPoverty, no hope, lack of employment AIDS and Hep C as a disincentive to addicts - hopelessnessAIDS and Hep C as a disincentive to addicts - hopelessness

Why is the criminal justice Why is the criminal justice model unsustainable?model unsustainable?

Increasing animosity towards our police, Increasing animosity towards our police, fear of repercussions has driven addicts and recreational users underground fear of repercussions has driven addicts and recreational users underground

making it harder for those individuals to seek helpmaking it harder for those individuals to seek help Criminalized users are unable to easily return into normal societyCriminalized users are unable to easily return into normal society Medical field is unable to pursue rational treatments (programs like insite), Medical field is unable to pursue rational treatments (programs like insite),

due to government restrictionsdue to government restrictions High number of minorities and vulnerable members of society incarcerated High number of minorities and vulnerable members of society incarcerated

because of drug use because of drug use False belief that locking addicts up will force them to quit, when in reality it False belief that locking addicts up will force them to quit, when in reality it

increases their ties with criminal elementsincreases their ties with criminal elements

Correction Service CanadaCorrection Service Canada "drugs are part of prison culture and reality""drugs are part of prison culture and reality" "many needles in the prisons""many needles in the prisons" In prison - extent of injection is difficult to determine but we know that clean needles In prison - extent of injection is difficult to determine but we know that clean needles

and syringes are not available.and syringes are not available. The spread of disease in prisons adds to the hardships of addicts when they The spread of disease in prisons adds to the hardships of addicts when they

return to society – AIDS and Hep C is epidemic with injection drug users, return to society – AIDS and Hep C is epidemic with injection drug users, society turns a blind eye on these citizens because they are considered society turns a blind eye on these citizens because they are considered “undesirables”, this only helps to spread disease throughout the prison “undesirables”, this only helps to spread disease throughout the prison population and thereby the public at large.population and thereby the public at large.

Criminalization does not significantly reduced use or cut down on the Criminalization does not significantly reduced use or cut down on the prevalence of drugs on our streets, it has made more criminals and more prevalence of drugs on our streets, it has made more criminals and more addicts. addicts.

Costs of incarceration?Costs of incarceration? Federal Average daily cost of prisoner - Federal Average daily cost of prisoner -

2004/2005 – approx.  $259.05 per day or 2004/2005 – approx.  $259.05 per day or $87, $87, 665 to 93,458.00 per year.665 to 93,458.00 per year.

Federal female prisoner: Federal female prisoner: $150,000-$250,000 / $150,000-$250,000 / per yearper year

Provincial prisoner: $141.78: per prisoner/per Provincial prisoner: $141.78: per prisoner/per day day ($51,749 per year)($51,749 per year)

Alternatives - probation, bail and community Alternatives - probation, bail and community supervision $supervision $5-$25/day5-$25/day. .

None of this includes the cost of lost revenue to None of this includes the cost of lost revenue to the country by not having the individual in a the country by not having the individual in a working environment. In addition society bears working environment. In addition society bears the burden of caring for any dependents.the burden of caring for any dependents.

Wrap upWrap up We will eventually need to move these issues into the public health We will eventually need to move these issues into the public health

field, society cannot realistically lock these people up indefinitely field, society cannot realistically lock these people up indefinitely or lock up every drug user and seller, why wait to change.or lock up every drug user and seller, why wait to change.

Increased health costs can be offset by legalization and sales, no Increased health costs can be offset by legalization and sales, no one grows their own tobacco, no different with legal pot. (bonus - one grows their own tobacco, no different with legal pot. (bonus - likely get rid of grow ops).likely get rid of grow ops).

Criminals will have to get real jobs - Lose profit center, police can Criminals will have to get real jobs - Lose profit center, police can then focus on prostitution, money laundering, violent crime, etc…then focus on prostitution, money laundering, violent crime, etc…

What about the children? By not informing them and not What about the children? By not informing them and not differentiating between heroin and pot we are failing our children differentiating between heroin and pot we are failing our children and leaving them susceptible to criminals.and leaving them susceptible to criminals.

Educate them to be more informed than their parents. and better Educate them to be more informed than their parents. and better prepared to make the right decisions. prepared to make the right decisions.

Where is the logic in locking up non-violent drug offenders? Can Where is the logic in locking up non-violent drug offenders? Can we not come up with better medical options? Treatment already we not come up with better medical options? Treatment already involves drug substitution.involves drug substitution.

The longer we wait the more entrenched beliefs become, when will The longer we wait the more entrenched beliefs become, when will we get politicians and the public to reverse their stereotypes and we get politicians and the public to reverse their stereotypes and look for rational solutions.look for rational solutions.