vancouver's four pillars drug policy
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Four Pillars Drug Policy Program
Introduction
Vancouver:
Port of entry for Asian opium since 1800s
Later, heroin and Colombian cocaine
Downtown eastside a regional drug market for alcohol and other drugs
Methamphetamine
Large cannabis crop in BC
Well established and flourishing organized crime
Crisis of ‘80s and ‘90s
Dramatic increase in high quality, low cost heroin and cocaine
Became known as the site of the highest rate of HIV infection in the western world among IV drug users
Highest drug overdose death rate in Canada
Open drug scene
Downtown eastside in crisis
The Downtown Eastside
16,000 residents
Historic centre of Vancouver
Poorest urban postal code in Canada
Chinatown, Gastown heritage districts
5,000 residential hotel rooms – in poor condition
Concentration of social problems over a period of 20-30 years
Crisis of ‘80s and ‘90s
1988 - 17 illicit drug OD deaths
1993 - 200 illicit drug OD deaths
1993 - 2001: 150 annual average in OD deaths
Illicit drug overdose becomes leading cause of death for men 30-45
Other municipalities experiencing a similar phenomena throughout BC
Vancouver Illicit Drug Deaths1996-2008Office of the Chief Coroner of BC
020
40
60
80100
120
140
160180
200
1996 1998 2000 2002 2004 2006 2008
Responding to a continuing problem
1994: Chief Coroner Task Force into overdose deaths in BC
1995 – Back Alley Injection room opened by drug users
1996: HIV epidemic among injection drug users
1997: Health Region declares a public health emergency in the Downtown Eastside of Vancouver
1997 - Provincial Health Officer report – Pay Now or Pay Later
1997 – Vancouver Area Network of Drug Users formed
1998 – close to 200 overdose deaths in Vancouver
1998 – Out of Harms Way – community conference
Responding cont’d
1998 – Mayor’s conference on drug policy
1999 – Keeping the Door Open and Harm Reduction Action Society
2000 - Four Pillars Drug Strategy developed
2000 – Vancouver Agreement signed
2000 – From Grief to Action comes out
2002 – Dr. Peter Centre opens injection room
2003 – In the spring – 327 Carrall Street opens
2003 – September, Insite opens
Street Drug Scene
Abstinence
HighThresholdServices
Thresholds of Access to Healthcare System2
Medium Threshold Services
Contact with only 20% of active users
Increased Access to Healthcare SystemIn
crea
se in
Pub
lic H
ealth
Incr
ease
in P
ublic
Ord
er
Abstinence
3
Street Drug Scene
50%
15%
Heroin Prescription
Medium Threshold Services
HighThresholdServices
Low Threshold Methadone
Serv
ices
In P
rison
Nee
dle
Exch
ange
Dro
p In
D
ay C
entr
es
Safe
Inje
ctio
n Si
tes
Wor
k Pr
ogra
ms
Yout
h Pr
ogra
ms
Out
reac
h
Men
tal H
ealth
Se
rvic
es
Supp
ortiv
eH
ousi
ng
6 The Box
1515
Public Health
Insite – A brief history since it opened
Outcomes
Research has been overwhelmingly positive
Researchers have used publications in peer reviewed journals as the means with which to disseminate the findings
No negative impacts
Threats
No diffusion of the intervention to other localities
No “scaling up” to meet the need for supervised injection
Federal government has refused to issue exemption from Controlled Drugs and Substances Act for Insite to continue to provide service
The battle continues in court