SULLIVAN'S DRUG INITIATIVES RAISE QUESTIONS FOR MANY

Brilliant and counter-intuitive strategist? Fool who rushes in where
angels fear to tread? A flake?

Those are questions floating around Vancouver Mayor Sam Sullivan,
after his recent admission that his number-one priority in tackling
the city's world-class drug problem is to fight for a way to provide
drugs or drug substitutes for addicts because enough effort has been
expended on treatment and enforcement.

Sullivan is the first to admit he doesn't use standard operating
techniques to get things done. Never has, never will.

"People call me a dreamer and completely naive," he said in a recent interview.

The debate about his statements has not really been over whether
"heroin maintenance," as it's called in the health-research world, is
worth trying out or even whether it's politically possible.

Except for a core of diehard opponents, Vancouverites have already
shown themselves to be broad-minded about tolerating experimental
approaches to drug treatment. The city's supervised-injection site --
the only one in North America -- has been running for almost three
years with little public comment.

And a research trial that dispenses heroin to a select group of
long-time heroin addicts, the NAOMI (North American Opiate Management
Initiative), has been running for a year in the Downtown Eastside
with even less public debate.

There is also a growing body of research from Europe, Australia and
even the United States bolstering the idea that giving some addicts
either the drugs they're addicted to or good substitutes is a form of
treatment that produces noticeable benefits.

Instead, the questions are more like: What the heck is the mayor talking about?

And: Does he have a plan or is he just thinking out loud? Is he
really not interested in also fighting for housing, other kinds of
treatment, prevention, and mental health services or is it just his
way of expressing himself that makes it seem that way? Is Sullivan's
strategy -- if it can be called that -- really the best way to
generate popular and political support or is it possible that it will
cause a backlash?

Finally, this question: Even if his ideas turn into reality, will
they change anything in Vancouver?

Supporters of harm reduction, who don't have many outspoken political
champions, admire Sullivan for his unambiguous support -- although
they acknowledge he doesn't have a concrete strategy yet.

"I think it's incorrect to say he's got a plan," says Alex Wodak, an
Australian addictions expert and one of several harm-reduction
advocates who had lengthy private meetings with Sullivan this week
during the International Harm Reduction Conference. "He's got a set
of principles. But his principles are right. What we're doing in law
enforcement isn't working. And he's right to keep on emphasizing
heroin maintenance."

The group of heroin users who would benefit from a heroin-maintenance
plan is small, says Wodak. But they are the ones who cause the most
problems. They use the most drugs, commit the most crime and are the
most responsible for pulling in new users.

Long-time Downtown Eastside drug users' advocate Ann Livingston
echoes that: "There is no plan at all. He is championing a cause and
having a mayor do that is extremely helpful."

She too is a believer that a heroin maintenance plan should be a
priority, and having access to drugs is the key to helping addicts
get their lives together.

But critics say Sullivan could end up undermining public sympathy
with a focus that seems to be so limited.

"He has been musing aloud in a very confusing way about his personal
philosophy. That is risking a loss of support for the general idea of
the Four Pillars in pursuit of a personal hobbyhorse," says Geoff
Meggs, chief strategist for former mayor Larry Campbell. Meggs thinks
it does far more harm than good to talk in a vague way about an idea,
with no plan behind it, that some people see as extreme.

Community groups who support Sulllivan and are far from opposed to
the idea of heroin maintenance sound frustrated when asked to respond
to his ideas.

"I understand Sam and I've talked to him many times," says Chris
Taulu, the venerable director of the community policing station in
Collingwood, a neighbourhood where Sullivan lived for many years.
"But there has to be more going on than [heroin maintenance]. It has
to be that plus the other stuff."

Taulu and a residents' drug and alcohol committee in the
neighbourhood would like to see the mayor devote as much energy to
pushing for detox on demand, prevention programs in the schools, and
outreach programs for groups like the middle-aged native alcoholics
who are mostly ignored these days.

Kate Gibson, director of the Downtown Eastside prostitute support
program WISH, sounds equally baffled.

"How is drug maintenance going to work without the other pieces of
the puzzle?" she asks.

Sullivan, who has said helping street prostitutes is one of his
priorities, met with half a dozen women at the WISH drop-in centre
several months ago. Gibson says the issue the women brought up over
and over was their need for housing and financial security.

When Sullivan was interviewed at length recently about his priorities
for addiction policy, he didn't talk about housing and acted as
though it was news to him that many people have identified that as a key need.

And Sullivan has managed to confuse even his former political
colleagues and supporters.

"None of us know what it is that he plans on doing," says former NPA
councillor Lynne Kennedy. "From what I've heard so far, it doesn't
make any sense because the prostitutes he wants to help don't just
use heroin. They use crystal meth, ice, ecstasy." And she has no idea
what Sullivan's plan is for that.

Sullivan acknowledges some people judge him as flaky. "Here, I'm
jumping in in my usual fashion," he said in an interview. "I flail
away . . . and eventually someone comes to rescue me."

Former mayor Philip Owen, who has been a stalwart supporter of
Sullivan's in recent months, backs that up.

"Sam's just like that -- he's trying to stir the pot. He's throwing
all kinds of things in the air. He periodically tries to raise the
bar. He has a goal but he takes a different route to get there."

Owen blames the media for making Sullivan sound as though all he
cares about is giving out heroin or drug substitutes; Owen is
convinced Sullivan understands the drug issue is a complex one that
requires moving forward on many fronts at once.

But he does acknowledge Sullivan needs to do more work to put that across.

Certainly, Sullivan's approach is wildly different from Owen's, which
started in 1998 when Owen went to a seminar in California that got
him considering the idea of other strategies for the city's drug/crime problem.

Until then, his approach to crime reduction had been to lobby for
changes to the Canadian Charter of Rights giving accused criminals
less protection.

After the California conference, Owen, with the help of city manager
Judy Rogers, consultant Judy Kirk and others, built up slowly to the
idea of trying new ideas in drug policy. They had staff look at other
jurisdictions. They organized public conferences with experts from
Europe. Owen worked with coalition of groups who endorsed the
directions he was going in. Eventually, his staff came up with a
policy and held a series of public forums to debate it. And behind
the scenes, he and his staff were talking to other levels of
government to nudge them towards support.

At first, Owen was tentative about the idea of a supervised injection
site -- the city's original Four Pillars policy only recommended a
feasibility study. And Owen always emphasized that harm reduction was
only one part of the approach to drug addiction.

Through all the political work, he brought a good part of the public
along with him. But he hadn't worked as closely with his own NPA councillors.

Larry Campbell, who swept into power in 2002 after Owen and his party
fractured, was elected with a mandate to bring in a supervised
injection site in the eyes of many.

He did the next stage of arm-twisting at the federal and provincial
level to make it a reality, behind-the-scenes work that wasn't as visible.

But, like Owen, Campbell and his staff were cautious about moving too
fast without lots of policy and discussion. Talk of a second
supervised injection site or an inhalation room for crack cocaine
users gradually evaporated. The city produced a prevention policy,
but it didn't appear until June 7, 2005 -- three weeks before a
clearly exasperated, Campbell announced his resignation from city politics.

Sullivan has let it be known far and wide in private conversations,
speeches and, recently, media interviews that he wants to see some
kind of drug maintenance program. But he has been vague about what
drugs, to whom, where, how and when.

It's only by talking to people around him that you can get a sense of
what realistically might be coming down the road and how.

Harm reduction experts in Vancouver this week who met privately with
him are pushing one idea in particular.

"Vancouver could show international leadership by coming forward with
a NAOMI-like trial involving stimulants," said Ethan Nadelmann,
director of the New York-based Drug Policy Alliance, who helped make
Philip Owen a convert to harm reduction ideas in the 90s. That would
involve providing some kind of amphetamine substitute for cocaine and
crystal meth users, a strategy that has been tried by researchers in
Europe and Texas.

As well, people would like to see the current NAOMI heroin
maintenance trial became a regular health program that would be
available to a slightly larger pool of people than the current
research rules allow.

The drug substitution trial would have somewhat fewer legal barriers
than the supervised injection site, since it would involve giving
cocaine and meth users new kinds of drugs that are not labelled
illegal and are therefore available by prescription.

But in both cases -- heroin maintenance and a stimulant substitution
program -- a minority of drug users would be eligible, no more than
25 per cent, if that, because the program is only for hard-core users
who have failed to go clean.

But there's more than just plans for drug substitution or drug maintenance.

Donald MacPherson, the city's drug policy coordinator who has worked
under three mayors, meets with police Chief Jamie Graham, Vancouver
Coastal Health Authority director Ida Goodreau, and other key players
in mental health and housing.

The group has talked about plans for those two programs, he says. But
that's part of a broader mission to make a difference for three key
groups of drug users: the mentally ill drug addicted, chronic
offenders, and sex trade workers.

Low threshold drug programs are part of the plan. That means adding
supervised injection sites, as well as the drug-maintenance programs.

The other part is housing.

"The consensus is that supportive housing is key. Everything else
will work better if supportive housing is there," says MacPherson.
"And we're looking at how can we move more quickly to improve the
housing stock, stabilize hotels that house the mentally ill."

Could this actually change the way Vancouver looks?

"Yes, it will make a difference and it will make a difference by 2010."

But ultimately, it may not matter. The winds of change are in the air
for the Downtown Eastside, whether there's a heroin maintenance program or not.

The supervised injection site, health clinics, and spiffy new social
housing projects built in the last five years have all helped make
the area a little less scary to people.

Added to that, land shortage downtown, new incentives from the city
for heritage areas, and prodding from Vancouver's co-director of
planning, Larry Beasley, have encouraged developers to move east.

The result is that land values are going up and development
applications are percolating for the Downtown Eastside, Gastown and Chinatown.