THE SEARCH FOR A VEIN OF HOPE

Does Our Drug Policy Really Have Four Pillars, Or Is There Just 'One
Shaky Toothpick?'

It's Thursday night and Johnny Young is cruising back alleys of the
Downtown Eastside where street lights shine on a woman picking crack
from a palm, an addict with a needle rolling down his sock.

Everyone seems to know Young. The one-time addict spends hours every
week trolling the dark heart of the drug ghetto. But he's not here to
score. He's here to help.

Young's been a needle-exchange van driver for the Downtown Eastside
Youth Activities Society for 10 years. The van runs 19 hours a day,
every day of the year. Someone always needs needles.

In fact, the sheer volume of needles Vancouver's addicts go through is
staggering. In the society's East Broadway office, a dozen plastic
barrels tagged "Biohazard" are stacked by the door, each packed with
hundreds of dirty orange syringes.

On this night, in less than an hour, Young gives out two dozen
needles, plus alcohol swabs, crack sticks, mouthpieces, vitamins and
handfuls of water packs used to cook drugs.

Several addicts don't ask for new syringes, but something more basic.
"You got any snacks?" one man asks. "I'm all hungry," a woman laments.
Young listens as regulars tell him about their HIV. He asks after an
addict's mom. He tells another his sister wants him to call.

"People don't end up down here on drugs because they are happy,
healthy people," he says. "You're really dealing with desperate people
in desperate situations.

"There are a lot more drugs down here than there used to be," he
continues. "They say the mark of a good society is how you treat your
most vulnerable. To me, it appears society's disintegrated."

The burly, bearded man does his best to change that. He ends each
encounter with a gruff and hopeful goodbye: "Keep safe, eh?"

How big is the drug problem in the Downtown Eastside?

It depends whom you ask. A 2004 B.C. Justice Review Task Force report
estimated there were 9,000 intravenous drug users in Vancouver. A 2001
Vancouver Coastal Health study estimated there were 4,700 in the
Downtown Eastside and 12,000 in total. These conservative estimates
don't include non-intravenous drug users, such as crack smokers -- and
crack, experts agree, is now the drug of choice in the Downtown Eastside.

Who are these users? A B.C. Centre of Excellence in HIV/AIDS study of
1,400 addicts found intravenous drug users were mostly men (65 per
cent), Caucasian (62 per cent), and aged 15 to 58. Three-quarters had
been in prison. Two-thirds were on welfare.

There are three ways to look at the Downtown Eastside's drug problem:
as a crime crisis, a health crisis, or both. But it is a crisis, and
the drug use is highly correlated with criminal activity and poor health.

With so many users needing money to score, drug crime has plagued
Vancouver's neighbourhoods. The Vancouver Board of Trade pegs our
annual drug-related property-crime bill at $125 million.

According to a 2003 Simon Fraser University/Vancouver Police
Department study of 100 users, Treadmill of Addiction, almost half
said they spent more than $100 a day on illegal drugs. Sixty-one per
cent said they regularly committed crimes to buy drugs.

If users aren't locked in a cycle of crime, they are trapped in a
downward spiral of poor health.

The Downtown Eastside is a public-health nightmare. A 2008 study in
the Canadian Medical Association Journal found that of 7,000
intravenous drug users in the city, 17 per cent had HIV and 88 per
cent had hepatitis C.

Dr. Thomas Kerr, principal investigator of the Vancouver Injection
Drug User Study and a senior scientist with the B.C. Centre for
Excellence in HIV/AIDS at the University of B.C. and St. Paul's
Hospital, estimates 25 to 30 per cent of Vancouver's intravenous drug
users are now infected with HIV and 90 per cent are living with
hepatitis C.

The city's current solution to the scourge of drugs and related crime
and disease in the Downtown Eastside is the "Four Pillars" approach.

The four pillars (policing, treatment, prevention and harm reduction)
were introduced in a 2000 report and endorsed by city government. The
pillars are supported by the Vancouver Agreement, enacted in 2000 and
extended to 2010, which links three levels of government to tackle the
"economic, social, public-health and safety challenges" of "addiction,
homelessness and prostitution."

Together these directives frame the approach to addiction in the
Downtown Eastside. Simply put: harm reduction sees addiction as a
health, not a criminal issue; the mission is to tolerate use, treat
users and crack down on dealers.

It's an approach that's earned international attention recently as
U.S. President Barack Obama's new drug czar voiced support in a United
Nations report for a similarly public-health-focused tactic in the war
on drugs.

Yet the practice has its critics.

In his book, The Globalization of Addiction, SFU psychology professor
emeritus Bruce Alexander writes that it "provides no way of assigning
funding priorities to diverse agencies, all competing for scarce
public resources," so agencies "seem to work at cross-purposes."

Dr. Meldon Kahan, director of addictions medicine at St. Joseph's
Hospital in Toronto, believes harm reduction is often code for giving
up.

"If strategies such as safe-injection sites and heroin clinics aren't
connected with treatment options, then they become 'palliative care'
- -- they have given up on patients ever recovering from their addiction
and are attempting to keep patients safe while they continue to use
drugs. The latter goal is fine, but the 'giving up' on patients is
not," says Kahan, an associate professor of family medicine at the
University of Toronto who has written books on addiction and has
visited the Downtown Eastside.

Vancouver police union president Tom Stamatakis has charged that
funding favours harm reduction over the other pillars, creating just
"one shaky toothpick" -- "a strategy that's doomed to fail."

Vancouver Police Chief Jim Chu takes a politically neutral
stance.

"If the medical practitioners think this is an important aspect to
improving community health, then the police aren't going to comment."

But generally, Chu says, police support treatment.

"We believe treatment to help the addict and reduce their dependency
on illicit drugs is a good thing. Our focus, a lot, is on chronic
offenders, the addicts who commit a significant amount of property
crime to fuel their drug habits," he says.

Increases in law enforcement can crack down on drug-related crime by
rounding up dealers or running property-crime stings, and Vancouver
police often do, but for all their effort, the question remains: Can
you police away addiction?

According to a B.C. Centre for Excellence in HIV/AIDS report, the
answer is no. It studied a 2003 Vancouver police crackdown that cost
about $2.3 million and involved 50 officers. In the first weeks of the
operation, 236 trafficking charges against 162 people were reported.

The researchers found it had little positive effect on reducing drug
use: it "did not alter the price of drugs or the frequency of use, nor
did it encourage enrolment in methadone treatment programs" but rather
displaced drug use to other areas.

Downtown Eastside police Sgt. Toby Hinton argues a police presence
does make a difference.

"Public disorder, with police presence, is substantially cut. Public
drug dealing, although some people might minimize it, is actually a
festering ground for a lot of violent crime and criminal activity, and
it's important for us to try and tackle and deal with that."

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People who live and work in the Downtown Eastside have a different
view: open drug use is a nuisance, not a scourge; the real problem is
poverty and homelessness.

"Residents who live there say they want more help for people who are
street-entrenched and who are drug users, but they are not saying we
need police to clean it up and we need to throw them into a community
court system," says Streams of Justice's Dave Diewart.

There is support in the community for more treatment, detox beds and
programs such as Insite. The B.C. Ministry of Health funds about 200
detox beds in the province and about 2,186 detox, treatment and
recovery beds in total.

Insite, a supervised drug-injection site, opened in September 2003 on
the advice of a 2002 Health Canada report with the aim of reducing
disease transmission and overdoses. Its 12 nurse-supervised booths now
serve 800 users per day and the Portland Hotel Society, which runs
Insite, reports that 7,278 unique individual users are registered to
make use of the service.

Since it opened, a million injections have moved from the street to
Insite.

Ann Livingston, executive program director of the Vancouver Area Drug
Users Network, says what's needed to get drug use off the streets is
several more injection sites and places to smoke drugs safely, placed
in facilities that already exist.

"Addicts are already out there using drugs. There isn't a place in
this neighbourhood they're not using drugs, every inch of sidewalk and
restaurant bathroom," she says.

"Let's do this as a way of creating outreach. Shooting dope in peace
will get people in the door" so they can be exposed to services and
"build a tiny bit of self-worth and believe they can have a better
life."