DISPLACEMENT OF CANADA'S LARGEST PUBLIC ILLICIT DRUG MARKET IN RESPONSE TO
A POLICE CRACKDOWN

ABSTRACT

Background:

Law enforcement is often used in an effort to reduce the social, community
and health-related harms of illicit drug use by injection drug users
(IDUs). There are, however, few data on the benefits of such enforcement or
on the potential harms. A large-scale police "crackdown" to control illicit
drug use in Vancouver's Downtown Eastside provided us with an opportunity
to evaluate the effect.

Methods:

As part of our ongoing prospective cohort study of IDUs in Vancouver, we
examined data collected from 244 IDUs in the 3 months before the police
crackdown and from 142 IDUs in the 3 months after the start of the
crackdown, on Apr. 7, 2003. All study subjects were active drug users. We
also examined external data on needle exchanges and syringe disposal.

Results:

The 2 groups of IDUs were statistically similar: they were mainly young
(mean age 39 years) and male (63%), and they had injected illicit drugs for
13 years on average. Ethnic background and the proportion homeless were
also similar. There were no statistically significant reported differences
(all p 0.1) in the street price of heroin, cocaine or "crack" in the 2
periods. In the 3-month periods before and after the crackdown,
respectively, the rates of daily heroin injection were 27.9% and 26.8%,
daily cocaine injection 28.7% and 27.5%, and daily crack use 59.4% and
60.6% (all p 0.1). The proportions of study subjects receiving methadone
treatment, 41.0% and 44.4% (p = 0.516), did not differ. However, the
proportions reporting a change in where drugs were used, 22.5% and 33.8% (p
( 0.05), and the proportions reporting a change in the neighbourhood of use
because of police presence, 18.1% and 26.8% (p ( 0.05), increased
significantly. Needle-exchange data confirmed that the community levels of
drug use were unchanged. Disposal statistics demonstrated that the monthly
average number of used syringes found on the streets outside the
traditional area of drug use increased from 784 in the 3 months before Apr.
1 to 1253 in the subsequent 3 months (p = 0.002) and the monthly average
number of used syringes found in public boxes for the safe disposal of
syringes decreased from 865 to 502 (p = 0.018).

Interpretation:

The effort to control illicit drug use did not alter the price of drugs or
the frequency of use, nor did it encourage enrolment in methadone treatment
programs. Several measures indicated displacement of injection drug use
from the area of the crackdown into adjacent areas of the city, which has
implications for both recruitment of new initiates into injection drug use
and HIV prevention efforts.