Close-Up

FIXING TO DIE

Kelowna's Intravenous Drug Problem May Not Rival Vancouver's but It's
Growing. Here's What the City Wants to Do About It.

If there is a physical divide between the Okanagan Valley and the
Lower Mainland, the Coquihalla Highway is it.

Treacherous in the winter, still deserving of respect in the summer,
the alpine highway is what separates the still-largely rural Okanagan
with the bustling urban centres of the Fraser River delta.

But it's the mental divide between the two areas that is much higher
and steeper. The Okanagan Valley is where many people in B.C. go to
escape the worst of what the big cities represent-traffic congestion,
pollution and crime.

For many, given what they may have left behind, we are the land of
milk and honey, Shangri-la and the Garden of Eden all rolled into on.

So it's hard for many of them to wrap their heads around the fact that
the urban centres of the valley-Kelowna, Penticton, Vernon-could
actually face elements of the same problems they left behind.

"You don't know what a traffic jam is," the former urbanites will
sneer at complaints about bridge-induced traffic jams. "You call this
pollution," they laugh. "Drug problem, what drug problem?" they say
with a shrug.

Locals, too, are guilty of dismissing serious social issues with the
blanket statement, "That's a big city problem. We don't have that here."

But while our urban centres may not have the same volume, it's a fact
of life that the same problems that can blight big-city living are
here and here to stay. It's that combined mindset, more than anything,
which often stands in the way of finding local solutions to common
urban problems.

In fact, full-blown collective denial can make it even more difficult
to arrive at an answer. How do you solve a problem when you won't even
admit you have one?

Kelowna, the valley's largest urban centre and the one most likely to
be afflicted by big-city problems, took a tentative step in the right
direction this week with the Forum on Community Safety and Harm Reduction.

Led by Mayor Walter Gray and anchored by a panel of representatives
from law enforcement, public health, local businesses and drug users,
it was as close as we've ever got to an admission from community
leaders that a drug problem exists in Kelowna.

"As we are all aware, problems with drug addiction and drug-related
crime are now rather epidemic in Vancouver," said Gray in his opening
address to the audience assembled in the Mary Irwin Theatre. "But here
in Kelowna, we are motivated to move at an earlier stage to meet the
problem head on while solutions are somewhat easier."

Gray said growth is behind much of Kelowna's problems. "Because of
growth we have increased traffic problems; because of growth we have
land-use challenges; because of growth we have environmental issues,"
he said. "We have become a magnet for people who want to retire here,
travel here and yes, regrettably, the criminal element which causes a
proliferation of drug use and drug related crime."

The mayor used the forum to introduce to the audience the so-called
Four Pillars approach to dealing with drug addiction and its attendant
crime.

Initially developed in Switzerland, the Four Pillars approach, simply
put, calls for equal parts prevention, treatment, enforcement and harm
reduction as the way to solve the problem.

Vancouver city council under then-mayor Philip Owen adopted the
strategy in 2001 in an attempt to deal with that city's rampant drug
use epidemic in the Downtown Eastside, Canada's poorest urban
neighbourhood.

To say its introduction was controversial is a vast understatement.
Many business leaders in the neighbourhood were dead set against any
new treatment facilities in the area.

The Vancouver Police Department was split down the
middle.

Some officers derided it as a liberal, do-gooder approach that would
only make the problem worse. Others were willing to give it a try,
admitting that they had lost control of the situation, and that
something, anything, would work better than what they were then doing.

Many citizens were against it, especially those in the suburban
communities who didn't have much contact with the open drug use that
was epidemic in the area-addicts shooting up on the sidewalks and in
back alleys.

Vancouver city council was a house divided.

Traditional party lines between the conservative Non-Partisan
Association and the more liberal Coalition of Progressive Electors
were blurred.

The controversy even cost NPA mayor Owen his job when his support for
the Four Pillars approach lost him the support of his own party and
allowed COPE candidate Larry Campbell to assume the top job during a
bitterly contested civic election in November, 2002.

The former provincial coroner campaigned on continued support for the
Four Pillars approach and the voters of Vancouver responded by ending
the 16-year domination of the NPA over city council.

One year later, the Four Pillars approach in Vancouver has culminated
in the opening of North America's first safe injection site, a
publicly-funded facility run by the Vancouver Coastal Health Authority
where addicts can inject drugs under supervision in a clinical setting.

But Four Pillars means different things to different people and Mayor
Gray made it clear that it will be tailor made to Kelowna. "We need a
made-in-Kelowna solution for this problem," Gray said. "Anything less
than the Four Pillar approach will be a Band-Aid solution."

If someone sitting in the audience at the community forum had no
knowledge of the drug scene in Kelowna, they could be forgiven for
interpreting Mayor Gray's address as meaning the city is starting from
scratch on the Four Pillars approach.

But in fact, elements of all of the four pillars are already in place,
albeit with varying degrees of effectiveness.

Enforcement is well-entrenched here in the form of the 160-member
Kelowna RCMP known for its zero tolerance of drug use and aggressive
pursuit of drug offenders.

For treatment there is Crossroads Treatment Centre which operates a
residential treatment program, a supportive recovery house plus an
eight-bed detox centre. Freedom's Door, a religious-based
organization, operates three recovery houses with 25 beds between them.

The Kelowna Family Addictions Centre offers a government-run
outpatient drug and alcohol counseling service.

At Kelowna General Hospital, there is the chemical dependency team
that deals with patients who also suffer from an addiction.

On the prevention side, the Central Okanagan school board offers the
DARE anti-drug program in local schools.

For harm reduction, there exists the Outreach Health needle exchange
operated by the Okanagan Boys and Girls Clubs which gave out 55,000
needles last year. A methadone clinic operated by the Vancouver-based
Gardell and Associates just recently opened in downtown Kelowna.

There are critics of various aspects of these services.

Over the years, Crossroads has been accused by some clients of
offering an outdated, ineffective treatment program. The supportive
recovery house has been plagued with unconfirmed reports of drug use
within the facility and the detox centre is known to be perpetually
full with a lengthy waiting list.

The Outreach needle exchange, open only during the day, has been
described by some addicts as out of touch with the nocturnal realities
of drug addiction.

The DARE program, originating in the United States, has been
discredited by some researchers for its use of a strident message and
an unrealistic portrayal of drug use and abuse.

And the Kelowna RCMP have been accused of conducting low-level but
high publicity street drug sweeps at the expense of higher-level
drug-dealing investigations.

But those criticisms aside, what some say is really lacking is the
coordination amongst various agencies that forms the centrepiece of
the Four Pillars approach. "If this is really going to work, it needs
to be centrally coordinated by all of the players," said Pat Townsley,
addictions manager for the Okanagan Health Service Area, a sub-region
of the Interior Health Authority.

As such, Townsley is responsible for government-funded service
providers such as Crossroads and Kelowna Family Addictions.

She sees the health authority as integral to the coordination of the
Four Pillars approach. "We're responsible for parts of two of the four
pillars," she pointed out. "Prevention through public health and
treatment through our service providers."

Harm reduction, at least in the form of a safe injection site, would
also fall under its jurisdiction.

If harm reduction is the spear, safe injection sites are the point of
the spear, only stopping short of actually providing drugs to addicts.

Does Townsley support the concept? Not without more
research.

"Safe injection sites are a specific intervention for a specific
problem," she said. "They help to reduce overdose deaths. To reduce
the spread of diseases like HIV and hepatitis C. And also as a first
point of contact for IV drug users with the health care system."

Townsley said there were three overdose deaths in the Central Okanagan
last year, part of 171 ambulance calls for nonfatal overdoses. "You
really need to analyze where those ambulance calls are coming from.
Are they happening in back alleys or are they happening in people's
homes in bedroom communities? If they are, does it make sense to have
a safe injection site in downtown Kelowna?"

If you ask the operators of North America's only legal safe injection
site in Vancouver, the answer is unequivocally yes.

Operational for only two months, the safe injection site, is already
seeing upwards of 500 visits on some days, a number Viviana Zanocco
says can only mean good things, if for nothing else other than an
economic perspective.

"Administration costs $2 million per year and most of that is for
staff," said the spokeswoman for the Vancouver Coastal Health
Authority. "For each case of HIV, it costs us $150,000 to $200,000. If
we can stop ten people from getting it, we've already made our money
back."

Zanocco added that doesn't count the possible cases of endocarditis
contracted when addicts use dirty mud puddle water in back alleys to
shoot up or the cost of skin grafts to reconstruct arms damaged by
improper injecting techniques.

"There are so many ways we save money, it's unbelievable," she
added.

As for the so-called "honeybee effect" where it was feared the
facility would draw addicts from all over the Lower Mainland and the
rest of the province, Zanocco dismisses it.

"We haven't seen any drug tourists," she said. "95 per cent of junkies
live outside the Downtown Eastside and they're not going to travel
here just to use."

She also dismisses the theory that those who had never used hard drugs
would flock to the site. "Somebody who has never seen hard drugs
before who goes to the Downtown Eastside would be horrified," Zanocco
said.

She admits to her own initial skepticism about the value of the safe
injection site but is now clearly a convert. "I hear anecdotally from
the street nurses there is definitely fewer people using in alleys,"
said Zanocco. "Even the police say it's different out there."

For her, that qualified support is the most surprising. "If you had
told me two years ago the police would be in favour of this, I would
have died laughing," said Zanocco. "But people's views have come
around to seeing this as a health issue. The chief of police said 'I
don't want to be the one standing in the way of something that might
work.'"

At this point, local police do not share that view. Superintendent Don
Harrison made it clear that nothing short of a Section 56 exemption
(the part of the criminal code that allows the Vancouver site as well
as the use of medical marijuana) would make local police support a
safe injection site.

"Look at all our problems. Assaults, murders, robberies, the majority
of them are tied to drug use. I would not support that in any way,
shape or form," said Harrison. "If it was legislated then we would
have no choice but otherwise we would be down there kicking the doors
down the minute it opened."

The superintendent called the name safe injection site a misnomer.
"There's nothing safe about injecting drugs in your arm," he said.
"I'm all for harm reduction but I don't think giving them a place to
shoot up illegal drugs is the answer. People who want to quit their
habit, I'm all for that." Harrison predicted a safe injection site
would draw users from all over. "Are we going to be dealing with
Kelowna's problems or everyone else's," he asked.

Most tellingly however, is that Harrison doesn't believe the the
community will support it. "I'd be very surprised if people are going
to bang the drum and open up the doors to a safe injection site," he
said.

Harrison's prediction may be right on the money.

At the community forum Mayor Gray chose his words carefully when
talking about safe injection sites.

"Our intention today is to use the Four Pillars as a template but we
must recognize that modifications for a made in Kelowna solution will
be the eventual outcome," Gray said. "Vancouver is looking at safe
injection sites. Here in Kelowna, it may be concluded that safe
injection sites are not needed or appropriate." Whether that route
will be chosen will become clearer on Jan. 7 when the task force
created from the community forum is supposed to meet again.

If there's anything all agree on, it's that whatever eventual solution
is reached it must be agreed to by the majority of the community.

"It's long been recognized that a coordinated, balanced approach
produces the best results providing there is a complete community
buy-in," Gray said.

The health authority's Townsley echoed Gray's words. "Whatever
solution they come up with has to be relevant to our community. You
need to put time and effort into educating the public about why we are
doing whatever it is we decide to do. Without that, we can sit up here
and plan all we want but nothing will come of it."

One community forum attendee who asked not to be named took it a step
further. "The forum was a nice first step but we've taken many first
steps before," he said. "What's really important is the second and
third steps."