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

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Nee

dle

Exch

ange

Dro

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ay C

entr

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Safe

Inje

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Wor

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ogra

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Yout

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Out

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Men

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Supp

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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