Vancouver's Radical Approach to Drugs: Let Junkies Be Junkies

By Vince Beiser, Miller-McCune Magazine. Posted November 18, 2008.

Give them methadone -- or even heroin -- for free so they don't break into cars and homes to get money for the next fix.
These aren't just theoretical notions. Some harm reduction tactics have been researched extensively -- and the findings are often impressive. In recent years, no fewer than eight major studies in the U.S. on needle-exchange programs -- probably the best-known and most widespread harm reduction technique -- have concluded that they work. As then-Assistant Surgeon General David Satcher summed up in a 2000 report, "There is conclusive scientific evidence that syringe exchange programs are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs."

Methadone maintenance, first introduced in the 1960s, has been the subject of hundreds of scientific studies. "The findings have been consistent," according to a recent article in the Mount Sinai Journal of Medicine. "Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use and allows patients to improve their health and social productivity. In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with heroin injection, such as hepatitis and HIV."

In Vancouver, harm reduction seems to be delivering. Since the city began seriously supporting needle exchanges and other such tactics in the 1990s, HIV infections have fallen by half, and hepatitis C rates have plunged by two-thirds, according to city and provincial health authorities. The annual number of drug-induced deaths has dropped from a peak of 191 in 1998 to 46 in 2005, the most recent year for which statistics are available.

Nonetheless, harm reduction remains controversial, even in relatively liberal Vancouver. "People are always going to beat each other up, too -- so should we be handing out boxing gloves to reduce the harm they do?" asks Al Arsenault, a recently retired Vancouver cop who spent much of his 27-year career in the Downtown East Side and now makes documentaries about the area. "That's just normalizing the behavior. The whole premise is nonsense."

It took a careful, sustained campaign to convince politicians and a critical mass of voters that such critics were misguided. Philip Owen, who as Vancouver's mayor from 1993 to 2002 was one of the key forces pushing the city to embrace harm reduction, was convinced by the research on the subject, some of which was brought to his attention by the U.S.-based Drug Policy Alliance Network and other advocacy groups.

Once on board, Owen set about building support. "You need to walk slowly before you can run," he says. Owen organized dozens of public meetings with community groups and cultivated provincial and federal officials. He even took the then-federal Minister of Health on an undercover tour, both of them wearing blue jeans and old hats, of the Downtown East Side to see the problem firsthand.

Owen's groundwork helped Vancouver secure a special exception to federal drug laws that allowed Insite to open. The heroin maintenance program won approval on a trial basis. "If you set something like that up as a scientific experiment rather than a policy change, it's easier to sell," says Ethan Nadelmann, executive director of the Drug Policy Alliance Network. Meanwhile, a local activist group, the Vancouver Area Network of Drug Users, kept up the pressure with noisy street demonstrations.

A quick visit to the Downtown East Side is enough to convince anyone that the city had to do something. The area was always sketchy, but Vancouver's booming economy and rapid growth have combined to gentrify most of downtown, pushing the dope fiends and crackheads and mentally ill homeless into an ever smaller, more densely concentrated island of cheap housing, where their addictions and pathologies and sundry bad behaviors feed on each other.

Today, the Downtown East Side protrudes like a gangrenous limb from the city's sleek core. Literally from one block to the next, a world of chic clothing boutiques, jewelry shops and high-rise luxury condos suddenly gives way to Planet Junkie. Haggard, prematurely aged men and women with sunken cheeks, missing teeth and feral expressions drift along trash-strewn sidewalks lined with abandoned buildings. The only legitimate businesses are check-cashing operations, pawn shops, bars, squalid residential hotels and 24-hour convenience stores with barred doors and windows. It's a bit like an unsupervised, open-air hospice where the patients have been left to find their own medications and get them into their bodies however they see fit, a dark carnival of misery smack in the middle of what The Economist recently dubbed "the most livable city in the world."

In just an hour of randomly walking around one recent morning, I passed at least a dozen people smoking crack in plain view, stepped over countless discarded needles and turned down muttered offers of a whole pharmacopeia of substances. The worst that police are likely to do to street-level users is take away their drugs. That evening, I accompanied a couple of constables walking the beat who passed a grizzled man with long, greasy hair smoking crack at a bus stop on busy Hastings Street. Sighing at his stupidity -- couldn't he have at least gone around the corner into an alley? -- the cops made him drop his pipe, crushed it underfoot, gave him a warning and walked away without even searching him.

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Vince Beiser is a Miller-McCune contributing editor based in Los Angeles. He has hunted down stories from the Balkans to the Middle East on assignments for Harper's, Wired, The Los Angeles Times Magazine, The Village Voice, The New Republic, The Nation and Rolling Stone.

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