The Politics of Change

1. The Politics of Change A PUBLIC HEALTH OR CRIMINAL JUSTICE ISSUE

2. In The Beginning • DTES (Downtown Eastside) • Origin of Vancouver – Skid Road • Vibrant community – retired, families, businesses • 70’s Decline – Woodwards • 80’s Cocaine • 90’s Crack/Meth

3. Four Pillars • Wide public discussion • 2002 – drug policy passed • “Preventing Harm From Psychoactive Substance Abuse” Website - http://www.vch.ca/sis • 27 recommendations

4. What are the motivators behind drug use and some solutions? • Vancouver - the four pillar program – Prevention, Treatment, Harm Reduction and Enforcement • Vancouver’s policy and plan for reducing drug-related harm is designed to deal with overdose deaths, public disorder and root causes of poverty. • Circumstances that led to harm reduction programs • poverty; • substandard housing; • high unemployment; • increased availability and low cost of heroin and cocaine; • flight of legitimate business from the area; • de-institutionalization of the mentally ill without adequate support; • structures in the Lower Mainland; • displacement as a result of enforcement initiatives in the 1970s and 1980s that had the effect of pushing street level drug dealers into the Downtown Eastside from other areas of the city, thereby increasing the concentration of these factors in this community. • Today's drive-by journalists - little understanding of history • Attribute the problems of the downtown eastside to the treatment • See a community of addicts and blame it on the individuals rather than lack of housing, programs, criminal records etc…

5. Goals • Reduced individual, family neighbourhood and community harm from substance use • Delayed onset of first substance use • Reduced incidence (rate of new cases over a period of time) and prevalence (number of cases at one time in population of problematic substance use and substance dependence; and improved public health, safety and order

6. Why Harm Reduction? - Insite • BC - overdose deaths Increase from 39 in 1988 to 201 in 1993 (Insite opened in 2003) • 1998 injection drug use - leading cause of death for adult males age 30–49 in British Columbia. • Not always heavy users who overdose - properties / quality of street heroin not known plus mixing heroin and alcohol increases risks dramatically • We help alcoholics and prescription drug users but dehumanized and vilify addicts as weak and useless – This is neither productive or useful to society. • Insite (2006) • Over 7,200 registered users • women 26%, • aboriginal peoples 18%, • Heroin 41% of injections, • Cocaine 27%, • Morphine 12%. • Over 453 overdoses at center > zero fatalities. • Over 4,000 referrals to counselling • 40% for addiction counselling. • 2 individuals per week are referred to methadone maintenance. • 607 average daily visits. • Over 2,000 interventions for abscesses.

7. Growing problems, same old failed solutions • Drug use is a health issue • If we treated alcohol and tobacco in the same fashion as marijuana, we would have identical problems with respect to crime, quality/content and addictions. • Incarceration, increased sentences, criminalization and prohibition has failed to obtain the desired results of reducing use and associated crime.

8. Scientific Evidence • Constant research • Proper Scientific testing • Peer reviewed • Published in reputable journals • All positive • Website: • http://www.communityinsite.ca/science.html

9. Scientific Papers • 30% increase in detoxification • Reduced syringe sharing • Improved public order • Reduced public injection drug use and public syringe disposal • No increase in drug trafficking or assaults/robbery • Decline in vehicle break-ins/vehicle theft

10. Scientific Papers Continued • Large number of O.D.’s – No Deaths • Disease intervention – HIV, Heps

11. Time for Change is upon us • The Canadian public is intelligent and educated enough to understand that there is a problem with current drug policies. • Although many cannot agree on the approach, there are only two viable directions • Greater incarceration, policing, criminalization and legislation (which has failed in the USA) or A framework of legalization and regulation of drugs • legalize least hazardous drugs , manage worst AND research to reduce consumption rates • Teams of specialists would propose suggestions, treatments that work • Teams should include specialists from various fields including: • Medical • Scientific • Social • Addiction • Enforcement

12. Who should be in charge? • Medical officials should be tasked with treating and reintegrating addicts • In addition: • Alternatives to harmful addictive drugs can be distributed (Methadone/Buprenorphine) and education can be used to discourage use • Harm reduction facilities should be expanded for those who are not yet willing to clean up • Treatment facilities which remove the addict from the drug community need to be drastically increased • Affordable, safe and clean housing needs to be a priority for those individuals who have cleaned up • Hospitals for the mentally ill need to be reintroduced in society and funded properly • Law enforcement should be used to deal with criminals and should not be expected to provide counselling and medical advise to addicts and mentally ill patients. Locking up drug addicts in prisons where criminals and drugs are in abundance is simply counterproductive.

13. What are the benefits of moving drugs into the health field • Save tax dollars spent on enforcement and reinvest in education, treatment and harm reeducation • Eliminate the stranglehold which the criminal element has on sales and distribution of drugs (thereby reducing the level of drug related harm through overdose and gateway activity • Empty jails • Improve society by treating addicts as human rather than annoyances. • Removal of employment barriers due to criminal records will help to eliminate poverty and create a more productive society • Greater investment and research into various treatments • Methadone or buprenorphine for heroine and other opiates • Pharmacotherapy and behavioural treatment for cocaine and crack • Through investment in these types of solutions • Users able to lead productive lives, maybe not rocket scientist but better than lying huddled in the street or in a cell • reduce risks associated with injection drug use.  • Methadone $10 a day vs. $141.78: per prisoner/per day in provincial jail • What about the children? • denying sex education to teens in Africa, and refusing to distribute condoms creates a public outcry in the west but when we deny grown adults access to clean needles and refuse to give our children honest information about the effects of drugs, we consider it protecting. No different than the aversion to sex education. • As with sex education, by keeping children ignorant they are left susceptible to myths, criminal influence and overdose, Make them aware of the risks and they have the tools to make their own decisions • Remove the glamorous act of rebellion

14. Summary of recommendations • Public education • Employment training and jobs • Supportive and transitional housing • Easily accessible healthcare • Legislative and regulatory changes to create a regulatory system for all currently illegal drugs • Control potentially harmful substances • Limit the control that organized criminals have over the drugs

15. So why does there continue to be a drug problem in Vancouver? • Inadequate treatment facilities • A focus on criminalization and incarceration • Inadequate housing / specifically affordable or subsidised • Criminal records which prevent users from reintegrating into • Communities of users who are excluded from society • Poverty, no hope, lack of employment • AIDS and Hep C as a disincentive to addicts - hopelessness

16. Why is the criminal justice model unsustainable? • Increasing animosity towards our police, • fear of repercussions has driven addicts and recreational users underground making it harder for those individuals to seek help • Criminalized users are unable to easily return into normal society • Medical field is unable to pursue rational treatments (programs like insite), due to government restrictions • High number of minorities and vulnerable members of society incarcerated because of drug use • False belief that locking addicts up will force them to quit, when in reality it increases their ties with criminal elements • Correction Service Canada • "drugs are part of prison culture and reality" • "many needles in the prisons" • In prison - extent of injection is difficult to determine but we know that clean needles and syringes are not available. • The spread of disease in prisons adds to the hardships of addicts when they return to society – AIDS and Hep C is epidemic with injection drug users, society turns a blind eye on these citizens because they are considered “undesirables”, this only helps to spread disease throughout the prison population and thereby the public at large. • Criminalization does not significantly reduced use or cut down on the prevalence of drugs on our streets, it has made more criminals and more addicts.

17. Costs of incarceration? • Federal Average daily cost of prisoner - 2004/2005 – approx.  $259.05 per day or $87, 665 to 93,458.00 per year. • Federal female prisoner: $150,000-$250,000 / per year • Provincial prisoner: $141.78: per prisoner/per day ($51,749 per year) • Alternatives - probation, bail and community supervision $5-$25/day. • None of this includes the cost of lost revenue to the country by not having the individual in a working environment. In addition society bears the burden of caring for any dependents.

18. Wrap up • We will eventually need to move these issues into the public health field, society cannot realistically lock these people up indefinitely or lock up every drug user and seller, why wait to change. • Increased health costs can be offset by legalization and sales, no one grows their own tobacco, no different with legal pot. (bonus - likely get rid of grow ops). • Criminals will have to get real jobs - Lose profit center, police can then focus on prostitution, money laundering, violent crime, etc… • What about the children? By not informing them and not differentiating between heroin and pot we are failing our children and leaving them susceptible to criminals. • Educate them to be more informed than their parents. and better prepared to make the right decisions. • Where is the logic in locking up non-violent drug offenders? Can we not come up with better medical options? Treatment already involves drug substitution. • The longer we wait the more entrenched beliefs become, when will we get politicians and the public to reverse their stereotypes and look for rational solutions.