In a decisive showing, voters elected a full slate of lefty politicians in Vancouver, BC last fall, overhauling the city council and voting in new Mayor Larry Campbell--who got 66 percent of the vote. The election debates largely turned on the HIV and overdose crisis that's plagued Vancouver's Downtown Eastside for the last decade. The Downtown Eastside is a former entertainment district that once looked a little like Pioneer Square, but has become an open drug scene with the highest rates of HIV ever documented in the developed world. The new mayor and the new city council (from a crew called the Coalition of Progressive Electors, or COPE) have vowed to save it.
The first item of business comes straight from Campbell's campaign platform: the immediate establishment of safe injection sites. Campbell, a former BC coroner, has favored a radical new approach since he watched overdose deaths spiral during his days in that job. His aggressive stand--compared to the other candidates' lukewarm hemming and hawing--proved wildly popular during the election. His triumph seemed a clear sign that Vancouverites were ready and willing to embrace a new approach.
The idea sounds radical to American ears--give users a safe place to shoot up, where they won't get HIV or overdose and die--but it's been working in Europe and for over a decade. This summer, after a long wait and much debate, it looks like the sites may actually happen. And the idea is making the Bush administration furious.
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I live in Vancouver, along an arc of streets that sweeps toward the mountains and the sea. At night, the lights from the ski slopes hover against the darkness. I fall asleep to the sound of trains coming from across Canada, across the States, to this last outpost, the westernmost and northernmost metropolis. The Terminal City. Sometimes I walk to the end of my street, where the concrete fades into water, and daydream about soaring over the inlet, escaping from the city and into the wilderness.
But follow these same streets even five blocks and the picture turns grayer, more gritty. Here the mountains and the water hide behind decaying buildings, and fantasies of escape come most often in small vials, plastic baggies, bits of paper. Much has been written about Vancouver's Downtown Eastside, at least in the Canadian press. It's shocking, everyone says. And they're right: The area has the lowest per capita income in Canada, 5,000 of the roughly 16,000 residents are drug-dependent, over half the children live in poverty, and over half the adults never finished high school. Many of those who aren't homeless live in tiny hotel rooms without their own bathrooms or kitchens. The HIV infection rate dips and jumps, but it's now at about 30 percent. In 1997, the local health authority declared an epidemic.
It's easy to go on, to marshal a horrifying procession of facts. For those of us who live here, though, the facts aren't as brutal as what we've seen every day for years: 14-year-old prostitutes, ambulances day and night, addicts with faces full of weeping scars.
It's taken a crisis like this for Vancouver to radically alter its drug policy, to decide this is a problem no amount of incarceration or American drug-war-style tactics can solve. The city's mayor, city council, health officials, and activists now believe it's time for a new strategy, based in part on the harm reduction policies developed in places like Frankfurt and Zurich. One of the touchiest recommendations of their plan is a research pilot program that would provide safe injection sites. In March, the local health authority sent off a proposal for the sites to Health Canada--and if the feds approve it, one site could open this summer.
But U.S. drug policy head John Walters calls safe injection sites "state-sponsored suicide," and rails against the European model. It's pretty clear he's getting nervous. In several interviews on Canadian television he's said how "regrettable" it would be if Canadians started having some trouble getting their 350 billion annual dollars in goods across the border.
So why are Vancouverites willing to take such a daring step, pissing off their closest neighbor and trading partner in the process? Why does a city just 150 miles north support a move that the U.S. administration insists is so wrong? Are they criminally insane, as Walters seems to allege--or very, very smart?
Answering those questions means looking at the history of the Downtown Eastside--and delving into the debate that's seized Vancouver for the past several years.
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It is astonishingly cold this March morning. Freezing, in fact, and beginning to snow. The streets have an eerie early-morning calm as I hurry past groups trying to sleep in the doorways and alleys, huddling for warmth. I'm on my way to meet Mark Townsend of the Portland Hotel Society.
Townsend was worried that we wouldn't recognize each other, but I'd seen his picture in the paper several times. The Portland Hotel Society are key players in the area: social housing advocates who buy up derelict buildings, renovate them, and then rent them out to the region's hardest-to-house. In February, they helped build a demo safe injection site along the area's worst stretch; that's the site that could start running this summer.
The cafe where Townsend's asked to meet me, just a half-block away from the demo site, is doing brisk business at 10:00 a.m. When I walk in, I'm a little surprised to find a bright, bustling coffee shop that'd be at home on any Seattle street. It's a far cry from the Downtown Eastside's usual decaying diners and pubs, with their peeling paint and bargain meat specials. Turns out the building was recently bought by the Portland, who brought in the cafe. It's a great example of the kind of work being done in the area, by activists and a city government willing to take chances.
I tell Townsend I'm trying to get a sense of what happened to the Downtown Eastside--how an entertainment district that was bustling 30 years ago has turned into a war zone. I know that for over a century, an underground network fed the desires of the miners and loggers coming from the province's interior. Yet for years the drug scene somehow managed to seethe relatively discreetly beneath the façade of a civilized, beautiful city. Then, in the early '90s, the underworld got so big it burst its skin and turned inside out, leaving its bloody entrails all over the street. What happened?
Townsend starts by telling me that the story of the Downtown Eastside's demise is linked to the fate of inner cities across North America. And certainly, Vancouver is not the only town whose former shopping and entertainment district fell victim to the flow of commerce outward, toward the suburbs, toward the mall, toward parking lots big as ancestral villages.
But according to Townsend and other sources, the '86 Expo in Vancouver brought the situation to a head. Preparations for Expo apparently involved a thorough "cleanup" of the city. Translation: Low-cost housing was swept from the fairgrounds and around the city, into the Downtown Eastside. There, "affordable housing" meant mostly single-room-occupancy hotels notorious for crime and filth.
Townsend says despite perceptions "that lots of social housing has been put in the DES, if you look over the last 10 years the number of units has declined drastically. So what you have are less and less places for people to live that are more and more expensive, that they can't afford."
Around the same time, the area began to feel the effects of deinstitutionalization policies for the mentally ill. Vancouver's psychiatric beds decreased from 5,000 in 1987 to less than 800 in 1996. That meant that a lot of very ill people found only one place in the city they could possibly afford. According to most studies, there's a worrisome overlap between mental illness and injection drug use.
Apparently, there were also police attempts at containing addicts and dealers in the area, consciously creating a red-light district. Treatment services haven't kept pace with the growth in need over the past 10 years; there are 54 detox beds in Vancouver now, and all are at capacity, with a waiting list of at least several days. In the Downtown Eastside, there's a nine-week wait for day treatment. And all of this coincided with a general increase in the availability of heroin and cocaine--which was partly due to free-trade slackening of port policing.
Throughout the 1990s, addiction and overdose rates kept climbing. In Vancouver in the '90s, 1,200 people died of drug overdoses. Not surprisingly, those living and working in the Downtown Eastside decided the status quo was unacceptable.
It was time for a new approach. That's why, in the pouring rain of November 1999, the Portland Hotel Society helped put on a major drug conference on the lawn of a nearby park. Called "Out of Harm's Way," the symposium brought European policy experts into the debate and helped jump-start local interest in bringing safe injection sites to the table.
"What we wanted to do was level the information playing field down here, because at that time people were very confused around that stuff; there was a lot of emotion around addictions," Townsend says. "And we thought, well, people are pretty logical--if they hear the chief of the Frankfurt drug squad and the [Vancouver] drug policy coordinator talk about things like [safe sites], they'll see that... the sky is not going to fall if you do them."
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The small, prosperous German city of Frankfurt eventually became a major inspiration for Vancouver. After two decades fighting the drug war, in 1990 Frankfurt--along with Hamburg, Zurich, and Amsterdam--signed a document called the Frankfurt Resolution, declaring drug prohibition an official flop. The policy instead championed harm reduction: essentially, the theory that drug use has always existed in society and always will. Instead of punishing users, harm reduction proponents say, the task is to figure out how to minimize the harm of drug use for the user and society. The goal behind safe injection sites is, in part, to keep people alive so that they can one day quit. As one activist put it, you can't detox if you're dead.
The results of Frankfurt's comprehensive plan--decriminalization of the possession of small amounts of drugs, and establishment of needle exchanges, safe sites, and methadone clinics, among other initiatives--included an 80 percent reduction in drug-related deaths between 1991 and 1999, plus dramatic drops in auto theft, property crime, and street violence. After years of a drug market spiraling out of control and many failed enforcement attempts, "most of the harms related to illicit drug use were reversed," according to Benedikt Fischer, a research scientist at Toronto's Centre for Addiction and Mental Health.
Evidence also shows that safe sites, in the context of harm-reduction services, will reduce HIV. Frankfurt found significant declines in the number of drug users dying with HIV/AIDS after the city started its program--from 65% in 1984 to 12-15% in 1994.
In 1999, the results of Frankfurt's strategy sounded like a miracle to Donald MacPherson. For 10 years, MacPherson, now Vancouver's drug policy coordinator, was the director of the Carnegie Centre, the community center located at ground zero of the Downtown Eastside's open drug trade. For decades, walking by the Carnegie was like entering a waking nightmare--the streets crowded with people tweaking, yelling, and dancing as various poisons coursed through their veins.
So MacPherson took a trip to Europe--which ended up being both a personal turning point and a catalyst in the city's move toward harm reduction.
"I went to Frankfurt and Geneva," he says, "and... I felt very strongly that they had been through a similar process to us, and had arrived at a pretty good idea of what was needed to minimize the harm to their communities of illicit drug use."
For MacPherson, "the real eye-opener was the notion of low-threshold services, of needing services that people can access very easily. Conventional treatment approaches [are] too high-threshold--in other words, people have to jump through too many hoops. You have to [have already gone through a detox program] to get into treatment, so what do we do for all those folks who are using on the street, who need a place to go where they're not harming themselves or the neighborhood? [That type of service] is what the Europeans put in place."
Safe sites are a perfect example of that kind of service. Asked why addicts need them, Rob Weppler of the Vancouver Area Network of Drug Users (VANDU) says simply, "The sites are essential to bring the people that health workers consider the 'unreachable addicts' closer to the services that they need."
So when MacPherson took office as the city's first drug policy coordinator a year after his European tour, one of the first things he did was draft A Framework for Action. The document is based on what proponents call the "four pillars": prevention (education); treatment (detox); enforcement (stiffer penalties for dealing; drug courts focusing on treatment for users); and harm reduction (health services that don't focus on abstinence alone).
The Framework became the center of a major consciousness-raising effort by MacPherson, former Vancouver mayor Philip Owen, the local health authority, VANDU, the Portland Hotel Society, and others.
"When we released A Framework for Action in the fall of 2000, [then-mayor] Owen really took it upon himself to raise this issue big time," MacPherson said. "There was a tremendous amount of interest expressed by the public, and a tremendous amount of support. Even those people who didn't know much about treatment, weren't that familiar with needle exchange, were very supportive of the city's efforts to try and do something."
MacPherson says that this marked a real shift in opinion: "Previous to that, I think the public did not really have any new ideas. They just had the feeling that we needed more police and more drug treatment.... It's not as simple as putting people in jail. It's not as simple as opening a drug treatment center. It's not as simple as having a needle exchange. You need a whole array of services, and you need a very intelligent approach to what is basically a public health issue. And that's the other big benchmark in Vancouver--people really did get it."
Under concerted public pressure, the Framework guidelines were unanimously voted in by the city council later that year.
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But it's not like everyone in Vancouver woke up, got enlightened, and started chanting harm reduction slogans overnight. Despite the city's reputation as a new Amsterdam, some in Vancouver feel strongly that harm reduction has serious holes.
An architect named Bryce Rositch and a group of Chinatown businessmen got the most media play for their anti-harm-reduction politics. Though Rositch's posh offices lie toward the fringes of the open drug market, he managed to make his way to the center of the harm reduction debate as spokesperson for a group called the Community Alliance. At its peak, the Alliance--formed by local business-improvement and community groups--claimed to represent 5,000 property owners and 30,000 individuals. In the fall of 2000, Rositch told TV cameras that the Alliance's demands were twofold: one, that no resources of any kind should be used to facilitate or maintain the use or dealing of illegal drugs; and two, that police should enforce the criminal code of Canada equally throughout their jurisdiction--instead of throwing their hands in the air and ignoring drug use in the Downtown Eastside, as many claimed.
Albert Fok, chairman of the city's Chinatown Merchants Association, says he's worried about the impact the safe site will have on his community; Chinatown lies just alongside the Eastside's worst stretch. Fok is concerned that the site will become a magnet for the addicted, leading to an increase in public disorder and crime that will victimize his community.
"We can't concentrate it in one specific area," he says. "We should move the safe site to other cities, or other parts of the city. Otherwise people will converge here, and it will escalate, and even more suppliers will come here." But he says that his group won't protest the site if it opens.
"We will give it some time, and have a closer look at its efficacy. It'll be under scrutiny; it'll be watched under close eyes."
Some addicts themselves are also opposed to the site. When the Vancouver Sun canvassed opinion last November, several former users spoke out. Perhaps ironically--or perhaps not--their sentiments echoed those of the U.S. administration.
"Safe injection sites are not the answer. All they do is promote the disease. As long as you feed the disease, people are going to be hostages to it.... In the all-over scheme, what a terrible message to give our children," said recovering heroin and cocaine addict Billy Weselowski.
Former heroin addict Barry Joneson agreed. "If an addict is shooting up in a safe injection site, he is still a slave to the drug that is killing him. He doesn't improve the quality of his life. His children are still wondering where he is. I would sooner have been dead than have someone prolonging my life like that."
But the Centre for Addiction and Mental Health's Fischer likes to point out that if enforcement and abstinence-oriented drug policies led to less drug use, "the U.S. should have the smallest population of illicit drug users, and the Netherlands should have the highest. But it's completely the opposite."
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There's a note of hostility in MacPherson's voice when I ask him if he's had any little tête-à-têtes with American officials lately. "People can have whatever opinion they want," the drug policy coordinator says. "We're trying to look at stuff that is evidence-based, and not ideologically based. We're going to implement these sites, and see what happens, and actually learn, instead of having this hysterical debate."
The frustration I hear makes sense: Americans are known for waging a rhetoric-ridden war on drug abuse that tends to focus on the "moral message" drug policies send. Baltimore's health commissioner, Peter Beilenson, recently told the Canadian newsweekly Maclean's that he would be "crucified" if he tried to institute safe injection sites in that city, which sees around 1,000 overdose deaths annually.
And while the U.S. doesn't have the power to directly crucify any Canadian official, it does have other, more covert ways of displaying its anger. The most immediate effect of a Canadian shift in policy will be an increase in border control, snarling trade that's vital to Canada's economy. And there's another method the U.S. uses to enforce the drug war internationally.
Barry Beyerstein, a founding member of both the United States' Drug Policy Foundation and the Canadian Foundation for Drug Policy, says that the U.S. has major sway in the International Narcotics Control Board (INCB), the UN body responsible for enforcing drug prohibition. The INCB uses a "certification process" to list who's been naughty and who's been nice enforcing drug prohibition--that is, who's getting lax and who's sufficiently militant. "Decerti-fication" can mean sanctions, international isolation, and cuts in foreign aid. In 1999, the INCB threatened that if Australia went ahead with their safe injection sites, the board might embargo the huge opium-poppy industry (which produces codeine) in the Australian state of Tasmania.
U.S. officials have, in fact, told Vancouver officials point-blank that Vancouver's plans are wrong. In early May, David Murray, special assistant in the U.S. Office of National Drug Control Policy, gave a lecture to local police, health groups, and municipal politicians in Vancouver. Murray said that the city's approach is misguided because addicts just aren't capable of getting themselves into treatment. He argued that only harsh incentives--like jail--will force them there.
But Vancouver is determined to ignore U.S. criticisms. After a November visit from U.S. drug czar John Walters, former Vancouver mayor Philip Owen told reporters flat out that Walters needs to pay more attention to the U.S. drug problem.
And Mayor Larry Campbell bluntly dismissed Murray's remarks. "In the coming years, the U.S. will probably want to emulate us," he told reporters.
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Given that Seattle is physically and intellectually much closer to Vancouver than D.C., you might think Seattle would be first in line to mimic Vancouver's plan. Though the drug scene here remains largely underground, far from the obvious misery of Vancouver (the HIV rate among Seattle users is only about 3 percent), that hardly means all is well. Seattle saw over 100 drug-related deaths last year, and about 85 percent of King County's 12,000-15,000 injection drug users may have hepatitis C, according to the King County medical examiner and the Department of Public Health. Hep C is one of the illnesses the sites are specifically designed to prevent.
And despite the argument that European cities implicitly condone drug use, places like Frankfurt, with its safe sites, have actually seen a decrease in users. The chief of the Frankfurt drug squad says that since his city instituted the sites, it's seen the number of dealers go from 5,000 to 1,400. There's also plenty of evidence showing that cities with safe sites actually see a sharp drop in surrounding street violence and crime; that's one of the main reasons the Frankfurt police are such proponents.
So could the idea work in Seattle? Michael Hanrahan, of the King County HIV/AIDS program, which runs Seattle's needle exchange, says there's definitely evidence enough to support the sites in principle: "There's a growing body of literature that indicates that supervised safe injecting environments can be effective in reducing the spread of bloodborne illnesses such as hep C and HIV--and also reduce incidents of overdose, and certainly mortality related to overdose. The evidence for that is actually fairly strong."
Andy Ko, who heads up the Drug Policy Reform Project over at ACLU of Washington, calls the sites "fantastic": "I think it's long overdue in every community with an injection drug problem. It will go a long way towards reducing the spread of disease, and towards bringing people into these services."
But Hanrahan notes that the decision to implement the sites isn't a public health question: "The decision whether or not any particular jurisdiction is going to adopt that strategy is largely a political one, and I really can't comment on that. But infer what you like. I don't see it any time soon. We certainly are not planning [on it]."
Ko's a little more blunt--he says there's no way the U.S. administration will let safe sites happen here. "Canada is just so far ahead of us on this point," he sighs. "The main obstacle is [our] federal government. They make these laws and then leave the localities to deal with the problem. It's our communities that have people in emergency rooms with soft-tissue infections and all these other problems. The people in the White House basically make their political careers on the backs of the suffering, and they don't have to watch this stuff."
James Walker of Seattle's Street Outreach Services is equally outspoken. "The police don't want you downtown; you know they're not going to go open an injection site for people to use. Really... uh-uh. I don't foresee that here."
The Seattle Police Department's media office did not return calls by deadline, but the officer answering the phone at the East Precinct said he hadn't heard of Vancouver's plans. Pressed, he said that the safe injection sites were of "no consequence" to him.
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Vancouver isn't Lotusland just yet. The beginning of April saw a major police crackdown throughout the Downtown Eastside, causing one international human rights group to file a report alleging police brutality. Some say that the police presence is a necessary complement to the harm reduction policies--but activists are furious that the crackdown has occurred while the legal safe site in one of Portland Hotel Society's building has yet to go through. In response, other activists have started running an illegal site of their own, just blocks from the planned legal demonstration site.
And although Campbell had promised safe sites by January 1--and every month thereafter--it took most of the spring to iron out the details of the proposal. The feds say they're into it, given that study after study they've commissioned recommends the sites.
But now the real problem is securing funding. So far, no level of government has committed any money, though the provincial health officer says he's confident funds will be found. They might come from the $20 million in the Vancouver Agreement, contributed by all three levels of government to pay for programs to improve the Downtown Eastside. No one's decided yet how that money should be spent, but the pending safe site housed by the Portland Hotel Society may be the perfect candidate.
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The legal demo safe site is just a short walk from the cafe where I met Townsend. (It's not open for clients yet, obviously, because the government funding is still pending.) As our Friday chat wound down, I asked Townsend if he'd take me there. Inside, I was blown away by the obvious time, care, and money that had been spent. The waiting room is gorgeous: wood floors, potted palms, art prints on the wall. It looks more like a spa than a fixing facility. Inside the using room, seven booths boast shining steel tables, sinks, and large mirrors, plus a wide observation platform. The beauty of the place seems to say to addicts, you are not disposable, you too deserve glimpses of calm and happiness. Or as VANDU coordinator Ann Livingston has said, the site "lets people know, in the most subtle and yet absolutely thorough way, that people care if they remain alive in order to one day stop using drugs."
If Vancouver can go its own way, this northern city will once again be the frontier.