losing ground, gaining support

A discussion with Alan Campbell, Director of Mental Health and Addiction Services for the Vancouver Island Health Authority (VIHA). VIHA offers a range of services for addiction and their priority is providing appropriate accessible services for adults with serious mental illness and/or addictions. (Note: the views expressed here are of Alan Campbell’s, and do not reflect the views of the Vancouver Island Health Authority). 

As someone who works day-to-day addressing addiction and drug use, Alan is in a unique position to provide us with some insightful feedback on our social issue, drug policy, and our proposed solution. Addiction and drug use is a greater issue than treatment and prevention, it is about drug policy and how we deal with drugs overall; how we respond to this issue will affect addiction. Alan stated that this social issue is a ‘critical public policy issue’ an went further to say that ‘engaging the general public and providing clear information about addiction and substance abuse’ is vital. The hope is that this would ultimately result in a greater support for alternative and more effective approaches to dealing with the issue.

In our society at this time, we are facing an increase in drug use and there are views that we are ‘losing ground’ on drug availability, use, and addiction. Campbell stated his belief that the illegal drug industry has evolved more rapidly, with greater funding than the public policies that we have put in place to combat it. There is a sense of exasperation among people who work in the addiction community that they cannot alone tackle the problem and this creates a welcoming of alternative ideas from outside the community. 

The combination of feelings and evidence this presents a opportune time to step back from the issue, examine what is not working and look at what we can be doing differently to address this social issue. An open dialogue event such as the one we are proposing we hope would do just that. Addiction and drug use affects all areas of society and unfortunately, according to Campbell, not all groups affected are included in policy making. A discussion and generation of policy alternatives would have to include and represent everyone.

Campbell said the key issue that must be addressed is that most people do not understand what addiction is and what it is not- this is important to understand as it might allow people to address policy in a more effective way. In particular, I would argue this applies to policy makers at higher levels. They are often not exposed to the day-to-day consequences of addiction and drug use that communities are, however, policy makers often fall short of including these types of groups when designing policy. An event such as ours would need to present facts and evidence describing why exactly addiction is a problem and what impact it has on the various areas of society- a goal we would hope to achieve with our diverse panel of speakers.

Speaking about business students in particular, Campbell offered some reassurance that we do have something to contribute to the policy discussion and extended this to other groups outside the realm of addiction. Though we are fairly uninvolved and outside the addiction community, this may be an asset as we can see the issue from a different angle than someone surrounded by it. When you are do deeply involved in an issue, particularly addiction, you tend to become very passionate and your emotions can weigh in on the decision making process. Discussing addiction as outsiders and from more of an economical viewpoint as business student may provide some interesting ideas on alternatives; particularly in Vancouver where drug addiction is a visible issue. Campbell also went on to stress the importance of the commerce side of society to be informed and involved in social issues as it ultimately affects them as well.

Economic Drain

A discussion with Donald MacPherson, creator of Vancouver’s Four Pillar Drug Strategy to reduce drug related harm in the city. The approach is a coordinated, comprehensive approach that balances public order and public health in order to create a safer, healthier community. (Also see previous post)

Given Donald’s extensive experience with the issue of drug use, policy, and addressing addiction, speaking with him regarding our ideas was an excellent opportunity to receive valuable input. A really interesting point that Donald made was that cities have quite a unique opportunity to inform and shape drug policy from higher levels of government. Cities are experiencing the issue of addiction/drug use on a day-to-day level and and observing the consequences of use that federal policy makers do not observe. Unfortunately, drug policy development often does not include representation from municipal levels of government, which is a tragedy as they have much to offer.

Given this, change in opinion and the movement to reform drug policy must really come from cities and lower levels of government. Drug policy transformation must follow from changes in policy at the Federal level, which starts by transforming the way we look at drugs and addiction. Part of the resistance to abandoning prohibition is the stigma associated with users- whereby any policy that is compassionate is just feeding their addiction. According to Donald, society must first come out of denial about the extent of drug use in our city. Collaboration between all areas of society and levels of government is needed for policy transformation to become a reality, and its critical that users are included in policy development.

Speaking directly about the business community, the perspective of people in business toward drugs and addiction must change. Business people need to understand the economic and social costs associated with prohibition to understand that perhaps an alternative approach will be better socially and economically for all of society. Dialogue is needed between all facets of society for this to be realized. 

When I asked Donald what he felt was critical to include in an event such as the one we are proposing, he had some interesting suggestions. An inclusive dialogue between all areas of society that must include research people to inform the dialogue with a certain amount of scientific evidence. The dialogue itself should be just that, and not a debate as they tend to become largely ineffective for exploring alternative ideas. Exploration of a variety of perspectives would lead to a greater sharing and creativity overall.

SALOME, one more solution for drug addicts in Vancouver

I came across an article published in The Province July 8th, about InnerChange Foundation which is an organization that does research on exit strategies for drug addicts. They recently came up with a new solution following the recommendations of the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME). Opioid is a chemical that can be used to stabilize drug addicts and is seens as very promising in DTES. The research has the support of John Reynolds a former Conservative MP. This is a good news since the Tories have been well known for the their hardline position and policies against drug addiction, in particular against the successful InSite program. In the article, Mr. Reynolds is quoted as saying: “It is about time that we end the stigma around addiction and start thinking about this as treatable illness instead of a moral failing.” which is aligned with our own belief and summarize the main message of this blog.

The InnerChange Foundation brings a wind of change in the city by its very nature of researching new efficient and realistic solutions (therapies, drugs) that will help drug addicts to quit. This means they have an open mind and have to face unpopular and misunderstood programs in which they give away less damaging and less addictive drugs in the hope to facilitate quitting. We think the foundation is on the right way by looking at the problem for a different perspective while educating students directly at school. The new generation will most likely have a better understanding and hopefully be touched by the misery of the dozen of people living on DTES. Prejudices are already slowly shifting towards a desire from the citizens to help and try new bold strategies that have never been used before.

A diverse network of contacts.

A discussion with Ann Livingston, Executive board member of Vancouver Area Network of Drug Users (VANDU), a non-profit society funded by the Vancouver Coastal Health Authority as part of their harm reduction strategy. They are a group of users and former users who work to improve the lives of people who use illicit drugs through user-based peer support and education.

At first discussion of the aspects surrounding our event, Ann suggested that business and people involved in social issues is “a marriage long overdue”. There is often a misconception of pitting business and social work against each other, when if fact the collaboration of them may be an effective and worthwhile means of addressing social issues. Ann went as far to suggest that business has a fair amount to contribute to addressing social issues such as addiction and drugs. 

Ann described a push by libertarians for a free market approach to drugs and to deal with the associated affects including crime and addiction and suggested a common view that drug prohibition as a policy for drugs has to end. Despite this view, however, a shift away from drug prohibition policies is not happening due to a lack of collaboration. In order for a fundamental shift in drug policy to come about, it requires a collaboration between all parties affected- business, libertarians, students, politicians, research and drug professionals, addiction workers- to transform the way we look at drugs and create the momentum necessary for change.

When asked if VANDU would be an organization interested in being involved in such an event and providing users interested in being a part of the educational panel, Ann referred to the organization’s goals and beliefs. These include assisting in facilitation of open dialogue between users and other groups in the community in order to transform attitudes toward addiction and drug use and developing a diverse network of contacts for furthering the discussion on policy alternatives.

From VANDU’s website regarding the purpose of the organization: “VANDU’s primary objective is to increase capacity of people who use illicit drugs to live healthy and productive lives. The purposes of the society are to improve the quality of life for people who use illicit drugs, to develop local networks and coalitions of informed and empowered people who will work to ensure public policies and practices are favourable to people who use illicit drugs, to keep informed and to inform the public concerning the social, economic, health and treatment issues related to the use of illicit drugs.”

Its is reassuring to know that we have an organization with parallel goals to assist and guide us in accomplishing ours.

Broad Exposure

A discussion with Mark Haden, a supervisor at Vancouver Coastal Health, a published author on drug policy in Canadian and international journals, an advocate of the failure of drug prohibition, a public educator on drugs and drug policy, and a member of the Keeping the Door Open (KDO) coalition. 

Mark is an advocate of drug policy reform with a number of publications on policy alternatives, and as such was very interested in being involved in our event. He provided a great deal of resources to assist in policy and in organizing and facilitating discussion at a dialogue such as the one we are proposing. As a member of the KDO coalition, Mark participates in open dialogue on drug policy and other drug related issues in Vancouver, much like the event we are hoping to launch for students.

To begin with, Mark described our dialogue event as ‘fascinating challenge’, whereas developing drug policy alternatives is no easy task. However, Mark welcomed the idea of ‘thinking outside the box’ and utilizing a collaboration of people for discussing policy alternatives especially those who may not commonly be exposed to an issue such as a addiction. In order to have the creative and innovative discussion necessary, we must have a variety of individuals speak about this issue and expose participants to a variety of views. The idea of collaboration is essential to the development of such novel alternatives. 

In exposing participants to such a variety of views however, it was recommended that we steer the discussion away from a debate format. As Mark suggested, the debate format often quickly narrows the discussion to only those views and people will tend to be less creative. Using more of an open dialogue approach to looking at addiction and drug policy will allow for a broader range of thought; people will be much more creative and apt to explore the edges of what is possible in approaching this topic. It was also suggested that the discussion not focus on the failures of current or previous policies, but strictly on the creative aspect of developing an alternative method. Perhaps our event discussion can focus specifically on foundations of a new model for drug policy and the best approach for an alternative.

A really great suggestion for recognizing the views of the whole group of participants was to use an activity that asks all the participants specific questions on how a specific drug should be controlled for a variety of drugs. This engaging exercise would create a collective model and help promote discussion in the smaller group exercise involving the development of policy alternatives.

Staying Alive – Dr. Gabor Mate

Staying Alive – Dr. Gabor Mate | CBC News: the fifth estate

Gabor Mate has been the staff physician at Portland Hotel Society, a residence and harm reduction facility in the DTES, for the past ten years. He operates Onsite- a detox and addiction treatment center located with Insite, North America’s only legal, supervised safe injection site. He is also a best selling author of numerous publications on the social issue of addiction and advocating the transformation of drug policy.

The above video is a candid interview conducted with CBC’s Fifth Estate program in a segment called “Staying Alive”, showcasing Vancouver’s DTES neighborhood and raising awareness of the benefits of Insite. Mate begins by outlining what draws him to the troubled neighborhood stressing the large need that is present there. He sees a great deal of suffering and believes that the neighborhood is one where he can help the most and mitigate the suffering.

As seen in the video and his writings, he is an advocate of harm reduction drug policy. Mate describes it as not treating the disease or addiction directly, but reducing the harm caused by the habit to both the addict and the harms to society that arise due to the addiction. Although research regarding such approaches has showed positive benefits (see previous post), funding is not proportionally allocated to them. Mate argues this is a matter of ‘social priority’; money that is available goes predominantly to enforcement and other means that have shown to be largely ineffective. Harm reduction policies and programs may be better funded if public opinion and support were tilted toward it. 

Mate goes on to suggest this has been one of the success of Insite- public approval of the facility has gone up considerably since it opened among residents of Vancouver and business owners, and no political figure at the civic level opposes the facility. The altering of opinion towards Insite and harm reduction in Vancouver is a testament to the transformative power it has had among perception and in formulating drug policy as a result. He doesn’t describe Insite as a place for addicts to safely use drugs, but a place to ‘protect them from some of the worst effects of addiction”. This success is in addition to the improvements in the quality of life of addicts by reducing suffering through the use of such harm reduction programs. 

There is evidence and opinion to suggest that closing Insite, thereby increasing efforts toward enforcement and away from harm reduction, would result in negative consequences for addicts and the community. Mate claims of all studies completed regarding Insite’s benefits. they have all reported both health AND social benefits. Despite the ‘success’ claimed and benefits shown for harm reduction policies, such as the safe injection site, it remains as the only one in North America and funding continuing to be placed in what is called ‘ineffective’ policies. A solution to addiction and its negative residual effects on Vancouver community may require a radically different way of thinking among both policy makers at all levels and the general public.

Drug Distribution International (TSX: DDI)

The shift from traditional enforcement approaches to innovative approaches, or at least consideration of alternative approaches, seems to be gaining ground not only with U.S. administration but on a global scale.

Last week the United Nations released its annual World Drug Report which supported drug decriminalization as an approach to dealing with global drug issues- a reversal in opinion from previous years. It showed strong approval for public health rather than criminal enforcement strategies for for drug control and drug prohibition and control has only resulted in profits for gangs, cartels, and drug lords. It went further to say that controls on drugs have created a ‘black market’ of large proportions that utilizes violence and corruption.

The UN report has a heavy focus on Portugal, who in 2001 instituted a decriminalization of all drugs making them an administrative offense not a criminal offense. Although initial criticism of this decision was high, research emerging now shows that it had profound impact on drug issues. The report stated decriminalization has lead to a large reduction in drug overdose and HIV infection, has decreased drug use to the lowest in the European Union, and seen a 150 percent increase in the number of people entering addiction treatment along with a decrease in a number of other drug-related problems.

The fear over drug decriminalization appears to be that it would then become a legitimate economic enterprise. The opposing argument is that it already is economic with drug controls creating a lucrative black market for drug trafficking and distribution. The problem with this is that the large gains go into the hands of gangs and drug lords and it has been argued increase crime.

The current drug controls do little to address addiction directly, with little focus on treatment or assistance. Decriminalization may increase the amount of individuals entering treatment and decrease some of the adverse residual effects of drug abuse, as observed in Portugal. However, for this method to work there would need to be adequate measures in place to still control drugs and it would need to be in collaboration with a well structured addiction treatment program to be successful.

Celebrity Endorsement

The overwhelmingly traditional approach to drugs and drug use among policy makers and levels of government has been through enforcement means. This was especially evident over the last eight years with the Bush administration’s ‘War on Drugs’ which the current Obama administration has openly stated the approach has been a failure. This approach centers on curbing the illegal drug trade by decreasing supply and demand for such substances. It utilizes a set of laws and policies intended to discourage the production, distribution, and consumption of targeted substances.

The current administration’s Director of National Drug Policy, Gil Kerlikowske, stated in May that the War on Drugs would no longer be used to address drug issues as it is counter-productive and contrary to policy favoring treatment over incarceration for reducing drug use. A recent U.S. drug policy reversal in Afghanistan echoes these policy initiatives; the Obama administration has vowed to eliminate its poppy eradication program to combat the drug trade and focus on intercepting drugs and chemicals used to make them as well as going after drug lords.

President Obama and his National Drug administration also appears to making a similar shift in drug policy in the U.S itself- one that echoes the principles of drug policy here in Vancouver. Kerlikowske’s drug strategy shift from the war on drugs is Vancouver’s 4 pillars strategy exactly, according to an SFU criminologist, and recognizes that addiction is a disease and treating addicts as criminals has been largely ineffective at addressing drug issues. Kerlikowske stated himself:

“We have learned a great deal about the disease of drug addiction and know that treatment works. Through comprehensive and effective enforcement, education, prevention and treatment we will be successful in reducing illicit drug use and its devastating consequences.”

From a local perspective Vancouver currently makes use of both addiction treatment and alternative approaches to drugs and addiction, including Insite safe injection site and needle exchanges with its Four Pillar strategy. Dr. Evan Wood, editor of the Harm Reduction Journal and Director of the urban health program at BC Center for Excellence in HIV/AIDS, the body that conducts independent research on the effects and benefits of Insite in Vancouver, has spoken about the failure of prohibition and that drugs are not a simple law enforcement problem. Research has shown considerable benefits to Insite’s presence in the community, previously addressed in another post.

A successful, sustainable solution to drugs and addiction must approach the issue of addiction as a disease. This would stress treatment and health alternatives in place of enforcement and incarceration. Completely removing enforcement would likely provide adverse effects and there would likely be strong opposition. Dealing with the social issue of addiction requires an integrated approach- treating the addiction itself, combating the residual effects, controlling drug supply and demand, and enforcing those who are trafficking substances. Perhaps a better approach would be an integration of harm reduction, decriminalization, and control policies to have a single collaborative approach for addiction.

A pillar of the community

The City of Vancouver, Vancouver Coastal Health, and the Vancouver Police Department currently approach drug policy following Vancouver’s Four Pillars Drug Strategy defined as ’a coordinated, comprehensive approach that balances public order and public health in order to create a safer, healthier community’.

This not only includes policy makers and drug enforcement agencies, but the Four Pillars Coalition; a consortium including government, businesses, non-profit organizations, and advocacy groups to engage and collaborate in addressing the drug problem and related crime in this city.

PREVENTION: refers to strategies that aim to prevent the use of all addictive substances. The goals include reducing harm from substance abuse for all areas of the community, delaying first substance use, reduced rate of new cases and number of current cases of substance dependence, and improved health, safety, and order. To achieve these programs including public education, training and jobs, transition housing, accessible health care, and prevention efforts tailored specifically to Vancouver’s youth.

TREATMENT: includes interventions and support programs that target individuals with addiction problems to make healthier choices in their lives. The overall goal is to improve health by decreasing preventable deaths, disease, and injuries, and improving social integration. Also focuses on tailored treatment to individual needs as well as treatment targeting specific populations.

ENFORCEMENT: The VPD plays the greatest role in this particular pillar of the strategy, although, the organization has openly endorsed the Four Pillars Strategy overall. This pillar focuses on the need for peace, order, and safety. The VPD’s drug policy outlines a mission to reduce crime, fear of crime, and street disorder while protecting the vulnerable and preserving and protecting life.

HARM REDUCTION: The overall goal of the Four Pillars Strategy is harm reduction, which centers on the need to minimize harm to those suffering from substance addiction and focuses on the harm caused by problematic substance use, rather than substance use specifically. This is done by setting a strata of achievable goals that when met create incremental gains that lead to a healthier life for users and a healthier community overall. Vancouver’s harm reduction programs include the supervised injection site (SIS), needle exchanges and low-threshold community health services.

With the cooperative implementation of the Four Pillars Drug Strategy and the collaboration of the partners involved, the City of Vancouver, VPD, and Coastal Health all support and encourage a harm reduction model of approaching substance abuse. The strategy appears to also include an open attitude towards experimental treatment, innovative approaches, and harm reduction initiatives.

This is evident in the way the strategy engages all areas of the community including substance users and focuses on the harms to the community as a whole. The harm reduction model is visible through programs such as the safe injection site (Insite) openly supported by all involved in this strategy and other community groups, needle exchange programs, and participation in novel approaches to addiction treatment including the North American Opiate Medication Initiative (NAOMI).

The city is a proponent of a coordinated approach- including harm reduction with traditional enforcement methods. Addiction is not a single issue or at a single stage for all users. A novel solution that takes into consideration the varying degrees and stages of addiction as well as the varied responses of users will likely see the most success.