Vancouver, British Columbia, the beautiful 'lotus land' of Canada, is, unfortunately, threatened by the destructive forces of addiction. This disease has become of epidemic proportions, affecting all sectors, ethnicities, and socio-economic classes. While Vancouver is well known for its abundance, affluence, opportunity, beauty, and growth, there is an insidious spread of addiction that is devastating individual lives, families, cultures, and communities throughout the lower mainland and rest of BC. The drain on social services and health care providers and institutions is well known and documented.
Vancouver has put tremendous governmental and social service effort and resource into developing a plan to address this important and growing issue. The result of much effort and deliberation is what is known as Vancouver's Four Pillars Drug Strategy (1); referred to as a coordinated, comprehensive approach designed to balance public order and public health in order to create a safer, healthier community.
The four pillars approach to drug addiction (harm reduction, prevention, treatment and enforcement) is hoped to result in a reduction in the number of drug users consuming drugs on the street, a drop in overdose deaths and a reduction in the infection rates for HIV and hepatitis.
In 2000, former Vancouver Mayor Philip Owen released the "Framework for Action: A Four Pillar Approach to Vancouver's Drug Problems," which outlined this integrated approach as a way of addressing Vancouver's drug problem and open drug scene, particularly in the Downtown Eastside (1). In May 2001, the four pillars approach was adopted as policy by the City of Vancouver.
Earlier, the City of Vancouver had created what's now called the Four Pillars Coalition, made up of business, government, non-profit organizations and advocacy groups, to engage the community in addressing Vancouver's drug problem and drug-related crime. The Four Pillars Coalition now includes over 60 organizations dedicated to implementation of the strategy throughout the city.
In 2005, the City of Vancouver's Drug Policy Program released the drug policy prevention plan, Preventing Harm from Psychoactive Substance Use. In November 2005, Vancouver City Council unanimously endorsed it. The result of extensive research and diverse community consultations, the strategy, which is the first of its kind at the municipal level in Canada, is comprehensive, integrated and based on the best evidence and research available.
The Four Pillars Drug Strategy is the City of Vancouver's policy and plan for reducing drug-related harm in Vancouver. It represents the strategy, and now policy, by which government funded programs and treatment centers must abide by. All forms of chemical dependency treatment, drug rehab, alcoholism treatment, drug & alcohol rehabilitation, detox centers, drug withdrawal or detoxification programs, and drug maintenance harm reduction approaches are all funded, and thus directed by the strategy of this policy. The effort is admirable. The results are dismal.
On any given day, the Vancouver and British Columbia news media can be found to report some desperate reflection of the magnitude and nature of this growing drug and alcohol problem. Traditional, approaches to addiction treatment and prevention haven't been working. Excerpts from "Doors of St. Paul's are swinging ever faster" (Ethan Baron, The Province, February 5, 2009) characterize and exemplify the scope of the drug problem and the frustration of treatment providers working within the confines of the 'revolving door' traditional government institutional approaches.
A Home Away offers an alternative. A simple solution. No task forces. No government funding, strategy, or control. Not harm reduction; but rather life enhancing. Drug addiction is a disease; chronic, progressive, and ultimately fatal. Like cancer. We don't treat cancer by attempting to 'reduce harm', help the cancer victim 'live with cancer', call upon the law to police the distribution and consumption of carcinogens, such as nicotine products or the consumption of unhealthy foods. We treat persons with chronic, progressive, potentially fatal diseases with compassion, and the best therapies demonstrated through evidenced based medical models to be effective. This is what we've done at A Home Away. Simple. Loving. Compassionate. Respectful. Effective.
See our philosophy, services and programs to understand us more. See testimonials of what our guests say about their stays at A Home Away.
If you or a loved one from Vancouver, or any other city in British Columbia, rest of Canada or United States (US), are suffering from chemical dependency or other form of addiction, and are looking for 'drug rehab' or an 'addiction treatment center', you now have a choice. Seek help from a traditional, government funded (and controlled) facility, and get the same results that have been delivered and reported for decades, or try something new, promising, hopeful, and sensible. A Home Away offers that alternative. Call us today: 1-866-337-3324.
1. City of Vancouver, Four Pillars Drug Strategy, detailed at : www.vancouver.ca/fourpillars/
2. Ethan Baron; Doors of St. Paul's are swinging ever faster. The Province, February 5, 2009.
Promoting healthy families and communities, protecting child and youth development, preventing or delaying the start of substance use among young people and reducing harm associated with substance use. Successful prevention efforts aim to improve the health of the general population and reduce differences in health between groups of people.
(more info )
Prevention refers to strategies and interventions that help prevent harmful use of alcohol, tobacco and both illegal and prescription drugs.
In November 2005, Vancouver City Council unanimously endorsed the drug policy prevention plan, Preventing Harm from Psychoactive Substance Use. The result of extensive research and diverse community consultations, the plan makes 27 recommendations. The strategy, which is the first of its kind at the municipal level in Canada, is comprehensive, integrated and based on the best evidence and research available. It aims to expand awareness, understanding and discourse around prevention.
The plan seeks:
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 current cases at one time in a population) of problematic substance use and substance dependence; and
Improved public health, safety and order.
The 27 recommendations in the report map out a comprehensive strategy for reaching those goals. They call for public education, employment training and jobs, supportive and transitional housing and easily accessible healthcare. They also call for prevention efforts tailored to Vancouver's youth and its diverse ethno-cultural and Aboriginal communities. The recommendations address marijuana grow operations and methamphetamine labs, as well as the need for a syringe recovery system. The report calls for increasing limits on the sale of tobacco and a community partnership approach to the development and implementation of a comprehensive alcohol strategy. Finally, the report calls for legislative and regulatory changes to create a regulatory system for all currently illegal drugs that would increase our ability to control potentially harmful substances and limit the control that organized criminals have over these drugs.
The prevention of problematic substance use contributes to the public good by reducing costs to society as well as harm to individuals and communities. Important prevention goals include delaying the onset of substance use among youth and addressing the underlying causes of drug use. Prevention acknowledges that individuals usually make the best choices available to them, but that factors such as abuse, poverty or a history of addiction in the family may constrain those choices.
Of the four pillars, prevention requires the greatest amount of commitment and collaboration across all sectors of the community over a sustained period of time to show significant results. In the long-term though, prevention will have the greatest impact in reducing harm from substance use.
Treatment
Offering individuals access to services that help people come to terms with problem substance use and lead healthier lives, including outpatient and peer-based counseling, methadone programs, daytime and residential treatment, housing support and ongoing medical care. (more info)
The treatment pillar includes a range of interventions and support programs that encourage people with addiction problems to make healthier decisions about their lives.
Treatment improves health by decreasing preventable deaths, illnesses and injuries, while improving social integration. Early intervention is a crucial aspect of any treatment system. Treatment seeks to create a continuum of care by recognizing that different drug use patterns must guide treatment strategies. Since there is a chronic relapse pattern with addictions treatment, abstinence is not always the only measure of success. Treatment interventions must also respond to multiple individual needs as well as particular needs of specific populations.
Treatment services, delivered by Vancouver Coastal health, include core services at community health centres, withdrawal management and residential and non-residential services. Currently, there are four levels within withdrawal management ranging from home detox to medical detox. Treatment is most effective when it considers factors unique to each individual and tailors treatment accordingly. Addiction services have been decentralized in Vancouver, with the goals of decreasing acute care demand and improving treatment completion rates.
Currently in Vancouver, alcohol dependence affects over 12,000 people and injection drugs over 9,000 people. Treatment makes sense on both humanitarian as well as economic grounds. According to the March, 2006 Canadian Centre on Substance Abuse report, The Costs of Substance Abuse in Canada 2002, the overall social cost of substance (tobacco, alcohol and illegal drug) abuse in Canada in 2002 was $39.8 billion.
Methadone treatment and counselling has been an area of significant growth in the treatment of heroin addiction in the province. The number of people in BC treated with methadone was 8,319 at the end of 2006.
Vancouver is also one of three Canadian cities that participated in the North American Opiate Medication Initiative (NAOMI). Supported by the City of Vancouver, the study seeks to determine whether prescription heroin, or a combination of heroin and methadone, might be a better treatment for those who do not respond to methadone alone. Enrolment started in February 2005 and the study results are expected in the summer of 2008.
Meanwhile, Vancouver Coastal Health has increased its treatment budget by about $2 million per year, over the past five years, adding new addiction services, an increased number of detox beds and the development of addiction housing.
Harm Reduction
Reducing the spread of deadly communicable diseases, preventing drug overdose deaths, increasing substance users' contact with health care services and drug treatment programs and reducing consumption of drugs in the street. (more info)
The goal of the Four Pillars Drug Strategy is to reduce harm to individuals and communities from the sale and use of both legal and illegal substances. The principles of harm reduction require that we do no harm to those suffering from substance addiction and that we focus on the harm caused by problematic substance use, rather than substance use per se.
Harm reduction involves establishing a hierarchy of achievable goals which, when taken step by step, can lead to a healthier life for drug users and a healthier community for everyone. It accepts that abstinence may not be a realistic goal for some drug users, particularly in the short term. Harm reduction involves an achievable, pragmatic approach to drug issues.
A 2002 International Narcotics Control Board (INCB) legal opinion on harm reduction approaches noted that the concept of harm reduction had only emerged in the previous decade but aspects of the existing international drug control treaties addressed harm reduction issues. It pointed to a provision in the 1988 Convention: "Demand reduction policies shall: (i) Aim at preventing the use of drugs and at reducing the adverse consequences of drug abuse." The legal opinion said it could be argued that this provision provides a mandate for harm reduction.
Harm reduction interventions have proven successful in decreasing the open drug scene, the spread of HIV/AIDS and hepatitis, overdoses and overdose deaths in countries such as Germany, Switzerland and Australia.
Vancouver's harm reduction programs include the supervised injection site (SIS), needle exchanges and low-threshold community health services. Vancouver has 24-hour-a-day access to needles through low-threshold, peer-based needle exchanges, to mobile exchanges and needle exchanges attached to primary health care services.
North America's first Supervised Injection Site (SIS), InSite, opened in Vancouver in September 2003. The scientific pilot project, operated by Vancouver Coastal Health, will provide a comprehensive assessment of the numbers of people using the site, community impacts and health outcomes. InSite operates under a Health Canada drug law exemption, which expires in June 2008.
The SIS provides:
Supervision of injections, including emergency response to drug overdoses;
Injection-related first aid (such as wound and abscess care);
Assessment and referral to primary health care and service providers;
Harm reduction teaching and counselling;
Access to condoms, needles and other injecting equipment.
To date, researchers have tracked a 30-per-cent increase in detox enrolments among SIS users and noted reduced overall rates of needle sharing in the community, the number of people injecting in public and the amount of injection-related litter in Vancouver's Downtown Eastside.
Enforcement
Recognizing the need for peace and quiet, public order and safety in the Downtown Eastside and other Vancouver neighbourhoods by targeting organized crime, drug dealing, drug houses, problem businesses involved in the drug trade, and improving coordination with health services and other agencies that link drug users to withdrawal management (detox), treatment, counseling and prevention services. (more info)
The enforcement pillar of Vancouver's four pillars strategy recognizes the need for peace, public order and safety in the Downtown Eastside and other Vancouver neighbourhoods. History tells us, however, that policing alone is not a solution to Vancouver's drug problem and that an integrated approach including prevention, treatment, harm reduction and policing has proven to be effective. The Vancouver Police Department (VPD) has formally endorsed the four pillars strategy and its principles.
In 2006, the VPD published its drug policy. It says that the VPD's mission, as related to drug policy, is to reduce crime, fear of crime, and street disorder while protecting the vulnerable and preserving and protecting life.
The VPD drug policy sees prevention as the most important of the four pillars, but said there is concern that a lack of resources dedicated to this pillar does not allow for large-scale prevention programs. Success in this pillar, it says, would reduce needs in the other three.
The policy says that the VPD will continue to target street and middle-level drug traffickers and producers. Police will be guided by an individual's behaviour in determining whether or not to lay drug or alcohol possession charges. Police will also target areas frequented by children, such as schools and parks, and other areas where possession or use of drugs could interfere with lawful use of the public areas by members of the community.
The VPD supports the Supervised Injection Site, located on East Hastings Street. It also supports the North American Opiate Medication Initiative, a clinical trial testing whether medically prescribed heroin can successfully attract and retain heroin users who have not benefited from previous repeated attempts at methadone maintenance and abstinence programs. It also supports accessible and immediate treatment for substance abuse on demand, for both adults and youth.
Police officers will continue to work to improve coordination with health services and other agencies that link drug users to immediate medical care, withdrawal management (detox), treatment and other counseling and prevention services. Vancouver police efforts are complemented by Drug Treatment Courts. These provide an alternative to incarceration for non-violent offenders addicted to heroin, cocaine or opiates, to follow treatments such as methadone maintenance.
Excerpts from "Doors of St. Paul's are swinging ever faster". Ethan Baron, The Province, February 5, 2009 (2):
- This is where the swollen tide of human misery from Vancouver's Downtown Eastside washes up, casting ashore its thousands from a sea of drugs...
- They are poisoned by drugs, by alcohol, by bacterial infections. They suffer grievous maladies of the mind, and fatal illnesses of the body...
- And every year, more of them are ending up here, at St. Paul's Hospital emergency room, taking more resources from our overburdened health-care system...
- In 2002, 9,523 homeless people and Downtown Eastside residents came through this ER's doors. Last year, the number was 16,483...
- Drug addiction and mental illness form the heart of the darkness in the Downtown Eastside. But there's a story behind every wasted, drug-destroyed face...
- ...and dealers of crack, heroin and crystal meth coming from outside the community to hunt the streets and alleys, the troubled zone is no place for the vulnerable...
- On the monthly Welfare Wednesday, when the provincial government shovels out taxpayers' money to thousands of people with addictions drug dealers swarm outside cheque-cashing shops...
- For those wanting to get into drug treatment, or detox, the demand far exceeds the supply...
St. Paul's provides world-class treatment across the social spectrum, and could devote more time and money to other areas of health care if it didn't have to spend 20 per cent of its ER resources trying to fix the people thrown through its doors by the Downtown Eastside's perpetual-misery machine.
Non-Institutional Rehab that Works. Turns Addictions into Assets.
