Mayor's new harm-reduction study to debut in fall

Sullivan hopes the strategy will reduce crime, aid those living with addiction

The health and humanitarian crises that have come about as a result of Vancouver's high rates of illicit drug use are truly disturbing. Among the resident population of those living in the Downtown Eastside (DTES), for example, the rate of HIV/AIDS is the highest in North America, and the average life expectancy in the DTES is the lowest in Vancouver.

Correspondingly, harm-reduction programs have arisen as part of Vancouver's Four Pillars strategy - which also includes prevention, enforcement, and treatment - to address addiction in Vancouver. These include several needle exchanges to reduce the incidence of infections from needle-sharing and re-use, such as the mobile needle exchange run by the Vancouver Area Network of Drug Users, a 24-hour needle exchange, and the exchanges that run through all Vancouver's community health clinics. Also currently underway is the North American Opiate Medication Initiative (NAOMI), a research project testing the therapeutic benefits of prescription heroin for addicts with opiate addictions who haven't had sucess with other treatments, such as methadone therapy.

When Vancouver Coastal Health and the Portland Hotel Society opened Insite, Vancouver became the first city in North America to operate a facility where drug users could inject under the supervision of nurses, and make contact with health care providers and addiction counsellors. Thousands of people have used Insite, and nurses have intervened in hundreds of overdoses that occurred at the facility where, importantly, no one has died. Despite these successes, the Federal government remains silent over whether or not they will allow Insite to remain open past 2007. But a new harm reduction program, Chronic Addiction Substitution Treatment (CAST), is in the works for a more comprehensive approach to treating drug addiction.

"Health Canada hasn't yet seen a proposal for a poly-drug study, so it would be breaking new ground," says David Holtzman, who sits on CAST's board of directors.

CAST would see people living with dependencies on one or more drugs, such as cocaine, crack, heroin, and crystal meth, prescribed substitution treatment for their addictions. Substitution treatment entails prescribing legal drugs in the place of illicit ones. CAST would be the first study of its kind in Canada. The study is hoping to attract 700 people, with what Holtzman is calling "a two-pronged approach" of public health and public order.

Survival sex trade workers, people dealing with other health problems in addition to their addictions, and chronic drug-related offenders would be the study's prime targets. Health Canada must approve CAST, because although legal drugs would be prescribed, the medications would be used at different indications.

Then, there's the issue of funding. Holtzman says it will cost somewhere between $500,000 and $1,000, 000 to run the study, depending on its size.

Dr. Don Rix, one of the founders of Metro Laboratories, and a Director of the Vancouver Board of Trade - a lobby group which has long complained that drug addiction underlies most property crime in Vancouver - provided the Inner Change Society with $50,000 to kickstart CAST. "Because it's research and because it's a community initiative we need to do our own funding. We may get some money from Health Canada, we may get some money from the provincial government, but we're not counting on anything," says Holtzman.

"The most common crimes in Vancouver... are done by addicts who are supporting an expensive habit. The cost of not doing it is much more expensive than the cost of doing it, " says Holtzman. According to the City of Vancouver, cocaine accounts for haas the recently shutdown Picadilly Hot el, "however crappy it is, is dissapearing, so that means that people will be displaced, and they really will have nowhere to go." The Greater Vancouver Homeless Count found that between 2002 and 2005, homelessness almost doubled from 1,121 to 2,174 persons. Addiction was the most common health issue among the homeless, with almost half of the those surveyed reporting it as a problem in their lives.

This spring's federal budget says nothing about the relief of homelessness, nor anything under it's health care portion about treating drug addiction.

However, the provincial government announced in early April that they would be buying 11 hotels that provide low-income housing.

This housing stock accounts for about 20% of this kind of housing in the DTES. Despite Project Civil City's goals, homeless participants in the CAST program will not be guaranteed housing as soon as they receive substitution therapy. Says David Eby, a lawyer with the Pivot Legal Society, "While Mayor Sullivan's proposal for the CAST proposal is a good one. if you want someone to stabilize their lives, the first thing you need to do is get them into safe secure housing. And the second thing you need to do is look after the addiction... Neither [drug addiction nor homelessness] are technically within the municipal jurisdiction. That's been [Mayor Sullivan's] argument for not getting involved in housing, that it's a provincial responsibility. Well, drugs have always been a federal responsibility. So if we're going toget involved in one we need to get involved in the other." But David Holtzman maintains the program will to make homeless people more "houseable" by stabilizing their addictions first.

CAST will launch as early as September 2007.