The Problem

Downtown Vancouver, in particular the area known as the Downtown Eastside (DTES), has become known for its large open drug scene, unsafe conditions for survival sex trade workers, violence, poor health outcomes and one of the most explosive HIV epidemics in North America. Despite decades of concerted interventions on the part of both the public and the private sector, people who live in, work in or visit this area remain at significant risk from both a health and a public order perspective.

Public illegal drug use, in particular the use of cocaine, is rampant; sex work remains visible and unsafe; addiction services are inadequate, poverty and homelessness are common - in fact, the rate of homelessness in the DTES has doubled in the past 5 years; and the HIV and HCV epidemics continue to grow. The average life expectancy for a man living in the downtown eastside is approximately 20 years less than in most other neighbourhoods in the city.

The illicit drug problem and the accompanying crime and public disorder caused by the drug problem are the greatest threats to livability in Vancouver. Most recent epidemiological data suggest that approximately 33,000 British Columbians have a dependence upon illicit drugs; 1 rates of illegal drug use, drug-related mortality, and drug-related pregnancy and childbirth complications are all higher in BC than in the other provinces.2 Illegal drugs seized in BC have the highest average potency in North America. In Greater Vancouver alone in 2005 there were over 140,000 property crimes reported to police - more than any other centre in Canada. Although the overall crime rate in BC has decreased over the past decade, drug offences have increased by 63%.3

The Downtown Eastside (DTES) of Vancouver is the oldest neighborhood in Vancouver, bearing the dubious distinction of being Canada's poorest postal code. Once the thriving centre of turn of the century Vancouver, the city's original City Hall, courthouse and first public library are all located here.

Today, pockmarked heritage buildings and unsafe streets and alleys have become a transitional home for thousands, and the homeless population continues to rise. During the last official homelessness count in Greater Vancouver in March 2005, officials estimated that the total number of homeless had doubled to 2000 in just three years. As reported in the Vancouver Sun on Monday January 29 2007, outreach workers in Vancouver's suburbs estimate the real number of homeless people in their communities in four to five times higher than the more than 2,000 found living in shelters and sleeping outdoors.4

The streets of the DTES are also walked by many of Vancouver's sex workers, many of who are also drug addicts. As reported by the CBC, more than 60 women, many of them sex workers and drug addicts, have disappeared from the DTES in the past decade.

Vancouver surely faces one of its most pressing health and public order challenges in its history. Today the DTES maintains the highest HIV infection rate in North America, affecting as many as 30 per cent of the local population, mainly women; many of them also suffer from Hepatitis C. Public drug use, in particular of cocaine - long recognized as an important driver of the HIV epidemic - is rampant. The high prevalence of crack cocaine and methamphetamine use are well known risk factors for sexual transmission of HIV; addiction to crack cocaine and/or methamphetamine is associated with heightened violence, crime, and public disorder.

Currently, the focus of medical practitioners is on the health of their patients; except in situations of institutionalization, the goals of public order and civil behaviour are not presently accepted as a legitimate cause for therapeutic intervention by medical practitioners. However, in many instances addicted people, because of their multi-diagnosis (HIV/AIDS, hepatitis C, mental illness, FAE/FAS, ADHD, lack of adequate nutrition and housing etc.) can be medically described as "walking palliative" - people who, if they were living a more "normal" Canadian life, would have access to pain and other medications in order to mitigate their health issues and so as not to spread infectious diseases.

We know maintenance works to reduce crime. We know that by removing the need for addicted people to purchase illegal drugs we are reducing the profits of organized crime.

Vancouver citizens are convinced that the problems associated with drug use are getting worse.

Footnotes

  1. Statistics Canada. (2004). Mental Health and Well-being profile, Canadian Mental Health Survey (CCHS), by age group and sex, Canada and provinces, occasional, 2002. Ottawa: Statistics Canada. Available online at: cansim2.statcan.ca
  2. Canadian Centre on Substance Abuse. (1999) Canadian Profile 1999 Survey. Ottawa: Canadian Centre on Substance Abuse
  3. Vancouver Drug Use Epidemiology July 2003, Prepared by Jane Buxton MBBS MHSc FRCPC CCENDU - Vancouver Site Representative www.drugabuse.gov downloaded December 13, 2006
  4. Randy Shore, GVRD homeless count too low, The Vancouver Sun, January 29, 2007, page A1


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