Vancouver Drug Program Raises Controversy

It's Welfare Wednesday in VANCOUVER's grim downtown eastside. Ben, a 32-year-old chronic drug user from Hawaii selling rock cocaine near the intersection of Hastings and Main, is beaming. Just west of him, Hastings street is buzzing with activity.

Vancouver Drug Program Raises Controversy

It's Welfare Wednesday in VANCOUVER's grim downtown eastside. Ben, a 32-year-old chronic drug user from Hawaii selling rock cocaine near the intersection of Hastings and Main, is beaming. Just west of him, Hastings street is buzzing with activity. Forty per cent of the 12,000 residents of the dysfunctional tract rely on the welfare cheques issued on the last Wednesday of the month. For a day, Ben says, everyone has a smile, and a cigarette. Downtown eastsiders call it Mardi Gras.

Canada's Olympic city stretches over 144 square km. But Vancouver's previous two mayors have made and broken their careers in these 10 blocks, where an estimated 5,000 people inject or inhale drugs daily. Now, with the Games just 2½ years away and readiness plans already in the works, it's time for Mayor Sam Sullivan, midway through his three-year mandate, to show whether he's smarter, or luckier, than his predecessors.

The heat is on Sullivan in a way it wasn't with Larry Campbell or Philip Owen. In February 2010, 5,000 athletes and 10,000 media representatives will flood the province for the Winter Games, putting the city under the microscope, warts and all. Some worry the blighted neighbourhood, with its sickness, ghoulish alleys and open drug market - all a 10-minute walk from the downtown core and within sight of Gastown, the tourist area - risks knocking the bloom off Vancouver, routinely crowned the world's most livable city.

But a pre-Olympic cleanup means getting the people who live here off street drugs. Vancouver has a history of tackling the problem with controversial drug strategies. The city's historic core is already home to free needle exchanges, methadone maintenance programs, a safe injection site and a trial program treating opiate addicts with prescription heroin. Come fall, the vanguard city hopes to try again, with an experimental project called the Chronic Addiction Substitution Treatment.

CAST will use legally prescribed medicines, from Ritalin to OxyContin, to help chronic drug users kick addiction to heroin, cocaine and methamphetamines. The research trial has a tentative $10-million price tag, and could treat 1,000 addicts over three years, making it the largest of its kind in the world, by far. Priority will be given to the city's 800 chronic and "super chronic" offenders, some of whom commit 15 crimes a day to fund their addictions. Sullivan's chief goal is significantly reducing crime and disorder by 2010.

Unlike Insite, Vancouver's safe injection site, or the North American Opiate Medication Initiative, which gives free heroin to street users, CAST will not require an exemption from the federal government, since doctors will be giving away legal drugs, says the provincial health officer, Perry Kendall. But Health Canada will have to approve the off-label use of medicines like Dilaudid, normally used to treat chronic pain. Should CAST be approved, the trials could start in the fall. "Substitution offers an option out," says Kendall. "We substitute a slow-acting amphetamine to replace crystal meth, or cocaine. We keep the receptors busy, and the blood levels high enough, so they don't get peaks and dips, or feel the effect of withdrawal."

Donald MacPherson, drug policy co-ordinator for the City of Vancouver - the only such point man for a Canadian city - says the idea for CAST was the mayor's. Like Campbell, who set up Canada's first supervised injection site in 2003 and Owen, who took a compassionate view of addiction in 2001, Sullivan, 47, favours a progressive approach. He also knows CAST's success depends on erecting a big tent. He's drawn the support of high-profile Tory strategist and ex-MP John Reynolds and former NDP MLA Joy MacPhail. He has the backing of non-profits like the Pivot Legal Society and medical bigwigs like Dr. John Blatherwick, chief medical health officer for the city. He recalls Owen - who was mayor when crack cocaine first appeared in the downtown eastside leading to an explosion in the addict population - being forced from office for his unpopular stance. Sullivan is prepared to stick his neck out for CAST.

"That takes cojones," says Eugene Oscapella, an Ottawa lawyer and founder of the Canadian Foundation for Drug Policy. For Sullivan, a quadriplegic, the more appropriate word is "experience." At 19, Sullivan broke his neck trying to ski through a friend's outstretched legs at Cypress Mountain on Vancouver's North Shore. To him, forcing an addict to go cold turkey is like forcing a quadriplegic to walk; they need help managing their "disability," the same way he learned to manage his. "After I broke my neck, my family and friends did not want me to use a wheelchair. They wanted me to be healed, to try harder. I used to sit - for hours - trying to move my toes. People were saying: 'Okay, up down, move them.' There was a sense that the reason that I was not able to move was a lack of willpower." Of course I wanted to walk, Sullivan says, his Celtic eyes narrowing, "but abstinence was not a viable option for me."

It took seven years and hitting rock bottom for Sullivan to beat his demons. At 26 he was, by his description, a quad on welfare. He'd chased off most of his friends. Living in social housing, alone one night, he considered shooting himself - imagined his "blood and brains dripping down the wall." He credits that moment with jolting him from his depression. He earned a business degree from Simon Fraser University and started six disability-focused foundations. He knows people see him as a poster boy for the welfare system, and says they are shocked to hear he is not "some left-wing whiner." In 1993, he was elected to Vancouver city council as a member of the conservative, pro-business Non-Partisan Association, a seat he held until 2005, when he knocked off Campbell's chosen successor, downtown activist Jim Green, to become mayor.

For some, however, the mayor has a little too much experience with the drug file. Controversy erupted during the 2005 municipal election when Sullivan confirmed a long-standing rumour that, as a sitting councillor, he bought crack for a young addict and watched as it was consumed in his van. Sullivan says he was trying to understand addiction. Political opponents and local media loudly debated the recklessness - and legality - of his actions.

The mayor's judgment on addiction is again being called into question with CAST, which has irked some law-enforcement advocates. To Al Arsenault, a retired Vancouver police constable who walked the downtown eastside beat, Sullivan's comparison between addicts and quadriplegics - who, barring a medical breakthrough will never walk again - is offensive, and speaks volumes about Sullivan's philosophy about drug policy: "At the very core of his beliefs is this idea that addiction is not treatable. He is saying, 'Why bother? Addicts have no hope of beating addiction.' "

Sullivan's plan has also left some in the addictions field scratching their heads. They say the 1,000-strong clinical trial is too ambitious and the science behind it weak; they foresee problems treating drug addicts with "high abuse risk" medications like Dexedrine, Dilaudid - which is twice to eight times stronger than morphine - and OxyContin, the highly addictive pain medication also known as hillbilly heroin. Under CAST, users will not be supervised (as with methadone), opening the door to abuse, say critics.

"What are we going to do when addicts start developing increasing tolerance to dextroamphetamines? What happens when we can no longer treat for euphoria?" says Dr. Donald Hedges, one of Canada's leading experts in addictions medicine. "CAST uses six studies to support their case, stemming from short-term clinical trials in the U.S. and Australia, yet the majority report 'no positive findings.' " Another heavyweight, Dr. Robert Newman of Manhattan's International Center for the Advancement of Addiction Treatment, a medical maverick dubbed the Methadone Pope for his 35-year advocacy of the heroin replacement, says CAST is "lacking in seriousness," and not geared to the medical well-being of the patient.

"The physician's ethical, moral and legal obligation is first and foremost to the patient," says Newman. "The outcome should not be irrational, politically-motivated goals like cutting crime in Vancouver by 50 per cent. That's a totally inappropriate objective. And - by the way - there's no way Ritalin will achieve that on 700 patients." Methadone, he says, has been proven effective, unlike CAST's "untried and untested" approach. All other efforts should be kept on a very small scale.

In the end, all the arguments over the downtown eastside's intractable drug problem may be moot. The city core has run out of room. After years of oversight, Vancouver developers are drooling over the downtown eyesore and its 125 undervalued, century-old flop houses. Frenzied pre-Olympic redevelopment is driving up land values and rents in the neighbourhood, threatening to displace thousands of low-income residents - which may push the drug problem out of sight.

See alsoDRUG USE, NON MEDICAL.

Maclean's August 6, 2007