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International Journal of Drug Policy 17 (2006) 127132

Policy Analysis

The evolution of drug policy in Vancouver, Canada: Strategies


for preventing harm from psychoactive substance use
Donald MacPherson , Zarina Mulla, Lindsey Richardson
Community services, City of Vancouver, 453 West 12th Avenue, Vancouver, BC, Canada V5Y 1V4

Received 6 October 2005; received in revised form 13 October 2005; accepted 16 October 2005

Abstract

In December of 2000, the City of Vancouver released its Four Pillars Drug Strategy in response to a serious public health crisis driven by illicit
drug use in Vancouver. Following initial actions in the area of harm reduction and enforcement, in June 2005 the City of Vancouver developed
its draft prevention plan titled Preventing Harm from Psychoactive Substance Use. The plan is based on a synthesis of international research
and evaluation, examples of successful programs from other jurisdictions, and a community dialogue process. Its recommendations fall under
five key prevention priorities, including reducing risk factors and increasing protective factors across the life course, community centred
interventions, addressing impacts on communities, legislative and public policy change and regulated markets. Together, these prevention
priorities form an integrated plan to prevent harm from substance use. This article provides a description of the process leading to the
development of the plan and seeks to articulate its key strategies.
2006 Published by Elsevier B.V.

Keywords: Prevention; Policy; Drugs; Cities

Introduction conditions for an HIV epidemic among injection drug users


were developing, the drug trade was overrunning a commu-
Vancouver has always been home to a large proportion of nity and no one in authority and few in the community really
the heroin users in Canada and the Downtown Eastside has a understood what was occurring. A public health disaster was
history of having a significant heroin-using population. How- beginning to take place.
ever, in terms of drug-related harm, the drug that historically In 1993 the Chief Coroner of British Columbia, Vince
was the primary cause of drug-related harm in the community Cain, announced a special task force to look into the rash
was alcohol. However, something changed during the latter of overdose deaths. The report he produced after months
part of the 1980s. There was a significant shift in the market- of public consultations was a hard hitting and comprehen-
ing and use of heroin and cocaine in the Vancouver region sive analysis of a broken system (Cain, 1994). He called for
and throughout the Province of British Columbia (BC). By strong action to address the flaws that he saw in our approach
1990, the Downtown Eastside was home to one of the fastest to addiction to illegal drugs. He called for society to view
growing open-air drug markets in Canada, an infrastructure of addiction as a health issue to be addressed by health care
illegitimate businesses to support this market, and the epicen- interventions.
tre of an epidemic of property crime. In 1993 there were 200 Cain called for a total overhaul of the drug treatment sys-
overdose deaths in Vancouver and close to 400 in the Province tem and the fashion in which the criminal justice system
of British Columbia. Highly potent heroin appeared on the addressed addicted individuals. He also suggested that the
market as well as cheap powder cocaine. Something had gone criminalisation of these substances contributed significantly
seriously wrong and people were dying in great numbers. The to the harm that we were seeing in our communities and posed
the question, Should we consider decriminalisation or legal-
Corresponding author. Tel.: +1 604 871 6040. isation for some, if not all of illegal substances? There was
E-mail address: donald.macpherson@vancouver.ca (D. MacPherson). no doubt in Cains analysis: the status quo was not working

0955-3959/$ see front matter 2006 Published by Elsevier B.V.


doi:10.1016/j.drugpo.2005.10.006
128 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132

and urgent action was required to fix it. Unfortunately little addiction should be treated as a health issue and that actions
action came as a result of the Cain Report. The paper gath- across the four pillars of Prevention, Treatment, Harm Reduc-
ered dust on the shelves of government while the drama in the tion and Enforcement be implemented to reduce the negative
inner City of Vancouver played out with devastating results impact of the sale and use of illegal drugs on individuals
throughout the decade 19902000. and the community. The strategy was inclusive of health and
enforcement and had a main goal of public health and pub-
lic order. The Citys proposed drug strategy was a catalyst
A Four Pillar Approach for a broad public discussion that took place over the win-
ter of 2001 culminating in the adoption by Vancouver City
In December of 2000, the Mayor of Vancouver, Philip Council of the Four Pillars Drug Strategy in May 2001. Most
Owen, released the Citys drug strategy: A Framework for importantly though, the development of the drug strategy,
Action: A Four Pillar Approach to Drug Problems in Van- lead by then Mayor Philip Owen, brought the issue of addic-
couver (MacPherson, 2000). The release of the Four Pillars tion into the political arena. The drug strategy became part
Drug Strategy was the municipal contribution to efforts that of a political process that saw civic politicians appealing to
were being mounted by the local health authority, the Vancou- other levels of government to work together with the city to
ver Police and the provincial and federal governments and the fund and implement the plan. The civic election of 2002 saw
community to respond to a serious public health crisis in Van- a new mayor, Larry Campbell sweep to victory promising
couver. The strategy articulated a comprehensive approach to to implement the Four Pillars Drug Strategy and open North
addressing the dire circumstances existing in Vancouver and Americas first supervised injection site as soon as possible
challenged the status quo by calling for new and innovative after being elected.
interventions such as supervised injection sites and heroin The initial emphasis of the Four Pillars Drug Strategy was
assisted treatment programmes where heroin users receive a call to action across all four pillars to reduce the drug-
pharmaceutical grade heroin. The strategy stated clearly that related harm occurring in Vancouver at the time. It focused

Fig. 1. Preventing Harm from Psychoactive Substance Use: prevention priorities, areas of action and recommendations.
D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132 129

on harm reduction initiatives such as supervised injection for collaboration among prevention practicing individuals
sites in the Downtown Eastside, a call for the expansion of and organisations, and the establishment of monitoring and
addiction treatment interventions and the development of a evaluation bodies. The creation of a sustainable prevention
policing strategy to disrupt the open-air drug market. During infrastructure within the Vancouver region is central to, and
the initial phases of the work, there was little emphasis on pre- the first step towards, the implementation of effective preven-
vention efforts or much analysis of what prevention activities tion initiatives.
were taking place in Vancouver. Prevention of problematic The plans other recommendations fall under five key pre-
drug use was seen as a longer-term proposition and an area vention priorities. These priorities are: reducing risk factors
that was not well understood by the general public. Simplis- and increasing protective factors across the life course, com-
tic notions of prevention dominated the public discourse. As munity centred interventions, addressing impacts on com-
part of the Four Pillars Drug Strategy, staff began developing munities, legislative and public policy change and regulated
a prevention plan in the fall of 2003, holding a symposium markets. Taken together, these prevention priorities form an
that initiated a dialogue on prevention of problematic drug integrated plan to prevent harm from substance use.
use in Vancouver and considered the best evidence of what
works in the field of prevention. In June of 2005, the City of Risk and protection across the life course
Vancouver released a draft plan: Preventing Harm from Psy-
choactive Substance Use (MacPherson, Mulla, Richardson, This prevention priority focuses on risk factors for harmful
& Beer, 2005). The plan was adopted unanimously by Van- substance use and protective factors that mediate individ-
couver City Council on 3 November 2005. This article will ual risk across ones lifetime and at key transition points.
articulate the key strategies of this prevention plan (Fig. 1). It identifies strategies that prevent harm from use through
mutually reinforcing change at the individual, family and
community levels. These strategies, which include support
The prevention pillar for non-use and safer substance use, target both the general
population and specific groups at increased risk of harm. Rec-
The prevention planPreventing Harm from Psychoac- ommendations reflect this, and include calls for support for
tive Substance Useis based on a synthesis of international the best early childhood care and learning programs for fami-
research and evaluation, examples of successful programmes lies, engaging young people in meaningful activities, creating
from other jurisdictions, and a community dialogue process. healthy school environments and educating parents and fam-
Fifty dialogue sessions were conducted with various stake- ilies. Prevention initiatives can also be directed throughout
holder communities, representing different life stages, sexual adulthood as individuals move through life transitions. A rec-
orientations, ethnicities, vulnerable populations and service ommendation to develop a strategy for older adults who are
providers. These sessions provided valuable input about the particularly vulnerable to problems from alcohol and phar-
issues, obstacles and visions specific to each of these commu- maceutical drug use is included. In addition, targeted social
nities, and their input has been incorporated into the content marketing and mass media campaigns, combined with a local
of the plan. media advocacy strategy will increase public understanding
The plan draws on a number of perspectives on and bring these issues to the fore.
preventionranging from population health models to
community-based, legal and regulatory approachesand Community-centred prevention
recommends strategies that have shown the strongest evi-
dence for success. The plan acknowledges that the use of This prevention priority focuses on the community as the
psychoactive substances is a part of our society and that the primary site of intervention. Community centred interven-
desire to alter consciousness with psychoactive substances is tions attempt to build capacity for individuals and organisa-
natural. The plan recognizes that drug use can occur across a tions to engage at the local level in developing prevention ini-
spectrum of use from beneficial or therapeutic uses to recre- tiatives. It acknowledges that harmful drug use is influenced
ational uses moving into problematic drug use. The plan is by broad social determinants of health. The recommendations
predominantly concerned with problematic and dependent in this priority call for assistance to vulnerable populations
substance use, or use that has clear harmful effects on individ- through employment and housing supports as well as meth-
uals and society, and seeks to expand awareness, understand- ods to strengthen community capacity through information
ing and discourse around prevention. The intended outcomes sharing, networks, coalitions and the development of a sus-
for this plan include reduced individual, family, neighbour- tainable youth engagement strategy.
hood and community harm from substance use, delayed onset
of first substance use, reduced incidence and prevalence Addressing impacts on communities
of problematic substance use, and improved public health,
safety and order. The plan identifies significant gaps in local This prevention priority focuses on addressing the
prevention capacity, and recommends institutional support impacts from problematic and dependent substance use on
for municipal research and programme delivery, mechanisms the community. It is based on the need to keep community
130 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132

neighbourhoods and the environment as safe and healthy to regulate the production, sale and use of psychoactive sub-
as possible within the context of active substance use. This stances. It offers regulatory options in anticipation of future
priority outlines initiatives that can reduce the impacts of changes to the legal structures for some currently prohibited
harmful use in public places, on individuals in potentially substances.
high-risk situations, and on neighbourhoods. The focus is The City of Vancouver does not advocate a free market sys-
on individual well being, public safety and order, the social tem for psychoactive substances. Regulatory options instead
and economic health of communities, and the environment. aim to ensure that drugs are not bought and sold without
The plan recommends implementing a Safer Bars Pilot appropriate controls. The City advocates a regulatory regime
Program to deal with violence in bars and clubs as well as based on the particular health and social harms related to each
neighbourhood disorder, addressing the dangers associated substance. This priority also discusses ways to influence mar-
with clandestine methamphetamine production labs and ket forces that reduce the efficiency and profitability of illegal
developing a city-wide syringe recovery program. drug markets, and explores some substance-specific regula-
tory strategies.
Legislative and public policy change Recommendations include more stringent regulation of
premises selling tobacco, the implementation of the British
The prevention plan takes the position that there is a ceiling Columbia Provincial Health Officers recommendations to
to what can be achieved through prevention efforts without mitigate potential harm from new provincial policies that
considering changes to the legal frameworks within which have increased access to alcohol, the development of a
psychoactive substances exist. The plan states that the his- municipal alcohol strategy, and stricter control of metham-
torical policy of prohibition of certain drugs has failed in its phetamine precursor chemicals.
attempt to eliminate availability of illegal drugs and their con- Developing and implementing a plan to prevent harm from
sumption. Markets for these substances continue to flourish substance use is a complex undertaking that will require a
and street level prices are at an all time low. coordinated, integrated and sustained effort over many years.
Preventing Harm from Psychoactive Substance Use The biggest barrier to prevention thus far has been the failure
explores how prohibition as a policy restricts governments so far to implement a comprehensive and sustainable strategy
ability to stop, influence, administer or regulate the produc- at any level of government. Preventing Harm from Psychoac-
tion, sale, and consumption of these substances. A policy of tive Substance Use highlights the need to put prevention of
prohibition prevents the possibility of controlling both access harmful drug use front and centre in the implementation of
to these substances and the circumstances surrounding their the Four Pillars Drug Strategy.
use, and as a result, how these substances impact our commu-
nities. The plan takes the position that as a society we must
move towards considering alternatives to prohibition and that The municipality as the site of action
currently illegal psychoactive substances must not be left in
the hands of organized criminals and unregulated dealers. The complexity of implementing a comprehensive pre-
To address psychoactive substance use in a proactive, pre- vention plan and the sustained and multi-sectoral efforts it
ventative way, it is important to create a legal context that warrants makes it imperative to have a cohesive action strat-
enables a more appropriate and nuanced response than the egy in place. As in the original sense of the term government,
simple prohibition of these substances. The focus of this sec- the Latin and Greek roots of which mean to steer, as in a ship,
tion is therefore the reduction of policy-related harm through the prevention plan intends to provide a map to the local
the creation of public health focused and evidence-based government to navigate the waters of prevention by means
legal responses to substance use. This plan recommends that of a strategy for action encapsulated in the 25 recommen-
the Federal Government adopt a legislative framework to dations. Taken together, these recommendations advocate
deal with currently illegal substances based on population sensible, compassionate, scientific and health-oriented solu-
health models, the relative toxicity of each substance and tions to some of the problems associated with the demand
each drugs potential for creating dependency. It also rec- for and supply of psychoactive substances. How the strategy
ommends changes to Canadas current proposed legislation unfolds will ultimately depend on a variety of factors, the
to depenalize the possession and use of small amounts of most important of which are political commitment, funding
cannabis to enable a comprehensive cannabis strategy. and collaboration.
While much of the responsibility for prevention initiatives
Market regulation falls outside of the Citys jurisdiction and mandate, munici-
palities can play a variety of roles in moving towards a more
Legal structures also determine which regulatory mecha- concerted effort to build capacity for prevention in the com-
nisms are available for market intervention. Alcohol, tobacco munity. The City of Vancouver has commenced work on some
and pharmaceuticals are legal psychoactive substances that recommendations, especially those directly within its coordi-
all levels of governments control through regulations and nating capacities. They are in the drawing board phase, i.e.
taxes. This priority describes ways in which it is possible they have started to coalesce in their respective partnerships
D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132 131

and begun the process of collaborative planning. Some of the more informed participants and supporters of prevention-
roles that the municipalities can play towards strengthening based initiatives. A recent survey has helped identify preven-
prevention in their local context are outlined below with, in tion service providers in Vancouver. The City of Vancouver
some cases, corresponding recommendations from the pre- intends to convene an annual prevention summit on an ongo-
vention plan. ing basis that invites these organisations to come together
with other relevant stakeholders including local community
The City as a provider of support to vulnerable serving organisations, drug users, funders, researchers, mem-
populations bers of the public and other levels of government to facilitate
dialogue and discussion of prevention of harm from substance
The City has a key role to play in supporting vulnerable use.
populations through outreach, targeted programmes and ini-
tiatives, advocacy and by promoting awareness and action The City as a facilitator for building capacity
on issues specific to vulnerable populations. Employment is
a protective factor that mitigates the risks for problematic The Citys role in capacity building may be as a facili-
substance use. In Vancouver, there are programmes and ser- tator, funding source, liaison, coordinator or educator. This
vices that help clients obtain and retain employment. But is a crucial step in moving towards a community-based and
many of these programmes are inaccessible to most active community-driven approach to prevention that is fully sup-
and recovering users, as these citizens often do not meet the ported by local government. The City of Vancouver has
necessary requirements of being on income assistance. Con- partnered with the Vancouver Public Library, Vancouver
sequently the City of Vancouver is planning a pilot project Coastal Health and Centre for Addictions Research of BC
targeting those recovering drug users willing to explore their to provide a public education series on drugs and addic-
potential for job readiness. In Phase I of this project, clients tions. The purpose of this campaign would include providing
would undergo a job literacy training on topics including information and raising awareness, promoting discussion,
work ethics, negotiation skills, anger management and high dispelling myths, reducing stigma and increasing commu-
school completion where applicable. In addition to the train- nity resourcefulness. The exact topics for the series will be
ing, there would also be one-to-one support from a case coor- determined at the end of a survey being conducted through
dinator towards employment search and placement. Phase II various channels to gauge the kind of issues the public would
would involve the actual placement in a working environment like to see addressed. Another initiativefor school aged
under the guidance of a mentor. The City is collaborating preventionbrings together the Vancouver School Board,
on this project with the Vancouver Agreement, an urban Vancouver Coastal Health, Vancouver Police Department,
development initiative between the federal government, the the University of British Columbia and City of Vancouver
provincial government and the municipality of Vancouver. in planning the development of a comprehensive prevention
strategy for school-aged children and youth. Its implementa-
The City as a facilitator of services tion plan explores the following areas: enhancing the capac-
ity of school staff and administration to address substance-
The City facilitates programs and services on a regular and related incidents; increasing student awareness, knowledge
ongoing basis, and in some cases is also involved directly in and skills to avoid problematic substance use; and increas-
program delivery. Consideration of the prevention of harm ing parents knowledge and skills to prevent and intervene in
from psychoactive substance use in decisions about services substance using situations.
serves to promote a more integrated approach. For example, The engagement of youth in Vancouver in the strategy for
the City of Vancouver is partnering with Vancouver Coastal preventing harm from substance use is also a key component.
Health to develop a plan for collecting and managing dis- Youth are engaged in the planning and implementation of a
carded syringes in Vancouver. This plan is expected to: estab- youth component of the prevention plan. As a first step, youth
lish a clear syringe management structure and plan, includ- are an important part of the consultation process on the plan
ing monitoring and evaluation activities; improve awareness to get their feedback on it. Funding has been secured for the
among the general public and injection drug using popula- recommendation advocating the hiring of a youth coordinator
tion about syringe recovery efforts; maximize appropriate for assisting in the planning of a long-term youth engagement
disposal of syringes in community settings, and collect inap- strategy.
propriately discarded syringes in a timely fashion.
The City as an advocate
The City as a facilitator of communication and dialogue
The development by the City of Vancouver of both the
The City often plays a significant role in facilitating com- Four Pillars Drug Strategy and the current draft Prevention
munication, dialogue, education and knowledge exchanges Plan has placed the City squarely in the position of advocat-
with organisations and citizens on significant issues. This ing for a new approach to addressing problematic drug use in
prevention plan maintains that an engaged public will be Vancouver. This approach is one that: considers alternatives
132 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132

to the present system of prohibition; is evidence based and across Canada. Action at the municipal level on problematic
robustly funded by all levels of government; acknowledges drug use is increasing across Canada. Municipalities have tra-
the breadth of prevention possibilities across the life course; ditionally looked towards provincial and federal authorities
engages communities in meaningful dialogue on problem- to provide policy frameworks and to fund health services and
atic drug use; and builds capacity for healthy responses to criminal justice interventions that respond to drug use and the
substance use. drug trade. Increasingly cities are taking the lead in working
Responsibility for funding health interventions addressing with other levels of government and their local communities
problematic drug use is beyond the mandate of the City of to develop approaches that work best at the local level.
Vancouver as is the ability to draft legislation that could pro-
vide the environment for the creation of regulatory schemes
for currently illegal substances. The City therefore advocates Conclusion
a collaborative working relationship with senior governments
and calls for action by Federal and Provincial governments The plan Preventing Harm from Psychoactive Substance
to create the environment for evidence based strategies to Use was presented to Vancouver City Council on Novem-
succeed. ber 3, 2005, and was adopted unanimously. As this article
goes to press, a new Mayor and Council have been elected,
The City as regulator and will be faced with the significant challenge of imple-
menting this prevention plan for Vancouver. The develop-
Cities develop regulations that stem from legislation cre- ment of more rational, evidence-based and comprehensive
ated by senior levels of government. Land use policies are at approaches to preventing harm from psychoactive substance
the centre of municipal regulatory functions. Cities regulate use will only come about through a long-term commitment to
a wide range of activities that flow from overall land use poli- exploring and understanding our relationship with these sub-
cies such as the contexts of drug use in the case of alcohol and stances. The evolution of drug policy in Vancouver continues
tobacco. City bylaws help to determine the location of estab- to broaden the discussion of substance use in our communities
lishments that provide alcohol to the public and direct many and to focus our attention where it belongs, on the prevention
operational considerations such as occupancy loads, num- of harm from the use of psychoactive substances in whatever
bers of seats and hours of operation. Non-compliance with form they are taken, and for whatever purposes they may be
municipal regulations can lead to a loss of business licenses used.
and the closure of problem businesses. Recommendations in
the area of regulation include increasing controls on the sale
and display of tobacco and developing a municipal alcohol References
strategy. Regulatory functions of local government are not
possible when considering illegal substances. Cain, V. (1994). Report on the Task Force into illicit narcotic overdose
deaths in BC. Victoria, BC: Government of British Columbia, Ministry
of the Attorney General.
The City as a role model MacPherson, D. (2000). A framework for action: A Four Pillar Approach
to drug problems in Vancouver. Available online: http://www.city.
Municipalities can become role models in how to address vancouver.bc.ca/fourpillars/pdf/Framework REVISED.pdf.
a wide variety of issues from housing, transportation, cultural MacPherson, D., Mulla, Z., Richardson, L., & Beer, T. (2005). Preventing
life, architecture and liveability to name a few. The Four Pil- harm from psychoactive substance use. Available online: http://www.
city.vancouver.bc.ca/fourpillars/pdf/preventingharm report.pdf.
lars Drug Strategy has become a model for other jurisdictions