The Medicalization of Addiction in Vancouver's Downtown Eastside

Definitions

Medicalization

Medicalization is the process by which some aspects of the human life is to be considered as a medical problem and is to be treated as a medical concern, problem or disorder.

Addiction

Addiction is a compulsive need for and use of a habit-forming substance (such as heroin, nicotine or alcohol) characterised by tolerance and by well-defined physiological symptoms upon withdrawal.

Gentrification

Gentrification is the process of renewal and rebuilding accompanying the influx of middle-class people into deteriorating areas that often displaces poorer residents.

Safe Injection Sites

A safe injection site is a specialized facility that provides injection drug users a clean and safe environment, sterile injection equipment, heath care and social service professionals to deal with health issues and counselling. These sites also facilitate access to detoxification and treatment programs.

Current British Columbia Health Care System

Canada offers its residents a universal, government-funded health care system. Even though it is funded on a federal level, it is managed on a provincial level which means the health care system is subject to adjustments depending on what province you are residing in. In British Columbia, the health care system provided to its residents is called the British Columbia Medical Service Plan (MSP). This plan pays for health costs such as doctors, most medical tests and treatments but excludes dental, eye care, prescription medication and extended health care services such as ambulances. Private health care is an option for residents if they are unable to qualify for the provincial sponsored health care insurance plan. In order to qualify for the British Columbia Medical Service Plan you must be a Canadian citizen, a landed immigrant, a government assisted refugee, a post-secondary international student with a study permit or a temporary worker with a work permit for six months or longer.

Canada's Controlled Drugs and Substances Act (CDSA)

The Controlled Drugs and Substances Act (CDSA) is an act that was passed by Prime Minister Jean Chrétien’s government in 1996. The act represents the control of certain drugs, their precursors and other substances. It also provides the framework for the control of certain substances that can alter mental processes and that could produce harm to an individual or to a society when diverted to an illicit market.

Vancouver Area Network of Drug Users (VANDU)

The Vancouver Area Network of Drug Users (VANDU) is an advocacy group that believes that all drug users should have their own rights and freedoms. The advocacy group has been actively involved in lobbying for support of INSITE, which is Canada’s (and North America’s) only safe injection site located in the Downtown Eastside of Vancouver.

Addiction in Downtown Eastside of Vancouver

Vancouver’s Downtown Eastside (DTES) was the center of an emerging city and started as a commercial core of finance, retailing and culture. Decades later, Vancouver’s Eastside is now home to bars, pawnshops, alcoholics, sex trade workers and a high concentration of illicit drug users. When the toxic, synthetic opioid fentanyl arrived in Eastside Vancouver as well as an even more dangerous synthetic opioid called carfentanil reached Vancouver in November of 2016, drug overdose deaths jumped from a yearly average of 212 to 922 deaths. Out of these 922 illicit drug overdose deaths that occurred in 2016 in British Columbia, the opioid fentanyl was detected in 60% of the overdose educed deaths. Overdose deaths from illicit drugs brought up a question on whether or not provincial health care should intervene and provide programs to encourage healthier methods of drug use (such as needles, syringes and needle cleaning kits).

A homeless count was done in Metro Vancouver in 2017 that determined an increase in homeless people as well as determining the percentage of homeless people with physical or mental conditions. The BC Non-Profit Housing Association and Matt Thomson Consulting found a 30% increase since 2014 of homeless people in Vancouver’s DTES. They also reported that 64% of them were sheltered and 29% unsheltered. 83% of the people who were conducted in the count reported themselves of having at least one ‘health condition’. 53% of them admitted to having an addiction, 44% had a mental condition, 38% had a mental illness and 33% has a physical disability. 34% also self-identified as Indigenous or Aboriginal.

Gentrification in Vancouver

Gentrification has caused many problems in Vancouver’s DTES as the municipal government is not doing enough to prevent gentrification which allows for rent increases and pushes out business that low-income residents depend on. These new businesses are referred to as “Zones of Exclusion” as they exclude low income people and they are stigmatized and feel unwelcome when they enter the shops. The Vancouver Affordable Housing Agency is working to create jobs and boost economies in neighbourhoods that are similar to Vancouver’s DTES as the residents of these communities feel identified based on their deficiencies such as being disproportionately low-income, marginalized, addicted and mentally ill.

Safe Injection Sites

History of Safe Injection Sites in Vancouver

In 1994, the first unsanctioned safe injection site opened on Powell street in the City of Vancouver. These tents were put up without approval of the federal government or the provincial police.

Current Safe Injection Sites in Vancouver

On September 22nd 2003, the first and only government sanctioned safe injection site that opened is located on East Hastings Street in Vancouver, British Columbia. In these supervised injection facilities, illicit drug users bring in their previously obtained drugs and nurses will help prepare a specific dosage that has been prescribed by a doctor of the user’s illicit drug of choice. The users are provided with a safe place and safe equipment to inject their drugs. The medical staff located at these INSITE’s are not allowed to perform injections but are able to help users prepare their injection and provide medical attention after if necessary.

Goals of the safe injection sites are to improve the health and welfare of injection centers, reduce the spread of disease through shared needles and reduce the deaths that are related to drug overdose. The facilities also encourage users to seek counselling, detoxification and treatment.

There is no evidence that there has been increased drug trafficking or crime related to drug use. The fatality overdose rate has significantly lowered after the safe injection site has been implemented and regular users of INSITE have been provided stability and increased the probability of initiating and maintaining treatment for their addiction.

Future Strategies for Overdoses

A meeting occurred on July 25th in 2017 where the General Manager of Community Services gave a report to the Vancouver City Council of recommendations for the 2017 contingency budget for the overdose crisis in Vancouver. His recommendation was that the council grants $601,800 to non-profit organizations to mitigate the effects of the crisis. It also addresses priority needs of innovating anti-stigma programs, addressing social isolation for drug users, especially men, expanding interventions beyond Vancouver’s DTES as well as strategies to address toxic drug supplies.