Second Generation health care puts a squeeze on space in the Downtown Eastside

The Portland Hotel Society's Coco Culbertson is concerned about changes to health-care in the Downtown Eastside coming at the expense of non-medical programs that are often preferred by clients distrustful of larger institutions. Travis Lupick photo.
The Portland Hotel Society’s Coco Culbertson is concerned about changes to health-care in the Downtown Eastside coming at the expense of non-medical programs that are often preferred by clients distrustful of larger institutions. Travis Lupick photo.

David Ogilvie has created artwork since his childhood, but it wasn’t until he was 66 years old that he sold his first drawing. At a café on Main Street, the artist gave credit to Gallery Gachet, a space on Cordova Street near Columbia.

“The modest success that I’ve gained has been at least partly due to them,” Ogilvie said. He recounted that in 2015, Gallery Gachet gave him his first proper exhibition and, soon after, the Capilano Review made an offer for a series of his work.

Ogilvie said it can be hard to explain the difference this made in his life, and similarly difficult to explain the health benefits that Gallery Gachet provides to the Downtown Eastside. But he argued that its impact on mental health in the community is significant.

“Without Gallery Gachet, I don’t think I would have gotten this far,” he said. “I might not have made it at all.”

For 22 years, the gallery has operated with support from the provincial health ministry. But in September 2015, Vancouver Coastal Health (VCH), the regional care provider in charge of that money, eliminated Gallery Gachet’s $132,000 in annual funding.

The cut was the first of many moves VCH has begun as part of its “Second Generation” strategy for health care in the Downtown Eastside. The plan is described by VCH as no less than a “system transformation”. As the name Second Generation suggests, it represents the most significant revision of health care in the Downtown Eastside since VCH’s inception in 2001.

Already five years in the making, Second Generation entered an implementation phase last February. That is scheduled to continue through to October, with an official launch planned for the following month.

What’s at stake is almost $60 million that VCH spends every year on the health of Vancouver’s most marginalized residents, those of the Downtown Eastside.

A September 3 VCH media release lists a host of new mental-health and addictions services planned as part of Second Generation. That document and related materials describe a renewed emphasis on clinical services and integrated care delivered with a low-barriers approach that is heavy on peer involvement. The release warns that programs not falling within this focus on clinical applications may be discontinued.

“VCH contracts without a clear health mandate or those offering stand-alone services without formal connections to health care services may not be renewed,” it reads.

Critics of the plan argue that such a tight focus on medical and psychiatric programs will come at the expense of services that, though less formal, are no less beneficial.

Ted Bruce was interim executive director of the Portland Hotel Society for 14 months before he retired in August 2015.

“There is a need for clinical services but there is also a need to balance the clinical services we provide with some of those other, softer, support systems, which are just as important,” he told the Straight.

Portland operates Insite, North America’s first supervised-injection facility, plus 19 social-housing projects throughout the Downtown Eastside.

“What’s important to any population—and, particularly, these folks—is social inclusion, the ability to build community amongst themselves, and the ability to support each other,” Bruce explained. “The kind of programming that has long-term vision—of not just a clinical service but services that build inclusiveness and community—it’s a very important. But that’s often what is not happening when there is an emphasis only on the clinical.”

Bruce stopped short of direct criticism of Second Generation but added: “There are some things that VCH needs to think long and hard about.”

VCH’s chief medical health officer, Dr. Patricia Daly, is quoted in the September release acknowledging that the transition may encounter resistance.

“This is just the beginning of a long-term strategy for change in the Downtown Eastside that will evolve over time,” she said. “We know not everyone will agree with the changes being made, but as health care providers we know that services in the Downtown Eastside can be improved”.

Three organizations lost in the shuffle

Gallery Gachet was the first nonprofit to lose funding.

On April 7, VCH announced that a second organization would be dropped in the shuffle: the Drug User Resource Centre (DURC), a drop-in across the street from Oppenheimer Park that the Portland Hotel Society has run since 2003. DURC previously received $634,000 a year from VCH.

On May 13, in an email to the Straight, VCH named a third: ARA Mental Health, which offers advocacy services for people with mental-health challenges in a building at Pender and Beatty streets. The organization, founded in 1996, has received about $220,000 in annual government funding the past few years.

VCH has extended support to both DURC and ARA to continue operating while they seek new sources of funding, but only through to the end of this summer.

To be sure, VCH services in the Downtown Eastside are expanding by a number of measures. The clearest of these is funding. VCH has said it is increasing what it spends in the neighbourhood by $4 million a year, bringing the annual total to $59 million. There are also extended service hours coming to a number of existing clinics and an entirely new addictions-treatment centre tentatively planned for Powell Street.

Of course, Gallery Gachet’s take on Second Generation focuses on the money it lost to allow for those programs to expand.

“The pattern that I would say seems to be becoming clear,” said Cecily Nicholson, the organization’s financial administrator, “is that there is a lack of attention to preventative means, social, and tertiary services—services that are not directly clinical but are also completely necessary.”

She described Ogilvie’s story as typical of the gallery’s membership, many of whom struggle with mental-health challenges.

“Like the fellow who just brought in his sculpture last week,” Nicholson said. “These are people who are isolated in SROs—very poor housing conditions—but with wall-to-wall art in their rooms. And they have not been able to share it. That is a common narrative.”

She warned that as VCH moves to fill gaps in its system, it is this population that’s at risk of falling through new cracks that open up.

A state of extreme anxiety

For this article, the Straight spoke with some two dozen people employed by VCH-funded nonprofits and the clients for whom those organizations provide care.

Several people who have spoken to the Straight on a regular basis in the past refused to go on the record for an interview about Second Generation. They cited fears of placing funding in jeopardy. Some pointed to nondisclosure agreements that are now routinely built into contracts with VCH and even applications for VCH contracts.

Those and other conversations revealed a community in a state of extreme anxiety for the changes that are coming.

Coco Culbertson is in charge of housing, community, and peer development for the Portland Hotel Society, one of the few nonprofits that was willing to comment on the record for this story.

She noted that it is still early days in the rollout of Second Generation, and she stressed that service providers don’t yet fully understand how the plan will change health care in the Downtown Eastside.

“It remains to be seen,” she said. “And I think it’s important we stay in discussion with VCH.”

At the same time, Culbertson expressed concern for a focus on clinical services coming at the expense of community programs that she maintained—although perhaps not involving a psychiatrist in a lab coat—do improve people’s health.

“From the PHS Community Services Society’s perspective, nonclinical, nonmedicalized, and noninstitutional approaches to care are at the heart of what we do and why we’ve been successful in engaging thousands of people every day in the Downtown Eastside,” Culbertson said. “I would hope that VCH will continue to value those interventions.”

Marion Allaart is executive director of the Vancouver Area Network of Drug Users (Vandu), a nonprofit founded in 1998 that was instrumental in the fight for Insite. Asked about Second Generation, Allaart’s response was representative of other nonprofit employees who only spoke off the record.

“We’ve been expecting them to come for us for a long time,” Allaart told the Straight.

Service improvements throughout the community

VCH’s mental-health and addictions programs in the Downtown Eastside are overseen by Andrew MacFarlane, operations director of community health services (inner city–east). In a wide-ranging interview at VCH headquarters at West 6th Avenue and Cambie Street, he began by outlining the problems that VCH aims to address with Second Generation.

“We’ve, historically, not been great about being low-barrier and accessible for vulnerable people,” MacFarlane said. “Between 9 a.m. and 4 p.m. doesn’t work for a lot of people that have chaos in their lives.”

To that end, MacFarlane said, VCH is extending service hours and expanding programs at three existing clinics: at 59 West Pender Street, 569 Powell Street, and 330 Heatley Street.

At those locations, he said, doors will soon be open 12 hours a day, seven days a week.

A second complaint VCH heard in its consultation phase for Second Generation was of a system heavily burdened by its complicated structure, where services are isolated from one another in ways that prevent many mentally ill people from receiving care.

“We had programs that were really siloed,” MacFarlane said. “If you saw a mental-health clinician somewhere, then you had to walk somewhere else to a primary-care doctor, who may or may not be in the loop on what is happening with your mental-health treatment.”

To address that problem, new “integrated health-care teams” will deploy at those three locations and others to offer more holistic care, he continued.

“We have a model that we’re implementing that is about having one care team that is really interdisciplinary with a single care coordinator at the centre of it,” MacFarlane said. “Each client will have a designated care coordinator, which will provide a single point of contact for other care providers and agencies.”

Second Generation will also bring a whole new point of access to the Downtown Eastside: the Railtown Centre for Addictions (a working title that could change). VCH declined to reveal a location for the building but multiple sources told the Straight it will likely open on Powell Street east of Oppenheimer Park. VCH will run the centre itself (as opposed to contracting it to a nonprofit). It is scheduled to open this fall.

MacFarlane described the Railtown Centre as a low-barriers medical hub for people with addiction issues.

“This includes an interdisciplinary team, an on-site physician, pharmacist, nurses, and evidence-based psychosocial supports such as social workers, counsellors, peers, and financial workers,” he said.

He noted it will also involve a drop-in component that, crucially, will allow people to connect with addictions services without having to make an appointment or work their way up a wait list.

Through all of that, MacFarlane maintained that harm-reduction programs such as needle exchanges will continue to be a “core competency” of VCH’s work in the Downtown Eastside.

He said that Insite, the city’s only low-barrier supervised-injection facility, has already seen its hours shifted to open earlier in the morning. MacFarlane added that VCH also hopes to soon see supervised injection occur at additional locations. “We are actively pursuing approval to go ahead with that,” he said.

Feedback falling on deaf ears?

For Second Generation, VCH conducted an extensive consultation process that lasted longer than two years.

It commissioned three lengthy papers that presented Downtown Eastside residents’ views on what they want for the community. Today, VCH points to those documents as evidence the Second Generation rollout is following the advice of the people it serves.

At the daily street market on the unit block of East Hastings Street, the Straight asked one of those papers’ authors, Ann Livingston, if Second Generation’s implementation fits with the community feedback she presented in her report.

“Hell, no,” she replied. “I don’t think they’ve looked at it at all.”

Livingston, a cofounder of Vandu, argued that Gallery Gachet and DURC, though not perfect, made people feel welcome and a part of decisions related to their care.

“The things that make the most difference in people’s lives is being welcomed, having autonomy, and having power,” Livingston explained. “Trauma-informed services should be accessible. People should feel welcome. They shouldn’t have to buzz to get in; they shouldn’t have to be a client; they shouldn’t have to give their name….That’s a model for trauma-informed services. But that seems to have been dropped.”

Support for change

Livingston and other Downtown Eastside residents interviewed for this story also raised serious questions about the first big winner in the funding shuffle that’s come with Second Generation: Lookout Emergency Aid Society. She criticized the group’s record on harm reduction in Surrey, where it previously operated as Keys Housing and Health Solutions under the direction of Fraser Health Authority. Livingston took issue with restrictive hours for harm-reduction programs and a past requirement for needle exchange to happen on a one-for-one basis (since abolished).

When DURC lost $634,000 in annual funding from VCH, Lookout gained about $200,000 to allow it to extend hours and expand services at a drop-in centre called LivingRoom, located on Powell Street just east of Oppenheimer Park.

In a telephone interview, Lookout’s executive director, Shayne Williams, defended the organization’s harm-reduction services in both Surrey and Vancouver. He said harm reduction will also be a big part of expanded programs at LivingRoom, though he added it was too early to say exactly what shape those will take.

Williams did, however, note the new LivingRoom will fit with VCH’s stated emphasis on clinical applications. “It certainly won’t be hardcore clinical,” he said. “But the focus will be to be proactive. To help folks get connections to care, to VCH services, to other, more clinical services, and to be that kind of entry point for folks.”

Stephen Finlay is executive director of ARA Mental Health. Despite VCH eliminating funding for his organization, he was largely supportive of Second Generation.

“For many years, everybody has complained—and rightly so—that clients get shuffled from door to door,” he began. “Vancouver Coastal Health listened to that. And they are trying to set up this service so that there is less of that.”

Discussing cuts to his organizations and others like Gallery Gachet and DURC, Finlay alluded to an issue larger than VCH. He pointed out that the health-care provider no longer receives annual budget increases like it once did.

Budgetary constraints

A review of VCH’s annual reports shows Finlay is correct.

In 2009, the B.C. Ministry of Health gave VCH a seven-percent increase to its total operating budget. Since then, there’s been a downward trend in the amount of annual increases. In 2010 and 2011, the increase was three percent each year, then four percent in 2012, two percent in 2013, and three percent in 2014. Then, in 2015, provincial contributions to VCH were reduced by one percent from the previous year.

Since 2010, the change in ministry funding for VCH has averaged plus–two percent per year, barely keeping up with inflation, let alone costs associated with new technologies and aging baby boomers.

Asked if this situation has put a squeeze on services in the Downtown Eastside, VCH’s director of strategy deployment, Natasha Golbeck, remained upbeat.

“We’re always challenged in health care to do more with less and to be increasingly efficient and thoughtful about where we spend resources,” she said. “We are not doing more with less; we’re doing more with more.”

Pressed on whether or not VCH is preparing to eliminate funding for other programs beyond Gallery Gachet, DURC, and ARA Mental Health, Golbeck responded: “The things that are going to be lost have already been lost. At this point, we have made the reallocations that we’ve needed to make.”

The Ministry of Health did not make a representative available for an interview. Quoted in a VCH media release, minister Terry Lake threw his weight behind the Second Generation.

“Change is never easy, but we know it’s desperately needed in the Downtown Eastside,” he said. “Many residents increasingly struggle with chronic conditions and changing addiction issues, but a lack of integration between health services creates barriers to accessing treatment. I applaud Vancouver Coastal Health for making the changes needed to improve patient care in this neighbourhood.”

Losing space

DURC, expected to close by the end of the summer, is a low-barriers community centre that serves as a safe space for alcoholics and people addicted to hard drugs, including stimulants such as methamphetamine and crack cocaine. It offers laundry and showers plus harm-reduction services such as a crack-pipe vending machine and a managed-alcohol program that lets severe alcoholics brew their own beer.

Each Friday afternoon, the managed-alcohol program convenes at DURC for a regular meeting called the “Drinkers Lounge”. What’s said there is usually confidential (as with Alcoholics Anonymous meetings), but the group permitted the Straight to attend on April 29 on the condition that names be withheld.

Participants explained how the program saves people from drinking Listerine and hand sanitizer across the street in Oppenheimer Park. The homebrew they make at DURC is safer, and the Friday meetings allow DURC to connect members to health services, including detox and rehab.

The April 29 meeting began with a roll call of the 35 people in attendance. Next there was a round of happy birthdays, followed by a reading of the group’s rules and mandate. To conclude the meeting’s opening, people were asked to stand for a moment of silence and invited to recite the names of friends or family who had recently passed away or gone missing. One by one, 16 names were called out.

Moving to an open discussion, the topic of the day was DURC’s pending closure and VCH’s reallocation of funds to the Lookout drop-in centre called LivingRoom.

“Where are we going to go?” asked a man in the back. “The City of Vancouver doesn’t want us on the streets around here. They don’t want us in the park. They’re doing this to get rid of us.”

Liz Evans founded the Portland Hotel Society in 1993 and served on the organization’s executive management team for 20 years before she resigned in 2014. She declined to speak specifically on Second Generation, but expressed concern for marginalized people losing the spaces where they feel comfortable.

“If you’re living in a tiny SRO room, 120 square feet, where all you have that’s yours is a sink and a fridge, then having a café to sit in is meaningful,” she said. “And it just feels like space is being lost.”

On May 6, the Portland Hotel Society’s interim executive director abruptly stepped down. Pending the appointment of a new leader, Coco Culbertson is acting as a spokesperson for the organization.

She voiced concerns about the pace with which the Downtown Eastside is changing but maintained that it has learned to take care of itself.

“This community has always had a strong voice when it gets together,” Culbertson said.

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This article originally appeared in print and online at Straight.com on May 21, 2016.

Health Canada proposes regulation change to permit prescription heroin for severe addicts

At Crosstown Clinic in the Downtown Eastside, Dr. Scott MacDonald oversees patients with severe addictions who are given prescription heroin and hydromorphone to stabilize their lives. Travis Lupick photo.
At Crosstown Clinic in the Downtown Eastside, Dr. Scott MacDonald oversees patients with severe addictions who are given prescription heroin and hydromorphone to stabilize their lives. Travis Lupick photo.

Canadian doctors could soon be allowed to offer patients prescription heroin as a method of treatment for a severe addiction to opioids.

Today (May 13), Health Canada proposed a regulatory change that would let doctors apply for special access to the drug, also called diacetylmorphine, and offer it to patients as they see fit.

“A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence,” reads a Health Canada media release.

Since December 2014, a small group of specific patients has hadaccess to prescription heroin at a clinic called Crosstown in Vancouver’s Downtown Eastside.

Three times a day, 110 patients can visit the clinic at set times and receive an intravenous dose of heroin under the supervision of nurses. The treatment is paid for by taxpayers and operates under Providence Health Care, the regional authority that also runs St. Paul’s Hospital.

The 110 people are only allowed access to the drug via a court injunction. They are previous participants in a clinical trial. Upon that study’s conclusion, they were essentially grandfathered into the program pending the resolution of a legal challenge.

If the proposed regulatory changes pass, it would eliminate the need for that legal challenge and open the door for people outside of the group of Crosstown patients to gain access to prescription heroin via their doctors.

A consultation period of 30 days is now underway.

Dr. Scott MacDonald is the lead physician at Crosstown Clinic who oversees the heroin maintenance program there.

“This is good news,” he said in a telephone interview. “There are going to be more people having access to diacetylmorphine as a safe, effective, and cost effective treatment.”

MacDonald however added the proposed regulations are only a “good first step”. He noted the bureaucratic requirements for a doctor to prescribe heroin would remain arduous.

The idea behind heroin maintenance is harm reduction, MacDonald explained.

He pointed to studies that show patients enrolled in a heroin-maintenance program will have less negative interactions with police, greater access to medical treatment, and a new degree of stability that can help them improve other areas of their lives, such as housing and family relations.

“These people are involved in a chaotic lifestyle and an illicit drug trade that supports organized crime and general chaos for the community,” he said. “It is important that we engage everybody in care that is using illicit opioids. We need all the tools in the tool kit, whether that is methadone, suboxone, hydromorphone for some, and diacetylmorphine or prescription heroin for the small number of people that need that.”

The treatment is only recommended for chronic addicts who have previously failed with traditional forms of rehabilitation such as abstinence and methadone.

For the 110 patients receiving prescription heroin at Crosstown, the average number of years they have been addicted to opioids is 26.6 years. The average number of times they have failed with a traditional treatment is 11.4.

MacDonald estimated that if heroin maintenance could be administered without bureaucratic restrictions, the number of Vancouver residents for which the treatment would be appropriate would not exceed 500.

The court challenge was launched in March 2014 when Providence Health Care and five long-time heroin addicts filed a lawsuit against the Canadian government in an effort to secure diacetylmorphine as a legal means of managing addiction.

That action was in response to a regulatory change that former health minister Rona Ambrose enacted in October 2013. That month, she closed what she described as a “loophole”, barring clinicians from applying for special access to administer drugs such as heroin, cocaine, and ecstasy (MDMA).

Canadian doctors had never prescribed those drugs on a regular basis. But at that time, Vancouver’s heroin-maintenance program at Crosstown was gaining attention. Doctors were also beginning to write diacetylmorphine prescriptions for patients who had cycled out of the academic trial, and moving to make the treatment available to addicts who were not enrolled in earlier studies.

Doug King is a lawyer with Pivot Legal Society, the group representing the five plaintiffs in their lawsuit against the federal government. In a telephone interview, he said the regulatory change could lead the group to drop its court action.

“We’re happy,” he told the Straight. “We expect we’ll get the change in regulations that we are asking for in our lawsuit, and that will, essentially, be a victory for us.

“The point of the lawsuit was to nullify the regulation change that was made by the Conservative government and bring it back to the way it was,” King continued. “And that is essentially what they are doing here.”

Libby Davies was the member of parliament representing Vancouver East from 1997 to 2015. During those years, she repeatedly called for the government to legalize heroin as a means of reducing overdose deaths and improving the lives of addicts.

In a telephone interview, Davies placed the benefits of prescription heroin in the context of recent deaths attributed to fentanyl. She noted that drug, which is often sold as heroin but is much more dangerous, is killing an average of 64 British Columbians every month this year.

“People don’t know what they are taking,” she told the Straight. “So to have a prescribed program where people are in the health-care system, to me, that is the critical thing.”

B.C. Health Minister Terry Lake voiced his support for Crosstown’s heroin-maintenance program in a release back in October 2013.

“We have to think outside of the box sometimes,” he said. “I know that the thought of using heroin as a treatment is scary, but I think we have to take the emotion out of it and let science inform the discussion.”

Health Canada’s May 13 release notes prescription heroin has been available in other jurisdictions for some time, including Germany, the Netherlands, Denmark, and Switzerland.

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This article originally appeared in print and online at Straight.com on May 13, 2016.

Downtown Eastside street vendors blame city for loss of income and community

A new city-sanctioned site for vending at 501 Powell Street has failed to attract many customers. Travis Lupick photo.
A new city-sanctioned site for vending at 501 Powell Street has failed to attract many customers. Travis Lupick photo.

A survey of more than 50 street venders in the Downtown Eastside reveals that a majority feel they are negatively impacted by new policies the City of Vancouver implemented on November 16.

Since that date, the Vancouver Police Department has kept hawkers off the once-crowded unit block of East Hastings Street, which runs between Carrall and Columbia streets.

The survey, conducted between November 21 and November 24 by the Carnegie Community Action Project, collected 48 responses to the question: “How have you been impacted by the VPD’s crackdown?” Of those, 38 people, or 79 percent, reported a loss of income.

One respondent claimed that the change led them to prostitute themselves. Several others warned that the crackdown on venders will drive low-income people to commit crimes such as robberies.

In a telephone interview, Vision Vancouver councillor Andrea Reimer acknowledged concerns for venders’ incomes. “That came through loud and clear,” she said about the survey.

Reimer emphasized that the city didn’t just “encourage” venders to move from the unit block but also made two alternative sites available. Those are 62 East Hastings and 501 Powell Street. (A Sunday market on Carrall between Cordova and East Hastings will also continue to operate.)

The survey suggests a majority of venders have issues with those sites, mainly, that they do not attract the same volume of foot traffic as the unit block.

Reimer noted that very few respondents suggested abolishing either of the new sites. “If there were a way to get the customers up…if you can solve that problem, then this is a preferable model,” she said. “But it’s really challenging.”

According to Reimer, part of the blame for so many people living in poverty in the Downtown Eastside lies with the province. “If anything, what that document represents to me a damning indictment of a lack of welfare-rate increase since 2007,” she explained.

In addition to economic hardship, a number of people said the clearing of the unit block resulted in a loss of community.

“I don’t know where everyone is,” one response reads. “I can’t find friends and family. The street market was social and we looked out for each other. I have lost friends.”

A small minority describe the city’s program in a positive light. “Glad its been cleared up,” one person said. “I was embarrassed.”

Doug King is a lawyer with Pivot Legal Society who has publicly denounced the city’s new policy on the unit block as one of “displacement”.

“We believe that the ultimate solution is bylaw reform,” he said. “The street-and-traffic bylaw is archaic in how it is worded.”

That piece of municipal legislation forbids unauthorized street vending. King suggested the law be amended to limit nuisances related to vending but allow the activity itself.

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This article originally appeared in print and online at Straight.com on December 2, 2015.

Protesters cry gentrification after city clears vendors from unit block of East Hastings

SFU student Amy Widmer said she organized a protest against the city clearing vendors from the unit block of East Hastings because that program fits into a wider pattern of gentrification and displacement. Travis Lupick photo.
SFU student Amy Widmer said she organized a protest against the city clearing vendors from the unit block of East Hastings because that program fits into a wider pattern of gentrification and displacement. Travis Lupick photo.

A small but vocal protest stopped the flow of traffic along East Hastings Street at Main for more than an hour this afternoon (November 20).

The demonstrators, mostly students from Simon Fraser University, said they were there in response to what they described as the city’s forced removal of vendors who once lined the unit block of Hastings between Carrall and Columbia streets.

“The recent police action displaced vendors along East Hastings Street and displaced everyone who was sleeping along this street as well,” said Amy Widmer, an SFU student and one of the protest organizers. “I don’t want to swear but this is bullshit. It’s another action to provide space for the wealthy.”

Before last Monday (November 16), the unit block was crowded with hawkers, many of whom survive off vending as their primary source of income. But beginning on that date, the City of Vancouver working with the Vancouver Police Department implemented a program that aims to keep the block free of street vending.

A heightened police presence was deployed to the area in an effort to deter crowds from congregating there. Meanwhile, the city made available two new sanctioned sites for vending. Those are at 62 East Hastings Street and 501 Powell Street. A third location open on Sundays at Pigeon Park will also continue to operate.

The November 20 protest began on the south side of the unit block of East Hastings Street near Carrall. Interviewed there, a well-known activist who calls himself Homeless Dave told the Straight the new sites the city is promoting don’t make up for the space they took from vendors by moving people from the unit block.

“This is a small marketplace,” he said of 62 East Hastings. “It’s much smaller than what’s required, it’s off the street to the side, and it isn’t frequented. It’s not visible.”

Dave similarly described the second new site, at 501 Pender Street, as “terrible”.

“There are no people there,” he said. “It is out of the way. People, the foot track around here and from Gastown, they’re not going to go there.”

From the south sidewalk of the unit block, a crowd of between 20 and 30 people moved into the street and blocked both lanes of traffic along East Hastings. The group then moved to 138 East Hastings and stopped there, continuing to impede vehicles.

Widmer said the demonstration targeted that address because it’s an example of higher-income people moving into the Downtown Eastside in ways that push lower-income residents from the neighbourhood.

“We are at Sequel 138 because these condos are opening in three weeks and it is no coincidence that they [the city] are displacing all the vendors just before the opening of these condos,” she said. “This is the gentrification process.”

From the sidelines of the demonstration, Landon Hoyt, executive director of the Hastings Crossing Business Improvement Association, said he sympathizes with a lot of what the student demonstrators were saying.

“We understand the reasons for wanting to protest this kind of stuff,” he said. “We’ve worked with the Downtown Eastside Street Market for quite a while now. We’re all about finding income-generating opportunities in whatever form. And so the city providing this space that is safe and legal and checks all the boxes for these people to vend, we think it’s a really positive thing.”

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This article was originally published online at Straight.com on November 20, 2015.

City sweeps Downtown Eastside vendors off the unit block of East Hastings

Before Monday, November 16, a section of East Hastings Street that runs between Carrall and Columbia was crowded with street vendors. But since that date, merchants have been kept away by an increased police presence. Travis Lupick photo.
Before Monday, November 16, a section of East Hastings Street that runs between Carrall and Columbia was crowded with street vendors. But since that date, merchants have been kept away by an increased police presence. Travis Lupick photo.

The City of Vancouver has finally cleared vendors from the unit block of East Hastings Street, officials confirmed in a November 17 meeting with community members and police at the Woodward’s Building.

Taking care to avoid saying that people are being forced to leave the area, the city made clear it will no longer tolerate the crowd that for years has congregated along the north side of the street that runs between Carrall and Columbia.

An email obtained by the Georgia Straight provides more information. On November 13,Mary Clare Zak, City of Vancouver managing director of social policy and projects, sent relevant stakeholders a note about the initiative.

“As many of you are aware, City staff (along with Park Rangers, VPD and Housing Outreach) have been working over the past months to find ways to address the subject of street vending in the DTES, most notably in the 0-300 blocks of East Hastings,” it begins.

“The objective of the Street Vending Task Force is to assist and facilitate the movement of street vendors from the Unit Block E. Hastings Street and surrounding area, to designated vending locations,” the email continues.

It states that beginning November 16, “you will begin to see a larger City presence in the DTES, including VPD officers, as we continue our efforts in the area to ensure it is a safe place for everyone”.

It appears three events aligned to create the right time and an opportunity for the city to clear the block of hawkers, many of whom survive off vending as their primary source of income.

The first, discussed in Zak’s email, is the city opening new sanctioned sites for street vending; those locations are 62 East Hastings and 501 Powell Street. Council approved these last June.

“The ability to better consolidate the activity, along with a thoughtful and constructive enforcement approach, will decrease and address unlawful vending taking place in other areas of the Downtown Eastside, including the blocks of East Hastings between Main and Carrall Street,” a staff report reads.

In addition, the Sunday market on Carrall Street between Cordova Street and East Hastings will continue to operate.

The second issue at play is what Vision Vancouver councillor Andrea Reimer told the Straight is an increased level of violent crime in the area and deteriorating health conditions on the block.

“There is not a desire to force anyone [to move],” she said by phone. “There is a desire to support the safest possible environment.” Reimer denied that the actions described in Zak’s email are about moving vendors off the block.

The third factor is the demolition of a building that previously occupied 41 East Hastings, at the centre of the block. According to a report that went before city council in September 2013, that site—previously a three-storey building housing a ground-floor bottle depot—will soon host a 14-storey social-housing project operated by Atira Development Society.

VPD Const. Brian Montague said the construction project will not leave room for vendors.

“There is going to be scaffolding there,” the force spokesperson told the Straight. “They are just not going to be able to be there anymore. So we are using it as an opportunity to encourage people to go to one of these three sites rather than making it a habit to go to that specific block.”

As the Straight went to press on November 17, city officials were still in the meeting with vendors and community members convened to discuss the project.

There at the Woodward’s Building, city communications manager Tobin Postma said there are now enough official locations for vending and so no longer any reason for unsanctioned vendors to line the block. VPD district commander Howard Chow confirmed that the force has increased patrols in the area. Addressing community concerns, Chow claimed that ticketing would not be used as a tactic for moving people along.

In a telephone interview, Roland Clarke, a coordinator for the Downtown Eastside Street Market Society, recounted watching the first day of the initiative unfold.

“There were at least five or six police officers visible on the block,” he said. Clarke added that they remained there for some time and their presence dissuaded people from stopping to sell goods.

“The city is rolling out a policy to really try and prevent the unsanctioned vending,” he concluded.

Clarke noted the market society has no formal interest in vending on the unit block but said it plays an informal role in keeping the peace in the area, given many people who occupy the strip are also registered members who participate in the sanctioned Sunday market on Carrall.

A video recorded on November 16 and shared with the Straight confirms Clarke’s account of November 16, showing the north side of the unit block completely cleared of vendors. When the Straight visited on November 17, VPD officers were stationed in pairs at either end of the block and for the second day in a row, the area remained empty.

Sarah Blyth is a member of the street market society’s board of directors and a former Vision Vancouver parks commissioner. She said the non-profit—which has more than 800 registered vendors—is trying to make the best of a bad situation.

“I think it is a push to get rid of the vendors on Hastings Street and to get them into 62 and 501 Powell,” she said. “The thing is, there is not enough space. So it’s really going to be difficult to do.”

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This article originally appeared in print and online at Straight.com on November 17, 2015.

Downtown Eastside hotel tenants dying at a rate eight times Canada’s average, UBC study finds

Despite sometimes-shoddy conditions, residents of Downtown Eastside hotels have protested the gentrification of their neighbourhood and called for the city to protect that kind of affordable housing stock. Travis Lupick photo.
Despite sometimes-shoddy conditions, residents of Downtown Eastside hotels have protested the gentrification of their neighbourhood and called for the city to protect that kind of affordable housing stock. Travis Lupick photo.

Downtown Eastside residents living in the city’s derelict hotels are dying at a rate more than eight times the national average, a UBC study has found. The risk is especially great for people living with a mental illness, even when that group is compared to people similarly living in poverty.

“The probability that an individual with psychosis would survive to age 50 is 68% compared with 94% for those without the diagnosis among marginally housed individuals,” reads an August 2015 paper published in the British Medical Journal Open. “Individuals with psychosis may face a greater than eightfold increase in mortality risk compared with those without psychosis.”

While those grim statistics may not come as a shock to those familiar with the impoverished neighbourhood, what’s causing many of these early deaths did surprise researchers.

The paper presents findings based on a sample of 290 men and 81 women who were recruited through Downtown Eastside single-room occupancy hotels (SROs) and Vancouver’s Downtown Community Court. The group was monitored from November 2008 to August 2012 and, during that time, 31 participants died. That’s a rate of eight times the national average. And for those aged 20 to 59, the mortality rate was 10 times the Canadian average.

Contrary to popular assumptions, researchers “did not find any link with HIV or substance addiction”, a UBC media release states. In cases where participants passed away, psychosis and hepatitis C-related liver dysfunction was “significantly associated with increased mortality”.

For younger participants under the age of 59, the situation is even worse. For that group of Downtown Eastside residents, the mortality rate was found to be 10 times Canada’s average.

“We were somewhat surprised because most people thinking about the Downtown Eastside think about HIV/AIDS or the possibility of overdosing on opioids like heroin,” said William Honer, one of the study’s co-authors and head of UBC’s department of psychiatry, quoted in the release. “Our system is not doing as well in getting treatments out there for psychosis and hepatitis C in this group, and it’s interesting that those two illnesses are causing risk for early mortality.”

It was discovered only one-third of the 173 participants diagnosed with psychosis were receiving treatment for that mental-health condition. And for the 57 people with an active hepatitis C infection and related liver dysfunction, not one of them was receiving treatment for that illness.

“Psychosis is an extremely prevalent issue among inner city populations and we need to address this,” said Andrea Jones, another of the study’s authors and an MD/PhD candidate in mental health and addictions research at UBC, quoted in the release. “We need to be ready to detect and treat mental illness in an integrated way that really meets the patients where they’re at. We need to improve the detection and treatment of psychosis and hepatitis C in marginalized people across Canada.”

The study was funded by the Canadian Institutes of Health Research and by B.C. Mental Health and Substance Use Services.

It states there are some 3,800 people living in SROs in the Downtown Eastside.

There are an estimated 2,000 “severely ill” SRO tenants not receiving the care they require for mental-health and addiction challenges, according to a September 2014 report of the Mayor’s Task Force on Mental Health and Addictions.

Vancouver Coastal Health (VCH) is the regional authority the province tasks with delivering the bulk of health-care services provided to the Downtown Eastside. It spends roughly $55 million a year in the neighbourhood. A February 2015 policy paper lays out strategies and specific recommendations for a “second generation” of health-care designed for the Downtown Eastside. It acknowledges that VCH has largely failed to keep pace with changing needs, and promises the health authority will adapt and improve.

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The article was originally published in print and online at Straight.com on September 10, 2015.

Ottawa blocking supervised injection site that would save lives, Victoria councillor says

SFU researcher Ehsan Jozaghi looked at the numbers and found that opening a supervised-injection facility like Insite in B.C.'s capital would save lives and save the city.
SFU researcher Ehsan Jozaghi looked at the numbers and found that opening a supervised-injection facility like Insite in B.C.’s capital would save lives and save the city.

A supervised-injection facility similar to Vancouver’s Insite would be a good deal for Victoria taxpayers, a new study by researchers with Simon Fraser University concludes.

“We would not only be saving people’s lives but also reducing costs to the health-care system,” said Ehsan Jozaghi, the paper’s lead author. “I think people should move away from ideology and just look at the numbers.”

Specifically, researchers found that by opening one supervised-injection facility in Victoria, the city would avoid 13 new HIV cases annually and prevent 2.3 fatal overdoses each year.

The paper, published by the journal Urban Geography on July 3, notes that one HIV infection costs Canada’s health-care system an estimated $210,000 per year and that the loss of one life is valued at roughly $979,000.

Victoria mayor Lisa Helps has spoken in support of harm-reduction programs. “I will work hard to make sure that we have a safe consumption site in this city,” she said during a candidates’ debate ahead of last November’s civic election.

Since then, Victoria has included supervised-consumption services in its strategic plan for 2015 to 2018.

In a telephone interview, Coun. Marianne Alto said she’s optimistic the city will open its first supervised-injection facility before the end of that period.

“We can do a lot of the prep work,” she said. “But, ultimately, we are going to come to a point where we are going to hit a brick wall and that is called the federal government.”

Alto explained that Bill C-2, the Respect for Communities Act, which passed into law in March this year, has made it significantly more difficult for regional health authorities to obtain the permissions required to open a facility similar to Vancouver’s Insite.

Nevertheless, she said stakeholders will meet in the fall to begin the long process required to open such a facility.

The Dr. Peter Centre in Vancouver’s West End operates an unsanctioned supervised-injection room. It applied for federal exemptions required to operate legitimately in February 2013 and is still waiting for an answer on that application.

Health Canada did not make a representative available for an interview by deadline.

In related news, a July 12 bulletin issued by the B.C. Centre for Disease Control (BCCDC) states there has been a surge in drugs found to contain fentanyl, a synthetic opioid that’s more toxic than heroin.

A province-wide study found 29 percent of participants tested positive for fentanyl and, of those drug users, 73 percent said they did not consume fentanyl knowingly.

“Fentanyl-detected illicit drug overdose deaths in British Columbia increased from 5% of total illicit drug deaths in 2012 to over 25% in 2014,” the BCCDC warns.

It notes it is not just heroin that is testing positive for fentanyl but virtually every street drug, including cocaine, methamphetamine, ecstasy, and cloned prescription pills such as those sold as OxyContin.

This article originally appeared in print and online at Straight.com on July 29, 2015.

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