Tag Archives: vancouver

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.

Follow Travis Lupick on Twitter, Facebook, and Instagram.

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.

Follow Travis Lupick on Twitter, Facebook, and Instagram.

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

Airbnb could be taking 2,400 units out of Vancouver housing stock, study finds

Applying filters to data presented by the Inside Airbnb website shows a large number of Vancouver listings are for an entire place that is also available for more than 90 days of the year. That suggests some of these 2,408 units may not have full-time residents and are essentially operating as hotels.
Applying filters to data presented by the Inside Airbnb website shows a large number of Vancouver listings are for an entire place that is also available for more than 90 days of the year. That suggests some of these 2,408 units may not have full-time residents and are essentially operating as hotels.

Fresh data about Airbnb rentals in Vancouver suggests a growing number of the city’s couches, spare rooms, and entire homes and apartments are up for rent via the popular mobile app.

According to online information obtained on December 3, there were 4,728 Airbnb listings for the city.

Of those, 3,179, or 67 percent, were for an entire place; 1,399, or 30 percent, were for a private room; and 150, or three percent, were for a shared room.

The data was collected and made available by Inside Airbnb, a website run by New York–based photojournalist Murray Cox. He describes the project as an “independent, non-commercial set of tools and data that allows you to explore how Airbnb is really being used in cities around the world”.

Cox’s study also found that of those 3,179 Vancouver listings for an entire place, 76 percent or 2,408 units fall into a “high availability” category, meaning they are available to rent for more than 90 days per year.

“Entire homes or apartments highly available year-round for tourists probably don’t have the owner present, could be illegal, and, more importantly, are displacing residents,” the website states.

In April 2015, the vacancy rate for the Vancouver region (as opposed to the city) was 1.4 percent, according to the Canadian Mortgage and Housing Corperationdown. That’s down from 1.8 percent the previous year.

Cox’s look at Vancouver was constructed with the help of Karen Sawatzky, an SFU master’s student who published similar information last summer. In a telephone interview, she cautioned that there are differences in how the two packages were assembled and presented. But Sawatzky said even a rough comparison makes clear that more Vancouver residents are renting spaces on Airbnb.

Her data was captured on June 1, 2015. It showed 3,473 Airbnb listings for Vancouver, 2,466 of which were for an entire dwelling.

Sawatzky noted June is typically a busy month for the tourism industry, whereas December is not. She said the increase in the number of listings heading into the winter months raises questions about whether Airbnb is seasonal or becoming a more permanent way for people to make money by renting rooms year-round.

NPA city councillor Melissa De Genova told the Straight she requested that city staff review the Airbnb issue last summer and is waiting to hear back.

“We have to look at our existing rental stock and how Airbnb is affecting that,” De Genova said. “If those properties are coming off the market because it is more lucrative for the owner to rent them as an Airbnb to tourists, we certainly have to look at that.”

De Genova emphasized that the so-called sharing economy has developed as an important new sector and one that provides services many people enjoy. She said she doesn’t believe Airbnb should be banned from Vancouver and recommended the city accommodate and regulate Airbnb in ways that minimize impacts on renters and communities.

Follow Travis Lupick on Twitter, Facebook, and Instagram.

This article originally appeared in print and online at Straight.com on December 9, 2015.

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.

Follow Travis Lupick on Twitter, Facebook, and Instagram.

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

Follow Travis Lupick on Twitter, Facebook, and Instagram.

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

From activists to CEOs, here are 14 women who run Vancouver’s booming marijuana industry

Village Dispensary owner Andrea Dobbs is part of a wave of women at the forefront of Vancouver-based cannabis businesses. Travis Lupick photo.
Village Dispensary owner Andrea Dobbs is part of a wave of women at the forefront of Vancouver-based cannabis businesses. Travis Lupick photo.

One of the first lessons a marijuana enthusiast learns is to purge a grow operation of males. Only the females of the cannabis plant—identifiable by pistillate flowers, in contrast to a male’s staminate flowers—produce the cannabinoid chemicals sought for their psychoactive effects. So gardeners pull the male plants out by their roots and discard them as useless.

On the human side, nobody is actively purging Vancouver’s burgeoning marijuana industry of men, but many facets of the business are similarly dominated by women.

“Here in Vancouver, women have been at the forefront of this industry from the very beginning,” said Jamie Shaw, president of the Canadian Association of Medical Cannabis Dispensaries (CAMCD).

She recalled that one of North America’s first marijuana storefronts, the nonprofit B.C. Compassion Club Society, was founded in 1997 with feminist ideals at its core.

“In our early days, 70 percent of the Canadian workforce was male, so we made it policy that 70 percent of our staff had to be female,” Shaw told the Georgia Straight. “And we still have that policy.”

Hilary Black, who cofounded the Compassion Club alongside Shaw, recalls that things happened a little more organically.

“I was 20 years old,” Black recounted. “We were all in our mid- to young 20s. It was just a group of women who were willing to engage in civil disobedience and provide services for marginalized and chronically ill people.”

Regardless of how conscious the group was of its feminist bent back then, Black said the tradition is something worth keeping alive today.

“Women were the roots and the pioneers of medical cannabis in this country,” she emphasized. “And I think it is really important that we continue to see them having a leading voice and influence as the movement moves into an industry.”

Almost 20 years after the Compassion Club opened its doors on Commercial Drive, there are plenty of Vancouver women following in its footsteps. Shaw pointed to Dori Dempster of the Medicinal Cannabis Dispensary, the Village Dispensary’s Andrea Dobbs, and Jessika Villano of Buddha Barn Medicinal Cannabis. Women are also behind some of the city’s most popular oils and edibles, Shaw continued—Brina Levittof Green Penguin Delights, for example, and Apothecary Labs’ Gabriele Jerousek. Another is Mary Jean Dunsdon, better known as Watermelon, whose online cooking show has earned her an international following. (Dunsdon also appeared on the cover of the Straight back in 2008.)

It’s not just in the dispensary industry that women are running the show.

UBC’s Rielle Capler has focused on marijuana and patient care as a research area for more than a decade. Before that, she was another woman involved early with the Compassion Club. More recently, Capler has become a big contributor to evolving legal frameworks, having helped draft the standards and certification program for dispensaries that the City of Vancouver adopted last June.

On the research front, Capler called attention to a cannabis study that was published in the journal Drug and Alcohol Review on September 14. Bucking the academic trend of papers often being dominated by men’s names at the top, that study was coauthored by eight B.C. researchers, including Capler, plus Kim Crosby, Lynne Belle-Isle, andSusan Holtzman.

“To do the dispensaries, that was civil disobedience,” she said. “And research was an area that needed pioneering as well because it is still a taboo topic.”

Of course, the Canadian cannabis movement’s most visible face is also a woman’s.

Jodie Emery has carried the crown since her husband, Marc, began a five-year prison sentence in 2010. He was released in August 2014 but has appeared content to see Jodie remain the lead spokesperson for the push to reform marijuana laws.

In a telephone interview, Jodie Emery speculated that one of the reasons women have risen to the top of marijuana reform is that pot—or at least its more legitimate areas—is a relatively new industry that’s going mainstream after efforts began to force old-boys’ networks and institutional sexism out of the workplace.

“Because the legal or semilegal marijuana industry is new, there are positions available for women that men may have otherwise filled before,” she said. “Women have had an equal opportunity to be involved.”

That doesn’t mean there isn’t room for improvement, she added. For example, Emery agreed that her husband’s name often still comes first in media reports on the reform movement, despite Marc taking a back seat for some time.

“Something that women have always dealt with is being somebody based on their husband being somebody,” she said. “I struggle with it.…But I’ve never encountered anyone belittling a female [marijuana] activist.”

At the Village Dispensary in False Creek, Dobbs similarly told the Straight that the marijuana industry is better to women than most but is still far from perfect.

“You get a lot of people calling you ‘darling’; you get a lot of references to ‘the kind of girl that smokes weed’,” she said. “Or, ‘She’s pretty for a girl that smokes weed.’ So there is a lot of that kind of stuff.”

Dobbs also noted that as Canada inches closer to legalizing recreational marijuana, she has started to see the industry adopt chauvinistic advertising strategies, like those on display in beer commercials.

“You see a lot of young, hypersexualized girls handing out leaflets and flyers feeling kind of excited to be part of it but not recognizing that they are not being taken seriously,” she explained.

Working to counter that sort of sexism is Women Grow, a professional association with groups in more than 40 cities across North America.

The Vancouver chapter was founded by Shaw and Shega A’Mula, CAMCD chief operating officer and a relatively new face in B.C.’s marijuana movement.

In a telephone interview, A’Mula gave credit to the women who blazed a trail for her and said she hopes Women Grow can help do the same for the next generation. She invited anybody interested to the group’s next meeting, a networking event scheduled for this Thursday (October 1).

“It’s a really empowering environment,” A’Mula said. “It’s not all big business, like other cannabis events.…It’s a way to have fun, connect, and have conversations you probably can’t have elsewhere.”

Follow Travis Lupick on Twitter, Facebook, and Instagram.

This article was originally published in print and online at Straight.com on September 30, 2015.

Chris Hedges to tell Vancouver the world needs rebels to lead a revolution

Pulitzer Prize winning author Chris Hedges is scheduled to speak on state decay and revolution at a September 25 event in Vancouver.
Pulitzer Prize winning author Chris Hedges is scheduled to speak on state decay and revolution at a September 25 event in Vancouver.

Chris Hedges sees revolution on the horizon.

It’s a phenomenon he’s witnessed before. Hedges draws on decades of experience reporting from revolts and counter-insurgencies around the world. He’s covered the dissolution of the Soviet Union in Czechoslovakia and Romania, met with guerilla leaders amid conflicts in Central American, and reported from Yugoslavia as the country fell into civil war and acts of genocide.

“The veneer of power appears untouched before a revolution, but the internal rot, unseen by the outside world, steadily hollows out the edifice state,” Hedges writes in his latest book, Wages of Rebellion. “And when dying regimes collapse, they do so with dizzying speed.”

The world is once again characterized by “popular uprisings exploding in waves”, he continues.

“The promised prosperity that was to have raised the living standards of workers through trickle-down economics has been exposed as a lie,” Hedges writes. “A tiny global oligarchy has amassed obscene wealth, while the engine of unfettered corporate capitalism plunders resources; exploits cheap, unorganized labour; and creates pliable, corrupt governments that abandon the common good to serve corporate profit. The relentless drive by the fossil fuel industry for profits is destroying the ecosystem, threatening the viability of the human species. And no mechanism to institute genuine reform or halt the corporate assault are left within the structures of power, which have surrendered to corporate control. The citizen has become irrelevant.”

On Friday, September 25, the American journalist and Pulitzer Prize winning author is scheduled to opine on those ideas in Vancouver at St. Andrew’s Wesley United Church at Nelson and Burrard.

Ahead of that engagement, Hedges spoke with the Georgia Straight. The transcript of that conversation that follows has been lightly edited for length.

Georgia Straight: “Can you give us a short preview of your upcoming talk in Vancouver?”

Chris Hedges: “The system of corporate capitalism, or what political philosopher Sheldon Wolin called inverted totalitarianism, is not only not sustainable, but it is unravelling. We can’t continue this kind of assault on the climate, we can’t continue these kinds of wars, we can’t continue the reconfiguration of the global economy into a global neo-feudalism, where money is concentrated into the hands of an all-powerful, tiny, oligarchic elite at the expense of everyone else. We are already seeing the signs of disintegration. You look at the political farce that is happening in the United States because the system has been seized by corporate oligarchs and no-longer responds to the grievances, needs, justices, or rights of the citizenry. You see it in the refugee crisis that is besetting Europe, you see it in the wildfires that are sweeping across California. We better wake up and we better respond quickly, or we’re headed for massive societal breakdown. It is already beginning.”

GS: “Getting to your latest book, Wages of Rebellion: You use the word ‘rebel’ with a positive connotation. Let’s begin there: What is a rebel and why is that what’s needed?”

CH: “A rebel is somebody who rises up against the established order and is willing to carry out acts of self-sacrifice in order to defy that order. It is rebels that have always moved history forward. Rebels very rarely succeed. Most of them are wiped out. I mean, that is just a historical fact. But our passive acquiescence to this system, at this point, makes us complicit in our own self-annihilation. So it is to the rebels that we have to listen.”

GS: “When you look around today, who do you see who fits that description?”

CH: “There are lots of them. [Edward] Snowden, [Julian] Assange. They’re there. [Noam] Chomsky, [Ralph] Nader.”

GS: “Early in this conversation, I wanted to raise the issue of Canada’s upcoming election happening this October. Are you watching or thinking about Canada’s election?”

CH: “I’m aware of it. You are able to mount a third party in the NDP in a way that we [the United States] are not. I mean, the game is fixed here.”

GS: “What differences do you see between the two systems? Are the differences as strong as they used to be?”

CH: “There is quite a bit of difference. There is more room within the national discourse for more radical critiques in Canada. Canada is not, like the United States, an inherently violent culture. You are not an imperial power; we, across the border, are infected with that imperial hubris, that belief that we have the right to use our military to impose our ‘virtues’ on the rest of the world. And your political system is not as corrupted as ours. So there is more space for dissent within the system. Now, I don’t know to what extent, if the NDP takes power, it can actually confront these corporate forces embodied in TransCanada and everything else. That I don’t know. I just don’t spend enough time in Canada to know the answers to those questions.”

GS: “Speaking more generally now, how would you describe your faith in electoral politics?”

CH: “I don’t have any faith in electoral politics. We have to begin to build mass movements that take power back. I spend a lot of time in the book, Death of the Liberal Class, chronicling how all the mechanisms by which citizens once were able to defend their interests have been taken from them. So I don’t waste much time on electoral politics.”

GS: “Electoral politics is obviously failing to solve very big and complex problems like inequality and climate change. After so many years, what can be done?”

CH: “I think what people are doing: organizing at a local level to stop fracking, getting arrested at military bases that operate drones, severing ourselves as much as possible from the tentacles of consumer society – that’s what local food production and sustainable agriculture is about. There is a myriad of ways in which we can fight back, and on all of those fronts, that is what offers us hope. But believing that the NDP or Bernie Sanders is going to come in alone and change anything of any substance is very naïve.”

GS: “Towards the end of Wages of Rebellion, you present the story of an Albertan man named Wiebo Ludwig. Some people would call that example radical or an extremist. Is that what’s needed and where we’re at?”

CH: “He was an extremist and he was a radical.”

GS: “And is that what is needed?”

CH: “Yes. Wiebo Ludwig found out that it didn’t matter how many letters he sent. They were going to take that sour gas out of the land and he was right.”

GS: “Can you talk about online activism? Where does it fit into all this? And young voters and the need to overcome apathy?”

CH: “The young generation kind of gets it. Obviously, you have that segment that is staring with their mouths open at their electronic hallucinations, which is just what the corporate state wants. But you look in the United States at groups like Black Lives Matter, or at Idle No More or the Quebec student movement, and you have pretty sophisticated movements among young people who have figured out the political system. Even the protests at the G20. Occupy was a youth-driven movement, the Quebec student movement was a youth-driven movement, Black Lives Matter is a youth-driven movement. And I’ve met all of these leaders and I am a lot more impressed with them than I am with people my own age.”

GS: “I’m surprised we were able to end on an optimistic note.”

CH: “I’m not very optimistic. Things are pretty grim. And that is part of the existential crisis of our time. We do have to grasp the reality that we face and yet resist anyway. But I certainly find a lot more hope in the young, in this generation – which is not being fooled by Obama – than I do anywhere else. I certainly don’t find it among the old, established left, which has kind of just sold out to the Democratic Party of the United States. The political consciousness in the groups that I just mentioned, I think, is quite high.”

Chris Hedges is scheduled to speak in Vancouver at St. Andrew’s Wesley United Church at 7 p.m. on Friday, September 25.

Follow Travis Lupick on Twitter, Facebook, and Instagram.

The article was originally published at Straight.com on September 20, 2015.

Ottawa threatens to bypass VPD and send in RCMP to bust Vancouver marijuana dispensaries

Don Briere of Weeds Glass and Gifts is just one of dozens of Vancouver marijuana dispensary operators whose businesses could be at risk if Ottawa makes good on a threat to shut them down using the RCMP. Travis Lupick photo.
Don Briere of Weeds Glass and Gifts is just one of dozens of Vancouver marijuana dispensary operators whose businesses could be at risk if Ottawa makes good on a threat to shut them down using the RCMP. Travis Lupick photo.

The Vancouver Police Department is playing it cool in response to the suggestion the RCMP could be on its way into the City of Vancouver to shut down marijuana dispensaries.

“We have a great working relationship with the RCMP,” VPD Const. Brian Montague told the Straight. “I’ll let them [RCMP] respond to any insinuation that they are going to come into Vancouver.”

The spokesperson for the force made those remarks in response to the distribution of letters sent from Health Canada to a number of Vancouver marijuana dispensaries. In those documents, Ottawa threatens to send RCMP officers into the City of Vancouver.

“If the [named dispensary redacted] does not immediately cease all activities with controlled substances, we will contact, within 30 days of the date of this letter, the Royal Canadian Mounted Police for enforcement action as they deem necessary,” reads a copy of the letter posted online at LiftCannabis.ca.

“The Controlled Drugs and Substances Act (CDSA) prohibits any person from engaging in activities such as production, provision, sale (including offering for sale, import, export, transport, delivering of controlled substances unless authorized under its Regulations),” it continues.

The letters do not include an individual’s signature but are marked “Office of Medical Cannabis” and “Health Canada”.

In an email to the Straight, Health Canada spokesperson Patrick Gaebel subsequently confirmed the letters’ authenticity.

“On September 9, 2015, the Department (Office of Medical Cannabis) sent 13 letters to organizations who were found to be illegally advertising the sale of marijuana. The letters require that all advertising activities with marijuana cease,” Gaebel wrote. “Health Canada will attempt to work cooperatively with all parties involved to encourage compliance. If continued non-compliance is identified, the Department may refer the case to law enforcement agencies for appropriate action.”

If RCMP officers did cross into Vancouver and began to shut down marijuana storefronts, that would be a de facto overruling of both the City of Vancouver and the VPD. Those bodies have at least tacitly worked together on a hands-off approach while stating publicly that the illegal dispensaries are simply not a policing priority.

On the prospect of the RCMP conducting policing activities within the City of Vancouver and without the VPD’s cooperation, Montague declined to comment further and directed questions to the RCMP.

Speaking more generally, Montague said the nature of the Lower Mainland means the VPD and RCMP work together on a routine basis and regularly coordinate regional policing efforts.

“The Vancouver police will go into RCMP jurisdiction cities like Surrey, Coquitlam, and Richmond, to investigate crimes that originated in Vancouver,” he explained. “Of course criminals don’t look at city borders so there are often cases that take us beyond the City of Vancouver as well as cases the RCMP would have that would take them into our jurisdiction.”

The RCMP refused to grant an interview.

In June 2015, the City of Vancouver responded to a proliferation of marijuana storefronts by adopting a legal framework and regulations that Mayor Gregor Robertson has said will bring order to an illegal industry that the federal Conservative government has ignored.

Today (September 10) Robertson responded to the alleged Health Canada letter by calling it “curious”.

According to the Globe and Mail’s Andrea Woo, Robertson added he is hopeful the federal government “actually does something meaningful here — has some modern policy toward marijuana”.

It’s estimated there are more than 90 cannabis shops operating within Vancouver city limits.

In April 2015, Canadian Health Minister Rona Ambrose and Public Safety MinisterSteven Blaney co-signed a letter sent to Robertson and the VPD wherein they expressed Ottawa’s disapproval of Vancouver’s plan to regulate those dispensaries.

“Storefront sales of marijuana are illegal and under our government, will remain illegal,” it reads. “Like the vast majority of Canadians, the Government expects that police will enforce the laws of Canada as written.”

Follow Travis Lupick on Twitter, Facebook, and Instagram.

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

Vancouver hospitals predict 2015 will see emergency mental-health visits surpass 10,000

St. Paul’s has gained only nine new long-term mental-health care beds since the City of Vancouver made a call for 300. Charlie Smith photo.
St. Paul’s has gained only nine new long-term mental-health care beds since the City of Vancouver made a call for 300. Charlie Smith photo.

Vancouver is experiencing a crisis in mental-health care that continues unchecked. That’s the conclusion Vision Vancouver councillor Kerry Jang draws from data covering 2009 to the end of June 2015, which show emergency mental-health and substance-misuse hospital visits have increased every year and are on track to hit a record high come December.

“We clearly need more long-term mental-health care,” Jang said in a phone interview. “We know that there are so many people in the Downtown Eastside who don’t see or have any contact with mental-health professionals at all. So the emergency ward is very much becoming primary care. That is something that has to change.”

Jang was responding to information provided at the Straight’s request by Providence Health Care, which operates St. Paul’s Hospital, and Vancouver Coastal Health, which runs Vancouver General Hospital. The statistics show that during the first six months of this year, the two hospitals together saw 5,110 people experiencing a mental-health crisis admitted and 3,703 visits for substance-misuse problems such as a drug overdose. The comparable numbers for 2014 are 4,895 mental-health emergencies and 2,830 cases of substance-misuse issues.

By the end of 2015, these numbers are projected to surpass 10,220 mental-health emergencies and 6,146 substance-misuse incidents. Taken together, that translates to an increase of 76 percent compared to 2009.

Over the last five years, the Vancouver Police Department has observed a similar rise in the number of apprehensions its officers make under the B.C. Mental Health Act. In 2014, officers detained 3,010 people under Section 28 of the act, which allows police to take into custody an individual deemed mentally unfit and a threat to themselves or others. That’s up from 2,278 in 2009. During the first six months of 2015, the VPD made 1,510 Section 28 apprehensions.

Jang, who sits on the Mayor’s Task Force on Mental Health and Addictions, said what’s needed to reverse these trends is greater involvement by the province. He reiterated a call for more long-term-care beds that Mayor Gregor Robertson has made repeatedly since declaring a “mental-health crisis” in September 2013.

The B.C. Ministry of Health declined to make a representative available for an interview.

In recent years, the province has allocated money for mental-health-care infrastructure. For example, in January 2015, it announced that an addition to VGH will open in 2017 as the largest facility for mental-health and addiction services in British Columbia. However, the city has said what’s required to address the problem in Vancouver is 300 “long-term and secure mental health treatment beds” and, in September 2014, warned that the province was falling short of that number by 250. (The province has made small numbers of new beds available—nine at St. Paul’s Hospital, for example, and 14 on the Riverview grounds in Coquitlam. But the majority of funding is going to replacing outdated facilities.)

Mark Levy is the medical manager of the VGH psychiatric-assessment unit. He told theStraight the statistics match what he’s observed on the ground.

“It does put a strain on resources,” Levy said in a phone interview. “There really hasn’t been an increase in in-patient beds to any significant degree. We do run into situations where we are in a crisis mode and we have to accommodate patients that are in the emergency room.”

Levy emphasized the numbers make clear there is a problem. But he also said they include good news, explaining that they’re at least partly the result of changing attitudes and a shift away from the justice system in favour of health care.

“People who might have been taken to cells in the past are seen by an arresting officer as suffering from a mental-health issue,” Levy said. “Now, rather than charge them—as long as it’s not a serious offence—they will bring them to hospital.”

He suggested the next step should be making more mental-health care available in communities where people live, so they receive treatment before their mental health declines to a point where they end up in an emergency room.

“These are chronic problems,” Levy said. “Are people best treated in a hospital or should we try to do whatever we can to help them deal with their problems while they are residing in the community?”

Follow Travis Lupick on Twitter, Facebook, and Instagram.

This article was originally published in print and online at Straight.com on August 19, 2015.

Vancouver prescription heroin program hits a snag that interrupts treatment for some patients

The supervised injection room at Providence Crosstown Clinic, where patients are given prescribed heroin as a means of managing their addictions. Travis Lupick photo.
The supervised injection room at Providence Crosstown Clinic, where patients are given prescribed heroin as a means of managing their addictions. Travis Lupick photo.

Perhaps to no one’s surprise, it turns out that supplying heroin to people without breaking the law is not an easy or a simple thing to do.

Since November 2014, a program run out of a clinic in Vancouver’s Downtown Eastside has done just that—that is, giving chronic addicts free prescription heroin, otherwise known as diacetylmorphine. But there was recently a hitch in the supply chain, which effectively put the harm-reduction initiative called heroin maintenance on hold.

David Lefebvre, a spokesperson for its operator, Providence Health Care, told the Straight that “due to a permit issue”, doctors at Crosstown Clinic had to transition patients to another drug called hydromorphone, a synthetic derivative of morphine. He noted that for some addicts, the change has been a struggle.

“This is the first time in North America that any clinic has provided diacetylmorphine to people who have chronic heroin addictions and that is a process that is extremely complex,” he said in a telephone interview.

Lefebvre explained that Crosstown was forced to begin transitioning patients roughly two weeks ago and hopes to have a majority of those people back on diacetylmorphine when a shipment of the drug arrives from a supplier in Europe “sometime in mid-September”.

“The reality is, the movement of diacetylmorphine is governed internationally, so it is so much more complex than people realize,” he explained. “It is not just a national issue with Health Canada, it is not just a national issue with the Office of Controlled Substances. It is also an international issue.”

Lefebvre said where exactly in the supply chain this problem occurred is in transit at a point across the Atlantic Ocean.

“The permit system in Europe takes six to eight weeks for drugs to be exported to Canada,” he said. “That results in delays that affect our ability to provide diacetylmorphine to our patients. Due to this time lag, Crosstown has had to transition some patients onto hydromorphone.”

Lefebvre cautioned that even after Providence receives its next shipment of diacetylmorphine in mid-September, the same problem could occur again.

“We are expecting continued issues with regard to supply due to this importation time lag,” he conceded.

Lefebvre acknowledged that for many long-term addicts, the transition off of heroin, even to another opiate such as hydromorphone, is not a painless experience. “We appreciate that this is challenging for them,” he said.

In past interviews, Lefebvre stressed that heroin-assisted treatment is only recommended as an appropriate intervention for individuals who have repeatedly failed with traditional therapies such as methadone.

In accordance with a B.C. Supreme Court injunction granted in May 2014, to be eligible to receive prescription heroin, a patient must have participated in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), an academic program that began at Crosstown Clinic in 2011. The average SALOME participant has failed with traditional treatment for opioid dependence an average of 11 times.

The number of eligible past SALOME participants is 202. Of that group, Lefebvre said doctors have written diacetylmorphine prescriptions for 120 patients. He declined to specify how many of that group were affected by disruptions in the supply chain.

Health Canada has steadfastly opposed Vancouver’s prescription heroin program. The province’s Health Minister, Terry Lake, has stood behind regional authorities and supported it.

This article originally appeared online at Straight.com on August 5, 2015.

Follow Travis Lupick on Twitter, Facebook, and Instagram.