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CRIM100Lecture5Summer2020R15.pptxCRIM 100: Lecture 5
Drug Addiction, Mental Health, and Homelessness
Please Note…
Warning: slides and hyperlinks include graphic, and sometimes disturbing images & content
Slides are for CRIM 100 internal use ONLY and may not be replicated, distributed or published by any means and are expressly for educational purposes by students officially registered in this course.
“Often times, when we picture an addict, we think of a homeless person begging for money. We associate homelessness and addiction, assuming that with one comes the other. This stereotype is so strong that it is often how the homeless population is depicted in TV shows and movies. There is the prevalent idea that people who are homeless are unable to take care of their own affairs and that their addiction is a sign of this failure. People often say that they do not like giving money to the homeless as they will just use the money on drugs or alcohol, and the homeless population is further stigmatized as unworthy. Though the proportion of addicts within the homeless population is high, it would be inaccurate to say that all homeless people have addiction issues. This stereotype does not help when it comes to addressing the connection between the homeless population and addiction.”
Source: Addiction and Homeless Population. Canadian Centre for Addictions.
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According to Global News, “2,223 homeless people living in Vancouver, marking the highest number since the survey began in 2002.” (Global News, July 2019).
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History of the Downtown Eastside
The downtown eastside in Vancouver is one of the oldest parts of the city, characterized by extreme drug use, prostitution, mental illness and homelessness. In the early 1980s the area experienced a major shift as it prepared for Expo 86. During this time, approximately1000 tenants were evicted from the DTES hotels to accommodate the massive tourism. Due to the increased tourist activity, drug dealers in the area began buying and selling high-purity cocaine and heroin. As a result, police tried to respond to the high levels of drug use and prostitution, but it was challenging given how fast and rampant the drug use was. As such, they dedicated their effort to focusing more on the dealers rather than the users. At this time, the government adopted the policy of deinstitutionalization of the mentally ill, resulting in the release of hundreds of patients from Riverview hospital. Some argued that many of these individuals congregated in the DTES because of the low-income housing. These individuals didn’t end up getting the community treatment they were supposed to get and soon became addicted to the drug scene in this area.
During the early 1980s to 2002, women were disappearing from the DTES, most of whom were sex workers. In 2007, Robert Pickton, was charged and convicted on six counts of murder.
During the 1990s conditions in the DTES took a turn for the worse when one of the biggest department stores, Woodward’s, closed. This resulted in devastating effect on what was otherwise a very active retail community. At this time, the city began to see major challenges with housing availability and homelessness. Without the presence of a strong economy due to retail, a drug economy emerged as did increases in crime. In 1995, crack cocaine hit the streets and, in 1997 the local health authority declared a public health emergency.
Source: Addiction and Homeless Population. Canadian Centre for Addictions.
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Mid 1980s (Expo 86)
Tourism and evictions
Drug trafficking
Deinstitutionalization of psychiatric hospitals
Drug problems escalated in the 1990
Woodward's closed
1997 declared a public health emergency
Led to new initiatives today
Prostitution
2016 declared another public health emergency
The Closure of Riverview Hospital
When Riverview hospital opened in May 1913, it was known as the “Hospital of the Mind.” The facility housed all men who were thought to be suffering from insanity. This form of mental illness was believed to be the result of hereditary or caused by intemperance, syphilis or masturbation. Over the span of 110 years, the facility began to shift its focuses to more progressive care and began implementing deinstitutionalization policies, which focuses on delivering mental health services in the community rather than in an institutional setting. However, some believed that this closure resulted in mentally ill patients congregating on the downtown eastide.
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”The number of homeless people living in Vancouver based on homeless counts conducted between 2005 and 2019. City of Vancouver.”
Source: Vancouver homeless numbers rise to highest levels since 2002, latest count shows: Global News. July 5, 2019.
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As many of you probably know, this increase was the result of the fentanyl crisis.
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Vancouver homeless numbers rise to highest levels since 2002, latest count shows
https://globalnews.ca/news/5383602/vancouver-homeless-count-results/
Please read this article to get an idea of the homelessness issue we face here in Vancouver, B.C.
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As homeless people were moved out of Oppenheimer Park, many were prescribed a safe supply of drugs
https://www.cbc.ca/news/canada/british-columbia/safe-supply-guidelines-oppenheimer-park-1.5576390
https://www.cbc.ca/news/indigenous/bc-safe-supply-opioid-pandemic-1.5565081
Critical thinking question:
Given the issues you just read about, do you agree with this approach? Should homeless people who are addicted to drugs be given a safe supply? How does the current Covid-19 pandemic affect your answer?
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Supervised Injection Sites
Given the issues on the DTES, and based on your readings for this week, this lecture examines the current challenges surrounding mental illness, drug use and criminality, by paying special attention to the Supervised Injection Sites, particularly the role of Vancouver's Supervised Injection site, Insite. Supervised injection sites are part of harm reduction – a progressive alternative to the prohibition of certain lifestyle choices. Harm reduction refers to policies, initiatives, and programs that work to reduce the negative health impacts associated with dangerous activities.
Can you think of some other examples of harm reduction initiatives or programs?
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Vancouver’s Supervised Injection Site
In 2003, INSITE opened North America’s first Supervised Injection Site, which is a safe, clean place where people with addictions can go to inject their drugs while connecting with health care professionals and addiction service providers.
Prior to considering the implementation of a SIS in Vancouver, the city formally adopted harm reduction as a centerpiece to the drug strategy to respond to what many were calling an IV drug use epidemic. And, by 2001 Vancouver adopted the 4 pillars approach. This approach was in line with Canada’s drug strategy that claims that substance abuse is primarily a health issue, rather than a law enforcement issue.
The 4 Pillars Approach was partly in response to the Mayor’s claim that enforcement was not enough of a solution, and that only an integrated approach would be effective. By focusing on all 4 pillars, the purpose was to improve the lives of both the IV users and the broader community.
InSite is funded by the Van Coastal Health Authority and operates at 500,000 a year. This site is located in the center of the downtown east side where drug use is clearly visible. There are several small parks characterized by congregations of addicted and visibly mentally disordered individuals. This site is funded by the Vancouver Coastal Authority along with Health Canada who required an evaluation of INSITE regarding its proposed health and social benefits.
Source: This information is from the Vancouver Coastal Health Wesbite (http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites/insite-user-statistics).
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Supreme Court Decision
This was the pivotal decision that paved the way for the future of Insite.
Critical thinking questions:
Do you agree? Is drug addiction a moral choice or an illness? Why or why not?
What other options or ideas do you have?
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“Serious drug addiction is not a moral choice; it is an illness which essentially negates the notion of “choice” altogether, Adopting a moral attitude toward an addict's “choices” – as the federal government did – was simply the wrong approach to take.”
Chief Justice McLachlin- Supreme Court ruling opens doors to drug injection clinics across Canada (September 30, 2011)
“Local, provincial and federal authorities combined their efforts to create it,” she said. “It was launched as an experiment. The experiment has proven successful. Insite has saved lives and improved health. And it did those things without increasing the incidence of drug use and crime in the surrounding area. The Vancouver police support Insite. The city and provincial government want it to stay open.”
What is a Supervised Injection Site?
The primary purpose of supervised injection sites is to reduce the health risks associated with the injection of drugs, to deliver drug, health and welfare services to a population that is conventionally hard to reach, and to reduce public disorder. These sites have the potential to reduce blood borne diseases and accidental fatal overdoses. In terms of delivering drug, health and welfare services, this includes providing referrals to drug substitution or detox programs, shelters, welfare services, and medical services.
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Reduce health risks
Deliver services to a population traditionally hard to reach
Reduce public disorder
Purpose of SIS
Goals of Supervised Injection Sites
THE OBJECTIVES OF SIS:
(1) reaching the target population; (2) health issues; (3) public order and safety concerns.
In terms of connecting with the target population, all SIS share a common interest in reaching as many people within the defined target population as possible. These sites largely target long term heroin and cocaine users, drug injectors, street users, and sex trade workers. The purpose is to establish an acceptable site so users can access it regularly while reducing the risks and harms associated with the public injection of drugs.
In terms of the health benefits, there are several benefits provided to the users. They provide clean needles and a safe place for the users to inject their drugs while remaining in a safe place following their drug injection, they reduce the number of discarded needles that end up on the streets, and they provide care on site.
In terms of public order and safety concerns, supervised injection sites are intended to reduce public nuisance and social disorder. The goal of such facilities is also to reduce the number of injections in public and to reduce the number of overdoses and deaths.
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Reaching the target population
Encouraging service uptake
Improving health and reducing risk behaviours
Reducing the incidence of infectious disease
Reducing drug overdose and deaths
Reducing public nuisance and disorder
Avoiding an increase in neighbourhood crime
Harm Reduction
Prior to considering the implementations of a supervised injection site, Vancouver formally adopted harm reduction as a centerpiece of its drug policy to respond to what many described as an injection drug epidemic. By doing this, in 2001, Vancouver implemented the 4 pillars approach.
This approach combines elements of public order and public health in order to create a safer, healthier community. This coalition is made up of business, government, non-profit organizations and advocacy groups to engage the community in addressing Vancouver’s drug problem.
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A philosophy of public health, intended to be a progressive alternative to the prohibition of certain lifestyles choices
Main objective is to mitigate the potential dangers and health risks associated with the behaviors themselves
Ex: Legalizing prostitution, condoms in schools, drug legalization, and safe injection sites
Benefits of Supervised Injection Sites
ARGUMENTS FOR: (1) mitigate risk to the general public by decreasing the amount of drug injecting that occurs in open public spaces; (2) reduce health, social and economic costs to the community; (3) reduce behaviors that are commonly associated with drug use such as petty theft, open drug dealing, and the appearance of drug use in open public spaces.
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Reduce Blood Borne Diseases
Reduce Fatal Overdoses
Access to On and Off Site Services
Reduce Level of Drug Use
Reduce Drug Use in Public
Reduced Levels of Crime Near Site
Reduce # of Publicly Discarded Needles
Reduce Public Nuisance
Reduce Open Drug Scene
Opposition to Supervised Injection Sites
ARGUMENTS AGAINST: (1) contend that these facilities increase the likelihood of intravenous drug use by making it easier for those who wish to inject drugs and that this type of service draws drug users from other areas to those communities with supervised injection services.
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Honey Pot Effect
Resistance to Treatment
Public Condoning of Drug Use
Increase in Acquisitive Crimes
Increase in Drug Dealing
Marginalized Remain Marginalized
Supervised Injection Sites
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Three criteria for SIS:
(1) the appearance and resilience of open drug scenes
(2) the HIV epidemic among IV drug users
(3) an increasing acknowledgment that previous policies were failing to work
Insite
This is a picture of the injection room at 195 East Hastings street in Vancouver.
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A Walk through Insite…
https://globalnews.ca/video/2580260/tour-vancouvers-first-supervised-injection-site
Please watch this videos to get an idea of what Insite looks like and how it operates.
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This is the harm reduction kit given to users upon entry to the facility.
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Please review the article and watch the video found in this link. This gives you some more information on supervised injection sites, other facilities around the world, and the benefits of such facilities.
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Insite
“Insite is a supervised drug consumption site accessible to street drug users. Insite has injection booths where clients inject pre-obtained illicit drugs under the supervision of nurses and health care staff. Clean injection equipment such as syringes, cookers, filters, water and tourniquets are supplied. If an overdose occurs, the team, led by a nurse, are available to intervene immediately. Nurses also provide other health care services, like wound care and immunizations” (Vancouver Coastal Health website http://www.vch.ca/locations-services/result?res_id=964).
“Many Insite clients are marginalized and do not have regular connections to health care services. The men and women who use Insite often have concurrent disorder. Some have a history of trauma and can be homeless, live in shelters or live in substandard housing” ( http://www.vch.ca/locations-services/result?res_id=964)
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13 individual self-injection stations
Clients must be buzzed in and security cameras are located in the facility
Clients must inject themselves and will be observed by the nurse
No restrictions on type of drug injected
Users will remain in the “chill-out” room for up to 15 minutes after so that staff can assess the medical stability of the patient
Onsite- 30 units on the 2nd and 3rd floor with detox and A&D free beds
Open 7 days a week from 9:00 am - 3:00 am, but open 24 hours a day on the Wed, Thurs, and Fri when social assistance cheques are issued
16 years and older
Insite
User statistics from January 1 – December 31, 2018
189,837 visits by 5,436 individuals
An average of 337 injection room visits per day
1,466 overdose interventions
3,725 clinical treatment interventions (such as wound care, pregnancy tests)
Substances reported used were opioids (62% of instances), stimulant (19% of instances), and mixed (19% of instances)
28% of participants were women
19% of participants were Indigenous
For the fiscal year 2017/18 443 clients accessed Onsite, the adjoining detox treatment facility, with an average stay of 11 days. Note: Clients may have been referred to other detox or treatment services elsewhere
These numbers are from the Vancouver Coastal Health Website (http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites/insite-user-statistics).
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Involves nurses, community outreach workers, drug and alcohol counselors, other health care professionals, and peers
Clients are provided with:
Water containers
New needles
Syringes
Alcohol swabs
Cooking spoons
Insite Demographics
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Designed for vulnerable populations:
Injection drug users-men and women
Addiction and mental disorder
History of trauma
Live on income assistance
Indigenous
Live in substandard housing or are homeless
Harm Reduction and the 4 Pillars Approach
What harm reduction services are offered at Insite?
“Education on safer drug use and safer sex, as well as referrals to health services, addictions services and other supports
Education and access to testing and treatment for communicable diseases as well as referrals to counseling services
Needle exchange services to promote safe recovery and disposal of used needles
Overdose prevention and response services
Referrals for clients seeking drug detox, treatment or counseling.”
This information is from the Vancouver Coastal Health Wesbite (http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites/insite-user-statistics).
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1) Prevention- Promoting healthy families and communities, protecting child and youth development, preventing or delaying the start of substance use among young people and reducing harm associated with substance use. Successful prevention efforts aim to improve the health of the general population and reduce differences in health between groups of people.
(2) Treatment- Offering individuals access to services that help people come to terms with problem substance use and lead healthier lives, including outpatient and peer-based counseling, methadone programs, daytime and residential treatment, housing support and ongoing medical care.
(3) Harm Reduction-Reducing the spread of deadly communicable diseases, preventing drug overdose deaths, increasing substance users' contact with health care services and drug treatment programs and reducing consumption of drugs in the street.
(4) Enforcement- Recognizing the need for peace and quiet, public order and safety in the Downtown Eastside and other Vancouver neighborhoods by targeting organized crime, drug dealing, drug houses, problem businesses involved in the drug trade, and improving coordination with health services and other agencies that link drug users to withdrawal management (detox), treatment, counseling and prevention services.
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4 Pillars Approach
Prevention
Treatment
Enforcement
Harm Reduction
Conclusions
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INSITE clients have similar characteristics to the target population
Positive impact at the individual level
Substantial number of referrals
Community impact requires further study
Critical Thinking Exercise
From the following positions, provide arguments for and against having a SIS in Vancouver
Business owners in the areas
Homeowner in the area
Medical personnel employed at INSITE
Police
Injection drug users
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Thank you! Amy Prevost
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