Agenda Index City of Vancouver

POLICY REPORT
HEALTH AND PUBLIC SAFETY

TO:

Vancouver City Council

FROM:

City Manager

SUBJECT:

Framework For Action: A Four Pillar Approach to Vancouver's Drug Problems

 

RECOMMENDATION

CITY MANAGER'S COMMENTS

COUNCIL POLICY

In 1998, Council approved A Program of Strategic Actions for the Downtown Eastside which included developing directions for the City to address substance misuse issues in the Downtown Eastside and the city.

PURPOSE AND SUMMARY

This report outlines the revisions to the Framework for Action paper as a result of public input and requests that Council adopt the actions in the report as a basis for further work on developing a strategy to address substance misuse in Vancouver.

The report outlines in detail the revisions to the draft document that was widely circulated and reviewed by the public. In addition to reflecting the need for a greater emphasis on meeting the needs of multi-cultural communities and a number of minor revisions, the changes include strengthening the Prevention Pillar by including new actions focussing on measures for youth at risk and parents of young children and adolescents. A new action under the Treatment Pillar calls for long-tern residential treatment for youth. Under the Enforcement Pillar, a new action is proposed for addicted youth involved in the sex trade that would increase enforcement against customers and pimps and co-ordinate the efforts of health services to direct youth towards treatment programs.

The report also provides a brief comparative summary of four other recently released
papers on substance misuse strategies from the Federal and Provincial governments, the Lower Mainland Municipal Association and Community Directions, a Downtown Eastside community development organization.

BACKGROUND

On November 21, 2000 City Council released the draft document: A Framework for Action: A Four Pillar Approach to Drug Problems in Vancouver for public discussion. Between November, 2000 and March, 2001 the public consultation involved: six public forums, 27 meetings sponsored by residents organizations, community serving agencies and business organizations, over 25 meetings with members of the Chinese, Vietnamese, Indo-Canadian and Latin American communities, 250,000 English newspaper inserts in the Vancouver Sun, 100,000 thousand Chinese language inserts in the two major Chinese newspapers Sing Tao and Ming Pao.

Minutes were recorded of all meetings by staff of Vancouver's Coalition for Crime Prevention and Drug Treatment and several hundred feedback forms in English and Chinese were received and forwarded for analysis with all minutes of meetings before February 15 to Joan McIntyre Market and Opinion Research. In addition, since February 15, Vancouver's Coalition for Crime Prevention and Drug Treatment has conducted an ongoing collection and analysis of feedback on the Framework for Action as feedback has come in.

DISCUSSION

1. General Public Reaction

Public reaction to the Framework for Action document has been overwhelmingly supportive overall. Strong support was indicated for all four goals of the paper and many of the actions outlined in the paper. Joan McIntyre of Joan McIntyre Market and Opinion Research, who conducted the independent analysis states in her report: "The public appears to be very receptive to implementing a new integrated approach to tackle drug problems in Vancouver and welcomes the City's leadership in this area. The feedback expresses an urgent need for treatment facilities and a variety of supports for adult and youth addicts. Additionally, there is a recognized need for (greater) community involvement, prevention/education campaigns, harm reduction measures and increased and /or better-targeted enforcement efforts - all to deal with city-wide problems. The public consultation feedback also expressly asks for (better) co-ordination of services and action now". A copy of Ms. McIntyre's report is in limited circulation - copies are available at City Clerk's (Appendix A).

2. Revisions to the Framework for Action

The Revised Framework for Action is attached as Appendix B (on file in the City Clerk's Office) to this report. While the public response to the Framework for Action was very positive overall, a number of participants indicated several areas that needed further development:

· Some individuals expressed a concern that there was not enough emphasis on the Prevention Pillar in the paper and that this pillar needed to be strengthened in order to attain a balanced approach to drug and alcohol issues in Vancouver.
· Some individuals felt that there was not enough focus on the relationship between substance misuse and the sexual exploitation of youth and that there should be a stronger focus on youth, particularly "at risk" youth, in the paper.
· Others pointed out that there was not any mention of long-term treatment for youth and that this was a significant item that should be addressed given the lack of this kind of option for youth in Vancouver and British Columbia.
· Some of the input also indicated the importance of reaching out to Vancouver's multi-cultural communities and to Vancouver's Aboriginal community in order to involve members of these communities in the development and implementation of strategies to reduce the negative impact of drugs and alcohol in the city.
· Some new actions, described below, were added as a result of the input.

i) Specific Changes to the Framework for Action

The revised Framework for Action document has a number of additions in the Actions
section of each of the four pillars of prevention, treatment, enforcement and harm reduction.
In addition there are several areas of the discussion paper where issues have been more fully
discussed than in the draft paper. Below are the specific changes to the document made in
response to the public input.

1. Message from the Mayor, page 1, addition of the last two paragraphs acknowledging the public process.

2. Executive Summary, page 3, paragraph four, strengthens the interconnectedness of the four pillars and the relationship with other municipal strategies such as economic development, community safety, and other health and housing strategies. Also this paragraph notes that change must come about on a foundation of social and economic development activities.

3. Executive Summary, page 4-6, a brief overview of the public consultation has been added that outlines the major themes that came out of this public process including meetings with the multi-cultural community.

4. Regional, National and International Context: page 9, paragraph two has been added to note the recent strategy paper, Regional Action Plan to Reduce the Harmful Effects of Alcohol and Drug Misuse in the Lower Mainland, released by the Lower Mainland Municipal Association in March, 2001.

5. Section 5, The Costs of Drug Addiction, page 21, the last paragraph emphasizes that much money is being spent on the addiction issues through emergency services and that earlier intervention in a persons addiction may be much more cost effective and calls for a cost-benefit analysis of initiatives under each of the four pillars.

6. Section 6, Working Towards Solutions - A Community Effort, page 23, last two paragraphs have been added to acknowledge Vancouver's multi-cultural communities and the importance of their involvement in the development and implementation of substance misuse strategies.

7. Section 9, Provincial and Federal Responsibility, page 33, Action 6 under Prevention in the draft paper has been moved to the Action section under Provincial responsibility and slightly revised to include community consultation with regard to this issue.

8. Section 10, Pillar One - Prevention
This section has been significantly strengthened in response to the public consultations and feedback from substance misuse prevention experts. The discussion of the issues regarding prevention has been increased from just over two pages to just over 4 pages. Sections 10.4, page 35, and 10.5, pages 36-38 have been strengthened to include a broader range of issues including: acknowledging the growing body of research that is available for use in designing programs; the importance of early intervention; the importance of special populations on whom to focus prevention resources such as at risk youth; the importance of peer based supports and counselling; and the involvement of youth in the development, and where appropriate, the delivery of prevention programs.

On page 37, a new side bar has been added that summarizes the range of prevention
activities. Also, on pages 37-38 two new paragraphs appear that give more detail about the Healthy City Office that was created by the City of Toronto in 1989.

Section 10.6, Prevention Actions, page 38-39, two new prevention actions have been
added and two have been revised to be more comprehensive. Prevention Action 5 has been revised and split into two actions. Action 5 focuses solely on the establishment of a prevention/education task force. The Ministry of Education has been added to the lead
agencies and several other organizations have been added to the partner agencies.

Prevention Action 6 now focuses solely on the development of a public education
campaign regarding substance misuse prevention throughout the city. In addition, partner agencies have been expanded to include a wider range of agencies.

Prevention Action 7, page 39, is a new action that proposes a focus on parent education regarding substance misuse, particularly early parents and parents of teenagers with the goals of increasing awareness and understanding of substance misuse issues among all parents, including those with English as a second language, single parents and parents with addiction problems, and providing information and support for those parents with children who are experimenting with substance use.

Prevention Action 9, page 39, is also a new action that proposes a focus on high risk youth 8 to 13 years of age in inner city neighbourhoods, increasing contact with these youth and providing increased opportunities for youth to integrate into the community through positive peer group activities.

Section 11, Pillar Two - Treatment
Changes to the treatment section include: some minor edits to Section 11.4, page 43 with regard to the need for future social housing developments to include projects that have the necessary support services to accommodate people with addiction problems before, during and after recovery; to Section 11.5, page 44, acknowledging the ongoing evaluation of the Toronto Drug Treatment Court and Section 11.6, page 44, acknowledging the role of the College of Physicians and Surgeons in administering the provincial methadone program. In Section 11.9, pages 46-48, there is an expanded discussion of issues surrounding needle distribution, exchange and recovery. In Section 11.11, page 48, there is a brief discussion of some issues regarding mandated treatment.

Treatment Action 11, page 49, has been revised to call for a greater expansion of the
methadone program based on information provided by the College of Physicians and
Surgeons about the pace at which the program is currently expanding. Action 11 now calls
for expansion of the program in the Lower Mainland by 2000 (up from 1000 in the draft
discussion paper) over the next two years.

Treatment Action 15, page 50, is new and calls for the establishment of a long-term (eight
months to two year) treatment centre for youth with severe addiction problems. Numerous
individuals and organizations throughout the course of the consultation called for this type
of treatment centre.

Treatment Action 20, page 51, regarding the expansion and decentralization of needle
exchange has been revised to include a focus on encouraging increased responsibility among
drug users to return needles and the development of incentives to return needles and
innovative approaches to needle recovery and disposal in the community.
Treatment Action 22, page 51, has been revised to include a broader range of partner
agencies within the Federal Government and the inclusion of the Vancouver Aboriginal
Council as a partner agency.

Treatment Actions 23 and 24, page 51, have been moved from the Enforcement section
of the report to the Treatment section as they deal primarily with treatment issues that are
integrated into the criminal justice system.

Section 12, Pillar Three-Enforcement
Enforcement Action 30, page 59, is new and calls for a pilot project focussing on youth
(including addicted youth) involved in the sex trade. The action calls for a coordinated effort
involving increased enforcement against customers and pimps co-ordinated with health and
social support services to better direct individual youth to treatment programs with the goal
of preventing their return to the street sex trade.

Section 13, Pillar Four - Harm Reduction
Harm Reduction Action 34, page 65, has been revised to call for the creation of a data
base on the purity of street drugs to be used by police, health and the community to work
together to develop overdose prevention strategies. In addition the language with regard to
rave parties has been broadened and refers to the implementation of a range of harm
reduction measures to minimize the risks encountered at raves. Reference to specific
measure to be implemented such as drug testing have been omitted.

3. Other Recent Papers on Substance Misuse Strategies

The revised Framework for Action Paper is timely in that the other levels of government,
the Lower Mainland Municipal Association and one organization in the Downtown Eastside
(Community Directions) have produced discussion papers in the past several months. Below,
are brief summaries of these documents in light of a Framework for Action. Included in
Appendix C is a full summary and analysis of these four documents.

i) Federal Government Report

In March, 2001, the Federal Government released a discussion document, "Reducing the
Harm Associated with Injection Drug Use in Canada". This document was prepared by the
Federal/Provincial/Territorial Advisory Committee on Population Health as a joint effort
with four Federal/Provincial/Territorial Committees representing drugs, AIDS, Corrections
and Justice. These committees are:

· the Federal/Provincial/Territorial Committee on Alcohol and Other Drug Issues.
· the Federal/Provincial/Territorial Advisory Committee on AIDS.
· the Federal/Provincial/Territorial Heads of Corrections Working Group on HIV/AIDS.
· the Multi-disciplinary Committee of Senior Justice and Health Officials Developing a Comprehensive Canada-Wide Response to Illicit Drug Use and Emerging Substance Abuse Issues.

In addition to these committees, contributions to this paper were made by: Health Canada,
The Royal Canadian Mounted Police, the Correctional Service of Canada and Justice
Canada.

The paper recommends that the Federal, Provincial and Territorial governments take
immediate action within a harm reduction framework of: prevention, outreach, research,
surveillance and knowledge dissemination. The goals of the paper are outlined as:

· increasing efforts to address the determinants of heath and underlying factors associated with drug misuse.
· reducing injection drug-related mortality and morbidity
· reducing the incidence and prevalence of injection drug use, and
· reducing the costs and other health, social and economic consequences of injection drug use.

The document outlines a health strategy to deal with injection drug use in Canada and links
key enforcement initiatives into outreach, treatment and research. It recommends
enhancement of links between health and enforcement sectors, particularly in implementing
harm reduction measures such as needle exchange programs, addressing barriers to
treatment and considering pilot harm reduction projects in prison. Legal and justice issues
and the problem of drugs in prison are also addressed. The voluntary participation of non-
violent offenders in drug treatment courts is highly condoned as an effective, humane
alternative to incarceration as a way to address minor drug crimes and set participants on a
road to treatment and recovery.

The working document strongly emphasizes research, evaluation and development of
initiatives that address the underlying factors of drug misuse. Overall, it outlines a strategy
that recommends moving in the same direction with several similar actions and the same
urgency as the Framework for Action.

ii) British Columbia Addictions Task Group Report

In March, 2001, the Provincial Government released the report "Weaving the Threads
Together: A New Approach to Addictions in BC" prepared by the British Columbia
Addictions Task Group appointed by the Provincial Government in December of 2000. This
report is a high level report that addresses systemic issues and proposes a new partnership
between government ministries, service providers and communities in order to make the
addictions system more responsive to the needs of individuals and communities. A results
driven system is proposed, with investment in the infrastructure necessary to evaluate
outcomes and enhance knowledge and practice.

The new system is based on seven foundational principles:

V. Target groups must be involved in research, program planning, development, delivery and evaluation.

The report makes six recommendations:

1. Develop and adopt a comprehensive strategy for prevention and reducing the harm related to problem substance use and problem gambling through a system that is evidence-based, sustainable, accountable and inclusive.

2. Endorse a collaborative model in which identified ministries, agencies and communities contribute to the comprehensive strategy in a coordinated way.

3. Create a statutory body known as the "British Columbia Addiction Council" to advise government on policy relating to problem substance use and problem gambling and to provide leadership on these issues within the province of British Columbia.

4. Create a "British Columbia Centre for the Advancement of Addiction Knowledge and Practice", incorporated under the Society Act of British Columbia.

5. Adopt a local/regional cluster-based planning process, supported by the "British Columbia Centre for the Advancement of Addition Knowledge and Practice" and the "British Columbia Addiction Council" and endorsed by the Provincial Government and its ministries and agencies.

6. Create an Interim Addiction Council immediately to assist government in implementing the other recommendations in this report.

The Addiction Task Group Report outlines a health strategy that supports a prevention
framework and addresses a broad range of addictions including illicit and prescription drug,
alcohol, tobacco and gambling addiction. The strategy acknowledges that specialized
protection, prevention, harm reduction and treatment services must be situated within a
broad continuum of addiction services. It supports the development of a comprehensive
strategy that outlines a range of services required to minimize the harms caused by problem
substance use and gambling. This is not specific to, but encompasses and must be
coordinated with, programs targeted towards injection drug users.

Overall, the provincial framework is complementary to the Framework for Action paper and
recommends the actions needed to facilitate collaboration among the various agencies and
levels of governments involved in order to move forward in a cooperative and efficient
manner.

iii) Lower Mainland Crime and Drug Misuse Prevention Strategy

In March, 2001, the Lower Mainland Municipal Association released a paper titled
"Regional Action Plan to Reduce the Harmful Effects of Alcohol and Drug Misuse" The
LMMA action plan supports the long-term goal of Canada's official drug strategy "to reduce
the harm associated with alcohol and other drugs to individuals, families and communities".
It recognizes that actions taken by one community (as well as inaction) can often displace
problems to other communities, and a lack of coordination of local initiatives often leads to
duplication of efforts and poor utilization of scarce resources.

The LMMA proposes to play a coordination and advocacy role on behalf of its member
communities and to promote cooperation and the sharing of information and expertise.

The LMMA strategy has five main objectives:

The goals of the strategy fall under the following headings:

1. Leadership and cooperation
2. Primary Prevention
3. Early Intervention
4. Precautionary Harm Reduction Measures
5. Crime Control, Drug Control and Law Enforcement

The LMMA Regional Action Plan is a crime and drug misuse prevention strategy that
embraces a harm reduction approach to alcohol and drug misuse. It supports the four main
elements of primary prevention, early intervention and treatment, precautionary harm
reduction and crime and drug control and law enforcement under the overall goal of
leadership and cooperation. City of Vancouver Councillors and staff have been directly
involved in the ongoing development of the LMMA strategy, which identifies similar issues,
concerns and actions as those outlined in the Framework for Action.

The LMMA proposes to play a coordination and advocacy role on behalf of its members.
The Associations' role in promoting cooperation and sharing of information and expertise
will help to facilitate and expedite the implementation and monitoring of programs and
services in the City of Vancouver and throughout the Lower Mainland.

iv) Community Directions

In February, 2001, the community coalition, Community Directions, released a draft report
titled, "An Alcohol and Drug Plan for the Downtown Eastside/Strathcona: Draft Plan for
Community Discussion". This report outlines 27 actions to address alcohol and drug
addiction in the Downtown Eastside of Vancouver. The document adopts the four-pillar
framework of prevention, harm reduction, treatment and enforcement. It recommends a
continuum of services, a coordinated and cooperative approach, that is inclusive of the
community and those with addictions in the planning and development of services. The
report is critical of the level of emphasis that enforcement has received in the past and states
that all four pillars must be implemented equally in order to develop a successful,
coordinated strategy.

The Alcohol and Drug Plan for the Downtown Eastside has many of the elements that are
present in the Framework for Action, such as the development of a realistic substance
misuse education program, the expansion of the methadone program, a drug overdose
strategy, increased access to detox beds, better coordination and the implementation of a
strategy to better meet the specific needs of the Aboriginal community. The plan
emphasizes the need for harm reduction approaches to better address street level issues in
the Downtown Eastside and the important role of the business community and the police in
coming to understand harm reduction principles. Similar to the Framework for Action the
Community Directions plan addresses the need for accountability to all in the community
and recommends ongoing evaluation and reporting.

CONCLUSION

The Framework for Action is an important initiative by the City that has received broad
public support. The four pillar approach provides a direction for the future work with the
provincial and federal governments and the community in developing a strategy to reduce
the negative impact of substance misuse in Vancouver. The issues around addiction to drugs
are many and complex and require ongoing communication with the public and our partners
in government in determining strategies that will work for individuals and neighbourhoods
in the city. There is clearly much work taking place on substance misuse issues at the
community, regional, provincial and federal levels that will facilitate work at the municipal
level in developing local strategies to deal with substance misuse. The next steps towards
implementation of the Framework for Action are critical and will entail the cooperation and
collaboration of the provincial and federal governments, the community and service
agencies. All four pillars need to be interconnected and must be implemented across the city
as well as regionally and nationally in order to create a comprehensive strategy.

Link to Appendix A (Summary of Public Consultation Feedback re A Framework for Action).  Note:  Appendices to Appendix A are not available on the website.  Hard copies can be obtained from the City Clerk's Office.

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