CITY OF VANCOUVER

FRAMEWORK FOR ACTION: A FOUR PILLAR APPROACH TO DRUG PROBLEMS IN VANCOUVER

DRAFT PILOT PROJECT PROPOSAL

INTRODUCTION

1. FRAMEWORK FOR ACTION

On May 15, 2001, after an extensive public consultation during the period November, 2000 to April 2001, Vancouver City Council unanimously approved a Framework for Action: A Four Pillar Approach to Drug Problems in Vancouver. The Framework for Action outlines a conceptual model for addressing the issue of substance misuse in Vancouver by implementing 36 actions under the four pillars of Prevention, Treatment, Enforcement and Harm Reduction over the next four years. The six-month public consultation provided an opportunity for citizens of Vancouver, service providers and community organizations to have input into the substance and direction of the Framework for Action drug strategy. During the consultation an overwhelming majority of individuals and organizations that participated expressed strong support for the actions outlined in this policy paper. (Summary of Public Consultation Feedback Regarding A Framework for Action, A Four Pillar Approach to Drug Problems in Vancouver, Joan McIntyre, Market and Opinion Research, April 24, 2000)

This pilot project proposal outlines the 18 urgent actions that must be taken as a first phase of implementation of the Framework for Action. The Framework for Action pilot project has been developed in conjunction with the Health and Safety subcommittee of the Vancouver Agreement and takes into consideration work currently being undertaken by other jurisdictions and the community in developing strategies to address substance misuse in Vancouver.

2. VANCOUVER AGREEMENT

The Vancouver Agreement, signed in March, 2000, demonstrates the commitment of the Federal and Provincial governments and the City of Vancouver to work together, within their respective jurisdictions and mandates and with the communities of Vancouver, to develop and implement a coordinated strategy for sustainable economic, social and community development. The Vancouver Agreement will be the implementation vehicle for the Framework for Action Pilot Project.

The development of a comprehensive substance misuse strategy for Vancouver is part of the work that is currently being carried out through the Vancouver Agreement. The Health and Safety subcommittee of the Vancouver Agreement has developed a set of priorities for action in the areas of Primary Health Care, Substance Misuse and Safety and Justice. The City of Vancouver, in collaboration with the Health and Safety subcommittee, has developed a pilot project based on the Framework for Action and the priorities for action in the substance misuse strategy.

STATEMENT OF NEED

In order to address the urgent health, social and economic consequences of substance misuse in Vancouver, the City of Vancouver and the Vancouver Agreement have identified the need to:

1. Develop collaborative and sustainable structures and processes to implement the Framework for Action; and to

2. Pilot and/or directly implement the 18 priority actions contained in the first phase of the Framework for Action pilot project.

The City of Vancouver and the Vancouver Agreement propose that Health Canada fund the Framework for Action pilot project as a demonstration project of the Canada Drug Strategy. Further the City of Vancouver recommends that the Federal, Provincial governments work with the City of Vancouver to fund those areas of the pilot that lie outside of the jurisdiction of Health Canada.

CONTRIBUTION TO CANADA'S DRUG STRATEGY

The Framework for Action pilot project will contribute significantly to the achievement of the five goals of Canada's Drug Strategy:

· To reduce the demand for drugs
· to reduce drug-related mortality and morbidity
· to improve the effectiveness of and accessibility to substance abuse information and interventions
· to restrict the supply of illicit drugs and reduce the profitability of illicit drug trafficking
· To reduce the costs of substance abuse to society.

The goals of Canada's Drug Strategy are addressed in the key outcomes of the pilot project. The intended outcomes in the areas of public health and public order will inform the design, delivery and evaluation of the individual priority actions.

The Framework for Action pilot project also incorporates the principles of Canada's Drug Strategy in its core values. These values will guide the development of the project's infrastructure, its processes and ensure the priority actions are implemented in a manner consistent with policies at the Federal, Provincial and Municipal level.

PILOT PROJECT GOALS AND OUTCOMES

GOALS

· To work towards the restoration of public order across Vancouver
· To work towards addressing the drug-related health crisis in Vancouver
· To create healthy, safe and sustainable communities in Vancouver
· To work with all levels of government to take action and responsibility for elements of the Framework for Action within their jurisdiction
· To create an evaluation and monitoring process for the actions in the Framework.

PILOT PROJECT OUTCOMES
1. DRUG DEMAND	· To reduce the number of people who misuse drugs in Vancouver
2. DRUG SUPPLY	· To reduce availability of illicit drugs in Vancouver · To reduce profitability of illicit drug trafficking in Vancouver and BC
3. PUBLIC HEALTH	· To increase awareness of substance misuse as a health issue in Vancouver · To reduce preventable illness and death related to substance misuse in Vancouver · To improve the health and well being of Vancouver residents
4. PUBLIC ORDER	· To reduce public nuisance related to substance misuse in Vancouver · To reduce criminal activity related to substance misuse in Vancouver · To improve the sense of safety of Vancouver residents
5. SERVICE DELIVERY	· To increase coordination of organizations, sectors and levels of government responding to substance misuse · To increase availability and accessibility of appropriate substance misuse services in Vancouver and BC · To increase accountability of organizations, sectors and levels of government responding to substance misuse
6. SERVICE COSTS	· To reduce health, social service and law enforcement costs of substance misuse

PILOT PROJECT CORE VALUES

The Framework for Action pilot project will be informed by a set of core values that provide a sound, ethical basis for decision making, action and evaluation. These values represent a synthesis of the guiding principles contained in the various substance misuse strategies, plans and papers prepared by the project's partners and other key stakeholders.

Individual and Community

· Do not create or increase harm to the individual, community and society
· Build the capacity of communities to nurture, support and care for their residents
· Focus on the health of the entire population and at-risk population groups
· Respect the dignity and rights of substance users

Service Design and Delivery

· Implement actions across all four pillars of prevention, treatment, enforcement and harm reduction in a balanced fashion
· Monitor and evaluate actions in a transparent manner with public and service provider input.
· Actively involve consumers in research, planning, development, delivery and evaluation
· Address the social, economic and environmental determinants of health
· Provide appropriate, relevant and accessible programs and services
· Actively collaborate with other sectors, jurisdictions and levels of government to deliver and sustain efforts
· Be sensitive to gender, culture and life stage in formulating policies, programs and services

KEY ASSUMPTIONS

The Framework for Action pilot project is based on the following assumptions:

· The priority actions will be based on the best available knowledge and evidence
· The priority actions will be delivered at the community level and coordinated on a regional basis as part of a continuum of health and safety services
· The priority actions will be supported at sustainable levels
· The pilot project will have effective leadership and a stable organizational structure with adequate technical, administrative and communications support
· The pilot project will be implemented by the Vancouver Agreement partners which will be accountable for results

PILOT PROJECT DESCRIPTION

1. COLLABORATIVE STRUCTURE and PROCESS

The Framework for Action will be implemented through the Vancouver Agreement.
As a strategic initiative that recognizes the need for intersectoral and intergovernmental collaboration in addressing the health and safety needs of the population, the Vancouver Agreement is the ideal vehicle for the implementation and management of the Framework for Action pilot project.

Structure

The current structure of the Vancouver Agreement will be enhanced to better support the pilot project through the development of a secretariat that will oversee a network of project-based working teams (see Figure 1).

The project-based teams will be responsible for the detailed operational, resource and evaluation planning of the 18 priority actions identified by the Health and Safety sub-committee of the Vancouver Agreement. Members of these teams will be drawn from a wide range of consumer and service organizations, community groups, and appropriate professions, across sectors and jurisdictions. The chairs of each team will report to the Health and Safety sub-committee.

The project-based working teams will support and work with community processes and projects currently underway in the area of substance misuse prevention, treatment, enforcement and harm reduction.

The Vancouver Agreement secretariat will provide technical, administrative and communications support to the project-based working teams and all three Vancouver Agreement sub-committees. This staffed unit will report to the Executive Coordinator and be overseen by the Coordinating Committee of the Vancouver Agreement.

Processes

The current operational and management processes of the Vancouver Agreement will be enhanced to better support the Framework for Action pilot project through the adoption of a set of global core values: collaborative action, evidence-based decision making, accountability, transparency, community capacity building and consumer involvement. These values will inform the plans, decisions and actions of the Vancouver Agreement secretariat, committees and project-based working teams.

2. PRIORITY ACTIONS

The Framework for Action pilot project will adopt a life-cycle approach to the implementation of individual priority actions. This approach recognizes the distinct stages in the life cycle of each action: research, planning, priority-setting, feasibility assessment (including policy analysis), prototype or model development, testing and operationalization.

To date, most of the actions contained in the Framework for Action have moved through the research and priority-setting stages. The 18 priority actions identified for the first phase of the pilot project are now at the planning stage where the broad resource and jurisdictional issues are being identified for each action. The next step will be to begin the detailed operational, resource and evaluation planning for all the priority actions.

Brief descriptions of the 18 priority actions and an implementation checklist template are contained in the appendix to this proposal.

PROJECT TIMELINE

The Framework for Action pilot project will be divided into two phases and implemented over four years. In Phase One, corresponding to years one and two of the pilot project, the Vancouver Agreement infrastructure will be enhanced to support the implementation of the overall project, and the first 18 priority actions contained in the Framework for Action will be piloted. In Phase Two, corresponding to years three and four of the pilot project, the remaining priority actions in the Framework for Action will be piloted. The Framework for Action pilot project will be divided into two phases and implemented over four years. In Phase One, corresponding to years one and two of the pilot project, the Vancouver Agreement infrastructure will be enhanced to support the implementation of the overall project, and the first 18 priority actions contained in the Framework for Action will be piloted. In Phase Two, corresponding to years three and four of the pilot project, the remaining priority actions in the Framework for Action will be piloted.

COMMUNICATION

The activities and results of the Framework for Action pilot project will be communicated to participants (consumers and service providers), Vancouver Agreement partners, key stakeholders and the public in an open and transparent manner and in accordance with the project's stated values. Communication efforts will strive to keep the issues associated with substance misuse in the public eye and to promote informed debate of those issues by citizens, service providers and public decision-makers. Each action will require analysis to establish the appropriate type of consultation/collaboration with the public and service providers.

EVALUATION

The Framework for Action pilot project will be evaluated on the extent to which it helps restore public order and improve public health in Vancouver, at a reasonable cost, and in accordance with fundamental values.

To do this, measurable outputs, (product of activities) and outcomes (intended results of activities) will be identified for the entire project and for individual priority actions prior to implementation. It is important that these outputs and outcomes are meaningful to project beneficiaries, stakeholders and decision-makers.

The project level outputs and outcomes will define broad activities and results in the areas of drug supply, drug demand, public health, public order, service delivery and service costs. For example, one broad public order outcome could be a ?reduction in drug-related crime in Vancouver? and one broad public health outcome could be a ?reduction in drug-related illness and injury in Vancouver.?

The priority action level outputs and outcomes will be nested within those of the larger project and will define specific activities and results for target groups of consumers and/or service providers. For example, one priority action calls for the testing of supervised injection sites in locations throughout the city. A specific public order outcome for that action could be a ?reduction in the open drug scene at Hastings and Main Streets?. A specific public health outcome could be a ?reduction in overdose deaths among injection drug users?.

The outputs and outcomes will be measured by indicators. These are specific, measurable and observable units of information that identify the desired change in an activity or result. In choosing appropriate indicators, it is important that they are meaningful to stakeholders, reflect the multi-dimensional nature of the activities and results, and are reliable over time.

For example, one indicator of drug-related illness could be the rate of HIV/AIDS and Hepatitis C infection among people who use injection drugs. Similarly, one indicator of an open drug scene at Hastings and Main streets could be the number of people observed dealing drugs at that location. A Framework for Action evaluation plan is attached in Appendix 2.

DISSEMINATION

The Framework for Action pilot project will benefit urban centres across Canada that are experiencing public order and public health problems associated with substance misuse. The activities and results of the pilot project will be carefully documented and disseminated to individuals, organizations, communities and other jurisdictions wishing to replicate these or similar approaches to addressing substance misuse.

SUSTAINABILITY

Funds will be required to operationalize the priority actions that are successfully piloted through this project. These funds will be solicited from the three levels of government (operational and special project funding), the Vancouver and BC business communities, and private and community foundations.

BUDGET

Year 1
Year 2
Year 3
Year 4

Phase One: Year 1 - 2

(1) Develop a sustainable Vancouver Agreement infrastructure to implement the
Framework for Action pilot project.

(2) Implement the first 18 priority actions contained in the Framework for Action

Phase Two: Year 3 - 4

(1) Implement the remaining priority actions contained in the Framework for Action

Appendix 1

Priority Actions
FRAMEWORK FOR ACTION PILOT PROJECT

PRIORITY ACTION PROFILE (SAMPLE)

TITLE:

REFERENCE #: PILLAR:

DESCRIPTION:

IMPLEMENTATION CHECKLIST:
ISSUE	YES*	NO	N/A
Legislative change required
Regulatory change required
Policy development required
New programs required
MOU or administrative agreements required
Service or funding partnerships required
Community mobilization or action required

* If yes, proceed with appropriate analysis and development of options

RESOURCES REQUIRED:
Financial Resources:
Capital:	Operating:

Human Resources:
FTE:	Category/Profession:

IMPLICATIONS:
	Gender	Culture	Life-Stage
Benefits for target group
Disadvantages for target group
Constraints to equitable participation

FRAMEWORK FOR ACTION PILOT PROJECT

PRIORITY ACTION PROFILE - Example

TITLE: Integrated Pilot Prevention Projects for high risk youth eight to thirteen years of age and their families, in neighbourhoods that meet the socioeconomic criteria definition of ?inner city?.

REFERENCE #: Framework For Action - Action 9 PILLAR: Prevention

DESCRIPTION: Integrated pilot projects will focus on increasing involvement with high-risk youth in this age range and their families. Critical programming will provide positive peer interaction, strengthen constructive connections to community, provide access for crisis intervention, improve the abilities of communities to provide support and involvement to these youth and their families and involves youth and families in the development of the programs.

IMPLEMENTATION CHECKLIST:
ISSUE	YES	NO	N/A
Legislative change required		NO
Regulatory change required		NO
Policy development required	YES
New programs required	YES
MOU or administrative agreements required	YES
Service or funding partnerships required	YES
Community mobilization or action required	?	?

RESOURCES REQUIRED:
Financial Resources:
Capital:	Operating: Salaries, program enhancements to existing programs that have contact with this population.

Human Resources:
FTE: four			Category/Profession: Youth workers, coordinators, one to one workers, alcohol and drug counseling experience
LENS ANALYSIS:
	Gender	Culture		Life-Stage
Opportunities		Disproportionate number of Aboriginal youth		Youth eight ? thirteen years of age
Constraints

A full discussion of the issues outlined above would appear here and so on with each action. The appropriate working group including government, agency and community people working on this particular action would identify issues and flesh out in great detail what evaluation indicators and measures might be considered.

Framework for Action - #9

Prevention Project for High Risk Youth

Action #9: Develop and implement integrated pilot prevention projects for high risk youth, eight to thirteen years of age and their families, in neighbourhoods that meet the socio-economic criteria definition of "inner city". Focusing on increasing involvement with these youth and their families, critical programming should occur which provides positive peer interaction, strengthens constructive connections to their communities, provides access for crisis intervention, improves the ability of communities to provide support and involvement to these youth and their families and involves youth and families in the development of the programs.

Lead Agencies: Ministry for Child and Family Development, City of Vancouver.
Partner Agencies: Vancouver Richmond Health Board, Neighbourhood Houses, Community Centres, and other community serving agencies.

FRAMEWORK FOR ACTION PILOT PROJECT

PRIORITY ACTION PROFILE - Example

TITLE: Establish a prevention/education task force to develop a pilot, city-wide school curriculum for elementary and high school students.
REFERENCE #: Framework for Action - Action 5 PILLAR: Prevention

DESCRIPTION: Establish a task force to develop substance misuse prevention curriculum for elementary and high schools that is interactive, age-appropriate, and delivered by classroom teachers. The program would be designed to enhance d4ecision making and refusal skills, promote dialogue, convey accurate information concerning substances, assist students to delay drug use and/or get help if they are using, support mental health and foster sense of connectedness and optimism.

IMPLEMENTATION CHECKLIST:
ISSUE	YES	NO	N/A
Legislative change required		NO
Regulatory change required		NO
Policy development required	YES
New programs required	YES
MOU or administrative agreements required	YES
Service or funding partnerships required	YES
Community mobilization or action required	?	?

RESOURCES REQUIRED:
Financial Resources:
Capital: Printing, translation etc. Graphics	Operating: Consultants

Human Resources:
FTE:	Category/Profession:

LENS ANALYSIS:
	Gender	Culture	Life-Stage
Opportunities
Constraints

A full discussion of the issues outlined above would appear here and so on with each action. The appropriate working group including government, agency and community people working on this particular action would identify issues and flesh out indicators and measures that might be considered within each action.

Framework for Action - #5

Prevention Education Task Force

Action #5: Establish a prevention/education task force to develop a pilot, city-wide school curriculum for elementary and high schools (K-12) that is interactive, age-appropriate, and delivered by classroom teachers (with some participation from resource people such as nurses, police, counselors). The program would be designed to enhance decision making and refusal skills, promote dialogue, convey accurate information concerning substances, assist students to delay drug use and/or get help if they are using, support mental health, and foster a sense of connectedness and optimism. Members of the task force would include the Vancouver School Board, Vancouver Elementary and Secondary School Teachers Association (VESTA), the British Columbia Teachers Federation (BCTF), Ministry of Education, Ministry for Children and Family Development, Vancouver Richmond Health Board, City of Vancouver, Vancouver Parks Board, Vancouver Police Department, addiction prevention specialists, parents of addicted children, youth and community representatives.

Lead Agencies: Ministry of Education,
Partner Agencies: City of Vancouver, Vancouver School Board, Vancouver Richmond Health Board, Vancouver Police Department, Vancouver Coalition for Crime Prevention and Drug Treatment, VESTA, BCTF.

Framework for Action - # 6

Prevention Education Task Force

Action # 6: Develop a public education campaign to be delivered by community centre, neighbourhood houses, public institution, business organizations and through the mass media that targets the general public as well as specific populations such as pre-drug using children, university/college students, children in alcohol or drug dependent homes, women, seniors, ethnic and cultural communities, immigrants and other groups in society.

Research on prevention efforts indicates that learning outcomes and decision making strategies regarding substance use/misuse are most effective when individuals receive consistent messages from a variety of sources including schools, community centres, the mass media etc. This action will build on the broad public education and consultation effort that the development of the Framework for Action has achieved. Implementation of this action will deepen the broader community discussion of substance misuse issues, provide educational forums, tools, and materials to organizations at the community and neighbourhood level. The campaign will allow the public discussion of substance misuse to move to a neighbourhood level and will enable the major ethno-specific communities within Vancouver to participate more fully in a public process that has been taking place primarily using a variety of English language media.

This campaign will speak to a broad public audience as well as acknowledging specific populations that may be at higher risk for developing substance misuse problems.

Framework for Action - #14 and #15

Expansion of treatment services for Youth.

Action 14: Establish 20 treatment beds for youth outside of the Downtown Eastside in several small, low-community-impact, residential treatment programs that recognize the role of drug misuse and risk taking in adolescent development; have safety and the long-term well being of youth, rather than abstinence, as the overriding goal; and recognize that abstinence is also an important goal for many.

Action 15: Establish a long-term (eight months to two years) treatment centre for youth with severe addiction problems. The philosophy should embrace the whole person and provide a range of educational programs, skill development, job training and linkages back to housing, family (where appropriate) and the community in addition to addiction treatment in order to prepare individuals for return to the community.

Expansion of treatment options for youth are an immediate priority for the Vancouver Agreement Health and Safety subcommittee. The Vancouver Richmond Health Board has recently received responsibility for the development of addiction services for youth and is in the process of conducting an analysis of the current capacity and organization of these addiction services. There are two main issues that must be addressed through these actions. First there is a need for more capacity so that when youth present themselves as wishing to get into treatment there is a treatment spot for them readily available. Second, there is a need for a place for youth to get away from the drug scene or from their current living situation for a significant amount of time (eight months to two years) in order to work towards building self esteem, learning new skills that will allow them to consider and achieve healthier life strategies.

Framework for Action - # 11

Increased Access to Methadone

Action #11: Increase methadone availability by removing current barriers (such as user fees, counseling fees, and restrictive regulations) for the methadone maintenance program in order to treat an additional 2,000 clients in the Lower Mainland over the next two years, with the Downtown Eastside as a priority area for expansion. Continue the expansion of the Provincial methadone Maintenance Treatment programs within other areas across Vancouver and the province where there is a highly marginalized group of opiate users and those who use opiates and stimulants in combination.

Lead Agency: Ministry of Health Services
Partner Agencies: College of Physicians and Surgeons, Vancouver Richmond Health Board, BC College of Pharmacists.

Increasing access to methadone in British Columbia is seen as an integral part of building a comprehensive system of care for those with addiction problems in British Columbia. In an effort to provide an opiate replacement therapy for a greater number of opiate users the British Columbia methadone program administered by the College of Physicians and Surgeons has expanded in recent years from 1,491 patients in 1995 to close to 6,500 in 2001. There continues, however to be considerable room for improvement as barriers to methadone treatment persist. These include:

· Delays in access
· User and dispensing fees
· Additional fees for counseling
· Too few physicians who are licensed to prescribe
· Restrictive rules and procedures
· Lack of integration with other addiction services

New and innovative approaches to methadone prescribing should be considered in an effort to maximise contact with the population of opiate users in the region.

Framework for Action - # 19

Heroin Assisted Treatment Research

Action #19: Proceed with the proposed multi-city clinical research trials into the feasibility of heroin-assisted treatment through St. Paul's hospital and the BC Centre for Excellence in HIV/AIDS Research in Vancouver and other Canadian cities for those who are methadone-resistant or who have not responded to treatment options over the long term.

Lead Agency: Health Canada
Partner Agencies: Ministry of Health, BC College of Physicians and Surgeons
Partner Agencies: Ministry of Health, BC College of Physicians and Surgeons

The North American Opiate Medications Initiative (NAOMI) research project into heroin-assisted treatment is currently under review by the Canadian Institute of Health Research. This project, if approved will allow Canadian researchers in several Canadian cities to develop knowledge of the benefits of heroin-assisted treatment for long term heroin users.
Framework for Action - #20

Expansion of Needle Exchange Services

Action #20: Expand and decentralize needle-exchange in all primary health care clinics, hospitals, pharmacies and through non-profit groups and user groups. Encourage increased responsibility among drug users to return needles by developing incentives and innovative approaches to needle recovery and disposal in the community.

Lead Agencies: Ministry of Health Services and Vancouver Richmond Health Board
Partner Agencies: BC College of Pharmacists, City of Vancouver

There has been an increasing call for the decentralization of services for intra-venous drug users throughout the city and the region. Currently needle exchange services are centrally located in the Downtown Eastside with several locations exchanging needles in other parts of the city. The VRHB is currently in the process of reviewing needle exchange in Vancouver and Richmond with a goal to integrating Harm Reduction philosophy and services within service sites city-wide.

Framework for Action - #21

Low Threshold Support Programs

Action #21: Pilot accessible (low threshold) support programs of day centres for addicts in neighbourhoods outside of the Downtown Eastside to help prevent those who use drugs, particularly youth, from becoming more deeply involved in the inner city drug scene.

Lead Agencies: Health Canada, Vancouver Richmond Health Board
Partner Agencies: City of Vancouver, Ministry of Health Services, Ministry for Children and Family Development

Low threshold support programs operate out of a variety of facilities and provide a place for people to get off of the street, get away from the drug scene and engage with others, in positive activities. Support programs can be found in a variety of forms, including employment and skills training, contact cafes, day centres, art and poetry workshops or other types of programs with the goal of integrating those with substance misuse problems into the community. These programs provide the necessary linkages with other treatment programs, social services and employment programs and housing. Often basic services such as food, showers, telephones and laundry are provided. These programs can exist as stand alone facilities or exist as an adjunct to other service delivery programs and structures.

Implementation issues may include:

· integration of programs and facilities into existing service infrastructure
· community education and awareness and support for such programs in specific neighbourhoods
· service partnerships among community serving agencies
· linkages to treatment and post treatment support programs
· ensuring sustainable funding arrangements
· appropriate locations

Framework for Action - #12

Supportive Housing Continuum

Action #12: Ensure that a continuum of supportive housing is developed including housing and /or shelter to stabilize those who misuse drugs and alcohol, and drug- and alcohol-free housing for individuals in recovery and that funding from the Ministry of Health Services for support services to new LIUS projects is tied to new allocations of these units.

Lead Agency: BC Housing
Partner Agencies: Ministry of Health Services, Vancouver Richmond Health Board, City of Vancouver, Human Resources Development Canada.

Framework for Action - #35

Mental Health and Concurrent Disorders.

Action #35 - Develop appropriate housing for those with mental illness throughout the region and the province.

Lead Agency: BC Housing
Partner Agencies: Vancouver Richmond Health Board, City of Vancouver, Ministry of Health Services, and municipalities throughout the province.

Substance misuse interventions, including housing and housing supports, for those with concurrent disorders continues to be a high priority within the Lower Mainland region. The frequency of concurrent disorders is well documented and poses additional challenges to service providers. People with mental health problems are particularly vulnerable to injection drug use and they are not well suited or well served by group interventions.

The move towards de-institutionalization of the mentally ill without adequate housing, medical and support structures has left many homeless and hopeless. Integration into the addictions system of services for those with concurrent disorders is a critical next step in the development of a comprehensive addictions system for Vancouver.
Framework for Action - #30

Sexual Exploitation of Youth

Action #30: Develop a program for youth, including addicted youth, involved in the sex trade that would integrate enforcement efforts against customers and pimps and co-ordinate with health and social support services to direct youth to treatment programs with the goal of preventing their return to the street sex trade. In addition this project would need to give special consideration to certain groups such as aboriginal youth.

Lead Agencies: City of Vancouver, Vancouver Police Department, Ministry for children and family development
Partner Agencies: Ministry of Health Services, Vancouver Richmond Health Board, Attorney General, Solicitor General (Provincial), Justice Canada, Service providers.

Framework for Action - #25

Strengthen Local and Regional Drug Squads

Action #25: Increase the Organized Crime Unit, the Vancouver Police Department Drug Squad and the RCMP Drug Squad unit in order to better target organized crime, drug houses that cause neighbourhood disruption and mid and upper level drug dealers that supply street level drug dealers.

Lead Agencies: Solicitor General (Federal), Solicitor General (Provincial), and City of Vancouver.
Partner Agencies: Vancouver Police Department, Organized Crime Unit, and RCMP.

The scale of the illicit drug market within the Lower Mainland currently overwhelms police and other enforcement agencies. In addition to drug enforcement measures targeting illicit drugs, police and enforcement agencies allocate significant resources towards enforcing regulations and dealing with crime related to alcohol, other legal substances and addiction to gambling among some individuals.

The market in drugs and alcohol in the Downtown Eastside area of Vancouver draws customers from the entire Lower Mainland region and overwhelms this community with the negative impacts of such a market in an inner city neighbourhood. Recent enforcement efforts by police and other enforcement agencies have had some positive impacts over time but have been difficult to sustain and often simply displace drug markets a short distance without lasting effects. Efforts to improve enforcement on problem bars and hotels have contributed to increased order within bars and hotels and to some extent has created more disorder in the public realm as drug market activities have been forced outside.

Increasing interdiction, particularly at the wholesale level, and targeting businesses that exist to support the drug trade will reduce the scale of the drug market in this community and bring some level of relief to residents and business owners in the area.

The increasing collaboration among Vancouver Agreement partners, enforcement agencies and the community will provide a sound basis for improving the enforcement strategy within the city of Vancouver.

Framework for Action - #32

Supervised Consumption Sites

Action #32: Establish a multi-sectoral task force with representation from all levels of government to consider the feasibility of a scientific medical project to develop safe injection sites or supervised consumption facilities in Vancouver and in other appropriate areas in the region and across the country in order to reduce health risks and minimize open drug scenes.

Lead Agency: Health Canada
Partner Agencies: Vancouver Richmond Health Board, City of Vancouver, Vancouver Police Department, RCMP, Solicitor General (Provincial), Ministry of Health Services.

The federal government has established a multi-sectoral committee to explore the feasibility of supervised consumption facilities within a Canadian context. These kinds of facilities have been shown to be an important element in a comprehensive approach to addressing both public health issues and public order issues with regard to inner city drug scenes. Currently the committee is conducting an environmental scan of Canadian cities to determine in which locales pilot projects may be desirable.

Supervised consumption sites address 3 problem areas:

· Public consumption of drugs. Consumption sites allow for an enforcement strategy that directs drug users to inject within specified facilities that are officially sanctioned, supervised, and removed from the public realm. The public nuisance created by open injecting is eliminated and the litter associated with used drug paraphernalia is contained.
· Overdose risks are reduced
· Access to clean injecting equipment is maximized.

The establishment of supervised consumption sites will benefit both the communities in which consumption sites exist and drug injectors who at this time may be injecting in high-risk situations such as back alleys, hotel rooms, public washrooms etc.

A local multi-sectoral task force to explore the feasibility of this type of substance misuse intervention should be set up to link Vancouver with activities taking place at the national level.
Framework for Action - #33

Overdose Prevention Strategies

Action #33: Implement an overdose death prevention campaign that involves the Vancouver Richmond Health Board, Vancouver Police, BC Ambulance Service, City of Vancouver, Ministry of Health Services, Health Canada, Drug User Organizations and community agencies in the development of overdose prevention strategies.

Lead Agency: Vancouver Richmond Health Board
Partner Agencies: Vancouver Police Department, BC Ambulance Service, City of Vancouver, Ministry of Health Services, Health Canada.

Overdose deaths continue to occur at an alarming rate in Vancouver. Recent attention to education with regard to the risks of injection drug use and practices that users can perform to minimize these risks may have had some impact in the recent modest reductions in overdose death figures. However death rates from overdose while showing some decrease in recent months continue to be high on an annual basis. A comprehensive and integrated city-wide overdose prevention campaign will maximize public health efforts to address this issue and contribute to the public discussion regarding addiction as a public health issue that must be addressed.

Framework for Action - #3

Policy Framework to Reduce Harm

Action #3: The Provincial Government implement a policy framework for reducing the harms to the community and individuals associated with alcohol, tobacco and illicit drugs to guide and inform municipal decision makers in determining priorities for action.

Framework for Action - #22

Aboriginal Strategies and Services

Action #22: Commit to creating a range of culturally appropriate strategies and services for Aboriginal persons within the four pillars of prevention, treatment, enforcement and harm reduction with a priority on the development of services for Aboriginal women with addictions and Aboriginal youth at risk.

Framework for Action - # 1

Development of Substance Misuse Services In All Municipalities

Action #1: The Provincial ministries responsible implement policy that ensures municipalities throughout British Columbia support the development of a full range of drug and alcohol services.

A major premise underlying the development of a comprehensive substance misuse strategy for the Lower Mainland is the development of appropriate services for those with addiction problems in all areas of British Columbia. Municipalities across the Province and particularly in the Lower Mainland must ensure access to services for their citizens under all four pillars of Prevention, Treatment, Enforcement and Harm Reduction.

Appendix 2

Framework For Action

Draft Evaluation Plan

(c) 1998 City of Vancouver