At 55, Dianne Tobin feels she is too old to quit heroin. She started shooting up at 17. “At my age, I’ve got to live with what I have right now,” she says.

An active member of the Vancouver Area Network of Drug Users, Tobin teaches her peers how to reduce drug-related harm to themselves and the community. The group gives out supplies like needles, condoms, and clean water. Wearing a light-yellow poncho, she had just finished volunteer work—calling on people hanging out at the corner of Main and Hastings streets to have their flu shots—when she talked with the Georgia Straight.

Twice a day, Tobin goes to a site on Abbott Street for her free heroin shots as a participant in the North American Opiate Maintenance Initiative. A controlled medical study, NAOMI is testing whether or not prescribed heroin can stabilize chronic users who have not benefited from other treatment approaches like methadone therapy and abstinence programs.

Tobin has two children. Her daughter is married and living on the East Coast; her son works for an oil company in Alberta. Tobin told the Straight: “I’m content with my life.”

Harm reduction and treatment—two of the components of Vancouver’s Four Pillars Drug Strategy—have found a living expression in people like Tobin. Launched in 2001, the strategy aims to achieve a balance between public health and public safety through harm reduction, treatment, prevention, and law enforcement.

But health advocates fear that such a policy for balance may tilt under pressure from a new scheme initiated by Mayor Sam Sullivan. Launched on November 27 as “Project Civil City”, it is supposedly aimed at restoring public order. On the drug issue, Sullivan made this recommendation: “Reconfigure the Four Pillars Coalition to ensure that public disorder becomes a main area of focus over the next 24 months.”

Dr. Evan Wood, a UBC professor of epidemiology and a researcher with the B.C. Centre for Excellence in HIV/AIDS, said that the problem of public disorder arising from drug use can be resolved by recognizing that “people need a place to go”.

“When people congregate on Denman Street outside a gelato shop, there is no problem,” Wood told the Straight. “When poor people congregate at the East Side, it’s viewed as public disorder.”

Wood and his colleagues in the UBC department of medicine studied the operations of Insite, Vancouver’s supervised injection site, which opened in September 2003. In a report, they established a direct correlation between such a facility and an improvement in public order.

“All measures of public disorder showed decreases in the wake of the facility’s opening,” noted the study, published in the November 21, 2006, issue of the Canadian Medical Association Journal. These measures were the number of publicly discarded syringes, the frequency of public injection-drug use, the amount of injection-related litter, and the presence of suspected drug dealers.

“Subsequent to this, police have continued to report a qualitative decline in public drug use,” the Wood-led study noted.

A previous study, also headed by Wood, took a look at the massive drug crackdown conducted by the Vancouver police department in the Downtown Eastside in April 2003. The operation’s stated goal involved “disrupting the open drug market and interrupting the cycle of crime and drug use that marks the streets of the Downtown Eastside”, the study, published in the May 11, 2004, edition of the CMAJ, noted.

“We detected no reduction in drug-use frequency or drug price in response to a large-scale police crackdown on drug users in Vancouver’s DTES,” the study reported. It noted that the crackdown merely displaced drug dealers.

“Our results probably explain reports of increased injection drug use, drug-related crime and other public-order concerns in neighbourhoods where activities related to illicit drug use and the sex trade emerged or intensified in the wake of the crackdown,” the study said. “Future enforcement strategies should be coordinated with expanded public-health and addiction treatment strategies.”

In September 2003, the Vancouver Coastal Health Authority—which, along with the Portland Hotel Society, operates Insite using federal and provincial funding—reported that there were about 20,000 to 25,000 injection-drug users in British Columbia. In Vancouver, IDUs numbered almost 8,000, with about 4,700 in the DTES.

The agency also cited estimates from the B.C. Centre for Disease Control that approximately 30 to 40 percent of IDUs in the DTES had HIV and that 90 percent of IDUs in the DTES had hepatitis C.

Gillian Maxwell is a former member of the Vancouver Police Board who now chairs Keeping the Door Open, a coalition dedicated to preventing and reducing harm associated with drug use. Maxwell told the Straight: “The police don’t have the answer. They are part of the solution, but they are not the only solution.”

Brenda Plant is the executive director of the Turning Point Recovery Society, a group running three residential recovery facilities for people with drug and alcohol problems. “We’re definitely the treatment end of it,” Plant said in an interview with the Straight. “I applaud the city’s efforts to address the issue of civil concerns, but I think they need to still focus on treatment.”

Provincial NDP health critic Adrian Dix said a successful drug strategy entails commitment to all four pillars. He told the Straight: “To try to transform this comprehensive approach into just law enforcement is going back in time.”