It’s been a while since the Vancouver last overhauled its strategies on drugs and addiction.

A Framework for Action: A Four-Pillar Approach to the Drug Problems in Vancouver—the city's internationally-lauded guiding document that says illegal drugs should be met with equal parts prevention, treatment, enforcement, and harm reduction—was adopted by council more than 18 years ago, in May 2001.

The document was drafted in response to a rise in overdose deaths that Vancouver struggled with through the 1990s. During the peak year of that crisis, 1998, there were 400 fatal overdoses across B.C.

After Vancouver adopted the Four Pillars strategy, annual overdose deaths in the province fell to below 200, for a while. It could be argued that the Four Pillars worked. But that was before the dangerous synthetic-opioid fentanyl arrived in western Canada in 2013. Last year, B.C. suffered 1,541 fatal overdoses.

Where does Vancouver’s Four Pillars strategy stand today?

That’s the question behind a motion NPA councillor Melissa De Genova is scheduled to take to council tomorrow (October 22). It calls for the city to hire one full-time staff member to conduct a “comprehensive review” of the Four Pillars strategy.

Donald MacPherson served as Vancouver’s drug-policy coordinator from 2000 to 2009. He’s the author of the Four Pillars document. In a telephone interview, MacPherson said he agrees it’s time for a review of the Four Pillars. But he added he hopes a review occurs with one key point in mind: that his strategy was never fully implemented.

“It stalled out,” MacPherson told the Straight. “It was meant to be part of the Vancouver Agreement, with all three levels of government coming together to accelerate their response to issues in the Downtown Eastside. It was just starting to pick up steam…and then the orders of other governments changed.”

MacPherson, who today is executive director of the Canadian Drug Policy Coalition, explained that with the 2006 election of Conservative prime minister Stephen Harper, Vancouver's embrace of harm reduction largely came to a halt. Yes, in 2003 the city established North America’s first supervised-injection facility, Insite, MacPherson continued. But the Four Pillars document speaks of “injection sites”. The plan was never to stop at one because there’s only so much that a single location can accomplish. When in 2013 fentanyl crept into every city and town in B.C., there was still only Insite at 139 East Hastings Street. It wasn't until 2017 that the first injection facility opened outside of Vancouver.

“When the federal government changed, it ground to a halt,” MacPherson emphasized.

De Genova’s motion also asks for staff to report back on “new to Vancouver initiatives” that have “proven to be successful in drug policy strategy” elsewhere in the world. It mentions Portugal by name. The European country is famous in drug-policy circles for decriminalizing the personal possession of narcotics in 2001. But there were other lesser-known policies that Portugal introduced alongside decriminalization. As an alternative to the criminal-justice system, Portugal established a “Commission for the Dissuasion of Drug Addiction” for people caught with drugs. It also made massive new investments in treatment. De Genova’s motion is not just a call for decriminalization; it also mentions these other sorts of programs.

On Portugal, MacPherson cautioned that British Columbians should temper their expectations for what the so-called "Portugal Model" might acomplish in B.C.

He explained that fentanyl has never hit Europe like it has B.C. And decriminalization, MacPherson continued, only addresses the demand side of illegal drugs. “It would help users, it would destigmatize people, but this is a supply-side problem,” he said.

There are things that city could do with De Genova’s call for a drug-policy review that MacPherson said could enhance Vancouver’s response to the overdose crisis.

For example, he said, council could reinstate the title he held with the city and elevate its position within City Hall so that whoever takes the job has access to the mayor, like MacPherson did when he was drug-policy coordinator.

In addition, the city could formalize the Vancouver Police Department’s de-facto policy against arresting people for personal possession.

Finally, MacPherson said he wants to see the city regulate “opioid compassion clubs,” like it regulated cannabis storefronts before the federal government legalized recreational marijuana in 2018. That way, MacPherson said, the city could work with nonprofits and Vancouver Coastal Health to monitor illegal-opioid sales and minimize the risks of fentanyl and other unknown substances adulterating illegal markets.

“This is an emergency and there should be an emergency response,” MacPherson said.