In the recent hullabaloo over Insite, Vancouver's safe injection site for drug users, critics of the facility are doing their best to create the impression that harm reduction is the recent product of radicals. Those radicals' machinations apparently have been so successful that harm reduction is now orthodoxy, while dissenters are marginalized and can even lose their jobs just for questioning Insite. This conspiracy theory might be more convincing if Insite's supposedly silenced critics didn't have such a loud voice in the national and local media, or didn't hold such non-marginal positions as health minister of Canada.
A similar debate in Vancouver in the 1950s was structured by the acknowledgment that the police, prisons and courts failed miserably in dealing with the drug problem. People from the left, right and centre argued that a dramatically different approach was needed, and proposed far more radical solutions than anything offered at Insite. What they got was more prisons and more police.
Although there were proportionately fewer hard drug addicts in Vancouver in the prosperous 1950s than before the war or anytime since, the city was caught up in its first drug panic in 30 years. Newspaper headlines such as "Teen-Age Girls Tell of Dope Orgies" implied more young people were being lured into drug addiction, but this reflected more the preoccupation with juvenile delinquency in this period than any new development. But in other ways, there were more real harms associated with heroin use than before the war.
'An addict kept his respect'
Wartime shortages caused the price of illegal drugs to skyrocket, which was bad for addicts, but a boon to organized crime. Consequently, gang violence over the lucrative drug trade was commonplace by the '50s, and users had to be full-time criminals just to feed their addiction. "A guy wouldn't be so desperate if he didn't have to pay so much for the stuff," a long-term East Hastings addict told a Maclean's reporter in 1947. "Was a time," he said, "when addicts could carry on like normal people. Drugs were cheap and it didn't take a lot of money to get all you needed. An addict kept his respect and remained congenial and polite.... To meet him then, you wouldn't have known he was a drug fiend."
The Community Chest and Council, the forerunner to the United Way, struck a narcotics committee in 1952 to examine the problem. The committee recommended a comprehensive drug strategy that included rehab centres, educational campaigns and stiffer penalties for traffickers. But what really stirred debate was its proposal for clinics that would provide maintenance-level doses of heroin to addicts.
The drug clinic scheme was intended to "maintain a constant check on the number of addicts in any community. It would also protect the life of the addict and support him as a useful member of society. This existence would hasten his rehabilitation, or at least reduce the amount of his addiction since many of the stresses in the addict's life would be reduced." What's regarded today as the novel philosophy of harm reduction was simple pragmatism in 1952.
Both The Province and Sun newspapers printed the Community Chest's report along with gushing editorials endorsing its recommendations. The Sun noted that Vancouver alone had four times as many addicts as all of Britain, leaving "little doubt that the European system of cheap drugs and medical treatment is infinitely superior to our faltering system of straight police suppression." The editor agreed that the Community Chest's plan would eliminate the illegal drug trade by "destroying its root -- the fabulous underworld profit in drugs."
Shooting at reforms
The Community Chest anticipated resistance to the drug clinics, predicting they would be "violently opposed by those who profit from drug trafficking, and one should expect opposition and interference from such criminals."
Stiff opposition did kill the clinic plan, but it came from the government rather than criminals.
To nip the plan in the bud, the head of the federal Division of Narcotic Control flew to Vancouver to dissuade the Community Chest from advocating for drug clinics. The feds also found their own expert, psychiatrist George H. Stevenson, and set him up at the University of British Columbia to research addiction.
Stevenson's team conducted a series of poorly designed studies, several of which were not even worth completing. In making the case against heroin clinics, he relied instead on historical examples from the U.S. in the early 1920s and China in the 19th century. Economics was not the root of the drug problem, according to Stevenson. Rather, it was the addicts' own distorted personalities, as reflected in their "restlessness, hedonism, selfishness, ingratitude, parasitism, cruelty, resentment of discipline and lack of concern for the future," that predisposed them to drug use and crime. One opinion that Stevenson did share with the Community Chest was that treatment had to be voluntary for it to be successful.
Even before the Stevenson or Community Chest reports, the B.C. government was already planning a large treatment centre, but there was a snag. A special committee studying the drug problem under the federal health minister opposed the project because it found that similar treatment centres elsewhere "had not proved very successful." The largest such failure was a prison hospital for addicts in Lexington, Kentucky, that the B.C. government was planning to use as a model for B.C. Attorney-General Gordon Wismer refused to be pessimistic, however, and told the media he was "determined to go ahead to see if we can prove that it will work."
Top cop wanted addict island
It took yet another inquiry into the drug problem to get the federal government to reverse its position and support the treatment centre plan. A Senate committee was launched by B.C.'s Senator Thomas Reid to look into the drug problem. It heard testimony from numerous experts and stakeholders, including addicts.
Vancouver's chief constable told the committee that addicts should all be quarantined on an island somewhere to prevent them from recruiting new users. Activist Edna MacCullie explained that no treatment options existed for a man "with a family, who took to drugs two months ago, and wants to stop before he loses his job and is caught by the police." MacCullie had been arguing for years that "Federal control and dispensation of habit-forming substances" must be the first step in any plan to deal with the drug problem.
Dr. J. Ross MacLean, one of the authors of the Community Chest report, told the senate committee about his own mini-experiment. Seven addicts were selected to receive diminishing doses of heroin. Two dropped out before the three-month experiment concluded, and another failed to make it through the withdrawal stage. One woman managed to quit drugs but started using again after her husband was killed. A couple completed the program and left town, but were rumoured to have started using again. Significantly, all seven participants were able to find jobs during the treatment, though one was fired after the RCMP disclosed his past drug use to his employer. "Discouraged, he reverted to drugs," Dr. MacLean told the senate committee.
The senate committee firmly rejected the idea of heroin-dispensing clinics. It felt that the miniscule number of addicts in Britain meant comparisons with Canada were invalid, not that they had a more effective approach overseas.
For its most heavily weighted recommendation -- to step up law enforcement, especially in Vancouver -- the committee referred not to the expert testimony at its own hearings, but to one given by American drug czar H. J. Anslinger before a special committee of the United States Senate.
Creating 'Heroin Hotel'
The government's solution to the drug problem was finally ready to go in 1966. Some called it the "Heroin Hotel" and we know it today as the Matsqui prison. Matsqui Institution was designed as a treatment centre for 300 male and 150 female incarcerated heroin addicts. The penitentiary commissioner believed that four or five similar institutions needed to be constructed for when Matsqui filled up.
Matsqui was built so that it could be repurposed as a regular prison or hospital in case the $8.7 million dollar experiment failed. And it did. By 1969, only 129 inmates occupied the 450-capacity prison, and non-addicts were soon being admitted. Mervyn Davis of the John Howard Society wasn't surprised. "You can't learn to face and handle life by being in an incubator," he said. "That is, unless you're going to live there permanently and that will be your life."
Judges tended to agree and were more likely to parole addicts than sentence them to Matsqui, which required a minimum two-year sentence. Early parole for addicts became more common in the '60s following the introduction of methadone clinics that produced much better results than Matsqui.
Death toll mounted
The John Howard Society also reported "a radical upswing in addict deaths in B.C." since Matsqui opened. Mervyn Davis explained that it was probably "the result of increasing police pressure on the drug market, which usually results in inferior drugs and a wider variety of potentially dangerous drugs -- such as barbiturates -- being used as a substitute for heroin."
By the time of the Matsqui experiment, a new drug panic was already in full swing, this time over marijuana and LSD use in the new youth culture. Heroin addicts would have to wait for anything resembling harm reduction until the 1980s, when the needle exchange was set up to curb the spread of HIV-AIDS. The harm-reduction debate wasn't truly rekindled until the '90s after a huge spike in the number of fatal overdoses (from 18 in 1988 to 200 in 1993 in Vancouver), and the health board's 1997 declaration of a public health emergency when it realized the city had the highest rate of HIV infection among injection drug users in the Western world.
The formal results of the recent NAOMI herion study aren't yet available, but unofficial reports confirm what the Community Chest and many others already knew decades ago: that the harms associated with injection drug use are greatly reduced when addicts don't have to rely on the street drug trade.
Related Tyee stories:
- 'The Dope Craze that's Terrorizing Vancouver'
The long, true history of hard drugs in Canada's poorest neighbourhood.
- Where Carla and Wayne Shoot Up
Inside the world of the Insite safe injection clinic.
- Psychedelics Could Treat Addiction Says Vancouver Official
City's drug policy honcho sees 'profound benefits'. A special report.