How Vancouver, B.C. is Responding to the Heroin Epidemic and Homelessness in the Downtown Eastside

Last week I traveled to Vancouver, B.C. with my colleagues, Councilmembers Larry Gossett and Kathy Lambert, to visit two safe consumption sites, a community resource center, a treatment facility and a day center providing care in various forms to people experiencing homelessness and substance use disorder. All of these visits were located within eight blocks of one another in the East Hastings area of the Downtown Eastside. We had a full day at these locations speaking with people in recovery, outreach workers, law enforcement, health care providers and more. Seattle and Vancouver are both beautiful cities, but are each struggling with the effects of income inequality, increasing costs of housing and rates of homelessness, as well as illicit drug use and overdose fatalities and risks to public health and safety. I went on this tour with an open mind, knowing Vancouver is a much different city than Seattle, but aware of the opportunity we would have to learn from its efforts.

I learned that Vancouver, like Seattle, lays claim to coining the term “skid row.” The Downtown Eastside neighborhood, where logs once skidded down the street, hosts most of the city’s single room occupancy (SRO) buildings today. After the local logging industry took a downturn, these SROs became a hub for the disenfranchised and marginalized. I don’t believe there is any area in King County that precisely resembles this area, although parts of Pioneer Square, Downtown, and Capitol Hill have similar characteristics. I was surprised by how clean and affluent it is only three blocks away from this area that includes Insite, the safe consumption site that opened in 2003 that has been an issue of controversy here in Seattle. The Downtown Eastside has been a highly concentrated area for homelessness and addiction for decades. In fact, a clinic director with whom we spoke called it “the worst six blocks in North America.” Thankfully, there are many organizations working to solve these problems and assist people in need.


We began our tour early in the morning at the Powell St Getaway, which is operated by The Lookout Society, and has been a drop-in “living room” center for people who have experienced homelessness over the past 20 years. The Lookout Society is a non-profit charitable organization established in 1971 with the mission of solving homelessness, and offers a range of services 24 hours a day at 33 locations across British Columbia.

The Getaway provides clients a place to shower and do laundry, receive snacks throughout the day, and be able to get off the streets and relax as well as get referrals to housing and health care programs. We spoke with its medical director and other staff. This past July, Health Canada authorized the Getaway to add a safe consumption space with five booths as part of its services.

Getaway Booths

The Getaway serves 200 to 300 people daily, and reported having prevented 32 overdose deaths in its safe consumption site since its opening last July. It’s also important to note that the retention rate for people seeking addiction treatment through the Getaway has been above average since this program began.
Our second stop was the Lookout Society’s Hazleton Residences, a 24/7 shelter, transitional housing, permanent supportive housing, and services provider, all in one building. It was a busy place, and we couldn’t take photographs, but were able to observe the first floor common and emergency shelter space, and learned that it frequently has to turn people away due to insufficient capacity to meet higher levels of need.

Downtown Eastside Connections Board.JPG

Our third stop was at Downtown Eastside Connections Clinic. The clinic is staffed by social workers, a pharmacy, and a family doctor to help provide casework support, addiction treatment, and many other health needs for the local population.


There we spoke with staff, including the manager and medical director, and Guy Fellicella, who related his firsthand experience of what it’s like to be a long-term drug user in the area. Read more about him in the Seattle PI and the Today Show. He lived on the streets, using drugs in Vancouver’s Downtown Eastside for over twenty years. Without Insite’s supervised consumption services, Guy believes he would not be here today. He credits Insite for saving his life six times over a ten-year period by its staff bringing him back from near-fatal overdoses and by engaging him to eventually seek treatment.

Today, he is deeply thankful for the opportunity to have continued living and to have been supported on his journey to recovery. In his case, the services he received at Insite were able to help keep him alive and become a contributing member of society. Guy is now a community health liaison at Vancouver Coastal Health, and has a wife and two small children. Guy was incredibly inspiring, and will be presenting at a TED conference in May next year on his life and the power of harm reduction principles.

After that, we walked several blocks towards Insite and through the heart of East Hastings and the Downtown Eastside.

Sharps container - Vancouver Trip

Along the way we met a member of the Downtown Vancouver Business Improvement Association’s “Clean Team.” He walks the neighborhood, responding to business owners’ concerns and cleaning the streets and sidewalks of used needles. In 2015, the number of used sharps recovered from outdoor spaces in Vancouver was 250,732, according to Vancouver Coastal Health. These cleanup efforts, along with safe consumption sites, work to solve this public safety and health hazard.

naloxone kit - Vancouver Trip

He also carries Naloxone, which can be administered to reverse an overdose, which thankfully he has only had to use once so far.

cops in front of insite - Vancouver Trip.jpg

In front of Insite, we struck up a conversation with a group of three police officers who were walking by. They shared their perspective on how important it is that safe consumption sites be sanctioned and go through Canada Health’s rigorous application process. Some unsanctioned “pop up” overdose prevention sites have opened in the neighborhood, and the officers were concerned about their effectiveness. Hearing about these unsanctioned sites indicated to me how much more unmet demand there is for this service. One of the officers also emphasized the importance of being able to follow through with treatment, housing, and other wrap around services to get people off the street permanently. There are seven beat cops on each shift (two shifts per day) in the four-square blocks considered to be the high drug use area.

Unfortunately, Insite wasn’t available for an official tour, although we had been trying to schedule one for quite some time. However, I was able to step inside and look over the facility for a few minutes. It was very active. During the half hour or so we stood outside speaking with the police we saw dozens of people enter and exit the facility, all who would not be leaving dirty needles/syringes in public places.  But sadly, we observed two young women sitting in front on the sidewalk who were shooting up. The police officers said that’s not uncommon and that Insite staff will come outside to administer Naloxone if someone goes into an overdose.  I was struck by the irony of their being right at the doorstep, but not going inside.  Perhaps a first step, though, to actually go inside and get help at another time.  The key, as we learned, is to get people to trust and become engaged in a path to treatment and recovery.

The City of Vancouver has a “Four Pillars” drug strategy: harm reduction, prevention, treatment, and enforcement. Safe consumption sites are meant only for areas with high levels of public drug use and for people who don’t have a support network to keep them safe. Such sites are NOT located in affluent and suburban areas of the city and environs. They are located where they’re needed. Safe consumption sites alone will not stem the crisis of the opioid epidemic but they have proven their ability to keep people alive so the other pillars of this strategy can reach more people in need.

The heroin epidemic has been growing for years across North America, and it can be discouraging to see this problem continue despite all of the good work we saw. In particular, there’s been a marked increase in overdose deaths as a result of drugs now being laced with Fentanyl, which have been coming into Vancouver from Asia and are much more potent. We also learned of a new portable kit that can test drugs brought into safe consumption sites so users can be informed, but it is very costly to purchase. This is of enormous concern in B.C., and has not yet hit Seattle and King County. Over and over again, we heard about the escalating rise in overdose fatalities, but that the number would be much higher without the availability of safe consumption sites.

To me, this experience reinforces how vital it is to take a comprehensive approach. Canada is expanding the opening of safe consumption sites across British Columbia as well as in Ottawa and Toronto because the peer-reviewed research, along with the firsthand experience, has proven the sites save lives, reduce crime and threats to public health and safety, and support people on their journey to recovery. Public Health – Seattle and King County plans on developing its own model, not using that of Insite, in taking a comprehensive, multi-services approach in order to get people into treatment and eventually work toward full recovery.

On Monday, I joined Executive Constantine in announcing new efforts to provide treatment on-demand throughout King County for more than 20,000 people, including expansion of Evergreen Treatment Services’ mobile opiate treatment program.

As we wait for the legal dispute over I-27 to be resolved, we will continue to work on expanding our efforts in other ways but the longer we wait to implement safe consumption sites, the more lives will be lost.

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