International Journal of Drug Policy 17 (2006) 127132

Policy Analysis

The evolution of drug policy in Vancouver, Canada: Strategies

for preventing harm from psychoactive substance use
Donald MacPherson , Zarina Mulla, Lindsey Richardson
Community services, City of Vancouver, 453 West 12th Avenue, Vancouver, BC, Canada V5Y 1V4

Received 6 October 2005; received in revised form 13 October 2005; accepted 16 October 2005

Abstract

In December of 2000, the City of Vancouver released its Four Pillars Drug Strategy in response to a serious public health crisis driven by illicit
drug use in Vancouver. Following initial actions in the area of harm reduction and enforcement, in June 2005 the City of Vancouver developed
its draft prevention plan titled Preventing Harm from Psychoactive Substance Use. The plan is based on a synthesis of international research
and evaluation, examples of successful programs from other jurisdictions, and a community dialogue process. Its recommendations fall under
five key prevention priorities, including reducing risk factors and increasing protective factors across the life course, community centred
interventions, addressing impacts on communities, legislative and public policy change and regulated markets. Together, these prevention
priorities form an integrated plan to prevent harm from substance use. This article provides a description of the process leading to the
development of the plan and seeks to articulate its key strategies.
2006 Published by Elsevier B.V.

Keywords: Prevention; Policy; Drugs; Cities

Introduction conditions for an HIV epidemic among injection drug users

Vancouver has always been home to a large proportion of
the heroin users in Canada and the Downtown Eastside has a
history of having a significant heroin-using population. How-
ever, in terms of drug-related harm, the drug that historically
was the primary cause of drug-related harm in the community
was alcohol. However, something changed during the latter
part of the 1980s. There was a significant shift in the market-
ing and use of heroin and cocaine in the Vancouver region
and throughout the Province of British Columbia (BC). By
1990, the Downtown Eastside was home to one of the fastest
growing open-air drug markets in Canada, an infrastructure of
illegitimate businesses to support this market, and the epicen-
tre of an epidemic of property crime. In 1993 there were 200
overdose deaths in Vancouver and close to 400 in the Province
of British Columbia. Highly potent heroin appeared on the
market as well as cheap powder cocaine. Something had gone
seriously wrong and people were dying in great numbers. The
Corresponding author. Tel.: +1 604 871 6040.
E-mail address: donald.macpherson@vancouver.ca (D. MacPherson).
were developing, the drug trade was overrunning a commu-
nity and no one in authority and few in the community really
understood what was occurring. A public health disaster was
beginning to take place.
In 1993 the Chief Coroner of British Columbia, Vince
Cain, announced a special task force to look into the rash
of overdose deaths. The report he produced after months
of public consultations was a hard hitting and comprehen-
sive analysis of a broken system (Cain, 1994). He called for
strong action to address the flaws that he saw in our approach
to addiction to illegal drugs. He called for society to view
addiction as a health issue to be addressed by health care
interventions.
Cain called for a total overhaul of the drug treatment sys-
tem and the fashion in which the criminal justice system
addressed addicted individuals. He also suggested that the
criminalisation of these substances contributed significantly
to the harm that we were seeing in our communities and posed
the question, Should we consider decriminalisation or legal-
isation for some, if not all of illegal substances? There was
no doubt in Cains analysis: the status quo was not working

0955-3959/$ see front matter 2006 Published by Elsevier B.V.

doi:10.1016/j.drugpo.2005.10.006
128 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132
and urgent action was required to fix it. Unfortunately little
action came as a result of the Cain Report. The paper gath-
ered dust on the shelves of government while the drama in the
inner City of Vancouver played out with devastating results
throughout the decade 19902000.
A Four Pillar Approach
In December of 2000, the Mayor of Vancouver, Philip
Owen, released the Citys drug strategy: A Framework for
Action: A Four Pillar Approach to Drug Problems in Van-
couver (MacPherson, 2000). The release of the Four Pillars
Drug Strategy was the municipal contribution to efforts that
were being mounted by the local health authority, the Vancou-
ver Police and the provincial and federal governments and the
community to respond to a serious public health crisis in Van-
couver. The strategy articulated a comprehensive approach to
addressing the dire circumstances existing in Vancouver and
challenged the status quo by calling for new and innovative
interventions such as supervised injection sites and heroin
assisted treatment programmes where heroin users receive
pharmaceutical grade heroin. The strategy stated clearly that
Fig. 1. Preventing Harm from Psychoactive Substance Use: prevention priorities, areas of action and recommendations.
addiction should be treated as a health issue and that actions
across the four pillars of Prevention, Treatment, Harm Reduc-
tion and Enforcement be implemented to reduce the negative
impact of the sale and use of illegal drugs on individuals
and the community. The strategy was inclusive of health and
enforcement and had a main goal of public health and pub-
lic order. The Citys proposed drug strategy was a catalyst
for a broad public discussion that took place over the win-
ter of 2001 culminating in the adoption by Vancouver City
Council of the Four Pillars Drug Strategy in May 2001. Most
importantly though, the development of the drug strategy,
lead by then Mayor Philip Owen, brought the issue of addic-
tion into the political arena. The drug strategy became part
of a political process that saw civic politicians appealing to
other levels of government to work together with the city to
fund and implement the plan. The civic election of 2002 saw
a new mayor, Larry Campbell sweep to victory promising
to implement the Four Pillars Drug Strategy and open North
Americas first supervised injection site as soon as possible
after being elected.
The initial emphasis of the Four Pillars Drug Strategy was
a call to action across all four pillars to reduce the drug-
related harm occurring in Vancouver at the time. It focused
 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132
on harm reduction initiatives such as supervised injection
sites in the Downtown Eastside, a call for the expansion of
addiction treatment interventions and the development of a
policing strategy to disrupt the open-air drug market. During
the initial phases of the work, there was little emphasis on pre-
vention efforts or much analysis of what prevention activities
were taking place in Vancouver. Prevention of problematic
drug use was seen as a longer-term proposition and an area
that was not well understood by the general public. Simplis-
tic notions of prevention dominated the public discourse. As
part of the Four Pillars Drug Strategy, staff began developing
a prevention plan in the fall of 2003, holding a symposium
that initiated a dialogue on prevention of problematic drug
use in Vancouver and considered the best evidence of what
works in the field of prevention. In June of 2005, the City of
Vancouver released a draft plan: Preventing Harm from Psy-
choactive Substance Use (MacPherson, Mulla, Richardson,
& Beer, 2005). The plan was adopted unanimously by Van-
couver City Council on 3 November 2005. This article will
articulate the key strategies of this prevention plan (Fig. 1).
The prevention pillar
The prevention planPreventing Harm from Psychoac-
tive Substance Useis based on a synthesis of international
research and evaluation, examples of successful programmes
from other jurisdictions, and a community dialogue process.
Fifty dialogue sessions were conducted with various stake-
holder communities, representing different life stages, sexual
orientations, ethnicities, vulnerable populations and service
providers. These sessions provided valuable input about the
issues, obstacles and visions specific to each of these commu-
nities, and their input has been incorporated into the content
of the plan.
The plan draws on a number of perspectives on
preventionranging from population health models to
community-based, legal and regulatory approachesand
recommends strategies that have shown the strongest evi-
dence for success. The plan acknowledges that the use of
psychoactive substances is a part of our society and that the
desire to alter consciousness with psychoactive substances is
natural. The plan recognizes that drug use can occur across a
spectrum of use from beneficial or therapeutic uses to recre-
ational uses moving into problematic drug use. The plan is
predominantly concerned with problematic and dependent
substance use, or use that has clear harmful effects on individ-
uals and society, and seeks to expand awareness, understand-
ing and discourse around prevention. The intended outcomes
for this plan include reduced individual, family, neighbour-
hood and community harm from substance use, delayed onset
of first substance use, reduced incidence and prevalence
of problematic substance use, and improved public health,
safety and order. The plan identifies significant gaps in local
prevention capacity, and recommends institutional support
for municipal research and programme delivery, mechanisms
129
for collaboration among prevention practicing individuals
and organisations, and the establishment of monitoring and
evaluation bodies. The creation of a sustainable prevention
infrastructure within the Vancouver region is central to, and
the first step towards, the implementation of effective preven-
tion initiatives.
The plans other recommendations fall under five key pre-
vention priorities. These priorities are: reducing risk factors
and increasing protective factors across the life course, com-
munity centred interventions, addressing impacts on com-
munities, legislative and public policy change and regulated
markets. Taken together, these prevention priorities form an
integrated plan to prevent harm from substance use.
Risk and protection across the life course
This prevention priority focuses on risk factors for harmful
substance use and protective factors that mediate individ-
ual risk across ones lifetime and at key transition points.
It identifies strategies that prevent harm from use through
mutually reinforcing change at the individual, family and
community levels. These strategies, which include support
for non-use and safer substance use, target both the general
population and specific groups at increased risk of harm. Rec-
ommendations reflect this, and include calls for support for
the best early childhood care and learning programs for fami-
lies, engaging young people in meaningful activities, creating
healthy school environments and educating parents and fam-
ilies. Prevention initiatives can also be directed throughout
adulthood as individuals move through life transitions. A rec-
ommendation to develop a strategy for older adults who are
particularly vulnerable to problems from alcohol and phar-
maceutical drug use is included. In addition, targeted social
marketing and mass media campaigns, combined with a local
media advocacy strategy will increase public understanding
and bring these issues to the fore.
Community-centred prevention
This prevention priority focuses on the community as the
primary site of intervention. Community centred interven-
tions attempt to build capacity for individuals and organisa-
tions to engage at the local level in developing prevention ini-
tiatives. It acknowledges that harmful drug use is influenced
by broad social determinants of health. The recommendations
in this priority call for assistance to vulnerable populations
through employment and housing supports as well as meth-
ods to strengthen community capacity through information
sharing, networks, coalitions and the development of a sus-
tainable youth engagement strategy.
Addressing impacts on communities
This prevention priority focuses on addressing the
impacts from problematic and dependent substance use on
the community. It is based on the need to keep community
130 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132
neighbourhoods and the environment as safe and healthy
as possible within the context of active substance use. This
priority outlines initiatives that can reduce the impacts of
harmful use in public places, on individuals in potentially
high-risk situations, and on neighbourhoods. The focus is
on individual well being, public safety and order, the social
and economic health of communities, and the environment.
The plan recommends implementing a Safer Bars Pilot
Program to deal with violence in bars and clubs as well as
neighbourhood disorder, addressing the dangers associated
with clandestine methamphetamine production labs and
developing a city-wide syringe recovery program.
Legislative and public policy change
The prevention plan takes the position that there is a ceiling
to what can be achieved through prevention efforts without
considering changes to the legal frameworks within which
psychoactive substances exist. The plan states that the his-
torical policy of prohibition of certain drugs has failed in its
attempt to eliminate availability of illegal drugs and their con-
sumption. Markets for these substances continue to flourish
and street level prices are at an all time low.
Preventing Harm from Psychoactive Substance Use
explores how prohibition as a policy restricts governments
ability to stop, influence, administer or regulate the produc-
tion, sale, and consumption of these substances. A policy of
prohibition prevents the possibility of controlling both access
to these substances and the circumstances surrounding their
use, and as a result, how these substances impact our commu-
nities. The plan takes the position that as a society we must
move towards considering alternatives to prohibition and that
currently illegal psychoactive substances must not be left in
the hands of organized criminals and unregulated dealers.
To address psychoactive substance use in a proactive, pre-
ventative way, it is important to create a legal context that
enables a more appropriate and nuanced response than the
simple prohibition of these substances. The focus of this sec-
tion is therefore the reduction of policy-related harm through
the creation of public health focused and evidence-based
legal responses to substance use. This plan recommends that
the Federal Government adopt a legislative framework to
deal with currently illegal substances based on population
health models, the relative toxicity of each substance and
each drugs potential for creating dependency. It also rec-
ommends changes to Canadas current proposed legislation
to depenalize the possession and use of small amounts of
cannabis to enable a comprehensive cannabis strategy.
Market regulation
Legal structures also determine which regulatory mecha-
nisms are available for market intervention. Alcohol, tobacco
and pharmaceuticals are legal psychoactive substances that
all levels of governments control through regulations and
taxes. This priority describes ways in which it is possible
to regulate the production, sale and use of psychoactive sub-
stances. It offers regulatory options in anticipation of future
changes to the legal structures for some currently prohibited
substances.
The City of Vancouver does not advocate a free market sys-
tem for psychoactive substances. Regulatory options instead
aim to ensure that drugs are not bought and sold without
appropriate controls. The City advocates a regulatory regime
based on the particular health and social harms related to each
substance. This priority also discusses ways to influence mar-
ket forces that reduce the efficiency and profitability of illegal
drug markets, and explores some substance-specific regula-
tory strategies.
Recommendations include more stringent regulation of
premises selling tobacco, the implementation of the British
Columbia Provincial Health Officers recommendations to
mitigate potential harm from new provincial policies that
have increased access to alcohol, the development of a
municipal alcohol strategy, and stricter control of metham-
phetamine precursor chemicals.
Developing and implementing a plan to prevent harm from
substance use is a complex undertaking that will require a
coordinated, integrated and sustained effort over many years.
The biggest barrier to prevention thus far has been the failure
so far to implement a comprehensive and sustainable strategy
at any level of government. Preventing Harm from Psychoac-
tive Substance Use highlights the need to put prevention of
harmful drug use front and centre in the implementation of
the Four Pillars Drug Strategy.
The municipality as the site of action
The complexity of implementing a comprehensive pre-
vention plan and the sustained and multi-sectoral efforts it
warrants makes it imperative to have a cohesive action strat-
egy in place. As in the original sense of the term government,
the Latin and Greek roots of which mean to steer, as in a ship,
the prevention plan intends to provide a map to the local
government to navigate the waters of prevention by means
of a strategy for action encapsulated in the 25 recommen-
dations. Taken together, these recommendations advocate
sensible, compassionate, scientific and health-oriented solu-
tions to some of the problems associated with the demand
for and supply of psychoactive substances. How the strategy
unfolds will ultimately depend on a variety of factors, the
most important of which are political commitment, funding
and collaboration.
While much of the responsibility for prevention initiatives
falls outside of the Citys jurisdiction and mandate, munici-
palities can play a variety of roles in moving towards a more
concerted effort to build capacity for prevention in the com-
munity. The City of Vancouver has commenced work on some
recommendations, especially those directly within its coordi-
nating capacities. They are in the drawing board phase, i.e.
they have started to coalesce in their respective partnerships
 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132
and begun the process of collaborative planning. Some of the
roles that the municipalities can play towards strengthening
prevention in their local context are outlined below with, in
some cases, corresponding recommendations from the pre-
vention plan.
The City as a provider of support to vulnerable
populations
The City has a key role to play in supporting vulnerable
populations through outreach, targeted programmes and ini-
tiatives, advocacy and by promoting awareness and action
on issues specific to vulnerable populations. Employment is
a protective factor that mitigates the risks for problematic
substance use. In Vancouver, there are programmes and ser-
vices that help clients obtain and retain employment. But
many of these programmes are inaccessible to most active
and recovering users, as these citizens often do not meet the
necessary requirements of being on income assistance. Con-
sequently the City of Vancouver is planning a pilot project
targeting those recovering drug users willing to explore their
potential for job readiness. In Phase I of this project, clients
would undergo a job literacy training on topics including
work ethics, negotiation skills, anger management and high
school completion where applicable. In addition to the train-
ing, there would also be one-to-one support from a case coor-
dinator towards employment search and placement. Phase II
would involve the actual placement in a working environment
under the guidance of a mentor. The City is collaborating
on this project with the Vancouver Agreement, an urban
development initiative between the federal government, the
provincial government and the municipality of Vancouver.
The City as a facilitator of services
The City facilitates programs and services on a regular and
ongoing basis, and in some cases is also involved directly in
program delivery. Consideration of the prevention of harm
from psychoactive substance use in decisions about services
serves to promote a more integrated approach. For example,
the City of Vancouver is partnering with Vancouver Coastal
Health to develop a plan for collecting and managing dis-
carded syringes in Vancouver. This plan is expected to: estab-
lish a clear syringe management structure and plan, includ-
ing monitoring and evaluation activities; improve awareness
among the general public and injection drug using popula-
tion about syringe recovery efforts; maximize appropriate
disposal of syringes in community settings, and collect inap-
propriately discarded syringes in a timely fashion.
The City as a facilitator of communication and dialogue
The City often plays a significant role in facilitating com-
munication, dialogue, education and knowledge exchanges
with organisations and citizens on significant issues. This
prevention plan maintains that an engaged public will be
131
more informed participants and supporters of prevention-
based initiatives. A recent survey has helped identify preven-
tion service providers in Vancouver. The City of Vancouver
intends to convene an annual prevention summit on an ongo-
ing basis that invites these organisations to come together
with other relevant stakeholders including local community
serving organisations, drug users, funders, researchers, mem-
bers of the public and other levels of government to facilitate
dialogue and discussion of prevention of harm from substance
use.
The City as a facilitator for building capacity
The Citys role in capacity building may be as a facili-
tator, funding source, liaison, coordinator or educator. This
is a crucial step in moving towards a community-based and
community-driven approach to prevention that is fully sup-
ported by local government. The City of Vancouver has
partnered with the Vancouver Public Library, Vancouver
Coastal Health and Centre for Addictions Research of BC
to provide a public education series on drugs and addic-
tions. The purpose of this campaign would include providing
information and raising awareness, promoting discussion,
dispelling myths, reducing stigma and increasing commu-
nity resourcefulness. The exact topics for the series will be
determined at the end of a survey being conducted through
various channels to gauge the kind of issues the public would
like to see addressed. Another initiativefor school aged
preventionbrings together the Vancouver School Board,
Vancouver Coastal Health, Vancouver Police Department,
the University of British Columbia and City of Vancouver
in planning the development of a comprehensive prevention
strategy for school-aged children and youth. Its implementa-
tion plan explores the following areas: enhancing the capac-
ity of school staff and administration to address substance-
related incidents; increasing student awareness, knowledge
and skills to avoid problematic substance use; and increas-
ing parents knowledge and skills to prevent and intervene in
substance using situations.
The engagement of youth in Vancouver in the strategy for
preventing harm from substance use is also a key component.
Youth are engaged in the planning and implementation of a
youth component of the prevention plan. As a first step, youth
are an important part of the consultation process on the plan
to get their feedback on it. Funding has been secured for the
recommendation advocating the hiring of a youth coordinator
for assisting in the planning of a long-term youth engagement
strategy.
The City as an advocate
The development by the City of Vancouver of both the
Four Pillars Drug Strategy and the current draft Prevention
Plan has placed the City squarely in the position of advocat-
ing for a new approach to addressing problematic drug use in
Vancouver. This approach is one that: considers alternatives
132 D. MacPherson et al. / International Journal of Drug Policy 17 (2006) 127132
to the present system of prohibition; is evidence based and
robustly funded by all levels of government; acknowledges
the breadth of prevention possibilities across the life course;
engages communities in meaningful dialogue on problem-
atic drug use; and builds capacity for healthy responses to
substance use.
Responsibility for funding health interventions addressing
problematic drug use is beyond the mandate of the City of
Vancouver as is the ability to draft legislation that could pro-
vide the environment for the creation of regulatory schemes
for currently illegal substances. The City therefore advocates
a collaborative working relationship with senior governments
and calls for action by Federal and Provincial governments
to create the environment for evidence based strategies to
succeed.
The City as regulator
Cities develop regulations that stem from legislation cre-
ated by senior levels of government. Land use policies are at
the centre of municipal regulatory functions. Cities regulate
a wide range of activities that flow from overall land use poli-
cies such as the contexts of drug use in the case of alcohol and
tobacco. City bylaws help to determine the location of estab-
lishments that provide alcohol to the public and direct many
operational considerations such as occupancy loads, num-
bers of seats and hours of operation. Non-compliance with
municipal regulations can lead to a loss of business licenses
and the closure of problem businesses. Recommendations in
the area of regulation include increasing controls on the sale
and display of tobacco and developing a municipal alcohol
strategy. Regulatory functions of local government are not
possible when considering illegal substances.
The City as a role model
Municipalities can become role models in how to address
a wide variety of issues from housing, transportation, cultural
life, architecture and liveability to name a few. The Four Pil-
lars Drug Strategy has become a model for other jurisdictions
across Canada. Action at the municipal level on problematic
drug use is increasing across Canada. Municipalities have tra-
ditionally looked towards provincial and federal authorities
to provide policy frameworks and to fund health services and
criminal justice interventions that respond to drug use and the
drug trade. Increasingly cities are taking the lead in working
with other levels of government and their local communities
to develop approaches that work best at the local level.
Conclusion
The plan Preventing Harm from Psychoactive Substance
Use was presented to Vancouver City Council on Novem-
ber 3, 2005, and was adopted unanimously. As this article
goes to press, a new Mayor and Council have been elected,
and will be faced with the significant challenge of imple-
menting this prevention plan for Vancouver. The develop-
ment of more rational, evidence-based and comprehensive
approaches to preventing harm from psychoactive substance
use will only come about through a long-term commitment to
exploring and understanding our relationship with these sub-
stances. The evolution of drug policy in Vancouver continues
to broaden the discussion of substance use in our communities
and to focus our attention where it belongs, on the prevention
of harm from the use of psychoactive substances in whatever
form they are taken, and for whatever purposes they may be
used.
References
Cain, V. (1994). Report on the Task Force into illicit narcotic overdose
deaths in BC. Victoria, BC: Government of British Columbia, Ministry
of the Attorney General.
MacPherson, D. (2000). A framework for action: A Four Pillar Approach
to drug problems in Vancouver. Available online: http://www.city.
vancouver.bc.ca/fourpillars/pdf/Framework REVISED.pdf.
MacPherson, D., Mulla, Z., Richardson, L., & Beer, T. (2005). Preventing
harm from psychoactive substance use. Available online: http://www.
city.vancouver.bc.ca/fourpillars/pdf/preventingharm report.pdf.