Nonprofits like the Portland Hotel Society, which runs Insite, have utterly reimagined the streetscape of the Downtown Eastside, retrofitting pockets of urban decay into a kind of social-services campus for drug addicts and the indigent. "The main goal is creating these environments where people can begin to heal," says PHS Executive Director Liz Evans. In a shuttered saloon, a café has been opened up, with a dental clinic providing free care in the back room. A needle-distribution center gives out 6,000 syringes a day, and collection teams pick up just as many from the alleys. Down the street, a live-in medical treatment facility provides courses of intravenous antibiotics for addicts suffering from endocarditis and other infections, while another housing facility houses seniors. A community bank has been established to allow savings accounts and plans to start a microcredit program. A recycling depot called United We Can collects 20 million containers a year from Vancouver's "binners," employing 150 local sorters and pumping $2 million a year back into the neighborhood's economy. A life-skills center offers classes from computers to bicycle repair to "beauty night" for prostitutes, and its kitchen delivers 700 high-protein meals a day to PHS's housing facilities via bicycle cart. Some of the kitchen's produce comes from a large community garden next door to Insite, where volunteers tend neat raised beds of tomatoes, squash, and beans. The garden is also the frequent site of memorials for the community's many dead. "The most important thing we do is give a sense of dignity," says Liz Evans.
For more radical advocates of Vancouver's addict population, even the projects run by PHS are not enough. A storefront a few blocks east of Insite serves as the headquarters of VANDU, the Vancouver Area Network of Drug Users. Their logo is a syringe and crack pipe crossed over a red heart. VANDU conducts "user-based peer support and education" through a variety of programs, sponsored by Vancouver Coastal Health as part of the organization's overall harm-reduction strategy. Activists from VANDU were instrumental in agitating for Insite's creation, and in the years before it was implemented members ran as many as three illegal supervised injection sites around the neighborhood. Aiyanas Ormond, the office manager of VANDU, is not himself a drug user. As we talked, he sat behind his desk carefully packing brass screens into the stems of a handful of crack pipes. The pipes are Pyrex, less likely to break and cut a user's mouth, and thereby reducing disease transmission. A 2009 study found that sharing crack pipes can spread HIV, and was cited in support of opening a crack-smoking room at Insite. VANDU sells crack pipes to users at cost, $2 each. Ormond saw the organization's role as "pushing the envelope, doing things that official channels won't."
To see how far they push, I walked through the neighborhood with a couple of VANDU staffers, Ken Franklin and Diane Taubin. The organization's "Injection Support Teams" travel the alleys to hand out syringes, sterilized water, and plastic mouthpieces to crack pipes. The pair were in their 60s, both recovering addicts of methadone. They carry plastic buckets and salad tongs to collect discarded needles, and a cell phone to call an ambulance if they come across an overdose. Franklin and Taubin would also help inject addicts who were too physically limited to properly inject themselves, which the staff at Insite is forbidden to do.
Taubin was a stout, grandmotherly woman, with thick glasses and a wide smile. "We started this because one of our members was blind, and her husband ended up in jail, and she couldn't use," she said. Franklin acquired hepatitis C while serving an eight-year sentence for a bank robbery spree; he and a group of 10 inmates had shared the same syringe for three years. Taubin got the disease in prison as well, while serving four years for heroin possession, and is frequently fatigued by the interferon treatment she is undergoing. In the alley directly behind Insite, one of them stopped to bandage the bleeding finger of a prostitute who had cut herself on a broken crack pipe.
For all the support they provide, even the VANDU volunteers admit there are limits to grassroots outreach. During the walk through the neighborhood, we saw a disheveled man writhing and crawling on the ground in the throes of schizophrenia, covered in grease and black mud as he scraped in a puddle with a bent syringe. Franklin did not even try to approach him. The severely mentally ill are among the hardest to reach in the street population, and the most likely to be exploited. Despite all the tolerant attempts at dealing with the street population in the neighborhood on their own terms, the need to institutionalize Vancouver's most severely mentally ill is undeniable. Sometimes the government is forced to get involved, and that responsibility often falls to the police.
The perennial problems of the Downtown Eastside create a particularly difficult job for the Vancouver Police Department. From a station house on Hastings and Main, an average of nine officers a night patrol the streets and alleys of the neighborhood, which accounts for 40 percent of the violent crime in the entire city. One night I met up with Sergeant Toby Hinton, a 20-year veteran of the VPD, and followed as he patrolled the alleys on foot. The alleys are hundreds of feet long, poorly lit, filled with doorways and dumpsters. Crack smokers hide their pipes long before Hinton reaches them, and for the most part he has no plans to arrest them. "The pathetic addict that's down here and using, that's not in our target sights," he said. "I'd rather see them get some type of help, go into recovery or treatment. I would far rather spend the millions of dollars that are used to operate Insite and put it into residential treatment programs that are a little bit removed from here." Hinton speaks in measured, disciplined tones, but has no reservations about his criticisms, even though they diverge from official VPD policy.
Inspector Scott Thompson, the drug policy coordinator for the VPD, says that the role of the police regarding Insite is "to be apolitical, to be neutral, and to be professional." Thompson drafted the VPD's drug enforcement strategy and has worked closely with Insite's management to establish clear protocols for police interactions with the site. But in the streets and alleys, officer discretion is the key. "When it comes to trafficking, we have very much a zero-tolerance policy," says Thompson. "When it comes to users, addicted users, there's very much an application of discretion."
In practice, the VPD's policy of "selective targeted enforcement" means not arresting anyone for drug use unless they are creating a public nuisance, like smoking crack in a bus stop or near a school. If someone is caught with drugs, they are usually confiscated, and crack pipes are smashed. On this night's rounds, Hinton took a joint from a group of young men standing in a food line, and later confiscated a Ziploc filled with low-grade pot. Generally, as Hinton put it, "I'd rather go after some bigger fish." Those bigger fish include some of the international gangs that control drug trafficking in Canada and run the networks that trickle down to the neighborhood's alleys. Hinton recently arrested a member of the notorious Honduran gang MS-13 who was wanted on a murder warrant there. Gun violence is relatively low, and Vancouver had just 36 murders in 2008—a fraction of those in a comparably-sized American city—but Hinton regularly confiscates the pipes, bats, and sawed-off hockey sticks favored in the neighborhood. (This is a place where the word pipe is used as a verb: "He stole my stash so I piped him.") In one of Hinton's undercover operations, "Project Oldtimer," makeup artists spent hours transforming him into a very convincing elderly man. He lay in an alley, pretending to be passed out drunk with money sticking from his pocket. When an unsuspecting thief robbed Hinton, he soon found himself surrounded by a dozen police. But such enforcement victories are rare, and the harm-reduction policies of Vancouver have done little to stem the violence that plagues the neighborhood.
"This is what I would call a failed social experiment," said Hinton. "I do find it a bit ironic, a lot of people running around touting us as being on the enlightened path, and it's almost as though you're being asked to deny your eyes."