In a 2014 survey of 593 homeless people, researchers found some surprising numbers. Of those surveyed, 36 per cent said they using drugs, with 45 per cent of those saying they used methamphetamine and 44.6 per cent used heroin.
It’s not the drug use among the homeless that was so surprising, but where the survey was done: Tehran.
Even the capital of the Islamic Republic of Iran – where petty drug dealing is punishable by death and simple drug use can mean jail time – has a problem with drug addicts living and dying on the streets.
So, to what extent is North America’s “unsheltered” homelessness crisis – people living in the streets or in tent encampments – largely an addiction and enforcement problem?
And to what extent would decriminalization, with addiction being treated as a medical condition and addicts prescribed hard drugs, address the overdose crisis and reduce the number of people living and dying on the streets?
There are many reasons that people end up homeless – not the least of which is a lack of housing, affordable or otherwise, especially in Vancouver. An Employment and Social Development Canada survey of 19,536 homeless Canadians in 2018 found one-quarter cited “addiction or substance use” as a reason for being homeless.
While some progress is being made to house the homeless in Vancouver and elsewhere, public frustration has grown as the problem has become more visible, with open drug use, encampments, vandalism, petty crime and violence creeping out of places like the Downtown Eastside and into public parks and residential neighbourhoods.
And it’s not just a Vancouver problem. Like Vancouver, Nanaimo has played a Whac-A-Mole game with tent encampments – shutting one down only to find another popping up a few months later somewhere else.
“There’s a whole bunch of very sick people living in our streets, and it’s bad for everybody,” said Leonard Krog, former NDP MLA, current mayor of Nanaimo and outspoken critic of what he says are decades of failed social policies targeting addiction, mental illness and homelessness.
“My frustration, as a mayor, is that the history is known, the solutions are obvious,” he said. “The reservoir of compassion is drying up.”
According to the 2020 homeless count in Vancouver (there was no count in 2021), there were 2,095 homeless people in the city, about one-quarter of whom (547) were classed as “unsheltered” – sleeping in the streets or in tents.
According to the B.C. government, as of March 2020, there were 1,276 shelter spaces and 6,292 supportive housing units in Vancouver. That has since increased to 1,369 shelter spaces and 7,186 supportive housing units in Vancouver.
If the problem with drugs and homelessness is bad in Vancouver, it is magnitudes worse in San Francisco, which prompted Michael Shellenberger, a longtime environmental and social activist, to write a book about it. Shellenberger takes aim at his erstwhile fellow “progressives” in San Fransicko: Why Progressives Ruin Cities.
Shellenberger said he has long supported harm-reduction approaches to drug addiction. But the end goal was always supposed to be treatment and recovery, he said.
He points out that liberal states and cities in the U.S. have taken a libertarian approach when it comes to addiction, crime and vagrancy – tolerating suffering and death among the mentally ill and drug addicted in the name of civil rights.
He is critical of the “housing first” model, argues for a tough love approach and points to the Netherlands and Portugal as better models for dealing with addiction. There, the approach is shelter first, followed by treatment, with permanent housing offered only when it has been earned with sobriety.
“There’s a difference between decriminalizing and removing all consequences for dysfunctional behaviour,” he told BIV. “They decriminalized in Portugal, but if you’re caught injecting heroin in public, they will arrest you, and they will bring you before a commission for the dissuasion of addiction. It’s a combination of family and government officials.”
Nor is camping in public spaces tolerated in the Netherlands, he said.
“I shadowed a social worker in the Netherlands. We found a guy sleeping on the street, and he told him very clearly, ‘You can’t sleep on the street. You have to go into shelter.’”
There have been moves recently to decriminalize hard drug use and treat it as an illness. In B.C., addicts can now be prescribed fentanyl patches and other opioids, and federal NDP Leader Jagmeet Singh recently introduced a private member’s bill to decriminalize drugs in Canada.
Sarah Blyth, executive director of the Overdose Prevention Society, said decriminalization may help address the overdose crisis, but said it would not necessarily address some of the core homelessness problems.
More people died from drug overdoses in B.C. in 2020 and 2021 (4,164) than from COVID-19 (2,707).
There are many reasons people end up homeless, Blyth said, and addiction isn’t always the only or even the main reason.
“With decriminalization, it’s not the only thing – it’s part of the thing. There’s a bunch of things that need to happen to help people that we’ve totally left behind.”
She added that addressing the homelessness problem starts with more supportive housing, more treatment and a harm reduction model that acknowledges that abstinence does not work for some people.
Krog believes decriminalization is one of those “pillars” of the four-pillar drug strategy that won’t work if some of the other pillars, like enforcement, are missing. What is missing is proper support for mental illness through what he calls a “continuum of care,” which could include institutionalization.
When B.C. mental hospitals were shut down, starting in the 1970s, there was a promise of community support for the mentally ill that didn’t materialize. This was followed by an explosion of ever more powerful narcotics, a futile war on drugs and criminalization of what was often, at the core, untreated mental illness.
“That kind of a program will literally save lives,” Krog said of decriminalization. “However, you’re still feeding a poisonous substance to people, and if that’s all you’re doing it’s not going to be effective.
“I think most of us, for a long time, honestly thought if we provided the housing – the housing first, and we forgot about the other three pillars – that things would improve. And for some people just the housing alone gets them on the road to recovery, and it does work.
“But it doesn’t work significantly when you’re dealing with what I call the severe cases – the people with existing brain injury, severe mental health issues. The housing in and of itself, it just becomes a place to hang out or take your drugs or collapse in between fixes.
“Everyone who deals in addiction gets it. When someone who has an addiction issue – let alone mental health, brain injury, etcetera – when they say they’re ready to get clean, you need to have the detox bed available and then you need the continuum of care and treatment. And if you don’t have that, quite candidly, it’s not going to work. So stop pissing around and get on with real solutions.”