Opinion: Bring back 'Four Pillar' approach to address B.C.'s toxic drug issue

'Four Pillar' approach

Our communities are being ripped apart from the inside out.

Across the province, the impacts of the toxic drug supply are demonstrated all too frequently. Human despair and misery are visible in parks, sidewalks, and in front of businesses. No one group is immune to the risks or the consequences of addictions.

The intersection of this public health emergency and the growing number of affordable housing casualties, paired with our inability to hold people accountable for criminal activity, has left us with a tsunami of social and health impacts.

As someone who has worked in the social services field for more than 25 years, I have seen the pendulum swing from one strategy to another in attempting to remedy and address the impacts of addiction.

During the early 2000s in B.C., we were first introduced to harm reduction as a tool to reduce the spread of transmittable inflections. Soon after, in an attempt to develop a strategy to combat and address the increasing presence of crystal methamphetamine and “China White” heroin in Vancouver, then Mayor Phillip Owen adopted the "Four Pillar" approach to tackle the toll that severe addiction was taking on both individuals and the community.

The approach took some time for public acceptance. Many groups were wary of the foundations of harm reduction. They included supplying condoms and access to sterile and free needles for those using injectable substances.

A collaborative effort to implement the principles of harm reduction with a focus on community safety, through shared dialogue with community service providers, municipal and provincial government, and law enforcement, seemed preposterous at the time, yet was effective in transforming the community issues noted above.

Fast forward 20 years and we must ask, where did the Four Pillars go?

For those unfamiliar, the model, first pioneered in Switzerland, involves promoting and bringing together the resources of prevention (early intervention, education), harm reduction (reducing as best as possible the most severe impacts of substance use), treatment and recovery (options to treat substance use disorder effectively, promptly, and universally) and finally, using enforcement (incarceration, judicial orders for those who commit offences related to addictions).

These Four Pillars provided the backbone for tackling addiction for more than a decade as communities developed committees and round tables to integrate a local response to what then seemed like a monumental, but absolutely necessary, coordinated approach.

This model was never intended to rely primarily on one pillar, such as harm reduction. No structure can rest on one pillar, or it will topple.

Looking at the landscape today, what seems so glaringly absent is a coordinated framework— a pathway out of this human and civic catastrophe. Across the province, we can see the conflicting battle being waged between the advocates of harm reduction and enforcement.

The result has been various levels of government fighting with each other, neighbours at odds with neighbours and community groups lashing out at the agencies tasked with supporting those attempting to address their addictions and establish stable housing.

As the leader of a large non-profit organization drowning in the demands of people without access to affordable housing, criticized at every step by an outraged populace witnessing the impacts of addictions untethered by any real pillar of enforcement and a recovery system burdened by almost impossible rules and lacking linkages to harm reduction services, I am now reaching out to provincial leaders.

I implore our provincial parties to come together, as they did during COVID, to map out a meaningful and measurable strategy to address what everyone agrees is both unacceptable and tragic.

There needs to be complementary discussion and focus, with equal consideration to each of the Four Pillars. Harm reduction saves lives. But once saved, those lives need access to support and motivation, and in some cases, enforcement, to help shift behaviours and attitudes to again engage with their communities through meaningful and positive contributions.

We have had a model for decades that is logical and based on proven benefits. Perhaps the Four Pillar approach needs a new name in order for it to appear worthy.

We as service providers remain open to alternate models that truly address the issues that all communities are facing. However, in the absence of anything that makes more sense to you and me, I can’t but help but ask, why not actively support, implement, and embrace each pillar of response as part of the solution.

Bob Hughes is the executive officer of ASK Wellness Society in Kamloops.

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