The Downtown Eastside is growing, but not in the way we want it to

The Downtown Eastside (DTES) of Vancouver is a section of the city known for its high mental health and substance using population. It is the poorest neighbourhood in the city and is often referred to as the “epicentre of the opioid crisis in British Columbia” (Imtiaz et al., 2021). The public perception of the DTES is often quite negative as it has contributed to higher rates of crime and violence, creating an undesirable neighbourhood for its residents. The DTES in itself is much more than an inconvenience to its neighbours, it is home to many vulnerable populations that continue to expand. The DTES community is growing despite the fact that Vancouver offers some of the best resources to people suffering from substance use and mental illness (Daily Hive, 2022).

So why is the DTES such a problem for Vancouver?

Fig.1 (Gabor Mate 2022)

In an interview with Daily Hive, Dr Gabor Mate, a Canadian physician, and addiction expert discusses the possible reasons behind the continual expansion of the DTES. Dr Mate suggests that the DTES is a community where people can connect with those of similar circumstances and treat their pain with substances (2022). It is a shared space with readily available access to substances and substance use resources. People use substances, it’s a fact that will always be true. If people are needing to buy substances on a regular basis, the DTES serves as an accessible resource for their needs. The DTES is home to many resources including low-income housing, shelters, transitional housing, and a variety of community outreach services. Community mental health teams, addiction doctors and nurses are consistently on the streets providing care to those in need. In 1996, the province began its Opioid Agonist Treatment (OAT) program, which has expanded over time to include methadone, suboxone, slow-release morphine and injectables (Piske et al., 2020). Despite the province’s best efforts, the opioid crisis continues to rise largely driven by an increase in contaminated substances. In hopes of decreasing the toxic drug supply, Vancouver has opened several safe supply sites and free drug testing at safe injection sites. Unfortunately, the province can’t seem to keep up with the high demands for safe supply, and while these drugs remain illegal in Canada, people will continue to be forced to buy from an unsafe supply.

The physical environment plays a large role in the ongoing growth of the DTES. Vancouver is one of the warmest climates in western Canada. For the transient, homeless population, it is sought out to provide shelter and refuge from Canada’s cold winters. Being homeless is very difficult in any situation but being homeless in -40 Celsius weather is life-threatening. In my experience as a nurse in Vancouver, I see quite an influx of out-of-province patients in the winter months. People travel from all over the country seeking refuge in the DTES, making it not just an issue for Vancouver, but a problem for all of Canada (Daily Hive, 2022). Vancouver is warm but very expensive. According to Mercer’s 2022 Cost of Living survey, Vancouver is the second most expensive city to live in Canada, and the 108th most expensive city worldwide (Mercer Cost of Living Survey, 2022)The current housing crisis is contributing to the poverty associated with the DTES (Daily Hive, 2022).

Another factor contributing to the expansion of the DTES is the increase of Indigenous residents. People from indigenous backgrounds in Canada have higher rates of illness, substance use, unemployment and homelessness compared to those from non-indigenous backgrounds (Benoit et al., 2003). Over half the population of indigenous people in Canada live in urban settings, and the majority of that population lives in Western Canada (2003). The DTES is home to 70% of the total indigenous population of Vancouver (2003). Most of the indigenous residents of the DTES are not from the area, but rather have been displaced from surrounding areas and out of province (2003). In the interview with Daily Hive, Dr. Gabor Mate describes the indigenous residents of the DTES as people from all over the country suffering from the effects of intergenerational trauma at the hands of colonialism (2022). With high rates of mental illness and substance use, this population also suffers from discrimination and decreased access to resources such as healthcare, education and employment, resulting in overall inequality.

In order to start actually affecting change on the DTES, we need to look at the community not as a burden but as an opportunity for healthy growth and change. The DTES is home to the most vulnerable, marginalized population in the country. People are gathering in this community from all over Canada due to a variety of common factors that have affected them all on a deep level. Increased access to safe drug supply, ideally decriminalization of all illicit substances would help greatly decrease the number of deaths related to overdose. Access to more affordable low-income housing options in Vancouver would help keep this vulnerable population off the street, leading to less overall crime and violence rates in the area. Finally, further focus on trauma-informed care, and education on indigenous health and wellness to health care professionals, so that we can better support the indigenous community.

References

2022 Cost of Living Survey | Mercer Canada. (n.d.). 2022 Cost of Living Survey. Retrieved November 29, 2022, from https://www.mercer.ca/en/newsroom/cost-of-living-in-canada-2022.html

Benoit, C., Carroll, D., & Chaudhry, M. (2003). In search of a Healing Place: Aboriginal women in Vancouver’s Downtown Eastside. Social Science & Medicine, 56(4), 821–833. https://doi.org/10.1016/S0277-9536(02)00081-3

Daily Hive (Director). (2022). Dr Gabor Maté on the housing crisis and Vancouver’s Downtown Eastside. https://www.youtube.com/watch?v=6xCVxz-shRI

Gabor Maté. (2022). Image in Wikipedia. https://en.wikipedia.org/w/index.php?title=Gabor_Mat%C3%A9&oldid=1121356670

Imtiaz, S., Hayashi, K., & Nolan, S. (2021). An Innovative Acute Care Based Intervention to Address the Opioid Crisis in a Canadian Setting. Drug & Alcohol Review, 40(4), 553–556. https://doi.org/10.1111/dar.13193

Piske, M., Zhou, H., Min, J. E., Hongdilokkul, N., Pearce, L. A., Homayra, F., Socias, M. E., McGowan, G., & Nosyk, B. (2020). The cascade of care for opioid use disorder: A retrospective study in British Columbia, Canada. Addiction, 115(8), 1482–1493. https://doi.org/10.1111/add.14947