Contradictheory: When helping seems to hurt

Homelessness is a complex issue – addiction, poverty, illness, abuse, circumstances beyond a person’s control, all can cause displacement. Addressing it is just as complex but we have to believe it's possible to help. — Filepic/The Star

A few weeks ago I was in Vancouver in British Columbia, Canada, a fairly modest city of about 700,000 people that swells during the summer months when nearly four million tourists visit, thanks to cruise ships, conventions, and mountain views.

I was visiting the science centre (my idea of a good time) and sent my mother off in a random direction for an ice cream and a coffee (her idea of a good time). But at the time, I didn’t realise I was directing her to the gateway to perdition.

Actually, it was Vancouver’s Downtown/Eastside (DTES), one of the city’s oldest neighbourhoods, and also one of the most troubled. The homeless are openly present, putting on display high rates of poverty, drug use, crime, and mental illness.

When I eventually tracked my mother down, she was safely ensconced in a gentrified coffee shop that had locked all their doors but the main one for security reasons.

From inside, the streets outside were a different world. People shuffled around slowly, in small groups but not really talking, clothes worn and dirty. Some walked bent at the waist, a condition known as the “fentanyl fold” or the “heroin hunch”.

A 2019 article documented how shocked tourists were to find such scenes just a few hundred metres from the city’s famed and very touristy Gastown district. While most cities have their own rough areas, those interviewed noted that the “volume of open drug use and street disorder was jarring”.

For a guy like me who lives in Taman Tun Dr Ismail (TTDI) in Kuala Lumpur, this is foreign territory. The meanest streets in KL – which I see as an area bordered by Chow Kit and Jalan Raja Laut and dotted with homeless shelters – are very tame in comparison.

Over the last few years, though, I have seen the odd homeless person in TTDI, usually sleeping on one of the pedestrian bridges. I always wonder why they ended on the streets, and more importantly, what can I do to help.

In Vancouver, many locals blame the province’s drug decriminalisation policy. In 2016, things were so bad that British Columbia declared a public health emergency after a surge in overdose deaths, largely driven by the cheap, addictive, and very lethal fentanyl. In the DTES, a 2019 survey found that about a third of the residents were addicted to opioids, about a similar number to methamphetamine, while 14% were cocaine addicts.

The province decided to try something drastically different. Instead of seeing drug addicts as criminals, they instead looked at them as patients. In March 2020, they rolled out Prescribed Safer Supply, a programme that issued pharmaceutical-grade drugs, like hydromorphone tablets, intended to replace the poisoned street supply. In January 2023, they decriminalised possession of up to 2.5gm of certain drugs for adults.

It sounds counterintuitive. Your war against drugs now stops prosecuting drug possession, and by the way, also gives away drugs for free? But the idea is to reduce the risk of death from a toxic illegal market, and welcome addicts with open arms into health and social services.

Indeed, it’s something I support in principle. If it’s your child in addiction, you’d rather they got treatment than end up in the morgue.

However, the reality is that the policies haven’t delivered the hoped-for results. When the programme was introduced, opioid- related hospitalisations rose by 33%. When decriminalisation was added, they rose another 25%. Meanwhile, there was no change in overdose deaths.

One theory why this is the case is that the programme has successfully destigmatised drug use, and people are more likely to visit hospitals for help.

However there is also concern that hydromorphone is not strong enough for serious addicts who have built up high opioid tolerance, so they are selling the safer, weaker tablets they get for free to buy the more dangerous and stronger fentanyl or similar.

Despite this being entirely unintended effects of a radical public health policy, from my conversations with Vancouver locals, the programme is a failure.

But a point has to be made that the whole DTES area itself is a study in urban decline, and the drugs are as much a symptom as a cause. While the DTES was Vancouver’s prosperous centre for most of the 20th century, after the 1971 Gastown Riot (sparked by youth protesting drug laws) and subsequent zoning changes, residents were pushed out, buildings became vacant, and the neighbourhood slipped into poverty.

The result is what you see today, a patchwork of entrenched homeless who suffer while milling around gentrified islands like the cafe my mother took refuge in.

What’s more bizarre is that the DTES is a relatively small area, with about 18,000 residents in a city of 700,000. Most of the rest of Vancouver is actually very pleasant and quite welcoming to visitors. Yet this rough patch refuses to be smoothed out despite the best efforts and intentions.

Not everything you try to do helps. Like with the woman sleeping on a pedestrian bridge in my neighbourhood: I know some have tried to give her food and money. My worry is that I don’t know if that helps her or if it keeps her away from connecting with services offered by the local authorities that could help her get out of homelessness.

But I have to believe that doing something, even if it’s imperfect, is better than doing nothing at all.

In his fortnightly column Contradictheory, mathematician-turned-scriptwriter Dzof Azmi explores the theory that logic is the antithesis of emotion but people need both to make sense of life’s vagaries and contradictions. Write to Dzof at [e-mail]. The views expressed here are entirely the writer's own.