At the core of his argument was that it is not the drugs themselves that are most harmful to addicts; rather it is the laws that criminalize drugs that hurt people the most. “How do we characterize giving the addicts heroin as harm reduction?” Arvay recalls asking himself. “It required putting together a really interesting record to educate the court. For some people, providing them with heroin isn’t necessarily going to lead to other forms of treatment or abstinence … But at least it would start to stabilize their lives … If the heroin is safe and administered in proper doses, a heroin addict can function and function for a long time. They can hold a job, they can keep their housing, they can keep their family.”
On May 29, 2014, the court agreed, at least on an interim basis. In a thirty-four-page decision, Chief Justice Christopher Hinkson granted an interlocutory injunction. It didn’t make a final determination on the issue of prescription heroin, but said that while that question is discussed before the courts, Health Canada should approve “all outstanding plaintiff requests and future SALOME requests for access to diacetylmorphine.”
Crosstown Clinic’s prescription-heroin program could not take on new patients or expand in any way. But for the time being, doctors could use the special access program to prescribe diacetylmorphine to those specific individuals who had previously received the drug via SALOME.
The federal government signalled its intention to continue fighting Crosstown Clinic but complied with the judge’s decision and approved Vancouver doctors’ SAP applications. On November 26, 2014, the first batch arrived.
MacDonald remembers his patients’ general reaction: “It’s about time.”
Drug users at Crosstown Clinic are not required to wean themselves off of heroin, but the stability the program provides has helped many do just that.
By early 2017, twenty-five former injection-drug users had transitioned to oral therapies, according to statistics provided by Providence Health Care. Nine of those people transitioned to oral hydromorphone and sixteen to methadone, Suboxone, or slow-release oral morphine. An additional two Crosstown patients went completely free of drugs for the first extended period since they began using heroin decades ago.
Dianne Tobin was one of the first Crosstown patients to receive prescription heroin in November 2014, when it was first administered beyond the confines of an academic study. Then, in early 2017, she became one of Crosstown’s first patients to give up opioids completely. Tobin went from injecting diacetylmorphine to ingesting oral hydromorphone and then to abstinence. It was the first time her body went without drugs in more than forty years.
From her family’s home in Bridgewater, Nova Scotia, Tobin acknowledges it was a long road. She recounts a childhood of trauma. She came from a happy middle-class home and got along well with her parents. “But I couldn’t handle society the way it was,” Tobin begins.
It was the 1960s, and after repeated problems at school, the courts intervened. She was sent to the Ontario Training School for Girls, an old-fashioned institution where young women could be held for transgressions involving truancy, drugs, or promiscuity. Tobin was one of the youngest boarders there, and the older girls treated her badly.
When she was sixteen, authorities let her attend grade twelve at a public school. Terrified of being sent back to the institution, Tobin figured out a way to ensure that would never happen.
“I got married,” she says. “I married the worst person in the whole world. Once we got married, I was black and blue all the time.”
In 1968, the young couple moved to Vancouver, to the Downtown Eastside. At their apartment at Jackson and Pender, their neighbour was a heroin dealer. He gave Tobin the first drugs she ever tried. “It gave me courage and made me feel more like myself instead of an abused victim,” she recalls. “After the first time I took heroin, from then on I was a woman of my own and I was able to stand up for myself.”
Her husband drank and grew more abusive. After she tried to leave him, he tied her to a chair and confined her for six days in a room at the Downtown Eastside’s Patricia Hotel. Fully addicted to heroin at the time, Tobin suffered through a cold-turkey withdrawal. “I was in total withdrawal that whole time, and it was terrible,” she says. “You don’t sleep, you don’t sleep, you don’t sleep. And then it gets worse.”
By 1973, Tobin was twenty-two-years old and had two young children. She took them, ran to Edmonton, and never saw that man again. She was free of her husband but stuck with an addiction to heroin that would last the next forty years.
Vancouver’s drug scene pulled her back to the Downtown Eastside. The hassles and tragedies of an addict’s life followed. Tobin tried and failed to get clean. A long-time romantic partner was killed while he was in prison. She once spent three months in a coma after two guys smashed a brick over her head in a robbery that turned violent. Decades passed.
Then, on March 15, 2006, she was one of the first Vancouver residents to receive diacetylmorphine as part of the NAOMI study. SALOME came next. And then, in November 2014, Vancouver doctors began using the special access program to administer prescription heroin to patients outside of those research projects.
Prescription heroin brought stability to Tobin’s life. She recounts how she became more involved in activism, for several years serving as president of VANDU. She also helped Murray organize NAOMI patients and had a hand in the clinic’s successful fight against the Conservative government that eventually allowed for the program to exist as it does today. (In 2016, the Conservative government was voted out of power. Shortly after, the new Liberal government revised regulations to again allow doctors to use the SAP to prescribe diacetylmorphine. The court challenge was subsequently dropped.)
In late 2016, Tobin transitioned to oral hydromorphone and, for the first time since she was seventeen years old, spent an extended period of time without using needles. Next, with the help of her doctor at the clinic, Scott MacDonald, she lowered her hydromorphone intake in increments, from 425 milligrams per day to 125 per day and then to a seventy-five-milligram dose just twice a week. On December 5, 2016, she visited Crosstown Clinic for the last time.
Tobin remained in the Downtown Eastside for a short while after that. But the neighbourhood began to get to her. “I just finally got tired of it and I told the doc, ‘I’m going home, where I don’t have to hear ambulances all day.’”
Sitting beside Tobin at their home in Nova Scotia is her niece, Jenna Zinck. “It’s like I finally have a chance to meet my aunt and get to know her,” she says. “I’m just proud of her. With tears in my eyes right now, I am so proud of her.”
There’s a pause, and then Tobin responds. “To have my family trust me again, it’s a gift,” she says.
Still with her family in Nova Scotia today, Tobin thinks about the Downtown Eastside often and the people she knows there who used to ask her about Crosstown Clinic.
“So many of my friends wanted to get on it,” Tobin says. “A lot of them died before they could.”
67Eugenia Oviedo-Joekes, Suzanne Brissette, David C. Marsh, Pierre Lauzon, Daphne Guh, Aslam Anis, Martin Schechter, “Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction,” The New England Journal of Medicine 361 (2009): 777-786.
68Bohdan Nosyk, Daphne Guh, Nicholas Bansback, Eugenia Oviedo-Joekes, Suzanne Brissette, David Marsh, Evan Meikleham, Martin Schechter, Aslam Anis, “Cost-effectiveness of Diacetylmorphine versus Methadone for Chronic Opioid Dependence Refractory to Treatment,” Canadian Medical Association Journal 184 (6) (2012): 317-328.
69NAOMI Patients Association, Susan Boyd, “NAOMI Research Survivors: Experiences and Recommendations,” Vancouver Area Network of Drug Users. Vancouver, BC: NAOMI Patients Association (February 20, 2012).
70Quoting from the declaration’s sixth revision, published in 2008. (A seventh revision was subsequently released in 2013.)
71Health Canada. “Heroin and Other Dangerous Drugs Are Banned from Health Canada’s Special Access Programme,” Ottawa,
ON: Health Canada, October 3, 2013.
Chapter 32
“The Assassination”
On a Friday afternoon in late February 2014, Liz Evans received an email from BC Housing vice-president of operations Craig Crawford. “BC Housing no longer has confidence in the process that we’re engaged in,” Evans remembers the email read.
In the preceding year, beginning shortly after the New Fountain and Rainier campaigns, BC Housing had reviewed the Portland’s books. It had contracted two major accounting firms, KPMG and Deloitte, and they had been digging through PHS receipts line by line.
Evans recounts how that process became intensely frustrating. KPMG found spending issues and raised concerns about accounting practices, she concedes. But when BC Housing got involved, there didn’t seem to be a genuine interest in correcting anything. “I kept going to those meetings thinking that there was going to be something specific and tangible that we were meant to address, but nothing was ever said,” Evans recalls. “We were trying to get them to help us to fix stuff, but they would never come back to us and say what it was that we had to fix … There was nothing tangible, there was nothing real about those meetings,” she continues. “And then, fairly abruptly and out of the blue, I got an email [from Crawford] on a Friday afternoon.”
She called BC Housing’s CEO, Shayne Ramsay, with whom PHS had a long and good working relationship. The two agreed to meet face to face Monday morning. “This is what is going to happen,” Evans remembers Ramsay telling her. “The Portland is going to be dismantled. We’re going to burn the village. Unless you all leave.”
It wasn’t official notice but neither was it a chance to change anyone’s mind. The decision had been made, Evans remembers. She’d known Ramsay for a long time, and he was giving her a heads-up. “That’s it, it’s done,” Evans says Ramsay told her. “It’s not working anymore.”
Evans left the meeting in a state of shock. She walked to her car, got inside, and for a while just sat there. Then she called Mark Townsend and the rest of the Portland’s management team—Kerstin Stuerzbecher, Dan Small, and Tom Laviolette. “We need to get together,” she said. “It’s urgent. We need to meet.” They gathered at a hotel bar in downtown Vancouver, and Evans told them what was coming. “I was crying and didn’t know how to talk about it,” she remembers.
A few days later, the Portland’s entire management team plus the board’s president, Jack Bibby, was called to a meeting with Ramsay and Mary Ackenhusen, Vancouver Coastal Health’s new president and CEO who had recently replaced David Ostrow.
Townsend remembers there was no negotiation, only a choice.
“I said I would resign and then Liz said she would resign, and we asked if we could leave Dan and Kerstin,” he recounts. “But they wanted everyone gone.”
“They presented us with the option of stepping down,” Evans says. “If we did that, they would keep the village. If we left and took the board with us and walked away, they would not dismantle the organization. They would keep it. And if we didn’t …” She trails off.
Ackenhusen declined to grant an interview. Ramsay confirms that was essentially the message, but maintains it was conveyed in very different words. “I would not have said it or presented it in that strong of an ultimatum,” he explains. “I mean, they could see the writing on the wall, that there was no satisfaction in the way things were going and no belief that they could be improved. And so we suggested the way forward for the organization was that one.”
Bibby’s recollection of these events is closer to Evans’s. “They told us, if the executive does not resign and if the board does not resign, that they would cancel every contract, one by one, until we did,” Bibby recalls. “They said, ‘You guys turn and walk away or we are burning the village.’” He adds, “They hated us.”
Implicit in the deal was that PHS would not fight back. “The message was really clear,” Evans says. “We had to be compliant, we had to do what they said, we could not fight, we could not stand up and create resistance.”
News of a serious problem at PHS became public on March 4, 2014. “The unconventional partnership between government and the activist nonprofit that runs a supervised-injection site and housing for hundreds in the city’s Downtown Eastside appears headed for a major rupture after a forensic audit,” reads an article published in the Globe and Mail. “Housing Minister Rich Coleman said within ten days, his ministry will decide what action to take on the PHS Community Services Society—usually referred to as the Portland—because of significant problems discovered.”72
Townsend is quoted in the article, expressing surprise. He acknowledged problems but claimed it was his understanding PHS was working with Deloitte auditors to correct them. “There was a sense that progress had been made,” Townsend told the newspaper.
Two weeks later, Evans, Townsend, Stuerzbecher, Small, Laviolette, and all nine members of the Portland’s volunteer board officially resigned from the Portland Hotel Society.
“Shock, sadness and a fervent hope for no drastic changes to services were the emotions that filtered through the Downtown Eastside with the news that the founders of a legendary nonprofit housing group had been forced out by the province,” one report reads. “The organization’s leaders, Mark Townsend and Liz Evans, revealed this week that they had agreed to resign under provincial pressure.”73
The next day, on March 20, 2014, BC Housing made its financial review public. It detailed a laundry list of allegedly inappropriate spending by Evans and her team.
The newspapers crucified them. “Top managers at a Vancouver charity that’s supposed to help the poor in the Downtown Eastside have racked up hundreds of thousands of dollars in limos, overseas trips, meals, parties and other perks because of lax financial oversight,” reads a report in the Vancouver Sun newspaper. “The two audits, conducted by Vancouver Coastal Health Authority and BC Housing, paint a picture of lavish expenses for Portland Hotel Society managers and directors at a time when the society—charged with operating many services for the Downtown Eastside’s at-risk population—is teetering on the verge of financial trouble and potentially unable to pay its debts.
“Managers and directors expensed more than $69,000 over three years on restaurants, and more than $300,000 on travel to Vienna, Paris, Istanbul, New York City, Los Angeles, Banff and Ottawa, among other locations,” the Sun article continues. “Hotel rooms of up to $880 per night were charged for trips to the United Kingdom and Austria, including flowers, alcohol and spa services. There were also more than $8,658 in limo fees in 2013, a trip to Disneyland in Anaheim, a $5,832 cruise for a PHS manager, a $917 baby shower and a $7,025 ‘celebration of life’ for a deceased employee.”74
Other reports attacked PHS staff on a personal level. “One of the most unpleasant interviews I have endured in four decades of journalism was a few years back with Mark Townsend,” reads the first sentence of another article about PHS finances.75
Today Dan Small begins a conversation about the review by acknowledging that PHS’s accounting was sometimes sloppy. He points out that it was the Portland’s flexibility—its ability to quickly adapt to a situation and deploy a response to a problem on twenty-four-hours’ notice—that made the organization such a strong on-the-ground partner for BC Housing and Vancouver Coastal Health. PHS was only able to operate that way, Small maintains, because of the very tactics that BC Housing used to justify the management team’s ousting. “We were fast and loose and we did make mistakes,” he says before pausing for a moment. “And some of that stuff was just complete cockups. Some of it was stupid, and I wish it had never happened.”
The response from Evans and Townsend was uncharacteristically muted. Townsend offered various explanations to the press. He argued that occasional trips to somewhere warm were given to staff members who hadn’t take a vacation in years. Other expenses were rationalized. What was described in the report as a limousine, for example, was actually just a larger town car that was cheaper for a group than
it would have been to pay for two taxis. Townsend claimed that those hotel rooms in Europe were actually paid for with private donors’ money, not that of taxpayers. A lot of it could be explained, he maintained. But there were questions that the KPMG report raised that PHS didn’t try tried to defend. For example, each member of the management team was paid for vacation days they never took off, unused sick time, and for statutory holidays, all on top of their salaries, something that KPMG described as “unusual.”
“We were trying to deal with things that the bureaucracy found difficult to deal with,” Townsend says. “So how were we going to do that? We were not going to be shaped like them or look like them.”
Townsend uses his final word on the review to point to PHS administration expenses, which he says always hovered around ten percent, the benchmark for charities and nonprofit organizations around the world. Filings with Revenue Canada support his claim. In 2012, total revenue was $28.1 million and total management and administration expenditures were $2.4 million, or 8.57 percent. In 2013, that number was 10.55 percent, and in 2014, it was 9.89 percent. “Our admin fees were always fucking low,” Townsend says. “Lower than anyone else, and we were doing complicated work.”
Today Townsend has somewhat hardened his position on “the assassination,” as he calls it. But he has expressed regret in the past. “I suppose there are many mistakes I made,” Townsend told an online publication in 2014. “I am always trying to do the best I can with my heart and soul … But one of the things that I didn’t really put in my mind is that we were seen as quite scary. And I didn’t feel like we had any power. So there’s an illusion of that, and I was very unaware of it.”76
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