LAW ENFORCEMENT AND PUBLIC HEALTH IN THE DTES

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Law Enforcement and Public Health:
Vancouver Police and Drug Use in the Downtown Eastside

Grace Timney
J0346413
Bachelor of Law Enforcement Studies, School of Criminal Justice & Security, Justice Institute of
British Columbia

Author Note
Portions of these findings were presented as a poster to the Justice Institute of British
Columbia.
This paper was completed for LAWS 4003: Research Project, instructed by Melanie
Chernoff. Submitted December 1, 2023. This paper is 7717 words.

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Abstract
Despite international recognition, the intersectional field of “law enforcement and public health”
(LEPH) is not referenced by the Vancouver Police Department (VPD) or generally across
Canadian policing. This study examines how the Vancouver Police Department (VPD)
demonstrates LEPH in the context of drug use in the Downtown Eastside (DTES) through
evaluation of strategy, operational actions, residents’ experiences of VPD practices, and police
officers’ perspectives. The study uses secondary data analysis, particularly thematic coding and
reflexive analysis from a diverse selection of community-based research and police-based
sources. Findings indicate that the VPD predominantly demonstrates LEPH through
collaborative initiatives and strategic statements, which are generally aligned with LEPH
principles identified through an international literature review. However, there is a gap between
strategic intentions and the operational realities experienced by people who use drugs in the
DTES. Exacerbated by power imbalances and other systemic factors, this endangers lives in the
community. This study is significant in improving understanding of LEPH in the DTES, and puts
forward recommendations to the VPD and future research.
Keywords: law enforcement and public health, harm reduction policing, Downtown
Eastside, Vancouver Police Department, drug policing

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Table of Contents
Background ..................................................................................................................................... 4
Research Questions ..................................................................................................................... 5
Literature Review............................................................................................................................ 7
Literature Review Methodology ................................................................................................. 7
Description of Literature ............................................................................................................. 7
Literature Analysis .................................................................................................................... 10
Design and Methodology .............................................................................................................. 12
Data Collection ......................................................................................................................... 12
Data Analysis ............................................................................................................................ 15
Ethical Considerations .............................................................................................................. 15
Findings......................................................................................................................................... 16
“It Doesn’t Need to Be Siloed” ................................................................................................. 18
Vancouver as a Leader in Progressive Policing ........................................................................ 20
Intention Does Not Cause Effect .............................................................................................. 23
Discussion ..................................................................................................................................... 26
Limitations ................................................................................................................................ 28
Recommendations ......................................................................................................................... 29
Recommendations to the Vancouver Police ............................................................................. 29
Recommendations for Future Research .................................................................................... 30
Conclusion .................................................................................................................................... 31
References ..................................................................................................................................... 32

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Law Enforcement and Public Health:
Vancouver Police and Drug Use in the Downtown Eastside
“Law enforcement and public health” (LEPH) is a phrase understood internationally and
in academia to describe a continuum of interoperability between the two disciplines. Both police
and public health actors try to regulate behaviour among populations that are subject to similar
social determinants of health and safety, and this shared common ground has identified the need
for closer collaboration between police and public health, particularly on joint-interest issues
such as drug use (van Djik & Crofts, 2017). However, LEPH is not frequently referenced in
Canadian spaces, despite having societal similarities to leading LEPH countries and areas of
priority populations.
Background
A key Canadian area that draws heavy police and public health resources is Vancouver’s
Downtown Eastside (DTES), unceded territory of the xʷməθkʷəy̓əm (Musqueam),
Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations. The community has a long
history of displacement (colonial, gentrification, and political-based), has been impacted by
deinstitutionalization in the province, and is grieving years of an international drug poisoning
crisis. These examples and more frame a specific dynamic of mutual distrust between the
community and law enforcement; in tandem with the strategic securitization (in the lens of state
power) of public health issues and poverty, this continues to impact police relations and tactics in
the community. Today, prevalent LEPH issues in the DTES include mental health, poverty,
gender-based violence, intimate partner violence, sex work, epidemics, youth and elder health
and safety, and - notably for this study - high rates of substance use.

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The Vancouver Police Department (VPD) tries to balance tactics of enforcement with
community policing, and has at times shown highly progressive perspectives within the realm of
law enforcement (VPD, 2020). Progressive public health approaches to drug use have also been
endorsed at a high level by police strategy in Vancouver and Canada (Canadian Association of
Chiefs of Police [CACP], 2020; VPD, 2006). However, it is unclear to what extent a LEPH
approach is actually being applied in the DTES due to differences in terminology and a gap in
consolidated research on the topic. The purpose of this research study is to begin addressing this
gap by exploring the alignment of LEPH in the DTES, with a focus on VPD operations and
strategy on drug use.
Research Questions
The main research question is: how does the VPD demonstrate "law enforcement and
public health" through the policing of people who use drugs (PWUD) in the DTES? Four subquestions will be addressed; the main sub-questions to be answered are:
1. What are examples of operational partnerships or applications of LEPH methodology in
the DTES to address drug use?
2. How are values or strategy of LEPH integrated in policy and mission by the VPD or in
Canadian policing strategy?
Two additional sub-questions considered are:
3. How do residents of the DTES experience VPD practices in relation to public health and
harm reduction?
4. What are police officer attitudes towards public health and harm reduction?
Harm reduction is included as it is a main public health strategy in the DTES, and to account for
different terminology, including the concept of “harm reduction policing”.

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The scope of this project has been refined to account for constraints in time and existing
research. The initial objective was to examine LEPH in Canada, but a lack of available research
narrowed focus to the more heavily-studied DTES. Data are primarily focused on the DTES, but
studies are included from broader Canada and, within the literature review, similar areas of other
countries. With this scope, there is a huge limitation to the extent of intersectionality and nuance
of the DTES that can be addressed in the required time frame. Drug use is focused on as it holds
the attention of research, media, and policy; this excludes other prevalent LEPH issues
previously mentioned. Poverty and houselessness are impossible to fully exclude in context of
the DTES, but are not focused on to control scope. The LEPH focus on COVID-19 is also
excluded. Finally, the LEPH landscape is contextualized, but this study does not conduct an indepth analysis of whether police should be operating as public health actors. Due to time
constraints, this paper is unable to meaningfully contribute to debates of police reform,
defunding, or the core purpose of law enforcement in society.
Multiple theoretical perspectives are considered through this research, beginning with
constructivist and transformative worldviews. Constructivism focuses on how LEPH theory is
built in the DTES through social interaction. Within this, grounded theory is considered, using
personal perspectives of residents and police where available to create meaning within LEPH
(Creswell, 2018). In comparison, the transformative worldview aligns with progressive policy
and reform and seeks to account for marginalization and social inequity surrounding the DTES
community. The focal point of this worldview from LEPH is considering vulnerability and social
determinants within populations to reduce harm and improve community safety and wellbeing.

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Literature Review
The primary purpose of this literature review is to ground this study in academic theory
of LEPH. Secondarily, this review conducts an international scan of leading LEPH drug policing
practices in similar policing systems, with sources expanding beyond Canada to the United
States of America, Scotland, Denmark, and the Netherlands.
Literature Review Methodology
Literature searches for this review were focused on identifying scholarly sources that are
widely cited or on the leading edge of the LEPH field. Searches were conducted through the
Justice Institute of British Columbia (JIBC) Library and Google Scholar, and the software
Litmaps was used to help identify the most relevant and additional articles. 20 articles were
initially identified for abstract review and seven were chosen for final review and analysis. These
were chosen for their intersectional perspective of LEPH, influence or critique to the LEPH field,
and relevance to policing the DTES or policing drug use. To account for the rapidly evolving
subject area, strong consideration was given to whether the articles were recently studied or a
cornerstone article within the field. Of the seven articles included, more than half focus on the
broader academic and professional field of LEPH, with one being a critique of the parallels
drawn between policing and public health. The remaining focus on the policing of drug use.
Description of Literature
“Researching Law Enforcement and Public Health” frames a special edition of the
journal Policing and Society published in 2017, during a strong emergence of LEPH discourse
and literature. In this article, Punch and James discuss the development, focus areas, and research
of LEPH. Although attention to LEPH is relatively new, its concepts are not; parallels are drawn
to common community policing methods and to early representations of police as a social

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service. Some LEPH issues mentioned are mental health, sexual offences, domestic violence, and
abuse in care. Ultimately, Punch and James assert that “addressing the LEPH area raises the
question as to what sort of society [we] live in and what sort of society [we] wish to live in”
(2017, p. 259).
A cornerstone article relating to the emergence of LEPH is written by Auke van Djik and
Nick Crofts from the Netherlands (2017). It is a widely cited overview of LEPH foundations,
shortly after its emergence as an academic and professional field, as demonstrated by increased
publication and the establishment of an international conference series. Van Djik and Crofts
advocate for LEPH collaboration, including partnerships and the police application of public
health methodology. The article provides examples of effective LEPH initiatives and context for
the broad extent of dual-interest issues in LEPH.
Another study goes beyond collaboration to analyze the value of applying a public
health-based prevention typology to police practice, considering “A Journey Upstream” of the
issues that police typically react to (Bland et al., 2021). The authors assert that innovative police
initiatives can be measured empirically using the public health-based theory of primary,
secondary, and tertiary prevention. Using examples from Police Scotland, it was found that most
upstream police activities fall under secondary prevention; the initiatives aim to reduce the
impact of harm and prevent the harm from reoccurring. This article demonstrates that there can
be strategic and methodological alignment between policing and public health.
Conversely, Anderson and Burris argue that policing and public health is “Not Quite the
Right Analogy” in their analysis article of that name, and draw insightful parallels between law
enforcement and acute medicine (2017). They focus on how police, like doctors, have little
capacity to engage in prevention-based activities, how both disciplines can inflict severe

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unintended harm, and they discuss the internal culture of both practices. This is an interesting
counterpoint to the LEPH narrative but has become less relevant in recent years with public and
leadership outcries for a broader and more nuanced scope for police work (Clover, 2022).
James Clover, an editor of Law Enforcement and Public Health: Partners for Community
Safety and Wellbeing, discusses recent demands and scrutiny of police in the chapter “Defund,
Dismantle, or Define” (2022). Clover states that in the conversation of police reform, “policing
for the public health–or public health policing–may be the start to realizing a replacement
institution” (2022, p. 49). The chapter speaks to how although the core function of police is
believed to be the “enforcement of laws and criminalization of people”, police report that much
of their work is most strongly focused on public health, community safety and social wellbeing
(Clover, 2022, p. 50).
Although LEPH language is most used in academia, the same themes are discussed under
terminology of ‘harm reduction’, particularly in reference to policing drug use. Tobias
Kammersgaard authored “Harm Reduction Policing: From Drug Law Enforcement to
Protection”, a study conducted in Denmark around their safe consumption sites (SCS) and drug
decriminalization initiatives similar to those in British Columbia (2019). The article discusses
how marginalization and criminalization of people who use drugs (PWUD) perpetuates distrust
of the police and makes PWUD less safe. Most importantly, the study shows how
decriminalization and a focus on harm reduction can shift police perspective of PWUD from
being criminals to being “citizens with rights”, who deserve respect and protection from
victimization (Kammersgaard, 2019, p. 18).
Other research shows how, despite police’s beliefs or intention, mere police presence can
be a barrier to health-based harm reduction services among PWUD. Greene et al. (2022)

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interviewed PWUD in Calgary about how compounding surveillance and social control
(including police, cameras, and the broader community) limit access to services such as SCS.
This study builds on research showing how police deter safer drug use practices, increase
violence and victimization, and discourage other medical care access (Greene et al., 2022, p. 2).
Notably, this study found that PWUD’s perception of compounding social control strongly
dissuaded service access despite whether social control actors intended to or were actually
working together.
Literature Analysis
Despite the different focuses of these sources, multiple themes emerge relating to LEPH
as a discipline, the community being served, and the profession of policing. A main theme within
LEPH is collaboration. Although Bland et al. (2021) and Clover (2022) show that strategically,
the application of LEPH methodology can push traditional boundaries of police practice towards
innovation, the strongest focus, and a foundational element of LEPH is strong cooperation
between police and public health partners working in their traditional roles together (Punch &
James, 2017; van Djik & Crofts, 2017). Anderson and Burris even assert that “greater
cooperation and even integration between health and law enforcement systems might lead to new
and better approaches” (2016, p. 2). However, research focused on PWUD shows that despite
police cooperation and buy-in to public health or harm reduction initiatives, police cause
unintentional harm to already marginalized populations (Kammersgaard, 2019). Furthermore,
without intention, police presence interacts with other social control actors to impede access to
public health services, which increases victimization, healthcare barriers, and death (Greene et
al., 2022).

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Two themes that emerge around the community are vulnerability and marginalization.
Across literature, both terms are used to describe PWUD, and generally, people caught in the
intersection of LEPH. Vulnerability is a construct that, in a public health context, can relate to
the social determinants of health and adverse childhood experiences, which are also understood
to be a contributor to crime and disorder (Clover, 2022). In policing, there is a push to protect the
vulnerable, but as our systems operate, vulnerable people are often marginalized and vice versa.
Police engage with these priority populations but, as described above, are ultimately a strong
contributor to their marginalization (Clover, 2022; van Djik & Crofts, 2017). Through research
with PWUD in Calgary, Greene et al. state that “paradoxically…structural marginalization is
also what makes some of our participants more vulnerable to…surveillance, social control, and
harassment” (2022, p. 6). Although marginalization and vulnerability are not synonyms, there are
many interdependencies, and both are related to victimization across literature. Perhaps, as
Kammersgaard (2019) leans toward in discussing citizen rights, if police-inflicted
marginalization and criminalization is removed, people under that label can be seen as deserving
protection and thus become less vulnerable.
Finally, literature demonstrates that the institution of policing is in an important
transitional time, and this can not be taken lightly. The core mission and scope of law
enforcement is up for debate and, although outside of the scope of this study, this deserves
significant further research (Anderson & Burris, 2016; Clover, 2022; van Djik & Crofts, 2017).
Furthermore, an unexpected theme emerged around mental wellbeing and occupational health
within law enforcement culture. Considering the scrutiny and possible expanding mission of
policing personnel, it is noted that a “culture of health” must be instilled to protect the members
paving a road to reform (Anderson & Burris, 2016, p. 11; Clover, 2022).

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The literature reviewed in this report shows that LEPH is a relevant and important field.
Although it only emerged strongly within the last 10 years, LEPH research overwhelmingly
supports the strategic reform and repositioning of police toward a preventative, nuanced, harmreduction focus. Such changes can not be taken quickly, but should be prioritized in complexly
marginalized areas such as the DTES. Considering these themes and existing literature, it
remains unclear to what extent and how the VPD’s approach to drug use in the DTES
demonstrates current LEPH wise practices.
Design and Methodology
To explore how LEPH is aligned in the DTES around drug use, this study used
qualitative secondary research design and drew on multiple secondary data analysis techniques.
Qualitative design is consistent with the study’s constructivist and transformative worldviews, as
well as ethnography and grounded theory (Creswell, 2018). Data collection and analysis were
also guided by the four sub-questions.
Data Collection
The search methodology employed key search terms, shown below in Table 1, run
through the JIBC library (EBSCOhost) and Google Scholar. Other web-based databases used
include Sage Open, PubMed, and ProQuest’s Criminal Justice database.
Table 1
Key Search Terms
“Law enforcement”
Police
Policing
“Public safety”

AND

“Public health”
“Harm reduction”a

Optional 1

“Downtown Eastside”
“British Columbia”

Optional 2

“Substance use”

Vancouver
Canada

“Drug use”

Addiction

Note. aHarm reduction is included as a main public health strategy in the DTES, and to account for
different terminology use within LEPH.

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Numbers of results from these searches depended on the combination of search terms and
search engine, ranging from hundreds to thousands. Focusing on peer-reviewed articles since
2010 and excluding studies on similar LEPH issues or COVID-19, articles for title review ranged
from 80-200. Additional sources were identified by citation chaining (manual and using the
software Litmaps) and from searches using the software Consensus. Grey literature was retrieved
from the VPD and Canadian Association of Chiefs of Police (CACP). From title review across
search engines and citation chaining, 28 sources were identified for abstract review. 12 were
ultimately chosen for analysis, listed below in Table 2. These were chosen for their primary
research methods and ability to address at least one of the research questions. Sources include
police publications (4 sources) and policy (1 source), interview-based research with community
members (4 sources) or law enforcement (1 source) focused on drug use, and other highly
relevant peer-reviewed research (2 sources). All sources are connected to the policing of drug
use and all but one are specific to the DTES or Vancouver (police perspectives are collected
from multiple jurisdictions across BC).
Table 2
Sources for Secondary Data Analysis
Author(s)
(year)

Title

Type

Source data
collection

Source data
analysis

Notes

Total systems failure: police
officers’ perspectives on the
Butler et al.
impacts of the justice, health,
(2022)
and social service systems on
people who use drugs

Journal
article

Inductive and
Semi-structured
deductive
interviews
thematic analysis

The British Columbia Drug
Overdose and Alert
Buxton et al.
Partnership: Interpreting and
(2019)
sharing timely illicit drug
information to reduce harms

Journal
article

Health and
public safety
agencies in BC

Use of USCDC
framework to
evaluate system
effectiveness

Evaluates a specific
example of LEPH
collaboration

N/A

N/A

Statement from
collective police
leadership in

Canadian
Canada’s police leaders
Grey
Association recommend adopting a public
literature
of Chiefs of health led diversionary

LAW ENFORCEMENT AND PUBLIC HEALTH IN THE DTES
Police
(2020)

approach to illicit substance
use

14
Canada

Specific operational
and strategic
Literature review examples excluded
from data analysis
due to time range

As strong as the weakest
Cohen &
Journal
pillar: Harm reduction, law
Csete (2006)
article
enforcement and human rights

Literature
review

Policing space in the overdose
crisis: A rapid ethnographic
Collins et al. study of the impact of law
Journal
(2019)
enforcement practices on the article
effectiveness of overdose
prevention sites

Ethnographic:
observation,
unstructured
Thematic
discussions,
analysis: coding
semi-structured
interviews

Declining trends in exposures
Landsberg et to policing among people who Journal
al. (2016)
inject drugs in Vancouver,
article
Canada

Intervieweradministered
questionnaire

Analysis using
multivariable
generalized
estimating
equation models

Biopower, disciplinary power
and surveillance: An
Thesis /
ethnographic analysis of the
Scher (2020)
journal
lived experience of people
article
who use drugs in Vancouver’s
Downtown Eastside

Ethnographic
observation,
focus group
discussions,
semi-structured
interviews,
document
review

Ethnographic
analysis (framed
by existing
theories of power)

Small et al.
(2006)

Impacts of intensified police
activity on injection drug
users: Evidence from an
ethnographic investigation

Spearn &
Gill (2019)

Grey
Journey to hope: An update
literature
report on the VPD’s continued
(VPD
fight against the opioid crisis
report)

Journal
article

Semi-structured
interviews and Thematic
ethnographic
analysis: coding
observation

Internal data

Unknown

Vancouver
Grey
Police
Vancouver Police Department literature
Department drug policy
(VPD
(2006)
policy)

N/A

N/A

Vancouver
Our community in need: The
Police
VPD’s community-focused
Department
safety strategies
(2020)

Internal data

Unknown

Grey
literature
(VPD
report)

Vancouver
Grey
Serving the community:
Police
literature
Vancouver Police Department
Department
(VPD
2022-2026 strategic plan
(2022)
report)

N/A/

Specific operational
and strategic
examples excluded
from data analysis
due to time range

N/A

Outside of time
range, but included
because the policy
is still in force

Influence on VPD
operations,
priorities, and
direction

Note. Creation of this table was guided by Secondary Analysis of Qualitative Data: A Valuable Method
for Exploring Sensitive Issues with an Elusive Population? By Long-Sutehall, Sque, & Addington-Hall,
2010.

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Data Analysis
This study used secondary data analysis techniques to code and interpret the sourced
literature. Consistent with grounded theory, thematic analysis was used to identify emerging
themes and, where possible, direct quotes and perspectives from DTES residents were
highlighted through data analysis to further ground findings. Data were extracted from the
sources and coded using Excel spreadsheets. Codes were first identified under the four subquestions respectively. These codes were validated using themes identified in broader LEPH
scholarship through the literature review. Once all data points were extracted, a comprehensive
analysis of the validated codes was conducted to identify overall themes and sub-themes,
considering interdependencies, duplications, and contradictions across the four sub-questions.
The analysis took a reflexive approach through ongoing acknowledgement of how the
researcher’s personal experiences in the DTES influenced interpretation of the findings.
Ethical Considerations
Despite using secondary data, this study maintains a duty of care to the original research
participants, particularly considering studies within the DTES and with PWUD. As outlined by
Boilevin et al. in their collaborative report the “Manifesto for Ethical Research in the Downtown
Eastside”, research has a powerful potential to perpetuate stigma, trigger trauma, misrepresent
communities, and serve as an excuse to delay action in favour of searching for studied findings
(2019). There are also potential ethical issues when research can impact vulnerable populations.
In this study, conclusions and recommendations toward policing policy could cause direct and
vicarious harms to residents of the DTES. This issue deserves particular consideration as
research is conducted from an institution with deep links to systems of justice and public safety
that can victimize marginalized groups. This study has been unable to follow the community-

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based guidelines set forward for ethical research by Boilevin et al. because the research is limited
to secondary data. While the use of secondary data mitigates some potential of direct harm to
participants, it also asserts that original participants have been unable to provide free, prior, and
informed consent to this current study (Long-Sutehall et al., 2010). From Boilevin et al.’s report,
this study specifically commits to the following items:
● Working from a trauma-informed perspective and not perpetuating stigma (2019, pp 1719): this study commits to avoiding stigmatizing language and acknowledging where
stigmatizing language occurs in analyzed literature. Furthermore, this study commits to
seeking nuanced datasets and including discussion that highlights trauma-informed and
systemic considerations.
● Making the study “a celebration of community strength, resilience, and dignity” (2019, p.
22): this language resonates with the author from my grateful witness to the compassion,
determination, and capacity within the DTES community. This study commits to
celebrating these qualities through conscious literature selection and discussion.
● Making it “clear how research can lead to action” (2019, p. 22): this study commits to
developing clear recommendations for policing in the DTES and for future research.
Findings
Table 3 below notes the coding of significant data under each sub-question, including all
preliminary codes identified. Data were coded under the most applicable question; however,
strong overlap was noted between questions. For example, police perspectives often included
opinions of operational LEPH examples, and some anecdotal statements published by the VPD
could be interpreted as police attitude or as strategic integration. Further, the distinction between
operational and strategic actions is less black and white and more of a spectrum, with much of

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the influential LEPH actions occurring in the grey area at an operational leadership level.
Notably, although the three areas just mentioned were largely interdependent, nearly no overlap
was observed between the experiences of residents and any other question, and contradictions
were particularly present between strategic ideology by police and the community’s experiences
of VPD actions.
Table 3
Preliminary Codes
Sub-question

Preliminary codes identified
Collaboration

What are examples of operational
Harm reduction initiatives (SCS or OPS, decriminalization, safe supply)
partnerships or applications of
LEPH methodology in the DTES to Drug policing with reduced harm
address drug use?
Incorporation of public health in policing
Collaboration
Harm reduction in policy
How are values or strategy of
LEPH integrated in policy and
VPD/Canada strategic statements
mission by the VPD or in Canadian
Vancouver as a leader in progressive policing
policing strategy?
Police attitude shift

How do residents of the DTES
experience VPD practices in
relation to public health and harm
reduction?

Displacement from physical harm reduction services
Intimidation from harm reduction services or safe practices
Rights violations or direct harm
Distrust
Collaboration
Here to help

What are police officer attitudes
towards public health and harm
reduction?

Harm reduction
Social service or social issues
Public health methods
Police attitude shift
Pro-enforcement

Note. Codes are not listed in order of significance.

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The final thematic analysis examined all codes and supporting data outside the silos of specific
questions to account for these spaces of overlap and contradiction. Table 4 below summarizes
the three main themes and five sub-themes that emerged from this comprehensive analysis;
these are detailed in the following sections.
Table 4
Themes and Sub-themes
Theme

Sub-theme

Collaboration is the most common occurrence of LEPH

Officers are unable to handle LEPH issues alone

VPD is positioned as a leader in progressive policing

More progressive applications of LEPH appear to
be demonstrated strategically over operationally
Police attitudes are shifting

Intention does not cause effect

There is a disconnect between strategic statements
and operational actions or perceptions
Perceptions can cause as much harm as actions

“It Doesn’t Need to Be Siloed”
Collaboration is the most common occurrence of LEPH by the VPD to address drug use.
This is consistent with the theme of collaboration from this study’s literature review, reinforcing
that collaborative initiatives bringing police and public health together actors are the most
manageable within the LEPH spectrum for both the VPD and internationally. Collaborative
LEPH initiatives are particularly strong at operational and operational leadership levels in
Vancouver within the context of drug use. A main focus of these is diverting people in addiction
toward health treatment, as demonstrated through partnerships with health authorities. As
detailed in police publications, VPD officers can be a connection and referral point between
PWUD and Vancouver Coastal Health (VCH) outreach teams, and the VPD has also partnered
with VCH for educational drug use prevention initiatives (Spearn & Gill, 2019; VPD, 2020;

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VPD, 2006). A physical demonstration of LEPH collaboration is the St. Paul’s Hospital
Emergency Department HUB and Vancouver Police Foundation Transitional Care Centre
(TCC). The HUB is a 10-bed treatment facility for people living with mental health and/or
substance use disorders, and the TCC is a short-term accommodation facility to connect people
to community services post-discharge. The partnership includes the VPD, Vancouver Police
Foundation, Ministry of Health, and Providence Health Care (Spearn & Gill, 2019).
Another key focus of LEPH collaboration is information-sharing. The VPD sits on many
working groups, including BC’s Joint Task Force on Overdose Response and Vancouver’s
Community Action Team (CAT) (Spearn & Gill, 2019). Lastly, the VPD supports lifesaving
public alerts to poisoned drug supply, including VCH’s Real-time Drug Alert and Response
(RADAR, now transitioned to the provincial Toxic Drug and Health Alerts system) and the
provincial Drug Overdose and Alert Partnership (Buxton et al., 2019; Spearn & Gill, 2019).
These partnerships involve coordination and communication at an operational leadership level.
Officers Unable to Handle LEPH Issues Alone
A logical driving factor for collaboration is that police are unable to handle LEPH issues,
including drug use, alone. Frontline officers recognize that they do not have the training to
support PWUD; in an interview about the impacts of health, justice, and social systems on
PWUD, one police officer in BC states:
I think that a better partnership should be set up … and I love working with social
workers, and mental health workers. I think they’re great, they’re the people who are
trained to do those things, but it doesn’t need to be siloed…police can work alongside
these people to get the benefits that we need, right. (Butler et al., 2022, p. 8)

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In the same publication, officers refer to the same “revolving door” that the St. Paul’s HUB tries
to address; another officer says, “I think we’re getting a failing grade on how we deal with
addictions in BC, and Canada, and we definitely need to be doing better”, further explaining that
there is a lack of supports within the justice system (p. 6). Within the VPD, late Superintendent
Bill Spearn, a leader in progressive drug policing, acknowledged how traditional policing
systems are unable to support PWUD, saying:
When somebody is using ...contaminated drugs and they are overdosing, being Narcan’d
back to life, and then they are out of money.... they have to go commit crimes in order to
get their drugs, like breaking into cars, assaulting people... It’s just a revolving door.
Really, it’s much more humane and much more cost-effective to provide services to
people. (Spearn & Gill, 2019, p. 11)
Overall, police officers note limitations in their training, mandate, and capacity to address the
complex issue of drug use, and increasingly acknowledge the issue as being in the realm of
health authorities or public health actors.
Vancouver as a Leader in Progressive Policing
Although presented this way by police groups and leaders, the VPD is positioned as a
progressive leader of drug policing. Operationally, in 2020, the VPD jail was “the only shortterm facility in Canada to provide a complete addiction response” (VPD, 2020, p. 20). Supports
for PWUD at the jail are reported to include overdose response and opioid agonist therapy while
in custody, and take-home Naloxone kits and referrals to the VCH outreach team upon release.
A particular space of leadership for the VPD is sharing operational initiatives in
collaborative strategic spaces with other police leaders and decision-makers. The VPD has
presented at several conferences, including ‘Outside the Box Strategies for Policing the Opioid

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21

Crisis’ at the Ninth Annual Law of Policing Conference and ‘Pillars of Change - Priorities for
Addressing the Opioid Crisis’ on behalf of the CACP and co-facilitated by Health Canada
(Spearn & Gill, 2019). Similar leadership is demonstrated by contributing to committees such
as the CACP’s Drug Advisory Committee. In this collaborative way, the VPD has also sought
to learn from other regions and state they remain “receptive to new approaches to these
multifaceted issues and regularly [examine their] own service delivery, as well as those of other
police agencies, throughout the world, to continually improve public safety” (VPD, 2020, p. 5).
An example of this is the VPD sponsoring a representative travelling to Portugal to study their
drug policy and diversion initiatives; this experience contributed to a position paper on
decriminalization for the CACP (Spearn & Gill, 2019).
More Progressive Applications of LEPH Demonstrated Strategically
A trend noted in this data analysis is that the more highly progressive applications of
LEPH theory or methodology are more frequently documented in strategic spaces rather than at
an operational level, another finding consistent with the literature review. This is highlighted in
the VPD’s 2022-2026 Strategic Plan, where the need for holistic partnerships with community
partnerships is emphasised alongside the VPD’s goal to continue advocating for harm reduction
and treatment solutions within the opioid crisis (VPD, 2022). In addition to lofty statements
within VPD publications, policy does clearly state a focus on harm reduction policing in
Vancouver. In the VPD Drug Policy (2006), the department makes several strong statements,
including that harm reduction “requires a broader scope and should include all practices and
initiatives that reduce harm” (p. 7), and “should not be perceived as solely within the realm of
health authorities” (p. 8), hinting strongly that police have a responsibility to pursue harm
reduction for PWUD. The VPD has also formally endorsed Vancouver’s four pillars drug

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strategy, which supports harm reduction alongside prevention, treatment, and enforcement (VPD,
2006; VPD, 2020). Finally, a highly progressive approach within policing described by the VPD
is their involvement in implementing a safe drug supply. In addition to work with the BC Centre
for Disease Control on a hydromorphone dispensing project, the VPD has reportedly advocated
for safe supply to government partners as a member of the CAT (Spearn & Gill, 2019).
Contributors to the phenomenon of more progressive statements in strategic spaces may
include the fact that strategic publications are inherently documented, whereas individual officer
actions are not published. Alternatively, day-to-day operational priorities may limit officer
capacity to undertake complex LEPH tasks, and/or referral options may be unavailable, as police
in BC expressed to Butler et al. (2022). Lastly, resident distrust of the police, which is expanded
on in a subsequent theme, limits radical change in operational LEPH effectiveness overnight.
Police Attitudes Are Shifting
Provincial Health Officer Dr. Bonnie Henry states that “there has been a shift in focus for
police to support a harm reduction approach” (VPD, 2020, p. 19), and this shift can be seen from
operations to strategy and policy. Although Landsberg et al. (2019) note that individual police
officers within and outside of the VPD may oppose harm reduction policies based on personal
beliefs, this analysis showed that officers generally see drug use as an issue of health and
structural vulnerability rather than an issue of criminality (Butler et al., 2022; Spearn & Gill,
2019). VPD Chief Constable Adam Palmer even stated:
The traditional role of frontline policing has fundamentally shifted to harm reduction
when interacting with people experiencing addiction… Frequently, our officers are the
first point of contact and the ones who will assist individuals in accessing appropriate
services and pathways of care (CACP, 2020, p. 1)

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In this statement, Chief Palmer uses people-first language, highlights harm reduction as a
policing duty, positions police in a continuum of care supporting PWUD, and references
partnerships with health as detailed in the previous theme of collaboration.
This is a stark evolution in perspective since just the 2006 VPD Drug Policy, and
certainly since before then. Landsberg et al. studied trends in harmful policing exposure among
PWUD in Vancouver and noted a significant decline in drug paraphernalia confiscation and
police violence after the drug policy was implemented (2016). Furthermore, this analysis found a
strong shift in VPD language and focus even since 2006. Notably, the VPD used the term drug
‘abuse’ in their 2006 drug policy, asserting that past campaigns to dissuade harmful behaviour
such as smoking and drunk driving were successful because they “judged and stigmatized”
undesirable behaviour (VPD, 2006, p. 2). As shown in recent publications, the VPD’s language
has shifted to “substance use” and even to people-first language by 2019 (Spearn & Gill, 2019;
VPD, 2020).
Intention Does Not Cause Effect
Unfortunately, significant datasets highlighted a distinct difference between seemingly
well-intentioned statements from police and the daily realities of policing operations experienced
by residents of the DTES. Ultimately, good intentions are not a substitute for, and will not result
in, effective action. This finding corresponds with themes of unintended harm from the literature
review, and goes further to explore and validate harms caused by perceived intimidation.
Disconnect Between Strategic and Operational
Although police attitudes are shifting and individual officers want to help people,
policing practices on the block within the DTES can distinctly contradict ideological strategic
statements by the VPD and Canadian policing leadership. Looking at the impact of policing

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tactics on Overdose Prevention Sites (OPS), Collins et al. found that “despite the VPD’s open
support of evidence-based harm reduction…our findings underscore how police efforts to
increase neighbourhood safety reinforce the marginalization of PWUD in the same
neighbourhood as they sought to avoid police” (2019, p. 205). Observational data in the same
study noted VPD officers “regularly stopping and searching individuals, particularly Indigenous
and people of colour, within the drug-scene and within the immediate areas surrounding OPS,
including blocking OPS alley entrances with a police car while searching individuals” (p. 203).
Space-based policing practices physically displace people away from or intimidate people from
accessing harm reduction services. The VPD’s pervasive Beat Enforcement Team (BET) patrols
also create a barrier to safer drug use practices through fear of police disruption and harassment
(Scher, 2020). Safer drug use practices include phasing consumption starting with smaller
amounts to verify strength, and using in well-lit and populated areas to not cause undue injury
and have people around for potential overdose (Small et al., 2006). Through community-based
research, Collins et al. found:
The majority of participants described having negative interactions with police in the
neighborhood at some point, which created a lack of trust. Such interactions were linked
to participants’ structural vulnerability – including being harassed while using outside,
being forcefully displaced while sleeping outside, and having tents, tarps, and other
belongings disposed of while unhoused – and reinforced their marginality and drugrelated risks. (2019, p. 203)
This articulates a strong distrust of police that is observed throughout this analysis.

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Perceptions Can Cause as Much Harm as Actions
Police intimidation as a barrier to harm reduction services or practices was particularly
noted in how residents experience VPD practices, both through concrete examples of specific
police tactics and within a general theme of the community’s distrust of police. This is
particularly significant with the VPD’s history of documented human rights violations around
drug use and health services before the 2006 drug policy (Small et al., 2006). Through
ethnographic research on power and surveillance in the DTES, Scher noted:
Perceptions of police rely on both individual and collective community experience with
police and are influenced as much by modes of policing within a neighbourhood as they
are by the individual treatment of citizens. This collective negative discourse of fear
towards law enforcement then manifests in a collective distrust towards law enforcement.
(2020, p. 8)
Scher compares persistent policing tactics in the DTES, such as the BET, to the panopticon
model of surveillance, in which subjects “are unable to see whether they are being observed or
not”, and thus live within the threat and perception of surveillance 24/7 (2020, p. 22). This
panoptic presence of the VPD is noted in Figure 1, street art in the DTES by Smokey D., which
states “remember tha [sic] cops have this entire alley on 24/7 video… Not paranoid…Just
facts…Be alert”. Within SCS, Scher (2020) specifically found that the perception of VPD’s
presence and access does not reflect the relatively low numbers of calls for service. This
perception of constant police overwatch is correlated with a deterrence from harm reduction
facilities and practices, including being a barrier to lifesaving actions. For example, Collins et al.
noted:

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Although the Vancouver police have a policy of non-attendance at overdoses unless
advised to do so by emergency services…their existing, heavy presence in various spaces
left participants to choose between responding to an overdose alone, not responding, or
responding with the assistance of emergency medical staff and potentially being arrested.
(2019, p. 203)
Figure 1
Smokey D. on VPD Surveillance
The pervasive, implied, and feared presence
of the VPD throughout the DTES,
amplified by individual and community
experiences and the phenomenon of
compounding surveillance, actively results
in harm and death to PWUD because fear
dissuades harm reduction practices and
service access. The quantitative occurrence
or risk of police activity does not impact
residents’ perceived risk and efforts to
evade it.

Note. From Policing Space in the Overdose Crisis, by Collins et al., 2017. Art by Smokey D., Photograph
by Jade Boyd and Ryan McNeil. Alley behind the street market.

Discussion
Longstanding community experiences of displacement at the hands of police continues
today without conscious police effort. Furthermore, securitization and gentrification validate the

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VPD’s presence through calls for service for behaviour associated with poverty and
houselessness rather than criminality (Collins et al., 2019). This presence, and the good intent by
individual officers, is validated under the guise of upholding safety but further endangers the
lives of PWUD. Distrust between the community and law enforcement is held up by individual
and collective perception, and reinforced every time harassment and harm occurs by the VPD.
This relationship already limits LEPH in the community and will continue to be a complicating
factor, but this should not allow the VPD to dismiss the evidence-based purpose and potential
effectiveness of LEPH.
Broader conversations across society are already prompting re-evaluation of the core role
of policing. This deserves focused academic and professional attention within the DTES and
across Canadian policing, including considerations of LEPH integration into operations and
strategy. Many officers in BC are already advocating for more progressive initiatives in policing,
but this is a source of role tension across the profession. Butler et al. (2022) found that although
some officers feel that police have been wrongly compelled to take on health issues beyond their
appropriate scope, other officers believe they should be trained and supported to respond to these
calls effectively. For example, one officer suggested that police position their mandate to include
health and social support. The officer asserts that “there needs to be a new kind of police
officer.... Could follow the same thing in harm reduction... having a kind of a social worker class
of police officer, or mental health police officer, something new” (Butler et al., 2022, p. 9). The
exploration of what radical application of public health principles to policing in the DTES would
look like, in coordination with an intersectional and systemic understanding, is critical to
evolving LEPH in the area and transforming the dynamic between the VPD and the community.

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LEPH in the DTES must also be framed in the broader context of the Four Pillars Drug
Strategy, which acknowledges similarities between police and public health realities and sets the
principles of harm reduction, prevention, treatment, and enforcement. However, how this
strategy and LEPH are demonstrated operationally will always be imbalanced due to the inherent
amount of power held by law enforcement, and the systemic marginalization and securitization
of PWUD. An advocate once described the strategy as “three toothpicks and a tree trunk” (Cohen
& Csete, 2006, p. 102). To move toward more effective LEPH work in the DTES, policy and
training must show a deep understanding of this power imbalance, systemic factors, and the
unintended impacts of policing practices. A possible framework for drug policy is based on a
human rights approach. This reframes PWUD as people with rights, as remarked in the literature
review around harm reduction policing, and importantly focuses the VPD on upholding human
rights, thereby limiting harmful policing actions.
Limitations
The main limitations of this study are time and data. Data are limited to secondary
sources, and police resources are limited to publicly available content. Sources are not
exclusively peer-reviewed because police policy and other grey literature were needed to answer
the research questions. The combination of these limitations restricts the most important voice of
lived experience, though effort was made to highlight ethnographic, community-based, and
interview-based sources wherever possible. Furthermore, this study can not determine causation,
and generalizability is limited from the specific sampling and lack of variable control across
secondary data groups. Although primary data collection methods have mitigated this where
possible, response bias and participant self-selection may have influenced data (Landsberg et al,
2016).

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These overlapping limitations unfortunately restricted fulsome considerations of
intersectionality in this study, particularly of the intersections with other LEPH issues and
initiatives in the DTES. As Butler et al. describe:
Discussions about the drug–crime relationship often fail to consider the intersectional
structural vulnerability of PWUD who face multiple, overlapping inequities that
contribute to the ongoing harms that they experience… PWUD experience stigma,
housing unaffordability, poor therapeutic relationships, and lack of trust in the health care
system to a greater extent than those who do not use drugs… The trauma inflicted
through colonial violence in Canada has also been associated with overdose, for example,
Indigenous women who had experienced child removal had over twice the odds of an
unintended overdose than non-Indigenous women who had not lost custody. (2022, p. 2)
More comprehensive exploration of these intersectional issues and systemic influences beyond
this study will be vital to understanding the nuance required for successful LEPH application in
the DTES.
Recommendations
Recommendations to the Vancouver Police
The following recommendations to the VPD focus increasing the effectiveness of LEPH
in the DTES, and aligning operational practices with strategic direction:
● Day-to-day policing practices of the BET should be evaluated to assess barriers they
affect to evidence-based harm reduction. Police should also be trained on unintended
public health consequences of hotspot policing, and the practice should be discouraged
(Collins et al., 2019).

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● To address the gap in operational capacity, training in trauma-informed care, harm
reduction, cultural safety, and community competency in the DTES should be enhanced,
through collaboration and engagement with police, public health, and harm reduction
services (Landsberg et al., 2016).
● Police partnerships with public health services and support of harm reduction services
should be continued and enhanced, as these services have been shown to benefit PWUD
(CACP, 2020; Landsberg et al., 2016). Expanded police engagement with harm reduction
services may improved understanding of police impacts on public health and PWUD.
● The VPD should adopt LEPH terminology in reports, policy, and internal
communications to align with international practice.
Recommendations for Future Research
Findings from this study highlight the following recommendations for future research
endeavors:
● Future research should evaluate the effectiveness of policing drug policies and practices
alongside their operational effects on the health and safety of PWUD (Scher, 2020).
● For this study, the decision was made to focus on the policing of PWUD based on high
levels of research in this area compared to other LEPH issues, and therefore better
availability of quality secondary data; thus, it is recommended that future research
explores other LEPH issues and the intersectionality of LEPH issues in the DTES.
● Future research should explore whether and how policy changes impact daily policing
practices, and further, whether the department’s strategic direction influences individual
officer perspectives (Landsberg et al., 2016).

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● As highlighted in the literature review and discussion, future research should explore the
core mission and scope of law enforcement.
Conclusion
This study shows that LEPH is applicable to the VPD’s work in the DTES. Further,
LEPH is already demonstrated by the VPD, but is disproportionately evidenced between
strategic statements and operational realities. Strategically, the VPD and CACP support LEPH
and harm reduction with some language in policy and endorsement of the Four Pillars Drug
Strategy, and further demonstrate a shift toward less stigmatizing language use in official reports.
Operationally, by the VPD and beyond, collaboration is a common LEPH initiative, and should
continue to be supported and enhanced due to its evidence-based effectiveness and appreciation
from police officers, who feel unprepared to support LEPH cases alone. Although officers have
differing opinions of harm reduction, they are generally supportive of LEPH partnerships. More
comprehensive training may improve police understanding of harm reduction, public health
principles, and systemic factors around the DTES and PWUD.
Despite strategic support, and a trend of police officers shifting from pro-enforcement
towards a more nuanced perspective of drug use, residents and PWUD in the DTES find that
police actions are a barrier to harm reduction and public health. The pervasive influence of
institutional power, through individual and collective experiences in the DTES, is a barrier to
operational effectiveness of the VPD. Further, role tension within policing limits efficient LEPH
progress and could create a divide between officers. More research should be conducted to
explore these outstanding areas, and the VPD should pursue this evidence-based approach but
should not delay recommended changes and effective action through excuses of waiting for
research findings.

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