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In the early 1980s, the DTES was an edgy but still relatively calm place to live. The neighbourhood began a marked shift before Expo 86, when an estimated 800 to 1,000 tenants were evicted from DTES residential hotels to make room for tourists. With the increased tourist traffic of Expo 86, dealers introduced an influx of high-purity cocaine and heroin. In efforts to clean up other areas of the city, police cracked down on the cocaine market and street prostitution, but these activities resurfaced in the DTES. Within the DTES, police officers gave up on arresting the huge numbers of individual drug users, and chose to focus their efforts on dealers instead.
Crack Dirt 3 Skidrow 41
On its core blocks, dozens of people are shuffling or staggering, flinching with cocaine tics, scratching scabs. Except for the young women dressed to lure customers for sex, many are in dirt-streaked clothing that hangs from their emaciated frames. Drugs and cash are openly exchanged. The alleys are worse.
Without the presence of a viable retail economy, a drug economy proliferated, with an accompanying increase in crime, while police presence decreased. Crack cocaine arrived in Vancouver in 1995, and crystal methamphetamine started to appear in the DTES in 2003. In 1997 the local health authority declared a public health emergency in the DTES: Rates of HIV infection, spread by needle-sharing amongst drug users, were worse than anywhere in the world outside Sub-Saharan Africa, and more than 1000 people had died of drug overdoses. Efforts to reduce drug-related deaths in the DTES included the opening of a needle exchange in 1989, the opening of North America's first legal safe injection site in 2003, and treatment with anti-retroviral drugs for HIV. A shift among users from injected cocaine to crack cocaine use may have also slowed the spread of disease. Rates of HIV infection dropped from 8.1 cases per 100 person-years in 1997 to 0.37 cases per 100 person-years by 2011.
A 2010 BBC article described the DTES as "home to one of the worst drug problems in North America." In 2011, crack cocaine was the most commonly used illicit hard drug in Vancouver, followed by injected prescription opioids (such as fentanyl and OxyContin), heroin, crystal methamphetamine (usually injected rather than smoked), and cocaine (also usually injected). Alcoholism, especially when it involves the use of highly toxic isopropyl alcohol, is a significant source of harm to residents of the DTES.
Since the 1980s, the VPD has generally ignored drug use in the DTES, as the sheer volume of users makes it unfeasible to arrest all of them. A large-scale police crackdown on DTES drug users in 2003 made no difference except to displace drug use to adjacent neighbourhoods. To encourage people to call for help when a drug user is overdosing, paramedics rather than police respond to 911 calls about overdose deaths, except in cases where public safety is at risk.
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