Beyond the Sweep: Rethinking Public Health and Human Dignity in Vancouver’s Downtown Eastside
Vancouver’s Downtown Eastside (DTES) has long stood at the epicentre of Canada’s unregulated drug-poisoning crisis. The infiltration of fentanyl, benzodiazepine analogues, and other adulterants into the illicit supply has driven overdose deaths to record levels. In this challenging environment, policies and practices affecting people experiencing homelessness, drug use, and marginalization take on heightened importance.
“Street sweeps” refer to operations in which municipal or other authorities relocate people who are unhoused or living in public spaces, often dismantling encampments and moving individuals into shelters or alternative locations. These actions are typically framed as “clean-up” initiatives, yet from a public health perspective, they carry significant risks—particularly for people who use drugs or live without stable housing.
A recent study examining the health impacts of street sweeps in San Francisco recruited 39 healthcare providers who worked with people experiencing homelessness. Participants described severe harms associated with the loss of medications and medical supplies during sweeps, which worsened the spread of infectious diseases and drove people back to the illicit drug market (Qi et al., 2022).
“Loss of retroviral medications along with increased barriers to engagement with medical providers leads to higher rates of transmission of HIV and Hepatitis C, creates medication resistance, and results in other infections due to compromised immune systems.” — Outreach Worker
“People get really sick from opioid withdrawal without their meds, and it often drives them to purchase illegal drugs in order to self-medicate. Losing injecting equipment makes people share needles and increases their risk of HIV and HCV.” — Executive Director, Community Health Organization
“Patients with chronic medical conditions need to take medications regularly. When their medications are taken during sweeps, their conditions worsen, often leading to emergency visits or hospitalization. This is costly and detrimental to their health.” — Anonymous Participant
While that research was conducted in the United States, it offers valuable insights for Vancouver’s DTES, where similar structural vulnerabilities—housing instability, substance use, and social marginalization—prevail.
Demonstrators have increasingly rallied against the practice of street sweeps, arguing that they displace rather than support those most in need (Little, 2022). In contrast, harm reduction approaches aim to reduce risk while building trust, safety, and continuity of services. In Vancouver, such strategies have shown measurable benefits in improving health outcomes and saving lives (CTV News, 2025).
Vancouver’s DTES remains a focal point of intersecting public health and social crises, where homelessness, substance use, and toxic drug supply converge. Evidence from both local and international contexts demonstrates that coercive measures like street sweeps, though often intended to restore public order, can undermine health, safety, and trust among marginalized populations (Qi et al., 2022; Eren et al., 2025).
By contrast, integrated harm reduction and care strategies—such as those advanced by the Province of British Columbia—prioritize safety, continuity, and dignity. Expanding mental health and addiction services, creating stable housing, and maintaining low-barrier access to supports have all demonstrated measurable success in saving lives and strengthening community well-being (Province of British Columbia, 2025a, 2025b).
Ultimately, moving forward in the DTES requires centring evidence-based, person-focused approaches that recognize the interconnectedness of housing, health, and harm reduction. Sustainable solutions will depend on replacing punitive interventions with coordinated care systems that reduce harm, build stability, and uphold the health and human rights of Vancouver’s most marginalized residents.
By: Nora Ainsley (she/her) | Blog Committee Member
References
B.C. moves to ban drug use in public spaces, taking more steps to keep people safe. BC Gov News. (2024, April 26). https://news.gov.bc.ca/releases/2024PREM0021-000643
Building Better Mental Health and Addictions Care. Province of British Columbia. (2025a, October 24). https://www2.gov.bc.ca/gov/content/health/mental-health-and-addictions/building-better-mental-health-and-addictions-care
CTVNews. (2025, August 28). How harm reduction efforts save lives. CTV News. https://www.ctvnews.ca/vancouver/video/2025/08/28/how-harm-reduction-efforts-save-lives/
Eren, I. M., Sayre, E. C., Shane, C., Singh Kelsall, T., Beatrice, M., Sudds, R., DeBeck, K., Milloy, M.-J., Kerr, T., & Hayashi, K. (2025). “Street Sweeps”: The municipal government-enforced confiscation of personal belongings among unstably housed people who use drugs in Vancouver, Canada. Public Health, 105885. https://doi.org/10.1016/j.puhe.2025.105885
Little, S. (2022, June 15). DTES group rallies against “street sweeps,” says area’s homeless targeted. Global News. https://globalnews.ca/news/8923303/dtes-street-sweep-rally/
Preventing and reducing homelessness: An integrated data project. Province of British Columbia. (2025b, September 16). https://www2.gov.bc.ca/gov/content/housing-tenancy/affordable-and-social-housing/homelessness/homelessness-cohort
Qi, D., Abri, K., Mukherjee, M. R., Rosenwohl-Mack, A., Khoeur, L., Barnard, L., & Knight, K. R. (2022). Health impact of street sweeps from the perspective of healthcare providers. Journal of General Internal Medicine, 37(14), 3707–3714. https://doi.org/10.1007/s11606-022-07471-y
