Today, he is one of Canada's leading advocates for drug-policy reform, having championed once-radical initiatives such as supervised consumption sites, prescription heroin and drug decriminalization as more thoughtful alternatives to the war on drugs.
But when Donald MacPherson first arrived in Vancouver from Toronto in 1986, he knew nothing about the issue. Working as director of the Carnegie Community Centre in the city's Downtown Eastside, he recalled witnessing over a few years what was once largely an alcohol and pill culture shift toward a "full-blown drug scene" with heroin, cocaine and crack cocaine.
"I was on the corner, running this centre, and just watching this take place," recalled Mr. MacPherson, now the executive director of the Canadian Drug Policy Coalition. "I became totally puzzled by why no one was doing anything to respond to this."
In 2000, he became the city's first drug-policy co-ordinator, developing the four-pillars drug strategy and advocating for evidence-based, albeit often controversial, approaches to problematic substance use. Among 36 recommendations were two – supervised drug-use sites and heroin-assisted treatment – that quietly signalled that the city would start to do things differently.
Mr. MacPherson this week received Simon Fraser University's 2017 Nora and Ted Sterling Prize in Support of Controversy – an award to recognize those who look beyond conventional wisdom to advance human progress in the face of opposition.
He used his lecture to discuss some of the successes that came out of Vancouver's drug epidemic of the 1990s – such as the opening of Insite, Canada's first public supervised-injection site – but also the lull in progress since.
"Somehow, we lost our momentum," Mr. MacPherson told the full house at SFU's Harbour Centre. "Politics changed. The urgency changed. The overdose rate came down to a 'tolerable' 200 or 250 [from a then-high of 400]."
Sixteen years after the launch of the four-pillars approach, British Columbia has more than two dozen government-sanctioned sites where drug users can consume under supervision; a small-scale prescription-heroin program; and a circle of top health officials calling for the decriminalization of petty drug use and possession. (The four-pillars approach is based on harm reduction, prevention, treatment and enforcement.)
And on Wednesday, the province officially adopted guidelines for supervised injectable opioid-assisted treatment, which signals a new and critical approach to reaching drug users who don't respond to traditional therapies such as methadone and buprenorphine-naloxone.
But Mr. MacPherson doesn't see these developments as signs of good progress.
"I think we failed to scale up the four-pillars approach," he said. "We started down a road that looked comprehensive … but we didn't go past Insite. Thirteen years later, we have more injection sites; what happened in that 13 years? Insite was at capacity in a few weeks.
"We did some good things: methadone prescribing increase, the outreach to people around HIV medications," he continued. "But we did not really scale up as Europeans did, to meet the scale of the problem. We got started down a road and then got stalled."
The relative inaction until recent years compounded the current overdose crisis because the province was not prepared for the arrival of illicit fentanyl, Mr. MacPherson added: "Fentanyl is a game-changer – therefore, we need to change the game."
Mr. MacPherson donated his $5,000 award to several drug-policy advocacy groups, including the Canadian Association of Drug Users, which is raising funds to send a delegation to Portugal to study the effect the country's decriminalization of drugs has had.
In attendance at the SFU event was long-time drug user and drug-policy activist Dean Wilson, who shared an anecdote about showing up at Mr. MacPherson's door in the Christmas of 2004, when he had dropped to 110 pounds and had "few options and even less hope."
"Your continued support has allowed me to come through to the other side, where I've had the same house for seven years, the same phone number for 10," Mr. Wilson said. "Donald, it's an honour for me to call you friend."