Not four pillars. One shaky toothpick.

Criticism of Vancouver's implementation of their four pillar model:

SFU psychology professor emeritus Bruce Alexander writes that it "provides no way of assigning funding priorities to diverse agencies, all competing for scarce public resources," so agencies "seem to work at cross-purposes."

Dr. Meldon Kahan, director of addictions medicine at St. Joseph's Hospital in Toronto, believes harm reduction is often code for giving up.

"If strategies such as safe-injection sites and heroin clinics aren't connected with treatment options, then they become 'palliative care' -- they have given up on patients ever recovering from their addiction and are attempting to keep patients safe while they continue to use drugs. The latter goal is fine, but the 'giving up' on patients is not," says Kahan, an associate professor of family medicine at the University of Toronto who has written books on addiction and has visited the Downtown Eastside.

Vancouver police union president Tom Stamatakis has charged that funding favours harm reduction over the other pillars, creating just "one shaky toothpick" — "a strategy that's doomed to fail."

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