The Fentanyl Overdose Crisis in Vancouver’s Downtown East Side
Story and Photos by Robert J. Galbraith

A humpback whale breaches near Vancouver in the Salish Sea of British, Columbia, Canada, October 31, 2017. What the tourists to this province don’t know, is that an entire 6-block-section of this ‘city in the mountains,’ is being turned into a graveyard, from overdoses of the deadly opioid fentanyl. It is being used to mix with heroin, cocaine, crystal-meth and other hard drugs. 

Steveston, British Columbia, Canada, November-December 2017—I have lived in British Columbia since the middle of October. During this time, I have photographed the limitless beauty of this province; and witnessed some of the most spectacular and moving natural wonders I have ever seen. From marauding killer whales and breaching humpback whales, to snow-capped mountain scenes that literally took my breath away, this province is a true heaven on earth that simple words cannot fully describe.

As a photographer of wildlife and nature, British Columbia and its natural wonders are literally unsurpassed, and I thank the Lord that my wanderings have unveiled to me this new-found paradise.

During a break from my photography and part-time job, (working on the fishing docks unloading boat-fulls of salmon and herring from the gill netters that ply these waters of the Salish Sea), a co-worker asked me if I’d like to join him on the skytrain for a trip to downtown Vancouver. It was a good opportunity to get to see the downtown and orient myself to that area.

It was here, just over a half-hour’s drive northwest from the fishing town of Steveston, to the City of Vancouver, that I found what I never expected to find in any modern Canadian metropolis; I found hell on earth. I was face-to-face with unimaginable suffering, destitution and the everyday threat of death that is stalking a large segment of our Canadian population. Here, in downtown Vancouver’s east side, I entered what the locals call, “The War Zone.”

A killer whale surfaces off of the City of Vancouver, British Columbia, October 30, 2017. Just minutes from the stunning natural wonders of this province, so far this year, over 1100 Canadians have died from overdosing on fentanyl-tainted hard drugs. This, while our federal political leaders appear turn a blind eye to the catastrophe, lacking the courage to confront the situation. 

As a journalist, I have covered the dregs of our society before and covered actual war zones overseas, but this was way different. Here in this war zone, in my own country, live an army of discarded humanity; the homeless, junkies, crack heads, meth heads, alkies, the mentally unbalanced, and scores of other unfortunates. They line the East Hastings Street area and every piss-stenching alleyway that separate the late-nineteenth-century brick and stone buildings, where many live in cardboard boxes, tarpaulin tents and other impromptu shanties; which, by comparison, would make the worst slum of Kabul, look like a stretch of Park Avenue condos.

Five-year-old, Ali Mustapha Ghaleb is cradled in his mothers arms after being maimed by an unexploded bomblet from a cluster bomb in Baghdad, Irag, April 17, 2003.

The worst part is that it drew me in; like that hospital in Baghdad where I was drawn in by my journalistic inquisitiveness, to see the carnage that cluster bombs rain upon the innocent children in war zones. Most people would turn and run; get the hell out! But not me. I have some sort of misplaced curiosity concerning the psychology of suffering and pain. It draws me, but at the same time it hurts me deep, very deep down inside. But I hide this pain from all, and that has cost me dearly, especially covering this nightmare of a story.

Like those in this story who live fix-to-fix, every once in a while I need my fix of horror, of fear. Perhaps it is some warped version of penance for the wrongs I have done in my life, but for what exactly, I am yet uncertain.  

All I do know is, like that moth to the fire, it was my involuntary duty to document this hell, from my point of view; that from the street, from the curb, from the alleyways. So do not try to question my motives of why I do what I do. Because I don’t know myself. 

The whales, sea life and the pulse of the ocean are my escape, the base for my spirituality. But now it was time to document the beast, which can overtake any of us, our family members, our lives. It is about that precipice of conscience, love and hate, and the humanity and inhumanity that we are all capable of. Yes, it is my penance, and my duty to those who suffer, that I write this feature. 

An Introduction to Fentanyl—Now let me introduce you to the opioid fentanyl, the beast that is stalking the streets of Vancouver, its suburbs, the province, and heading east. As it becomes more entrenched, it is killing and sending into comas, the hard core drug users who gravitate to Vancouver’s notorious Downtown East Side (DTES).

According to the RCMP, traffickers are turning to pharmaceutical-manufacturing giants in China to produce a deadly, black-market version of non-medical fentanyl which ends up here. Canada’s chief public health officer said this September that at least 2,816 people across the country died from opioid-related deaths in 2016 and that fatalities involving fentanyl more than doubled in the first three months of 2017, compared with the same time period last year. Diplomatic pressure is being put on the Dragon Nation, the principle source of illegally produced fentanyl in Canada. Officials are asking them to assist in seizures and shutting down sources and the distributors of fentanyl.

Analogs, (designer, synthetic drugs mimicking the pharmacological effects of the original drug) of fentanyl are much easier to synthesize and are being produced in these laboratories, and are much more powerful and deadly than the pharmaceutical version.

A few of these analogs now being found on the streets of Vancouver include the powerful carfentanil, acrylfentanyl and alpha-methylfentanyl, which goes by the name “China White,” and is twice the strength of the pharmaceutical version of fentanyl most common on the streets. The analogs last much longer in the body and are more difficult to treat with the antidote, naloxone, requiring multiple doses of the antidote. 

You can buy fentanyl on the internet if you are even slightly computer savvy. It is shipped to the customer in a disguised form, to avoid detection by customs. One of numerous methods used is to gift-wrap the package or label it as household detergent. It can be delivered through the mail system or by courier packages, which typically range from the size of a package of cigarettes to a cell phone box. This so-called ‘dark web,’ is being used to anonymously sell fentanyl. But beside lone individuals ordering on the internet from their home, organized crime is heavily involved. 

A half-kilo of pure fentanyl and its analogs are so powerful, that it can be worth as much as $1-million and more, when broken down (or stepped-on with fine powdered sugar, baby laxative or others) for street use, with British Columbia and Alberta being the main locations for this activity. 

So what we have is Canadians knowingly killing thousands of their fellow Canadians, because of greed and profit. It is the poorly mixed, inconsistent batches ending up on the street that are the worst problem because you never know how strong the dose is your are taking. 

Fentanyl is quickly moving across our nation, like a modern-day Black Plague, looking for new victims to harvest and bury. There is no other way to describe it; it is the devil in the needle that has outright killed over 1,103 so far this year (as of November 3rd, 2017), and that number is speculated to increase to around 1,400 deaths in BC by year end. In 2016, over 900 people fatally overdosed in British Columbia , most having taken fentanyl-laced drugs. As a result of the increasing overdoses and overdose deaths, a public health emergency was declared by the province in 2016.

A plastic bag holds fentanyl, in Vancouver’s downtown east side, November 12, 2017. Known on the streets as ‘Purple Pebble’, most hard-core users buy their dope hit by hit, rather than a day or two supply. They smash (the present day term for hitting up) 6-8 times a day, depending on the amount they can afford. This bag is in the hands of a small-time street dealer. 

The latest data suggests almost 2,500 Canadians died from opioid-related overdoses in 2016, most of these occurring in British Columbia, Alberta and Ontario.

Preliminary data from the BC Coroner’s Office suggests that the proportion of illicit drug overdose deaths for which illicit fentanyl was detected (alone or in combination with other drugs) was approximately 68% in 2016 and 83% in Jan-Sep 2017.

In 2012, when fentanyl started to infiltrate hard street drugs, it was detected in just 4% of overdose deaths. Prior to fentanyl, about 300 overdose deaths were recorded on average, each year in British Columbia. The top relevant drugs among drug death overdoses in 2016-17 are; fentanyl 64.1%, cocaine 47.5%, heroin 33.3%, meth/amph 32.4%, according to the BC Coroner’s Office.

Technically, opioids are synthesized in a lab (based on the compounds which are found naturally in the opium poppy), while opiates are considered to be natural, i.e. morphine, from the poppy plant. However, the term opioid is the modern term used to designate all substances, synthetic and natural. Both heroin and fentanyl are downers, and very similar, except in their strength.

Pure fentanyl can be extremely deadly and just a few milligrams, the size of a couple grains of sand, can kill. 

Fentanyl acts on the nervous system to reduce acute and chronic pain, when used in supervised medical situations. It has a rapid onset and short duration of action and is usually applied as a patch on the arm. It can be a wonder anesthetic when used in the proper medical situation. However, fentanyl is 50 to 100 times more powerful than heroin, so controlling the dosage is very important to reduce any potential overdose situation, which can vary from person to person.

Illegally produced fentanyl is now being mixed into heroin, crack, morphine, methadone, ecstasy, crystal-meth, cocaine and others, by hard drug dealers and distributors; increasing the potency of these drugs to deadly new levels, and making rich the fabricators and large distributors of illegally produced fentanyl. 

Much more potent than heroin, there is a huge, increased risk of overdose and death. It produces a much stronger buzz for the user, but the high does not last nearly as long as a heroin high, so it requires more doses to maintain that euphoria craved by the user.

 So the situation isn’t getting better, it’s getting much worse fast.

Just a five-minute walk from Vancouver’s famous Gastown steam clock, shown here on Water Street, is the notorious downtown east side.

The politics of fentanyl–Everyday, about 3 more people die of fentanyl overdoses in British Columbia; and it is coming to a neighborhood near you, where you live, if it hasn’t already arrived. What we are witnessing is an epidemic of death that shows no sign of stopping, only increasing. It really is a full-scale war largely against the most vulnerable segment of our society and it is claiming the lives of thousands of Canadians. For those who are caught up in it, there is little hope in sight, and little or nonexistent political motivation to stop the carnage.

It would appear, from my perspective, that those who can the most change or at least challenge this epidemic – our elected federal leaders, are crossing their fingers and hoping this problem will just go away, while lacking any courage or sense of what real governance really means. This hear-no-evil, see-no-evil, do-no-evil attitude has to change!

One of numerous memorials in remembrance to those who have died of drug overdoses in the DTES.

The present catastrophe of mass death is not just a Vancouver or BC anomaly,  because no drug user is safe, no matter where you may live, or how financially stable you may be. The addicts who live here, or exist here, come from every corner of Canada, from Digby to Nanaimo and everywhere in-between.

It is a Canada-wide problem; and should be officially made so. Anyone who tells you any different is an idiot, such as those politicians who have never even considered setting a foot on the east side, to look into the eye of this hurricane. It is a political hot potato for them, and because of this, they have become as much part of the problem as the beast on the streets.

A recently published Health Canada statement expressed that; “The Government of Canada is committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health approach when considering and addressing drug issues.” It also stated that; “Harm reduction has been restored as a core pillar of Canada’s drug policy, along with prevention, treatment and enforcement.”

This statement is just more political gibberish from our leaders while Canadians continue to die in record numbers. Not only that, but it binds the hands of the BC provincial government, which is at least saving lives. Enough of the political smoke-and-mirrors, it is time for responsible governance to come together, for the benefit of our nation and its dignity. I personally pity them for their ignorance.

Vancouver’s Downtown East Side (DTES)—Justin; A Fentanyl Dealer—Thirty-five-year-old Justin (he asked that he not be identified with his real name or exact age) is a former pothead, cocaine addict, crackhead, crystal meth addict, heroin addict; and now for the past year, a fentanyl addict. He is also a low-level street dealer in fentanyl, which helps pay for his $200-a-day-plus fentanyl habit. He will do a smash (the street term for hitting-up) 4 times a day at $50 or more a smash. Sometimes he does more fentanyl, but he rarely does less. The more fentanyl the better – and the stronger the better. 

A heroin/fentanyl user ‘milks blood’ before ramming a smash of fentanyl into the jugular vein of his neck.

I met with Justin in a rain-soaked Oppenheimer Park, on your typical wet, overcast east side Vancouver autumn day, after being introduced to him by another user the day before. As we walked east along East Hastings Street, we pass by users huddled under tarpaulin-covered, makeshift shelters, smashing and smoking (‘doing a dragon,’ the modern street term for smoking hard dope) fentanyl-laced heroin, meth and crack in plain view on the sidewalks.

Used syringes and other drug paraphernalia litter the sidewalk. Addicts lay passed-out on wet blankets, or plastic sheets, drenched by the cool rain, in the oblivion of a drug stupor. It was a sight I had never seen before – a world of unbelievable hurt littering the sidewalks. But much more was to follow. 

Used syringes, clean syringes, a tourniquet, bloodied swabs, a pipe for ‘doing a dragon’ (smoking hard drugs) and used tinfoil cookers lay on a flattened cardboard box where a user, or users were sitting to smash or smoke their hard drugs, in Piss Alley, in Vancouver’s downtown east side. This kind of thing is typically seen everywhere in east side Van. 

Justin explains that he buys ‘8 Balls’ (3.5 grams) of fentanyl, which he cuts into points or half-points, whatever the users want, selling it in the east side ‘war zone.’ A point ($20) is one tenth of a gram, while a half-point ($10) is half of a point. “It is usually from $250-400 for an ‘8 Ball,” he explained. “The price varies depending on your source, and depending on availability. I do my regular dosage of 2.5 points, 4 times a day. You become more resistant, so the more you do, and the longer you use it, the more the dose goes up. Sometimes I wake up sick and have to smash. It’s a scary fucking thing,” he admitted.

When I first started fentanyl I was on a 24-hour clock, 24 hours to make enough for a $20 point. Now, it has increased to $50 or $60 every 3 hours.”

Since early 2016, when fentanyl really hit the streets with a vengeance, everything has changed, turning the hard drug users’ life into a nightmare of ‘Fentanyl Overdose, Russian Roulette.’

Fentanyl has taken over the street drug scene so fast that if you think you are injecting straight heroin, you are dead wrong. Fentanyl is being mixed into all the heroin sold on the streets. And all of that heroin sold on the streets, is now mostly fentanyl, and very little heroin, if any at all is in the mix. Users are being weaned off heroin and onto fentanyl, but most don’t even know it, or care; as long as it kicks ass and sends them into oblivion.

It’s like that old sci-fi movie; ‘Invasion of the Body Snatchers,’ where humans are being replaced by alien duplicates; each a perfect copy of the person replaced, only devoid of human emotion. Fentanyl is taking over the former heroin user’s body. But in this reality, they don’t even care, they just care about getting fucked-up big time. 

It has upped the ante on how high you can go, and is much more profitable for the producers, while being much cheaper to produce than heroin. 

It is being smashed on the streets, in the alleyways, in the rooming houses, at weekend parties and private residences across the British Columbia. But soon, very, very soon, it will be available on your block (if it isn’t already), no matter where you live in Canada. Your teenage kids could be using it right now, upstairs in the house, while you are in the rec room watching the hockey game and having a beer and a donut. (Fentanyl was the drug that the rock star ‘Prince’ overdosed and died from in 2016).

The price for so-called heroin (where heroin is mentioned in this feature story, it is always mixed with fentanyl and difficult to predict how much real heroin you are buying in a dose) on the street level is the same as it is for fentanyl. 

Justin (not his real name), a small time, street-level fentanyl dealer, finishes a smash into the vein of his arm. The vein is dimpled with tracks where he has smashed before. He also injects into his hands and jugular vein of his neck.

Justin would prefer to inject straight fentanyl, (with no heroin whatsoever mixed in) into the veins of his arm, hand or jugular, over straight heroin, as fentanyl gives him a cleaner, higher high or rush, and that is the Shangri-la that all junkies (users) seek out, that ultimate rush. But the fentanyl high doesn’t last nearly as long as a heroin high. So it takes more to stay high. It is a vicious circle.

“Fentanyl is harder to kick than heroin and is a more intense high than heroin, but the high doesn’t last as long,” explained the clean-dressed, polite-spoken addict. “I know the dosage of fentanyl I am using, so I don’t go into an overdose,” he explained. “But anything can happen. You’re dealing with death every time you smash. It’s the way it is, every day.”

Some users will do a half dose, then more, if they don’t slip into an OD. “But there is really no way of telling for certain, unless you smash a half dose of what you would normally do, then increase the dosage if you come out of it OK. But most will do their full hit, and take that chance. I don’t do half doses, I go all the way.” 

He further explained that he regularly buys from the same connection, rather than buying from just anyone. “It is also smart business for me to buy from the same connection, rather than from people I don’t regularly deal with. For obvious reasons. If I don’t buy from the same source, then I buy from the same circle because I know what I am getting.” 

There are now paper strip testers the user can get to tell if fentanyl is in the dope they are about to take. They are available at the 7 supervised inject sites (also referred to as safe injection sites) for the users. You just dip the test strip into the cooker spoon with the dissolved drug in it and wait a minute. If two lines appear on the strip, it contains no fentanyl. If one line appears, it contains fentanyl. It is hoped these strips may curb potential overdoses on fentanyl before they happen. Perhaps influencing the user to smash a smaller dose. 

“I got my dope (fentanyl) tested 2 days ago and there was no heroin in it whatsoever,” he stated. “What fentanyl does to you, is the same as heroin does to you, though much more intense. But both are downers,” he confirmed.

He further confirmed that, “They (the users) don’t ask if it’s heroin or fentanyl, they don’t really give a shit, they just care if it’s just going to fuck you up, (get you powerfully high). That’s all they care about. And I don’t say don’t do too much, it’s strong, or do a half dose. I ain’t their fucking babysitter.” 

Justin went on to explain a little of his drug use background. “I was snorting cocaine before I got into crack 10 years ago, at around 21-years-old. Before coke I smoked pot. I started smoking speed (crystal meth) and that’s what got me off crack. I wasn’t with the same crowd,” he explained. “When you use it (crack), you reach the rock bottom. That’s why they call it ‘rock crack.’ It is always that way with crack.”

For Justin, life and death walk hand-in-hand. “I also started using heroin 4 years ago, and at that time, I also found out that my stuff was being mixed with fentanyl. So I stayed using fentanyl. Then I OD’ed last December, on fentanyl, and went into a 9-day coma.  Now I don’t have any heroin in my system. Now I do straight fentanyl,” he admitted.

A dose of Fentanyl is cooked with a few drops of water, to dissolve the hit before doing a smash into a vein. November 12, 2017.

“When using heroin, crack, cocaine or crystal-meth, which is always mixed with fentanyl, you never know what dose of fentanyl you’re getting, so it’s easier to overdose. That’s why there are so many OD’s.”

Besides selling doses of fentanyl, Justin supports his habit by selling or flipping black market objects sold openly on the streets and sidewalks of the east side. Users also pay for their habit through selling stuff at what are called ‘street markets,’ where a number of sellers will congregate and have their own covered stalls, like outdoor flea markets. “I will buy a cell phone at one of the open markets and flip it for a profit. I do this with bikes, electronic gear, anything I can get my hands on and can sell at a profit.”

Justin explained that, “They get these items by theft and B&E’s, petty crimes and shoplifting.”

“When the welfare cheques come in at the end of the month, that is an especially busy time of the month in the east side for drug buying and consumption.”

In fact, the latest monthly statistics state that in the five days after the monthly distribution of social assistance cheques this year, an average of six people died each day, that compared with 3.6 for all other days of the month.

Justin also has a part-time job, (about 8-10 hours a week) but didn’t want me identifying where or what he does. You have to have your poker in many fires to survive as a junkie, or user, as is the modern term used now. To use the word junkie, is a no-no, not politically or time-correct. 

Sitting at a table in a location (that I cannot disclose) where Justin visits on his milk run (so to speak); he measures out points and half-points of fentanyl with a digital scale, then tucks the purple pebbles into small, thumb-sized plastic dope bags, or into folded squares of tin foil; whatever the user wants. The table is covered with drug kits, syringes, dope bags, twenty-dollar-bills, packs of cigarettes and juice containers. 

A number of users sit at one or two of the tables there, buying their dope and fixing it up for smashing. One user, an aboriginal woman in her twenties, draws a fix of fentanyl (mixed with water then dissolved under the heat from a lighter) from the cooker, then taps the top of the syringe, while holding it pointed upright, (to shake-out any bubbles from the fix), and using a make-up mirror to see what she is doing (as she can’t see that part of her neck), injects the syringe into her jugular vein, slowly pushing the plunger, emptying the concoction into her neck. (Not meaning to be comical but, the way she did this, reminded me of Annie Oakley from the old cowboy movies, when Oakley would use a small mirror to fire a handgun at a target behind her back over her shoulder – trick shooting). Pulling the needle out, she uses her index finger and wipes a drop of blood from her neck, where the needle entered the large neck vein. 

A scene on East Hastings.

After that, she grabs a mascara pencil and starts applying the mascara to her eyebrows, as a yellow-blue needle hickey forms around where she did the smash in her neck. Looking at the bruise on her neck with the mirror, she responds; “Shit, that’s kinda fucked up.”

Another user rolls up his pant leg and smashes into a vein of his leg, his leg full of bleeding scabs and sores from needles. Then Justin does a smash into a vein in his wrist.

To someone unfamiliar with the daily life of a hard drug user, it would have seemed that they had fallen into some kind of horrendous, morbid horror show; but this is the way of life in the DTES. A day in the life, so to speak.  

On another day, it had been a long afternoon of following Justin and a friend about the west side of Vancouver (during the Black Friday shopping day), trying to find a cheap deal on new cell phones. He confessed to me that, “I’m bored, I have nothing else to do. When I keep busy, I use less. Today I had no cravings or anything because I was so busy looking for cell deals. The busier I am, the less I do.”

Using a tourniquet to tie-off his upper arm, which swells up the veins of the arm, prior to smashing a fix of fentanyl.

Justin is no brain-dead, cloud-nine junkie. He is an intelligent, kind, interesting fellow who dresses clean and doesn’t swear or have a harsh word for anyone, unless they really piss him off. He was obviously well-raised, from a good family; but when I asked him, he told me not to put his family story into print. But he said it was OK to say he is from a large family, with numerous cousins with a very kind mother.

I could see this just in his demeanor, and I gained an admiration for this street survivor and small-time fentanyl dealer. But more importantly, and it may be difficult for the reader to understand, he is now my friend and I have a great amount of respect for him, and if anything ever happened to him, like overdosing, it would break my heart. Once again in my life, it was reinforced why, ‘we should not judge a book by its cover.’ 

Justin helped me see into the fentanyl monsters’ eyes. Perhaps he felt it was his duty to do so, to set the record straight and let you know, through myself, that sometimes life does not always follow in a straight line. It’s not Justin who is killing people, it’s the distributors higher up the chain of mixing, and sometimes users who push their limit of consumption. He looks for consistency in his fentanyl, as nobody wants to die, and that includes Justin.

The last question I had for Justin was if he had ever tried to kick his habit or break free of his drug life? He bluntly responded; “I haven’t tried to stop because I enjoy it.” 

The ‘Vancouver Area Network of Drug Users,’ VANDU for short, is a group of users and former users who work to improve the lives of people who use drugs through user-based peer support and education, and is committed to ensuring that drug users have a real voice in their community and in the creation of programs and policies designed to serve them.

Founded in 1998, it also provides users with clean needles and kits for the injection or smoking of hard drugs and is a supervised injection site (also referred to as a safe injection site), where a user can smash or smoke their dope under supervision, should the user go into an overdose.

VANDU is located right in the heart of ‘the war zone,’ at 380 East Hastings Street. It is a pioneering facility which pushes for the rights of the users. It is funded by Vancouver Coastal Health, which provides health care services through a network of hospitals, primary care clinics, community health centres and residential care homes. (Part of its funding also comes from anonymous donors).

I dropped into VANDU to meet with Lorna Bird, a cocaine user and the president of the organization. Entering the facility, I observed a gathering of hard drug users lounging about the facility, sitting and stretched out on a large leather couch and hunched-over on a handful of chairs, some with their head resting on fold-up tables or between their legs, recovering from the debilitating ‘Twilight Zone’ of a post injection haze that is referred to as ‘nodding,’ or ‘ringing’ by the users.

VANDU, is a group of users and former users who work to improve the lives of people who use drugs through user-based peer support and education. It also provides users with clean needles and kits for the injection or smoking of hard drugs in a supervised environment.

Lorna, a Métis and the first aboriginal president of the centre, (originally from the Ebb and Flow First Nation Reserve, in Manitoba), starts telling me her story. “I started using cocaine because I was cut-off of medication for a knee problem I still have, and couldn’t handle the pain,” she explained. “My doctor cut back on, then stopped prescribing methadone for me, because of a new standard aimed at preventing fatal overdoses with prescription drugs,” stated the 61-year-old president. 

“But the methadone never really reduced the pain. So I came down to the east side to get some real pain relief, and found it in cocaine.” 

She explained to me that, “Cocaine helps me with my knee pain, but the effect doesn’t last. It’s over too fast,” she said. “I used prescription methadone for the pain for three years, but it never really killed the pain. Then I tried morphine just the other day and I felt no pain, finally! My doctor had offered it to me and I just had my prescription changed to morphine. It (the pain) never goes away but I think eventually it will, with the morphine, but I still use cocaine, more for recreational use, I still use it everyday,” admitted Bird.

“If I have $500 I’ll blow $500. But usually I spend at least a $100 on coke a day.” (Lorna has lost a daughter to the HIV/AIDS epidemic, because of using a contaminated needle, and another daughter to a drug overdose). 

According to the Canadian Press, experts say Bird is among thousands of Canadians facing the predicament of seeking-out pain-numbing street drugs after being weaned or cut-off opioids to which they’ve become addicted or formed a reliance on; some because the clinic or doctor was over prescribing.

In 2014, the magazine, ‘Canadian Family Physician’ published an article stating that Canadians are the world’s biggest per capita consumers of legal opioids, with more than 30 million high-dose tablets and patches distributed every year. Stats Canada says that one in 10 Canadians suffers from chronic pain.

In the journal ‘Pain,’ an American researcher described that the average rate of abuse and misuse of prescribed painkillers is around 25 per cent, and that one in 10 medical users ends up addicted.  

The medical industry is a great part of the problem, leading many sufferers to seek pain relief from places like the east side. But the lack of compassion by some in the medical profession, clinics and government advisers, for those with chronic pain, continues. Meanwhile, the bodies keep piling up.

Intravenous drug users inject smash at the VANDU supervised injection site and facility November 17, 2017. There is little real heroin on the streets of Vancouver anymore. It all has some amount of fentanyl mixed with it. The person on the left is going through their nod; the debilitating ‘Twilight Zone’ of a post injection haze that is referred to as ‘nodding,’ by the users.

Bird described how she tries to avoid overdosing from fentanyl-laced cocaine. “First off, I don’t use (smash) dope by myself alone, unless I know the dope and its strength you know, if I know what the dope is like,” she described. “Some users, especially since fentanyl appeared on the streets, will inject half-a-point to try it out and if it’s OK, they will take larger doses.”

But for most hard core users, the urge to smash a dose of fentanyl, coke or meth into your arm, greatly outweighs any common sense or fear of death. You see, there is no common sense when you’re ‘sick.’ That urge to ‘get well,’ rules out everything else except ‘getting well,’ and it is very difficult for the non-user to understand this blind craving. “Very few ever do a tester. When they are sick, they don’t have time for that. They will do a full dose, regardless of the fentanyl that might be in it, or the risk,” described Bird.

Even more perplexing is that, “If someone OD’s on the street, everyone wants that stuff, because it must be strong – good shit!” expressed Bird. “It’s sad but true. Most people don’t think it (a deadly overdose) can happen to them.”

Members of the Cannabis Substitution Project hand out free cannabis, (a few joints and edibles), at VANDU Saturdays. Studies show that cannabis can be an effective substitute for many people using opioids and other hard street drugs.

I asked her about how many smashes a user will do in a day. She explained that, “It depends on who. Eight to 10 injections a day is the average for a user; that’s the norm, depending on the money they can get. If I had lots of dope I’d shoot-up 30 times a day,” she stated. “Coke has a short duration for what I need. But the average user will use 10 or more half-points a day, averaging to about a $150-a-day habit for the average user. Though many can easily use more, if they have the money,” she said.

“Most will smash or smoke at least a point at a time, if they can afford it,” (though when you ‘do a dragon’ or smoke heroin, you usually do it in smaller amounts to avoid not wasting any of the dope as it turns to smoke when heated under a small sheet of aluminum foil. So you smoke a bunch of smaller doses). 

VANDU has a friendly, community centre-like feel about it. It is a gathering area, or meeting place for street users. But most importantly it is a support organization where the users feel free to visit and at home in; more of a family gathering area, than an institution or facility. A sign on the wall reads; ‘You are a brother – Not a junkie.’

A heroin/fentanyl user does a dragon using a small sheet of tinfoil, a lighter to vaporize the heroin and a plastic toke tube.

Strangely enough, after a number of visits there, I felt very comfortable being there. Everyone’s in the same boat – there is no aggression or harsh words; it is a like a family trying to live how they can, with so little, but with compassion for each other. A sort of soldiers’ code is given off; though a users’ code. Everyone is sick! They have a sickness called addiction, and most are the poorest of the poor. But like that Dylan song, it is their ‘Shelter from the Storm,’ that is the streets of the DTES. 

They also offer live presentations for the users, on topics concerning their lifestyle, such as their rights as users or featuring a guest lecturer from another related organization; perhaps someone speaking about the public housing situation, the gentrification of the area, or aboriginal issues.

As we chat in Lorna’s office behind the first floor reception desk of the two-storey facility, a steady stream of users meander in, making their way over to a small table in a corner of the reception area to register their name, or handle, with an attendant seated there. There is no real paperwork except your signature on a roster sheet, to keep track of who and how many are using the room at any one time. You cannot pass unless you register your name. It is a security issue for the users’ own safety.

The injection room can service 6 users at the same time and is open from 10 am to 10 pm, 7 days a week. It can serve up to 180 users a day. Some of the users are repeats, who visit the facility a number of times a day.

A kit contains a syringe, alcohol swabs, distilled water, a tourniquet and a cooking spoon. A package of fentanyl lies ready to be dissolved and injected, (smashed). 

After signing-in, the user walks down a short hallway to the shooting room. At the open doorway to the room, a supervisor offers the user a clean kit to smash their dope. VANDU is not a drug dispensary, it does not give or sell drugs to users, just one of 7 supervised injection sites in the hood.

A kit consists of one or two sealed syringes, a tourniquet, two alcohol swabs, a plastic vial of  water (to mix with the drug) and a cooking spoon, used to dissolve the drug into a liquid form, prior to injecting. 

The room is a plain but bright, mauve, 20-square-foot room with two large windows (which the supervisor watches through), four small tables, each with two chairs. After each user uses the room, the supervisor takes an alcohol towel swab to wipe-down the table and chair, and make sure no residue remains and that any remaining part of a kit is thrown out. 

You are not allowed to loiter in the room, or smoke or eat. You have a 15-20 minute window to do what you have to do, then promptly leave, otherwise the line for using the room grows and that can lead to frustration and arguments. The patience level of an addict drops, the closer they get to needing to ‘get well,’ as is the term. (One minute a user is completely coherent and with it. But the next, he or she can be as spaced out and completely incoherent. That’s just the way of being an hard core addict, unpredictable).

After fixing, the user signs-out at the desk, and leaves the facility, or mingles for a while, chatting with the other users in the reception area, who also have dropped in to smash or who come in asking for information on other services available to them in the DTES. Others hunch over on the couch or chairs or sit bent over on the floor, as though in a deep trance or sleep, riding-out their nod. 

A plume of fentanyl smoke rises from the heated foil of a user, in this case an aboriginal woman formerly from Ontario. She is ‘doing a dragon,’ in Vancouver’s east side. November 19, 2017.

As a steady rain drenches the already surreal scene outside the main doorway, other users, in an almost continual procession, in a religious-like pilgimage, come in from the damp, and walking up to the large reception desk, ask the main receptionist for some tin foil, to ‘do a dragon.’ This technique turns the drug into a vapour or smoke, which is drawn through the plastic or glass tube into the mouth and lungs.

The receptionist hands them a small square of foil, a clear toking tube and matches. They are directed to the washroom; again, under the watchful eye of a supervisor.

Far fewer users ‘do a dragon’ compared to smashing. The supervisor does not stay in the washroom with the smoker but if they seem to be taking more time than they should, the supervisor knocks on the door or asks them “what’s the holdup?”

Others don’t come in to smash but to ask for a clean kit for hitting, but not at the injection room. They get the kit, ‘to go’, and will fix up somewhere else, maybe out on the street, a park or in their room.

The kits are provided free of charge, no questions asked. There are also free condoms available. The kits are provided to VANDU, and the 6 other supervised injection sites in the vicinity by Vancouver Coastal Heath. 


A Narcan Kit contains a pair of syringes, alcohol swabs and a bottle of naxolone, the opioid overdose antidote.

The supervisor and a number of the staff carry a small, portable carry case called a Narcan kit, which contains a bottle of the opioid overdose antidote naloxone and 2 syringes. “We are a lot more than a users support group. We’re basically the first responders,” she explained.

“If there is an overdose, the trained attendant first yells to the other staff that there is an overdose happening, then they call the ambulance, then we clear everybody out of the injection room while a staff member administers the naloxone,” she described.

At the first sign of the overdose, you stick the naloxone-filled needle into the skin or muscle. It doesn’t need to be injected into a vein and you can jab it right through a person’s clothing, which can save valuable seconds from taking off a coat and shirt. “Then we check their airway to make sure they are breathing. If not, we give them mouth-to-mouth, using a plastic breathing mask. If there’s no mask available, we go mouth-to-mouth. I doesn’t matter how when you are trying to save a person’s life. There is no hesitation about it,” she asserted. “If there is still no response and the ambulance hasn’t arrived, we give another shot or jab of the antidote.” 

Fentanyl severely disrupts the respiratory system, so the responder has to keep a close eye on the victim’s breathing. (Naloxone can only help those suffering from an opioid overdose).

If the victim still doesn’t show signs of recovery, more naloxone can be administered, up to around 6 injections. You cannot OD on naloxone.

This facility saves lives; rather than the user shooting up in an alleyway, the sidewalks or alone in a rooming house with no one with them to alert authorities or support should they slide into an overdose. At VANDU, the user is under constant supervision of a trained overdose attendant and other staff. No one has ever died of an overdose at VANDU, or any other supervised (or safe) injection site in the DTES, even though this centre sees an average of one overdose every couple of days, out of approximately 180 daily users.

Members of the Vancouver Police Force and first responders attend to a user who is overdosing in Piss Alley, a well-known alleyway where drug users and dealers congregate. To die in this syringe-strewn alleyway, would be unthinkable for most Canadians. But many do.

The supervised injection sites in Vancouver are where users can find clean kits and a place to smash, under the safety of a supervisor. While many people use the injection sites to smash, not all do. A greater number still prefer to shoot up in the alleyways, rooming houses or on the sidewalks. 

As I leave VANDU, across the street and under a bus shelter, a group of jovial drunkards, old men and a young staggering woman, are shouting aloud in drunken words, while passing-around a large bottle of piss-coloured Listerine, taking large belts of the alcohol-based mouthwash. Discarded bottles of cheap sherry lay about the bench and outside curb of the shelter. The DTES gives one a complete immersion into substance abuse, and not only hard drugs).

Being a user is not an institutionalized lifestyle, it is a life lived minute by minute, smash to smash, and many of the users would just as soon shoot up on a sidewalk than have to sign a paper, let alone show up at an injection site, leaving their gear or everyday possessions outside and vulnerable for the taking. A large number of users live on the sidewalk or alleyways, in makeshift tent or tarp structures. They move about the streets and alleyways moving their camps like modern, metropolitan nomads.

Vancouver City workers start dismantling makeshift homeless shelters, mostly tarpaulins and small tents thrown together along the sidewalks of East Hasting. These camps can also be found in parks and alleyways. The structures are illegal, though their presence is largely put up with by the police. One of the workers explained to me that the business owner, where the tents were installed outside of, couldn’t get any customers to come into his shop as the tents and site of people smoking and shooting drugs, scared them off. The tents were thrown into a truck and driven away, but the former occupants were allowed time to pack their personal belongings. 

Regardless, many users do a dragon or smash their dope alone in their room, or tent shelter, where they are at the greatest risk of overdosing and dying with a needle full of poison jammed into their arm. Up to 90% of user overdose deaths occur when they are alone, inside their room or in their residence. Smashing alone is a huge problem that feeds the death machine. 

This is the way it has been, is now, and probably always will be, but every effort must be made to attract the solitary user to use a facility. Without these facilities, the dead would be stacked on the streets.

You can find hard drugs, soft drugs or prescription drugs for sale anywhere on the streets of the East Side. It is an open drug market, in plain view to all, selling every kind of dope you might have heard of, from pot to smack, uppers and downers. Even the cops know enough to stay out of it, being so overwhelmed. They’re not even a finger in the dyke of this city of dope.

A Brief HistoryThe DTES is a six-block area of downtown Vancouver, with a present population of 8-10,000, (of which, it is estimated, around 4000 are hard core addicts). By the end of the late-nineteenth century and into the 20th century, the downtown east side of Vancouver was the cultural, political and retail hub of the city. Three decades later, as the city spread westward, the east side became less relevant and fell into neglect, becoming a poor neighbourhood.

The mentally ill are drawn to the east side where rent is cheap and they can disappear among the other destitute who gather there. But they soon fall into using hard drugs, along with the reality of non-existent counselling or assistance for their sickness. It truly is a pathetic situation, especially for those who are left to fend for themselves, where death stalks them in the streets. 

Starting in the 1980’s, the decline sped up due to the provincial government’s de-institutionalization of the mentally ill (and closing down of the two main institutions for the mentally handicapped), a rise in high purity hard drugs such as cocaine and heroin, regulations and policies that forced prostitution and hard drug use from the surrounding area and into the east side, and the dropping of federal funding for low-cost and social housing.

In the years 1980-2002, over 60 women, most of them sex trade workers, went missing from the DTES. “The Pig Farm Killer’ from Port Coquitlam, claimed to have killed 49 of these women and was officially charged with killing 26 women. He was eventually found guilty on six counts of second-degree murder, in December of 2007, resulting in six life-term sentences.

By 2016, the epidemic of drug overdoses and deaths from fentanyl skyrocketed, and by November 2017, eleven-hundred overdose deaths had occurred; and still counting.

Justin smashes into his hand because the veins in his arm had collapsed and they needed a couple of days to rebound. Other users will smash in the veins of the feet or legs, leaving the legs pocked with open sores.

Along with this, the never-ending problem of the shortage of low-cost housing, and an increase in mental illness due to hard drug use, and the emptying of mental institutions, turned Vancouver’s downtown east end into what many describe as ‘a war zone’, a no-go zone for the average citizen.

Susan Naomi Davis, is a sex trade worker and well-respected social justice advocate in Vancouver. She has spent time in prison, survived numerous assaults and several attempts on her life. Battled cocaine and heroin addiction and survived 4 overdoses. She is a member and coordinator of the BC Coalition of Experiential Communities and the owner of Calabria Meat Market, on Victoria Drive.

I talked with her on the phone. “For sex trade workers hooked on hard drugs, you are more likely to jump into a car with someone who could hurt you, because you need the money to buy your drugs to feed your habit,” described Davis. “About maybe 25% of sex trade workers in Vancouver are drug addicts, hard drug users, and those who are, tend to work in the east side, but not always.” 

The 49-year-old explained that a drug addicted sex trade worker ups the ante on risk and survival. “The people down there are doing sex work out of desperation. And when when they are starting to fall through the cracks, great chasms open up. People in that situation are already at risk. If now they fear the fentanyl, it just adds another level of fear. I have nothing but respect for them.”

Any one of these women could be a lost family member, someone’s angel who was drawn into the street scene of the DTES, losing contact with those back home due to embarrassment or circumstance. These lost angels live a life of hell, angels with needles in their arms. 

According to Davis, the City of Vancouver has 1500 sex trade workers on the street at any given time. “It’s still dangerous – horrible shit! But there have been no murders of a sex worker since 2009.”

Women are still going missing in the east side and some say that serial killers are still working in the area. Hard drug addicted sex trade workers who work in the east side, live a life of danger and uncertainty. The status of the woman in this poster remains unknown.

Ever since what happened with the “The Pig Farm Killer,” and the world-wide embarrassment it caused the force, communication between sex trade workers and Vancouver Police has changed dramatically. “They now have sex trade workers guidelines,” pointed out Davis. “If a worker is the victim of violence or a victim of a crime by a John, she can feel safe about calling it in to the cops, without being just told to go away or laughed-off.

They (the police) will intervene, and that’s been a huge change. The last few Vancouver police chiefs have really contributed to the safety and dignity of our lifestyles and I thank them for that. Their effort to turn it around – it’s pretty cool!”

As far as the fentanyl itself, she says it isn’t the pusher on the street that is the problem, but those higher up the chain who are mixing fentanyl into the drugs (called ‘stepping-on’), then passing them onto street-level sellers.

The partially-excavated farm of ‘The Pig Farm Killer’ in Port Coquitlam, British Columbia, January 12, 2003. This madman from Poco admitted to killing 49 women, but was officially charged with killing 26 women. He was eventually found guilty on six counts of second-degree murder, in December of 2007, resulting in six life-term sentences. He prowled and picked-up the women he killed in the DTES, where the most vulnerable lived and worked.

“This isn’t the low seller on the street doing this, its done further up the chain from them; they’re (street sellers) in the problem. They’re selling on the street, just trying to pay for their habit,” she explained. “The problem with the hard dope is that it is not mixed very well. Fentanyl is added but not blended very good. So you have a bag of dope you’re selling which has portions, or hot areas, that are purer than other parts of the bag. Most of the bag is OK then you inject stuff from a hot spot and you’re dead,” she says.

Distilled water is added to the cooking spoon or cup, then heated to dissolve the fentanyl into a liquid prior to smashing. Tap water can also be used. The distilled water comes in a sealed plastic sleeve and is provided with the free injection kits.

“Maybe the heroin wasn’t quite strong enough, so the guys cutting it add some extra fentanyl, that’s when the OD situation can happen. There is a lot of money to be made selling fentanyl and mixing it into dope. A lot of big money.”

Heroin is produced from the poppy plant. The raw opium, the base of heroin, is shipped out of a country, such as Afghanistan or Mexico, then processed into heroin and exported to Europe and North America. Heroin is very expensive to produce as well as risky to smuggle and get it through borders.

Mission Possible (MP) is a community economic development agency in Vancouver’s downtown east side. Formed in 1992, this Christian humanitarian organization assists in transforming lives by helping those challenged by homelessness and poverty to achieve a renewed sense of dignity and purpose through meaningful work. It also helps residents by managing personal issues related to addiction, harm reduction and job-readiness.

I met up with MP Neighbours’ Coordinator, J Hockley and co-worker Loretta, around noon on the western edge of the city’s east side, to follow them on another service they participate in; that is cleaning-up the dirty needles and kit paraphernalia dumped by users in the city’s alleyways, parks and along its sidewalks. “We find and safely deposit the discarded needles into metal box containers found in areas most used by users. These boxes are put up on walls by the City of Vancouver and emptied and the needles destroyed by Vancouver Coastal Health,” explained the 48-year-old coordinator.

“Usually, in a normal 3-hour shift, we will pick-up about 200 needles, or 1000 a week. We work 5 days a week, in two shifts. One from 9-12 and then again, 12:30-3:30. We do not work at night, for security reasons, or on weekends.” 

MP also helps in cleaning up public housing rooms. “Each month we will go into rooms where the tenant, a user moves out or is asked to leave because of their behavior. They are allowed to use the rooms on a monthly basis,” explained the coordinator. “Sometimes we will find the rooms in decrepit condition and very unsanitary. We have found between 150-300 used syringes in some of these rooms, lying about everywhere in the room.”   

As we walk along the trash-container-lined-alleyway behind the well-known ‘Insight’ supervised injection site (opened in 2003), some users crouch down on their haunches, taking cover behind the garbage bins, smashing into their hand, legs and arms. Another user holds a burning lighter under a small sheet of tinfoil, sucking up the smoke of heroin and fentanyl, as he does a dragon. Meanwhile a line of other users, perhaps more patient, wait for the supervised safe injection site to open its doors to smash their fix and get well. (Insight is open from 9 am till 2:15 am, and the only reason it would close its doors is because a user had an overdose inside the facility. But it will quickly re-open, when that users situation is addressed). 

Like the city trash collectors you see in parks picking up trash with long handle-squeeze tongs, J and Loretta use the same device as they work the alleyway, using the tongs like surgeons. Reaching their tongs under the dumpsters to retrieve their quarry – used needles – and once in a while using a pair of long-nosed pliers to pull a jammed needle out of some screen grating of a basement window or crack in the sidewalk, they thread their way down an alley.

Long handled tongs are used to safely pick up used syringes that are found in large numbers in the alleyways, streets and parks of the east side. Needles-nosed pliers are used to pull used needles out of cracks in sidewalks and if they are jammed into gratings of sewer covers or other difficult to retrieve areas.

The dirty needles are dropped into a portable plastic container they carry with them in a small carry bag. As the container fills up (holds about 15 syringes), they empty it into one the wall-hanging metal containers by using a pair of pliers to pull the syringes out, one by one, carefully placing them into the container.

“I once got pricked by a used needle. I was in a rush and shouldn’t have been, but these things can happen. I was fine from the incident. But it made me not rush again,” he described. “Right away I went to the hospital. They said that my risk of contact with HIV/AIDS was low but I had to do three further check-ups in a span of six months. Just to be sure.” 

As your typical steady, light Vancouver rain turned the streets black and white, we walk along the alleyways, being very careful where we stepped and my feeling glad I wore my heavy hiking boots, instead or running shoes; should I step on a needle. The alleyways in particular, can be a needle minefield, so you have to be very careful. If you go to sit on a park bench, you have to check where you are going to sit, as I found out when I nearly sat on a needle earlier in the week.

Used needles are pulled out of the needle tree with needle-nosed pliers and placed into a plastic container plastic before being dropped into one of the metal boxes placed in alleyways by the City of Vancouver to safely dispose of the needles.

Discarded needles can be and are anywhere, and for anyone unfamiliar with the hard drug culture that is the east side, and accidentally stumbles into it and its discarded syringes, the atmosphere is not only scary as hell, but completely alien and the stuff of nightmares. (I personally, have always hated needles. Going to a dentist and getting a needle is something that terrorizes my psyche. Seeing someone smash, can really make me squirm. But everyday I spend downtown, makes me more resilient to my inner fear of seeing it and facing this fear or needle phobia).

“We always go out in pairs for safety reasons. It is just common sense, as you never know how someone will react to us,” though J is well-known for what he does and most of the users we pass greet him and say a friendly hello or share a joke. But J and his team have been threatened on a couple of occasions, “They thought were the police,” he said. 

Everyone is bonded by misery, destitution, and living from smash to smash in the east side. No one drives a Mercedes, while the other drives a Toyota. No one lives in a big white house, while another in a lavish condo. What you wear on your back is pretty-well what you own, your existence, everything that you are, and probably ever will be.

The needle tree used for disposal of used needles or syringes in an alleyway on the border of the east side. Users put their used needles in the tree instead of throwing them onto the street.

We pass by what looks like a misplaced metal sculpture in the form of a seven-foot-high tree with its 3 limbs cut-off near the trunk, and adorned by a large metal sunflower at its top . But it isn’t meant to be a piece of art, it is a ‘needle tree,’ installed there for users to put their used needles into the holes of the cut-off limbs, rather than discarding them on the ground. It is one of two trees in the DTES.

It is chock-full of about 10 syringes, in each of its 3 limbs. J and Loretta hold their pliers with their latex gloves on, carefully pulling out each syringe individually, and placing them into their portable plastic needle holders. “It was installed by the City, a City idea,” expresses J. 

After defoliating the needle tree, J points out a series of signs lining the alleyway with street numbers on them. “Those signs indicate the exact location you are at in the alleyway, should someone need to report an OD. That way the person reporting the OD can give an exact location to where the OD is occurring, and help the ambulance and first responders to know exactly where to come to.” It is a brilliant idea, like the needle tree.

J, who has been with MP for 5 years, explains a little about how MP indoctrinates former users or other destitute people back into the workforce. “Our staff are hired for 6-month contracts, after being trained and deemed worthy of holding down their commitment. They are people from the community. We help our workers adjust back into the workforce, sometimes doing security, landscaping or other community work.”

Taking a short break, after a pause in the rain, we talked about the crisis in the DTES. “There is an opioid epidemic happening. We’re getting thousands of people dying and it seems like business as usual. The politicians – they talk – we die! It (the fentanyl crisis) hasn’t subsided, It’s just getting worse,” he stated.

“We have to consider free hard drugs for users, if they are monitored, to slowly bring people down from dependency. If they need a fix, they need a fix. If they could go in and get their prescription then yes.”

He further reiterated, “Most of the people have mental problems and need monetary help and controlled medication. “The calm-speaking coordinator testified that, “It’s gonna take more affordable housing, single occupancy apartments and Riverview Hospital (mental institution) being re-installed to get people with mental issues off the street. But we’re experiencing nimby-ism. People don’t want the destitute in their area. It’s got to be declared a national health crisis. An awareness across Canada.”

Part of the drug problem on the west coast is that Vancouver is a magnet destination for hard drug users from across the country. This is due to a combination of climate, where usually you won’t freeze to death if you have to live outside under a tarp, and geography; being a port city with close ties to Asia, where most of the illegal fentanyl is produced. It is also a port destination for heroin, crystal meth, cocaine etc. There is no other large city in Canada where this perfect storm of conditions exist, and drug users from all across Canada gather there, especially when winter starts setting in east of the Rockies. 

As our shift ended, J and I chatted a little about spirituality and the role of Christianity in his goal to help resolve the destitution. He confessed his deep devotion to his Christian faith and his love of God, something we both share. (But for myself, my beliefs have always been tainted with uncertainty. I think I have seen too much suffering in my life to give my full commitment to God. But I’m working on it).

“I’m going to bible school now,” said J. “God is calling me to plant a church. Maybe on a northern reserve.”

Later in the day, while I was sitting on a piece of cardboard and hunched against a wall in Piss Alley, checking out the scene, a user pushes away another, telling him to fuck-off and not to come back here anymore. The guy being pushed is a grubby, filthy looking bum, who walks away a few steps, then pulls up his coat sleeve, exposing an arm covered from wrist to elbow in his own blood. Grabbing a pre-loaded syringe from his coat pocket, he plunges the syringe into his bloodied arm, smashing, then throws the empty syringe onto the ground and walks away. 

The other guy races over and grabbing two used syringes from the asphalt of the alleyway, throws the syringes, like spears, at the guy, telling him to “Get the fuck away from here.” It is quite obvious the guy with the bloodied arm was mentally unbalanced. That is a huge problem down here; people who should be in a mental institution becoming junkies. Even the sane junkies can’t handle the psycho junkies. They give the normal users a bad name. Anyone who doesn’t take the time to clean up the blood from his arm after smashing, is bad news. Sad, but that’s the way it is. 

St. Paul’s Hospital is the closest hospital to the downtown east side of Vancouver and last year handled 4700 overdose cases. This year is much the same.

Dr. Brian Lahiffe, is an Emergency Room staff physician at St. Paul’s Hospital, Vancouver and Clinical Associate Professor, at the University of British Columbia, Department of Emergency Medicine.

Dr. Lahiffe is immersed in the trenches of the fentanyl overdose crisis of downtown Vancouver, with St. Paul’s being the closest hospital to the DTES. He has treated hundreds and hundreds of overdose victims at St. Paul’s. A father of two young children, I spoke with him in a trauma treatment room of the ER before he started his afternoon shift, on December 15th.

I asked Dr. Lahiffe if the fentanyl overdose epidemic has reached its peak, and is there any relief in site? “That’s real hard to say,” he explained. “I think from what I see in terms with people showing up with overdoses, my sense is we’ve hit a plateau. But at the same time, my true feeling is that the problem is going to get worse because these drugs (fentanyl and its analogs) contaminate a lot of other drugs which I think is an impending problem,” he predicted.

“Because somebody will buy what they think is cocaine or ecstasy, but if its tainted with one of the really potent analogs, like carfentanyl (which is 100 times more powerful that fentanyl, while fentanyl is at least 50 times more powerful than heroin), it will only take a tiny amount for that to cause a major overdose problem and that person taking the ecstasy had no idea that they were going to be taking opiates. And that is a problem now, and I suspect it will likely become a bigger problem, simply because that version is not being manufactured by high level chemists in high level labs.” 

In 2016, 4,700 overdose cases were treated at St. Paul’s. “There’s definitely not been a downward trend for this year (2017).”

Fentanyl diluted in water, is drawn into a syringe (also called a ‘fit’) before being injected or smashed into a users’ arm.

Regardless of the increased work loads and commitment, Lahiffe commented that the staff are up for the challenge and take pride in the work they do. “It definitely has not increased morale, but what it has done is focused putting a lot more resources into things. A lot of the staff who work here take a fair bit of pride in dealing with it. It’s difficult at times and it’s frustrating at times times, especially when you see the same people (users) coming in again and again and again, with the same problem, and that’s going to take a toll on morale. But I think that one of the reasons that you may choose to work here, as opposed to elsewhere, is that you enjoy trying to handle that kind of problem.”

Lahiffe further explained that, “Sometimes they (overdosing users) can be resource intensive and we have added extra resources to try to deal with the predictability. We’ve added a new nursing shift who’s role is to deal with acute overdose management and we’ve added the addictions clinic. So there’s definitely been more resources added.”

He felt obligated to mention that it isn’t only the hospital staff who have had to raise the bar on commitment. “Especially the ambulances, depending on time of month, yes they have had to deal with call after call after call for overdoses, which means that wait times for everybody else will go up.”

But it is just crazy on the few days just after ‘Welfare Wednesday,’ when the streets become a real horror show. “They’ll (first reponders including fire fighters, paramedics and police) get a gazillion overdose calls. So someone (non-users) with chest pains or vomiting will have to wait longer.” 

As fentanyl and its cousin-drugs overtake the streets, heroin may be on the road to extinction-a victim of drug economics and drug downsizing. “The other thing is you don’t need precursors to make fentanyl. To make heroin, you need to get opium. It’s labour intensive as you have to harvest the poppies and process the opium. You need people and stuff to do it.” So is heroin going the way of the dodo bird and the rotary phone? Probably! 

When asked if he feels there is a solution to the mental health and poverty problem of the DTES, Dr. Lahiffe rationalized that it depends on the real estate market prices in Vancouver. “The concentration of mental health and poverty in the DTES, that’s a tough one because there is a huge concentration of services. And there’s a huge concentration of people with mental health issues. If that area will be slowly gentrified (which is occurring), that same population will simply migrate, either en masse or disperse to another part of the lower mainland, and what is that going to do?” 

Continuing, he explained. “I suspect that is actually what’s is going to happen, so the answer to the DTES and its problems is more to do with Vancouver real estate prices. I think that’s going to be the evolution, not a plan, but the way it ends up.”

Emergency room physician, Dr. Brian Lahiffe, of St. Paul’s Hospital in downtown Vancouver, said he doesn’t see the province’s fentanyl overdose epidemic getting any better, only worse, with the introduction of new, super-strong illegal fentanyl analogs starting to appear on the streets of British Columbia. 

When questioned on what would be his solution to the drug problem sweeping the province, Lahiffe gave his personal opinion, being clear that it is not that of St. Paul’s. “Do I see a solution to the opiate crisis? My personal position, and not the St. Paul’s position, but my position, is that I believe that drugs should all be legalized and controlled. And I believe in doing so, we would at least have the opportunity to know that people are taking what they believe they are taking, and we would have an opportunity to possibly intervene, knowing what they have taken. At least they would know what they are putting into their bodies.” 

Explaining further he stated. “I think, along with that, we would have to dramatically increase the support services. Now I don’t believe that we should be able to go and buy crack rocks at a 7-Eleven, but I think we have a system where we already do control all sorts of substances, pharmaceuticals and alcohol for example. And I think that along with that, we have to put huge amounts of resources into detox facilities, drug and alcohol treatment programs and to accept that we will never get people not using drugs. You can at least hopefully limit the harm that is caused by that, and when people are in the position to stop, there are no other barriers to them getting help; but that’s my personal position.”

A fentanyl user ‘does a dragon.’ Sometimes users will smoke a little of their drug before injecting, if they don’t know the strength of the dose.

But whether this possible solution would ever become reality, he is doubtful. “I would say that it would be a very gutsy politician that would take that particular football and run with it, at whatever level. Someone who can actually be in a position to make a difference. Somebody who’s never going to make a difference can say whatever they want, but someone who is going to make a difference, I would have a great deal of respect for somebody like that, who had the courage to take up that particular one. It’s pie in the sky to say that people will some day stop using drugs.”

One case brought the fentanyl crisis very close to him personally. “The one personally, most difficult case I have had was a young gentleman who was probably in his mid-to-late twenties. He was a part-time drug user, not a hard core drug user; a fairly functional guy who had a job and housing. He came in and had overdosed. He had a hypoxic brain injury (brain hypoxia is when the brain isn’t getting enough oxygen) and it was clear that he was going to die,” Lahiffe contended.

“We didn’t know who he was initially and it took some sleuthing to figure it out, but he was the son of a colleague that I used to work with in a different hospital in a different city. So I had to call him (the father) up and say; remember me? I worked with you x number of years ago. I have some horrible news for you. You really should fly into Vancouver now. The only happy outcome of that was that he (the young man who died) became an organ donor. I had to call the father whom I knew personally and had worked with, and tell him his son was about to pass on; and he did pass away.” 

Seeing the misery, hopelessness and horror that fentanyl overdosing brings with it, I had to ask the inevitable of this ER physician and father of two young children. How, over the past few years treating this crisis, how has it changed you personally, spiritually for example? It was a very personal question, perhaps too personal to expect an answer. The following was his response.

“I have two young kids, 10 and 12-years-of-age, and it scares me in that an overdose is much closer to touching most peoples lives than most of us would ever care to think,” he explained.

“A lot of people take comfort in, ‘well oh well,’ that’s a bad crisis but that only happens to people over there. Where in reality, it is all very much closer to all British Colombians’ lives and Canadians’ lives, than they would care to admit.”

He went on, “And it scares me that in the next ten years, both of my kids will be making their own decisions around drugs and alcohol,  as teens and young adults do. And the consequences of synthetic drug use are much higher and at the same time it’s the same pressures they are all going to face. And I guess that seeing this has made me think of my own life, my own circumstances for my own family. I fear for the kid that wants to go out to a party, wants to go do some ecstasy, a super common thing. If that batch was cooked up in the same room where someone cooked carfentanyl, and a few micro grams of it contaminated his ecstasy, it’s ghastly.”

So as a thousand tears flow down the cheeks of those grieving family members, the souls of their dead brother, sister, daughter or son, meander past the discarded syringes, trickling down the cracks of the alleyways. They will not be forgotten.

Someone had better get a message to God – that the devil is winning in Vancouver’s Downtown East Side. It will take true courage and leadership not seen up till now, to follow through with what has to be done, to truly be able to say that we are our brother’s keeper. For this is my prayer to those souls lost to the darkness of Vancouver’s ‘City of Dope.’