“Yes, I feel fine,” she replies.
“Okay, hold still.”
Eyes wide and hands trembling, Larry, 32, flicks the syringe’s needle before crouching over his friend and injecting a mixture of fentanyl and benzodiazepines into a prominent vein in her neck.
Hailey, 38, is lying on a grimy pavement, surrounded by graffiti, filth, and other drug users. She inhales deeply, curls into a foetal position, and sucks on her thumb to hold her breath.
As the discoloured liquid enters her bloodstream, her body relaxes and her eyes lose focus.
“June 7th,” she murmurs. “I’m counting down the days until I can finally go to detox.”
Hailey and Larry are two of approximately 5,000 active drug users who reside in Vancouver’s Downtown Eastside, a 10-block corridor that runs through the heart of the city along Hastings Street.
Walking the half-mile stretch is profoundly shocking. Bodies lie scattered on the tree-lined streets, some scarcely breathing. Discarded needles are everywhere, and the detritus from makeshift encampments – tents, cardboard, sleeping bags – clutter alleys and verges. The scream of sirens is unrelenting.
The crisis is being fuelled by fentanyl, a synthetic opioid that is 50 times stronger than heroin. Manufactured in numerous illicit labs in Canada’s wilderness, fentanyl is now so common in Vancouver’s Downtown Eastside that you can literally pick it up off the street.
Vancouver once topped the charts of the world’s “most desirable places to live”. Its reputation is that of a city which provides the perfect balance – a metropolis “perched on the edge of nature” combining “outdoor recreation and a great cultural diversity”, as one local website puts it.
But a landmark experiment to decriminalise the possession of certain drugs in public – including fentanyl, heroin, cocaine, methamphetamines, and ecstasy – has allowed an opioid crisis to take hold that surpasses even the epidemic in the United States.
In April, David Eby, British Columbia’s premier announced that halfway into the three-year trial, the province would recriminalise drug use in public spaces.
With a severe backlash from police, politicians, and the public showing no sign of abating, Mr Eby is now under pressure to scrap the pilot scheme altogether.
Since last month, police once again have the power to approach and arrest drug users in hospitals, restaurants, parks, and beaches. But people are still able to legally consume 2.5 grams of hard drugs in their homes and in designated public shelters. It also remains unclear how the revised rules will be meaningfully enforced by the police.
Despite the province’s best efforts, opioid overdoses have become the leading cause of death for people aged 10-59 in British Columbia, and now account for more deaths than homicides, suicides, accidents, and natural diseases combined.
Last year, the province recorded 2,511 drug-related overdoses, 87 per cent of them down to fentanyl. The death rate in Vancouver itself now stands at 56 per 100,000 people – nearly three times the national average. And in the Downtown Eastside, the rate is nearly 30 times higher than the rest of the country.
For comparison, England and Wales have a drug-related mortality rate of 8.4 per 100,000 people. In Scotland – the worst in Europe – it stands at 19.8. The only G7 country with anything close to a comparable rate is the United States, at 32.6 per 100,000 people.
With the city gripped in an opioid epidemic nearly twice as fatal as America’s, the Downtown Eastside is becoming a key battleground for the province’s decriminalisation debate. As overdose numbers continue to rise, many view the liberal rollout as fuel to the fire. Yet others argue there are wider societal issues at play that are far more insidious than fentanyl.
Now entrenched in a public health emergency, Canadians of nearly all political stripes are asking, “How did we get here?”
Decriminalisation ‘not about drugs anymore’
In the first year of British Columbia’s decriminalisation rollout, public drug use exploded – with reports of people injecting heroin on family beaches and smoking crack in maternity wards.
Fiona Wilson, the deputy chief constable of the Vancouver Police Department, says the experiment has tied the hands of police across the city, leaving the wider community at risk. Despite having seized over 1,000 kilos of fentanyl from dealers in 2023 alone, officers are powerless to intervene when they see it used on the streets.
“Decriminalisation has been a massive challenge for the police because it’s taken away our ability to arrest someone. We don’t have any grounds to approach a person who is publicly using illicit drugs in the absence of any other criminality,” she says.
“If someone is sitting at a coffee shop and wants to snort a line of cocaine, we don’t have any authority to intervene in that situation. This presents a real problem because families don’t necessarily want to sit next to somebody in a restaurant who’s shooting up fentanyl.”
On the other side of the debate, left-wing advocates for liberalisation have sought to frame the debate around privilege and class.
Brittany Graham, the executive director of the Vancouver Area Network of Drug Users (VANDU), says bigger societal issues – namely, a lack of housing and inadequate welfare services – are to blame.
“Decriminalisation will always exist for the upper class. When someone has enough money to snort cocaine in the privacy of their own home, the police are never going to get them. What we are witnessing right now is a homelessness crisis on top of a toxic and unregulated drug supply.
“The right-wing is blaming everything on decriminalisation, but the reality is Vancouver has seen a 32 per cent increase in homelessness since the beginning of Covid. But the government continues to label poor drug users as the scapegoats for everything wrong in our province.
“Decriminalisation is not about drugs anymore, it’s about power and control. Drugs have been killing people for decades, now it’s toxic politics.”
Elenore Sturko, the shadow minister for mental health and addictions, says decriminalisation has been a “dangerous and disastrous” policy failure.
“The entire policy was politically motivated. Clearly, the government didn’t do the work on decriminalisation. In fact, they ignored the advice of the police. Now, we end up where we are today – not only failing to reduce death and overdoses, but actually causing increased harm.”
‘I never wanted to use fentanyl’
Beyond the issue of decriminalisation, British Columbia has introduced a raft of “harm reduction” measures in a bid to solve the public health emergency – but these too have proved controversial.
The backbone of the province’s harm reduction project revolves around “safe injection sites” where users can access clean needles and a regulated supply of drugs. In these government-run locations, drug users are able to consume their illicit substance of choice – predominantly fentanyl – while being monitored by healthcare workers with an opioid antidote on hand.
Tiffany, 37, says VANDU’s safe injection site has saved her life many times over. Shortly after moving to Vancouver at 15, she got hooked on heroin. Now, almost two decades later, fentanyl is her drug of choice.
“I never wanted to switch over to fentanyl, but it’s everywhere,” says Tiffany, preparing her needle at VANDU’s site. She’s already crushed and melted down her mixture of benzodiazepines and fentanyl.
“I use drugs as a way of coping with my emotions, and being separated from my son. But I do love myself – that’s why I can’t do this anymore. I refuse to become another statistic,” she says.
Vancouver has long been a pioneer in harm reduction. Over 30 years ago, during the heroin and HIV epidemic, the city opened its first safe injection facility in the Downtown Eastside – the only one of its kind in North America.
But what once helped stem the tide of HIV does not appear to be working now.
Some policymakers claim that harm reduction initiatives have become politicised and are perpetuating the problems of addiction, homelessness, and public disorder – specifically in the Downtown Eastside, which they argue has become a death trap for drug users.
Ms Graham from VANDU accepts that harm reduction can be hard to quantify, but continues to believe Vancouver’s clinics do some good.
“In principle, harm reduction is meeting a person where they’re at, no matter what substance they’re using or harm they’re causing. Inherently, we know that drugs are harmful, so it’s crucial to help them mitigate that harm – for example, providing clean needles and a sanitary space,” she says.
Tiffany shoots up twice in the VANDU facility before slumping over. As the mix of fentanyl and benzodiazepines takes control of her senses, she whispers, “The high feels like a warm hug.”
‘No question’ of drug diversion
While many users like Tiffany in the Downtown Eastside source their drugs from the street, the government has launched a “safer supply” program which allows users to receive pharmaceutical-grade opioids free of charge from a physician.
The initiative is “preventing overdoses, saving lives, and connecting drug users to health and social services”, the province says.
But according to those on the ground, safer supply has created many unexpected consequences. The Vancouver Police Department says a significant portion of the opioids being freely prescribed by doctors are not actually being consumed by their intended recipients.
Instead, the drugs are being resold on the black market at rock-bottom prices – in a process called “diversion” – typically to fund the ongoing purchase of fentanyl.
Deputy Wilson says “there is no question” that these drugs are being diverted to the streets, specifically the Downtown Eastside. In fact, she says that 50 per cent of hydromorphone seizures in British Columbia have originated from the government.
Not only are safer supply drugs being diverted to active users, there are also reports of these powerful opioids falling into the hands of children. Ms Sturko explains that highly addictive drugs are freely going out into every corner of the community, allowing new users to develop opioid use disorders.
“Parents in Vancouver are telling me stories of their children using high quantities of dillies [hydromorphone] because they thought the opioid was ‘safe’ under the government’s label of ‘safer supply’,” she says.
“It’s horrifying. It makes me angry because we’re talking about the lives of our children who may start experimenting with an opioid that won’t kill them, but it eventually leads them to use fentanyl which will kill them.
“It’s a potential pathway of serious addiction. These safer supply drugs are subsidising the fentanyl market.”
But Ms Graham from VANDU claims that banning safer supply drugs is not the answer. She says removing government-regulated opioids from the system would taint the drug supply to an even greater degree.
“It’s clear that stamping out the [regulated] drug supply doesn’t stop people from using the substances. It just makes the quality of the substances they can access less reliable.”
Ms Graham goes as far as to claim that the police are against a regulated drugs market and because it threatens their jobs.
“We need to solve the toxic drugs crisis by providing the substances,” she insists.
Andrew, a paramedic in the Downtown Eastside, has responded to hundreds – if not thousands – of overdose calls during his time as a first responder. In his view, the government is “subsidising and enabling” the fentanyl crisis by throwing money at it instead of solving it.
He says he can only speak anonymously, as the local health authority has cracked down on interviews in the lead up to the provincial election later this year.
“This is all our fault. We’ve created a system where people can wake up and get high everyday – why would they want to leave the Downtown Eastside? It’s a free ride in life that’s funded by taxpayers.
“You would never see anything like this in a poor country. The government is giving people enough slack so they don’t have to change – this perpetuates the problem that will never be solved.
“The Downtown Eastside is like a warzone. It’s unbelievable the depravity people will endure to simply exist.”
But getting clean is certainly not easy.
Mark Ng Shun from Vancouver Detox explains that “walk-ins” are not permitted in government-funded locations. Instead, drug users are told to join a waiting list that can average anywhere from three to six weeks.
To secure a spot, it’s mandatory to call every day, and users must start detoxing before being admitted.
“Vancouver’s detox system is not working for those who need it the most,” says Mr Ng Shun.
“Many Downtown Eastside residents are stuck in the ‘detox limbo’ – they have a desire to seek a different kind of life, but they’re told they have to wait six weeks. Many people can give up during that time.
“Plus, there is still a stigma attached to Downtown Eastside residents who are seeking help. The services themselves are tailored towards upper- and middle-class white people.
“Only certain lives are supported in detox. The system is oppressive. People who are the least advantaged have the least access to it.”
Lisa Weih lost her 29-year-old daughter, Renée, to an opioid overdose in 2020. She says the city’s detox and recovery systems are inadequate.
“Renée never stopped trying to get better. She put herself through the tortures of detox several times, but there was nothing there for her afterwards… our leaders want to get away with murder.”
On the frontlines of Vancouver’s fentanyl crisis, there is not much sign of change.
Ms Graham, who witnesses the carnage of the Downtown Eastside on a daily basis, says hope is the one thing she can’t afford to lose sight of.
“I’ve lost a school bus full of people to opioids. But there is a way forward, and it’s increased harm reduction,” she insists.
“This isn’t a political debate, it’s a human rights debate.”
Source: https://www.telegraph.co.uk/global-health/climate-and-people/vancouver-opioid-crisis-drug-addiction-british-columbia-canada/
