From his vantage point on the sidewalk next to Vancouver's supervised injection site, Jace Korpan watched a suspected fentanyl crisis unfold on Sunday.

Korpan, a regular presence in the Downtown Eastside, says he is not a drug user but is familiar with the Insite facility.

There was a lineup outside the door, and as word of overdoses on the street spread, workers ran back and forth to administer an antidote. The price of failure: death.

"Because of them, people are here still," said Korpan. "That's the honest truth. That's the bottom line."

An election issue?

You won't get much of an argument on that point from the addicts, business people and residents nearby.

Nor from the province, medical authorities or the Vancouver police, who put out a warning about a deadly batch of pink heroin, potentially tainted with fentanyl, in the hours after 16 people overdosed last weekend.

But more than a decade after opening its doors and getting support all the way to the Supreme Court of Canada, North America's first legal supervised injection site is still fighting Ottawa for survival.

Advocates say that battle may add a political edge to the current fentanyl crisis.

"I would be happy if this was an election issue," said Dr. Patricia Daly, chief medical health officer with Vancouver Coastal Health.

Most of the recent headlines around fentanyl have come from the shocking deaths of recreational users: a popular Burnaby teen; and the young North Vancouver parents of a two-year-old, now orphaned.

Jack Bodie, teen fentanyl overdose victim

The death of teenager Jack Bodie has raised concerns about fentanyl for recreational drug users, but the opioid is also a big problem for habitual users. (Facebook)

But there's another side to the problem; fentanyl has also cut a swath through the Lower Mainland's sizable population of habitual and injection drug users, where the synthetic opioid is passed off as OxyContin or cut into heroin.

"The value of a place like Insite — and we've seen this through a number of studies — is that overdoses do occur there, but there's immediate medical resources available, so that there have been no deaths from overdoses," said Daly.

"Even people who have had suspected fentanyl overdoses."

In fact, it was following a rash of fentanyl-related overdoses at Insite last October that police began an investigation, which they claim led them to a major distributor of the drug.

Respect for communities

Insite opened in 2003, partly in response to an earlier heroin crisis that saw as many as 200 people dying annually in the Downtown Eastside by the mid-1990s.

But the Conservative government has opposed the facility from the start, arguing communities should focus on prevention and enforcement, as opposed to helping addicts essentially poison themselves.

The fight ultimately wound up at the Supreme Court of Canada, which found Insite "saves lives" and ruled unanimously that the facility should be allowed to operate under an exemption from drug laws.

In response to the ruling, the Conservatives introduced Bill C-2, the Respect for Communities Act, which passed into law this June.

At the time, Health Minister Rona Ambrose said the legislation established "rigorous criteria" for the type of exemption a supervised drug injection site would need to operate.

"This law requires that the voices of law enforcement and parents be heard before drug injection sites can be considered to open in local neighbourhoods," she said.


Insite operates under a legal exemption that allows users to inject drugs under the supervision of medically trained professionals.

But advocates claim the rules instead set a bar no facility will be able to clear. Pivot Legal Services Society lawyer Adrienne Smith argued against Bill C-2 in front of a parliamentary committee.

"With this law in force, even if there were a Liberal or NDP health minister who wanted to grant an exemption, the wording of the legislation makes it nearly impossible," Smith said.

"So this Conservative government on its way out the door has effectively barred access to supervised injection services that could save lives across the country in the midst of a fentanyl crisis."

At present, Insite has to apply for its exemption every year.

No 'magic treatment'

Obviously, the government doesn't see things that way. 

Daly said she doesn't want to see young people taking drugs either, and she'd also like to help addicts stop using.

"I'm in agreement with the government on that," she said. 

"But where we disagree on that is we both have those goals, but how do we get there? I don't have a vaccine that can prevent addiction, and I don't have a magic treatment for addiction."

As with everything in Vancouver's drug wars, there appears to be a gulf between ideology and on-the-ground reality; politics fill the gap.

On the sidewalk near Insite, a dozy man sitting near Korpan speaks up: "I challenge you to find me some real heroin right now."

As Korpan nods, the man says the street is flooded with synthetic drugs. A lot of it is fentanyl.

That's reality. So is addiction. And regardless of the risk, desperate people are going to inject.

Which means overdoses are going to happen.