A longtime heroin addict named Max winds a band of blue rubber around his bicep.
"So my veins will stick up," he explains before quickly sliding the needle beneath his skin and injecting a powerful drug called hydromorphone.
This isn't happening in a back alley. Instead, Max is inside a brightly lit room where injection drug users are taking part in a clinical trial where they are given their drugs and needles.
The facility is called the Crosstown Clinic in Vancouver's downtown eastside.
The trial is the first of its kind in the world and one addiction expert is urging jurisdictions across the country to quickly follow suit.
Max, who didn't want his last name used, injects at one of several stations set up for drug users. A box of tissues and other supplies sit on a stainless steel counter gleaming under crisp, bright lights. Watchful medical staff dispense the needles, check identification and watch for medical problems.
- Safe injection sites have potential to save lives, says Jane Philpott
- Drug users, neighbours weigh in on safe injection site proposal for Ottawa
"I get the itchies really bad for about 30 or 60 seconds. My face will totally change colour," he says, describing the immediate impact of the drug flowing through his veins.
True to his word, Max then slips a back scratcher under his shirt as the itching hits right on schedule.
But it's a minor price to pay compared to the very real pain of heroin addiction.
A new study says the drug used by Max, hydromorphone, is a powerful tool that could helps thousands of other Canadians battling opioid addiction.
Max is part of a subset of drug users that don't respond to methadone, the drug most widely used to treat addicts.
Researchers say about ten per cent of addicts don't find relief from methadone, so they often keep using street drugs.
This new study involving 202 participants shows hydromorphone does work, and Max says it's changed his life.
When he was selected for the drug trial, things were looking grim.
"I was homeless, I was committing crimes to get my fix." He also didn't think he had long to live.
Since being enrolled in the trial, he has put on weight, works out every day and says he can function more or less normally after injecting hydromorphone.
"I'm not getting stoned, I'm not getting that kind of effect from it."
He says heroin addiction is incredibly powerful and that he fell into using it after getting addicted to prescription painkillers following a car accident.
"Your body starts to crave it to the point where almost nothing will stop you from getting it. There's a real dire need to get that into your system, and your body is screaming for it from every angle."
Dr. Scott MacDonald is the lead physician at the Crosstown Clinic. He says hydromorphone substitution prevents overdose deaths from street opiates, including fentanyl and heroin.
"In December, over 60 people in British Columbia died from fentanyl overdoses," MacDonald said. "Not one of the patients receiving care at our clinic on injectable opioid treatment died. The number was zero. I think that's relevant."
He says it's especially important now that overdose deaths are spiking to record numbers across Canada.
A report last year by the Ottawa-based Canadian Centre on Substance Abuse said, in some jurisdictions, deaths jumped by more than 20 times previous levels. An exact national number is difficult to determine, but about 300 died in British Columbia alone in 2014, a large increase from the previous year.
In addition to the hydromorphone trial, the Crosstown clinic has also been the only site allowed under a special permit to dispense a drug very similar to street heroin.
This recent trial was to find out if hydromorphone was just as effective.
MacDonald says the advantage is that hydromorphone is already licensed in Canada. That means other jurisdictions wouldn't need special permission from Ottawa to open up clinics and supply the drug to addicts.
Addiction not a 'second class' illness
Addiction researcher Dr. Eugenia Oviedo-Joekes says this trial is the first of its kind in the world and she is urging an expansion of clinics modeled on Vancouver's Crosstown.
"We are trying to provide alternative treatments for people that are continuing to inject in the street, and we are not serving them well with the few options we have," Eugenia Oviedo-Joekes says.
She says addiction should not be treated as a "second class" illness because of the social stigma attached to it.
She says access to drugs such as hydromorphone or even the medical equivalent of heroin are now proven to be the best form of treatment. And she said supplying the medication to patients in a controlled setting does not encourage people to use drugs.
"I really hope the government is willing to listen to the evidence. I really hope some people stop playing to the fear of what it means. This treatment is for those we are leaving behind, the poorest, the most vulnerable."
Researchers also point to other benefits from the trial, showing participants were much less likely to get involved in crime because they no longer had to scramble to pay for heroin. They also spent less time in emergency wards and were not as costly to the criminal justice system.