Dr. Bill MacEwan knocks on doors inside the Jubilee Rooms single room occupancy hotel in Vancouver's Downtown Eastside. Armed with a list of tenants from building staff, MacEwan is looking for a few people he's familiar with.
He speaks with one man who hasn't slept in two days, is facing an impending eviction and appears to be experiencing delusions.
Then MacEwan finds Jacob Langlands, 23, in the hallway.
"How are things going?"
"They're going okay," said Langlands, wearing a bandage taped above one eye.
"You've been beaten up," said MacEwan. "What happened?"
Langlands answered that he'd been a scuffle.
"I've been worried; how have things been going in terms of your drug use?" asked MacEwan.
"I've been clean for the last few days," said Langlands.
"Okay, and you used 'down' the other day?"
Langlands answered that he had used 'purple down,' which was supposedly heroin, but may have been fentanyl.
"Okay, because the big worry going around is with overdoses right now," said MacEwan. "How's that with you?"
The 23-year-old said he'd recently overdosed and wound up at the nearby Mobile Medical Unit. Langlands said it had taken six shots of naloxone to save his life, an extraordinary amount.
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The psychiatrist asked a few more questions, following up on previous conversations the two had had about psychosis, sleep issues and medications. Langlands admitted he did some self-medicating with street drugs to control his mood and thoughts.
MacEwan is based at St. Paul's Hospital, but spends many of his days working in the Downtown Eastside.
Mental illness going untreated
"There's a lot of people that are suffering from serious psychiatric illness, as well as drug addiction," he said, adding that, of the roughly 4,000 people dealing with mental illness in the neighbourhood, about half of them are going without any significant treatment.
"So often people have this inner pain, psychological, psychiatric difficulties from trauma or from mental illness and they're trying treat those, or deal with those symptoms through use of drugs," said MacEwan, adding that normally past trauma is what's being treated for patients, but in this neighbourhood, it's almost daily trauma.
In 2016 alone, officials reported 914 people were killed by illicit drugs in British Columbia. Many of those deaths involved fentanyl, and many of them happened in the relatively close-knit Downtown Eastside neighbourhood.
'Very difficult environment'
"This is a very difficult environment for many people," said MacEwan. "It's extraordinary the number of people who have passed away."
MacEwan said many people will use potentially deadly drugs to escape the trauma, and many will become reckless as they struggle with constant, untreated grief.
He said if you want to reduce the number of fatal overdoses, you need to respond to the medical needs with overdose interventions, attention to health issues and access to free heroin. But he said you also have to treat the psychiatric issues to break the cycle of drug use and addiction.
"If they're now having these [stimulants] and [sedatives] for mood disorders, or paranoia from their psychosis and the drugs on the street are helping it, then they'll go back to the drugs."
The Fentanyl Fix is a week long series exploring potential solutions to B.C.'s opioid overdose crisis
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