A copy of the Canadian Charter of Rights and Freedoms graces a wall around the corner from where a woman lies on the floor as a needle full of heroin is injected into her neck.

She rises quickly, sweeps her long brown hair over one shoulder and sits on a chair as a man is handed a needle by another woman also wanting his help at an overdose prevention site located at the office of the Vancouver Area Network of Drug Users (VANDU).

Vancouver Coastal Health has operated the site since December, but the peer support group known as VANDU began in 1997 with political activists who wanted drug users to demand health services when sharing of needles in the Downtown Eastside led to skyrocketing hepatitis C rates and the highest HIV prevalence of the AIDS virus in the western world.

These days, the painkiller fentanyl has been implicated in hundreds of opioid overdose deaths in the neighbourhood and around British Columbia, the epicentre of an ongoing crisis in Canada.

VANDU

Members of VANDU were honoured with a commendation by the Vancouver Fire & Rescue Services at a ceremony at city hall in October. (Rafferty Baker/CBC)

Hugh Lampkin, vice-president of VANDU, stands at the door as the first woman walks out about five minutes after her injection, past an attendant trained in CPR and administration of the overdose-reversing drug naloxone.

"Right now the most popular thing is probably heroin, but there's side,'' Lampkin says, referring to crystal meth, also called jib.

"We have a horn, and if somebody goes down they call me,'' the current drug user says. "With the fentanyl that's around now I try to tell people when I'm training them, 'Just look to see if people are staggering or they're slurring their words.'''

The not-for-profit organization, which is marking its 20th anniversary this month, shares its office on East Hastings Street in the heart of Vancouver's Dowtown Eastside with several sub groups.

They include the British Columbia Association of People on Methadone and the Western Aboriginal Harm Reduction Society, which on this day is holding its weekly meeting by remembering people who've died of fentanyl overdoses.

"Let this moment of silence be for them and for many more,'' says the group's secretary-treasurer Shelda Kastor, as ambulance sirens wail past the building.

VANDU

A VANDU board member cuts pieces of tubing to serve as clean pipes for drug users using crack and fentanyl in October. (Rafferty Baker/CBC)

Ann Livingston, a founding member of VANDU, says the group's first meeting was at a park 20 years ago.

Livingston says stigmatized drug users were being treated as "less than human'' so she used her organizing skills to bring them together, eventually helping to create a group led by the people who best know the issues affecting them.

They soon began reporting desperate users grinding up drywall into a powder and selling it as drugs or repackaging used needles, Livingston says.

"It was a real place for action and that was my job, constantly, to have my mind blown over and over again.''

"It's hard to describe how hated drug users are and how disregarded their lives were,'' she says of the years when 27 per cent of injection drug users in the impoverished neighbourhood became infected, says the Vancouver-based Centre for Excellence in HIV/AIDS.

Ann Livingston

Ann Livingston helps run a pop-up injection site on Hastings Street in Vancouver's Downtown Eastside. She is also the co-founder of the Overdose Prevention Society. (Stephanie Mercier/CBC)

Victories that involved VANDU members include the distribution of clean needles and the 2003 opening of Insite, North America's first supervised injection site in the heart of the Downtown Eastside.

Even after Insite opened, VANDU formed an injection support team of members who helped users injecting drugs in alleys and took the most destitute to the group's office.

"You see someone in an alley, they've got blood streaming down their arm, their rig is blocking and they've got their dope in there and they can't get it into their body,'' Livingston says, adding the unsanctioned injection site at VANDU was eventually shut down, prompting her to send users to her van for two months before Vancouver Coastal Health threatened to cut off funding.

The key to VANDU's success has been its large membership, which now includes 3,000 people, regular meetings allowing volunteers to learn how to read spread sheets, stretch limited funding dollars and participate on a board of directors that includes current and former drug users, Livingston says.

'There's a pile of dead bodies to prove what I'm saying'

The fentanyl crisis has created an even greater need for treatment options for people who are ready to take that step, but quality-controlled drugs are needed for others, Livingston says.

"People need to demand, and say, 'I am getting safe drugs from you. I have an opioid use disorder, it's a diagnosable illness, I'm in need of medical care and I'm guaranteed that medical care. To not give it to me is discrimination.' There's a pile of dead bodies to prove what I'm saying.''

Dr. Thomas Kerr, associate director of the BC Centre on Substance Use, says he was an HIV researcher in 2000 when he was "blown away'' by the political activism of Livingston and her now-deceased co-founder Bud Osborn, who promoted addiction as a health issue.

Bud osborn vandu

Bud Osborn was one of the co-founders of VANDU in 1997. (VANDU/Facebook)

"This idea of drug users self organizing and coming up with drug-user-led solutions seemed revolutionary to me, and I immediately visited VANDU,'' Kerr says, adding he soon learned that people at highest risk of disease and death were being reached by the organization and missed by conventional public-health programs.

"The thing about VANDU is they're usually two or three steps ahead of the bureaucracy and often lead the way in innovations and delivery of programs and helping initiate policy,'' he says.

"VANDU is known around the world as one of the biggest and most impactful drug user groups,'' he says.

"There may have been a time when people rolled their eyes at the sight of VANDU members showing up to an important meeting and demanding attention but now people are actually inviting VANDU to the table and recognizing them as essential players.''