Heroin addict Kevin Muchikekwanape pulls out several pieces of folded paper. He says it's heroin from a couple of different dealers as well as crystal meth.
"My drug of choice, my habit, is heroin, it's what I need. If I don't have it, I don't function," he says.
He talks to CBC News as he carefully unfolds the paper flaps. He puts a piece of brownish substance into a small metal container, mixes in purified water and heats it up with his lighter.
He's doing all this in what's called a pop-up injection site. It's nothing more than a free-standing white tent with a few plastic tables and chairs inside. Boxes of packaged needles, rubber tourniquets, alcohol wipes and other paraphernalia needed by drug users are close at hand. There are a few sites like this now in Vancouver's Downtown Eastside, in vacant lots and up against buildings in back alleys frequented by drug users.
Once he's cooked his heroin, Muchikekwanape plunges a needle into his tattooed arm without hesitation. But the longtime heroin addict only injects about half the drug to test its effects. Once he believes it's not tainted or too strong, he finishes the injection.
Earlier this week he nearly died of an overdose.
"I'm pretty sure it was fentanyl," he says. "But it was late at night and no one was able to warn me about what I was doing, and I just did my normal thing and dropped. But luckily I was here and they brought me back again."
Spike in OD deaths
Fentanyl, which is exponentially more potent than heroin, is behind a huge spike in overdose deaths across the country. The latest figures from the B.C. Coroners Service show 622 fatalities between Jan. 1 and Oct. 31 this year, in that province alone.
He's articulate and obviously bright, and mentions that he's a qualified heavy-duty mechanic and welder. But he can't beat his addiction, despite the death all around him. As the drugs take hold, his speech grows quieter. He continues to talk, albeit more slowly, and says several close friends have died recently from overdoses, leaving him basically alone in the world.
Muchikekwanape credits the pop-up injection site with saving his life, saying it's unlikely he would have survived if he had overdosed alone.
Drugs can be legally injected in only two government-sanctioned facilities in Vancouver, including Insite, the first in the country. But they're often full, and drug users don't want to wait when they need a fix.
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In one half-block-long section of alleyway not far from Insite, CBC News counted more than 60 people standing alone or in small groups. Many were openly using drugs. A young man took off his sock and injected into his foot. An older woman was lying on her back, her head in the lap of someone else, who injected drugs into her jugular. The alleys reek of feces and urine, a smell only marginally suppressed by intermittent November rains.
Health authorities are on edge with the recent surge in overdose deaths and have recently confirmed the presence of carfentanyl on Vancouver streets. It's far more powerful than the already feared fentanyl.
Sue Ouelette, who spends many wet, cold hours volunteering at the pop-up sites, is worried about the potent mix of drugs being misrepresented as pure heroin when it's sold to desperate addicts.
'This heroin that's out now is so fast and so strong that they don't have time to call for help.' - Sue Ouelette, volunteer
"This heroin that's out now is so fast and so strong that they don't have time to call for help," she says. "There's no time to call for help, so that's why these [injection sites] are really important right now, and there should be more."
But, Ouelette says, there aren't enough volunteers to keep the pop-up injection sites open around the clock. The gap in the system is painfully exposed after Oulette and other volunteers leave. Minutes later, a young woman collapses to the ground in the alley.
A crowd of drug users gather around. Eventually paramedics arrive and save the woman. In Vancouver, as in many cities in Canada, ambulance crews, police forces and other first responders are now equipped with the opioid-blocking drug naloxone. One paramedic, who would only give her first name, Erin, was weary.
"It's all overdoses," she says. "The medication could be fentanyl, carfentanyl, heroin ... this is our 12th today."
In just the period between November 18 and 22 there were 184 confirmed overdoses between area hospitals and the Insite drug-use site, health authorities confirm.
But many others never get reported — users are treated on the spot at these makeshift injection sites, often just to turn around and score more heroin hours later. Many who overdose recover without showing up in the statistics. At least for now.