Fentanyl lifeguards: The makeshift paramedics of Vancouver's Downtown Eastside
B.C. drug users becoming first responders in Canada's spreading opioid emergency
In the back alleys of Vancouver's Downtown Eastside, almost everyone has a fentanyl horror story.
Huddled behind a curtain of garbage bins — or right out in the open — a constant stream of people inject needles filled with drugs of unknown composition and strength into their bodies.
Many admit they don't know exactly what they're taking, just assuming that their dealers do — and hoping to avoid a deadly dose of fentanyl.
It's in these alleys where Canada's growing opioid crisis may be the most visible. And it's here where a growing number of addicts say they're becoming skilled first responders and saving lives.
"I've brought some back," says Douglas Racette, standing in an alley off Columbia Street as friends shoot up around him.
Like many here, Racette says he's completed training to administer naloxone (trade name Narcan), a drug that can reverse opioid overdoses. He now carries his own kit, complete with two doses of naloxone and syringes.
Racette has lost several friends to fentanyl overdoses in the past year or so, as the drug flooded into western Canada. But he says he's also managed to save two people close to him, and a stranger who he found overdosing.
"If someone goes down, hopefully I'm there and I can help. That's the best I can do with anything to do with the fentanyl problem that's going around," Racette uses other drugs, and he used to take fentanyl, but not anymore: "It's way too deadly."
For Racette and others who've become something like community lifeguards in the fentanyl crisis, helping people stay alive has given them a sense of purpose: "There's nothing better than seeing your buddy wake up, and his eyes open, and he's thankful that you did something for him."
'The ambulance just isn't getting there'
Long a blight on the postcard image of Vancouver, the area frequently referred to as Canada's poorest postal code is afflicted by poverty, mental illness and drug addiction.
Fentanyl is only the latest but perhaps most powerful scourge.
Sean Widdifield says he's had to use naloxone seven times since December to help others in his housing complex. "What are you going to do, let somebody die? The ambulance just isn't getting there," he says, sitting in Vancouver's Oppenheimer Park.
"It's worth it, you feel so good after, but it's scary, because what if they die? That's what scares me. What if they die? What if I couldn't do it, couldn't save them?"
Thankfully, Widdifield says his attempts to help so far have been successful.
"It felt good, because you've got to keep a calm, cool head, you know?"
An addict for many years, Widdifield says despite his recent experiences saving others from overdoses, he still uses fentanyl about once a month. But knowing how close he's come to seeing friends die, he's aware of what a "scary, poisonous, dangerous thing" it can be.
"I test it very, very carefully before I take it, because I don't know who's going to save my ass, right?"
Kits critical until new injection sites open
The B.C. Centre for Disease Control has now distributed 9,700 free Narcan kits, more than 1,400 of which have been used to help people overdosing.
About 8,900 people have been trained to administer the antidote through a provincial harm reduction program called Toward the Heart.
Officials say the fact so many of the kits are being used, and so many users have been trained, is important progress, and can help avert tragedy.
"We are still seeing people die from overdoses where they have not had naloxone available," says Dr.Bonnie Henry, B.C.'s Deputy Provincial Health Officer. "If anything [distributing kits] has prevented deaths, particularly in longtime drug users who are physically dependent on drugs," she told CBC News by email, adding that having drug users save each other is "appropriate, and the goal of the take-home naloxone program."
The kits allow the people who carry them to respond immediately in a crisis; they also help when medical facilities are overwhelmed.
"I overdosed from fentanyl and it took two shots of Narcan to bring me back," says a woman who calls herself Exile. She thought she was taking heroin.
Fortunately, she was at Insite, Vancouver's supervised injection site, and staff there were able to revive her.
But users say demand for Insite is too heavy: they sometime have to queue to get in. The province wants to open five new supervised injection sites, in the hopes of saving more lives. In the meantime, users say the majority of overdoses continue happening on the street or in people's homes, so personal naloxone kits are vital.
"There are a lot of overdoses at Insite, but Insite's only one place, and it's only open for so long," says Laura Shaver, a member of the board of the Vancouver Area Network of Drug Users, and a recovering heroin addict.
She says she has successfully treated people with naloxone nine times, and thinks the reason more people aren't dying is because drug users are taking matters into their own hands.
"It's the difference between saving a life and somebody overdosing."
The cost of saving lives
Naloxone kits are now available in B.C. pharmacies without a prescription. But users and advocates say they are too expensive, with kits in some places going for about $50.
At a press conference last week, Dr. Mark Tyndall of the B.C. Centre for Disease Control admitted price is a problem. "There probably needs to be some talk to the distributors ... to make sure the cost isn't prohibitive, because right now it's up to them to decide how much they cost."
Many say officials should be flooding the streets with the kits to prevent more deaths.
Walking down a back lane off Main and Hastings, Laura Shaver ran into a young man who told her that after witnessing three or four recent overdoses, he's frustrated that naloxone kits aren't more easily available to people like him. "Thankfully, in those situations I was in walking distance of a place that I knew had it," he said, "but there's lots of hypothetical situations where I'm not, and if I had the kit, it would save a life."
"People are so frantic for kits ... but they have no kits, they have no access," Shaver says. "They could give them out. Hearing that it's so few and far between to find somebody with a naloxone kit — there's no reason for it."
State of emergency
Despite the small legion of drug users getting Narcan training and a major awareness push by public health officials, fentanyl remains a deadly threat, especially in western Canada.
Fatal overdoses have now overtaken vehicle crashes as the leading cause of death in B.C.
An investigation by B.C.'s chief coroner found that fentanyl was detected in the blood of 148 people who died of a drug overdose in the first four months of 2016 — more than three times the number in same period of last year. In Vancouver, it has meant about one death every five days.
Many drug users are ignoring the warnings and still actively seeking out fentanyl, considered 30 to 50 times stronger than heroin.
One young man in the Downtown Eastside who did not want to be identified told CBC News fentanyl is now his drug of choice.
"I love the stuff," he says. Even though he has seen friends "turn blue and green," he believes he's become immune to the drug's dangerous effects through repeated exposure. The only reason he doesn't take fentanyl more often, he says, is because it's too expensive: about $35 a hit according to some drug users, compared to approximately $10 for heroin.
In an alley near Main and Hastings, Harley Frank pours a tiny plastic bag of a white powder into a metal spoon, preparing syringes of fentanyl for himself and his girlfriend, Stacey.
"We're not happy anymore doing this. It's not like that."
The couple thinks they're able to use fentanyl safely because they're aware of what they're taking, so they know how much to use.
"We treat all dope like it's going to be fentanyl, test it out, smoke it first, whatever, because there is so much of it around," Stacey says. A lot of people get angry at them for taking it. "It's like are you guys stupid? Oh so and so my friend or or my mom died from that."
But, she goes on: "It's real, it's there, you're not going to get rid of it."
Frank admits to nearly overdosing three times when he first started using the drug. Stacey says the first time he "barely made it through." But he was fortunate: there was an ambulance nearby.
The next time, if he's lucky again, a stranger with a naloxone kit may have to come to the rescue.