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Agence France-Presse

Sirens scream non-stop through the urban heart of Vancouver, as responders race toward drug addicts overdosing - and dying in such numbers that the city’s morgues are full.
This wealthy Pacific coast city is the bleak epicentre of an opioid epidemic that has claimed thousands of lives in Canada, while next door in the United States, drug overdoses are now the leading cause of accidental death.
“There’s not a single person down here that’s chosen to be a junkie,” said Martin Steward, a self-admitted drug user who manages a treatment facility in Vancouver’s gritty Downtown Eastside neighbourhood where the crisis is concentrated.
“Something happened in their lives: emotional, mental, physical, that brought them to where they are.”
On the neighbourhood’s Hastings Street, blocks that were once bustling with people are now emptier.
Vancouver increases property tax to pay for drug-overdose measures, amid fentanyl crisis
“There are less and less of the people I know here,” said Mary Mootrey, who has lived in the area for 25 years, pointing to a few milling around. “They’ve all overdosed.”
Authorities in British Columbia predict that 2016 will break all records for provincial deaths from opioid overdoses, including 128 in November alone.
Officials had first declared an emergency in the spring, as cheap synthetic fentanyl replaced expensive heroin and soon became mixed into most street drugs.
A pill sells for as little as C$2 (US$1.50), said the 59-year-old Mootrey.
“I wish they’d all go into treatment,” she said of the many addicts in her neighborhood.
But treatment facilities are full, with long waits to get a spot.
“There’s always been a problem here,” said Steward, who manages a facility run by the Vancouver Area Network of Drug Users. 
“But now the morgue’s full, they look at it and say, we better do something.”
The 44-year-old has personal experience with addiction: a cocaine user by age 12, he eventually found himself living on the streets in Montreal.
Steward said he now uses cocaine and heroin, taking care to buy only from a known dealer and never injecting alone, in case he overdoses.
“A lot of people here are under care, and targeted by drug dealers,” said Neil Arao, manager of Insite, North America’s only supervised injection site, located in the Downtown Eastside.
Prince died of accidental overdose of heroin-substitute fentanyl, autopsy report reveals
He estimated at least 1,200 locals are both mentally ill and addicted to drugs, though there are no accurate numbers.
Proposed solutions range from decriminalising hard drugs to prescribing heroin to adding rehabilitation facilities.
Long term, experts and advocates agree, the solution is to reduce the numbers of drug users by solving issues that begin, for most, in childhood.
That’s a challenge compounded by British Columbia’s child poverty rate of about 20 per cent, one of the highest in North America.
The acute poverty and despair in the Downtown Eastside is a shocking sight in the heart of Vancouver, an otherwise bustling and wealthy metropolis where average home prices are nearly C$1 million, according to the Canadian Real Estate Association.
It is “like a trap,” said Arao. “It’s hard to escape it.”
The numbers are stark. The Insite supervised injection centre serves about 700 drug users a day, Arao said. In the past, one or two overdosed each day but in recent weeks it’s up to 15 per day.
The emergency room at St Paul’s hospital has handled more than 6,000 overdose patients so far this year, said physician Nadia Fairbairn.
“Vancouver is right in the middle of the crisis,” she said.
In December, officials launched a mobile overdose clinic in the Downtown Eastside, staffed by emergency and addiction physicians.
Agencies have also set up rooms, and even tents in alleys, staffed by trained volunteers equipped with some 18,000 kits distributed by the government.
Each contains injectable naloxone, which quickly counters the effect of most opioids.
Most policy experts agree there is little prospect for stopping the supply of cheap synthetic opioids. Authorities say most are shipped from China, and mixed in Canada with other drugs or pressed into pills.
Synthetic opioids are also available on the internet, with sites advertising discreet mail order shipments.
Asked to describe the situation, Arao said to call it a “crisis” implies there will be an end.
“I’m wondering if this is now our normal,” he said.


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Fentanyl and other opioids

The impoverished downtown of Vancouver is ground zero for deadly fentanyl overdose crisis

An ambulance delivers a patient to a mobile emergency facility in Vancouver’s Downtown Eastside on December 22. The tent, staffed by emergency and addictions physicians, was set up this month by the government health authority to help tackle the fentanyl crisis that killed 128 people in Canada’s British Columbia in November. Photo: AFP

Martin Steward, shift manager and a heroin user himself, illustrates how to draw heroin or fentanyl into a clean syringe at the office of the Vancouver Area Network of Drug Users (VANDU) on December 22, 2016, in Vancouver’s Downtown Eastside. VANDU is one of several aid and government agencies in British Columbia that stock kits to prevent deaths in more overdose deaths in a fentanyl crisis that has killed hundreds, including 128 people in November alone in British Columbia. / AFP PHOTO / Deborah JONES

A mural in an alley in Vancouver’s Downtown Eastside, on December 21, 2016, painted by a man mourning the fentanyl overdose death of his wife, with names of other victims of the crisis that killed 128 people in British Columbia in November. / AFP PHOTO / Deborah JONES

Physician and research scientist Dr. Nadia Fairborn, outside St. Paul’s Hospital in Vancouver, said the emergency room has been deluged by some 6,000 patients with overdoses to date this year. If help reaches them in time victims always survive, but hundreds have died on the streets or in their homes in British Columbia this year, in a fentanyl abuse crisis that shows no sign of easing. / AFP PHOTO / Deborah JONES