The winter of 2016 was a scary time in Vancouver’s Downtown Eastside. Overdoses were occurring at a frightening pace.

Dr. Christy Sutherland’s patients were especially at risk. As a staff physician for the nonprofit Portland Hotel Society (PHS), she provides care for an especially vulnerable group. Many struggle with both mental-health and addiction issues. And with the dangerous synthetic opioid fentanyl replacing heroin, using street drugs was more dangerous than ever before.

If her patients were going to use drugs no matter what—if many were simply not ready to try for abstinence—how, Sutherland asked herself, could she minimize their risks?

Down the street from Sutherland’s office on East Hastings Street, a clinic called Crosstown had recently concluded an experiment determining that a prescription painkiller called hydromorphone could be used to treat a severe addiction to heroin.

One of the researchers suggested to Sutherland that she could offer the treatment to her patients, outside the confines of Crosstown’s academic trial.

In September 2016, that’s what Sutherland did. It began with just one patient, but before long the benefits were evident. Twice a day, Sutherland or one of her nurses supplied their patient with injection hydromorphone. And within a couple of months, the patient stopped using street drugs, reconnected with family, then secured a part-time job.

“We’ve got to expand this,” Sutherland told her team.

As of April 2019, there were 115 patients in the Downtown Eastside enrolled in PHS’s injection-hydromorphone opioid-substitution program.

Another 54 receive an oral form of the drug. Sutherland’s staff have not lost one patient to an overdose. In fact, they’ve never once even had to respond to an overdose.

“No overdoses,” Sutherland affirmed. “You can see the burden lift off them.”