How the worst overdose epidemic in Vancouver's history left the Downtown Eastside to fend for itself

“It was the last Wednesday of August,” Janet Charlie begins in an interview at a street market in the Downtown Eastside.

She was working at a concession stand there at 62 East Hastings when her son, Tyler, came by.

“He was walking through the market,” she tells the Georgia Straight. “He’d seen me working. But he knew I had an issue with his girlfriend, so he would never talk to me when she was around.

“He just looked at me and he walked out,” recounts the grandmother of four. “That was the last time I saw him alive.”

Tyler spent the next three hours hanging out with friends on the corner of Main and East Hastings, just one block from where his mother continued her shift. “Selling cigarettes and whatever, and they drink there,” she says.

Shortly after noon, a girl sprinted into the market and ran right up to Charlie.

“They said, ‘You’re son went down,’” Charlie says calmly. “‘It doesn’t look good. It doesn’t look like he’s going to make it.’

“And I said, ‘You know what? Don’t say that, because you’re not God.’”

Together, they ran up Hastings to the corner of Main, where Charlie found her son with paramedics bent over him, pumping oxygen into his lungs.

The last time Janet Charlie saw her son sober was last May, on Mother's Day. "Him and his brother dropped off some chocolates for me," she says.
Rafal Gerszak

She spent the next seven days with Tyler unconscious at Vancouver General Hospital.

“We thought he was going to be okay, because they had a little bit of wave in his brain,” Charlie continues. “But the next day, there was nothing. So on the seventh day, we had to take him off the machines that was keeping him alive.

“His birthday would have been on December 11,” Charlie says. “He would be 27, if he was still here. He left behind an ex-wife and two kids.”

In August, Janet Charlie lost her son, Tyler, to a fentanyl overdose. She wonders if a pop-up injection site like the one set up by the Overdose Prevention Society might have saved his life.
Amanda Siebert

An unprecedented number of deaths

By August 2016, the fentanyl crisis had already killed hundreds of people in Metro Vancouver—nearly 1,800 between the point at which a spike in statistics became observable in 2011 and the end of October 2016. And yet, even though a public-health emergency was declared last April, no level of government took significant action to stop the tide of fatal overdoses.

For the Downtown Eastside, Tyler’s death was one too many.

Five years into an epidemic, and still with little help from authorities forthcoming, the neighbourhood mobilized to take care of itself.

Worse than the '90s

The alley behind the market where Charlie works is always busy with drug users. There, late one evening, Ann Livingston tells the Straight she’s seen all of this before.

Back in the 1990s, when the Downtown Eastside was breaking under the AIDS epidemic and the arrival of intravenous cocaine, Livingston cofounded the Vancouver Area Network of Drug Users (VANDU) and, in 1994, opened the city’s first unsanctioned injection site, on Powell Street.

VANDU founder Ann Livingston has been working with drug users for decades. She says it's time for the government to step up.
Amanda Siebert

As bad as things were back then, during those years when the Downtown Eastside became synonymous with poverty and addiction, Livingston maintains there is no doubt the situation is worse today.

She says that through the summer of 2016, she racked her brain for new ideas about how activists could help, and reveals that a state of depression began to weigh her down.

“Then, when Janet’s son died, it really profoundly affected everyone in the market,” Livingston continues. “It was so dramatic. In slow motion, someone runs down the street and tells her, she runs back up the street, he doesn’t recover. And then for days, he’s in the hospital, on life support as each of his organs breaks down…” She trails off.

Over the years, Livingston has guided a number of prominent activists to groundbreaking work in the Downtown Eastside. In the late 1990s, she partnered with the community’s unofficial poet laureate, Bud Osborn, to transform how the city responds to people who struggle with addictions. Through the 2000s, she helped Dean Wilson, a plaintiff in the legal battle for Vancouver’s sanctioned injection facility, Insite, achieve a victory for that facility in the Supreme Court of Canada.

Sarah Blyth is one of three founders of the Overdose Prevention Society, which has set up pop-up injection tents in the Downtown Eastside in response to a drastic increase in the number of overdose deaths.
Amanda Siebert

Since fentanyl arrived on Vancouver streets, Livingston is often found with Sarah Blyth, a former park board commissioner who’s taken a lead role in the Downtown Eastside’s grassroots response to the overdose epidemic.

“When Janet’s son died, it was a turning point,” Blyth tells the Straight at the market. “A lot of us went to the memorial and we were really touched by one of our workers at the market losing her son.

“It actually made the workers and everybody come together and say, ‘We need to do something about this,’”she recounts. “We cannot sit around and have this happen on our watch. We can do something about this and we don’t have to wait for red tape or the government and bureaucracy. We’re just going to do it. We knew that no one could stop us, because we were doing the right thing.”

On the afternoon of September 21, Blyth, Livingston, and a third Downtown Eastside activist who also works at the market, Chris Ewart, pitched a tent facing into an alley that runs just south of East Hastings Street. Inside, they set up a semi-circle of tables and chairs. On the right-hand side, they placed a jug from which people can take water to cook their drugs, clean needles, and, crucially, a supply of naloxone, the so-called overdose antidote that’s used to reverse the effects of opioids like heroin and fentanyl.

From 2000 to 2010, there was an average of 207 overdose deaths per year in B.C. In 2016, it's projected there will be more than 740.
Travis Lupick / B.C. Coroners Service

“People were overdosing in the back alley and they would call to us for help,” Blyth says. “So here we witness them and talk to them about different things and just create an atmosphere that is safe and clean that is not the alley and not their houses, where they would risk using alone. We’re saying it’s better to come and hang out with us here.”

Working outside the system

Through October and November, overdoses occurred at the tent and throughout the Downtown Eastside with increasing frequency. In response, the group pitched a second tent in an alley one block east of the first one, around the corner from the intersection of Main Street and East Hastings.

“We went from seeing one overdose a day to seeing several overdoses a day to seeing seven overdoses in one day,” Blyth says. “Back to back to back. Just like absolute chaos.”

Two-and-a-half months after the first tent was pitched, Blyth estimates her teams have used naloxone to reverse more than 200 overdoses. She notes they stopped counting several weeks ago, and that overdoses have continued to occur every day since then. Despite more than 100 people a day visiting the tents to inject drugs, nobody has died at either location.

Livingston describes it as a miracle.

“Two weeks ago, it was an overdose a day or every second day back here,” she says. “Then suddenly it was three every day. It’s doubled. You think, ‘It’s so high, it’s not going to get worse’. Well, it did. Next, it tripled.”

Sue Ouelette volunteers at one of the Downtown Eastside's unsanctioned injection sites. She says she was prompted to do so after a friend who lives in her building died of a fentanyl overdose.
Amanda Siebert

That was November 25. Four days later, the B.C. Coroners Service confirmed that a synthetic opioid called carfentanil had been detected near the body of a man who had died in East Vancouver two weeks earlier. A news release warned the drug was significantly more dangerous than fentanyl, describing it as “the most toxic opioid used commercially”.

On December 6, in response to an inquiry made by the Straight, the B.C. Coroners Service acknowledged that the city’s morgues were often full, forcing health authorities to store bodies at funeral homes.

And yet Blyth’s tents continue to operate outside the law, without government funding or support of any kind.

Over the course of more than a dozen visits a reporter makes to the tents, it becomes apparent that everybody who works there has a story like the one Blyth and Livingston tell about Tyler. A moment in time when they realized they could no longer do nothing.

Lee Tran is a volunteer at one of the Overdose Prevention Society's pop-up injection tents. As a former addict, he says he identifies with what people there are going through.
Amanda Siebert

At the first of the two tents, the volunteer who seems to spend more time there than any other is Lee Tran. At the end of a 10-hour shift on November 23, a Wednesday when welfare cheques are issued, he sheds some light on what drives the group staffing the tents.

“Previously in my life, once, I was a drug addict,” he says. “So I feel what these guys are going through. I know what they need. And I heard about this work, so I felt like this was something I wanted to do.”

De facto paramedics

Across the street, down one block, and up eight flights of stairs, Jay Slaunwhite sits in the cramped room he lives in on the top floor of the Balmoral Hotel.

“Narcan here,” reads a sign on the door. “Knock if someone is Anytime!”

Interviewed there, Slaunwhite recounts how he came to function as the run-down hotel’s de facto paramedic.

“The first time, someone actually asked me to inject them,” he says. “They knocked on the door, and I did. She only did half of what she had. But still she went under. So she was in my bed, not breathing. So CPR and naloxone, screaming for someone to call an ambulance. And they came, and that was that.”

Residents of the Downtown Eastside's dilapidated hotels have taken to posting notices on their doors letting other tenants know they stock naloxone and are available to help if anybody encounters a drug overdose.
Travis Lupick

It was after that experience that he put the sign up on his door. Since then, Slaunwhite says, he’s used naloxone on another six people to save their lives. But more than six people have come running for help.

He says that several times, someone whose friend had stopped breathing knocked on his door when he was all out of naloxone.

“I don’t have a lot,” Slaunwhite explains. “And more people have come when I didn’t have it than came when I did have it.”

Asked what happened to those people, he replies quietly: “I don’t know.”

Jay Slaunwhite is a resident of the Balmoral Hotel in Vancouver's Downtown Eastside. He's used naloxone to reverse overdoses for at least six people living in the run-down building.
Amanda Siebert

Drug users as first responders

Slaunwhite has never been in contact with anybody representing government or even one of the Downtown Eastside’s many nonprofits. He’s simply a former drug user who thought it made sense to let people know he could help.

Two blocks east of the Balmoral, in an alley behind VANDU’s headquarters, a long-time member, Hugh Lampkin, emphasizes the extent to which past and present addicts—some of whom also struggle with mental-health issues—have come to play a lead role in the community’s response to the fentanyl crisis.

He recalls an event held on November 15 in which VANDU partnered with Vancouver Coastal Health and the City of Vancouver to educate drug users on overdose response.

“I believe we trained about 240 people that day,” Lampkin says.

Hugh Lampkin, a longtime member of the Vancouver Area Network of Drug Users (VANDU), helps oversee teams that make foot patrols through Downtown Eastside alleys.
Amanda Siebert

Since mid-November, VANDU has also dispatched foot patrols carrying naloxone through Downtown Eastside alleys. Lampkin estimates that since then, these teams, working 12 hours a day, have reversed more than 20 overdoses.

Lampkin notes that it’s a “train the trainers” program, where volunteers instruct the people they meet in the alleys on how to use naloxone and respond when somebody overdoses.

Where is the government?

Five years after this epidemic became observable in statistics, the B.C. government has yet to launch any sizable intervention. According to documents obtained through a freedom-of-information request, the provincial government has only allocated $5.77 million to address the fentanyl crisis since a public-health emergency was declared in April. The Ministry of Health has disputed that number, noting another $5 million was pledged in November, and puts the real amount much higher. But the $5.77-million figure was supplied by the government itself.

In a telephone interview with the Straight, Vancouver Coastal Health (VCH)’s regional director of prevention, Miranda Compton, outlines where the regional authority has beefed up programs since the onset of the crisis.

She mentions the VANDU foot patrols that Lampkin spoke of, and says VCH funds a similar program in a partnership with the Portland Hotel Society that sends bike patrols equipped with naloxone around the Downtown Eastside.

A volunteer at one of the Downtown Eastside's unsanctioned supervised-injection tents was found unresponsive but brought back to life by a colleague who injected him with naloxone.
Amanda Siebert

Just as Lampkin notes how much of the community’s response relies on current and former drug users—“peers”, in the bureaucratic language of government—Compton emphasizes that partnering with such individuals is integral to VCH’s strategy for the Downtown Eastside.

“Peers know what works,” she explains. Taking the VANDU partnership as an example, Compton says: “They were full of ideas, they know the community, they know what will work, they know what won’t work, and they know how to do it.”

But, with obvious frustration in her voice, Compton concedes that VCH has not been able to implement every program it wants to.

“Until we can get more sanctioned supervised-injection sites through on our exemption applications, we have to get as creative as we possibly can,” she adds. (Update: on December 8, after this story was filed, the province announced it is immediately opening two new “overdose prevention sites” in the Downtown Eastside.)

Compton’s frustration is in reference to Bill C-2, the Respect for Communities Act. That legislation, written by the former Conservative federal government, has been widely criticized for making it extremely difficult for cities to open facilities like Vancouver’s Insite.

Mayor Gregor Robertson and B.C. health minister Terry Lake have repeatedly called on Ottawa to repeal that legislation left over from the Harper era.

Health Minister Jane Philpott and her B.C. counterpart, Terry Lake, met first responders in the Downtown Eastside to discuss the ongoing epedemic of overdose deaths.
Travis Lupick

Federal Health Minister Jane Philpott responded to those calls when she was in Vancouver on November 10.

“I’ve made it clear to my officials that I did not want there to be any unnecessary barriers to supervised-consumption sites in communities who ask for them,” Philpott said at a press conference at a fire hall in the Downtown Eastside. “We had looked at the possibility of doing so within the current legislation, which was put in by the previous government. It is becoming increasingly apparent that it will require changes to that legislation. And we look forward to announcing very soon what those exact changes will be.”

But one month later, Bill C-2 remains in place and no new injection sites have opened anywhere in Canada.

Nonprofit staff stretched thin

Until Bill C-2 is repealed, Insite will continue to operate at capacity (as it has for many years) and people will go on using intravenous drugs in places where they lack that facility’s mindful care provided by nurses.

Hotels like the Balmoral are privately owned. Many other low-income buildings in the Downtown Eastside are run by the province with support services contracted to nonprofits such as the Portland Hotel Society.

One of those buildings is the Stanley Hotel and the adjoining New Fountain shelter, on East Cordova Street near Abbott.

In November B.C. Emergency Health Services received funding from the provincial government to deploy additional resources to the Downtown Eastside.
Travis Lupick

Interviewed there, Andy Bond, the Portland Hotel Society’s senior director of housing, and Duncan Higgon, its shelter programs manager, speak openly about how staff are stretched to a breaking point.

“Just in the last two days—in fact, in the last 36 hours—we have seen eight overdose interventions,” Higgon says. “We are delivering multiple, multiple doses of Narcan, having to use oxygen to engage, and for periods of time that are really difficult.”

Bond says the situation is the same in most of the 16 hotels that PHS is contracted to operate throughout the Downtown Eastside.

“Within our housing [sites], to give an example of just how bad the problem is, we have intervened in over 1,000 overdoses in the last 12 months, just within PHS units of housing,” he says. “That is an astronomically, alarmingly high number of overdose interventions. And that is just in housing. That does not include Insite.

“Everyone is overwhelmed,” he adds. “And it doesn’t seem to be getting better. It’s getting worse as we go along.”

As managers with the Portland Hotel Society, Andy Bond and Duncan Higgon have intervened in dozens of overdoses over the course of their careers.
Amanda Siebert

Saving money for headstones

Back at the market at 62 East Hastings, Janet Charlie recalls the last time her son Tyler spoke to her.

“The last time I’d seen him straight was on Mother’s Day [May 8],” she says. “Mother’s Day, he popped in where I was working at the street market. Him and his brother dropped off some chocolates for me on Mother’s Day. That was the last time I’d seen him normal. Then he was back to drinking and selling whatever he was selling.”

While Tyler’s death inspired so many of Charlie’s friends to organize a community response, she admits she hasn’t been able to bring herself to do the one-hour training session on how to use a naloxone kit.

“I don’t think I can yet,” she explains. “I’m not ready for it.” Charlie notes that it was only a year ago she lost her other son to alcohol poisoning.

Instead, she works at the market’s concession stand and keeps the volunteers at Blyth’s unsanctioned injection tents fed with hot dogs she sells for $1.

“Losing two sons in two years is hard,” Charlie says. “I’m saving what I make, when I make money here. I’m saving up for headstones for both my sons. And I’m paying each month out of my welfare cheque. Trying to pay for headstones for both of them.”