Hugh Lampkin is a first-responder, but not in the traditional "I went to school to be a paramedic" sense. He's a regular guy with a history of opiate use, who carries a kit with several doses of naloxone, a life-saving opiate blocker also known by the trade name Narcan.
On Friday evenings, Lampkin says he often "trips around" his Downtown Eastside neighborhood, stepping in with the naloxone and a 911 call if he sees someone going under. And on Monday, he hosted his second ever naloxone workshop at the Vancouver Area Network of Drug Users office, where he trained other drug users to spot signs of overdose and act as first responders until paramedics arrive.
Rob Lee Powell was one of a dozen people who attended the session, where participants learned CPR basics, practiced injecting naloxone into oranges, and each took home a kit of their own. Powell says he doesn't use opiates like heroin, but as a crack user, he's worried about fentanyl showing up in his drugs.
"That's a problem," he told VICE. "In this neighborhood, we all have to be first responders."
In British Columbia, this is what harm reduction looks like. Training at-risk users to save lives is one part of the province's effort to tackle the cheap and potent drug fentanyl, which has fueled a 75 percent leap in drug overdose deaths in the first five months of 2016. That's on top of a slower rise in fentanyl-related overdoses over the last several years.
Officials have had a tough time reducing harm caused by fentanyl because it's often cut with other drugs, and the super potency takes users by surprise. Dealers can import large shipments of fentanyl for way less money and trouble than pure heroin or morphine. The synthetic opioid that's 30 to 50 times more powerful than heroin is now increasingly found in off-market pills sold as OxyContin, or cut with other street drugs like meth and crack.
Of the 308 overdose deaths that have been recorded across the province this year so far, fentanyl was detected in 56 percent of them—up from 31 percent in 2015 and 25 percent in 2014.
"That's one very disconcerting thing—the proportion where fentanyl is detected," Dr. Jane Buxton, harm reduction lead at the BC Centre for Disease Control, told VICE. "It certainly looks like it's going far higher in 2016 than it was in 2015."
Though other provinces have seen a similar rise in fentanyl-related overdoses over the last 18 months, British Columbia became the first province to declare a public health state of emergency back in April. At the time, the provincial health officer, Dr. Perry Kendall, said the death toll could grow to 800 by the end of the year if left unchecked.
While Alberta and Ontario have been slower to distribute naloxone without a prescription, BC harm reduction programs have now handed out 9,723 kits. Without it, overdose victims can lose consciousness and stop breathing, and even die in the amount of time it takes for an ambulance to arrive. "We know naloxone is a very effective intervention," Dr. Buxton told VICE.
Another part of the province's strategy has included getting the antidote into the hands of firefighters, which began in Surrey and Vancouver in late January, and has been taken up by some other cities.
According to the BC coroner's latest numbers, drug-overdose deaths peaked in January at 77, and stabilized during the month of May at 42—a level consistent with previous years.
But first responders on the front lines say that doesn't mean the crisis is slowing down. Firefighters serving many Vancouver neighborhoods say they've seen "a dramatic steady rise" in emergency calls over the first half of 2016.
April had already set a new record of 866 emergency calls for Fire Hall 2 in Vancouver, the station that serves the Downtown Eastside. In May, that number rose to 943.
"The call volume makes it challenging to do other things," Rob Weeks, president of the city's fire association, told VICE. "It really affects our depth of response."
Weeks added other unexpected areas of the city, including Yaletown, are also experiencing an unprecedented number of calls. This month firefighters moved the borders of some response areas to deal with the flood of emergencies.
For Dr. Buxton, some of the biggest challenges are in those neighborhoods and suburbs not typically associated with drug use, where fentanyl makes its way into party drugs. Besides a "Know Your Source" ad campaign, there's no easy way to reach one-time "experimental" users who think they're taking something else. "People are afraid, they don't want to get in trouble," Buxton said. "We have to reinforce that's not going to happen if somebody overdoses."
Buxton's also waiting on real-time overdose data, which the province has promised but hasn't yet rolled out.
But for those like Lampkin in the Downtown Eastside, where overdoses tend to flare up following BC's social assistance cycle, there will be many summer nights spent bringing people back from the brink of death.
"This is my community and I know so many people here," Lampkin told VICE. "I can't stand around and watch more of my friends die like that."
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