First responders in Canada's poorest neighbourhood have been feeling pressure brought on by British Columbia's fentanyl crisis, and they're doing all they can outside the healthcare system to save lives.
In the months after BC became the first Canadian province to declare a public health emergency, the fire hall serving the Downtown Eastside has seen a record-breaking number of emergency calls.
"Our call volume has increased dramatically, and that's not just a spike—it's been a steady climb to where it is now," Rob Weeks, president of Vancouver's fire association, told VICE News. "We don't know where we're at in June yet, but I'd expect similar to months previous—May's record broke the record that was set in April."
While paramedics have their hands full, drug users like Hugh Lampkin are stepping in to respond to the opiate epidemic from the inside. A board member at the Vancouver Area Network of Drug Users, Lampkin is one of a growing number of users trained to administer the life saving opiate blocker naloxone, also known by its trade name Narcan.
In his day-to-day schedule Lampkin says he checks in on friends and residents, equipped with clean needles, fruit, several doses of naloxone and other supplies. On a Friday night, when the neighbourhood sees an uptick in overdoses, Lampkin walks a circuit around Hastings Street between Main and Oppenheimer Park to see how he can help.
VICE Canada went to the centre of the fentanyl epidemic to get a first-hand look at the effects of the drug, and how difficult it can be to get treatment for opiate addiction.
"What drives me is I've known so many people who have passed away," Lampkin told VICE News. "I would be dishonouring their memory if I was using without doing this work."
From crossed legs on the sidewalk, friends greet Lampkin. They chat about who they've seen, what service providers are busy. Further down the strip, acquaintance Raymond Hogan asks Lampkin for his help injecting. Lampkin offers his own steady hand.
More than 300 people have died from drug overdoses in BC in the first five months of 2016, and fentanyl was detected in over half of them. With inconsistent potency, the drug can take users by surprise, causing victims to stop breathing and even die in the time it takes an ambulance to arrive.
Though Vancouver's Downtown Eastside is viewed as an epicentre for addiction and poverty in the province, it's also the place with the most harm reduction infrastructure in place, and where the antidote to opiate overdose is most available. BC has now given away more than 9,000 naloxone kits—over 4,800 of them to at-risk opiate users—more than any other province.
"To be honest, with all the ODs happening in the province, we don't have that many here," said Lampkin. "Everybody wants to give the Downtown Eastside a kick in the ass, say we're just a bunch of junkies. We may be a bunch of junkies, but we're smart junkies.'
After returning for the night to the VANDU office, Lampkin remarks how quiet it's been—no fights to disperse, no overdoses. Since learning to use naloxone more than a year ago, he's used naloxone in 11 cases, and trained a few dozen others to do the same.
In those cases, when he arrived before an ambulance, Lampkin says many are grateful not to see someone in uniform first. "They'll just say: 'Thanks for saving my life. Where's my shoe?'"