In Canada and the United States, thousands of people have become addicted to fentanyl, a synthetic opiate up to 50 times stronger than heroin. Last year, more than 20,000 people fatally overdosed on the drug. For the Observers Direct TV show, our journalist Derek Thomson travelled to Vancouver to meet users of the drug as well as those who are trying to help them. Watch the report below, or read on for Derek's notes from the road.

“Cheap and Deadly: Inside Canada’s Opioids Crisis” was filmed by Marie Schuster.
 

"Fentanyl is the perfect drug for a dealer"

In the Downtown Eastside, you know when there’s a new shipment of drugs on the streets – you hear the sirens. The neighbourhood, just yards away from the city’s coffee houses and boutiques, is an open market for hard drugs, including fentanyl, the hardest of them all.

Fentanyl is the perfect drug for a dealer. You can order it online from an illegal factory in China, have them send it via the mail, then package it as pills, or add a few grains to the heroin, methamphetamines or cocaine you’re selling to your customers – without telling them. They’ll love the kick it gives them, and be back for more.

 

“God knows what they are taking”

The problem is they might die. Dealers are not known for their quality control, and if there’s too much fentanyl in the drugs, a user will overdose. “It goes out on the street and God knows what people are taking,” says our Observer Sarah Blyth, a volunteer who runs an overdose prevention site. Her staff test users’ drugs so they can tell them whether there’s fentanyl in them. But the users take the drugs regardless; many shoot up without even waiting for the test results.

Older users like Roy, 60, are used to the euphoric high of heroin and its long legs – they can go up to 12 hours before using again. When he learns that what he bought is 100 percent heroin, he does a little dance and says “Yesss.” Younger users like Vinnie, 23, like the harsher kick of the synthetic drug. He shoots up what he knows is 100 percent fentanyl, carefully wipes his arm with a sterile pad, drops the needle into a safe disposal bin, then slowly leans forward and appears to lose consciousness. We know he's not overdosing because when Sarah asks if he’s OK, he replies, with a barely audible "Yep." He’ll wake up half an hour later, and get ready for his next hit. Fentanyl users need to take the drug every two hours.

 

 

“Users in the suburbs are more likely to die”

When a user overdoses, they lose consciousness, stop breathing and start to turn blue. It happens most days at Sara’s centre, the Overdose Prevention Society. Her staff calmly administer Narcan, an anti-overdose medicine, then wait to see if the patient “comes back”. They always do. In the year the centre has been operating, no one has died. It's users in the suburbs, who shoot up alone in their basement, who are more likely to die.

 

Narcan, also known as Naloxone, is an overdose-prevention medicine that is widely distributed in Vancouver's Downtown Eastside. It's an accessory of choice for the neighbourhood's users, kept close at all times so they can save their friends' lives when they go into an overdose.
 

Sarah's centre, which sees around 300 users a day, is part of an approach known as “harm reduction” – the conviction that it’s more realistic to “manage” addiction and reduce the associated risks – than to try to eradicate it. Centres like Sarah's provide sterile needles and emergency overdose care to make sure addicts don’t die. The Vancouver Police Department tolerates drug use and low-level dealing, focusing their enforcement efforts on the organised crime gangs who traffic fentanyl around the world.

Everyone we talked to in Vancouver – police, politicians, health officials, researchers, volunteers and users – agreed that harm reduction is the most realistic and humane approach to addiction. “It was working,” Staff Sergeant Bill Spearn told us, “until fentanyl showed up.” Now the number of overdose deaths in British Columbia is nearly doubling every year. Between January and August, there were 1,013 fatal overdoses in the province, compared with 982 in all of 2016.