Jeff Martens and his friend Albert Paul amble into the new safe consumption site in the southern Alberta city of Lethbridge early on a Monday afternoon.
It is the sixth day the facility has been open and already dozens of drug users have come to smoke their drug of choice in the first government-sanctioned safe inhalation rooms in Canada.
Martens has been feeding a drug addiction for three decades. Paul describes himself as a recreational user. He uses two or three times a week, he says.
They are both here to smoke methamphetamines (meth) in one of the two safe inhalation rooms in Lethbridge, a couple of hours south of Calgary.
Martens says it's a far cry from the places he's used before.
"It's like 'OK, where can we go?' And it's like a bathroom stall here or over there, somewhere out of the wind and yes, out of the public's eye."
Paul adds there is a humiliation that comes along with using in public places.
"They stereotype you badly," he says. "We get people driving by and calling us junkies. I'm not a junkie.
"Everybody that has caught us using in a bathroom staff or around the corner, they think we're lesser than them and we're not really lesser. I felt walking through the door [at the safe consumption site] gave me dignity again."
Building trust
Here, Martens and Paul are greeted by drug counsellors and a nurse.
It's key to building a trusting relationship that the users are not judged for their habit or addiction, counsellors say.
After answering questions about their drug use and signing an undertaking to follow the rules of the facility, the pair are escorted to a glass-enclosed room with a table and three chairs.
It's not fancy but it's a long way from a gas station bathroom stall or beneath a local bridge, two of the most popular places to use in this city of 98,000.
The constant hum of an industrial exhaust system provides white noise as Martens and Pauls crush their meth with glass pipes known as a bubble.
Outside the room, a nurse and drug counsellor stand by in case of an emergency.
Stacey Bourque, the executive director of ARCHES, an outreach and support agency that runs the new facility, is taking CBC News on an exclusive tour
There are the now-familiar booths that drug users in many Canadian cities use at safe consumption sites to inject, snort drugs or take pills.
Emergency system
Then she points to a giant red button on the wall, no more than two metres from the safe inhalation rooms, that she says make this site unique.
"In the case of a medical emergency, if the staff do have to enter, they would just trigger the emergency system."
The heavy duty exhaust system is more than just a fan.
It allows staff to enter quickly and safely if a user overdoses or goes into medical distress, Bourque says.
"It takes a few seconds for the damper to close, but once it closes, it turns that air over in a about 10 seconds."
Stacey Bourque, executive director of outreach agency ARCHES, demonstrates the emergency exhaust system in the first Health Canada-approved safe inhalation site. (Dave Rae/CBC)
Nurses can run in with just a mask without fear of exposure.
Bourque was one of the driving forces behind the Health Canada application for approval to open the first government-sanctioned safe consumption-inhalation site in the country.
Restocking naloxone
A small city like Lethbridge may not be top of mind when it comes to building an innovative safe consumption site.
But not every small city has suffered the ravages of drug abuse and overdoses that Lethbridge has seen over the past few years. Statistics show that in the first six months of last year, about 60 per cent of fentanyl-related overdose deaths in Alberta Health's south zone occurred in Lethbridge.
Paramedic Kyle Vreekin holds a dose of naloxone, the drug used to reverse opioid overdose. Vreekin says it's taking more naloxone to bring back patients who have overdosed on increasingly potent opioids. (Allison Dempster/CBC)
They feel the brunt of it at the firehall in the downtown area.
There was one week last month in which there were so many overdoses in Lethbridge that the fire department ran out of naloxone, the drug that reverses opioid overdose, and had to restock the kits at the hospital until a new order came in.
That was the week paramedic Kyle Vreeken attended five overdose calls in one night.
'You're giving a lot more ... for them to start breathing on their own' - Kyle Vreeken
Some of the drugs making the rounds are so potent first responders are having to give 20 times the original recommended dose, Vreeken says, "So you're giving a lot more just to get the same result for them to start breathing on their own."
Vreeken's boss, Deputy Chief Dana Terry, says the crisis is wearing on the paramedics and first responders who are attending more and more overdoses.
"If we look at 2013, we administered naloxone about 17 times that year. In 2017, about 190 times is about what we went up to for naloxone administrations."
Vreeken shows his emergency medical kit. First responders have been overwhelmed with a growing opioid crisis in the city. (Allison Dempster/CBC News )
No one knows that more than drug users themselves.
Martens says he thought had seen it all — that is until this crisis started a few years ago.
"I have a friend who lost 13 people last year," he says, shaking his head before recalling watching an acquaintance turn purple while overdosing,
"The whole opioid crisis in the '80s, this is 10 times worse."
Martens reconsiders that thought. "Well, technically 5,000 times worse because carfentanil is 5,000 times more powerful than heroin."
Martens and Paul know there is almost certainly fentanyl or carfentanil cut into the meth they smoke.
Making the rounds
They believe it's small enough to avoid overdose.
Other addicts feel no such comfort. They are terrified of the drugs they are so addicted to.
Sherise Schlaht leads an outreach team that makes the rounds behind the homeless shelter, behind a local gas station and beneath a bridge where addicts tend to gather.
As she hands one user clean needles and supplies, Schlaht asks her if she knows the site is open. The user says she doesn't.
Outreach worker Sherise Schlaht picks up used needles around the train tracks in Lethbridge. (Allison Dempster/CBC)
There is drug debris, including used needles in places that have been recently cleaned up, a telltale sign that despite frigid temperatures, despite knowing the risks, addicts are still using outside.
"I think at that point, they're so dope sick and they're so psychologically dependent on the drug that it doesn't even matter," Schlaht says. They will risk taking the drug every single time, she says.
Schlaht says in these early days of the new site, it's essential for addicts to know and believe going to use at the safe consumption site won't land them in jail.
Police support
There is irony in that fear because the Lethbridge Police Service is one of 16 agencies involved in supporting the effort.
Insp. Jason Dobirstein says the crisis has grown out of control.
"We can't possibly have predicted how big this was going to get and I don't know how big it is going to get."
It is now well beyond a law and order problem, he says. "There's people suffering here that have got addiction issues that need more help than the police can provide in terms of arresting them."
There have been critics of the site who suggest it is simply enabling addicts.
'We have to try something.' - Chris Spearman,
Lethbridge Mayor Chris Spearman says his city is "overwhelmed" by the crisis.
"We have to try something," he told CBC News.
"I can't sit around and ignore the fact that we've got these issues of visible drug use and drug debris."
Every user CBC News spoke to said the site won't change what or how much they use. They will take drugs whether it's here or not.
Bourque dismisses the argument the site could enable drug use.
"The only thing we're enabling here is breathing. You know, you can't enable people to do something they're already doing. It's impossible."
She points to the observation room where everyone who has used drugs must sit.
It gives drug counsellors a chance to monitor their health and also offer the addict whatever help they're willing to take.
"We support people where they're at until they're ready to make changes," Bourque says. "At least if we keep people alive, they get to make that decision on another day. And that is why we're here."
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