Open this photo in gallery Trey Helten, frontline worker for the Overdose Prevention Society, opens the door for a user at the facility on East Hastings Street in Vancouver's Downtown Eastside. Rafal Gerszak/The Globe and Mail

It’s just another day on Vancouver’s Downtown Eastside.

A young man sits on the wet sidewalk, his legs spread wide, sucking the smoke from a burning fragment of dope with a plastic tube. A man with lank black hair is slumped against a wall, bent over double like a limp marionette, his dangling arm twitching at his side. A woman in skinny jeans, leaning on a storefront, pulls the plunger of a syringe carefully up and down, getting ready to give herself a hit. An open package of dainty cookies lies by her side.

Canada’s opioids crisis has swept like a wildfire from the West Coast to the cities and towns of the East. But in the place where the match first dropped, the fire is still burning hard.

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Scores are being killed by the poison in their drugs – their respiration slowing to a halt in an alleyway, a toilet stall or a lonely room. Eleven people died of overdoses in Vancouver in the space of just one awful week this past summer. On a single day, July 24, paramedics responded to 130 suspected-overdose calls. Of the nearly 8,000 such calls last year, about 5,000 were from the Downtown Eastside.

To get a sense for what the crisis looks like at ground zero, I spent a day there last week. This was a rough neighbourhood when I worked briefly at the local courthouse for a Vancouver newspaper in the 1970s, with alcoholics spilling out of the seedy bars, drug-dealing in the alleyways and hundreds of hard-up men living in flophouses. It is far, far worse now.

In the heart of one of the world’s most “livable” cities, just next to the boutiques and bistros of Gastown, shocking scenes of human degradation unfold every day. I don’t think I’ve seen anything like it – not in Mumbai or Manila, not in inner-city Detroit or the South Side of Chicago.

On the morning that I arrived, throngs of weathered, wounded people were out on the rain-soaked sidewalks of East Hastings Street, the neighbourhood’s broad central avenue. Some sold pathetic trinkets on the sidewalk. Others huddled in doorways to stay dry. Still others pushed overflowing carts full of belongings. Many were taking their drugs openly on the street.

Open this photo in gallery Mr. Helten was a former addict before helping to run the Overdose Prevention Society. Rafal Gerszak/The Globe and Mail

Trey Helten helped show me around. A towering 35-year-old wearing a biker jacket over a hoodie, he was an addict himself for seven years. He lived the last stretch on the street, homeless, scrounging for the next hit. Now he helps run the Overdose Prevention Society on Hastings.

Users come there to take their drugs under the watchful eyes of OPS staff, who hand out clean syringes and stand ready to intervene with oxygen and the emergency drug naloxone. Mr. Helten wears an oximeter on a lanyard around his neck so he can measure the pulse and oxygen level of visitors who show signs of going under.

The place opens at 8 in the morning, is full by 10 and stays busy till closing at 9. It gets 300 to 400 visitors a day and there are several others like it, including the pioneering Insite just across the street. Are you smokin’ or pokin’? – inhaling or injecting – the staff ask visitors who come to use the lighted cubicles in the society’s outdoor tent. Some do both.

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At a second set of cubicles inside, a burly French-Canadian with tattoos up and down his thick arms asked a pal to insert the needle straight into the jugular vein in his neck for a better rush. Before he used, he tested his supply at a new device that uses infrared light to search drugs for additives. It often detects powdered caffeine, sweetener and even drywall dust, used by dealers to bulk up their product.

Open this photo in gallery Mr. Helten fills syringes with naloxone, a medication used to counter the effects of opioid overdoses. Rafal Gerszak/The Globe and Mail

The site does its best to keep people safe, but many are still succumbing to drugs laced with fentanyl, the potent synthetic opioid. Despite its risks – a few grains can be deadly – fentanyl remains a popular drug because it’s so strong. Mr. Helten says some are ecstatic when tests find it in their dose. “It’s what they’re looking for.”

He took me out into the back alley, known as a favourite place to smoke crack-cocaine. A new wall mural shows a weeping angel carrying the Christ-like body of an overdose victim. On it, people have scrawled the names and nicknames of their dead pals: Russian Bobby, Sideshow, Buster, Tito, Fatal, Yaya. Just about everyone down here has lost a friend.

Yet the band plays on. At Hastings and Main, the neighbourhood’s historic heart, a corner man called out “drugs, hard drugs.” A few steps away in “Piss Alley,” named for its notorious stench, a couple of dozen men stood in the rain among the dumpsters and litter – buying, selling, using.

Open this photo in gallery Next door to the OPS, a wall mural is dedicated to "the loved ones we have lost" to drug overdoses. Rafal Gerszak/The Globe and Mail

Open this photo in gallery Graffiti artist Smokey D, who has lost many friends and a girlfriend to the opioid crisis, has drawn several tribute walls in the neighbourhood. Rafal Gerszak/The Globe and Mail

My visit left me reeling. How can it be that, instead of improving in the four decades since I first saw it, this neighbourhood has declined so dramatically? How have so many people come to live in such desolation? How can such a place exist in a country such as Canada?

It’s easy to despair of the Downtown Eastside. It has been so wretched for so long that it is tempting to think it will never change. Before the overdose crisis came the murder of local prostitutes by pig farmer Robert Pickton and the deinstitutionalization of the mentally ill, many of whom ended up vulnerable and homeless on local streets.

Governments have spent hundreds of millions trying to “fix” the area. Vancouver’s new mayor, Kennedy Stewart, has promised to set up an emergency task force, a gesture that makes those who know the place roll their eyes. The problems here are as complex as they get. The proffered answers – more money for social housing, better education about drugs and their dangers – often seem simplistic.

And yet, giving up on the Downtown Eastside would be an awful mistake. All of the failures of this fortunate, thriving, caring country are on display on these streets: its failure to grapple with the crisis of mental health, its failure to tame the epidemic of drug overdoses, its failure to improve the condition of many Indigenous people, its failure to put a roof over the heads of its neediest citizens.

The suffering of this neighbourhood and its people should weigh on us all.