LETHBRIDGE—One early summer evening in downtown Lethbridge, a scene of controlled chaos is playing out.

A man is sprawled on the ground, his face grey and expressionless as two paramedics and two nurses crouch by his side. An ambulance waits nearby.

A woman wearing a yellow T-shirt and blue rubber gloves works urgently by the man’s side. With practiced ease, she injects his thigh with a vial of the overdose-reversal drug naloxone. Beside her, a paramedic eases an orange tube into the man’s nostrils to open up his airway.

He doesn’t wake up.

It’s Wednesday. This is the first overdose of the day for workers at Lethbridge’s only supervised drug consumption site, and it has happened just outside the west doors of the nondescript, one-storey brick building in the city’s quiet downtown.

The woman in yellow is Jennifer Padalko, a harm-reduction specialist at the site. Without breaking her concentration, she injects the man with another vial, then another. The first responders attach a pulse monitor to his finger.

It beeps — signalling life, but he remains still and unmoving.

Lethbridge, located two hours south of Calgary, became the province’s third largest city this summer — overtaking Red Deer at just over 100,000 people.

Still, the community nestled in the coulees of southern Alberta has an almost sleepy feel. In its downtown core, many historic buildings remain intact, but there’s a new landmark as well: the busiest supervised drug-consumption site in North America.

The site opened in March 2018 and averages 663 visits per day, according to its executive director Stacey Bourque. That’s more daily visits than the busiest sites in Toronto — a city of more than two million, and Vancouver — where Canada’s first supervised consumption site was founded in 2003.

The numbers in Lethbridge have raised questions about why a small Alberta city is grappling with such a large drug problem, and whether the site is helping to fix what many say is the city’s decades-old issue of addiction. Consumption sites have become contentious issues in communities across the country, pitting people who say they save lives against neighbours who are tired of seeing needle debris by their homes and businesses.

Nowhere is this more apparent than Lethbridge, where a battle is brewing at city hall. The mayor is supportive, but on Monday a councillor plans to ask the province to stop funding the site until a province-wide review is completed.

But in this moment on a warm June evening, the only battle Padalko and the others are fighting is the one for this man’s life.

***

Lethbridge’s supervised consumption site is discreet compared to nearby businesses. There are no visible signs and the large steel doors at the front of the building are quiet. Giant, reflective windows don’t give a hint of what’s inside.

The west entrance is buzzing. About a dozen people hang around chatting. Most are familiar to both staff and frequent users of the facility. Some are homeless and for them, this area acts as a sanctuary — one of the few places they can simply be without feeling unwanted or being accused of loitering.

Leland Bastien, a 19-year-old from the nearby Piikani First Nation, enters the site through these doors Wednesday.

He began using drugs last February, he says to help with depression. In his young life, he’s lost many people to addiction.

“If I close my eyes, it’s just nothing,” Bastien says. “But with the drugs … it makes me feel like I’m not lonely.”

He tells the front desk he’s here to use heroin, then sets down a bright orange duffel bag filled with his belongings and settles into a hard, plastic seat in the reception area.

He waits for about 20 minutes and when his name is called, Bastien gathers his things and enters the consumption room.

Open 24 hours a day, the room has a clinical, grey feel. It’s dimly lit, aside from individual spotlights shining onto 13 injection booths, complete with a mirror and a biohazard bin to dispose of used needles. Users have to bring their own drugs and once inside the site, sharing or selling drugs is strictly prohibited. Breaking that rule could result in the loss of site privileges.

There are also two inhalation rooms where users can smoke drugs — one is for meth, the other for heroin. The size of broom closets, they hold up to four people and they’re almost always full. Lethbridge’s supervised consumption site is the only one in the country to offer inhalation services. The decision to include them was made after extensive consultations with the community on the drugs they use and how they use them, Bourque says.

A radio station plays in the background. The music is calming for users, one nurse says. Otherwise, the room is relatively quiet as people use.

Bastien grabs a sterile smoking pipe from the staff and heads into inhalation room No. 1. He quickly settles in, immediately appearing calmer and making conversation with three others. He’s inside for about 40 minutes.

Bastien, who is currently homeless and living in Lethbridge’s only shelter, says if he was home, he’d be “depressed, crying every night, picturing my life, not doing nothing ... just sitting there.”

There’s no limit to how many times users can access the site, but Bastien says he only visits when he has drugs on him, and is not an everyday user. He has never overdosed. “And I plan not to.”

“I’m still young,” he says. “I’m not tryna’ die today or tomorrow.”

***

Bourque, the executive director, says the site is here to help clients stay on the right path toward curbing their addiction. While doing this work, close bonds form between the staff and clients, making them more like a family.

“We get to see the side of these people that most don’t get to see,” she says. “We get to hear the stories that nobody else gets to hear.”

Though it’s hard to measure how many of the site’s users have recovered because they often lose touch with staff and sometimes live transient lives, Bourque says many have made great strides in overcoming addiction. Some, like Sam Mackey, have found not only recovery, but purpose.

As the site begins to fill with clients that afternoon, Mackey starts her shift. She roams around the consumption room, monitoring users and helping where she can — handing clean needles to one user, helping another find a vein.

This work is all too familiar for her. She was once on the other side, using methamphetamines and heroin. Mackey was the site’s first overdose when it opened last year.

Now 24, Mackey has been accessing social services in Lethbridge since she was 18. When plans for the site were underway, she was asked to attend consultation meetings to provide input on what drug users in the community might need from a supervised consumption site.

“I was probably at the worst of my worst when I was asked to do this,” Mackey recalls. “I was homeless; I was kicked out of my girlfriend’s house, my house ... overdosing.”

Mackey has overdosed countless times, and they’ve all been reversed with the help of her peers at the site.

The anchor tattoos on her middle fingers are a constant reminder of her tumultuous journey to recovery. They were etched at a time when she only had $160 to her name, she says, and wanted the money out of her hands. She had just been sexually assaulted and if she hadn’t spent her money on the tattoos, she says she would have spent it on drugs to numb the pain.

After the consultation process, Bourque asked Mackey if she wanted to stay and work at the site.

“I almost dropped to my knees,” Mackey says. “That’s exactly what I’ve been wanting to do — work in addictions. But I haven’t been able to sober up long enough to go to school.”

Now, Mackey has a consistent income and a place to live. She pays her bills on time, and can afford a cellphone. Her job has given her a new life, and Mackey says she is able to connect with other users without judgment, meeting them wherever they are on their path to getting better.

“I have a purpose, I have meaning.”

***

Brent Manning, another employee, tries to spread inspiration and hope through the Hip Hop for Healing program that he runs out of the site’s crafts room, which doubles as a recording studio.

The muted greyish-blue walls seem to wrap around Manning, almost resembling an Indigenous healing circle, adorned with dream catchers, smudge boxes and moccasins made by the site’s users. The room is illuminated by a large window overlooking the alley outside.

Using a laptop and some sound-mixing equipment, Manning works on a new track recorded by one of the clients. Beats are selected from a catalogue, but clients write their own lyrics.

Manning plays a piano melody and a woman raps angrily over the music, distraught over a broken heart. According to Manning, she came in with the lyrics memorized and recorded the song in 20 minutes.

“She just went through a breakup minutes earlier and wanted to get it off of her chest,” he says. Now, it’s one of more than 30 finished tracks uploaded to the site’s SoundCloud account.

“There’s so much talent here,” Manning says.

Some users freestyle, others mix traditional Indigenous music and hip hop. Some lyrics are reflective of pain and trauma, others foreshadow a future of healing, recovery and connection with one’s heritage and culture.

“‘This is the only thing I’d rather do than drugs,’” Manning recalls some saying after finishing a recording session. The music attracts all types of people, so he keeps an open-door policy, allowing anyone to record when inspiration strikes.

On this day, a man named Allen hangs out in the recording area, holding a rolled-up yellow notebook containing his thoughts about what the site means to him.

The 29-year-old Lethbridge man has been in and out of the building all afternoon.

Many people he knows have burned bridges, he says, losing friends to spiralling addictions. They are then forced to use alone, and run across drugs they may not understand. As a result, they overdose.

“We have no one to turn to,” he says. “Whereas I’m down there, you can always come to me, talk to me. I’m always there with open arms.”

Allen says he’s overdosed 59 times and considers himself lucky to be alive. He wants to quit. He’s lost many people to drug addiction, including his girlfriend and two brothers just last year. He thinks of the site as a safe haven for people who don’t want to experience pain alone.

“I was always raised up not to cry,” he says. “At least people here understand what I’m going through.”

Many of the site’s users have spent their entire lives in Lethbridge, but are from Piikani First Nation and Kainai First Nation about an hour west of the city.

Terry Provost, a member of Piikani First Nation’s council, says people from his community travel to Lethbridge for opportunities, whether it be school, work, or even housing as Lethbridge is the only nearby city with a homeless shelter.

Like many Indigenous communities across Canada, intergenerational trauma from the effects of colonization, residential schools and the Sixties Scoop run deep, and have fostered long-lasting grief and struggles with substance abuse. Provost says that for many from his community, addiction is mostly about numbing the pain.

“Nobody dies from old age anymore,” Provost says, adding that instead, many meet their end on the cold, hard ground.

“People will remember you,” he says. “But you’re eventually forgotten.”

***

Kalbert Chief Body was born and raised in Lethbridge. He was once addicted to alcohol, and had loved ones fighting the same demons. Over the years, he says he’s lost everyone close to him, including his parents and grandparents.

When the safe consumption site opened, the building — formerly a nightclub called Pulse — was divided into two sections: one for the site and one for all the services offered by Lethbridge ARCHES, a collection of social programs geared toward helping Lethbridge’s vulnerable community. Chief Body first began using ARCHES for medical services after contracting Hepatitis C in jail. By then, he’d replaced alcohol with drugs.

Chief Body, 42, walks into the consumption room Wednesday, asks for a clean needle and heads to booth 12 to inject his heroin. A visibly upset friend stands by his shoulder as he uses, venting to him quietly about a personal matter.

He says he’s lost 10 friends to drug use in the last five years, most were struggling to come to grips with life’s trauma and difficulties.

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“I can still remember them to this day,” he says.

Despite the lack of recovery options in the city, Chief Body says he’s in a better place now — Bourque has hired him to pick up needles and other drug debris and he encourages friends to use their drugs under supervision here, rather than alone outside.

At another booth, Stephanie Brown heats up a batch of carfentanil. Her friend died of an overdose three weeks earlier and as she gets ready to inject, she recalls the pain she felt the moment she found out, and how staff here took care of her.

“It’s nice to be somewhere where I fit in all the time,” Brown says.

She hasn’t lived in Lethbridge for long, having moved from B.C. to be closer to her sister. Reeling from a breakup, losing custody of her two children and some health problems, Brown says she’s struggled to cope and hasn’t seen her sister once since she arrived.

But staff at the site have become the family Brown has lost. They still love her, she says, even if she disappears from the site for weeks after “falling off the wagon,” as she puts it. When she returned, “everybody was happy to see me. It felt so good.”

Despite being homeless and having very little money, she sometimes brings treats bought at the nearby Dollar Tree store to share with staff and other visitors.

Brown hopes she can get better. “I want to be an addictions counsellor,” she says.

***

Lethbridge’s mayor says substance abuse was part of the former coal town’s fabric long before the supervised consumption site came to town.

“We’ve always had problems with poverty, we’ve always had problems with addiction,” says Chris Spearman. “We’ve been repeating this cycle for decades now.”

First, it was alcohol, he says. Now, it’s deadly opiates.

Spearman says a desperate need for resources, coupled with consistent neglect from the province over decades, has caused the city’s addiction issues to evolve.

“People come into Lethbridge for services that don’t exist,” he says, calling the city’s overcrowded homeless shelter an embarrassment and noting that Lethbridge has no supportive housing units for those battling addiction, as most recovery options require a person to be sober for a number of days. Spearman says all of this contributes to Lethbridge’s site being so busy.

While he’s supportive of the work being done there, the city remains fiercely divided over its existence.

City councillor and deputy mayor Blaine Hyggen says the site has contributed to rising crime in Lethbridge and shouldn’t distribute needles, adding that needle debris continues to be a problem throughout the community.

Hyggen says he’s not against the site, and doesn’t want to see it closed. “It is my opinion that the current facility is not run effectively or efficiently,” he says.

At Monday’s council meeting, he plans to introduce a motion with a clause asking the province to cut the site’s funding while an Alberta-wide review on drug consumption sites and their impacts on communities is being conducted.

Bourque, who calls Hyggen’s motion “clearly politically driven,” says cutting the site’s funding would effectively shut it down as it’s fully funded by the province.

“If it was rooted in addressing this crisis or in finding ways to resolve the social issues that are plaguing our community, then we would be looking at the evidence,” she says, referring to data such as number of referrals and needle distribution rates.

Hyggen is not the only one opposed. Douglas Hamilton says his business, Hamilton Carpet and Flooring, has suffered because of the site.

He frequently posted photos of debris from drug use found around the site on his personal Facebook page and has also publicly posted photos of the site’s users loitering in the area. In June, he began livestreaming the west doors 24 hours a day, seven days a week on YouTube, using a security camera he installed on his neighbouring property.

Hamilton released a statement on July 4, saying the site’s location has affected his business, and his livestream and social media posts are meant to ensure “this issue remains front and centre.”

“I should not be prevented from making known, and visible, that which is killing my business and threatening the viability of our downtown,” Hamilton’s statement reads. He says he is not unsympathetic toward people struggling with addiction, but is concerned about how symptoms of the drug crisis, including “crime, loitering, prostitution and drug transactions” are hurting businesses like his.

Bourque says the site hosts monthly “friendly neighbourhood meetings” with nearby businesses, none of which she says Hamilton has attended. Hamilton did not respond to questions about his lack of participation in those meetings.

“We’re not blind to the issues,” Bourque says in response to the criticism. “But we also recognize the human component to this issue that far supersedes some of the financial or nuisance issues that people are experiencing.”

Wednesday afternoon, Bourque sits at her desk, piled high with papers. She’s taken her lunch to-go, picking at some curly fries from Arby’s. With barely any time to eat as the demands of the day mount, her sandwich remains untouched.

She spent part of her hectic morning reading a letter in the Lethbridge Herald that blames the site for “the ongoing destruction of Lethbridge.” It references a “massive increase” in crime as a direct result of the site’s opening, and goes on to say the site allows the ingestion of “poison” into people’s bodies and is “perpetuating death by poisoning.”

This is just a glimpse of what Bourque says she deals with regularly. There are countless critical social media posts and she says it’s not uncommon for people to approach her at restaurants or the grocery store to express their disdain. In a small city like Lethbridge, everyone knows who you are, says the woman who was born and raised here.

“I am the face of this organization. I brought SCS to this community. I brought the opioid crisis. I brought homelessness,” Bourque says. “It’s very personal for people with me.”

Despite this, she is still devoted to the site, having spent most of her adult life working in social services. When she took the helm at Lethbridge ARCHES five years ago, it had two staff members and two programs. Bourque has grown the organization exponentially, adding 170 staff members and 15 different programs for the city’s vulnerable population.

Bourque says her job became increasingly difficult when ARCHES helped bring in the controversial supervised consumption site. She says she always knew Lethbridge needed the site, but never imagined it would be this busy.

“The last couple of years have been trying, for sure,” she says, but to her and the staff, the site is integral to harm reduction, which experts have identified as a key piece of the overall approach to combating the opioid crisis.

The site’s main goal, Bourque says, is to help drug users stay alive long enough to start thinking about recovery, and guide them toward that path. She says that for some in the community, the site is an unwanted reminder of the ugly, complex social issues facing cities. Even small ones like Lethbridge.

“At the end of the day, people here are desperately holding on to this small town idea,” Bourque says, adding they ask: “ ‘What happened to my Lethbridge?’ They’re really grieving the loss of their community.”

Lethbridge, she says, is not a town, it’s a city. “And we have city issues.”

***

By Wednesday evening, most of the booths are full, as are the inhalation rooms. The time limit in the rooms is 45 minutes, and a few have exceeded it. The site’s security officers escort them out, and they oblige, offering no resistance.

The guards, contracted from Paladin Security, play a significant role at the site, conducting hourly tours of the premises and nearby businesses and ensuring order is maintained and rules are followed. Most of the site’s users understand that accessing the facility is a privilege and breaking the rules could get them put on a temporary break for misconduct or banned for a year.

At one booth, a woman checks her reflection in the mirror before using. She holds a shirt up to her body, turning to her friend to ask if it looks good. Nearby, a frail, elderly woman in a wheelchair has passed out after using.

Joel Kramer, the paramedic on duty, says this happens often as many users are homeless, tired and haven’t slept in days.

“When they go down, they go down hard,” Kramer says, getting up to check the woman’s pulse and nudge her into consciousness. Sometimes, a gentle tap on the shoulder isn’t enough. Kramer says he’s reversed around 25 overdoses since he started in February.

“When you lift someone up and they’re still grey … I’m still human, so it’s strange to see.”

For the last half-hour of his shift, he moves to monitor the observation room. Here, there are no windows, but the walls are covered with artwork and there are board games and cards to pass the time. Brown, who has just finished her fourth visit of the day, stops by to play a quick game of crib with Kramer. They share jokes, banter and a KitKat bar.

New faces begin to emerge for the overnight shift and harm reduction specialist Sonya Taekema takes over in the observation room. It’s her favourite place to work because it offers the best chance to meaningfully interact with users and connect them with recovery services. She brings a guitar from home as an ice breaker.

“It’s through connections that people feel that they matter, that they feel worthy,” Taekema says.

“If this place wasn’t here and they were just hiding out under the bridge or in the back alley ... would those ideas (of recovery) even come to mind?”

“Everybody has a story,” Taekema says. “They’ve all got stories, they’ve all got hopes, they’ve all got dreams.”

The goal for many, she says, is to exit their current life of addiction and build a better future.

“You’re not going to be able to do that if you’re dead.”

***

Like clockwork, Padalko continues to administer naloxone to the man who has overdosed, while a nurse gives him oxygen from a tank linked to a mask covering his face. Both concentrate intensely on bringing him back to life.

Earlier, the man had been sitting by the west entrance, chatting with users as they came and went. Half an hour later, he was sprawled on the ground a few metres away, surrounded by paramedics. He did not use his drugs inside the site.

One dose of naloxone is sometimes enough to revive an overdose. Another shot must be given after two minutes if the person remains unconscious. Padalko gives this man five shots before he jolts awake.

He is disoriented and in pain when he gets up and angrily dismisses the paramedics.

Padalko is visibly shaken after reviving the man, but it wasn’t her first time. Staff sometimes respond to as many as a dozen drug overdoses a day and nobody has ever died. For her, it’s very clinical once the adrenalin kicks in.

“You kind of just respond, you don’t even think about it,” Padalko says. “You’re just making sure they’re staying alive.”

As the sun sets on the site, the man limps away, escorted by a friend who stood by silently, watching his friend battle death.

Nadine Yousif is a reporter/photographer for Star Edmonton. Follow her on twitter: @nadineyousif_

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