Dominique de Waard and Brianne Robinson are searching parking lots, grassy patches, and back alleys in north-end Halifax for used needles and other drug-use tools.

The women, both 25, aren't drug users — in fact, they don't think they've ever met one before — but they know where to look for their traces. This needle hunt is part of their second-year medical school training at Dalhousie University, designed to take them out of the lecture hall and onto the streets.

Two ex-drug users, called peer navigators, are guiding the students. It's part of a new outreach program from Mainline, Halifax's needle exchange.

One of many drug needles picked up by the Mainline peer navigator team. (Mark Crosby/CBC)

The students gain knowledge about the health needs of a community in a way they can't from text books. "Every time we've come out here, it's been an eye-opening experience," says de Waard.

A piece of rubber may look like regular trash, but the students now identify it as part of a crack pipe.

On a neighbourhood cleanup last Thursday, the future doctors were following Chris Clayton and Wilson Eshouzadeh. Both are peer navigators at Mainline. Clayton has been clean for years and Eshouzadeh has been recovering from his opiate addiction for about a year. Both men have served prison time, and spent many years abusing drugs — and survived.

Wilson Eshouzadeh has a knack for spotting drug paraphernalia like this stem of a crack pipe. His face is scarred from being 'shanked' in prison, a legacy of his years of drug use. (Mark Crosby/CBC)

Moments into this strange scavenger hunt, de Waard is the first to spot a dirty needle. It's underfoot by a well-used path beside a pit where a building was torn down a few years ago.

Eshouzadeh scurries over, bends down, and with gloved hands picks up the needle with pliers. It could be infected with HIV or Hep C, so he drops it into a hazardous materials container.

'Hawkeye' gives back

"I love what I do," says Eshouzadeh, 41. "I'm trying to help out here, give back."

The students call him "Hawkeye" for his knack at spotting signs of drug use. "He's always willing to explain it to you," de Waard says.

Eshouzadeh says the respect from the students gives him a "mind-blowing" boost. "What? You learned something from me? It should be the other way around, but it's true."

This daily neighbourhood cleanup continues onto the grounds of a former school now covered in graffiti. The two wide buildings provide plenty of cover for illegal activity. The crack pipes, needles, condoms, and other unsafe garbage scattered about are evidence this is one of several neighbourhood "hotspots" for drug abuse.

Neighbourhood children still run around here.

Chris Clayton points to drug paraphernalia on the steps at the former St. Patrick's-Alexandra School. He was an elementary student here. (Mark Crosby/CBC)

40,000 used needles collected in one month

Chris Clayton calls the littered streetscape "self-destruction." "We're seeing disease, we're seeing people falling." He says each needle found and removed reduces the risk to the community.

Mainline gave out 57,909 needles across HRM last month alone. A total of 39,810 dirty needles were returned to disposal sites, but that left about 18,000 unaccounted for.

The director of Mainline, Diane Bailey, believes more needles were actually safely disposed of, with people returning them to hospitals or pharmacies or burning them.

Mainline's peer navigator program started last fall and has already doubled to 16 peer navigators. The peer navigators also meet with drug users to exchange used supplies for clean ones.

Active drug users can participate as peer navigators, but they're not allowed to use substances while on the shift. Mainline has received $200,000 from the federal government for the program and the group is aiming to have 30 peer navigators by 2020.

There's no shortage of discarded drug supplies and condoms among the remnants of an abandoned squat. (Elizabeth Chiu/CBC)

Calls for safe injection sites

Mainline has been cleaning up streets since 2005, but the work is a stop gap.

Clayton says Halifax needs a safe injection site where people can get clean supplies and shoot up in a spot where medical help is available. "There would be less need for us to be out here picking up dirty needles and dirty stem kits," says Clayton.

The students say Halifax needs one for the health of drug users. Also known as supervised consumption sites, they're found in western and central Canada, but there are none east of Montreal.

Nova Scotia's chief medical officer of health, Dr. Robert Strang, has said the province is looking at the idea, but there are no applications with Health Canada to open one in the Atlantic region.

Clayton says removing the drug garbage from the neighbourhood he's lived in his whole life is "disgusting" and it makes him "sick to my guts that we have to do it."

But he's also feeling "pride" as he watches the group make a difference.

Outside a highrise apartment building, Eshouzadeh finds a used needle without a cap, so the risk is increased. Many young families, including Syrian refugees, live here. (Mark Crosby/CBC)

Eshouzadeh is weaning himself off methadone used to treat his addiction, and vows to never abuse opioids again. Teaming up with the students has reminded him of how far he's come. "At least these two students can say, 'Yes, I seen stuff, I talked to the people that use the stuff.' They can say, 'I kind of know how they feel.'"

'There's a person behind the addiction'

Eshouzadeh hopes the partnership leads the future doctors to consider accepting people with addictions as patients. "I was given a chance. I took it, and I ran with it, and it helped me," he says.

The medical students with peer navigator coordinator, Chris Clayton. (Elizabeth Chiu/CBC)

The students are grateful.

Brianne Robinson, from Kitchener-Waterloo, Ont., says doctors can forget there's a person behind the addiction. "They're much more similar to us than we really think sometimes and it can be easy to judge and not be as supportive as we should be."

She and de Waard, a Hubley, N.S. native, have written an article about their experience and hope Doctors Nova Scotia will publish it.

"We'll never forget this experience," says de Waard. "We might forget some of our material in class but we'll never forget Chris, we'll never forget Wilson."