VANCOUVER—Two years ago, something terrible was happening in Vancouver: a killer was on the loose and hundreds of people were dying.

The killer stalked construction workers who had been injured years ago on the job. It killed teenage girls. And soldiers who had fought in Afghanistan. It struck on the street, when people were alone in their houses, in coffee shop bathrooms and public libraries.

Sarah Blyth was determined to slow the carnage.

“There were just so many overdose deaths and there were so many overdoses every day and it became so overwhelming that we basically just … said can we do this? Can we open up the back gate and put a tent and put a couple people there?” Blyth said.

The killer was fentanyl, a powerful synthetic opioid that has tainted nearly all illicit drugs in British Columbia and is now reaching a deadly hand across Canada. With two other long-time activists and a team of volunteers, Blyth started the country’s first overdose prevention site in the Downtown Eastside, a Vancouver neighbourhood where many residents struggle with poverty, addiction and mental health.

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Blyth, 46, knew that if she set up a tent and a table in a Downtown Eastside alley and trained volunteers to administer the overdose reversal drug naloxone, they would save lives.

There was just one problem: it was completely illegal.

“We didn’t care, Sarah didn’t care,” said Norma Vaillancourt, who lost her husband years ago to an overdose and now works at the prevention site. “We just wanted to save lives.”

Blyth has a Grade 10 education; a learning disability and attention deficit disorder meant she never really found a place in the school system. She bounced around several schools on Vancouver’s middle-class west side: University Hill, Lord Byng, Kitsilano Secondary.

“I understand how people can slip through the cracks,” she said. “I understand how people don’t fit in certain parts of the system. It happens a lot.”

Instead, Blyth gravitated to snowboarding and skateboarding. In her early 20s, she and a group of friends started an indoor skateboarding space called the Clubhouse. Then it got shut down by the fire marshal, and there was suddenly nowhere for skateboarders to go.

Blyth started an advocacy group out of a community centre and began to lobby city politicians and neighbourhood residents for more outdoor skate parks. It was a hard sell.

“A lot of people think teenagers are loud and skate parks are loud and it brings chaos,” she said.

“We had to meet with people and teach them that having young people do something besides just hang around in their basement or be bored with doing things they shouldn’t be doing, why not let them do what they want to do.

“I learned how to push something through that people didn’t necessarily understand.”

Advocating for skate parks led Blyth to decide to run as a Vancouver park board commissioner in 2008. That was also the year she started working in the Downtown Eastside at the New Fountain shelter, a low-barrier shelter that allowed homeless people to bring in their pets (including, Blyth says, one pet snake), stay together with their partner, and keep their belongings with them.

By 2016, Blyth was managing the Downtown Eastside street market, located in an empty lot on East Hastings the city had designated as a place people could legally sell second-hand goods. Blyth now lives a short distance away from the neighbourhood, on Commercial Dr., but she said the Downtown Eastside is where she feels she belongs.

“It’s a great community. You won’t find a better, more interesting community of people in Vancouver,” Blyth said. “I think not everybody understands that, but it’s very colourful and I love it.”

Vaillancourt is a worker at Vancouver's overdose prevention clinic. She says it's rewarding work because she used to be "in that same spot."

The winter of 2016 was unusually cold in Vancouver, and the cold was particularly cruel to the people who lived on the streets of the Downtown Eastside and succumbed to overdose. In early December, the province’s chief health officer, Perry Kendall, issued a grim call for action: if people weren’t outright dying of an overdose, he said, they were often ending up severely brain damaged from exposure to the cold and lack of oxygen.

St. Paul’s Hospital in downtown Vancouver was overwhelmed, sometimes with people who were overdosing over and over again. The fire chief appeared before city council to plead for more resources: firefighters were burning out from attending so many calls. Every evening the air would be filled with the sound of sirens as ambulances and fire trucks raced through the streets.

In the Downtown Eastside, Blyth and her team of volunteers were fighting the cold with space heaters in the large white tent they had set up and filled with chairs, tables and harm-reduction supplies like clean needles and naloxone. There was also an open area beside the tent where people could either inject or smoke drugs. If someone overdosed, volunteers would spring into action, injecting naloxone and calling 911.

The idea had seemed like a no-brainer to Blyth and long-time Downtown Eastside advocates Ann Livingston and Chris Ewart: everyone who worked at the market was already helping with overdose after overdose.

The alley behind the market is where so many people go to use drugs, so it made sense to set up shop right there, Blyth said. While a Health Canada-approved legal safe-injection site, Insite, is just a block away, it’s almost always full, and the strict federal requirements then in place made it almost impossible to open another legal site. (At the time, there were only two safe-injection sites in Canada, both in downtown Vancouver.) Waiting for government policy to change would have taken months.

Blyth was working long hours, but it still didn’t seem like enough.

“You’d wonder if after you left, someone would die in the alley. Were we open late enough? Or could we be open earlier?” she said. “If people died who you knew, you’d worry about that.”

Then one night in Victoria, the province’s capital, then-health minister Terry Lake woke up at 4 a.m.

“It was freezing in my hotel room and I started thinking about people who are homeless and people who are volunteering at the overdose prevention site,” Lake recalled.

“It just crystallized in my mind, here I was in discomfort and I couldn’t even imagine the people on the street dealing with substance use issues and the threat of taking a toxic drug and dying.”

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Several weeks before, Lake had visited Blyth’s tent.

“She was so open and willing to share and didn’t treat me like some government guy,” said Lake, who has since left government.

“In the face of the crisis, she had such an impact on me that I thought, this is crazy: We’ve got someone out there by herself, you’re saving people’s lives, and it’s our job to do that very thing.”

In the first week of December, Kendall and Patricia Daly, chief health officer for Vancouver Coastal Health, called a news conference. At Lake’s direction, health authorities would immediately begin to open more overdose prevention sites, modelled after the site operating behind the Downtown Eastside market.

And Blyth and her team got a Christmas present: a heated trailer donated by a local construction company.

To date, there have been no deaths at any overdose prevention site in Canada.

After the tent behind the market had been open for a few months, Blyth started to get calls from people in other cities, usually frontline workers who wanted to know how to open an overdose prevention site in Nanaimo, Edmonton or Toronto.

Her advice was always the same. Set up a table and chairs, train volunteers. And don’t ask for permission.

A familiar pattern followed: In Toronto, Mayor John Tory at first opposed a site that volunteers opened in a park, but he softened his stance after visiting it. In Nanaimo, volunteers set up a site in a city hall parking spot, prompting staff to close the city hall building. The overdose prevention site then opened in another location and is still operating.

The leaders of American cities like New York, Seattle, San Francisco and Philadelphia have also expressed interest in the idea, although regulatory hurdles have so far prevented overdose prevention sites from opening there.

The Ontario government, meanwhile, is wrestling with the future of its overdose prevention sites and has paused plans to open three new temporary sites while it carries out a review of the existing facilities.

Vancouver’s first Overdose Prevention Site isn’t in a tent anymore: It’s now located inside a long, narrow storefront in a building beside the market. The front entrance is locked; the real action takes place in the back, where people enter from the alley and take a seat at a cubicle to inject drugs. If they overdose, volunteers are on hand to give them naloxone and call 911.

In 2016, 993 people died of overdose in B.C., almost double the number in 2015, according to the B.C. Coroners Service.

In 2017, the number of fatalities continued to climb, totalling 1,450 by year’s end — but in the summer of that year the number of deaths per month started to fall below 100 for the first time in 10 months. This summer, the number had started to once again tick upwards: 162 deaths in March, 133 in April, 134 in July. B.C. is currently on track to record 1,750 overdose deaths in 2018.

While the death toll continues to rise, the province’s chief coroner and health officers have acknowledged the role of overdose prevention sites in slowing the rate of fatalities.

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At the Overdose Prevention Site on East Hastings St., reminders of the heavy toll of the overdose crisis are never far away. On the other side of a red plastic curtain that separates the cubicles from the rest of the space, six notices of memorial services for people who lost their lives to overdose are posted: Tom Gordon, Chris McPartlin, Doris Schneider, Joseph Steinhauer, Bahman Jokar-Jangkar and Rose Brill.

Blyth says the work is far from over. In 2017, she founded the High Hopes Foundation to provide marijuana to help people get off opioids. But while many cannabis dispensaries operate in Vancouver, they’re all technically illegal, and last month a High Hopes kiosk was raided by Vancouver police.

Blyth is now running for city council in this month’s Vancouver election and she continues to push for change in drug treatment policy.

“People have to listen when you’re a city councillor,” she said.

“We need decriminalization, making sure people have safe access to drugs. More detox, more peer support for people with lived experience.”

Lake has endorsed her. “She had a way of making people see that was the right thing to do,” he said. “She comes at it in a way that makes you want to understand her point of view.”

The Star is profiling 12 Canadians who are making our lives better. Next week we talk to women’s business booster Vicki Saunders.

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