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Monday, August 31, 2020

Canada: 'Feeding the Monster' An addict's story of receiving free prescription heroin at the Crosstown Clinic in Vancouver

Canadiana Borderland Beat CBC

Low-dose drug program provides an alternative to potentially deadly street narcotics

Twice a day Kieran Collins, 39, injects prescription-grade heroin at the Crosstown Clinic in Vancouver. (Nick Purdon/CBC)

When I first met Kieran Collins in Vancouver three years ago, he had a $100-a-day street heroin habit that he fed any way he could.

"You're doing things that you don't really want to do — things that you weren't raised to do," said Collins, who was 36 at the time. "You know they are wrong, but you get accustomed to having to feed it."

He's still hooked, but a lot has changed.

Back then, Collins was haggard and desperate. He referred to his 20-year addiction to opioids as "a monster" as we sat in a park in Vancouver's Downtown Eastside, and he talked about what he thought would happen to him if things didn't change.

"I will be dead in not long," Collins said. "I have overdosed a couple of dozen times ... one of these times I won't come out of it.

"It's not the way I would like to go," he added. "Especially how that would make my family feel."

Fearing street drugs would one day kill him, Kieran Collins was desperate to get into a controversial program in 2016 at the Crosstown Clinic in Vancouver. It helps drug users manage their dependency on heroin by giving them controlled doses. 

Since I spoke with Collins in 2016, the opioid crisis gripping Canada has killed more than 10,000 people.

More than 10,300 Canadians lost their lives to opioids in less than 3 years
In British Columbia alone there have been so many overdose deaths that average life expectancy is actually going down in the province.

Collins has managed to stay alive through this crisis. He credits a unique, controversial clinic's approach to dealing with people who use drugs.
Free heroin

Twice a day, Collins visits the Crosstown Clinic in Vancouver's Downtown Eastside. A nurse hands him a syringe of prescription-grade heroin.

It's just enough of a dose so that he doesn't go into withdrawal.

"It's not like this makes the problem just go away," Collins says, but it allows him to function.
 In total, 140 people are prescribed heroin at the clinic. For each of them, other treatments such as methadone haven't worked.

After they take their shots, clients of the Crosstown Clinic in Vancouver gather in the meeting room while the drugs take effect to make sure there are no complications. (Nick Purdon/CBC)
The idea behind the program, which is publicly funded by the province, is that if users like Collins have a clean supply of heroin, they won't take street drugs like fentanyl — which was responsible for about 87 per cent of illicit-drug overdose deaths in B.C. last year.

After the Overdose: Survivors can be left with brain damage, other serious health issues
'Safe supply' at heart of regulating illicit drug use, say experts
Another patient sitting nearby, 58-year-old Kevin McGarragan, says the program has saved his life.
 "If I wasn't here I'd probably be in an urn or underground."

Dr. Scott MacDonald, the lead physician at the clinic — the only one in the country that prescribes diacetylmorphine, the medical term for heroin — says the way to curb the crisis is to stop viewing opioid addiction as a criminal problem.

"This is a treatment for a chronic relapsing illness, just like diabetes and high blood pressure," he says.

 "We need to get away from thinking this is a criminal problem — it is a medical problem and it is a chronic, manageable illness."

 'A chance at being human again'

When Collins is cleared to leave the clinic, he thanks the staff and heads off to meet his father who works across the city in a design studio.

On the way I ask Collins how his life has changed since he began getting his heroin from the clinic.

At first he's a bit defensive.

"They're not medicating us to the point where we are like 'arghhhh,'" he says throwing his head back and rolling his eyes. "They just give us enough so that we are not a mess. So we can feel what it is to have a chance at being human again.

"Before, it felt like I was almost just existing," Collins explains. "But now, some days I wake up and it's like whoa, I am lucky to be alive."

Kieran Collins says low-dose injections at the clinic keep his addiction under control and allow him to live a more normal life. (NIck Purdon/CBC)
Collins stayed in touch with his father throughout his 20-year addiction — but only since he started on the program has he reconnected with the rest of his family.

"I'm an uncle now, my little sister has a kid," he says proudly. "I see him all the time."

Kieran's father, Wayne Collins, likes to joke that his hair is white from worrying about  his son.

"I've nursed him through comas," he says. "I've nursed him through him having fallen out of a three-story window, wondering if he's going to come back to me."

Father and son hug for a moment before Wayne gives Kieran directions about the work he wants him to do cleaning up the studio. He says the biggest change in his son since starting on the heroin program is that now when Kieran says he'll do something, he follows through.

Kieren's father Wayne says his son has changed for the better since he started visiting the clinic for regular injections. 

When Kieran was feeding his habit on the street, he'd disappear for months — sometimes longer. And there were many times when Wayne feared he'd lost his son forever.

"I've had the phone call from the landlord that says, 'he's DOA, you gotta go down to the hospital and ID the body' — and he's back.

He's just got a spirit that keeps coming through.
- Wayne Collins
"I believe in my heart that he is going to walk out of this," Wayne adds. "Some people go, 'Oh you are crazy — 20 years.' But that's part of knowing the whole person."

Over the years Wayne says many people have told him the best way to deal with his son's addiction is through "tough love." But he insists Kieran has taught him about a different kind of love.

"I think people who talk about tough love for addicts — it's the easy way out," Wayne says. "It's way harder to stay engaged and practice unconditional love, and show love for somebody who is lost."

In the afternoon Kieran returns to the clinic to get his second shot of heroin.

"People get addicted to drugs," he explains. "They don't do them because they want to do them, they have to do them — like a frigging slave."
 That's the reality for many people in Vancouver's Downtown Eastside.

According to statistics obtained by the Georgia Straight newspaper, a two-block area along Vancouver's East Hastings Street had more than 3,000 overdose calls in just two years. That's seven per cent of the entire province's 911 calls for suspected drug overdoses.

If anyone understands these statistics, it's the Crosstown Clinic's research coordinator, Kurt Lock. He has worked in the Downtown Eastside for 20 years.

When I walk with him through the neighbourhood, it's clear that most people know who he is. Lock explains that when you're the guy who can get people free heroin, it increases your popularity.

The Crosstown Clinic’s research coordinator, Kurt Lock, says the focus is on improving the quality of life of people dependent on heroin, and this has positive benefits for society as a whole. (Nick Purdon/CBC)
He says the 140 spots for patients at the Crosstown Clinic are "a drop in the bucket." To meet demand, he estimates they'd have to open five more clinics.

But is it really a solution to expand a program that gives out free heroin and doesn't push people to quit — after all, isn't heroin a poison?

Lock shakes his head. "If you have a clean, regulated supply, the drug itself it's not harmful for you," he says.

"I won't say it is good for you, but someone could live to be 100 years old and use heroin every day if it's not tainted with any contaminants."

Lock explains that many long-time opioid users look older than they really are because of what it takes to feed a street habit. Bad nutrition, homelessness and the contaminants found in street drugs are some of the things that hurt most long-time, chronic users.

"The reason we provide heroin to people and we don't just expect them to quit is just that simply doesn't work," Lock says.
 "We tried that for the last many decades … Why don't we put people in treatment? Well, we have done that. Why don't we put people in jail? Well, we have done that too. But the problem still exists."

Instead, Lock says the clinic focuses on quality of life.

The idea is to attract users to the clinic by providing them with the drug, and then once they are in a health care setting, try to address the issues that led to their dependence on narcotics in the first place.

Typically, the retention rate in opioid replacement programs that use methadone is around 30 per cent. In comparison, the Crosstown clinic's retention rate is more than 80 per cent.

Life without drugs

To supply a single user like Kieran Collins with heroin for a year costs around $27,000.

Proponents of the Crosstown program argue that this is cheap, because if Collins was getting his drugs on the street then society would pay twice as much through things like social, policing and hospital costs.

Toronto Public Health, for example, says "the social cost of one untreated person dependent on opioid drugs, which is attributed to crime victimization, law enforcement, productivity loss, and health care costs, is estimated at $45,000 a year."

Wayne has taken what he calls the more difficult approach of showing unconditional love for his son. 'I think people who talk about tough love for addicts - it’s the easy way out.' (Nick Purdon/CBC)
Beyond the financial costs, there's no escaping the fact that 11 Canadians die of opioid-related overdoses every day.

Collins says he sometimes runs into the mother of a friend who died, and it's a reminder of the human toll of street drugs. "I was there when he overdosed and died. She always kind of stops me and she's obviously mad because she's lost her son — but I think she kind of blames me."

Perhaps the most surprising thing Collins said during the two days I spent with him is that now his drugs are supplied to him, for the first time he's started to think of a life without them.

"I would like to know what it's like to live without having a vice of putting narcotics in my body every day," he says.

"I would like to know what it feels like, when I leave this world, to be in a clear mindset."


  1. Thank you for this. I'm glad there are some compassionate people left.
    Not having to worry about your next fix, where to stay, is an enormous burden which, when relieved, allows a person to actually begin to become a better person.
    The hardest part is convincing the puritanical part of society that blames the sinner. There are alot of folks opposed to these sensible health strategies.
    In a dystopian future i can imagine the drug cartels aligning with the puritanicals to keep programs like these very few, in order to protect their profits.

  2. I think he should be working for the City cleaning up homeless camps picking up trash umm something to help pay back for his drug habit
    I dont have much compassion so I am spilt but if they become usefull citizens Why not but if its just to give and not ask anything back
    then i am against it
    glad there is help But Man up and go to work

    1. That mode of thinking went out with WWII

  3. Oh! Great!

    Lets enable addicts with drugs...smh

    Meanwhile people with diabetes, asthma etc have to buy their medicine to live. They dont get free drugs for their illness which they have no control over. There is something wrong here, the priorities are messed up. ,


    1. @4:05
      It's Canada, we get our diabetes and asthma meds covered here already, because we have some of our priorities right. Opiate addiction is a medical disease, most often resulting from trauma and should be covered just like any other disease. Prescription heroin is only being subscribed here to people that have tried methadone unsuccessfully, and studies shows it working much better for those people than existing methadone programs.

      The research overwhelmingly shows that providing people who use drugs with a safe supply will be MUCH cheaper than dealing with all of the costs of prohibition: overdoses, emergency calls, property crime, police, courts and incarceration of drug users.
      Additionally, evidence shows that many of those who are provided with a safe supply can hold down jobs (much like an alcoholic who can access a safe supply of regulated alcohol) and remain productive members of society, instead of ending up dependants.
      The reality is that it is prohibition that is the much more costly option for dealing with addiction than a medical (prescription) model would.

    2. In canada if you can't afford meds, like insulin, it is supplied.

    3. In Canada if you are not covered by work insurance, you buy your own!

      I know, my cousin is a diabetic and she does not have coverage thru work, so she buys all she needs...from insulin to syringes and glucose meter strips. Same with other things.

      Governmant pays if you are on wealfare...thats it.

      Hard workind Canadians pay for their own.

      Addiction is not a dieses , its a choice!!!

    4. They also have a thing called a wet house that tax payers get to pay for. And junkies get Todo their drugs. Right beside Schools too.

    5. 11:19 - It's as much a disease as type 2 diabetes. Yes, it begins with a choice. But you completely change your brain chemistry to the point your DNA tells you that you need a drink/hit/whatever. That's like saying someone who gets lung cancer from smoking a pack a day for 20 years doesn't have a disease since their cancer began with a choice. Addiction wouldn't be considered a disease by the entire medical community if it wasn't. If you've experienced addiction, or intimately know someone who's suffered from addiction, you'd know that the vast majority of addicts don't want to be addicts.

      I broke my neck in 2010 and had to take opiates for a couple years and guess what, i became an addict. I never stole or did anything dirty to support my addiction. I'd rather be sick than compromise my integrity. But i definitely didn't choose to be an addict. I don't care who you are, if you're put on opiates for an extended amount of time you will become an addict.

      Disclosure: I am clean now, but it takes a lot of work to stay clean.


    6. 11:08 you got played with the house next to schools :)
      Drugs are are a choice at the beginning but then it’s a disease.

      And to all the Americans complaining, your country isn’t the best and the sooner you understand this the better for your country.

  4. For forty or more years here in the USA we have viewed the drug problem as criminal. Now because of this we have more people in jail than any other country, more drugs on the street and at record low prices. DEA and other gov't cops have turned us into a police state and now daily we have people protesting in the streets over police actions. They don't call it a "war" for nothing. It's past time we sent the troops home and call drug use what it is, a health issues.

  5. I live 2 blocks away from this shit in my city. We lived here before they built this crap. If compassion is what you call this. This free dope. Just helps. They still end up in your back yard stealing shit. Yelling at you because you ask them to clean the mess up they made of you trash cans. Telling you their gonna come back with their friends and smash your car up. Well I'm still aloud guns where I live. And if my family is in danger from a junkie. I will call 911. That's my gun safe combo.

    1. I wonder what your library safe’s combo is. Read a book here and there bro. Improve that spelling and vocabulary.

    2. I am from vancouver n really from this area. Youre an idiot if you think the people getting ghis treatment are the ones in your back yard stealing. They do that becaude they are DOPESICK. If the dude is going through this clinic, he is not going to need to steal to feel normal.
      The ones in your backyard are the ones that havent yet been afforded this opportunity so they will do whatever to just feel normal.
      U have no idea how it is for these people that made a decision years/decades ago and that decision ending up having a life long hold on them.
      This is a good idea if you want the crimerate and hiv/aids rates to be much lower than it is at the moment

  6. Dear 12:03. Bravo. This inspirational article made me cry. The love between the father and son is so beautiful. Grazie for this article,which I will be sharing globally. Peace.

  7. Must be Canada's fault too.

    1. 6:35 beleeme, Canada supports their polluting mining and other corporations all over the world, even as they are not paying taxes in Canada, they belong to Canadians and they do their dirty businesses too; the Canadian Lebanese Bank is one example as Tejas' Union National Bank of the Carlos Hank Gonzales famiglia...drug trafficking is some people's job, other people's business and drug addiction is everybody's problem

  8. Deploying free drugs, "paid for with your taxes", may be cheaper than thwe war on drugs anywhere, about 10% of the war on drugs budget

  9. Bc and the downtown eastside has interested me for a long time- interesting how the trade works there- id love to read more about it. And vancouver is an awesome city.
    The people working at these places must be what makes it cost 27k per person- poppy prices are at an all time low. I dont ever see this happening EVER in the us- sad because methadone is way worse for you imo. Heroin isnt even the strongest opiate. Id fake oxymorphone over h any day of the week. Its funny when ignorant people get all upset at free heroin- but fail to realize theres companies in the us making stronger shit than h. But theyre traded on the stock market- so thats OK

  10. It’s always Mexico’s fault

  11. Free heroin. Thx canada for making being a junkie a acceptable. So awesome they now have a safe trusted supply of heroin instead of proper treatment to help with what has made them junkies. Treatment (therapy) is the only answer. My mother has been a heroin addict for over 30 years in vancouver. Giving free herion only promotes use. Lets all be junkies forever!! yay canada n prime minister trudope!!!

    1. 3:24 I agree with u 100%. But the bleeeding heart naive folks will think that supplying addicts with dope is the way to go. Forget the therapy they say, give them dope on tax payer’s dime.

    2. heroin is dirt cheap when you take out the cartels. The 27k/per patient must be for the other workers at these facilities.
      Theres already painkillers out there that are a lot stronger than street heroin. Props to canada for choosing to do things the RIGHT WAY. the war on drugs is a total joke. Even the usa was flying in their own dope by the plane load. What a total joke.
      And the worst thing the usa does, is let these cartel kingpins work for years/decades before they decide its time for that person to go to jail- so they can seize all their money/properties, and FINE THEM ON TOP.
      Im pretty sure vincente zambada paid 125 million $ as part of his "deal" with the united states gov. Do you think thats right??
      If the usa really cared as much as they said they did, they wouldnt take/use that dirty money. They would BURN IT. But we know thatll never happen.. speaking of all that money- WHERE DID IT GO??? I would love to find out the answer to that question..

  12. Its pathetic canada is creating a legal heroin dispensing market. Ive grown up in vancouver over the past 40+ years. I worked across the street from the first safe injection sight downtown. The problem has only gotten worse. There are many safe injection sights now and our overdose rate is worse than ever. And the powers that be think more drugs will fix the problem. I have a family member thats have had over 30yrs of herion use. Seen her thru all her good and bad times. Methadone treatment, clean heroin treatment, detox, arrests and prison had zero effect on her use. I have no clue how many times shes overdosed. Too many to count. Shes broken mentally like most of the drug addicts ive dealt with in my life. We need a system that will deal with their psychology and treat the underlying cause of their drug use. But that doesnt make the money. clean heroin or methadone do!!!

  13. If every addict got a free supply there would be NO more cartels! Why? Because as soon as user becomes an addict he would abandon the cartel, so their business model would fall apart!

    1. He he heee mira güey:
      Addicts are not necessarily cartel members and i doubt cartels want their associates to become addicts, they are too hard to control.

  14. a good miserable 7 days will detox. but from there is desperate measures to stay sober/or get high every minute of your life. Thats why users relapse after treatment.

  15. Vancouver is controlled by the Punjabi Mafia. They control Calgary too.

  16. Someone could live to be 100 years old and use heroin every day if it's not tainted with any contaminants."
    thos guy really knows what Genus talking about. It’s so true. Meet ppl on h since decades but live a normal life due to these programs.

    Keep on

  17. I know every person in this story I briefly worked at this clinic. Inmho Vancouver has went way to far to the left ...getting clean is a dirty word around life is better with drugs and thats from the professionals .No other city in Canada puts up with rhis nonsense ( crosstown is the only good program as it is monitored . Everyone else gets dilaudid by the bucketful by there drs which most sell to buy fentanyl


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