The first timeI went to Providence Health Care’s Crosstown Clinic on Vancouver’s notorious Downtown Eastside (DTES) was a surreal experience. Walking down Abbott Street, one encounters a true menagerie of urban living: fashionable business people; students; tourists; street people; drug dealers; and many people with walkers, wheelchairs or scooters.
The DTES is one of Canada’s poorest neighbourhoods and is ground zero for British Columbia’s opioid crisis. The Crosstown Clinic has been helping to address this crisis since 2011 by providing medically prescribed injectable heroin (diacetylmorphine) and hydromorphone for people with chronic and severe opioid use disorder who don’t benefit from other conventional treatments. Clients come into the clinic up to three times a day to self-inject medicine. There they are supported by nurses, care aides, doctors, social workers and myself—a spiritual care practitioner.
The first time I witnessed the clinic at work I found myself thinking, What on earth are we doing here? Are we really providing free drugs to heroin users? The clinic is firmly rooted in the philosophies of patient-centered care and harm reduction, so there is no expectation that clients will work towards abstinence or attempt to control or reduce their substance use.
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