It isn’t a subtle change by any means. One minute you’re surrounded by healthy-looking Korean students on Seymour Street, munching on kimbob and fish cake; a few blocks later, you’re standing across from a skinny junkie smoking crack cocaine on Hastings Street. This is the Downtown Eastside, a blatant rejection of the glassy, healthy city Vancouver tries to be. Here, under the ever-watchful red “W” on top of the abandoned Woodwards department store, reside more than five thousand drug addicts. They sleep in the residential hotels that line Hastings Street and hang out on the sidewalks, in the alleys or in the beautiful Carnegie Centre at the corner of Hastings and Main. The community centre’s library, classrooms, gym and kitchen make it the de facto heart of the neighbourhood.

Most Canadians probably know of the Downtown Eastside from news items about its rampant rate of HIV infection or about the infamous disappearance of over five dozen of its women. Others will have seen Fix: The Story of an Addicted City, Nettie Wild’s fantastic documentary about the fight for a safe injection site on the Downtown Eastside. The movie introduces us to Dean Wilson, a former IBM salesman and drug addict who is the president of the Vancouver Area Network of Drug Users (VANDU); Ann Livingston, VANDU’s sharp, confrontational organizer; and Philip Owen, the then mayor of Vancouver, a straight-edge conservative who becomes an unlikely proponent of harm reduction.“

The characters were all larger than life,” reminisces Wild. She originally set out to create a fictional story about Vancouver’s drug users, but changed her mind when she wandered into a meeting on the proposed safe injection site. “Everybody was mad as hell and where there’s action, there’s cinema.” She adds, “The safe injection site isn’t what this is all about. We’re on the cusp of a social movement.”

Fix dives into the stormy politics of the Downtown Eastside with all the subtlety of a cannonball. We first meet Livingston as she drives a van full of addicts dressed as skeletons to a city council meeting, where they confront Owen and the councillors over the city’s drug woes.

At the heart of matter is the concept of harm reduction. Proponents of this approach argue that instead of waging a US-style war on drugs, we need to accept addiction as a health problem and treat it as such. When addicts are forced to shoot up in squalid alleyways with dirty needles, under constant threat of arrest, the likelihood of overdosing or contracting a disease skyrockets. This philosophy of harm reduction informs programs like needle exchanges and safe injection sites; Vancouver, with rates of addiction and disease among the highest on the continent, makes for a good place to start.

Walking along Hastings Street, any illusions from reading too much Bukowski—romantic notions of aimless drifters in cheap hotels with neon signs—are immediately dispelled by the sunken faces and obvious desperation of the people around you. “Addiction is one of the ways in which we break,” says Wild. “You run into a whole gambit of people [on the Downtown Eastside]: It’s a catchment for people who, as a society, we run out of alternatives with what to do.” She offers stories of sons and daughters who came to the neighbourhood looking for a parent and ended up there themselves, caught in the vacuum of addiction. Nearly a third of all residents on the Downtown Eastside are aboriginal, having escaped trouble on reserves only to find even more of it in the city. Many of the area’s women fall into prostitution, making them vulnerable to predators. Port Coquitlam pig farmer Robert Pickton is expected to stand trial next year for the grisly murder and dismemberment of twenty-two Downtown Eastside women; all in all, more than sixty women have gone missing and are believed to be dead.

Such horror stories regularly make the rounds in the Canadian media, but they only serve to stigmatize the Downtown Eastside. It’s easy to forget that this is a real neighbourhood, home to real people. Until she made Fix, says Wild, she was like most Vancouverites: When she drove through the Downtown Eastside, she locked her doors and tried not to look at the junkies. “Now I ride my bike through and people who I’ve never even talked to wave and say hello. It’s a bit like racism … first everyone looks the same, they have unpronounceable names. Then the wool is lifted. Everyone begins to look distinct and names are easy to remember. You have to park your assumptions at the door.”

In Fix, Livingston, Owen, Wilson and their allies battled right-wing city councillors, an antagonistic community group and angry Chinatown merchants to open a place where drug addicts could safely inject their drugs under the supervision of health care professionals. Owen’s support of harm reduction cost him his job: When his term ended in 2002, his own party turfed him out, throwing its support behind Jennifer Clarke, a vehement opponent of the safe injection site. Clarke was crushed in a landslide victory by her opponent, Larry Campbell, a former police officer and coroner who campaigned in favour of the injection site. Owen used the money from his farewell party to pay for Fix’s distribution; in September 2003, shortly before the film’s release, North America’s first official supervised injection site opened at 139 East Hastings. The soothingly lit building features a twelve-seat injection room and two always present nurses; an addiction counsellor and physician are on call at all times.

Still, it isn’t enough. When asked about the injection site, Ann Livingston sighs. “It’s a huge political victory [and] it’s really good that the really messed up people are using it …" She trails off. "But it doesn’t meet the needs of the neighbourhood.” Although fewer people are seen injecting in public these days, she says, at least four or five other injection sites would be needed to really make a dent in the problem. The existing site, meanwhile, is just a three-year pilot program.

For all its benefits, the safe injection site fails to address the problem of crack users, who gather in large crowds on the street to smoke. VANDU, with the support of Mayor Campbell, is pressing hard for a safe inhalation room, but the response from the police and public has been underwhelming. One promising development is the establishment this fall of an experimental program that will distribute prescription heroin to seventy-five people. Such a program would be effective in reducing crime and putting dealers out of business, says Livingston, but the fact that it too is only a pilot program frustrates her. “Unlike researchers, I don’t think research makes the government change its mind. Public pressure does. It’s insane to have pilot programs with all this squalor in the streets.”

Livingston estimates that four to five thousand addicts have died on the Downtown Eastside over the past ten years. “[Larry Campbell] had to put the toe tags on those bodies. I hope he won’t forget about that.” Wild, for her part, hopes more cities in North America wise up. “We need to park our abhorrence of allowing people to use [drugs],” she says. Slowly, it seems, other cities are coming around. One Montreal politician is hoping to open a safe injection site in his borough. After all, what’s the alternative? When an addict falls into a neighbourhood like the Downtown Eastside, what comes afterward?

“They die,” says Wild. “There is no afterward.”

When not wandering our streets, Christopher DeWolf is the editor of Urbanphoto.net. The Urban Eye appears every second Friday.