WARNING: This story discusses substance use and the toxic drug crisis.
Amid the ongoing toxic drug crisis, an informal network of support has emerged among drug users. Part of this network are individuals referred to by their clients as “doctors” — everyday people with no formal medical training — who offer to inject people for a small fee. One of them accepted to be followed for a night. Meet Alan, the “hit doctor” assisting people across Vancouver.
The names in this story have been changed to protect their identities due to the legal risks involved.
It’s already dark outside, and the bearded man on the couch is getting anxious. We’re in his living room, and a beer sits on the coffee table.
With the left sleeve of his button-down shirt rolled up, Sean waits for his daily injection, looking away to not see the needle.
Beside him, a man wearing glasses has set up his equipment on the table, getting ready to administer the shot he came to give.
“Painless,” Sean says, as the syringe is withdrawn from his arm.
Staying nearby, the man who injected him checks in.
“Except for that flinch that you did, let me know if there’s any burning, OK? Walk it off.”
Alan, 42, isn’t a medical professional, but a drug user who learned his job by injecting himself and his friends, using Google and reading research papers.
“Doctor” and “doctoring” are code names used by his clients to discreetly identify him on their phones, or to describe what he does for them.
“For people to call me ‘doctor,’ it’s hilarious,” Alan says. “And at the same time, it’s very endearing to me, I guess, because they trust me and that’s a big thing.”
And while the title might sound unusual, it is a term used among drug users, says DJ Larkin, executive director of the Canadian Drug Policy Coalition. “I don’t know how common it is, but I’m familiar with the term.”
Because assisted injection is illegal in Canada, Alan agreed to be followed only on the condition that his and his clients’ identities remain anonymous due to the legal risks. For that reason, they have been given different names in this article. CBC News/Radio-Canada has confirmed all of their identities.
After cleaning up the living room, Alan packs away his gear and stays for a bit to make sure his client is safe.
“My whole thing is the risk of accidental overdose,” Alan explains. “I’m always right there beside them for at least 15-20 minutes after they do the shot. Because I know that I’m still technically responsible for that.”
Over the last 10 years, more than 55,000 people have died of toxic drug overdoses in Canada. Alan is one of several “doctors” who travel throughout Vancouver to prepare drugs, inject their clients, and monitor them to prevent accidental overdoses.
In Alan’s backpack are tourniquets, cookers and filters, clean needles (also known as rigs), water and sanitation wipes, gloves and naloxone.
“It’s kind of constant, all the time. I’m going 24/7. When they call, I go,” Alan says.
He estimates he performs between three and 12 visits on an average day, charging $20 for each one. He’s part of a trend that he says has been growing over the last 10 to 15 years.
While his job is unusual, his practice isn’t unique: he knows of about a dozen others who perform assisted injections across the city. A reference to “hit doctors” is even made in the Canadian Medical Association Journal as far back as 2017.
Earlier in the evening, before Alan meets with Sean, he heads to Steve’s, another regular client. Steve lives in the West End near Stanley Park, in a building filled with young families and long-term residents.
Steve used to work in the banking industry and has been addicted to drugs for more than 20 years. Among friends and colleagues, few would suspect he’s a regular user. Alan is his fourth “doctor” and he’s been paying for his services for more than four years. Including the doctoring fees and the drugs, Steve estimates he pays roughly $1,000 a month to maintain his addiction.
“I just don’t want to do it myself because I don’t know how and I don’t want to learn how because I want to have some control over it,” Steve says. “If I learn how to do it, I am afraid of the consequences.”
After decades of use, the veins in Steve’s hands are profoundly scarred, toughened to the point that they’re hard to get a needle into. Before Alan arrives, Steve exercises on a stationary bike to get his blood flowing, but Alan is still forced to inject him in the leg.
Not the addiction crisis you think
Alan’s clientele breaks down the stereotypes around the toxic drug crisis. To many, addiction is associated with Vancouver’s Downtown Eastside. But data paints a different picture.
According to Statistics Canada data from 2024, 74 per cent of people who die of an opioid overdose in Canada are men. Accidental poisoning, which includes any accidental overdose or exposure to noxious substances, is currently the leading cause of death for males between the ages of 20 and 49. The vast majority of these men die alone, behind closed doors, without anyone present to help.
“There are tens of thousands of people who use drugs, whether it’s once a week or monthly for other reasons, who would never go to a supervised consumption site,” says Larkin.
“People in trades and labour are dying at very high rates. People who have jobs and are professionals, people in universities, those are not folks who are likely to go to a supervised consumption service, but they also deserve care”.
Those are the men Alan is assisting.
“Most of my clients are older gentlemen who have had families and careers and lives and are still well known in the community,” he says.
Over the years, he says he’s “doctored” successful professionals, including university professors and a neurosurgeon. Some of his clients live in multimillion-dollar homes in Vancouver’s wealthy neighbourhoods of Point Grey and Kitsilano.
Tonight, though, all of them are gay men using crystal methamphetamine.
When asked why he doesn’t use Insite — North America’s first legally sanctioned supervised consumption site — Steve is adamant he doesn’t see himself fitting in there.
“I’ve never been to Insite. I’ve heard nothing but good stuff about them, but I just don’t want to be seen,” Steve explains. “[People think] that we collectively, I suppose, are degenerates. We are all human, we all have feelings, we all have emotions, and we all count…. Judgment hurts.”
Limits of the system
To addiction specialists, the existence of an underground network of “hit doctors” is a symptom of a health-care system failing to address the scope of the crisis.
Dr. Paxton Bach, a clinical assistant professor at the University of British Columbia and an addiction medicine specialist, says he is not surprised by the phenomenon, which falls in line with B.C.’s recommendations that drug users don’t consume alone.
“It’s an example of people doing what they need to do to try and make sure that friends and neighbours are safe in the absence of other available services,” says Bach.
While facilities like Insite are crucial and very effective, he says, they serve a relatively small population compared to the number of people at risk of dying of an overdose.
Despite the ethics and dangers of having an untrained civilian performing injections, Bach sees the pragmatic reality of the situation.
“If we’re not doing everything we can to try and keep people safe, then they’re going to find their own ways to do so, and I hope that they do it thoughtfully and conscientiously,” he says.
Dealing with the pain and loneliness
Later in the evening, Alan walks up Granville Street to visit Michael, an artist in his 60s who has been living with HIV for about 40 years.
Michael suffers from a neurological disorder that causes painful, constant muscle tension. After his doctor stopped prescribing him anxiety medication, Michael found that crystal meth helped him focus and relax. When he told his family doctor that he was going to buy street drugs to cope with the pain, “he simply replied with a shrug,” he says.
Michael relies entirely on Alan for safety. “He’ll make sure you’re safe and watch it for a while,” Michael says. “It’s like being able to relax and then get out of my mental state, my physical state, and it’s a security.”
Alan acknowledges that the isolation of his clients is also a driving force behind his nightly visits.
“Some of my guys that do it alone are just lonely,” he explains. “So, they enjoy the conversation as well as the service.”
“Do I feel like I’m enabling some of them? Yes, absolutely. Do I feel like they would damage themselves more if I wasn’t doing it? Yes, absolutely,” he says.
“But that doesn’t necessarily mean that I wish that they were doing it. Some of them do it for the wrong reasons. Some of them do it for enjoyment. Some of them do it to hide and to cover and those are the ones that really make you sad.”
Up to 3 visits a night
After leaving Michael, Alan heads to Sean, a man in his 50s. Sitting in his living room, surrounded by art and boxes, Sean is visibly nervous, his legs constantly fidgeting. He explains he relapsed and began using crystal meth two years ago after his partner passed away.
Using makes him forget the pain, he says. “It just hides everything. But I know it’s a mask”.
For Sean, hiring Alan sometimes up to three times a night is about ensuring his physical safety.
“It’s totally worth the cost,” he says. “I feel confident I’m not going to get infections and be in the hospital or have to go on a drip, IV penicillin.”
A risky business
Among experts and observers CBC News spoke to, the existence of “doctors” was either known or suspected, but the fact that individuals make money doing assisted injections, a practice deemed illegal, came as a surprise.
“The fact that we’re seeing civilians have to take on exceptional legal risk, I think, is a real testament to the fact that the community is having to step in where the government is not to prevent needless deaths,” says Caitlin Shane, a staff lawyer at Pivot Legal Society focused on drug policy.
“I strongly believe that this activity is a very predictable, and unfortunately necessary, response to government negligence.”
A major barrier for assisted injection is the legal framework around official safe consumption sites. In accordance with the exemptions under Section 56.1 of the Controlled Drugs and Substances Act, staff are not permitted to physically assist with the injection itself.
“Staff are there to help ensure people’s safety, respond in the event of an overdose, and offer support, but they do not handle or supply the drugs,” Health Canada confirmed in a statement to CBC News.
At most sites, however, peers are allowed to assist in providing the injection. According to Health Canada, a pilot project held from 2018 to 2019 showed that peer assistance “supported harm reduction education, and improved connections to health and social services.”
But the legal liabilities surrounding assisted injection can be severe. Simply taking a drug from a user and injecting it into their body can be considered sharing or transferring an illegal substance, which falls under drug trafficking laws.
If a client were to suffer a severe medical emergency, Alan could face charges under the Criminal Code for administering a noxious substance, an offence that carries a penalty of up to 14 years in prison. In the worst case scenario, if a client dies from an overdose, Alan could be charged with involuntary manslaughter, which carries a maximum sentence of life in prison.
Carrying the burden
Alan is aware of the stakes.
“I’ve heard of people who have had people die doing it,” he says. “But if somebody passed away and a family member took me to court, I’d go to court, absolutely. I’m responsible.”
Despite the threat of severe prison time, Alan feels a profound sense of duty.
“I would do anything for any of my guys,” Alan says. “I would take a bullet for one of them. I don’t think that I’m doing wrong. I know it’s wrong. But I don’t feel like it should be wrong.”
As for turning assisted injection into a legal form of harm reduction, Alan remains cautious.
“You know, every time you go to a different job, there’s the potential of the person dying. And that’s stressful. And there’s not too many people who would do that day in, day out. I don’t find too many people who want that kind of blood on their hands.”
