Healing the Downtown Eastside: Why Compassion Matters in Opioid Recovery

How the Overdose Prevention Society’s new day center is carrying forward Trey Helton’s vision of dignity, safety, and mental health care

By Jess Wight | July 14, 2026

“He went above and beyond, he always was like, ‘This is not a job, this is me helping my friends.’ And he would do it day and night. And everybody loved him; he was the best friend to everybody”

Executive director and founder of the OPS, Sarah Blyth, expressing the way Trey Helton left a lasting impact on his community

On Monday last week, the Overdose Prevention Society (OPS) announced the opening of a new community-led day center in Vancouver’s Downtown Eastside (DTES). The non-profit organization OPS is honoring the life of Trey Helton, an inspiration among the vulnerable DTES community who passed away suddenly last year, by naming the center the Ashtrey Recovery Resource Centre.

Trey dedicated the last 8 years of his life to the OPS, beginning as a volunteer in 2016 and progressing to general manager. Trey’s unwavering empathy and deep commitment to serving his community were rooted in years of his own experience of homelessness and drug-use. His death in April 2025 at only 42 years old affected the lives of many; he was well-known among the DTES community having used his own addiction to save the lives of hundreds of drug users during his career with the OPS.

In 2016, provincial health officer Dr Perry Kendall declared a public health emergency in Vancouver due to the unprecedented surge in illicit drug overdose deaths in the city. British Columbia was the first province to exercise emergency powers in response to the crisis, following 76 deaths from fentanyl in January 2016 alone, the largest number in one month in almost a decade.

However, sadly this was just the beginning. A harrowing look at a decade of data from the BC Coroners Service underscores the devastating toll of the toxic drug crisis. Between 2012 and 2023, annual fatalities skyrocketed from 270 to an unprecedented peak of 2,573 – a near tenfold increase that has cemented illicit drugs as the leading cause of death for British Columbians aged 10 to 59.

The path has not been a steady climb, but rather a series of catastrophic surges. The crisis entered a deadly new phase after the declaration of a public health emergency, with year-to-year deaths leaping by 88.5%. While a brief 36.6% reprieve was achieved in 2019, the onset of the COVID-19 pandemic shattered that progress, triggering a massive explosion in fatalities in 2020.

Taking a look at the chart below reporting life expectancies only further illustrates the stark tragedy continuing to impact the DTES community, represented here by the Vancouver – Centre North health area. The single, isolated line at the bottom clearly breaks away from the rest of metro Vancouver’s upward trajectory, where average life expectancies are steadily climbing towards 90 years. While the DTES initially saw significant gains – climbing from a low of 73 years in 2000 up to 81 years by 2014 – that progress was abruptly reversed and cratered as the fentanyl crisis intensified. The massive, widening chasm between the bottom line and the tight cluster of other municipalities visually quantifies the devastating localized effects of the crisis.

Chart showing life expectancy data for areas of Greater Vancouver from 2000 to 2024

When we look at charts and data, it is easy to get lost in the bars and percentages. But behind every single number is a person. A child, a parent, a friend, a neighbour. That is how Trey wanted people to see these figures; he dedicated his life to changing them. As part of his drive to serve his community, Trey worked for the BC Coroners Service doing body removal; he saw firsthand the devastation of Vancouver’s drug crisis, often recognizing the individuals he was picking up.

The first question—always—is not “Why the addiction?” but “Why the pain?” The answer, ever the same, is scrawled with crude eloquence on the wall of my patient Anna’s room at the Portland Hotel in the heart of Vancouver’s Downtown Eastside: “Any place I went to, I wasn’t wanted. And that bites large.”

Gabor Maté, physician and addiction expert, describing a patient’s experience with drug addiction

Opioid Use Disorder (OUD) is a chronic medical condition. Opioid Agonist Therapy (OAT) is a well-established pharmacological treatment approach for OUD that uses long-acting opioid medications to reduce cravings, prevent withdrawal symptoms, and support long-term recovery. Medically supervised, this therapy stabilizes brain chemistry and reduces the risks associated with illicit opioid use, allowing individuals to regain daily functioning and engage more fully in their recovery.   

While OAT is a highly effective, evidence-based treatment, medication alone rarely addresses the trauma, grief, mental illness, homelessness and isolation that often underpin problematic opioid use. Accessing medication-based therapy without the psychological care and social support makes sustained recovery far more difficult.

The Canadian Research Initiative in Substance Matters (CRISM) updated the national guidelines for clinical management of Opioid Use Disorder in 2024. The changes implemented represent an imperative move away from rigid, prescriptive medical models and a step toward a more empathetic, low-threshold approach to care.

The update moves away from a one-size-fits-all model of treatment. Instead, they emphasize shared decision-making, culturally safe care and recognition of the systemic stigma experienced by people who use drugs – particularly Indigenous Peoples. Medication remains central to treatment, but recovery goals should be defined by patients themselves rather than imposed by providers.

By treating OUD as a long-term, chronic condition rather than an acute failure, these guidelines seek to treat individuals in whatever capacity they may need. This progression ultimately highlights the desperate need for accessible treatment during the peak of a volatile, fentanyl-dominated drug crisis.

Research from the Hope to Health (H2H) Clinic in Vancouver's DTES highlights the importance of accessible, relationship-based community healthcare for people facing complex challenges. The study followed hundreds of residents with high rates of substance use, homelessness, and chronic health conditions who previously lacked a primary care provider. Despite these barriers, nearly three-quarters of participants remained engaged in care over more than a year of follow-up.

Researchers found that regular contact with physicians – and importantly, social workers – was strongly associated with staying connected to care, while people with alcohol use disorder were more likely to become disconnected or die during the study period. The findings suggest that low-barrier, multidisciplinary, and trust-based services can successfully engage people who have historically faced significant obstacles to accessing healthcare, while also pointing to the value of additional supports for those with the most complex needs.

These findings are corroborated by a systematic review of the use of psychosocial interventions alongside medication in OUD patients. This review establishes that while medications are a life-saving aspect of OUD treatment, pairing them with psychological care yields the best long-term outcomes. Focusing on restoring quality of life in patients following recovery from physical dependency is a vital part of remission by providing motivation and a sense of purpose for individuals whose lives have been consumed by drug use for many years.

In terms of the most effective psychological interventions for supporting those with OUD, a more recent review establishes Cognitive Behavioral Therapy (CBT) as a recommended treatment due to its ability to help patients identify and modify their own behaviors, rather than relying on external resources. The slow but durable nature of CBT facilitates the longer-term progression needed to follow-up the traditional detox methods currently used to treat OUD. Contingency management (CM) – a psychotherapy involving a monitoring and rewarding positive behaviors – is also identified as a positive strategy. This is often used in support groups like Narcotics Anonymous whereby personal milestones are celebrated and rewarded.

The narrative of this review emphasizes that the psychotherapies are not merely ‘extra credit’ services, but essential components of the overall recovery process. The Ashtrey Recovery Resource Centre vows to provide more than just essential facilities to those in times of need: there are plans to deliver recovery-focused programs as well as employing ‘recovery navigators’ to help people to connect with external services to improve access and retention. These navigators will also help individuals instantly access dedicated detox beds at Together We Can, an addiction rehabilitation center in Vancouver.

As well as washrooms, Wi-Fi, laundry facilities and other essentials, the Ashtrey will also have space for daily Narcotics Anonymous, Alcoholics Anonymous, and SMART Recovery meetings, enabling the implementation of the recommended CM practices. Executive director and founder of the OPS Sarah Blyth stresses that sobriety is not a requirement to access the center, demonstrating strong drive to instill a low-barrier approach to break down the stigma preventing access to services for many.

Like Trey himself, employees at the Ashtrey will be predominantly people from the DTES community who have undergone their own treatment and recovery journeys to help provide that unique understanding and empathy. Extensive training will be provided; however, the addition of specialized healthcare professionals would greatly improve the services the center is able to offer.

Relying entirely on annual provincial grants and donations, the center does not have the funding to provide the comprehensive care recommended in current literature, but it will act as a vital foundation for OUD recovery for many individuals struggling in the DTES. The current financial focus is to build an onsite kitchen so that they don’t have to rely on partnerships with local businesses to provide hot meals.

The Ashtrey Recovery Resource Centre cannot solve the overdose crisis on its own. But it represents something the DTES has needed for years: a place where recovery is supported not only with medication, but with dignity, compassion, and hope. It carries forward Trey Helton's belief that people deserve to be treated not as problems to be managed, but as neighbors worth fighting for. In a community that has lost far too many people, that may be one of the most powerful forms of healing we can offer.