Heroin, cocaine and amphetamines are the kind of street drugs you expect to find in the shady corners of any city, hiding away from the glare of law enforcement.
But in one small space in downtown Vancouver addicts openly inject their fixes -- as medics watch on.
This is InSite, North America's only legal safe drug injection center. A banner outside reads "InSite saves lives."
It's a facility where drug addicts can bring and use their drugs and not risk arrest.
Some of the addicts line up two or three times a day to use one of the 12 injection booths.
One of the first users of the day is Steve. The center opens at 10 a.m. and then runs steadily for 18 hours until 4 a.m. Approximately 800 people use the booths every day.
Steve gives his alias to the receptionist -- all InSite users have an official alias to protect their identity -- and moves into the injection room.
He takes a seat and calmly begins to prepare his hit of heroin. He uses the clean needle and sterile equipment provided by InSite.
The white powder is mixed with water in a spoon, gently heated with a candle, before being drawn into the syringe, and injected into the inside of Steve's elbow. It's not for the squeamish. There's quite a lot of blood.
With fluorescent lighting and lots of mirrors, the atmosphere is clinical, even as the room fills with drug addicts focused on one task only -- feeding their addiction.
Medical staff are on hand and watching closely. If needed they can help addicts find the right vein to shoot up into -- something which can be tricky for long-term users. But their main job is to step in when a user overdoses.
Steve has overdosed here three times.
"I'm glad it was here [where I overdosed]. It's still in my hope that maybe I can get clean. I'm only 48. And that's why these places ... it's just, it's common sense! When you have a problem that's grown for whatever reason to the epic proportions that it has in this city, it's time to come up with a really good solution, and this is it."
Vancouver is regularly lauded as one of the best places in the world to live. It's famously the city where you can ski in the morning, and swim in the afternoon. But the quality of life in the alleyways behind InSite is something altogether different.
The Downtown East side is often labeled as the poorest postal code in Canada, which stands in stark contrast to the rest of the city's red hot real estate market.
The alleyways are full of thousands of drug addicts, prostitutes and dealers. Vancouver Police Department estimates that these few blocks are home to more than 5,000 intravenous drug users.
In the alleys we meet Liane -- another long-term user - who has used InSite since it opened in 2003. She is articulate, educated, and angry.
She says that without InSite addicts would be still be getting high but without any of the medical oversight.
To many around the world it may seem astonishing that a place like InSite exists. But for the people in the nearby streets who use it, it's a lifeline.
Clean needles stop the spread of infections like HIV and Hepatitis C, and daily access to medical staff is all the more important for people living in harsh, exposed conditions.
In 1997, Vancouver had the highest rate of HIV in the developed world.
Using InSite makes sense, says Liane. It relieves the pressure of shooting up behind rubbish bins, or using dirty puddle water, or relying on a shared needle.
"We have to stop making it a moral issue and realise that this is a medical problem. Remember us addicts, we're somebody's mothers, we're somebody's sister, we're somebody's daughter -- we're not just a number -- the next time you pass me on the street and shake your head."
Of course not everyone agrees with safe injection sites.
Author, actor, and addiction counselor, David Berner, opened Canada's first ever residential treatment center for addicts back in 1967. He firmly believes that the best harm reduction strategies are centered on abstinence.