to severe addiction and/or mental illness, equivalent to 60% of the population in this category for the 1 million people in the Vancouver Coastal Health region. A 2013 study of SRO tenants in the greater DTES found that 95.2% had some form of substance dependence and 74.4% had a mental illness, including 47.4% with psychosis. Only one third of individuals with psychosis were receiving treatment, and among those with concurrent addiction, the proportion receiving treatment was even lower. A 2016 study of the 323 most chronic offenders in the DTES found that 99% had at least one mental disorder, and more than 80% also had substance abuse issues. Between 60% and 70% of mentally ill patients treated at St. Paul's Hospital, the hospital closest to the DTES, are estimated to have multiple addictions. Possible explanations for the high level of co-occurrence between addiction and mental illness in the DTES include the vulnerability of the mentally ill to drug dealers, and a recent rise in crystal methamphetamine use, which can cause permanent psychosis. Substance use A 2010 BBC article described the DTES as "home to one of the worst drug problems in North America." In 2011, crack cocaine was the most commonly used illicit hard drug in Vancouver, followed by injected prescription opioids (such as fentanyl and OxyContin), heroin, crystal methamphetamine (usually injected rather than smoked), and cocaine (also usually injected). Alcoholism, especially when it involves the use of highly toxic isopropyl alcohol, is a significant source of harm to residents of the DTES. In 2016, a board member of the Vancouver Area Network of Drug Users said that in the previous year, Vancouver's supply of heroin had virtually disappeared and been replaced by fentanyl, which is cheaper and more potent. At the end of 2014, the DTES saw a dramatic rise in fentanyl overdoses. In 2016 the surge in drug overdose deaths led to the declaration of a public health emergency across the province. In a 2008 survey of SRO residents in the greater DTES, 32% self-reported as being addicted to drugs, 20% were addicted to alcohol, 52% smoked cigarettes regularly, and 51% smoked marijuana. In 2003, the DTES was home to an estimated 4,700 injection drug users. Most live in unstable housing or are homeless, and approximately 20% are sex workers. In 2006, DTES residents incurred half of the deaths from illegal drug overdoses in the entire province. Between