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The Downtown Eastside (DTES) of Vancouver, Canada has been the epicentre of HIV, hepatitis C and drug overdose related to People who inject drugs (PWIDs) since the mid1990s. In response to the growing government inaction, numbers of peer-run organizations were formed. This dissertation was conducted to capture the genesis and influence of peer drug users, their networks and harm reduction programs over the past 18 years in shaping the neighborhood. Semi-structured qualitative interviews were conducted with peers from various harm reduction volunteer locations in the DTES. Moreover, various drug users were recruited from a controversial harm reduction program in the DTES that provides pharmaceutical heroin. Interviews were analyzed thematically using two methods of coding analysis. Findings suggest that peers were taking on important education and safety roles, and were able to alter the behaviour, attitude, and intention of injection drug users within the DTES area of the city. Attending heroin trials in Vancouver has been particularly effective in creating a unique microenvironment where PWIDs who have attended heroin trials have been able to form a collective identity advocating for their rights. The result of this dissertation and costing analyses conducted point to the need for the expansion of the peer and harm reduction programs beyond the current location in the DTES to other locations in Canada such as Montreal, Ottawa, Toronto, Saskatoon and Victoria.