Catherine Astin told the inquiry into the Robert Pickton case that drug addiction among those women is simply an effort to self-medicate their condition and sex work a way to pay for their habit.
Astin told the inquiry she has worked with residents of the Downtown Eastside for more than a decade. She painted a dire picture of life for women such as those Pickton brought back to his farm to murder — several of whom Astin had met.
She said many of the women she encounters in her work have stories of being sexually abused as children, as well as traumatic childhoods in foster care. They often found themselves living on the streets in their early teens.
Their world is one in which violence — whether rape or assault — is a daily reality, she testified.
"A lot of them use the drugs because they're self-medicating, because nothing else makes them feel better," said Astin, who currently works at a program called Sheway, which provides health and social services to pregnant women and mothers in the Downtown Eastside.
"The women didn't really have an education that would allow them to access work. They had a history of post-traumatic stress disorder, and the first time they used the drugs they're addicted to, it made them feel better."
The hearings are looking at the failure of police and prosecutors to stop Pickton before his arrest in 2002, but the first set of witnesses has instead dealt with the broader social issues facing women living in the Downtown Eastside, from drug addiction and poverty to Canada's prostitution laws.
Astin, who worked as a street nurse from 1997 to 2005 before joining Sheway, said women in the troubled neighbourhood ply their trade in isolated backstreets in the Downtown Eastside, which she described as dark, gloomy and "Dickensian."
When they are finished, they return home to the squalor of their low-income housing. Some find themselves in and out of jail.
"Would you agree that the women from the Downtown Eastside involved in the sex trade with whom you dealt were living in the most inhumane, squalid conditions?" asked Cameron Ward, a lawyer who represents the families of 18 of Pickton's victims.
"For the most part, I would say yes," replied Astin.
Astin said the women were afraid of law enforcement and didn't see the point of contacting police if they were attacked.
Astin had encountered several of the missing women linked to Pickton's farm in Port Coquitlam, though she couldn't recall ever hearing about the Pickton or his property before the serial killer's arrest in 2002.
Astin said she and other workers in the Downtown Eastside noticed women were disappearing, though she admitted she never contacted police.
Some of the staff did contact the coroner's office, she said.
She had vivid memories of Sereena Abotsway, who she had regular contact with until Abotsway's disappearance in August 2001.
"Sereena had been on the streets a long time. She was just lovely, she was a very kind-hearted, playful person," recalled Astin.
"She just disappeared. She didn't fade away; she was there one minute and she was gone. It was quite dramatic."
Thomas Kerr, a researcher with the BC Centre for Excellence in HIV/AIDS, agreed that using drugs on the street can push women and girls into prostitution.
He cited a study in which 63 per cent of sex workers surveyed said they would give up prostitution if they didn't need the money for drugs.
"Because people are often in need of a means to survive and generate money, and because they are already entrenched into the local drug scene, they avail themselves of the methods of generating income that are most available," Kerr told the inquiry.
"For many, that includes sex work or drug dealing."
Wednesday marked exactly 10 years since another missing women, Diane Rock, vanished from the Downtown Eastside. Pickton was charged with Rock's death, but her case was among 20 that were dropped after Pickton's six second-degree murder convictions were upheld.
Rock's sister, Lillian Beaudoin, was in the hearing room wearing a T-shirt emblazoned with Rock's photograph.
"Ten years is a long time to sit there and wait to be hearing what we're hearing now," Beaudoin, who has been attending the inquiry with her husband, said in an interview.
"It's just devastating, and hearing all these facts is horrible."
Beaudoin is expected to testify next week.
Pickton was arrested in 2002, setting off a massive search of his sprawling farm, where investigators found the remains or DNA of 33 women. He was eventually convicted of six counts of second-degree murder, but claimed to have killed 49.
Commissioner Wally Oppal is also conducting a less-formal set of hearings known as a study commission to examine broader issues surrounding missing women, including the so-called Highway of Tears in northern B.C.