Cities across Canada have responded to the opioid crisis in diverse ways. People who use drugs (PWUD) developed and administered unsanctioned services, including injection sites. Ottawa was host to an unsanctioned site run by Overdose Prevention Ottawa (OPO). This work is a case study on OPO's actions and rejections of medical practices. Through seven interviews with OPO organizers and managers of sanctioned sites, this project explores contestations of practices, knowledges, and logics governing substance use services. Analyses address contestations of practices from outside and inside the site, exploring visibility and invisibility of drug use and positioning of medical and experiential expertise. Care practices within the site highlight non-totalizing rejection of medical logics and practices, and articulate care on the fringes of these regimes. This is explored through a comparative analysis of sanctioned and unsanctioned replacement opioid programs. Ultimately this research investigates OPO's counter-conducts, highlighting alternative practices and logics of care.