Unregulated drug use in Sudbury, Ontario: A rapid ethnography examining risks and harm reduction service access in the North

Abstract

Background: Unregulated drug use in Ontario, Canada, has led to high rates of HIV, Hepatitis C, and drug overdose mortality. This crisis disproportionately impacts people who use drugs (PWUD) in Northern, rural, and smaller urban Canadian communities due to barriers such as limited resources and heightened stigma. For example, Sudbury, Ontario, has over double the provincial overdose rate. Supervised consumption sites (SCS) are intended to address these individual and community harms. However, the only SCS in Sudbury, The Spot, closed as of March 2024. The current thesis had the following objectives: i) Understand any perceived impacts of the local SCS closure, ii) Explore how necropolitics and structural violence create harm towards PWUD, iii) Qualitatively visualize areas of drug use, harm reduction sites, and participants’ living locations, iv) Provide recommendations to local organizations to address harm reduction gaps, and v) Provide research that addresses the literature gap regarding the health and well-being of Northern PWUD. Methods: We conducted a community-based rapid ethnography, which included naturalistic observations, semi-structured interviews (n=27), and spatial mapping. The data were analyzed thematically using a participatory analytic approach. Results: In Chapter Four, participants identified four key ways the SCS closure impacted them. They reported using substances unsupervised, which increased risks associated with isolated drug use. This led some to begin using drugs in public as a harm reduction strategy, hoping for intervention in case of an overdose; however, public use triggered fears of police intervention and social stigma if they were observed. Furthermore, losing an SCS resulted in social isolation and barriers to accessing harm reduction supplies, as the stigma associated with public health sites caused participants to avoid them altogether. In Chapter Five, our geospatial analysis of data derived from interviews, ethnographic observations, and peer knowledge allowed for a visualization of drug use, harm reduction access points, and living locations among participants. Our maps illustrate different daily geographies between those who used The Spot and those who did not. Overall, clients of The Spot had activity zones more centralized to downtown Sudbury than those who didn’t use services at The Spot, as the latter had more geographically sparse and distant activity zones. Conclusion: Northern and rural communities face unique barriers to accessing harm reduction services amid Canada’s current toxic, unregulated drug supply crisis. The closure of the only SCS in Sudbury, Ontario, with no replacement service planned in the foreseeable future, has resulted in participants increasingly consuming unregulated drugs in dangerous ways, leading to an increase of stigma, social isolation, and additional barriers to accessing health services. Furthermore, an apparent geospatial mismatch has been identified between the preferred areas for health services among participants and the locations of those services. Overall, we find that Sudbury’s layout of unregulated drug use is unique, fluid, and influences Sudbury’s high unregulated drug mortality rate.