With an average of five Albertans dying of drug poisoning each day, the toxic drug crisis has touched every corner of the province. Owing to sprawling distances, stigma, and a dearth of data, however, the impact of the crisis is often far less visible in rural Alberta.
Alberta's substance use surveillance system recorded 1508 drug poisoning deaths between January and September, 2023. Sixteen per cent of those deaths occurred outside of the province's seven major cities – Fort McMurray, Grande Prairie, Edmonton, Red Deer, Calgary Lethbridge, and Medicine Hat – an amount proportional to the estimated 15–22 per cent of Albertans who live in rural areas.
Since 2016, the number of drug poisoning deaths outside of urban centres have accounted for between 16 and 23 per cent of the provincial total. Though the harms experienced by communities may be commensurate with population size, the harm reduction resources available for those grappling with this crisis in rural areas are not.
Total drug poisoning deaths in Alberta, 2016–2023
Enormous distances and inadequate budgets
Red Deer-based Turning Point is one of the only organizations in Alberta with a dedicated rural outreach program, which delivers programming on health, harm reduction, and overdose prevention, including providing harm reduction and sexually transmitted and blood borne infection (STBBI) prevention supplies.
The organization says harm reduction "refers to policies, programs and practices that aim primarily to reduce the adverse health, social, and economic consequences of risk-taking behaviours such as drug use."
Turning Point's rural outreach covers the entire central zone – from Rocky Mountain House to Wainright, Drumheller to Two Hills. But because of chronic underfunding, just two rural outreach workers are responsible for that area, and only one is full-time.
"Even if we do have a staff member that's funded to specifically go into those communities, we aren't funded enough travel money to get to all of the communities. So we have to be very selective about where we're going and how many times we're going there," said Aisley Miles, hard reduction team lead at Turning Point.
Communities are normally identified because someone from that community has recognized issues with substance use in their area and reached out to Turning Point to do a presentation or provide resources, they said.
Greater risks in rural communities
Finding harm reduction programs and policies that address the present toxic drug problem is harder for people in rural communities, Miles said. "And they're at a significantly greater risk, I would say, due to the stigma and the isolated nature of where they live."
"There is a huge lack of funding for this work. And there's a lot of people that are going under-service or unserviced in rural communities, which is putting them at greater risk as well."
Changes to Alberta STBBI funding, which is what supports harm reduction programs in the province, have further limited how many people have access to this funding in recent years, Miles said. Now, only one agency or group from each zone can apply for this funding, they said.
Using drugs alone is one of the biggest risk factors for overdose or poisoning deaths. While some major centres have supervised consumption sites and street-level outreach teams that can intervene and reverse an accidental overdose, the geography of rural Alberta makes these approaches unfeasible. Instead, Turning Point tries to connect with community service providers like medical clinics and pharmacies to train staff and give them supplies to distribute in their communities.
"Our goal is never to have to be in a community forever if we can get a satellite site set up," Miles said. But the work to get a satellite site up and running can be "extremely slow."
"It's slow moving once you enter into a community because you have to establish rapport with service providers and do community capacity building around why the work that we're doing is important. And then eventually, those people begin to trust you and they may encounter people who they think fit the services and they all refer clients to you."
There are currently 14 of these satellite sites throughout central Alberta, which had 2188 contacts in 2022. The total number of people served is likely much higher, because "due to the stigma and shame around substance use in in rural communities, it's often that one person is contacting for supplies and then they're distributing to their peers." Miles explained.
Grassroots response to resource gap
Rural Harm Reduction (RHR) is a grassroots organization that is only beginning the slow work of increasing access to harm reduction resources in Brazeau County, which is home to just over 7,000 people.
"We think that drug use is a big city problem because it's much more prevalent, right? Because people are concentrated and centralized, there are services available and populations tend to flock around those services. And you can see them. They're visible," said RHR member K. Steele.
In rural areas, rates of drug use are high relative to population, but "what we're actually seeing is most of that drug use happening indoors, at home, out of the visible eye. So people don't think it's a problem."
So far, RHR has focused on talking with members of the community and chiselling away at the stigma that runs deep in rural areas, "to crack open people's preconceptions around what harm reduction is – AKA enabling people, AKA causing less safe communities – and going to a very humanistic point of everyone deserves love, dignity, and respect," she said.
"I always go off the assumption that generally people are good. People have lots of care and compassion for their neighbours. This is just a misunderstood, very deadly, very serious crisis."
"But in my professional career, I am a business major," she said. "I also can hit people with the argument for money. Harm reduction saves people money, let's be very clear. In health care costs alone, treating someone with HIV in Canada costs over $12,000 a year. Needle disposal and exchange programs cost less than $1 per needle."
In time, RHR hopes to have a drop off program for safer use supplies to rural residents, as well as a place paraphernalia can be securely deposited and properly disposed of.
