With a broad range of experience in public, private, as well as community-based NPOs and NGOs throughout rural and urban international contexts, R. Marcus is an applied public health researcher, registered psychiatric nurse, and a Master of Science student in the University of Alberta’s School of Public Health.

High rates of public drug use in urban areas presents as a significant public health challenge across Canada and elsewhere. People who use drugs (PWUD) in these environments face compounded health risks, social stigma, legal issues, and limited access to essential services, contributing to heightened morbidity and mortality risks. This study investigates – through the perspectives of PWUD in these settings - how environmental features of an urban central business district in a northwestern Canadian setting impact the daily lives of PWUD, including making it easier or harder to access services, and offers recommendations for inclusive, evidence-based policy, program, and practice interventions.

Using an integrated knowledge translation approach and focused ethnographic design, researchers conducted 25 semi-structured interviews with PWUD in the study setting. Ethnographic observations, field notes, and non-identifying photographs provided further contextual insights. Transcribed interviews were analyzed using latent content analysis and the intersectional risk environment framework to identify emergent key themes. A knowledge user group of folks with lived experience was involved in shaping the findings to improve knowledge translation.

Participants cited numerous daily challenges including spatial exclusion and displacement, social stigma, heightened legal risks, and concerns about increasing social disorder and urban decay; participants also discussed key resiliencies including innovative survival strategies amid resource scarcity and extreme weather events, and the importance of social cohesion. Multiple overlapping conditions such as rapidly changing provincial and municipal health resources - as well as houselessness and poor health - impacted their willingness and ability to seek health and social services, further marginalizing PWUD in these settings. The study emphasizes the importance of inclusive urban planning and place-based care models, particularly harm reduction services that meet PWUD where they are at. These findings support the development of evidence-based strategies to improve policies, programs, and services for PWUD in urban settings.