Submission ID 132035
| Issue/Objective | Since 2016, over 50,000 Canadians have died from the toxic drug supply crisis, yet the workers providing frontline harm reduction and outreach services, specifically in rural and resource-limited settings, remain among the most structurally neglected members of the health workforce. While harm reduction literature has grown substantially, it remains concentrated on urban service delivery and patient outcomes, leaving an important gap in understanding the realities of rural workers. This review examines the lived experiences of harm reduction and outreach workers navigating community-based practice in rural and resource-limited Canadian contexts, with attention to the structural, occupational, and psychological dimensions of that work. It addresses the conference theme of reclaiming health equity by centering the voices of workers who are themselves marginalized within the systems they sustain. |
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| Methodology/Approach | This integrative literature review followed the updated Whittemore and Knafl (2005) framework, which supports the simultaneous inclusion of diverse source types - qualitative studies, mixed-methods research, national surveys, policy analyses, and theoretical literature. A PICOT-informed research question guided source selection. Purposive sampling was conducted across PubMed, CINAHL, and Google Scholar, supplemented by grey literature from governmental and public health sources. Inclusion criteria prioritized sources published between 2000 and 2025 that centered frontline worker perspectives in community-based harm reduction settings. Thematic synthesis using constant comparison guided data analysis, moving from individual source findings toward higher-order interpretive conclusions. |
| Results | Three interconnected patterns emerged. First, geography functions as structural violence: rural harm reduction infrastructure is chronically underfunded, geographically concentrated, and politically undefined; producing a landscape of "policy whiplash" in which workers must continuously rebuild practice as services are defunded or closed. Second, peer and outreach workers, specifically those with lived experience of substance use, perform the highest-intensity relational labor while receiving the least institutional recognition: operating under stipend-based, benefit-free arrangements that constitute burden-shifting rather than task-shifting. Third, these structural conditions produce measurable moral suffering: secondary traumatic stress and burnout among harm reduction workers exceed benchmarks established for emergency department nurses. |
| Discussion/Conclusion | This review reframes harm reduction workforce distress as a predictable occupational hazard produced by deliberate policy choices. In rural settings, where the margin between a functioning service and no service is already thin, these conditions transform frontline practice into perpetual crisis management conducted without acknowledgement or structural protection. The implications of this are clear: sustainable harm reduction requires stable legislative funding, formal employment protections and pay equity for peer workers, and rural-specific occupational mental health supports that treat moral injury as a known workplace risk. These findings speak directly to Sub-theme 2's call to centre marginalized voices and Sub-theme 3's focus on health workforce strengthening, with this abstract arguing that reclaiming global health equity must begin with protecting the workers who hold the most vulnerable communities together. |
| Presenters and Affiliations | Oluwakemi Fasanmi Cape Breton University Oluwakemi Fasanmi Cape Breton University Bethany Antle Cape Breton University Janet Kuhnke Cape Breton University |
