The need to prioritize research, policy, and practice to address the overdose epidemic in smaller settings in Canada


The majority of research and policy directives targeting opioid use and overdose prevention are based in larger urban settings and not easily adaptable to smaller Canadian settings (i.e., small- to mid-sized cities and rural areas). We identify a variety of research and policy gaps in smaller settings, including limited access to supervised consumption services, safer supply and novel opioid agonist therapy programs, as well as housing-based services and supports. Additionally, we identify the need for novel strategies to improve healthcare access and health outcomes in a more equitable way for people who use drugs, including virtual opioid agonist therapy clinics, episodic overdose prevention services, and housing-based harm reduction programs that are better suited for smaller settings. These programs should be coupled with rigorous evaluation, in order to understand the unique factors that shape overdose risk, opioid use, and service uptake in smaller Canadian settings.


La recherche et les politiques d’orientation axées sur l’usage des opioïdes et la prévention des surdoses sont majoritairement basées dans les grandes agglomérations urbaines et ne sont donc pas faciles à adapter aux petites agglomérations du Canada (c.-à-d. aux villes petites et moyennes et aux agglomérations en milieu rural). Nous définissons plusieurs des lacunes de la recherche et des politiques dans les petites agglomérations, dont l’accès limité aux services de consommation supervisée, à l’approvisionnement sûr et aux nouveaux programmes de traitement par agonistes opioïdes, ainsi qu’aux services et aux mesures d’aide fondés sur le logement. Nous définissons aussi le besoin de stratégies novatrices pour améliorer l’accès aux soins de santé et les résultats cliniques de façon plus équitable pour les personnes qui font usage de drogue, notamment le besoin de cliniques virtuelles de traitement par agonistes opioïdes, de services épisodiques de prévention des surdoses et de programmes de réduction des méfaits fondés sur le logement, mieux adaptés aux petites agglomérations. De tels programmes devraient être assortis d’une évaluation rigoureuse pour mettre en lumière les facteurs particuliers qui influencent le risque de surdose, l’usage des opioïdes et le recours aux services dans les petites agglomérations canadiennes.

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This work was supported by funding from the US National Institutes of Health (R01DA044181). Geoff Bardwell is supported by a Canadian Institutes of Health Research Postdoctoral Fellowship.

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GB wrote the first draft. Both authors made substantial contributions to the work, approved the final version, and agreed to be accountable for all aspects of the manuscript.

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Correspondence to Geoff Bardwell.

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Bardwell, G., Lappalainen, L. The need to prioritize research, policy, and practice to address the overdose epidemic in smaller settings in Canada. Can J Public Health (2021).

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  • Research
  • Opioid overdose prevention
  • Opioid agonist therapy
  • Supervised consumption services
  • Smaller settings
  • Rural health


  • Recherche
  • prévention des surdoses d’opioïdes
  • traitement par agonistes opioïdes
  • services de consommation supervisée
  • petites agglomérations
  • santé en milieu rural