Mapping socio-spatial contexts of drug use and service access: A community-based rapid ethnography in Northern Ontario, Canada.

Greater Sudbury, Canada, is the largest geographical city in the province of Ontario. With urban and rural characteristics, Sudbury's population density is sparse, yet it features an active downtown core. Sudbury's only supervised consumption site (SCS) closed in 2024. We examine the socio-spatial contexts of drug use and access as a governance outcome of service placement, transportation access, and policing. By mapping and identifying areas of unregulated drug use in this study, we provide qualitative maps to explore the day-to-day geographies related to unregulated drug use and service access using participatory sketch-mapping. We conducted a community-based rapid ethnography consisting of naturalistic observations and semi-structured interviews with clients and non-clients of the local SCS (n = 27 across two waves, April-August 2024). Interviews involved self-mapping the approximate areas where participants lived/stayed, accessed harm reduction services, and purchased and used unregulated drugs. Data was incorporated into ArcGIS, a geographic information system (GIS) software. To analyze spatial data and emerging patterns while ensuring participant privacy, Kernel Density Estimation was employed, which provided insights into unregulated drug activity without disclosing exact coordinates. Findings indicate a high concentration of unregulated drug activities in Sudbury's downtown core, while significant activity extended across the city, with varying visibility. Study findings exhibit both the centrality of unregulated drug use and the peripheral areas where activities are less detectable, yet still present. These findings aid us in spatially understanding unregulated drug use in a Northern setting and can inform drug strategies related to the placement of harm reduction and health services, including mobile SCS.