The paradox of care: service providers’ experiences of delivering opioid-related care in rural Northwestern Ontario

Abstract

The opioid epidemic continues to impact rural communities across Canada, with Northwestern Ontario (NWO) experiencing disproportionately high rates of opioid-related harms relative to the rest of the province. Despite this, little research has examined how service providers in rural NWO understand and navigate opioid-related care in practice. Grounded in a Social Determinants of Health (SDOH) framework, this qualitative descriptive study explored how providers understand the influence of the SDOH on opioid-related harms and service engagement, what strategies they use to deliver and adapt care for clients who use illicit opioids, and what their experiences suggest for sustaining and strengthening rural opioid-related service systems. 14 semi-structured interviews were conducted with service providers across health, social service, and justice sectors in rural NWO, and the data were analyzed using reflective thematic analysis. Six themes were generated and organized into three conceptual pairings: Structural Inequities and Reconfiguring Service Delivery, Environmental Vulnerabilities and Relational Care, and Professional Strain and Workforce Sustainability. Across these three pairings, the findings revealed that the conditions constraining rural care simultaneously produced the practices that sustained it. Participants absorbed service gaps through role expansion and informal coordination, built trust within community and institutional contexts that caused harm, and sustained their commitment through the same attachments that depleted them. Together, these findings point to a service system whose functioning depends largely on invisible forms of labour unevenly distributed across the workforce. The findings have implications for social work practice, rural service policy, and the conditions needed to sustain providers.