How urban design and policy shape survival for people who use drugs

This ethnographic study explores how the urban environment in Edmonton's central business district shapes the daily lives of people who use drugs (PWUD), examining the intersection of criminalization, stigma, hostile urban design, and limited service access. Conducted over 15 months through interviews and field immersion, the research reveals that PWUD navigate multiple overlapping risks including displacement through gentrification, over-policing, and social marginalization that compound existing health disparities. However, the study also documents how these communities create meaningful survival strategies through informal social networks, mutual aid systems, and place-based belonging despite precarious conditions.

The research demonstrates that effective public health interventions must recognize the co-existence of both harmful and enabling conditions within urban environments. Rather than viewing these spaces solely through a deficit lens, the study highlights how PWUD develop culturally grounded survival knowledge and moral economies of reciprocity that sustain community resilience. The findings underscore the critical importance of centering the voices of affected communities in urban governance and policy decisions, as top-down interventions that ignore local knowledge and adaptive strategies may inadvertently worsen health outcomes and deepen social exclusion.

This research contributes to understanding how structural factors in urban design, governance, and criminalization directly impact the health and safety of vulnerable populations. The intersectional analysis reveals that addressing public drug use requires moving beyond enforcement-focused approaches to comprehensive urban planning that includes accessible services, harm reduction resources, and genuine community participation in decision-making processes.