Ashwini ChaudharyIn some rural Alberta communities, caregivers are driving hours each day so their children can access medication, while others supervise drug use at home in the absence of local services. For many families, this care is not exceptional, it is routine.
A new report led by researchers from the University of Alberta shares the invisible role of unpaid family caregivers supporting people who use drugs. The study found that families are increasingly acting as informal safety nets in under-resourced rural communities, stepping in where health-care systems fall short.
The report found that this is often an overlooked group in both research and policy.
The work beyond the label
Caregiving is widely recognized in other areas of health care, however, lead researcher on the study and assistant professor of family science Holly Mathias said families of people who use drugs are often excluded from those conversations.
“Families are doing a lot of unpaid care work, especially in rural communities where there might not be a lot of formal services and supports in place,” she said. “But they’re not always recognized as caregivers.”
This care extends far beyond what many might expect. Participants in the study described providing financial, emotional, and logistical support that sometimes comes at a significant personal cost. Some families were reported to have remortgaged their homes or used retirement savings to pay for private treatment because public options were unavailable.
Others took on daily transportation responsibilities, including long drives to access essential medications. In one case, a mother drove her son an hour each way, everyday, so he could receive methadone treatment.
“If you think about all the different things that you do in a day to take care of yourself, that’s pretty much what caregivers are doing every single day,” Mathias said.
In some cases, caregiving also spanned generations, with grandparents stepping in to raise young children, or youth taking on responsibilities for parents or siblings.
In rural communities, responsibilities are often intensified by the limited access to health care and support services. Longer travel distances, fewer treatment options, and gaps in harm reduction services mean families are often left to bridge the divide.
Mathias noted that policy decisions often prioritize urban populations. This leaves rural residents with fewer resources and limited access to care. As a result, caregivers are not just supporting loved ones, they step in to fill systemic gaps. They have to take on roles that might otherwise fall to health-care providers.
”They’re really falling through the cracks,” Mathias says
Despite their critical role, many caregivers receive little formal support. In Canada, caregiving policies vary by province and access to financial assistance is often tied to strict eligibility criteria. For those supporting people who use drugs, these barriers are even more pronounced.
”They’re really falling through the cracks,” Mathias said, noting that many do not qualify for existing benefits or lack access to peer and emotional support services. Caregivers are then left to manage complex, and many times high-risk, situations with little institutional support.
Beyond systemic barriers, caregivers also often face significant social stigma. Mathias said that stigma often extends beyond the individuals using drugs and onto the families supporting them.
”Stigma sort of trickles down,” she said.
She described how caregivers reported feeling judged, isolated, and in some cases, excluded from their communities. Participants spoke about strained relationships, negative experiences in the workplace, and hesitation to seek out support due to fear of feeling shamed or stigmatized.
Unlike caregivers that support loved ones with other health conditions, families of people who use drugs navigate their roles in silence. This further compounds the emotional toll of their work.
For Mathias, these findings point to an urgent need for greater recognition and support. She emphasized that families of people who use drugs should be considered legitimate caregivers and included in broader conversations.
“They’re doing it out of love … they want to keep their loved ones alive,” she said. “They often don’t feel like they have a choice.”
As governments continue to shape responses to substance use, she argues that understanding and supporting the role of families is essential.
“This is just the beginning of a conversation about how we can do better for families,” Mathias said.
