BACKGROUND: The unregulated toxic drug supply has had a disproportionate impact on rural communities across Canada, yet most health and social interventions target urban settings. Drawing on the Care Collective's (2020) work on universal care, families often provide care within the larger context of "careless" communities and governments that prioritize economic productivity over relational wellbeing. Although there is a growing body of research on care and caregiving experiences, little is known about the experiences of family caregivers of people who use drugs (PWUD) in rural settings.

METHODS: Using a community-engaged qualitative research design, we conducted semi-structured one-on-one interviews with 31 family members caregiving for a person who uses drugs in rural Prairie communities across Canada. Data were analyzed using reflexive thematic analysis to generate themes.

RESULTS: Families of PWUD in rural settings provide robust care as a result of the increasing "carelessness" of communities and governments. Neoliberal policy decisions on public service funding and delivery, combined with systemic stigma and racism, create conditions that shift care responsibilities to families. Caregiving for family and, at times, the wider community can result in significant personal impacts. Despite this, caregivers are vocal about the need for structural reforms to foster communities and governments that are more "caring" for PWUD.

CONCLUSIONS: The unregulated toxic drug supply has deeply impacted rural communities, placing the burden of care on families. An urgent comprehensive response to the crisis is needed; one that includes rural communities and families. This response should focus on structural changes that reduce sole reliance on family care, enhance resources and infrastructure for community care, adequately addresses families' grief and trauma, and ultimately place care as a central organizing principle in society.