Pinkerton had used substances for decades and is now on her own journey of recovery from addiction. 

She knows people in that house are going to use whether she's there or not. So Pinkerton said she'd rather they have clean supplies, to prevent the spread of disease, and access to naloxone, a life-saving drug that temporarily reverses the effects of an opioid overdose.

The illicit drug supply is becoming more toxic and unpredictable right across northern Ontario, like many parts of Canada, and experts say it's leading to more overdoses and more deaths.

But unlike other, larger communities, Pinkerton's hometown of Dryden — a city of 7,400 people located 300 kilometres west of Thunder Bay — doesn't have important resources like an emergency shelter, a detox centre or a safe injection site.

Faced with that reality, Pinkerton said she'll do whatever it takes to save the lives of her community members.

"I definitely see this as a turning point. If we do not get resources in here soon, we're just going to see more and more overdoses. We're going to see a lot more death and a lot more despair."

Pinkerton has been doing this for years on a volunteer basis, but recently, she has been hired part time as a community support worker for Thunder Bay-based agency Elevate NWO.

It's part of a new program that sees people with lived experience of addiction working in small towns and cities across northwestern Ontario, building trust and offering harm-reduction supplies to users of substances, in an effort to stem the rising tide of addiction in the region.

Walking into the house she's visited dozens of times as a community support worker, Pinkerton carries a new harm-reduction tool: fentanyl test strips, which can identify the presence of fentanyl in unregulated drugs, whether they're injectable, powders or pills.

One of the people living at the house hands her a used pipe in the dimly lit living room, and Pinkerton starts measuring water using a cooker — a container used for mixing and heating drugs —  flushing the residue from the pipe into a sterile cup. After stirring, she places one end of the test strip into the mixture. One line appears.

"Oh yeah, it's definitely positive for fentanyl. So just be aware of what you're smoking," Pinkerton cautions the man before giving him a hug and leaving the bag of supplies.

The fentanyl test strips were being piloted over the summer in Dryden by the Northwestern Health Unit (NWHU).

"A couple of months ago, we had a few overdoses, so we blitzed the whole community and our community partners with making sure they knew about naloxone, where to get it, and increasing accessibility to it. The fentanyl test strips are one part of that response," said Shelly McLarty, a public health nurse in the NWHU's sexual health and harm-reduction program. 

The NWHU services 19 small municipalities and 39 First Nations across one-fifth of Ontario's land mass.

Last year, 31 people died from an opioid-related overdose across the NWHU catchment area — an 82 per cent increase compared to 2020 — according to Public Health Ontario's interactive opioid tool. On a per capita basis, the NWHU has the sixth highest opioid mortality rate out of 36 health units in the province.

The NWHU has had peer support workers on a volunteer basis for years, McLarty said, but formalizing the relationship has extended the health unit's reach into the community of people who use substances or are living with homelessness.

"We wouldn't know where to be, and how to meet them where they're at, if we didn't have the support workers to connect us with them," she said.

"Really, without them vouching that we're OK to trust, to talk to, I don't know if some of [the people who use substances] would come and talk to us or access our services," said McLarty, adding the community support workers help build trust with a population that has good reason to distrust the healthcare system.

Holly Gauvin, executive director of Elevate NWO, said research has shown people prefer to get their information from family and friends.

"They don't want to hear it from a social worker like me, they don't really want to hear it from a nurse. So our peers are the lynchpin towards a successful intervention and towards reducing harms across the north," Gauvin said.

The ultimate goal, through a larger network that connects northern AIDS service organizations and the Ontario Aboriginal HIV/AIDS Strategy, is to have a network of connected peer workers from Barrie, Ont., all the way to the Manitoba border, Gauvin said, so they can spot trends in substance use and communicate best practices.

The community support workers receive a monthly $200 honorarium for this work — an amount based on limited funding, and because any more could affect eligibility for social housing or social assistance programs, Gauvin explained.

But the burden the support workers carry is a heavy one.

Pinkerton has responded to countless overdoses over the years. In March, she witnessed her first overdose death. It happened right across the street from her home, to someone she had been building a relationship with and trying to support in recovery.

"She was dead. I knew it right from the second I walked to the house. It took a real toll on my mental health. I probably didn't get out of bed for a month afterwards. My mind was just going and going, what could I have done differently?" Pinkerton recalled.

"It ripped my heart open, it really did. My heart. My soul. It felt like all that I have been trying to do just got washed away."

It was after months of support from family, NWHU staff, her counsellor, and getting back into the community to help others that Pinkerton grieved and was able to return to her work.

Another community support worker in Dryden, Norma Machimity, said that with the encouragement of the health unit, she's had to set boundaries for when people could come to her house to pick up clean supplies.

"I had to put a stop to it, because it was affecting me. They would come at all hours of the night, and, you know, you need to rest," Machimity said. "I put a time limit. Usually by 10 p.m. I'm shutting down."She said she's also had to clarify her role to people that come to her.

"I'm not a safe injection site, which people thought I was," Machimity added.

On the front lines of Canada's small-town addictions crisis, it's everything she can't do that most frustrates Pinkerton.

"First and foremost, we have no shelter. We need a shelter. We have no detox. We should have those two resources already in place and be looking at a safe injection site at this point."

But without those in place, and no timeline to establish them, Pinkerton said she will continue doing whatever she can to save lives in her hometown.