Identifying the impacts of the COVID-19 pandemic on service access for people who use drugs (PWUD): A national qualitative study

Abstract

Introduction: Closures and reductions in capacity of select health and social services in response to the COVID-19 pandemic may have placed people who use drugs (PWUD) at a disproportionately increased risk for experiencing harms, and resulted in critical treatment disruptions. We conducted the current national study among a cohort of PWUD to understand how COVID-19 has affected service access, including any significant impacts PWUD may have experienced. Results will contribute to the evidence base for informing future pandemic and public health policy planning for vulnerable populations. Methods: The project involved qualitative telephone-based interviews with 196 adult (aged 18+) PWUD from across Canada. Eligibility criteria included daily or weekly use of psychoactive substance(s), and/or current enrollment in opioid agonist treatment (OAT). Data collection took place between May and July 2020. Data underwent thematic analyses, and common themes informed the results. Results: Most participants experienced detrimental service access issues and treatment disruptions during COVID-19, including reduced access to harm reduction services, OAT, withdrawal management and treatment services, medical professionals (e.g., addictions and mental health counseling), shelters/housing, and food banks. Positive impacts included greater access to OAT take-home 'carries' and prescription deliveries. Decreases in service capacity resulted in increased health issues and risky substance use behaviors among PWUD, such as unaccompanied substance use, sharing/re-use of supplies, and overdose events. Conclusions: Reductions in the accessibility of critical services PWUD rely on during COVID-19 has increased existent substance use and health issues among PWUD, while decreasing their ability to mitigate risks related to substance use. Thus, the expansion of the depth and breadth of support options is crucial. Services must remain open and flexible to the unique needs of PWUD during COVID-19, while novel and effective adaptations and interventions should remain available and accessible post-COVID-19. ☆ In collaboration with the Canadian Research Initiative in Substance Misuse (CRISM) National Research Team.

Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study

“…Our results are similar to COVID-19-related changes in drug use and outcomes reported elsewhere [5,6,[18][19][20]. Some participants discussed changes in the kind of substances they use and their purchasing habits using during COVID-19 due to border closures, inability to access certain drugs, or changes in drug prices, which was previously anticipated [5].…”

“…Some participants discussed changes in the kind of substances they use and their purchasing habits using during COVID-19 due to border closures, inability to access certain drugs, or changes in drug prices, which was previously anticipated [5]. Many participants accessed supervised consumption and overdose prevention sites less frequently due to closures or long wait times as a result of physical distancing requirements, consistent with prior research [5,6,19,20]. Our results suggest that physical distancing recommendations and the inability to access safe spaces has created situations where individuals used drugs less safely.…”

Living Under Coronavirus and Injecting Drugs in Bristol (LUCID-B): A qualitative study of experiences of COVID-19 among people who inject drugs

“…This may be due to rapid changes to assertive outreach and NSP home delivery, which were well received and cited as addressing barriers to accessing equipment in pharmacies. These changes may have reduced accessibility issues which have emerged in recent North American research ( Russell et al, 2021 ). Research from jurisdictions where NSP home delivery was not possible identified this as a barrier to treatment access ( Seaman et al, 2021 ).…”

The Impact of the COVID-19 Pandemic on Opioid-Related Harm in Ontario

“…28 For example, prescribers were given increased discretion to provide extended takehome supplies ('carries') of OAT medications and permitted to prescribe OAT over the phone. 29 These measures improved OAT continuity and, despite initial concerns of sharing or improper dosing of OAT medications, there is no evidence that they increased the risk of harm to patients or communities. 30 Use a harm reduction approach to OAT by relaxing entry and management criteria.…”

“…17 These changes may impact PWUD in several ways including reduced tolerance due to an inability to access opioids or using unregulated fentanyl that also contains nonprescription benzodiazepines. 29,37 A strong evidence base for injectable OAT exists and programs are currently available in three provinces. 32,38 High dose injectable hydromorphone is currently not covered by the Ontario Drug Benefit, and adding it to the formulary would increase available treatment options.…”