Implementation of Safe Supply Alternatives During Intersecting COVID-19 and Overdose Health Emergencies in British Columbia, Canada, 2021

Abstract

Objectives. To explore the implementation and effectiveness of the British Columbia, Canada, risk mitigation guidelines among people who use drugs, focusing on how experiences with the illicit drug supply shaped motivations to seek prescription alternatives and the subsequent impacts on overdose vulnerability. Methods. From February to July 2021, we conducted qualitative interviews with 40 people who use drugs in British Columbia, Canada, and who accessed prescription opioids or stimulants under the risk mitigation guidelines. Results. COVID-19 disrupted British Columbia’s illicit drug market. Concerns about overdose because of drug supply changes, and deepening socioeconomic marginalization, motivated participants to access no-cost prescription alternatives. Reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market while allowing greater agency over drug use. Because prescriptions were primarily intended to manage withdrawal, participants supplemented with illicit drugs to experience enjoyment and manage pain. Conclusions. Providing prescription alternatives to illicit drugs is a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply, yet further optimizations are needed. (Am J Public Health. Published online ahead of print March 8, 2022: e1–e8. https://doi.org/10.2105/AJPH.2021.306692 )

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

“…Socioeconomic instability due to decreased income generation opportunities, and shifting drug markets due to changes in global drug trafficking [ 14 ], may also exacerbate vulnerability among PWUD, both indirectly, by affecting drug use patterns, and directly, through increased risk of overdose from contaminated or increasingly potent supplies [ 37 – 39 ]. Preventing harms, both in the immediate wake of Big Events and in the longer term, requires continued operation and funding of harm reduction services and monitoring of the drug supply, including through scale-up of drug checking services [ 40 ], which were accessed by a limited number in our sample. The pandemic has been a window of opportunity to implement and evaluate innovative responses such as providing a safe supply of pharmaceutical drugs [ 40 , 41 ], and adopting flexible OAT dispensation regimens, both of which reduce exposure to the illicit supply (and the costs and contaminants associated with it) [ 42 ].…”

“…Preventing harms, both in the immediate wake of Big Events and in the longer term, requires continued operation and funding of harm reduction services and monitoring of the drug supply, including through scale-up of drug checking services [ 40 ], which were accessed by a limited number in our sample. The pandemic has been a window of opportunity to implement and evaluate innovative responses such as providing a safe supply of pharmaceutical drugs [ 40 , 41 ], and adopting flexible OAT dispensation regimens, both of which reduce exposure to the illicit supply (and the costs and contaminants associated with it) [ 42 ]. It is important that the knowledge generated during this time be translated into progressive policies for the longer term.…”

Responding to Ontario’s Overdose Crisis in the Context of the COVID-19 Pandemic

“…For example, during the pandemic, there has been increased availability of safer opioid supply programs (wherein an opioid, usually hydromorphone, is prescribed as an alternative to the unregulated drug supply) (Government of Canada 2020) and more flexible provision of opioid agonist therapy (OAT) (Lam et al 2020;SAMHSA 2021). Early evaluations of these changes have demonstrated the benefits of these pandemic-related responses, including reduced overdose risk and improved retention in OAT (Gomes et al 2022b;McMurchy and Palmer 2021;McNeil et al 2022). This is reinforced by data from Ontario that showed a reduction in the prevalence of hydromorphone and methadone in deaths due to opioid toxicity during the pandemic (Table 1).…”

Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario

“…Emerging qualitative and program evaluation research highlights how clients in SOS programs attribute access to safer supply medications as being responsible for stabilizing their patterns of drug use and improving their health by reducing their use of drugs from the unregulated street supply (thereby reducing overdose risk) and, in some cases, reducing drug use overall or ceasing the use of drugs by injection. 16,28 There is likely strong benefit to the provision of comprehensive programming that includes SOS prescribing alongside comprehensive health and social supports to a high-risk population, and the relative contribution of different program elements to client outcomes is an important topic for future research.…”