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

Abstract

The Ontario COVID-19 Science Advisory Table is a group of scientific experts and health system leaders who evaluate and report on emerging evidence relevant to the COVID-19 pandemic, to inform Ontario's response. Our mandate is to provide weekly summaries of relevant scientific evidence for the COVID-19 Health Coordination Table of the Province of Ontario, integrating information from existing scientific tables, Ontario's universities and agencies, and the best global evidence. The Science Table summarizes its findings for the Health Coordination Table and the public in Science Briefs.The Mental Health Working Group comprises scientific experts and public health leaders with specific expertise in mental health. Their expertise spans mental health of children and youth, adults and geriatric populations, mental health of health care providers, women's health, mental health among LGBTQ persons, mental health among Black, Indigenous, and other racialized populations, and COVID-19. The Working Group evaluates emerging scientific evidence related to maintaining mental health during COVID-19, the mental health burden of disease and public health interventions on individuals across the lifespan, including children and adolescents, and the older adult population, as well as the need for assessment and recommendations

Evaluating interventions to facilitate opioid agonist treatment access among people who inject drugs in Toronto, Ontario during COVID-19 pandemic restrictions

“…Before the COVID-19 pandemic, only stabilized OAT patients who regularly attended daily observed doses over a sufficient period (typically ≥2 months) and routinely cleared urine drug screening (to rule out other opioid use) could receive days’ to weeks’ worth of take-home (non-observed) methadone or buprenorphine/naloxone doses per dispensation ( Eibl et al, 2017 ; Government of Ontario, 2018 ). However, during the pandemic, compliance with provincial COVID-19 emergency orders and public health guidelines by OAT dispensaries could result in reduced operating hours, reduced capacity, or temporary closures (e.g., due to outbreaks), thereby hindering treatment access at these sites ( Canadian Centre on Substance Use and Addiction, 2020 ; Friesen et al, 2021 ; Nguyen & Buxton, 2021 ). Even without such service interruptions, Ontarians with opioid use disorder may be deterred from initiating or maintaining OAT during the pandemic to mitigate their risk of SARS-CoV-2 infection or transmission, as treatment requires regular in-person clinical encounters ( Eibl et al, 2017 ; Government of Ontario, 2018 ).…”

Changes in mortality for the general population and individuals with pre-pandemic acute care for alcohol or opioids during the COVID-19 pandemic in Ontario, Canada

“…pandemic-related stressors and disruptions in treatment access and supportive services, particularly at the start of the pandemic) may have contributed to these trends. 2 Furthermore, individuals with SUDs are a marginalized population that may have been more vulnerable to the social and economic pressures associated with the COVID-19 pandemic than the general population. 4 …”

“…Rates of alcohol- and opioid-related harms, including emergency department (ED) visits, hospitalizations, and deaths caused by alcohol or opioids, have increased since the beginning of the pandemic. 1 , 2 It has been hypothesized that these increases in harms were driven by increased substance use by individuals with a prepandemic alcohol-use disorder (AUD) or opioid-use disorder (OUD) rather than by greater substance use during the pandemic in the general population. 3 , 4 Despite the face validity of these concerns, there is limited data on changes in mortality for individuals with prepandemic substance use disorders (SUDs).…”

The brave new world of pandemic resilience

“…Furthermore, closing schools and businesses to in person gatherings can have a differential impact among people in a community and likely widen already existing inequities. Studies have hinted at possible increases, likely due, in part, to stresses of lockdown and the existential threat of infection, in body mass 11 (which, for example, may increase the incidence of heart disease, vascular disease, and diabetes), alcohol intake (which may lead to increases in cancer and heart disease), 12 , 13 intimate partner violence, 14 mental health burden, 15 , 16 and drug overdose 17 over the course of the pandemic. We also saw the delay or cancellation of medical procedures 18 —what impact that may have on long‐term outcomes for those patients is not yet clear.…”