“It is devastating to see that the COVID-19 outbreak has worsened the situation for Canadians struggling with substance use disorders, including those living in Ontario. … Life-saving initiatives … are part of the Government’s efforts to help people at risk of overdose in Ontario stay safe during the outbreak and find access to care and treatment for substance use disorder.”
– The Honourable Patty Hajdu
Canadian Minister of Health
The COVID-19 pandemic has impacted Canadians all across the country, in a multitude of different ways. Beginning March 17th of 2020, the province of Ontario declared a state of emergency, resulting in the enforcement of social distancing practices and reduced access to many public spaces. While the provincial lockdown has shown to be effective for diminishing the impact and spread of COVID-19, it may have harmful effects on individuals with substance use disorders (SUDs).
Even in pre-pandemic times, people suffering from SUDs had less access to health care services and higher rates of homelessness and housing insecurity. Now, in the current pandemic state with many hospitals and various health care settings at full or reduced capacity aiding those infected with COVID-19, the stigma placed on people with SUDs and addiction may increase the barriers to receiving basic healthcare or even COVID-19 treatment. Individuals that lack housing security may be forced to find accommodations in environments that do not allow for social distancing, increasing their personal risk but also putting others at risk of being infected with COVID-19.
Canada has implemented many harm reduction strategies with the purpose of helping those with SUDs; however, public health control measures in Ontario and across Canada have limited the functional capacity of direct services to people who use drugs. Specifically, direct services including homeless shelters, outreach programs, residential treatment centres, needle exchange programs, drug checking services and safe injection sites have all faced issues concerning reduced capacity limits, decreased number of volunteers and staff, and shorter hours. This has severe impacts on the individuals seeking to use these services as treatment methods or to prevent the occurrence of adverse drug side effects and contamination of equipment leading to infection. In Ontario, this has caused an increase in the number of people suffering through withdrawal without proper support and a higher number of drug poisonings and overdoses.
Not only has COVID-19 affected access to harm reduction facilities, it has also drastically altered the Canadian illicit drug supply. The closure of the Canadian border has resulted in smaller amounts of drugs entering the country, leading to drug shortages and a higher consumer demand. The increase in illegal drug production within Canada in response to the high demand not being met has changed the quality and composition of the drugs currently available for illicit use. In some regions, the increased demand for illegal drugs has caused dealers to increase their price – this has commonly been referred to as the “COVID tax”, blamed on the increased danger of producing and selling drugs during the pandemic. Other regions have seen diluted drugs being sold with less of the active drug ingredient yet at the same or even increased price. Also, social distancing regulations may result in local dealers becoming less available or turning customers away, causing them to buy from new and unfamiliar sources. These incidents, along with the other complications of drug use during the pandemic, have caused many people to attempt making their own drugs or to alter their drug of choice. Both of those choices can have serious health implications for the individual, including, but not restricted to, increased risk of explosion, unintentional contamination with unknown substances and adverse drug interactions leading to a higher chance of overdose.
In response to the increased risk of drug use during the COVID-19 public health emergency, temporary exemptions were made to the Controlled Substances Act on March 19th, 2020:
- Prescribers have been authorized to refill or extend prescriptions verbally (over the phone of video call) for controlled substances eg. hydromorphone, stimulants, benzodiazepines
- Pharmacists have been permitted to extend prescriptions for controlled substances and transfer prescriptions to other pharmacies
- Pharmacy employees are allowed to deliver controlled substances to the home of the patient or other necessary locations
Other possible strategies for increasing the safety for drug users during the COVID-19 pandemic could include harm reduction responses such as:
- Implementation of virtual strategies to help users avoid consuming drugs alone and the increased risk of overdose being untreated
- Widespread access to naloxone or other opioid antagonists
- Onsite harm reduction and overdose prevention facilities in places such as hotels, dormitories, or community living establishments for people with addiction being housed there
- Harm reduction services should be established as essential services during the pandemic and provided with the appropriate personal protective equipment and barriers required to enforce physical distancing
Check out the video below for 7 ways for drug users to stay safe during COVID-19!
Ahamad, K. (2020). Risk Mitigation in the Context of Dual Public Health Emergencies. British Columbia Centre on Subtance Abuse. https://doi.org/10.1002/9781119549789.ch5
Canadian Community Epidemiology Network on Drug Use. (2020). Changes related to COVID-19 in the illegal drug supply and access to services, and resulting health harms, (May), 9. Retrieved from https://www.ccsa.ca/sites/default/files/2020-05/CCSA-COVID-19-CCENDU-Illegal-Drug-Supply-Alert-2020-en.pdf
Health Canada (2020, September 18). Government of Canada highlights support for safer drug supply projects in Ontario. Retrieved December 03, 2020, from https://www.canada.ca/en/health-canada/news/2020/09/government-of-canada-highlights-support-for-safer-drug-supply-projects-in-ontario.html
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The Ontario Drug Policy Research Network, The Office of the Chief Coroner for Ontario/Ontario Forensic Pathology Service, Public Health Ontario, & Centre on Drug Policy Evaluation. (2020). Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic. Retrieved from https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en