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

Changes in supervised consumption site use and emergency interventions in Montréal, Canada in the first twelve months of the COVID-19 pandemic: An interrupted time series study

“…Barriers to service access due to pandemic-related restrictions, including closures, capacity limitations, reduced hours of operation, have been reported in many settings ( Glick et al, 2020 ; Russell et al, 2021 ; Trayner et al, 2022 ; Whitfield et al, 2020 ). In addition to these service disruptions, SCS clients may have avoided attending in order to minimise their infection risk, particularly given the underlying vulnerabilities many clients face ( Ali et al, 2020 ; Bouck et al, 2022 ). Following the large, immediate decrease in monthly SCS visits, the trend of increasing SCS visits over time continued.…”

“…In addition to aforementioned safer supply medications, national guidance promoting increased telehealth and take-home dose coverage for OAT was established following the public health emergency declaration ( CRISM, 2020 ; CDSA Exemption and Interpretive Guide for Controlled Substances, 2020 ). Positive findings have emerged from Toronto, Ontario, where the pandemic was associated with an increase in OAT enrolment and take-home doses, but not in opioid-involved overdoses ( Bouck et al, 2022 ). While we do not have data on pandemic responses that occurred in Montréal outside of SCS, people who use drugs in Canada also developed other innovations to promote safety, including “virtual spotting” or supervising drug consumption remotely over video or telephone (outside of an SCS) ( Perri et al, 2021 ).…”

Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review

“…Most providers became more comfortable prescribing take-homes after observing little or no increase in diversion, overdose, or other adverse events. This perception is broadly supported by a rapidly growing body of literature on client outcomes (e.g., Amram et al, 2021 ; Bouck et al, 2022 ; Corace et al, 2022 ; Ezie et al, 2022 ; Garg et al, 2022 ; Lintzeris et al, 2022 ). Though the impact of supervised dosing on diversion and client health outcomes has been examined in previous systematic reviews, findings have been inconclusive ( Hov et al, 2016 ; Saulle et al, 2017 ).…”

“…To this end, the objective of this systematic review was to synthesize the evidence on providers’ experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. Though there is a substantial body of research examining the impact of COVID-19-related changes to substance use treatment (e.g., Bouck et al, 2022 ; Garg et al, 2022 ; Krawczyk et al, 2022a ; Lintzeris et al, 2022 ; May et al, 2022 ), this is, to our knowledge, the first systematic review of international scope to focus on providers’ experiences. Knowledge of these experiences is necessary to understand the effects of increased flexibility in prescribing take-home medications for opioid use disorder during COVID-19, to explain differences in the uptake of regulatory changes, and to inform post-pandemic policies and guidelines.…”

Trends in Rates of Opioid Agonist Treatment and Opioid-Related Deaths for Youths in Ontario, Canada, 2013-2021

“…In response to pandemic shifts in health care delivery, a number of changes in the delivery of care may have affected access to OAT. Some studies in Canada and in other jurisdictions have demonstrated increased access to OAT related to implementation of virtual care services for OUD, increase in take-home doses and home delivery of medications, and reduced urine drug screening requirements, among other measures. Some of these pandemic-related changes were also associated with lower rates of treatment interruption and discontinuation .…”