“It’s just a perfect storm”: Exploring the consequences of the COVID-19 pandemic on overdose risk in British Columbia from the perspectives of people who use substances

Abstract

Background Despite the implementation and expansion of public health and harm reduction strategies aimed at preventing and reversing overdoses, rates of overdose-related events and fatalities continue to rise in British Columbia. The COVID-19 pandemic created a second, concurrent public health emergency that further exacerbated the illicit drug toxicity crisis, reinforced existing social inequities and vulnerabilities, and highlighted the precariousness of systems in place that are meant to protect the health of communities. By exploring the perspectives of people with recent experience of illicit substance use, this study sought to characterize how the COVID-19 pandemic and associated public health measures influenced risk and protective factors related to unintentional overdose by altering the environment in which people live and use substances, influencing the ability of people who use substances to be safe and well. Methods One-on-one semi-structured interviews were conducted by phone or in-person with people who use illicit substances (n = 62) across the province. Thematic analysis was performed to identify factors shaping the overdose risk environment. Results Participants pointed to factors that increased risk of overdose, including: [1] physical distancing measures that created social and physical isolation and led to more substance use alone without bystanders nearby able to respond in the event of an emergency; [2] early drug price spikes and supply chain issues that created inconsistencies in drug availability; [3] increasing toxicity and impurities in unregulated substances; [4] restriction of harm reduction services and supply distribution sites; and [5] additional burden placed on peer workers on the frontlines of the illicit drug toxicity crisis. Despite these challenges, participants highlighted factors that protected against overdose and substance-related harm, including the emergence of new programs, the resiliency of communities of people who use substances who expanded their outreach efforts, the existence of established social relationships, and the ways that individuals consistently prioritized overdose response over concerns about COVID-19 transmission to care for one another. Conclusions The findings from this study illustrate the complex contextual factors that shape overdose risk and highlight the importance of ensuring that the needs of people who use substances are addressed in future public health emergency responses.

The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis

“…Although settings across the United States and Canada have witnessed sharp increases in drug poisoning deaths since the onset of the pandemic which have been attributed to COVID-19 infection control measures and related service access restrictions [ 15 , 21 , 44 ], we found that a majority of participants across all three cities reported no change in their frequency of experiencing non-fatal overdose during the pandemic. This may be explained by several reasons.…”

“…Combined with increased socioeconomic precarity and disruption in access to essential services, such stressors may have been in part responsible for the observed increase in overall drug use among some participants as a means to cope or self-medicate. Other qualitative studies have documented similar reasons for increases in drug use among people who use drugs during the pandemic including concerns related financial uncertainty, fear of catching COVID-19, and boredom associated with job loss and isolation from one’s family and friends [ 14 , 15 , 21 , 25 ]. In Toronto and Montreal, we further observed that approximately one-third to two-fifths of participants reported experiencing physical violence, witnessing violence, and feeling threatened or unsafe more often than usual during the pandemic.…”

“…The City of Vancouver implemented a number of measures to deliver essential services to its residents, including emergency response centres for people experiencing homelessness, increased provision of hygiene services and supplies, enhanced access to basic needs services, and safer options for Income Assistance disbursement [ 29 ]. Harm reduction and drug treatment services continued operation across the city, with capacity restrictions or adaptations to comply with public health guidelines for physical distancing [ 21 ].…”

“…If we are to establish robust and equitable preparedness strategies prior to and during such emergencies it is imperative to examine the varied ways in which the COVID-19 pandemic and associated public health responses may have contributed to the exacerbation of drug poisoning deaths, and understand the influence of measures that sought to mitigate impacts on people who use drugs (e.g., makeshift temporary shelters, relaxed eligibility criteria for take-home doses of opioid agonist therapies). While some Canadian studies have examined the health-related and behavioural impact of the COVID-19 pandemic on people who use drugs [ 16 , 21 – 24 ], few studies have compared the experiences people who use drugs across jurisdictions [ 16 , 25 ]. In the Canadian context, the administration and provision of health services–including harm reduction, treatment, and wrapround supports for people who use drugs–fall under the primary responsibility of provinces and territories [ 26 ].…”

Recent and lifetime maternal substance use: Rurality and economic distress

“…The opioid epidemic is dynamic; conclusions from one rural site several years ago may not generalize to another rural site more recently, especially because local economic conditions vary across the large swath of rural landmass. The opioid epidemic is also chaotic; there are concerns about toxicity of unregulated substances due to fentanyl contamination, with an increase in related fatal overdose cases from 5% in 2012 to 90% in 2018 (Foreman-Mackey et al, 2023;Hu et al, 2022).…”