Safer opioid distribution in response to the COVID-19 pandemic

Abstract

COVID-19 has turned the world upside down in a very short period of time. The impact of COVID-19 will disproportionately effect people who are least able to protect themselves and this will include people who use drugs. The arrival of the COVID-19 pandemic comes at time when North America is in the midst of a protracted overdose epidemic caused by a toxic illegal drug supply. Overdose deaths are likely to rise when people are isolated, social support programs are cut back, and the illicit drug supply is further compromised. Safer opioid distribution in response to a toxic street drug supply is a pragmatic and effective way to reduce overdose deaths. COVID-19 makes such an approach even more urgent and compelling.

COVID-19 and the health of people who use drugs: What is and what could be?

“…Overdose-related harms in many settings, including in parts of North America, have occurred as a result of the increase in fentanyl and fentanyl analogues creating an unsafe drug supply ( Beletsky & Davis, 2017 ). In this special issue, Tyndall (2020) argues that providing access to a safer supply of opioid drugs is a critical, yet often overlooked, strategy to reducing overdose and creating an environment enabling safer drug use. In response to COVID-19, the British Columbia Centre for Substance Use provided guidelines to support clinicians willing to provide pharmaceutical-grade opioids for people with COVID-19 or at risk of exposure, including hydromorphone tablets or long-acting morphine capsules for opioid dependency, dextroamphetamine or methylphenidate for stimulant dependency and nicotine patches for nicotine dependence ( BCCSU, 2020 , Tyndall, 2020 ).…”

“…In this special issue, Tyndall (2020) argues that providing access to a safer supply of opioid drugs is a critical, yet often overlooked, strategy to reducing overdose and creating an environment enabling safer drug use. In response to COVID-19, the British Columbia Centre for Substance Use provided guidelines to support clinicians willing to provide pharmaceutical-grade opioids for people with COVID-19 or at risk of exposure, including hydromorphone tablets or long-acting morphine capsules for opioid dependency, dextroamphetamine or methylphenidate for stimulant dependency and nicotine patches for nicotine dependence ( BCCSU, 2020 , Tyndall, 2020 ). However, a major barrier has been the lack of physicians willing to prescribe and take on the liability for these medications ( Tyndall, 2020 ).…”

Striving toward hepatitis C elimination in the era of COVID-19

“…Although governments are rightfully focused on controlling transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), marginalized populations struggle to maintain access to harm reduction and drug treatment services (5)(6)(7)(8). Beyond interfering with HCV elimination efforts, the pandemic may, through increased inequity and changes to social service and community support structures, exacerbate existing challenges faced by these groups, including stigma and discrimination, overdose risk, comorbidities, poverty, precarious housing, and domestic violence (9)(10)(11)(12). Recent increases in overdose-related deaths in North America reflect this reality (13)(14)(15).…”

Applying the lessons of COVID-19 response to Canada's worsening opioid epidemic

“…The Canadian COVID-19 response has been lauded at home and internationally for its early success in flattening the COVID-19 "curve." At the same time, the opioid response is receiving increasing criticism from public health experts [3]. In the province of British Columbia (BC), the epicentre of the opioid epidemic and where an opioid overdose public health emergency was declared in 2016, more than 5800 lives have been claimed, largely due to the presence of fentanyl and other synthetic opioid analogues in the illicit drug supply, which are highly potent and can easily lead to overdose [4].…”

“…Two policy interventions that would have an immediate impact and save lives, but have not been broadly implemented, are the decriminalization of personal use of drugs and the provision of a "safe supply" of legal and regulated pharmaceutical-grade drugs. 3 These policy interventions are supported by high-ranking health officials, including BC's Provincial Health Officer and Chief Coroner, but continue to face legal and regulatory barriers that prevent them from being widely available. A more significant barrier has been politicians and decision-makers, who are reticent to implement these policies despite mounting death tolls.…”