"COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Affiliations

¹ British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. Electronic address: stephanie.glegg@bccsu.ubc.ca.
² British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
³ Canadian Institute for Substance Use Research, Health and Wellness Building Room 273, University of Victoria, Victoria, BC V8P 5C2, Canada.
⁴ Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS B3A 1X4, Canada.
⁵ Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada.
⁶ Department of Medicine, Dalhousie University, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
⁷ Vancouver Coastal Health Authority, 801-601 West Broadway, Vancouver, BC V5Z 4C2, Canada; Department of Family Medicine, The University of British Columbia, 3(rd) Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
⁸ Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; PHS Community Services Society, 350 Columbia Street, Vancouver, BC V6A 4J1 Canada.
⁹ Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Faculty of Medicine, Institute of Medical Science, Departments of Psychiatry, Family and Community Medicine, and Pharmacology and Toxicology, University of Toronto, 250 Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada.
¹⁰ Schulich School of Medicine, Western University, Clinical Skills Building, London, ON V6A 5C1, Canada.
¹¹ Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Boulevard, QC H3T 1J4, Canada.
¹² Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 3157, Toronto, ON V5S 1A8, Canada.
¹³ Canadian Drug Policy Coalition, Simon Fraser University, 2400 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.

PMID: 35679695
PMCID: PMC9170132
DOI: 10.1016/j.drugpo.2022.103742

"COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Stephanie Glegg et al. Int J Drug Policy. 2022 Aug.

. 2022 Aug:106:103742.

doi: 10.1016/j.drugpo.2022.103742. Epub 2022 Jun 6.

Authors

Affiliations

¹ British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. Electronic address: stephanie.glegg@bccsu.ubc.ca.
² British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
³ Canadian Institute for Substance Use Research, Health and Wellness Building Room 273, University of Victoria, Victoria, BC V8P 5C2, Canada.
⁴ Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS B3A 1X4, Canada.
⁵ Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada.
⁶ Department of Medicine, Dalhousie University, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
⁷ Vancouver Coastal Health Authority, 801-601 West Broadway, Vancouver, BC V5Z 4C2, Canada; Department of Family Medicine, The University of British Columbia, 3(rd) Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
⁸ Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; PHS Community Services Society, 350 Columbia Street, Vancouver, BC V6A 4J1 Canada.
⁹ Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Faculty of Medicine, Institute of Medical Science, Departments of Psychiatry, Family and Community Medicine, and Pharmacology and Toxicology, University of Toronto, 250 Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada.
¹⁰ Schulich School of Medicine, Western University, Clinical Skills Building, London, ON V6A 5C1, Canada.
¹¹ Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Boulevard, QC H3T 1J4, Canada.
¹² Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 3157, Toronto, ON V5S 1A8, Canada.
¹³ Canadian Drug Policy Coalition, Simon Fraser University, 2400 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.

PMID: 35679695
PMCID: PMC9170132
DOI: 10.1016/j.drugpo.2022.103742

Abstract

Objectives: In the context of the ongoing overdose crisis, a stark increase in toxic drug deaths from the unregulated street supply accompanied the onset of the COVID-19 pandemic. Injectable opioid agonist treatment (iOAT - hydromorphone or medical-grade heroin), tablet-based iOAT (TiOAT), and safer supply prescribing are emerging interventions used to address this crisis in Canada. Given rapid clinical guidance and policy change to enable their local adoption, our objectives were to describe the state of these interventions before the pandemic, and to document and explain changes in implementation during the early pandemic response (March-May 2020).

Methods: Surveys and interviews with healthcare providers comprised this mixed methods national environmental scan of iOAT, TiOAT, and safer supply across Canada at two time points. Quantitative data were summarized using descriptive statistics; interview data were coded and analyzed thematically.

Results: 103 sites in 6 Canadian provinces included 19 iOAT, 3 TiOAT and 21 safer supply sites on March 1, 2020; 60 new safer supply sites by May 1 represented a 285% increase. Most common substances were opioids, available at all sites; most common settings were addiction treatment programs and primary care clinics, and onsite pharmacies models. 79% of safer supply services were unfunded. Diversity in service delivery models demonstrated broad adaptability. Qualitative data reinforced the COVID-19 pandemic as the driving force behind scale-up.

Discussion: Data confirmed the capacity for rapid scale-up of flexible, community-based safer supply prescribing during dual public health emergencies. Geographical, client demographic, and funding gaps highlight the need to target barriers to implementation, service delivery and sustainability.

Keywords: Addiction; COVID-19 pandemic; Canada; Harm reduction; Injectable opioid agonist treatment; Safer supply; Service delivery models; Substance use.

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Conflict of interest statement

Declarations of Interest Dr. Le Foll has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. Dr. Le Foll has some in-kind donations of cannabis products from Aurora, a medication donation from Pfizer and Bioprojet, was provided a coil for TMS study from Brainsway, and has been a consultant for Shionogi. Dr. Le Foll has obtained industry funding from Canopy (through research grants handled by CAMH or University of Toronto), Bioprojet, ACS and Alkermes, and in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and the National Institutes of Health (NIH). The other authors have no competing interests to declare.

Figures

Fig 1: — **Fig. 1**
Participating sites.

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References

1. Ahamad K., Bach P., Brar R., Chow N., Coll N., Compton M., Yau S. British Columbia Centre on Substance Use.; 2020. Risk mitigation in the context of dual health emergencies v1.5; p. 25. Retrieved from https://www.bccsu.ca/risk-mitigation-in-the-context-of-dual-public-healt...
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"COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Affiliations

"COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous