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. 2022 Jul 14;19(1):77.
doi: 10.1186/s12954-022-00657-x.

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

Karen McCrae  1 , Stephanie Glegg  1 , Marie-Éve Goyer  2 , Bernard Le Foll  3   4   5   6   7   8 , Rupi Brar  9   10 , Christy Sutherland  11   9 , Nadia Fairbairn  12   13
Affiliations

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19

Karen McCrae et al. Harm Reduct J. .

Abstract

Background: The dual COVID-19 and overdose emergencies amplified strain on healthcare systems tasked with responding to both. One downstream consequence of the pandemic in the USA and Canada was a surge in drug overdoses resulting from public health-restricted access to services and an increasingly toxic unregulated drug supply. This study aimed to describe changes implemented by programs prescribing pharmaceutical alternatives to the drug supply during the early stages of the COVID-19 pandemic.

Methods: An environmental scan used surveys and qualitative interviews with service providers across Canada to examine pharmaceutical alternative prescribing practices and programs before and during the pandemic. This study summarized the nature, frequency, and reasons for pandemic-driven service delivery changes using directed content analysis, counts, and thematic analysis.

Results: Eighty-two of the 103 participating sites reported 1193 unique changes in physical space (368), client protocols (347), program operations (342), ancillary services (127), and staffing (90). Four qualitative themes describing the reasons for these changes emerged, namely (1) decreasing risk of COVID-19 infection; (2) decreasing risk of overdose; (3) prioritizing acute care of COVID-19 patients; and (4) improving client access to treatment.

Conclusions: While most changes were aimed at decreasing risk of COVID-19 infection, some were found to be at odds with the measures needed to combat the overdose crisis; others met dual objectives of decreased risk of both overdose and infection. Further research should examine which changes should be kept or reversed once COVID-19-related public health measures are lifted.

Keywords: COVID-19 pandemic; Canada; Harm reduction; Injectable opioid agonist treatment; Safe supply; Substance use.

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Conflict of interest statement

Dr. Le Foll has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. Dr. Le Foll has some in-kind donation of cannabis product from Aurora and medication donation from Pfizer and Bioprojet and was provided a coil for TMS study from Brainsway. Dr. Le Foll has obtained industry funding from Canopy (through research grants handled by Centre for Addiction and Mental Health [CAMH] or University of Toronto), Bioprojet, American Chemical Society (ACS) and Alkermes. Dr. Le Foll has received in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and the National Institutes for Health (NIH). He has been consultant for Shionogi. No other authors have relevant financial or non-financial interests to disclose.

References

    1. Ahmad F, Rossen L, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics; 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
    1. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; 2021. https://health-infobase.canada.ca/src/doc/SRHD/UpdateDeathsSep2021.pdf.
    1. Health Canada. Government of Canada helping expand access to safer supply across Canada. 2021. https://www.canada.ca/en/health-canada/news/2021/06/government-of-canada....
    1. Ahamad K, Bach P, Brar R, Chow N, Coll N, Compton M, et al. Risk mitigation in the context of dual health emergencies v1.5. Vancouver: British Columbia Centre on Substance Use; 2020. p. 25.
    1. Brar R, Bruneau J, Goyer M, Lim R, Poulin G, Sereda A, et al. Medications and other clinical approaches to support physical distancing for people who use substances during the COVID-19 pandemic: National Rapid Guidance Document. Vancouver: CRISM; 2020. https://crism.ca/wp-content/uploads/2020/06/CRISM-Guidance-Medications-a....

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