Evaluation of innovative risk mitigation services in the context of dual crises of COVID‑19 and overdose among people who use opioids in Vancouver, BC
The province of British Columbia (BC) has been praised for having successfully flattened the curve of novel coronavirus infections early. However, this is in stark contrast with the status of its opioid overdose crisis, another health emergency plaguing BC since 2016. In May 2020, BC recorded 170 overdose deaths, which was the highest number ever recorded for a single month in Canadian history. COVID-19-related public health measures have been expected to pose significant challenges to addressing the overdose crisis that is primarily driven by the toxic illicit drug supply. Physical distancing measures risk interrupting access to key overdose prevention services, particularly opioid agonist therapies (OAT) for people with opioid use disorder. Border closures risk straining traditional illicit drug supplies (e.g., heroin), making the illicit drug market more toxic. In response, BC rapidly initiated a series of innovative measures to address the dual crises of COVID‑19 and overdose. Specifically, OAT prescription guidelines have been expanded to encourage OAT prescribers to consider a range of means (e.g., take-home doses, medication delivery) to prevent disruption of OAT. Additionally, pandemic prescribing allowed physicians and nurse practitioners to prescribe certain pharmaceuticals (e.g., opioids) to people who use illicit drugs. By providing pharmaceutical alternatives to the toxic illicit drug supply, the interventions are intended to reduce physical encounters involved in obtaining illicit drugs and the use of toxic street drugs, thereby supporting both overdose and COVID‑19 prevention efforts. To date, however, the impacts of these innovative interventions have not been evaluated. Our proposed research aims to fill critical knowledge gaps by examining the reach and impacts of pandemic prescribing and expanded OAT prescription services. Through this work, we seek to inform efforts to improve the delivery and effectiveness of the interventions.