Identifying the Needs and Challenges of People Who Use Drugs (PWUD) During the COVID-19 Pandemic

Citation: Ali, F., Russell, C., Nafeh, F., Narkar, R., Elton-Marshall, T., Lafond, K. G., Quenneville-Dumont, M., & Rehm, J. Identifying the Needs and Challenges of People Who Use Drugs (PWUD) During the COVID-19 Global Pandemic: A National Qualitative Assessment. Toronto, Ontario: Canadian Research Initiative in Substance Misuse; October 30, 2020

Executive Summary: The global coronavirus pandemic has impacted the lives of many Canadians, including specific populations such as people who use drugs (PWUD). PWUD are at increased risk of COVID-19 infection and likely to suffer a disproportionate burden of the social, economic, and health consequences related to the current pandemic. In response to COVID-19, in March 2020, jurisdictions across Canada implemented public health measures consisting of physical distancing, closure of non-essential services and businesses, limits on social gatherings, and to self-isolate and stay at home, among other measures. These pandemic response measures have had an unintended negative impact on the health and well-being of PWUD through various mechanisms such as increased barriers to important health and social support services, disruptions in drug supply markets, and aggravated structural vulnerabilities.

Emerging literature on the impact of COVID-19 on the lives of PWUD have reported a negative impact on the overall well-being of PWUD, however, there is a paucity of systematic,
observational research examining this issue within Canada. Different levels of government and other health agencies have announced recommendations and guidelines for services utilized by PWUD during this crisis, however, there is insufficient information on the ways in which any adopted changes are truly impacting these individuals.

The present national qualitative study was undertaken to help identify and understand the issues PWUD are experiencing during the pandemic, with an overarching goal of providing recommendations and highlighting potential ways that services and systems can adapt to respond to PWUD’s most urgent needs. The qualitative study consisted of n=200 individuals across Canada participating in semistructured, one-on-one, telephone interviews with trained members of the research team between May 4, 2020-July 27, 2020. The interview guide, developed in consultation with peer advisors, focused on exploratory questions identifying the needs and challenges of PWUD during the current pandemic.

Participants in this study reported important changes to substance use, substance supply, access to critical services as well as economic, social and health-related impacts, as well as impacts related to the inability to self-isolate due to housing situation or need to access substances, medications or supports daily. Specifically, participants indicated increases in substance use during COVID-19, including relapse episodes among those who had quit using. Public health measures such as self-isolation and social distancing resulted in limiting participants’ ability to mitigate overdose risk, e.g. having to use alone in their houses without supports. Major disruptions to substance supply were also discussed, including changes in potency and quality of substances (including references to an overall toxic and heavily adulterated substance supply) and accessibility issues, combined with increases in prices which led some participants to substitute their substances, ultimately increasing risk of toxicity. To further compound these issues, participants noted that many critical substance use services such as harm reduction and treatment facilities had reduced their capacity and ability to serve clients, which resulted in negative impacts such as increases in use and decreased availability to mitigate risks due to lack of services and supports. Additionally, participants detailed numerous economic, social and health-related concerns, including a detrimental increase in mental health issues, which, in some cases led them to increase their substance use as a means of coping with the pandemic and service reductions. Importantly, many of these impacts directly contributed to an increased risk for experiencing harms related to substance use, such as fatal and non-fatal overdoses.

These findings, in conjunction with specific services suggested by participants, warrant the need for accessible mental health and substance use supports for PWUD during the pandemic. Service providers should collaborate with PWUD to develop alternative solutions to continue providing services while also practicing public health pandemic measures. Most importantly, the increased harms associated with substance use described by participants during COVID-19 serves as a clear indication that specific harm-reduction services, such as supervised consumption services and/or outreach services, need to continue to operate and a reduced capacity of service operationalization will not be adequate to respond to the needs of PWUD during these times. With regards to changes to supply, it is imperative that PWUD have access to a non-toxic, safe drug supply. Safe supply was endorsed by the majority of participants, due to the need for a reliable, pharmaceutical grade supply of their substance(s) which would work to reduce harms and risks related to use. Access to take home naloxone and drug testing kits is also of significant importance when dealing with a potentially contaminated drug supply. As such, participants expressed that the government may consider this important health challenge to consider providing the supports that are needed by PWUD to reduce the risks associated with substance use, including the implementation of safe supply across the country.