A mixed methods evaluation of risk mitigation measures to address the dual public health crises of COVID-19 and overdose

The COVID-19 pandemic is occurring alongside the overdose public health emergency in British Columbia (BC) with one escalating the harms of the other. The dual public health emergencies has necessitated the development and implementation of innovative response efforts to promote physical distancing and also mitigate the secondary effects of public health measures on persons who use substances (PWUS). We will conduct a mixed-method study of the risk mitigation efforts introduced to reduce COVID-19 infection among PWUS including prescription of pharmaceutical alternatives (PALS) for opioids, stimulants, benzodiazepines, and other drugs or referral to a managed alcohol program (structured dispensing/delivery of alcohol). Linked administrative health data in combination with survey and interview data collected from PWUS and health care providers will be used to: 1) Determine the impact of PALS on COVID-19 infection; non-fatal/fatal overdose; and continuity of care for SUD and concurrent health conditions among PWUS. 2) Articulate how PALS has affected the uptake of physical distancing and other public health measures introduced to reduce the spread of COVID-19 (e.g., mask wearing, hand washing, self-isolation). 3) Identify barriers and facilitators to PALS implementation based on program uptake and the perspectives of PWUS, outreach workers, prescribers and other stakeholders. This project will focus on assessing the effects of risk mitigation efforts on PWUS with an emphasis on First Nations peoples, persons with criminal justice system involvement and pregnant women. PWUS are more likely to have risk factors for severe acute respiratory syndrome and experience homelessness and income insecurity. This project will provide critical evidence to inform pandemic planning and emergency response activities at federal, provincial and local levels in advance of the Health Canada exemption expiring, expansion of PALS in other Canadian provinces, and upcoming 2020 flu season.