Physicians and harm reduction workers say the need for a safer opioid supply as a way to curb overdose deaths is even more urgent now in the midst of the COVID-19 pandemic.
“If safe supply were something that was readily available to people who use drugs, it would drastically increase their ability to stay put and stay in place, wherever they deem their home to be,” said Andrea Sereda, a family physician at the London InterCommunity Health Centre in London, Ont.
She has been prescribing hydromorphone pills since last year to more than 100 patients who relied on illegal street opioids and were at risk of overdosing.
There were more than 14,700 opioid-related overdose deaths in Canada from 2016 to 2019, most of which were non-pharmaceutical fentanyl or a fentanyl analogue.
Sereda’s program — and a number of other programs like it across Canada that are part of the safe supply movement — has been successful at preventing people from overdosing and dying from the increasingly toxic illicit supply, and also helping them access stable housing and other health supports.
Sereda is part of a growing chorus of front-line workers who say this type of prescribing needs to be ramped up to help people who rely on the street supply in order to protect them from the spread of COVID-19 and also mitigate the increased risks of using street opioids alone.
“Having a safe supply for people who choose to continue using drugs would give them the ability to stay in place,” Sereda said. “Then they’re not out seeking their drug dealer. They’re not having that interaction with their drug dealer multiple times a day. They’re not out panhandling, doing sex work to acquire the medication that they then go home to use.”
Last year, Health Canada commissioned a group of experts to look into developing and funding pilot projects aimed at providing access to “pharmaceutical-grade medications as an alternative to the contaminated illegal drug supply.”
Details on which programs will receive funding for this won’t be made public until the agreements are signed, a Health Canada spokesperson told Global News earlier this month.
There’s also a lot of uncertainty about how the new restrictions at the U.S.-Canada border and reduced ability of movement are going to affect the street supply and possibly make it even more volatile.
“It could mean that there’s less street drug supply. It could mean that the cutting agents change. It could mean that the potency changes. It could just mean that none are available. We don’t know yet how that’s going to roll out other than to expect the unexpected,” Sereda said.
Zoë Dodd, a harm reduction worker with the Toronto Overdose Prevention Society, has long called for drug decriminalization and a safer, pharmaceutical supply as a way to help mitigate the overdose crisis she says has been getting even worse. The city saw a significant spike in overdoses in February alone, she said.
“We’re just not prepared,” Dodd said, “because we are always in a reactive position and we have all of these concurring crises happening” — like the ongoing overdose, the housing crisis and now COVID-19.
“The drug supply has just gotten incredibly toxic, and there’s deep concerns about people dying and dying alone at home. And without us knowing, because many of the programs that they access aren’t open.”
Sereda and Dodd would also like to see prescribers who work with patients who use opioid substitution drugs like methadone or Suboxone to consider ways they could allow patients to take more doses home, known as “carries,” instead of having to come into a clinic or pharmacy daily to get their doses. These types of substitution drugs, also referred to as opioid agonist treatment, help reduce cravings for opioids and withdrawal symptoms.
“There’s a real problem with people getting quarantined or isolated who can’t get access to their opiate substitution therapy,” Dodd said. “Doctors are rigid about giving people carries … they need to be flexible at this time with buprenorphine, Suboxone and with methadone.”
This week, Health Canada released a letter providing guidance for health-care providers and prescribers who are currently treating people with substance use disorders and chronic pain. It urged government ministries and regulators to “conduct a thorough assessment of any barriers to access to medicines that could contravene public health advice for social distancing and self-isolation, when appropriate.”
This could include “temporarily lifting restrictions on take-home doses (‘carries’) of opioid agonist treatments and allowing those with chronic conditions to obtain enough medication to last through a period of self-isolation.”
Sereda said nearly everyone who accesses her program has a prescription that is dispensed daily, meaning patients go to the pharmacy every day to pick up their hydromorphone doses and then take them home.
“Instead of coming out for six, eight times a day to access the meds that they need to inject throughout the day, they’re coming out once a day. So it’s still a risk reduction,” she said.
But as COVID-19 is prompting stringent social-distancing measures, Sereda said she and her colleagues are discussing whether there are some patients in the program who might be eligible to take home more of their doses so that they wouldn’t need to go to the pharmacy every day.
“We have not yet made any changes. Everybody is still on daily dispense. But we will need to consider, as the situation with COVID evolves, where the greater risk lies.”
Dodd also pointed out that a lot of social services, such as drop-ins and meal programs, have closed, leaving people with fewer points of contact with the community and support systems.
“This whole idea of social distancing is a risk of overdose for people . And then people being communal is a risk of COVID,” Dodd said.
“It would be great for people to be able to get a safer supply at this time, and it would be great if we could figure out a way to make sure that people have social supports. To be honest, I don’t know what the solution is to this yet.”
Questions about COVID-19? Here are some things you need to know:
Health officials say the risk is low for Canadians but warn this could change quickly. They caution against all international travel. Returning travellers are asked to self-isolate for 14 days in case they develop symptoms and to prevent spreading the virus to others.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. And if you get sick, stay at home.
For full COVID-19 coverage from Global News, click here.
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