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Learning from experience: COVID-19’s impact on people with opioid use disorder

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People who use drugs (PWUD) may be more likely to contract COVID-19 and, if they do, experience more severe illness and poorer outcomes due to underlying medical conditions. People with opioid use disorder (OUD) have an even higher risk of contracting COVID-19 than people with other substance use disorders.

British Columbia is sadly home to a well-known and lengthy opioid overdose crisis. The recently released B.C. coroner’s report revealed that, in 2020, 1,728 British Columbians lost their lives to illicit drug toxicity, and in the first five months of 2021, a staggering 851 deaths could be attributed to the same cause. To put that into perspective, for the entire year of 2019, before COVID-19 hit our shores, 984 people (a huge number in itself) died due to illicit drug toxicity, highlighting the detrimental impact the virus has had on PWUD.

Dr. Andrew Kestler

Using qualitative interviews, Lexis Galarneau, a Master of Public Health student at UBC*, led a new study to understand the experiences and needs of people with OUD during the pandemic, in order to inform public health measures. The research team, which included CHÉOS Scientists Drs. Andrew Kestler and Skye Barbic and Emergency Medicine Program Head Dr. Frank Scheuermeyer, specifically focused on people who were not already receiving opioid agonist therapy (OAT) to get the perspectives of those at greatest risk for overdose and death.

The team spoke with 19 individuals with OUD, aged between 23 and 59. Everyone was aware of COVID-19 and knew about, and mostly followed, the public health measures in place.

“Our society was saturated with it. It was saturated with COVID information. I think it would be impossible to not have been aware and of what was happening and know what to do.” – Participant, 48-year-old male

The interviews revealed that COVID-19 had a significant impact on how people used drugs and peoples’ feelings toward helping others. Half of participants were buying more drugs than usual, and two-thirds thought that people could be scared to help someone experiencing an overdose.

“Many participants said they bought more or different kinds of substances than usual and more people used drugs alone due to fear of the virus.” explained Dr. Kestler, clinical associate professor at UBC’s department of emergency medicine. “This is concerning to hear since some struggled to access medical, social support, and harm reduction services, such as overdose prevention sites, due to closures or long wait times caused by physical distancing.”

In addition, many participants explained that they endured more emotional and mental suffering during the pandemic. One participant recalls feeling terrified when Vancouver shut down. “That scared me to see your whole entire city just like go dark,” she said.

When we think of COVID-19 and OUD, our minds may immediately go to the health impacts, but it’s not just health that was negatively affected. Some of the participants reported that they struggled to provide for themselves financially due to job loss, fewer public donations, and selling fewer items.

“Yeah, they’re scared to donate now. And they’re scared to buy things from us. Like, I don’t know, the way that some people support themselves, they, you know, sell things and that whole industry is collapsed basically, for those people.” – Participant, 33-year-old female

“From the perspective of people with OUD, health and social supports did not increase sufficiently during COVID-19 to offset the hardships of the pandemic,” said Dr. Kestler. “We can never predict what is going to happen in the future, and it is important that we take and learn from these findings so we can effectively help people with OUD during public health emergencies in times ahead.”

Through understanding the profound effects COVID-19 has had on the social lives and safety of people with OUD, the research team has developed some key recommendations for future public health emergencies: expand harm reduction services; maintain or enhance access to mental health care during times of uncertainty; and maintain access to social supports. The pandemic also brought to light peoples’ different care preferences; some liked virtual appointments, while others could not access virtual care in any meaningful way. Having access to virtual and in-person care services would be beneficial, whether or not a pandemic is present. Finally, providing integrated services, such as offering COVID information and vaccines at harm reduction facilities, could help improve the health and lives of people with OUD.

“Ultimately, decision-makers should involve people with OUD to support them through public health emergencies, such as COVID-19, and maintain their access to vital services,” concluded Dr. Kestler.

The study was published in PLoS One.

*Lexis was a second year Master’s student at the time of research, and this project was her practicum. Under Dr. Kestler’s supervision, Lexis conducted the interviews, performed transcription, analyses, and took the lead in writing the manuscript. She is currently a research assistant at the University of Alberta.