“COVID just kind of opened a can of whoop-ass”: The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada

Stephanie Glegg, Karen McCrae, Gillian Kolla, Natasha Touesnard, Jeffrey Turnbull, Thomas D. Brothers, Rupinder Brar, Christy Sutherland, Bernard Le Foll, Andrea Sereda, Marie Ève Goyer, Nanky Rai, Scott Bernstein, Nadia Fairbairn

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53 Citas (Scopus)

Resumen

Objectives: In the context of the ongoing overdose crisis, a stark increase in toxic drug deaths from the unregulated street supply accompanied the onset of the COVID-19 pandemic. Injectable opioid agonist treatment (iOAT – hydromorphone or medical-grade heroin), tablet-based iOAT (TiOAT), and safer supply prescribing are emerging interventions used to address this crisis in Canada. Given rapid clinical guidance and policy change to enable their local adoption, our objectives were to describe the state of these interventions before the pandemic, and to document and explain changes in implementation during the early pandemic response (March–May 2020). Methods: Surveys and interviews with healthcare providers comprised this mixed methods national environmental scan of iOAT, TiOAT, and safer supply across Canada at two time points. Quantitative data were summarized using descriptive statistics; interview data were coded and analyzed thematically. Results: 103 sites in 6 Canadian provinces included 19 iOAT, 3 TiOAT and 21 safer supply sites on March 1, 2020; 60 new safer supply sites by May 1 represented a 285% increase. Most common substances were opioids, available at all sites; most common settings were addiction treatment programs and primary care clinics, and onsite pharmacies models. 79% of safer supply services were unfunded. Diversity in service delivery models demonstrated broad adaptability. Qualitative data reinforced the COVID-19 pandemic as the driving force behind scale-up. Discussion: Data confirmed the capacity for rapid scale-up of flexible, community-based safer supply prescribing during dual public health emergencies. Geographical, client demographic, and funding gaps highlight the need to target barriers to implementation, service delivery and sustainability.

Idioma originalEnglish
Número de artículo103742
PublicaciónInternational Journal of Drug Policy
Volumen106
DOI
EstadoPublished - ago. 2022

Nota bibliográfica

Funding Information:
This work was funded in part by the Canadian Institutes of Health Research (CIHR) through a Canadian Research Initiative on Substance Misuse (CRISM) grant. Dr. Glegg is supported by a CIHR Fellowship Award ( CIHR-FRN # 415293 ). Dr. Kolla is supported by a Canadian Network on Hepatitis C (CanHepC) Postdoctoral Fellowship and a CIHR Banting Postdoctoral Fellowship. Dr. Brothers is supported by a CIHR Fellowship Award ( CIHR-FRN # 171259 ) and a Dalhousie University Internal Medicine Research Foundation Fellowship Award. Dr. Le Foll is supported by the Centre for Addiction and Mental Health (CAMH) and a clinician-scientist award from the department of Family and Community Medicine of the University of Toronto and an Addiction Psychiatry Chair from the department of Psychiatry of the University of Toronto. Dr. Fairbairn is supported by a Philip Owen Professorship in Addiction Medicine at the University of British Columbia, and a Scholar Award from the Michael Smith Foundation for Health Research/St. Paul's Hospital Foundation. The funding organizations had no roles in the project's design, implementation or analysis.

Funding Information:
Dr. Le Foll has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. Dr. Le Foll has some in-kind donations of cannabis products from Aurora, a medication donation from Pfizer and Bioprojet, was provided a coil for TMS study from Brainsway, and has been a consultant for Shionogi. Dr. Le Foll has obtained industry funding from Canopy (through research grants handled by CAMH or University of Toronto), Bioprojet, ACS and Alkermes, and in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and the National Institutes of Health (NIH). The other authors have no competing interests to declare.

Publisher Copyright:
© 2022

ASJC Scopus Subject Areas

  • Medicine (miscellaneous)
  • Health Policy

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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