Opioids are prescribed as painkillers. Over prescription can lead to addiction or worse. Photo by Halacious, on Unsplash, CC0.

When the opioid epidemic met the coronavirus pandemic

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Sonja Soo, Communications, Education & Outreach editor

The opioid crisis in Canada has been a public emergency since 2016. According to the Government of Canada, there have been more than 22,000 opioid toxicity deaths in the last five years. The COVID-19 pandemic has worsened opioid-related deaths in Canada—in the months that followed the beginning of the pandemic, the number of opioid toxicity deaths has almost doubled.

Opioids are a class of drugs that includes prescription medication for pain relief such as oxycodone, hydrocodone, codeine, morphine, and fentanyl, as well as illegal opioids such as heroin. These drugs are primarily prescribed as pills for pain relief but can be highly addictive because they can produce a euphoric high.

How has the COVID-19 pandemic worsened the opioid crisis?

Disruption of treatment services

The pandemic disrupted the healthcare system. Treatment facilities that offer withdrawal management and outpatient services such as counselling and therapy experienced temporary facility closures and reduced capacity to ensure social distancing.

At safe consumption sites, which are available nationwide, medical professionals supervise illicit drug consumption. This supervision reduces self-injecting behaviour in clients and helps them access addiction treatment. This modified behaviour leads to fewer ambulance calls and decreased HIV infections. Safe consumption sites and other harm reduction services, like drop-in centres, shelters, and outreach clinics, saw a decrease in admissions and increased wait time during the pandemic. Early on, adherence to treatment by users decreased because there were fewer in-person services.

 

Insite in Vancouver, a safe consumption site. Photo by Vancouver Coastal Health, used with permission.

Safe consumption sites, such as Insite in Vancouver, aim to reduce the harm caused by illicit drug use. Photo by Vancouver Coastal Health, used with permission.

 

Opioid agonists such as methadone effectively treat cravings and withdrawal symptoms. And these treatments prevent patients from using illicit forms of opioids. At first, patients take these daily medications at the pharmacy or a clinic under supervision. Later, they transition to take-home kits. Now, there are more options for in-home medication delivery to accommodate social distancing requirements. This home delivery comes with complications. Patients sometimes miss deliveries causing them to suffer withdrawal symptoms and destabilizing their condition. This problem existed even before the pandemic, when there was limited access to these treatments, especially in remote and rural areas.

In some cases, the pivot to virtual care has its benefits. Some support groups are now online, and individuals in remote communities can access healthcare on their computers or smartphones. But virtual care is not feasible for everyone. Lower socio-economic and street-entrenched or homeless people are left behind. And, some patients may not feel comfortable taking calls in places that lack privacy.

outpatient services were affected by the pandemic. Photo by Tima Miroshnichenko, Pexels, CC0.

Some outpatient services such as counselling and support groups for opioid addiction were able to the pivot to virtual services during the pandemic. Photo by Tima Miroshnichenko, Pexels, CC0.

 

Worsening mental health

Physical distancing was mandated early in the pandemic because the coronavirus spreads through respiratory droplets and aerosols when people are in close physical proximity. Social distancing and social isolation can harmmental health. Factors such as isolation, job loss, and worrying about the virus may contribute to a poor outlook. Not surprisingly, the pandemic has affected the mental health of many Canadians. One year into the pandemic, mental stress is at an all-time high.

Considering the stress of social isolation is important because people with opioid addictions often have mental health disorders. Social isolation may increase the risk of addiction and overdose deaths because many opioid-related deaths occur indoors and in private residences. When people overdose alone at home, there is no one to call for help, so they may not receive life-saving treatment in time.

More toxic opioids

The border closure between the United States and Canada has disrupted the illicit drug supply because many of these drugs come from overseas. Drug prices have increased, and the quality has decreased.

More fentanyl, a very potent synthetic opioid, is being ingested.  The rise in the use of fentanyl is particularly concerning. It is up to 100 times stronger than other opioids like morphine and heroin, and a few grains of fentanyl can cause an overdose. Many other illicit drugs, such as heroin, cocaine, and ecstasy, are laced with it. Fentanyl has no odour or taste, so it is hard to detect. In the first half of 2017, 74 per cent of opioid-related deaths in Canada involved fentanyl and its related analogues, such as carfentanil, which can sometimes be even more potent and dangerous.

The change in the composition of street drugs is important because drug users have reported that they increased their substance use and experienced more relapses during the pandemic.

Strategies for preventing opioid-related deaths

We need to do more to help illicit drug users. Improving access to various harm reduction, treatment strategies, and mental health services is the first step. Changes also need to be made at a systemic level. British Columbia is currently working towards decriminalizing drugs. Today, the possession and use of drugs can result in legal consequences. Criminalization creates barriers for individuals to access treatment and creates stigma, resulting in significant health, social, and economic harm. By decriminalizing drugs, there will be fines and warnings instead of criminal penalties for possessing drugs.

The COVID pandemic has deepened Canada’s opioid crisis and brought it to the public’s attention. The opioid crisis is complex and multi-faceted. Its solution requires addressing the limitations in our healthcare system and our illicit drugs policies. The sooner we act, the more lives we can save.

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Banner image: Opioids are prescribed as painkillers. Overprescription can lead to addiction or worse. Photo by Halacious, on Unsplash, CC0.

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