Grant: CIHR Fellowship

Canada is experiencing two intersecting public health emergencies: an overdose crisis driven by illicitly manufactured fentanyl and fentanyl-adulterated drugs, and the COVID-19 pandemic. COVID-19 has compounded the overdose crisis, as overdose fatalities have increased since the pandemic began. Pandemic safety protocols (social distancing, self-isolation, quarantine) put people who use drugs at greater risk of overdose, withdrawal, and other harms related to the increasingly toxic drug supply. In response, British Columbia implemented risk mitigation prescribing guidelines, which allow physicians and nurse practitioners to prescribe pharmaceutical alternatives (e.g., hydromorphone, Dexadrine) to illicit or street-acquired opioids and stimulants. These guidelines are intended to support people who use drugs to socially-distance and self-isolate in order to prevent COVID-19 infection, transmission and community spread, while also reducing overdose, withdrawal, and other drug use-related risk. I will undertake a qualitative study to evaluate the implementation, uptake, and effectiveness of the guidelines targeting individuals at high fatal overdose and COVID-19 risk. The study will also examine prescriber perspectives on the program, and how these shape program implementation, access, and use. Additionally, I will explore socio-structural and geographic factors that shape people's access to and use of the intended pharmaceutical medications. Data collection will involve qualitative interviews with people who have obtained, or tried to obtain, a prescription for stimulants or opioids during the COVID-19 pandemic. There is an urgent need for national expansion of programs that reduce overdose and COVID risk, as jurisdictions across Canada grapple with these dual public health emergencies. Findings from the study will help inform public health approaches to addressing the unique needs of structurally vulnerable people who use drugs at high overdose risk.