Q&A: COVID-19 is worse for drug users, according to survey

Is the COVID-19 pandemic likely to affect the health and well-being of people who use illicit drugs such as opioids, cocaine and methamphetamines? Yes, and it's a key public-health issue, says Sarah Larney, a newly recruited researcher at the Center de recherche du Center hospitalier de l'Université de Montréal (CRCHUM).

She's addressing it through a pan-Canadian research project she launched in May 2020 with funding from the Canadian Institutes of Health Research and the help of CRCHUM colleague Dr. Julie Bruneau, a principal investigator at the Canadian Research Initiative in Substance Misuse (CRISM).

Many people who use drugs rely on regular contact with health and social services to meet their essential needs, including food, shelter and medical treatment. When these services were disrupted during disasters such as Hurricanes Sandy and Katrina or the 9/11 terrorist attacks, drug users suffered more severe adverse effects than the general population.

Coupled with their own psychological distress and and limited finances, the additional burden of coping with disaster jeopardized the ability of these marginalized members of society to survive.

To help Canadian decision-makers and health-care service providers adapt to the new reality of drug users during COVID-19, this summer Larney and her colleagues built on community-based cohort studies in Montreal, Vancouver and Toronto to reach and interview drug users quickly.

A professor in UdeM's Department of Family Medicine and Emergency Medicine, Larney interviewed 100 people in Montreal between May and June and will interview 150 more this fall. Her colleagues in Vancouver and Toronto also plan to recruit 250 participants for the study.

We discussed the preliminary results with her.

To date, what have you found?

Our data were collected during the initial confinement period of May to August and provide a snapshot of how people who use drugs are responding to the COVID-19 pandemic and highlight changes in access to services and drug markets.

Most participants reported being able to take steps to reduce their risk of SARS-CoV-2 infection. For example, 92 percent were able to regularly wash their hands or use hand sanitizer, and 59 percent were using public transport less than usual. This is great. We want to thank and encourage people to continue to do what they can to physically distance and stay safe.

Of concern, however, are changes observed in the drug supply. Of people who answered the question, "Do you think there is a change in the amount of fentanyl in the drug supply," 55 percent said that yes, there has been an increase.

This concords with warnings from public-health authorities. Since June 12, the Direction régionale de santé publique du CIUSSS du Center-Sud-de-l'Île-de-Montréal has issued several advisories that fentanyl is being falsely sold as heroin.

There are also reports that cocaine—both powder and crack cocaine—has increased in price and decreased in quality. My colleagues and I are monitoring price, availability and quality of various substances as the pandemic evolves.

How would you qualify the public-health implications of such changes in the drug supply?

Our findings suggest that fentanyl may be gaining a foothold in the Montreal drug market. Fentanyl and other synthetic opioids have wreaked havoc in other Canadian provinces, causing significant increases in deaths from overdose.

It is essential that people who inject drugs have sufficient access to supervised injecting facilities and to naloxone, and that they know how to administer it if they witness an overdose.

We ask people to take care and to inject their drugs at a supervised injection facility, and if that is not possible, we recommend they not use drugs if they're alone.

If fentanyl becomes more widely available in Montreal, we must be ready to respond and provide appropriate services to prevent people who use drugs from overdosing.

Other changes in the price and quality of drugs may have unpredictable effects on public health. We will be carefully monitoring these changes and their associated public-health impacts.

Why is it important to share this information now?

We want to get the message out that people who inject drugs are doing their part to protect themselves and the community against COVID-19.

At the same time, there is a public-health imperative to ensure that people who use and inject drugs are aware that fentanyl has been detected in the supply in Montreal, so that they can take steps to protect against overdose.