2. Implementation of safe supply alternatives during intersecting COVID-19 and overdose health emergencies in British Columbia, Canada, 2021

To examine how access to no-cost prescription opioids and stimulants through risk mitigation guidelines released in British Columbia (BC), Canada in response to COVID-19 impacted engagement with the illicit drug supply and overdose vulnerability amidst an overdose epidemic driven by fentanyl and adulterated drugs.

From February to July 2021, qualitative interviews were conducted with 40 people who use drugs in BC accessing prescription opioids or stimulants under the risk mitigation guidelines. Data were analyzed thematically and interpreted by drawing on the risk environment framework.

COVID-19 disrupted BC’s illicit drug market, including drug shortages, rising prices, and greater unpredictability (variable potency, cross-contamination, increased adulteration). Concerns about overdose due to these changes, along with deepening socio-economic marginalization, motivated participants to access no-cost prescription alternatives. Reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market, while allowing greater agency over drug use. Because prescriptions were primarily intended to manage withdrawal, participants supplemented with illicit drugs to experience enjoyment and manage pain.

Providing prescription alternatives to illicit drugs represents a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply and yet further optimizations are needed, including the expansion of drugs provided.

Disclosure of interest statement: This work was supported by the National Institutes of Health and the Canadian Institutes of Health Research