Health Canada toolkit: COVID-19 and substance use

Cases of COVID-19 and the related physical distancing measures designed to prevent the spread of the virus can compound harms from the ongoing overdose crisis in Canada.

People who use drugs or have a substance use disorder face increased risks related to COVID-19, including:

• risk of infection among those with underlying health conditions
• risks due to withdrawal for those who must self-isolate or quarantine
• overdose and harms related to an increasingly toxic and unpredictable illegal drug supply

Toolkit

Various rules apply when providing medication for substance use disorder treatment or as a pharmaceutical-grade alternative to the toxic street supply in Canada. This toolkit provides information to:

• support health care providers to understand their options in providing care for their patients who use drugs during the pandemic
• help people who use drugs learn about services they may be able to access through a health care provider

This toolkit includes:

• frequently asked questions about the legislative and regulatory requirements for substance use disorder treatment/safer supply
• all relevant exemptions that have been issued under the Controlled Drugs and Substances Act
• formulary coverage under drug plans of medications used for treatment and as pharmaceutical grade alternatives to the illegal supply

Additional Resources

COVID-19 Pandemic Prescribing Guidance

• COVID-19 Pandemic - National Rapid Guidance (Canadian Research Initiative in Substance Misuse, 2020)
  National guidance documents that address urgent needs of people who use drugs, service providers, and decision makers in relation to the COVID-19 pandemic.
• Risk Mitigation in the Context of Dual Public Health Emergencies (British Columbia Centre on Substance Use, 2020)
  Clinical guidance to health care providers to support patients to mitigate risks and balance competing priorities during the simultaneous opioid crisis and COVID-19 pandemic. This guide offers prescribed or regulated alternatives to legal and illegal substances.
• Substance Replacement Therapy in the Context of the COVID-19 Pandemic in Québec: Clinical Guidance for Prescribers (a publication of the lnstitut universitaire sur les dépendances (IUD) du CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 2020)
  Clinical guidance to health care providers to support patients to reduce their risk and facilitate, where possible, physical distancing and self-isolation with the aim of reducing and preventing the spread of COVID-19.
• COVID-19: Information for Opioid Agonist Treatment Prescribers and Pharmacists (British Columbia Centre on Substance Use, 2020)
  Guidance and planning recommendations for prescribers and pharmacists regarding patients on Opioid Agonist Therapy.

Letter from the Minister of Health regarding treatment and safer supply

• Letter calling for support to expand the availability of substance use disorder treatment and pharmaceutical-grade medications as alternatives to the toxic illegal drug supply in Canada.

General Safer Supply Information

• National Injectable Opioid Agonist Treatment Guideline (Canadian Research Initiative in Substance Misuse, 2019)
  National clinical guidelines and operational guidance for the provision of injectable opioid agonist treatment.

• Toolkit for Substance Use and Addictions Program Applicants (Implementation Task Team, 2019)

  Combines research and best practices, as well as regulatory and public health considerations, to create a set of reference materials that represent current evidence and service models in the safer supply field. These documents are available upon request by emailing hc.SUAP-PUDS.sc@canada.ca with the words Safer Supply Tools in the subject line.

• Safer Opioid Supply Programs (SOS): A Harm Reduction Informed Guiding Document for Primary Care Teams (Hales, Kolla, Man, O'Reilly, Rai and Sereda, 2020)
  Describes a safer supply model administered by a network of primary care clinicians and delivered out of community health centres and primary care clinics.

COVID-19 General Substance Use Treatment Guidance

• EMCDDA update on the implications of COVID-19 for people who use drugs (PWUD) and drug service providers (European Monitoring Centre for Drugs and Drug Addiction, March 2020)
  Highlights emerging risks linked to the COVID-19 pandemic for people who use drugs and those providing services for them, from a European perspective. Encourages the planning, review and adaption of frontline and specialist drug interventions.
• Recommendations on Chronic Pain Practice During the COVID-19 Pandemic (American Society of Regional Anesthesia and Pain Medication and European Society of Regional Anesthesia and Pain Therapy, 2020)
  Provides information and recommendations to chronic pain practitioners and patients during the COVID-19 pandemic.
• Suboxone Home Induction Protocol for Chronic Pain (Pain Society of Alberta, 2020)
  Designed to help with the initiation of buprenorphine/naloxone (Suboxone).

COVID-19 General Substance Use Resource Compilation

• COVID-19 Harm Reduction Resources (Canadian Drug Policy Coalition, 2020)
  A regularly updated list of COVID-19 harm reduction resources for people who use drugs (PWUD) and health care providers.
• Impacts of COVID-19 on Substance Use (Canadian Centre on Substance Use and Addiction, 2020)
  A regularly updated list of resources regarding COVID-19 and substance use for a broad audience.
• Resources for Canadians living with pain during COVID-19
  List of supportive resources assembled in collaboration with stakeholders that may be used by Canadians living with chronic pain and their partners to manage pain during COVID-19.