A comprehensive harm reduction plan for at-risk populations is essential to Canada’s COVID-19 recovery plan

The overdose epidemic has had a devastating impact on those who use drugs, made worse by the COVID-19 pandemic. The Public Health Agency of Canada reported 1,705 apparent opioid toxicity deaths between July and September, 2020, a 120-per-cent increase from the same period in 2019. This is the highest quarterly count since national surveillance began in 2016, the year when the British Columbia government declared overdose a public health emergency. Almost all of these deaths were accidental overdose deaths. COVID-19 border closures and travel restrictions have disrupted the illegal drug supply, making it less steady and more dangerous..

Many governments have expressed concern regarding this deepening crisis, yet public health measures have led to more people being forced to use alone, contrary to the universal harm reduction message to ‘not use alone, start low and go slow, and carry naloxone’. Furthermore, reduced access to harm reduction services, such as needle and syringe programs, and overdose prevention and supervised consumption sites, have further increasing overdose risks. Thus, to address the crisis words must be accompanied by a strong commitment to provide secure, scalable and sustainable funding for robust evidence-based prevention, treatment, and harm reduction programs. Like all other healthcare programs, the Canada Health Act requires that these programs be designed to protect and promote physical and mental well-being and be reasonably accessible to those who need them.

Although the pandemic has exacerbated the overdose epidemic, the primary cause of these deaths and drug related harms is the increasing presence of fentanyl, and other novel synthetic drugs, in the illegal drug supply. In 2020, 75 per cent of the opioid toxicity deaths in Canada involved fentanyl. Since drug checking services remain very limited in scope, it is nearly impossible for people to determine the quality or quantity of the drugs they are taking. This is why people die.

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Matthew Bonn is program coordinator, Canadian Association of People Who Use Drugs; Vanessa Gruben is associate professor, Faculty of Law, University of Ottawa; Elaine Hyshka is assistant professor, School of Public Health, University of Alberta; Carol Strike is professor, Dalla Lana School of Public Health, University of Toronto.