Substance use care innovations during COVID-19: barriers and facilitators to the provision of safer supply at a toronto COVID-19 isolation and recovery site

Gillian Kolla; Chowdhury Nishwara Tarannum; Kaitlin Fajber; Fiqir Worku; Kris Norris; Cathy Long; Raphaela Fagundes; Anne Rucchetto; Eileen Hannan; Richard Kikot; Michelle Klaiman; Michelle Firestone; Ahmed Bayoumi; Gab Laurence; Kate Hayman

doi:10.1186/s12954-024-00935-w

Substance use care innovations during COVID-19: barriers and facilitators to the provision of safer supply at a toronto COVID-19 isolation and recovery site

Harm Reduct J. 2024 Jan 20;21(1):17. doi: 10.1186/s12954-024-00935-w.

Authors

Gillian Kolla^{1

2

3}, Chowdhury Nishwara Tarannum⁴, Kaitlin Fajber⁵, Fiqir Worku⁴, Kris Norris⁴, Cathy Long⁴, Raphaela Fagundes^{4

6}, Anne Rucchetto⁴, Eileen Hannan^{4

6}, Richard Kikot⁷, Michelle Klaiman⁸, Michelle Firestone⁴, Ahmed Bayoumi^{4

9

10}, Gab Laurence⁷, Kate Hayman^{11

12}

Affiliations

¹ Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada. gkolla@mun.ca.
² MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, ON, Canada. gkolla@mun.ca.
³ Memorial University, St. John's, NL, Canada. gkolla@mun.ca.
⁴ MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ The Neighbourhood Group, Toronto, ON, Canada.
⁷ Parkdale Queen West Community Health Centre, Toronto, ON, Canada.
⁸ Department of Emergency Medicine, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
⁹ Faculty of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁰ Division of General Internal Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
¹¹ University Health Network, Toronto, ON, Canada.
¹² Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Early in the COVID-19 pandemic, there was an urgent need to establish isolation spaces for people experiencing homelessness who were exposed to or had COVID-19. In response, community agencies and the City of Toronto opened COVID-19 isolation and recovery sites (CIRS) in March 2020. We sought to examine the provision of comprehensive substance use services offered to clients on-site to facilitate isolation, particularly the uptake of safer supply prescribing (prescription of pharmaceutical opioids and/or stimulants) as part of a spectrum of comprehensive harm reduction and addiction treatment interventions.

Methods: We conducted in-depth, semi-structured interviews with 25 clients and 25 staff (including peer, harm reduction, nursing and medical team members) from the CIRS in April-July 2021. Iterative and thematic analytic methods were used to identify key themes that emerged in the interview discussions.

Results: At the time of implementation of the CIRS, the provision of a safer supply of opioids and stimulants was a novel and somewhat controversial practice. Prescribed safer supply was integrated to address the high risk of overdose among clients needing to isolate due to COVID-19. The impact of responding to on-site overdoses and presence of harm reduction and peer teams helped clinical staff overcome hesitation to prescribing safer supply. Site-specific clinical guidance and substance use specialist consults were crucial tools in building capacity to provide safer supply. Staff members had varied perspectives on what constitutes 'evidence-based' practice in a rapidly changing, crisis situation.

Conclusion: The urgency involved in intervening during a crisis enabled the adoption of prescribed safer supply, meeting the needs of people who use substances and assisting them to complete isolation periods, while also expanding what constitutes acceptable goals in the care of people who use drugs to include harm reduction approaches.

Keywords: COVID-19; Isolation site; Opioid use disorder; Overdose; Safe supply; Safer supply; Shelter; Substance use.

MeSH terms

Analgesics, Opioid
COVID-19*
Central Nervous System Stimulants*
Drug Overdose*
Harm Reduction
Humans
Pandemics
Social Problems
Substance-Related Disorders* / therapy

Substances

Central Nervous System Stimulants
Analgesics, Opioid