Carol Strike, PhD is a Professor at the University of Toronto. A harm reduction researcher for over 25 years, her community based research program aims to improve health services for people who use drugs.

Introduction: To reduce fatal overdoses, safer opioid supply programs (SSPs) that prescribe pharmaceutical-grade opioids for take-home dosing began operating before and during the COVID 19 pandemic to address increasing rates of opioid overdose In Canada. We explore pandemic impacts on these innovative harm reduction programs.
Methods: Between February and October 2021, we conducted semi-structured interviews and demographic surveys with service providers (n=27) and clients (n=52) from four SSPs in Ontario about program implementation, challenges, and impacts. Thematic analysis was conducted in MAXQDA and descriptive statistics in SPSSv28.
Results: Delivering SSPs during COVID-19 had some benefits for clients including less crowded waiting rooms, reduced wait times, less frequent appointments and public transit trips, access to COVID-19 vaccines, and increased housing options (e.g., COVID-19 isolation hotels), all of which reduced client’s risk of COVID-19 exposure. Pandemic conditions also contributed to more ‘privileged’ clients (e.g., with telephones) and those with established connections to service providers to enrol in SSPs more easily. But others struggled to find a safer supply prescriber in the community after discharge from the COVID-19 isolation hotel. The closure of drop-in services during early pandemic lockdowns devastated access to ancillary supports such as showers, laundry, toilets, food, and clothing, and the cancellation of group programming worsened the boredom reported by some clients. Likewise closures of other health and social services increased the complexity/acuity of clients’ needs, creating conditions for clinician burnout. Clinicians worried that reduced staffing during COVID-19 weakened contact with clients and interfered with titrating dosages which could increase overdose risks.
Discussion: COVID-19 facilitated an environment to try out different policies and experiment with service delivery, which decreased COVID-19 risk and may have reduced the burden on some clients. In contrast, this environment increased barriers for some and burnout conditions for service providers.