Large numbers of regular drug users report increased substance use during COVID-19

People who regularly use psychoactive substances report experiencing a variety of negative impacts since the COVID-19 pandemic began, including increased usage and fear of relapse or overdose, highlighting the need for improved supports and services, including better access to safe supply programs, according to a new CAMH survey published in the International Journal of Drug Policy.

"People who use drugs have been negatively impacted by the pandemic in ways that put them at greater risk for experiencing substance and health-related harms, including overdoses and a decreased ability to mitigate risk behaviours," writes lead author Dr. Farihah Ali. "These findings warrant the need for increased accessibility of safe supply programs, take-home naloxone and drug-testing kits, as well as novel approaches to help ensure they have the necessary tools available to make informed choices and mitigate risk."

Key Survey Findings:

• Nearly half of respondents (47 per cent) indicated their substance use had increased during COVID. "I find that I use more because when there's stuff around I tend to get more of it because you don't know when they're gonna get it next or you don't know when there's gonna be more," said one participant. "So you end up buying more, and then when you have more, you end up doing more."

• Almost four in ten (38 per cent) respondents said they believed they were more at risk to overdose due to supply disruptions that made drugs more expensive, harder to get and of unknown origin. "I've been using my whole life and I've never overdosed until just a couple weeks ago," said another. The drugs are cut with everything and anything. You never really know what you're getting."

• Among those who use syringes and other paraphernalia, nearly half (47 per cent) of respondents said they started re-using or sharing for the first time after COVID began due to reduced hours or COVID restrictions that decreased access to harm reduction or needle exchange programs.

• One in fourteen respondents (7 per cent) indicated they had relapsed during COVID.

"One of the potential factors in relapse is all the time spent alone and isolated with all the pandemic restrictions," said survey co-author Dr. Tara Elton-Marshall, Independent Scientist at the CAMH Institute for Mental Health Policy Research. "Using alone itself was a real concern. We know that people who use alone are more likely to die of an overdose, in part because there is nobody there to administer naloxone or call emergency services."

Principal Investigator Dr. Jürgen Rehm, Senior Scientist at the CAMH Institute for Mental Health Policy Research, says that sudden disruptions in the supply of street drugs when the pandemic began were associated with an increase in overdose deaths and other harms. In British Columbia, the number of illicit drug overdose deaths increased by 72 per cent during the first four months of the pandemic between March and July 2020 compared to the year before.

Dr. Rehm believes that the unprecedented circumstances caused by COVID-19 requires unprecedented action, including changes to existing drug laws.

"We need everything from good treatment and harm reduction measures to realizing that we are in an environment where everything is different during COVID and we need different solutions. We need to consider now how to decriminalize drug use. This survey lends strong support for the need for an integrated drug policy strategy including harm reduction."

"People who use drugs feel like they have been a forgotten entity throughout the COVID crisis," said survey co-author Sean LeBlanc. "There was already an overdose crisis in Canada before COVID and it has just gotten worse since then. They are not just numbers. They are all individuals with individual stories and individual losses and individual victories."

LeBlanc, a former opioid addict who has been actively involved in drug use advocacy groups for many years in Ottawa, had a relapse himself just a few weeks after the pandemic began. He says the experience and his successful recovery emphasizes how fragile the recovery experience can be in the face the blunt force of COVID.

"These are people who are at their most vulnerable now," said LeBlanc. "I think about the people who helped me the most when I needed it. That time when someone has the possibility to change, that is sometimes very fleeting. There is so much potential that is being unrealized right now because people aren't getting the help they need when they need it. For me that's the saddest thing right now."

###

CAMH is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.