‘By Madeline Tater’
Canada is currently facing dual public health crises, though one seems to be struggling to garner quite as much attention. While in a short period of time the spread of the novel coronavirus (COVID-19) has caused lasting impacts on the health and livelihoods of Canadians, the opioid crisis continues to see high rates of overdoses and deaths, as well as other acute substance use-related harms. Circumstances for people who use substances have only been further exacerbated by the impacts of the COVID-19 pandemic.
Recent border closures have interrupted the flow of illicit drugs into Canada, giving rise to an increasingly toxic drug supply as cheaper cutting agents, like fentanyl, are being relied on to make supplies last longer. Safe consumption sites (SCS) and other outreach support services have been forced to close or modify service delivery in adherence with public health guidelines.[1] Many people with substance use disorders “resid[ing] in congregate living situations, including group recovery housing, shelters, and correctional facilities” are at further risk of transmission where physical distancing is near impossible.[2] Interrupted treatment from required self-isolation or quarantine also places many individuals at heightened risk of drug withdrawal, harms stemming from using drugs alone, and other severe health risks.
In these instances, and others, the measures that have been put in place to reduce the spread of COVID-19 in our communities have inadvertently worsened the impacts of the opioid crisis through reduced services. Communities at risk include (but are not limited to): people in need of harm reduction services and supplies; people in medication-assisted treatment programs; people in abstinence-based recovery, such as Narcotics Anonymous, who have experienced disruptions to in-person treatment programs; people experiencing housing insecurity and homelessness; people engaged in sex work; and people involved in the criminal justice system on early release as a result of measures enacted to reduce the overcrowding and transmission of COVID-19 in correctional facilities.[3]
While recent spikes in opioid-related mortality and morbidity have been reported all across the country, including in smaller municipalities like Nain, Newfoundland and Labrador and Timmins, Ontario, some provinces have released particularly harrowing statistics. For example, in the month of May, 2020, the province of British Columbia reported greater than 170 suspected illicit-drug toxicity deaths, which equates to about 5.5 deaths per day over the course of the month. At the time, this represented the highest number of illicit drug toxicity deaths ever recorded in a month in British Columbia’s history. The province of Alberta reported 301 opioid overdose-related deaths between April and June, 2020 (compared to 188 in the same period last year);[4] and in Ontario, Toronto continues to see a rise in opioid-related overdose deaths, reporting an 85% increase since the COVID-19 pandemic began.
These numbers are especially staggering when compared to the number of COVID-19 related deaths reported in each province, which are not as high.[5]
The changing nature of legal environments in declared emergencies…
While “in nonemergencies [sic], existing laws and policies offer reasonable guidance on the empowerment of actors and entities to allocate health resources and deliver health care,” this legal environment can shift rather drastically during declared emergencies.[6] In the context of existential threats, such as those to public health and safety, emergency declarations can trigger an array of nonconventional powers devised to assist response efforts by both public and private actors, as we have seen in the interprovincial reallocation of personal protective equipment for frontline workers. Emergency declarations can waive specific regulatory requirements, permit the provision of public health services at non-traditional care sites (think of COVID-19 assessment centres erected in arenas and community centres), mobilize emergency funding, broaden or ease restrictions pertaining to the scope of service delivery, and provide for a host of other actions.[7]
While some of the above measures have been implemented to address the COVID-19 pandemic, the federal government has also sought to address the intersection between the pandemic and the opioid overdose crisis by implementing temporary modifications to existing health policy that aim to reduce the risk of harm for people who use substances. These modifications include:
- Transferring jurisdictional power to provinces and territories to erect temporary overdose prevention sites;
- Issuing a class exemption under subsection 56(1) of the Controlled Drugs and Substances Act to allow pharmacists to extend and renew prescriptions, and allow prescribers to issue verbal prescriptions for narcotics to ensure continued access to pharmacotherapy for addiction treatment (e.g. methadone and other opioid agonist treatments);
- Challenging provincial and territorial Health Ministers and regulatory colleges to consider safer supply prescribing, including the temporary lifting of restrictions on take-home doses (“carries”) of opioid agonist treatments; and
- Increasing funding to community-based organizations working in the areas that assist Canada’s most vulnerable.
As an example, the departure from stricter federal regulations that would normally require a patient to go in person to receive their daily dose of buprenorphine—a common medication prescribed to treat opioid use disorder—represents a positive shift towards more integrated health policy. In fact, “[t]here is no evidence that requiring individuals to visit a methadone clinic most mornings improves outcomes, and a great deal of evidence that it reduces access to that lifesaving treatment.”[8]
The ability for provinces and territories to now grant municipalities the authority to establish temporary spaces within existing SCS, shelters, or other temporary sites to provide overdose prevention services also marks a notable departure from the stricter divisions of power that have historically characterized the relationship between federal and provincial public health administration.
The temporary nature of these regulatory changes, however, feels precarious in a reality where the spread of COVID-19 is not abating and the world is unlikely to return to what it once was.
A cause for reflection…
What are the implications of temporary, emergency-related declarations that afford marginalized populations some rights in the context of access to lifesaving services by reducing barriers to treatment, but that are timestamped with an expiration date? For persons with lived or living experience using substances, does the temporality of these policies send the message that the right to life, liberty, and security of the person is transient?
As some medical experts have noted, the COVID-19 pandemic “has provided insight into our societal needs and shone [sic] a light on the ways in which law and policy negatively impact individuals with [opioid use disorder].”[9] We can only hope that in the wake of this dual public health crisis, and beyond the COVID-19 pandemic itself, the need to reduce existing policy barriers to evidence-based treatment and prevention for people who use substances will prevail, and that the temporary measures enacted will exist not only for the duration of this pandemic, but in perpetuity in order to protect Canadians from acute substance use-related harms.
With increasing awareness surrounding COVID-19 precautions and the rapid development of a vaccine, the efforts to reduce the harms of this public health crisis are well recorded and widespread. But what about the opioid overdose crisis?
If you are interested in learning more about the impacts of COVID-19 on substance-use related issues, check out the new webinar series by the Canadian Centre on Substance Use and Addiction (CCSA).
About the Author: Madeline Tater is a first-year student in the English Common Law program at the University of Ottawa Faculty of Law, located on the traditional unceded territories of the Algonquin Anishinaabeg Nation. She also holds a BA (Honours) with High Distinction from Carleton University in Legal Studies and English Literature. Madeline is currently on an educational leave from her role at Health Canada, where she works in the area of controlled substances and drug policy. While Madeline’s interests are wide-ranging, her curiosities are particularly rooted in health law, harm reduction, and the commodification of the body.
Disclaimer: The opinions expressed in this text belong to the author and do not reflect those of their positions nor of their affiliated institutions.
[1] Corey S Davis & Elizabeth A Samuels, “Opioid Policy Changes During the COVID-19 Pandemic – and Beyond” (2020) 14:4 J Addict Med e4 at e4.
[2] Ibid.
[3] Robert Heimer, Ryan McNeil & David Vlahov, “A Community Responds to the COVID-19 Pandemic: a Case Study in Protecting the Health and Human Rights of People Who Use Drugs” (2020) 97 J Urban Health 448 at 448.
[4] “Alberta COVID-19 Opioid Response Surveillance Report: Q2 2020” (September 2020) at 3, online (pdf): Government of Alberta<open.alberta.ca/dataset/f4b74c38-88cb-41ed-aa6f-32db93c7c391/resource/e8c44bab-900a-4af4-905a-8b3ef84ebe5f/download/health-alberta-covid-19-opioid-response-surveillance-report-2020-q2.pdf>.
[5] “Coronavirus disease 2019 (COVID-19): Epidemiology update” (2020), online: Government of Canada <health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html?stat=num&measure=deaths#a2>
[6] Institute of Medicine, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (Washington, DC: National Academies Press, 2012) at 57.
[7] Ibid.
[8] Supra note 1 at 2.
[9] Supra note 1 at 2.