A safer drug supply: a pragmatic and ethical response to the overdose crisis

Tyndall’s article (1) provides timely insight regarding the overdose epidemic. The COVID-19 pandemic poses unprecedented risk to Canadians with opioid use disorder, who- already marginalized -are quite dependent on in-person health care delivery. In regard to COVID-19 prevention, the Canadian Government defines clinically vulnerable people as those with “mild to moderate respiratory disease” or with a “weakened immune system as the result of certain conditions or medicines they are taking” and are advised to take extra care. Thus, patients with chronic opioid dependence should be included in the clinically vulnerable high-risk group, this means we need to create healthcare policies supporting them.

Due to COVID-19, there is a severe shortage of clean opioids for these patients. Hence, rapid action on the part of the healthcare community is needed to mitigate the risks of disrupted care for these patients. The COVID-19 pandemic has reversed system-level gains in expanding access to medication for opioid use disorder and halted critical opioid research on prevention and care. Resultantly, rises in opioid overdose-related problems have been seen due to multiple factors (1).

A key point in this article is that physicians in BC have been cautious prescribing opioid medications despite clinical guidance provided during the COVID-19 pandemic (1). The cautious approach to prescribing opioid medications may be the result of messages physicians have seen (2). These messages stigmatize opioids and create fear amongst physicians, as they worry their patients may become addicted and succumb to their addiction (2). It is important to address the discomforts physicians have in regard to prescribing opioids. Moreover, additional factors exist around opioid medications have to be considered including socioeconomic status, mental health and substance use problems (3). These factors create a situation where it is less likely physicians prescribe opioid medications.

We suggest further resources be created to support physicians become more comfortable prescribing opioid medications, as most physicians lack training to optimally prescribe opioids (4). The current guidelines in BC- addressing both the overdose and COVID-19 crises -provide a great deal of clinical support for prescribing healthcare professionals including valuable case studies (5). However, these guidelines would benefit from additional resources to support healthcare professionals reflect on their positionality in regard to prescribing opioids and to develop additional confidence in their ability to manage patients with opioid use disorder. Specifically, programs similar to the BC project ECHO on substance use disorder- it supports care providers assist patients with opioid use -are valuable resources that should be included in clinical guidelines. Resources that support health care professionals better understand how to use opioids empowers us to make evidence-based decisions confidently.