Helping people who use substances during the COVID-19 pandemic

On this page

• Risks for people who use substances during the COVID-19 pandemic
• Improving access to overdose prevention services
• Facilitating access to medications
• Providing guidance and awareness on changes to accessing medication
• Providing information to the impacts of COVID-19 on substance use
• Supporting those who are most vulnerable during the pandemic
• Addressing the urgent needs in Indigenous communities
• Connecting Canadians with mental health and substance use supports
• Allowing community organizations to mobilize resources

Risks for people who use substances during the COVID-19 pandemic

The COVID-19 pandemic is adding to the ongoing public health crisis related to high rates of overdose and deaths, as well as acute substance use harms. These crises are made worse in communities where there is chronic overcrowding, including a shortage of housing or other shelters.

At the intersection of these public health crises, people who use substances are likely to experience a number of increased risks:

• spread of COVID-19 due to many close contacts
• overdose and other harms related to an increasingly toxic illegal drug supply
• other severe health risks such as drug withdrawal for those:
  • whose care has been interrupted
  • who must self-isolate or quarantine
• death due to COVID-19 given higher prevalence of underlying health conditions such as:
  • respiratory illnesses
  • immunocompromised

To address these issues, we are taking a number of targeted actions to reduce the risk of harm for people who use substances.

Health Canada and the Public Health Agency of Canada have been working with provinces, territories and other partners, including researchers, advocates and people with lived and living experience. The goal of this work is to help make sure that people who use(d) substances can continue to access treatment and harm reduction services during the pandemic.

Improving access to overdose prevention services

For a limited time, Health Canada is allowing each province and territory to establish new temporary spaces where people can consume drugs under supervision to reduce risk of overdose death within existing supervised consumption sites, shelters or other temporary sites as needed. These temporary spaces will:

• reduce the risk of overdose due to using alone
• allow people to respect physical distancing measures

Facilitating access to medications

Ensuring that people can maintain access to medications and harm reduction services during the pandemic will:

• reduce the risk of withdrawal, overdose, and deaths
• facilitate the ability of individuals to self-isolate

1. Health Canada has asked provinces and territories and regulatory colleges to:
   • expand the spectrum of care options available to people who use drugs, including access to medications
   • allow for special accommodations that reduce or remove requirements that may not align with public health direction during the pandemic, including:
     • take-home dosing
     • removing the requirement for witnessed ingestion, doctors' visits and urine screening
2. Health Canada issued a class exemption to allow pharmacists to:
   • extend and renew prescriptions
   • transfer prescriptions to other pharmacies
   • allow other individuals to deliver prescriptions containing controlled substances to patients

These exemptions also ensure continued access to medications for treatment of substance use disorder and management of other health conditions, such as chronic pain.

3. Health Canada has allowed prescribers to issue verbal prescriptions for narcotics. This allows patients to follow physical distancing and self-isolation guidance.
4. Health Canada published a toolkit with resources for stakeholders to respond to a need for information on medications for people at risk of overdose during the pandemic.
5. The Minister of Health sent a letter to Provincial and Territorial Ministers of Health and regulatory colleges to encourage action at all levels to better provide people who use drugs with a full spectrum of options for receiving care from practitioners, including prescribing safer supply.

Providing guidance and awareness on changes to accessing medication

We are providing guidance and leadership on prescribing, dispensing and delivery of opioids and other narcotics during the pandemic. We will ensure that provinces, territories and health professionals are aware of the changes made to facilitate access to medication for people who use substances.

Canadian Research Initiative in Substance Misuse (CRISM) guidelines

Through funding from the Canadian Institutes of Health Research (CIHR), the Canadian Research Initiative in Substance Misuse (CRISM) has developed a series of national guidance documents related to substance use in the context of COVID-19.

All 6 are complete:

1. Telemedicine Support for Addiction Services
2. Supporting people who use substances in shelter settings during the COVID 19 pandemic
3. Supporting people who use substances in acute care settings during the COVID-19 pandemic
4. Medications and other clinical approaches to support physical distancing for people who use substances during the COVID-19 pandemic
5. Strategies to reduce SARS-CoV-2 transmission in supportive recovery programs and residential addiction treatment services
6. Harm reduction worker safety during the COVID-19 global pandemic

Guidelines are published in both official languages on the CRISM website.

CRISM is also undertaking a rapid assessment of the issues that people who use drugs are experiencing during the COVID-19 crisis and the health service interventions to support them.

Health Canada Toolkit: COVID-19 and substance use

Health Canada has developed and distributed a toolkit to service providers to support people who use drugs to physically distance and self-isolate and stay safe.

The toolkit includes:

• a summary of the exemptions now in place for health care providers to facilitate flexible models of care during the pandemic and responses to frequently asked questions;
• references to prescribing and practice guidelines for healthcare professionals and information about medication coverage; and
• links to resources to assist people who use drugs, harm reduction advocacy groups and families to understand the changes and exemptions in order to secure medications and treatment supports, as well as educate on harm reduction measures.

Providing information on the impacts of COVID-19 on substance use

We provide funding to organizations like the Canadian Centre on Substance Use and Addiction (CCSA), which has developed an Impacts of COVID-19 on Substance Use online information hub. The hub includes publications from CCSA experts and links to other resources about substance use and COVID-19.

Supporting those who are most vulnerable during the pandemic

We are:

• supporting 18 safer supply projects that are offering services across 30 sites in British Columbia, Ontario, Quebec, New Brunswick and Nova Scotia through the Substance Use and Addictions Program for a total investment of $59.9 million.
• providing over $400 million in emergency COVID-19 funding through Reaching Home to support those experiencing or at-risk of homelessness. These emergency, incremental investments provide communities with the flexibility they need to direct these funds toward local priority areas to help reduce the spread of COVID-19, including by establishing isolation spaces and placing individuals in temporary accommodations. In addition, Reaching Home communities can use these funds to deliver permanent housing solutions for those experiencing homelessness, as well as prevent further inflows into homelessness.
• providing an additional $299.4 million for Reaching Home for 2021-2022 fiscal year. These funds will enable the implementation of emergency health and safety measures to prevent the spread of COVID-19 amongst those experiencing homelessness and help prevent at-risk Canadians from becoming homeless by supporting targeted interventions that enable people to stay housed.
• recognizing that COVID-19 has increased the rates and severity of gender-based violence, the Government of Canada has provided $100 million in emergency COVID-19 funding to organizations serving women and children experiencing gender-based violence. To date, over 1,000 organizations across the country have received emergency funding supporting nearly 800,000 people.
• establishing a $350 million Emergency Community Support Fund to help charities and non-profits keep up their work assisting Canada's most vulnerable through the pandemic. This new investment will flow through national organizations that have the ability to get funds quickly to local organizations that serve vulnerable populations. The fund is designed to support initiatives such as:
  • help lines
  • benefit access
  • the training of volunteers
• investing over $10 million to support research on mental health and substance use during the pandemic. This research will provide timely, high quality and relevant evidence in a number of important areas, including effective substance use delivery models. As part of this initiative, an external Expert Advisory Panel works to identify and advise on COVID-19 and mental health knowledge gaps and how to access and mobilize the best evidence to effectively support mental health systems and services in Canada. Other initiatives include:
  • CRISM guidelines and rapid assessment.
  • Launch of a funding opportunity, in collaboration with four provincial partners, to support implementation science and population-level intervention research to address the impacts of the COVID-19 pandemic and its containment measures on mental health and substance use. The call supported 55 projects (including 17 that focus on substance use), for a total investment of $10.27 million.
  • Launch of a funding opportunity to support rapid knowledge synthesis and mobilization of current evidence on mental health and substance use services, delivery, and related guidelines, in the COVID-19 context. This call supported 45 projects including 11 with a focus on people who use drugs, for a total investment of $2.2 million.
• investing $ 500 million towards health care to respond to the pandemic, including support for Canadians experiencing challenges with substance use, mental health, or homelessness. This investment is part of the more than $19 billion through the Safe Restart Agreement to help provinces and territories safely restart their economies and ensure Canadians have the support they need in these challenging times.
• investing $20 million to organizations through the Substance Use and Addictions Program to provide opioid overdose response training and increase access to naloxone across the country, including to remote communities and isolated First Nations and Inuit communities, and to the homeless-serving sector.
• evaluating the program implementation and short-term impact of safer supply pilot interventions and supervised consumption sites through a funding opportunity launched by CIHR.

Addressing the urgent needs in Indigenous communities

As part of the Government of Canada's COVID-19 Economic Response Plan $305 million was committed for the new distinctions-based Indigenous Community Support Fund to address immediate needs related to COVID-19 in First Nations, Inuit and Metis Nation communities. An additional $760 million was added to this fund and could be used for measures such as:

• mental health assistance
• measures to address food insecurity
• educational and other support for children
• support for Elders and vulnerable community members
• emergency response services and preparedness measures to prevent the spread of COVID-19

To address the impacts of the pandemic and related public health measures on mental wellness in Indigenous communities, the Government of Canada announced on August 25, 2020, $82.5M in mental health and wellness supports to help Indigenous communities adapt and expand mental wellness services, improving access and addressing growing demand. This funding supports new activities in surge capacity (e.g., expanding services to meet demands, increasing number of mental wellness workers) and adaptation (e.g., supporting culturally-safe adaptation of mental wellness services to the COVID 19 context).

To support Indigenous women and children experiencing violence, we:

• have established a $10 million fund for emergency family violence prevention shelters on reserve and in Yukon.
• will invest $44.8 million over five years to build 12 new shelters. This funding will help build 10 shelters in First Nations communities on reserve across the country, and 2 in the territories. We will also provide $40.8 million to support operational costs for these new shelters over the first 5 years, and $10.2 million annually ongoing.
• announced $1 million a year ongoing, starting this year, to support engagement with Métis leaders and service providers on shelter provision and community-led violence prevention projects for Métis women, girls, and LGBTQ and two-spirit people.

Indigenous Services Canada's First Nations and Inuit Health Branch efforts include the new listing of Sublocade (buprenorphine extended-release injection) in the Non-Insured Health Benefits (NIHB) Program.

Effective April 27, 2020, NIHB listed Sublocade (buprenorphine extended-release injection) as a limited use benefit with the following criteria:

• for the management of moderate to severe opioid use disorder in adult patients who have been induced and clinically stabilized on a transmucosal buprenorphine-containing product and
• the patient must be induced and stabilized on an equivalent of 8 mg to 24 mg per day of transmucosal buprenorphine for a minimum of 7 days

Indigenous Services Canada supported the development of online resources for people who use substances during the COVID-19 pandemic, including fact sheets and online resources.

Supporting mental wellness during and after the COVID-19 pandemic is an essential service. There is a wide range of virtual resources available to help Indigenous communities with their mental wellness. Counselling, cultural supports, and other forms of treatment are available through telehealth and on-line platforms.

Connecting Canadians with mental health and substance use supports

The Minister of Health launched a new portal dedicated to mental health and substance use. Wellness Together Canada Portal provides free:

• wellness self-assessment and tracking
• group coaching and links to support communities
• self-guided mental health and substance use courses, apps, and other resources
• direct virtual counselling from peer support workers, social workers, psychologists and other professionals by phone or text

On March 29, 2020, the Prime Minister announced an investment of $7.5 million to Kids Help Phone to expand crisis supports for children and youth during the COVID-19 pandemic.

The Canadian Pain Task Force has assembled a list of resources which people living with pain and their partners in care may find helpful during this time. The list has been shared with stakeholders and posted to the Canadian Pain Task Force website.

Allowing community organizations to mobilize resources

Through the Fall Economic Statement 2020, the Government of Canada committed to help Canadians struggling with problematic substance use by providing an additional $66 million over two years. This funding, offered to community organizations by Health Canada's Substance Use and Addictions Program, is supporting community-based organizations responding to substance use issues, including to help them provide frontline services in a COVID-19 context.