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 a safer supply of medication-assisted treatment
• 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 to protect themselves

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 opioid 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 illicit 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, harm reduction and other substances 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 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

Provinces and territories can allow municipalities to exercise this authority on their behalf.

Facilitating access to a safer supply of medication-assisted treatment

Access to a safer supply of medication-assisted treatment and harm reduction measures during the pandemic will:

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

1) Health Canada has asked provinces and territories and regulatory colleges to:

• improve access to opioid 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 witness 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 pharmacists
• allow other individuals to deliver controlled substances to patients

These exemptions also ensure continued access to pharmacotherapy for addiction treatment 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 with chronic medical needs to follow social distancing and self-isolation guidance.

4) The Minister of Health has sent a letter to Provincial and Territorial Ministers of Health and regulatory colleges. This letter encourages action at all levels to better provide people who use drugs with a full spectrum of options for receiving care from practitioners, including safer supply prescribing.

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, 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 treatment services – version 1
6. Harm reduction worker safety during the COVID-19 global pandemic – version 1

Guidelines are published at https://crism.ca/projects/covid.

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 provides a summary of the exemptions now in place for health care providers to facilitate flexible models of care during the pandemic. The toolkit includes:

• references to prescribing and practice guidelines for healthcare professionals to increase the appropriate prescription of medications to address symptoms of withdrawal, including methadone and Suboxone, and to provide access to medications like hydromorphone as a pharmaceutical-grade alternative to the toxic street supply
• 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

Health Canada provides 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:

• providing $207.5 million to organizations that support those experiencing homelessness and women fleeing gender-based violence. These new funds will provide service providers with operational funding to manage or prevent the impacts of COVID-19 on their clients.
• 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 $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
  • how to access and mobilize the best evidence to effectively support mental health systems and services in Canada
• 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.

Addressing the urgent needs in Indigenous communities

We are establishing a $305 million new distinctions-based Indigenous Community Support Fund to address immediate needs related to COVID-19 in First Nations, Inuit and Metis Nation communities. This fund 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 support Indigenous women and children fleeing 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 (ISC-FNIHB) 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

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 M 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 to protect themselves

Health Canada is working with community organizations funded through the Substance Use and Addictions Program (SUAP) to re-direct funding to support the COVID-19 response. For example:

• the BC Ministry of Health will use a portion of its SUAP funding to provide personal protective equipment to pharmacists providing injectable opioid agonist treatment
• the University of Victoria will use a portion of its funding to purchase basic needs and supplies such as food for clients at select front-line harm reduction sites
• supporting pilot projects to provide pharmaceutical grade medications (“safer supply”) as an alternative to the toxic drug supply, and connect individuals with healthcare in a way that limits contact