Rapidly assessing the impact of the COVID-19 pandemic and response on clinical and social outcomes, service utilization, and the unregulated drug supply experienced by people who use drugs in Toronto

People who inject drugs are at high risk of dying of overdose in Canada. This overdose epidemic claimed almost 15,000 lives between 2016 and 2019, and in response Canadian municipalities, including Toronto, developed a network of harm reduction, clinical and social services to try to prevent these deaths. However, starting in March 2020, the COVID-19 pandemic has created major barriers that prevent people who inject drugs (PWID) from accessing these services and avoiding illness and death. This includes the closures of supervised injection facilities, lack of access to clinicians to provide addiction treatment, and a lack of stable housing which makes it difficult to engage in physical distancing. Simultaneously, Toronto experienced a spike in overdoses in March and April, reversing a year-long trend of declining overdoses, which appears to be related to the COVID-19 pandemic and its restrictions. It is not known, however, exactly how PWID are being impacted and how services need to be changed to prevent them from succumbing to the ongoing epidemic of overdose and the COVID-19 pandemic. This project is using a unique research tool to explore that issue: the only cohort of PWID in Canada that has full linkages to individual clinical data. We are therefore able to rapidly assess people's clinical outcomes--including COVID-19 diagnosis, overdose, loss of access to addiction treatment, and the severity of other health conditions--to their self-reported behaviours. By doing so, we can understand the many ways that the COVID-19 pandemic is directly affecting this vulnerable group, and identify those at highest risk of both COVID-19 and overdose, and how these risks interact. To understand the population-level impact of the pandemic on PWID in Toronto, this study will also track how distancing restrictions are impacting the use of services to prevent overdose across the city, including addiction treatment access, supervised injection services, and street drug checking.