Preventing Opioid Deaths due to COVID Related Increase in Smoking Illicit Substances (Preventing OD CRISIS)

During the COVID-19 pandemic, British Columbia (BC) has seen a tragic increase in drug overdose deaths, due to a toxic drug supply, people using drugs alone and difficulty accessing harm reduction services. Overdose prevention services (OPS), where people can use drugs in an observed setting, have struggled to meet physical distancing rules, and visits to OPS sites have fallen by 35% since COVID-19 began. At the same time as this recent spike in fatal overdoses, more people have been dying from smoking drugs in BC since 2016. Many people think that their risk of having an overdose is lower if they smoke opioids than if they inject, but this is not actually true. Also, it is more difficult for people who smoke drugs to use OPS, because many sites do not allow smoking, or if they do, have smoking areas outside that are hard for staff to monitor. During COVID-19, there has been a greater drop in people coming to OPS to smoke drugs than to use drugs in other ways, in part because OPS are not set up well to meet the needs of people who smoke. This study will introduce continuous oxygen monitoring at partnering OPS for people who come to smoke opioids or "down." We will train peer researchers at these sites to enroll participants, and to gather information from them. While smoking opioids, participants will attach a wrist monitor that will read and transmit their oxygen levels to iPads available to OPS staff. We will train OPS staff to check on participants if their low oxygen levels trigger an alarm. We will examine whether people who smoke drugs and OPS staff find our continuous oxygen monitoring protocol useful. We will also look at how and when oxygen levels change when people smoke opioids. We will use our findings to develop harm reduction messaging for people who smoke drugs, to expand monitoring to other OPS and private locations like supportive housing across BC, and to develop oxygen monitoring apps that allow people who use drugs alone to do so more safely.