Providing insight into and mitigating the impact of the COVID-19 pandemic on the occurrence, severity, complications, and long-term health effects of drug overdoses in people living with and without HIV in British Columbia, Canada.

The COVID-19 pandemic has exacerbated the ongoing drug toxicity and overdose (OD) crisis, resulting in an unprecedented rate of OD deaths in British Columbia (BC) since March 2020. People living with HIV (PLWH) have been disproportionately affected by substance use disorders and the ongoing OD crisis. As well, PLWH are at increased risk for negative indirect impacts of the pandemic, including increased levels of social isolation, loneliness, stress, anxiety, and substance use. More insight is needed in the extent of the impact of the COVID-19 pandemic on the occurrence of ODs, as well as the short and long-term health consequences of nonfatal ODs, in PLWH. We aim to study the impact of the COVID-19 pandemic on the occurrence of fatal and nonfatal drug ODs, and on the direct and long-term health outcomes after a nonfatal overdose (NFOD) in people living with and without HIV. We will use routinely collected health data on all PLWH in BC and a random sample of 10% of the general population. First, we will compare the incidence of fatal and NFODs before and during the COVID-19 pandemic, in people living with and without HIV. We will assess the severity of NFODs in terms of hospitalizations, complications, and duration of hospital stay. In addition, we will assess and compare trends in health care utilization and mortality in the six months after a nonfatal OD. Second, based on these analyses, and learning from the perspectives of community experts, health care providers, and policy makers, we will formulate recommendations for the care of PLWH who are at risk for or experienced an OD. These aim to reduce the risk for OD and adverse long-term health outcomes following a NFOD. This study will provide essential insights into the indirect impact of the COVID-19 pandemic on the coinciding OD crisis and HIV epidemic. These are urgently needed to inform targeted interventions to mediate the compounding effects of these three ongoing health crises.