Enhancing Public Health Through a Comparative Analysis of Drug Supply Data: Revealing the Impact of the Unregulated Drug Supply on Canadians' Health

The number of lives lost to the overdose public health emergency continues to rise with each passing day. In the province hit hardest by the crisis, British Columbia, signs of a reprieve were appearing through 2019, but COVID-19 exacerbated the crisis by disrupting both people's lives and the drug supply. Canada is contending with a drug supply saturated with potent fentanyl analogues and new substances which carry unique risks and harms. Novel public health responses have been introduced to abate this preventable loss of life, such as drug checking, a harm reduction approach which allows people who use drugs to have their substances chemically identified prior to use. Drug checking allows both service users to make informed decisions about their wellbeing and service providers an opportunity to speak directly with people to gather important contextual information about the samples being analyzed. The rapidly accessible drug supply data generated by drug checking can inform public health decision-makers more quickly than other sources of information, such as toxicology or police seizure analysis results. However, these other sources of data offer key elements that drug checking results lack, such as results from gold-standard technologies. While it is known that toxic drugs increase people's risk of overdose, not much is known about other health impacts rooted in the unregulated drug supply. This study aims to characterize trends in the drug supply by examining associations between different sources of drug supply data. Then, we will examine the downstream effects of disruptions (such as COVID-19) or policy interventions like decriminalization. Finally, using health administrative data, we will assess the impact of the drug supply on people's health. With the knowledge of what makes up the rapidly changing drug supply, and the specific harms associated with these changes, decision-makers can implement targeted and timely public health interventions to save lives.