The impact of the COVID-19 pandemic on access to harm reduction and treatment services among people who inject drugs in Toronto, Canada: A qualitative investigation

The COVID-19 pandemic and related restrictions exacerbated Canada's ongoing drug toxicity overdose crisis. Opioid agonist therapy (OAT), safer opioid supply (SOS), and supervised consumption sites (SCS) are interventions that aim to reduce risk of morbidity and mortality from drug toxicity and were affected by COVID-19. Between September and October 2020, we conducted qualitative interviews with 24 people who inject drugs receiving services at community harm reduction programs in Toronto, Canada to examine the health and socioeconomic impacts of COVID-related service disruptions. Participants who were already receiving OAT and SOS prior to the start of pandemic reported high levels of continuity of care when pandemic measures were implemented, with medical appointments switching to telemedicine. Participants reported easy access to harm reduction supplies, but those accessing SCS reported increased wait times due to COVID-related capacity restrictions that reduced the number of injection spaces available due to physical distancing requirements. Participants reported extreme difficulty accessing shelter beds and food insecurity due to the closure of drop-in programs, food banks, and food distribution programs and noted the deep impacts these changes had on their health and socioeconomic well-being. Disruption in service delivery of shelters and food programs reveal the need for adaptation of strategies to ensure service continuity. Preparedness planning for future public health emergencies can benefit from analysis of lessons learned, as continuity of care was successfully ensured in OAT, SOS and harm reduction service delivery.