• The Review Course in Family Medicine

DUAL Public Health Crisis In Canada?

Updated: Jul 11, 2020

by Dr. Birinder Narang MD CCFP


COVID-19 was declared a global pandemic on March 11, 2020.(1) But that is not the ONLY crisis facing Canadians today!

Across Canada there have been an alarming increase in opiate-related deaths amidst the COVID19 Pandemic. In BC there were >100 reported cases over overdose deaths in March & April, 2020. In Toronto, the Toronto Paramedic Services reported the highest number of illicit opioid related fatalities in a month since 2017. Similar trends are being seen across Canada.(2)

Why the higher risk?(3)

A) An adultered & toxic drug supply (limited importation/availability)

B) Difficulty in procuring drugs

C) Higher risk of exposure to COVID19 while trying to procure drugs to stop withdrawal

D) Those with housing insecurity may face difficulty maintaining physical distancing

E) Higher risk of overdose using alone, may occur while TRYING to maintain physical distancing

What can YOU as the patient’s Family Doctor do?(4)

It is paramount that you support your patients in this time, people with opiate use disorder should be considered for Opiate Agonist Therapy, offered take home Naloxone kits, and linked with follow up addictions care, along with being offered clean needles and pipes if possible.(5)

Consider:

A) Creating a treatment plan together ˯

a. Reduce in-person contact for your care (ie longer prescriptions, utilize virtual care when)

b. Explore options for fewer pharmacy visits (review carry protocols)

c. Determine what to do if your pharmacy is closed so you can stay on your medication

B) Treatment with medication (for example, Suboxone for opioid use disorder or naltrexone for alcohol use disorder)

C) Creating a plan to avoid withdrawal

D) Prescribing non-traditional medications to replace illicit use (ie, prescribed opioids, benzodiazepines, or stimulants)

E) Connecting with other resources (ie, a managed alcohol program or nicotine replacement therapy)




References:

1) https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19

2) https://www.canada.ca/en/public-health/news/2020/05/statement-from-the-chief-public-health-officer-of-canada-on-covid-198.html

3) https://www.bccsu.ca/wp-content/uploads/2020/05/Risk-Mitigation-in-the-Context-of-Dual-Public-Health-Emergencies-v1.6.pdf

4) https://www.bccsu.ca/wp-content/uploads/2020/05/Backgrounder-Information-for-PWUD-v2.pdf

5) https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/dont-forget-our-dual-public-health-crises/E3623295F26B26F8C1F82AC05F86F85F

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