DAY-TO-DAY IMPACT of COVID-19 ASSOCIATED with RISK of OVERDOSE: 3PNO COHORT FINDINGS

ABSTRACT

Background: People who use unregulated drugs (PWUD) in Canada and the United States (US) are contending with the intersection of two simultaneous health crises the COVID-19 pandemic and the longstanding drug poisoning crisis. However, the possible contributions of COVID-related factors to increases in overdoses during the pandemic are not well understood. Our study objectives were to assess the prevalence of non-fatal overdose and identify factors associated with overdose among participants in nine prospective cohorts of PWUD in urban centers in Canada (Vancouver, BC) and the US (Baltimore, MD;Miami, FL;Chicago, IL;Los Angeles, CA) during the COVID-19 pandemic. We further sought to examine the prevalence of and identify factors associated with reporting being highly impacted day-to-day by COVID-19. Methods: Data were derived from the nine cohorts in the NIDA-funded C3PNO consortium between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose and day-to-day impact among participants who had used unregulated drugs in the past month. Results: Among 885 participants, 253 (28.6%) were female and 41 (4.6%) had reported experiencing a non-fatal overdose. Most of the sample reported being worried and approximately half reported being highly impacted day-to-day by the pandemic. In multivariable analyses, individuals who had experienced an overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95% Confidence Interval [CI]1.10-4.30);unstably housed/homeless (AOR = 2.16;95% CI 1.11-4.26);engaged in medications for opioid use disorder (MOUD) (AOR = 2.45;95% CI 1.19-4.97);and highly impacted day-to-day by COVID-19 (AOR = 2.42;95% CI 1.22-5.10). In a second multivariable model, highly-impacted individuals were more likely to report higher levels of COVID-related worry (AOR = 1.30;95% CI 1.23-1.37) and stocking up on drugs (AOR = 1.59, 95% CI 1.09-2.32) due to the pandemic. Conclusion: Our findings indicate a need for a multi-level approach involving the spectrum of care services to meet the elevated risks of overdose in the context of the dual crises, particularly among women, those unstably housed/homeless and those who reported being highly impacted day-to-day by the pandemic. Efforts to prevent overdose, however, should prioritize addressing the root causes of the drug poisoning crisis, such as the continuous exposure to toxic and contaminated unregulated drug supplies among PWUD.