Background: Persons who use drugs (PWUD) are facing an epidemic during the global COVID-19 pandemic. In recent months, many medical institutions have released guidance documents to inform the management of PWUD as it pertains to COVID-19. Given the flurry of increasing guidance documents, we sought to synthesize the recommendations and identify consensus strategies to support PWUD during the pandemic.
Aim: To review existing COVID-19 guidelines for PWUD to synthesize evidence and identify consensus and disagreement areas.
Methods: We rapidly reviewed the grey literature (documents produced by organizations, including reports, working papers, government documents, white papers, and clinical guidelines) and published peer- reviewed articles using the World Health Organization guidelines. We organized recommendations by the substance use disorder considered (eg, opioid, stimulant, and alcohol), recommendation type (eg, pharmacothera- py and psychosocial), nature (eg, harm-reduction and abstinence), and score the responsibility (eg, physicians and allied health practitioners).
Results: We identified 85 representative articles span- ning alcohol, opioid, tobacco, stimulant, and cannabis use disorders. Most reports involved opioid use disorder, generated by Canadian institutions, such as the British Columbia Centre for Substance Use, the Canadian Centre for Substance Use and Addiction, and the Canadian Research Initiative in Substance Misuse. An overview of the problem typically prefaced guideline documents (eg, increasing numbers of opioid overdose deaths), followed by a structured approach to management (eg, addressing intoxication and withdrawal) using multiple forms of interventions (eg, harm-reduction, pharmacotherapy, and psychosocial services). Across guidelines, there was consensus regarding the importance of maintaining access to evidence-based treatment through various creative means, such as virtual platforms, take-home medications, and home delivery services. However, there was controversy regarding safe-supply, supervised con- sumption sites, and alcohol retailers’ designation as “essential services” during the pandemic.
Conclusions: With these challenges and insights in mind, the critical issue facing PWUD and their providers during the pandemic is maintaining access to evidence- based treatment and securing food, housing, and income. Along those lines, appropriate care should continue to be patient-centred, collaborative, and mindful of resources. Above all, we must continue to consider a biopsychosocial framework while providing evidence-based care. While these recommendations are helpful, we must apply our clinical judgment individually to weigh the risks and benefits to the patient and the public and destigmatize PWUD.