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People who use substances

Harm reduction information for people who use substances, overdose prevention services and supervised consumption sites and social services.
We recognize that many of the public health messages being shared on COVID-19 are hard to practice when people are living outside, in a tent, in an SRO, or in a shelter. People who use drugs are already doing incredible work to keep communities safe and reduce the spread of infection. We need creative solutions to slow down the spread of COVID-19 and protect people who use drugs, have underlying health conditions, and/or may be elderly. 

For people who use substances

Risk of overdose

  • COVID-19 is a virus that can cause a respiratory infection and other health problems.
  • Fentanyl and other opioids can slow a person's breathing rate, so COVID-19 may increase the risk of overdose death from opioids.

Practice safer drug use to decrease transmission

  • Remember ways to prevent overdoses: use with someone or let someone know you’re using, start low and go slow, split your doses, or use less if you are feeling unwell
  • Avoid sharing supplies, such as cigarettes, joints, pipes, injecting equipment, containers for alcohol, utensils, and other supplies. If you have to share, wipe pipes with alcohol wipes or use new mouthpieces. 
  • Reduce close contact (e.g. shaking hands, hugging, kissing) and use condoms. 
  • Wash your hands or use wipes before preparing, handling or using your drugs. Prepare your drugs yourself.
  • Cough or sneeze into your elbow or use tissues. Throw tissues away as soon as possible and wash your hands thoroughly.
  • Clean surfaces with soap and water, alcohol wipes, bleach or hydrogen peroxide before preparing drugs if possible.
  • Carry naloxone and have an overdose plan. 

Accessing testing

  • For most up to date information, see the testing page or use the self-assessment tool.
  • It is especially important for people who develop cold, influenza or COVID-19-like symptoms to be tested if they are:
    • People living and working in communal settings such as shelters, group homes, assisted living and seniors’ residences
    • People who are homeless or have unstable housing

Buddy up

  • Buddy up when you are using. COVID-19 is passed by droplets. Stay 2 metres (6.5 ft.) from your buddy to avoid passing the virus. Using with a buddy is safer than using alone.
  • Find your “buddies” who can bring you food, harm reduction supplies, medicine, and substances so that you can stay well. You can also be a buddy to those who may need extra support. Check in on your buddies regularly. 

If you are quarantined or in isolation

  • See if your buddy can pick up supplies including naloxone from a harm reduction site. 
  • Try to have the substances you need to stay well. Know that carrying large amounts may put you at risk by the police and other people looking to score. Consider alternatives to your drug of choice and prepare for potential supply disruptions.
  • You may go through involuntary withdrawal if your dealer gets sick. Have backup plans and be cautious if using a new supply.
  • Try to have the medications you need, re-fills may be available directly through your pharmacist or by phone without having to see your physician. If you are feeling unwell and require medications, call your pharmacy in advance.
  • The province of British Columbia  with the BC Centre on Substance Use, issued interim guidance titled Risk Mitigation: in the Context of Dual Public Health Emergencies. This was developed for people who use substances to enable physical distancing and self-isolation measures, to reduce and prevent the spread of COVID-19.

Continue to use overdose prevention services (OPS), supervised consumption sites (SCS) and supportive housing OPS sites

When responding to an overdose in the community

When responding to an opioid overdose there is a risk of infection, particularly if rescue breaths are given without protective equipment. This is why each kit contains gloves and a CPR face shield. The risk of infection is low relative to the very high risk of brain injury or death during an overdose. Taking basic precautions will minimize the risk of infection of both the person who overdoses and the responder.

  • Stimulate - put on gloves and try and rouse the person, encourage them to take big breaths.
  • If no response; call 9-1-1
  • Tilt their head back and check for any obstruction. Lift their chin to open the airway. 
  • Administer naloxone - if needed give two doses
  • Check for breathing and repeat the steps above, as necessary
  • Provide rescue breaths to restore oxygen to the brain and administer additional naloxone as needed
  • Anyone not responding to the overdose should leave the room or immediate area.
  • When using a take home naloxone kit or facility overdose response box
    • Use the face shield/breathing barrier to give rescue breaths.
    • The face shield has a one-way valve and large impermeable area which protects the responder from respiratory secretions.
    • After responding dispose of the face shield before taking off the gloves and wash/clean hands thoroughly.
  • If chest compressions are needed, gently place a towel or a piece of clothing over the person’s nose and mouth.

Cleaning

  • If you share a washroom with others, clean and disinfect high-touch surfaces, such as knobs, taps, and flushers with soap and water, bleach, hydrogen peroxide or alcohol-based wipes (70%) regularly (at least twice per day). Do not mix different types of cleaning solutions.
  • If you cannot wash your hands with soap or use hand sanitizer, try to access alcohol-based hand wipes

For registered harm reduction and naloxone sites in BC

  • BCCDC does not anticipate supply chain disruptions. 
  • Registered sites should continue to order supplies as needed weekly/monthly to avoid stock piling.
  • Please continue to distribute supplies as usual, and note that if there is a specific request for supplies for an individual who requires quarantine or isolation, additional supplies may be provided for the 14-day period.
  • If you are awaiting your next order to arrive and are temporarily low on any supplies, connect to your local Harm Reduction Coordinator. Individuals can also be referred to nearby existing sites by using the site finder.
  • Please circulate this information to any secondary or satellite sites of your location. 

More Information

For operators of OPS and SCS

View the guidance document for information on responding to an overdose in an OPS and SCS:

Provincial Episodic Overdose Prevention Service (e-OPS) Protocol

This document provides guidance on providing overdose prevention services outside of an established supervised consumption or overdose prevention site (SCS/OPS) such as in acute care, shelters, supportive housing or other social service settings. This guidance supports staff who may receive requests from patients, clients or residents to observe substance use and respond to overdose or may recognize the benefit of providing this service. 

Continuing essential services

Continuing essential social services while integrating public health principles to minimize transmission of COVID-19

The Provincial Health Officer’s order of no gatherings with more than 50 people is intended to apply to one-time, entertainment, community and social events. Shelters and single room occupancy housing are exempt from this order because from a public health perspective, shelters and SROs are regarded as peoples’ homes.

Overdose prevention sites and supervised consumption sites are exempt from the Provincial Health Officer’s order of no gatherings, as they are clinical spaces providing essential services. Service delivery should continue as much as possible.

The greatest health risk to a client at on OPS or SCS site is overdose.

While continuing to provide essential services, it is encouraged your services:

  • Encourage and provide access to hand hygiene
  • Encourage respiratory etiquette (e.g. cough or sneeze into elbow or sleeve, dispose of tissues properly)
  • Disinfect high touch surfaces frequently
  • When possible without limiting access, increase physical space between individuals

More information 

Information for healthcare professionals and pharmacists working with people who use drugs can be found on the healthcare professionals website.

SOURCE: People who use substances ( )
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