Collaborative Mentorship Network for Chronic Pain and Addiction

The Canadian Research Initiative on Substance Misuse (CRISM), a national research consortium focused on substance use and related harms, is rapidly developing six national guidance documents to address the specific needs of people who use substances, service providers, and decision makers.

https://crism.ca/wp-content/uploads/2020/06/CRISM-Guidance-Supporting-People-Who-Use-Substances-in-Emergency-Shelter-Settings-V1.pdf

Excerpt from page 12, Key points of the guidance document:

• The COVID‑19 pandemic has compounded risks already posed by the overdose epidemic, and placed people who use substances and are experiencing homelessness or housing vulnerability at high risk of negative health outcomes including death.
• The purpose of this guidance document is to support organizations operating new or existing shelter settings to provide evidence‑informed care for people who use substances during the COVID‑19 pandemic in Canada.
• For shelters providing care to people who use substances during COVID‑19, a pragmatic approach assumes that some level of drug and alcohol use will continue irrespective of formal or informal bans or criminal prohibitions.
• Under a harm reduction approach, modifying risks associated with unsafe substance use practices or settings takes precedence over enforcing abstinence, and residents are supported to access care based on self‑determined needs and goals.
• Design and delivery of shelter services should incorporate perspectives of people with lived or living experience of substance use and homelessness or housing vulnerability.
• Integrating supervised illegal drug consumption services into shelter settings is feasible, and has the potential to reduce overdose‑related mortality and other negative health outcomes.
• A variety of supervised consumption service models can be operated during COVID‑19 through use of appropriate infection prevention and control measures and personal protective equipment.
• Supervised consumption services should regularly review infection prevention and control and personal protective equipment procedures to ensure they remain consistent with the latest public health guidance in their jurisdiction.
• Shelters should facilitate access to healthcare providers who are able to assist with substance use disorder treatment, withdrawal management, and substance use stabilization/risk mitigation.
Supporting people who use substances in shelter settings during the COVID‑19 pandemic | NATIONAL RAPID GUIDANCE | PAGE 13
• A variety of first‑ and second‑line substance use disorder treatments are available to support shelter residents who wish to abstain from drugs and/or alcohol.
• Not all residents will accept or stabilize on evidence‑based treatment options for their substance use disorders. In these cases, health care professionals should consider providing access to replacement medications for withdrawal and craving management, and to mitigate harms associated with ongoing procurement and use of substances from the illegal drug market.
• Managed alcohol programs (MAPs) are a promising option for supporting shelter residents whose pattern of alcohol consumption may place them at increased risk of harm during COVID‑19.
• There are multiple possible avenues for shelter residents to receive their prescribed medications, including multi‑day dispensing, pharmacy delivery, and on‑site pharmacy services.
• Psychosocial interventions and supports should be routinely offered alone or in conjunction with prescribed medications or managed alcohol.
• Any resident receiving substance use disorder treatment, replacement pharmacotherapy, and/or managed alcohol should be assisted in achieving continuity of care following discharge from the shelter 

Stakeholders can also provide feedback on the guidance documents: CRISM Rapid COVID-19 Guidance Documents Feedback Form